A handy, two-part guide helping you explore different aspects of your mental health and wellbeing, from Anger through to Zen. Part one takes you from A to M.
 
A is for Anger – Anger can be a reaction to an event; a response to a substance; or a symptom of anxiety, depression or other mental illness. It may be directed at others or inwardly at yourself. Using anger management techniques can help you control your anger while you work out what triggers it and why.
 
B is for Brain – Brains are complex and can sometimes go a bit wrong, whether it’s faulty communication between neurons or an imbalance in chemicals. For example, your brain can unnecessarily put you into ‘fight or flight’ mode by misinterpreting the degree of threat you’re facing, leading to feelings of anxiety and panic. Therapies such as CBT can help you retrain your cognitive processes, while chemical imbalances are usually treated using medication.
 
C is for Confidence – Low self-confidence can be both a symptom and trigger of mental illness. A therapist can help you recognise and take control of your critical inner voice, and make changes to build your self-esteem.
 
D is for Diagnosis – A mental health diagnosis is given by a doctor and will be based on what you tell them and/or your answers to questionnaires or forms. Getting a diagnosis can be a relief but may also feel negative and scary. Showing information about your mental health condition to those around you can help them understand your diagnosis, while talking to others with a similar experience or diagnosis can help you feel less alone.
 
E is for Exercise – Exercising releases chemicals in the brain, such as serotonin and dopamine, that help to regulate and boost your mood. You could go for a walk, join a dance class or do some gardening. Whatever you choose, just make sure it’s something you enjoy – that way you’re more likely to keep doing it regularly.
 
F is for Food – Diet plays an important part in mental wellbeing. Sugary food and drinks create energy highs that leave you feeling tired and low when they’ve worn off, while slow-release energy foods, such as pasta and oats, can prevent drops in energy levels and mood. Avoiding stimulants like caffeine and drinking plenty of fluids is also beneficial. Importantly, some foods shouldn’t be eaten with certain medications – your GP can advise you about this.
 
G is for Goals – Setting goals can help you plan and move forward. But it’s important they’re realistic so you don’t set yourself up to fail. Consider having a different set of goals for difficult days, such as having a shower or getting dressed - achievements come in all sizes. And remember, when you achieve your goal take time to be proud of what you’ve done.
 
H is for Happiness – Looking after your mental health has a bigger impact on how happy you feel than money or material possessions.[i] But when you’re mentally unwell, it can feel like you’ll never be happy again. Keeping a gratitude journal and writing down three things you’re grateful for each day can provide small rays of sunshine as you go through your journey of recovery.
 
I is for IAPT – Improving Access to Psychological Therapies (IAPT) is the NHS therapy programme for adults with anxiety and depression. To receive it, your GP has to refer you for an IAPT assessment. Counselling is free, but sessions are limited and you have no choice over the type of therapy you receive (only cognitive behavioural therapy is used). Waiting times to start therapy can also vary. As well as individual therapy, IAPT also runs group therapy and online courses.
 
J is for Journal – Journaling provides a practical and creative way to help you manage your mental health. You can use a journal to write down your thoughts and feelings, or to help track your mood, diet, exercise and sleep. You can also use it to identify triggers and plan self-care, as well as to organise, plan and set goals.
 
K is for Knowledge – As the saying goes, knowledge is power. Spend time finding about your mental health condition to see whether there are common triggers, symptoms or helpful treatments. And find out what sources of support are available. Knowledge of yourself is important too, learning about your own personal triggers and symptoms.
 
L is for Low – Life events, illness and changes in season can all cause you to experience low mood. But if that feeling persists and doesn’t improve, you should make an appointment to speak to your GP. They’ll chat to you about how you’ve been feeling and make suggestions for appropriate treatment options. If you’re having thoughts of suicide or self-harm, you should seek immediate help from your GP, NHS 111 or the Samaritans.
 
M is for Medication – Medication is a treatment option for many mental health conditions, and may be used in combination with counselling, hypnotherapy or alternative therapies. Your GP, psychiatrist or other mental health professional will prescribe and adjust your medication as required. Self-medication - using drugs and/or alcohol to cope with the symptoms of mental illness – can make your mental health worse. If this sounds familiar, your GP or therapist can provide support.
 
Part two, taking you from N to Z, is coming soon. In the meantime, if you’d like some confidential support, get in touch to make an appointment.


[i] BBC News (2016), Mental health and relationships 'key to happiness’, Available: https://www.bbc.co.uk/news/uk-38285223

Talking about a loss is difficult at the best of times. But what about those losses that can’t be openly acknowledged or shared? The experience of being deprived the chance to openly grieve a loss is known as disenfranchised grief. The article explores when disenfranchised grief can occur, the effects it can have and how to cope with it.
 
When disenfranchised grief can occur
 
1. The relationship with the deceased isn’t recognised

• Death of an ex-spouse or ex-partner
• Death of a same sex spouse or partner
• Death of an unacknowledged partner
• Death of a lover
• Death of a step-child or step-parent
• Death of a foster child or foster parent
• Death of ex-in laws
• Death of a child given up for adoption
• Death of a birth parent of an adopted child
• Death of an unannounced baby (e.g. miscarriage or stillbirth)
• Death of an estranged family member
• Death of an imprisoned family member or friend
• Death of an abuser
• Death of a gang member

 
2. The loss is viewed as unimportant

• Death of a pet
• Death of a co-worker
• Death of a neighbour
• Death of a classmate
• Death of a childhood friend
• Death of an online friend
• Death of an extended family member
• Death of a family member that occurred before you were born
• Death of a professional figure (e.g. doctor or teacher)
• Death of a celebrity or public figure
• Losses that don’t involve death (e.g. moving house, a child moving out of home, physical illness, redundancy or retirement, end of a life stage, infertility, menopause, divorce or relationship breakdown, change in financial status etc.)

 
3. The nature of the death is stigmatised

• Death by suicide
• Death by murder
• Death from substance misuse
• Death from HIV/AIDS
• Death from drink driving or drug driving
• Abortion

 
4. The griever is not acknowledged

• They are physically or mentally unwell
• They are physically or mentally disabled
• They are elderly
• They are a child or young person

 
The effects of disenfranchised grief
 
The disenfranchised grief process is typically more complicated than for socially accepted or acknowledged bereavements. The loss can leave you feeling alone, isolated, unworthy and unsupported.
 
Other effects can include depression, anger, frustration, and intense and prolonged sadness. You may also experience physical, behavioural, cognitive and other emotional changes as you continue to grieve in silence.
 
How to cope with disenfranchised grief
 
If you experience disenfranchised grief, you may become ‘stuck’ in the grief process. Having no opportunity to talk about and work through your thoughts and emotions means it can feel impossible to move forward. It may also be difficult to understand why the loss continues to be so painful.
 
The first step is to confide in someone about how you’re feeling. This may be a friend, family member, co-worker, therapist, your GP, or a support organisation such as Cruse Bereavement Care. Voicing your loss can help to acknowledge its significance, and to validate and normalise how you’re feeling.
 
Other steps may include having your own personal ritual or ceremony to say goodbye, particularly if you were excluded from the public burial or cremation service, or creating a memory box. You should also focus on your own physical and mental health through sleep, diet, exercise and self-care, including requesting compassionate leave from work if applicable.
 
Remember, no loss is insignificant, no matter who or what it is and what the circumstances are. After any loss, you’re entitled to give yourself time and permission to grieve.
 
If you’ve experienced a loss and would like someone to talk to, get in touch for an appointment.

This year’s Mental Health Awareness Week, which runs from 14th to 20th May, is focusing on stress. To help you prevent and reduce stress, and to improve your ability to cope with it, here are some tips for creating your personal stress management toolkit.
 
Stress is something we all experience at some point in our lives. It’s a key factor in many mental health problems, yet too often we fail to recognise (or choose to ignore) we’re experiencing it until we reach crisis point.
 
Stress can be caused by:

• being placed under pressure
• facing big changes
• worrying about something
• not having control over the outcome of a situation
• having responsibilities that are overwhelming
• not having enough work, activities or change in your life
• times of uncertainty[i]

 
Stress can affect how we feel and behave. It can also create a wide range of physical symptoms, including: panic attacks, muscle tension, difficulty sleeping, headaches, nausea, indigestion, and chest pain.
 
You can improve your ability to cope with stress by:
 
1) Managing external pressures – to do this, identify your stress triggers, look for ways to address the cause(s), realistically plan your available time, ask for help and support, and accept the things you can’t change[ii]
 
2) Developing emotional resilience – to do this, look at making lifestyle changes (e.g. taking up a hobby), look after your physical health, be kinder to yourself, take a break, and build up your support network[iii]
 
To help you with these, it can be useful to create a personal toolkit of resources and materials.
 
Your stress management toolkit can be made up of:

• To-do list or task planners
• Time management schedulers
• Communication tips and reminders to be assertive
• A journal (to help track and identify stress triggers)
• Meal planners
• Self-care items (e.g. relaxation colouring books, bubble bath, favourite books, records, recipes etc.)
• Favourite sayings, mottos or quotes
• Memory prompts (e.g. objects or photos of family, friends and favourite places as a reminder of relaxed times in your life)
• A list of hobbies you enjoy doing
• A list of places you enjoy visiting
  
• Mindfulness meditations
  
• Sleep hygiene tips (read more about how to sleep better)
• Phone numbers of friends
• A list of support organisations and helplines (e.g. for housing, finance, debt, insurance, work union, student support, addiction, abuse etc.)
• Contact details for your GP
• Contact details for a therapist (here are my contact details)
  
• Anything else you find helpful!

 
As well as helping to improve your ability to cope with stress, regularly using your stress management toolkit can help you to identify triggers and prevent stress before it occurs. The result: improved mental health and wellbeing.


[i] Mind, How To Manage Stress: What causes stress?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/causes-of-stress/#.Wu7iJ8gh2gQ
 
[ii] Mind, How To Manage Stress: How can I deal with pressure?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/dealing-with-pressure/#.Wu7mxMgh2gQ

[iii] Mind, How To Manage Stress: How can I be more resilient?, Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/developing-resilience/#.Wu7mxsgh2gQ

If you’ve never had counselling before it can be hard to know what to expect. But, almost certainly, everyone who comes for therapy walks into the counselling room with a degree of expectation. It might be an expectation that the therapist is going to “fix” the problems you’re experiencing, or maybe that they’re going to be shocked by what you tell them. To help keep your expectations of therapy realistic, here’s a guide to what a therapist can and can’t do.
 
What a therapist can do
 
Give non-judgemental support – no matter what you tell us, your therapist is not going to judge you. We’re there to provide support in a space that’s free of judgement or criticism, so you feel safe to disclose your innermost thoughts and feelings.
 
Offer confidentiality – we don’t discuss clients with anyone else, unless it’s in supervision (where you’re kept anonymous) or in exceptional circumstances where something you tell us means we have to break confidence. Your therapist will always outline what these exceptional circumstances are when they contract with you in your first appointment.
 
Help you identify and change patterns – your therapist will reflect back what they hear you say and make observations in order to help you make links between the events in your life and identify behaviour patterns. We will then support you in making changes to break negative patterns.
 
Support you in achieving goals – we work with you to help you achieve your goals. In some cases, this may mean referring you to another therapist who is more experienced in a particular specialism so you can get the best support and therapy experience.
 
Increase your self-awareness – the therapy process is one of learning, and your therapist is there to offer observations and challenges to increase your self-awareness, which you can continue to use to inform your life decisions after therapy has ended.
 
Be human! – we’re not robots, and one effect of having empathy for your experiences is that we feel your emotions as we sit with you. It’s what helps us to understand the world from your point of view and offer non-judgemental support.
 
What a therapist can’t do
 
“Cure” you – while therapy can help you find ways to manage the problems/symptoms you’re experiencing and find new coping strategies, it can’t change the underlying stressors. For example, if you have anxiety life events may continue to cause you anxiety or stress. Therapy can’t eradicate this but it can help you to manage your anxiety more effectively.
 
“Fix” the problem(s) – therapists aren’t there to give advice but to support you, offer encouragement, and to challenge you along the way as you find your own solutions and way forward. We can’t offer fixes, tell you how to resolve a problem or guarantee there is a “solution”. Rather, we work with you to help you achieve goals and find a positive way to move forward.
 
Change other people – if you come to therapy hoping to change your partner or someone around you, you’re going to be disappointed. Therapy is about looking at your thoughts and behaviours, and how you relate to others. And while changing your behaviours may naturally have an effect on those around you, it may not necessarily be in the way you're hoping.
 
Give a diagnosis – therapists aren’t medically trained and we won’t give you a diagnosis of a mental health condition. Instead, we’ll signpost you to the relevant source of medical support while you continue with therapy.
 
Give guarantees – it can be difficult to know how long the therapy process will take, what might be uncovered or how the process will make you feel. Often, people believe they’re coming to therapy for one issue but the real issue is actually something different. New, unforeseen difficulties may also arise during counselling that extend the therapy process.
 
Be your friend – while your therapist is there to provide support, we’re not there to be your friend. This doesn’t mean we don’t care about you, just that this care is restricted to being in a professional capacity. Your therapist should outline the professional boundaries of their relationship with you in your first meeting (often called an initial consultation).
 
Be on call – your therapist isn’t there to provide a personal support line between sessions. But that doesn’t mean you’re alone. If you’re finding things difficult, we'll chat to you about who to contact between sessions when we’re not available so you always know where to go for support.
 
Be shocked by what you say – it’s unlikely that you’ll tell us something we haven’t heard before. And even if you do, we’re there to understand the world from your point of view.
 
All the work - there’s no getting away from it, therapy can be hard work. And it’s work that your therapist can’t do for you. We'll be there to provide support and guidance, but it’s down to you to make changes. This means putting in work both during and between sessions.
 
Now you know more about what to expect from counselling, why not find out what to expect from your first therapy session. Or simply get in touch for a chat and to make an appointment.

With the clocks changing, now is a good time to think about your sleep. Your sleeping pattern can affect your mental health, increasing feelings of anxiety, depression and stress. If your sleep is poor and you’re struggling to get some much needed zzzzs, take a look at how to sleep better and improve your mental health.
 
The Facts
 
Did you know we spend around a third of our lives asleep? Sleep is as important to our health as eating, drinking and breathing.[i] And a lack of sleep can affect both our physical and mental health.
 
Medicine has identified more than 80 different sleep disorders and problems.[ii] Some can be the result of other medical conditions, but most are short-term and typically triggered by temporary events in our lives or by behavioural factors (such as drinking too much caffeine).
 
Just as poor sleep can impact our mental health, so can mental illness lead to a disruption in our sleeping pattern. To help break this cycle, it’s important to treat both the sleep issue and mental health problem at the same time. In some instances, this may involve a referral to a sleep clinic or the use of sleep medication.
 
Many sleep problems can be improved or eradicated through simple changes to our sleep hygiene. The phrase ‘sleep hygiene’ refers to the habits and practices that help us get a good night’s sleep. If you’re wondering whether or not you need to improve your sleep hygiene, ask yourself: Are you getting enough sleep? Is it good quality sleep? If the answers are no, take a look at these top tips:
 
Top Tips For Good Sleep Hygiene
 
1) Set a routine – get up and go to bed at the same time each day. And don’t sleep in by more than an hour, even on your days off
 
2) Avoid stimulants – caffeine, alcohol and nicotine can affect both your ability to go to sleep and the quality of sleep you get, even if they’re used hours earlier
 
3) Avoid napping – when you’re tired it can be tempting to take a nap. But sleeping for over an hour in the day, or napping too late in the day, can have a big effect on your sleep
 
4) Only use your bed for sleeping – using your bed for other activities, such as playing video games or watching TV, can lead to your brain associating your bed with these, rather than sleep
 
5) Exercise and eat well – exercise and healthy eating can improve sleep. Just avoid strenuous exercise or large meals in the two hours before going to bed. Equally, a light snack before bed can stop you going to bed feeling hungry
 
6) Have a digital detox - the activity of checking emails, updating Facebook etc. stimulates your brain instead of helping you wind down. To avoid this, switch off and put away mobile devices for 90 minutes before going to bed
 
7) Create a comfortable environment – the room should be quiet, dark, and not too hot or cold. Ear plugs, eye masks and fans can help with this, if needed
 
8) Remove distractions – electronic devices, such as laptops, phones and tablets, emit blue light that makes you feel less sleepy. Notifications also tempt you into checking your devices after going to bed. Keeping devices downstairs or switching them off will remove this distraction. To help, invest in an alarm clock rather than using your mobile phone as your alarm
 
9) Don’t lie in bed awake – if you haven’t fallen asleep after 20 minutes, get up and do something calming (avoiding bright lights and screens, which will activate your brain more). Lying in bed awake will stop your brain associating bed with sleep
 
10) Avoid checking the clock – if you’re struggling to sleep, looking at the clock can cause anxiety and increase the pressure to fall sleep, keeping you awake longer
 
11) Write down your thoughts – racing thoughts can make it difficult to sleep. Keep a pen and paper by the bed to write down any worries – if they’re important you can return to them in the morning. Often, your worries will seem less daunting in the daylight
 
12) Try mindful meditation – meditations such as a body scan or mindful breathing can help to physically relax you and interrupt anxious thoughts, calming your body and mind and helping you drift off
 
Getting good quality sleep can benefit your mental health. But mental illness can be the very thing that stops you sleeping well. If you need support and someone to talk to about your mental health, get in touch to make an appointment.


[i] Mental Health Foundation (2011), Sleep Matters: The Impact Of Sleep On Health And Wellbeing, Available: https://www.mentalhealth.org.uk/publications/sleep-report

[ii] Mental Health Foundation, Sleep, Available: https://www.mentalhealth.org.uk/a-to-z/s/sleep