Category Archives: Uncategorized

Does the setting of therapy matter?

Recently I decided to seek private counselling. I made this decision because I felt it was something I desperately needed to break the cycle of being unwell mentally, and to address a number of issues that have built up over the years. I decided to seek a private counsellor for the following reasons:

  • The waiting period for an NHS appointed counsellor, if you qualify, is 6- to 12-months, and I’m not willing to wait.
  • NHS treatment is often limited to 6 sessions maximum and focussed on CBT, a treatment I have had several times which has only helped in the very short term.
  • The counsellor you see may not be a good fit for you, but you don’t get a choice, you have to work with that person or go back on a waiting list.

I wanted to be sure that I felt comfortable with a counsellor and wouldn’t be forced down the CBT road nor be limited to 6-sessions which causes all sorts of anxiety if you’re not feeling like you’ve made progress. Going private is an expensive option, but one I think is worthwhile because it’s my health at the end of the day and can you really put a price on that?

But this actually got me thinking, again, about something I’ve thought about before. Does the setting of these type of talk therapies, CBT included, make a difference to how well the treatment works or how comfortable someone feels in opening up and being involved in their care?

In my experience, with NHS treatment you are generally seen in quite a clinical setting. You’re sat in very uncomfortable chairs in a room normally used by a GP so there’s an examination bed/couch, a desk and computer, scales, and all manner of books, leaflets, and other information notices. Even when I’ve had CBT and brief counselling through my employer’s occupational health service, the setting isn’t much different to that of the NHS.

Privately, the setting is very different. It’s much more like sitting in a friend’s lounge on a sofa and having a chat over a cup of tea. There’s nothing clinical about this environment, it’s nicely decorated and comfortable. It just feels better, more relaxed.

So I’m wondering, does the physical setting make a difference in how people interact with talk therapies? Do you relax more and feel more comfortable in one or the other? Does it make a difference to whether they make progress or not? I’m genuinely curious. I don’t know if this is actually measurable, though I’m sure there’s plenty of anecdotal evidence.

What are your thoughts? Have you experienced any type of talk therapy in these different environments? If so, do you feel one was better than the other or is it more down to all the other things like the person you’re talking to, the type of treatment, the issue at hand?

NB I’ve left out group therapy as that’s a different thing altogether, and I have no personal experience of it so don’t feel I can comment.


Post depression anxiety

After every bout of depression that I overcome, I end up with anxiety issues. At times they’ve been crippling and become serious problems of their own as they lead to panic attacks and social phobia. This bout of depression has been no different and I’ve been lumbered with trying to get past the anxiety and ‘habits’ that have developed during this period. And just like this bout of depression that has manifested itself differently in the physical sense, so too has the anxiety.

I’ve not had the racing heart that leads to a panic attack, nor have I really had the social phobia. Instead I’ve developed some sort of anticipatory anxiety. I think it’s something I’ve always got (I’m a worrier by nature), but can usually control it without too much effort.

Every single day I wake up and I’m worried about how I will manage the day. I worry that I didn’t get enough sleep or the quality of my sleep was poor so I’ll find it difficult to function and stay awake. I worry that the slight pressure I feel behind my eyes or stiffness in my neck is going to become a full blown, crippling headache that will spiral out of control and lead to days of endless headaches followed by a headache hangover that will last several more days. I worry about aches and pains, and are they going to lead to other serious bouts of physical incapacity like I experienced three years ago.

And so I take it easy. I play it safe. I don’t want to rock the boat so I rest, and I rearrange meetings and readjust my working hours. I forgo social invitations and even basic self care like eating well and bathing.  Of course this leads back to those feelings of guilt and that I’m lazy, which means I don’t actually rest because I’m too busy listing all the things I should be doing but I’m not.

I feel trapped and paralysed by this anxiety. I can’t break it’s spell. I tell myself that if I just get up and get going everything will be OK. Getting bathed and dressed and fed will make me feel human and like nothing is wrong (and this is quite true). But some voice bubbles up from underneath all of this and tells me no, lie in, go to work later, take the strong painkillers and rest of the aches and pains. And I give into this voice because it is effortless to do so and I feel like everything takes more effort than it really should. It means that every night when I turn out the light and tell myself that tomorrow will be different, that tomorrow I’ll get up without any fuss and bathe and eat, I’m inevitably lying to myself as nine times out of ten, the voice tells me to take the easy road.

And the cycle continues. Unbreakable.

One of those days

I’d like to say I have ‘one of those days’ only occasionally, but I seem to have them a lot. I’m talking about one of those days where I’m actually not tired for once, I feel rested. Yet I find I have this incredible urge to pull the curtains tight, lie down, fall asleep, and not wake up until I’m ready. I think it’s down to a combination of guilt and feeling overwhelmed. 

Guilt from not following my new regime. Guilt from not being as present at work as I could be. Guilt from not being as productive at work as I could be. Guilt from the all the outstanding chores at home. Guilt for not keeping up with keeping the garden in good order. Guilt from not exercising as much as I should. 

I could go on. So much guilt. So much guilt that adds up to nothing in the long run! I know I won’t eventually get to a point where I say ‘I wish I kept the grass cut and dusting under control’, yet I beat myself up about it! 

And then the guilt leaves me feeling overwhelmed. There are so many things I ‘should’ be doing but I’m not and I don’t know where to start. And who cares anyway, it’s not like I’ll ever get on top of them. 

Which of course leads to the urge to hide away and hope I feel differently when I emerge, or that some little fairies have come and taken care of everything for me (or at least some of the things).

I’ve bought another self help book … Getting things done – how to achieve stress-free productivity. I’m hoping that it really does help me get a grip. 

Mental Health Awareness Week: Why is awareness so important?


I’m not sure if you’re aware, but this week is Mental Health Awareness Week. For those who spend much time around me, this must sound rather exhausting. Barely a week goes by where I don’t moan about my symptoms, complain about stigma, or behave in a generally ‘mental’ way. Rather than another week of raising awareness, I suspect many of my friends would prefer a Mental Health Ignorance Week. Where I’d be induced into a state of quiet normalness, and the rest of the world could continue… Well… pretty much as normal.

"Ignorance is bliss" “Ignorance is bliss” (This is one of my favourite pictures on the internet – I don’t know the original source)

And – if I’m fair – I’d have sympathy. For a start, I know how boring I can get when I feel motivated to speak. It’s like a terrible episode of Question Time, where the most annoying…

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How are you?

A must read. For everyone. Mentally ill or not.


One of the most difficult aspects of living in the UK is the bizarre mix of box-ticking politeness with genuine emotional reserve.

In other words, while almost everyone will ask, ‘how are you?’, the only acceptable answer is ‘fine thank you, how are you?’

Perhaps we should just invert the meaning of ‘fine’?

On a black dog day, this presents a problem. Either you break social convention and cause widespread panic:

‘Oh, the usual mix of abject misery and thoughts of self-harm, how about you?

Or, you lie.

In the short term, lying seems like the obvious option. For one thing, it creates less paperwork. I once made the mistake of being brutally honest with a colleague about my desires to end my life. Within a few hours I was being invited (that’s the British for ‘ordered’) to have a chat with both human resources and occupational health…

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