Beautiful Boy

David Sheff’s ‘Beautiful Boy: A Father’s Journey Through His Son’s Addiction’ is a book that I have revisited recently and is a heartbreaking, honest and brilliant depiction of some of the struggles involved in loving someone with addiction issues.

Try not to compare your insides with other people’s outsides. That is, it may look as if everyone else is doing great, their kids are sailing through. But no one sails through. When we tell others about our struggles, we find tremendous relief. We find comfort. We get help. We are reminded that life is hard for everyone”.


Coping with Covid-19

Whenever we are faced with a situation or event that is beyond our control, the most important question that we are left with is ‘How will and how do you respond?’. This is an aspect in which we always have a choice and is key to the development of resilience.

We have a choice in how we can respond to any given situation, you can choose whether you focus on what you still can do, what new opportunities may be available and what the learning from such an adversity might be, or solely what you have lost and the negative consequences to the situation.

“How you respond to the issue…is the issue” – Frankie Perez

“Between a stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. The last of human freedoms is to choose one’s attitude in any given set of circumstances” – Viktor Frankl

“Catch the moment; make a choice” –Janet Friedman

“Every moment has a choice; every choice has an impact”- Julia Butterfly Hill


“I am no longer afraid of storms, for I am learning how to sail my ship” -Louisa May Alcott

Focus on what you can do

It is apparent that almost everyone is affected by this current pandemic. Either because they have older parents they are worried about or they themselves are in the high risk categories, many have underlying health conditions, or they have children who may have asthma and other health conditions. Work and income avenues have been disrupted and huge life events or plans may have been put on hold/cancelled or changed drastically, holidays that have booked and looked forward to have been cancelled and some may have friends and family stuck abroad. We have all had to put our lives on hold indefinitely in one way or another. With schools being closed many are having to attempt to work while home schooling, while others the endless hours ahead of them each day with limited ways to occupy their mind is tormenting and terrifying and this is not to mention the more sinister consequences that the lockdown presents with increased instances of domestic violence.

It is completely normal to worry and to feel fear in response to such events. In response to such unexpected events, all we can do is acknowledge our feelings, stay alert and informed, be aware and cautious, take small positive actions, think beyond ourselves, see what we can learn from this.

Undoubtedly, Covid-19 has limited our lives in a whole host of ways, but it has also led to creativity in how to remain active, connected, help others, and allow vital processes and work to continue as much as possible. It has connected communities, families, allowed more time for self-reflection and slowing down and enabled us to ‘be’ more than ‘do’ – a rare experience. What can this period of time help you to develop? What changes that you have had to adopt have actually had a positive impact that you could continue to integrate post-lockdown? Who have you become closer to? What have you noticed that you used to spend time on that actually may not have been necessary? Have certain exercise/eating habits made a difference to your overall wellbeing – this is something that many of my clients have noticed.

At the same time, you may have found that your wellbeing and mood has actually improved in lockdown and it’s equally valuable to pay attention to this and consider the possible factors involved. This way you may be integrate these into your life post-covid-19. If you are someone that struggles to get out, perhaps knowing that others are having similar experiences to you is comforting, perhaps you feel that your situation may now be more readily understood, perhaps the change in communication systems has in fact meant that you can be more involved in life and relationships than you previously were, maybe certain pressures have been removed or you have realised that in the absence of certain experiences or people your anxiety has greatly reduced, perhaps there is some reassurance in knowing that you are not missing out on certain things. Many clients experiencing depression or chronic health conditions have reported how the acceptance that they have learnt to develop in light of uncertainty, their ability to live in the present, tolerate loss and isolation and find gratitude for what they can do each day has prepared them well. Those with health anxiety or OCD have reported feeling less alone now that much of the population is sharing this anxiety and having to take more extreme measures to protect themselves. I have heard some people say that they have more confidence in meetings over Zoom than they would face-to-face, some people who never speak to friends on the phone have changed this habit and feel closer as a result. How has this time impacted you? Some people have felt a huge amount of pride and an increased sense of resilience in observing how well they have adapted to this challenging situation. It has put life into perspective for some and forced us into facing our limitations, finitude and temporality, helping many to identify wider sources of meaning and purpose in their lives.

Choose which sources you will receive information from

Often there is a tendency surrounding feelings of panic, anxiety and uncertainty to take in as much information as possible. But as there are lots of fake scaremongering stories out there and misinformation/speculation regarding Covid-19, it is important to both be selective about your sources of information and also remind yourself that unless the source is peer reviewed by academics it may be “massaging the data” to promote an agenda and a particular political point of view. It can be useful to consider the motivation, agenda and background of any given spokesperson on an article or video and what paper or TV channel this takes place on and the subsequent values and beliefs of these also.

News tends to focus on the negative and shocking to draw in attention. There is less emphasis on positively spinning unfolding stories. We have a choice in ensuring that we have a balanced array of the information that we consume and whether we get drawn into a narrative of dread and fear or one of the power of humanity coming together, the incredible small acts of kindness being demonstrated etc, whilst also ensuring that we take this seriously.

Set good boundaries

Notice how your mood is impacted by news or discussions around Covid-19 and if it is triggering then limit how often and when you listen decide to consume it. Do you need to stay informed every hour of every day?

Maintain healthy routines

In the same way as when people work from home having had a structured routine in an office, or upon retirement, it is essential to continue positive health behaviours and include a routine if this helps you.

This means getting up at a set time, going to bed at a set time, ensuring that you get dressed before a certain time each day, eating healthily and regularly, drinking lots of water, sleeping well and making sure you do some exercise. This may be walking around the garden, doing some exercises in the house on the many free exercise classes being offered, cleaning or anything that keeps you active. If you are in self-isolation it is even more important to keep up with this to maintain your physical and mental health. It can be helpful to write a list of behaviours that you tend to find energy zapping or energising to ensure that you have the right balance of energising behaviours in your day. It can also help to keep a thought diary in order to identify what thoughts are currently ruminating in your mind and how they impact how you feel and act. If you are in the position of finding that you have more work and are doing longer hours, it is even more important to factor in breaks for exercise, rest and find ways to signify the ‘end of the working day’ as this is much harder in the absence of a commute, a separate living-working space and being surrounded by others.

If you are in a state of panic and anxiety, ensuring that your basic physical needs are met will help combat the flight / fight mode that will be activated.

Use digital technology to connect

Even small conversations are important in these times so ask for support or rely on family and friends more if you are lacking connection. Also most therapeutic services, therapists, physios, GPs are online now so make sure that you access the support you need. Most the time professional support services can offer a range of platforms to deliver services on, including the telephone, so do not let a lack of internet, devices or personal space deter you from that. There is no need for anyone to go through this time in literal isolation. I have had to conduct a number of therapy sessions with people sitting in their cars as this is the only space they can get and we are all having to be flexible and human in findings ways to work around the limitations.

Take this time to return to the simple things (enjoy a good song, book, film, garden, speak to friends you have lost touch with, take time to appreciate your surroundings on a walk). Do the things that you never have time to – learn to play an instrument, sow, paint, write a book or article, try a new language on duolingo for your next holiday, use the time to organise/throw things out, do things to the house you always put off, spend time fully immersing yourself in play with your children. Shift your mindset to embrace the lessons and potential growth this time is presenting us with. As with all suffering, we can get through it when we realise the lessons it is personally teaching us.



Yann Martel’s Life of Pi

“I must say a word about fear. It is life’s only true opponent. Only fear can defeat life. It is a clever, treacherous adversary, how well I know. It has no decency, respects no law or convention, shows no mercy. It goes for your weakest spot, which it finds with unnerving ease. It begins in your mind, always … so you must fight hard to express it. You must fight hard to shine the light of words upon it. Because if you don’t, if your fear becomes a wordless darkness that you avoid, perhaps even manage to forget, you open yourself to further attacks of fear because you never truly fought the opponent who defeated you.” (Martel 161)


Is CBT the most appropriate option always?

Often people will seek CBT without really knowing why they want that particular orientation of therapy for their particular difficulties. NICE tends to recommend CBT as the frontline option for all difficulties, regardless of the particular presentation and despite equal outcomes being repeatedly found across therapies. Therefore, it is not that CBT is more effective than other interventions, but it does have a significant evidence-base and is seen to be cost effective.

NICE relies on evidence largely from randomised controlled trials which are most suited to therapies that adopt diagnostic categories, adhere to standardised protocols, and obtain quantitative data. Those therapies that do not frame difficulties in terms of disorders, are client-led, explorative and adopt differing aims are less conducive to measurement by RCTs, with their aims and outcomes being harder to quantify. Many such therapies favour qualitative research into client experiences of therapy, over that of quantitative data on symptom reduction that do not always capture the whole picture for each individual, but this is only just starting to be recognised as a valid form of evidence by NICE and therefore these therapies are seen to have less of an evidence-base.

Take the treatment of PTSD in adults, NICE omits counselling as an option and recommends trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR). NICE states that these need to specifically address the trauma memories and for those not ready they are referred to non trauma-focused CBT to ‘promote uptake to a trauma-focused intervention’.

However, many therapies that includes a tri-phased approach – first establishing a good therapeutic relationship with emotional safety and regulation, followed by trauma reprocessing (uniting implicit and explicit memories into a comprehensive narrative of the trauma at the same time as eliminating arousal symptoms connected with those memories) and integration, are equally appropriate. Also somatic therapies can be very beneficial for somatic trauma memories that are stored non-verbally and are often hard to reach cognitively. Therefore, the type of therapy clearly cannot be ‘one size fits all’, but has to be tailored to individual needs.

As an example, the question of ‘to process or not to process?’ comes to mind. 

Some clients do not want to revisit and reprocess traumatic memories. Rothschild’s concept of trauma ‘recovery’ versus trauma  ‘resolution’ is useful here. If the impact of the trauma is no longer significantly affecting the quality of the client’s life then the client may consider this a good enough outcome, or recovery, without having to revisit the trauma memories, the decision should be the client’s. But if past traumas are constantly being triggered with flashbacks, nightmares, the client is living in an extreme state of arousal and sees threat everywhere, resulting in their lives becoming more and more restricted to avoid trauma triggers, the client will inevitably want these experiences to be reduced and to gain some control over their lives and responses again, which will require the deeper trauma work of revisiting and reprocessing trauma. But all therapy has to be first underpinned by client safety due to the possibility of retraumatisation, a substantial phase to establish emotional regulation and grounding techniques before the next phase can be addressed. However, this means that therapy can not always be entirely non-directive and client-led as such tools take time to establish and so for clients who just want to talk about the trauma experience as quickly as possible, they may need to be slowed to avoid the client becoming emotionally overwhelmed.

Hopefully NICE will begin to promote a wider range of therapies by giving more weight to qualitative evidence and enable more orientations that adopt a compassionate-collaborative stance of ‘what happened to you?’ over an expert-symptom-driven one of ‘what is wrong with you?’ to be embraced. 

But in the meantime, the most important thing as with any decision, is to make an informed choice about the type of therapy that best suits your needs. Understand their differing aims, philosophies, outcomes, whether you want symptom reduction primarily or to understand the meaning and potential causes of your symptoms before the consideration of their removal, whether you want a forward-focused therapy, past-focused therapy or one that gives equal weight to the temporal stages depending on your experience etc. Be sceptical of what you have seen advertised most and what is deemed as an evidence-base. All therapies have revealed equal outcomes so it’s far more about the relationship with your therapist and what particular intervention fits your needs at a particular point in time and your own attributes that you bring to the therapy ie. levels of engagement, involvement, motivation, proactiveness, willingness to reflect between sessions. 


Some questions to consider from a conference on Shame

Shame is a primary emotion and therefore is something that we will all be familiar with experiencing it. Shame has an adaptive pro-social function so its not about eliminating all experiences of shame, but identifying if and where we experience toxic/chronic shame.

Q. What was your earliest experience of shame? and how do you feel you adapted your future behaviours as a result of this? Often compensatory behaviour occurs as a result of shame – for example if you can’t read and write, but have physicality then you may compensate with violence  Or if you feel a lot of shame about your body or sexuality you may disguise this by being hypersexual. Can you think of any compensatory behaviour that you may display born out of shame?

Parents use adaptive shame, but if this is too extreme then it can develop into chronic shame. Q. How do your parents use shame?

Some examples that shame-based families will experience are: disapproval of spontaneity, rigid expectations of behaviours, shame linked to curiosity (for asking questions etc), fault-blame focused families (most vulnerable child is scapegoated and carries all the fault and blame of the whole family), suppression and invalidation of feelings and needs, constant comparisons to others, lack of affect regulation (told how you should be feeling and sex, drugs, food, alcohol relied on to manage feelings with expression of feelings being deemed as too needy, involved, wet etc), objectification (where children are an accessory for image of family, not accepted in their own unique being), lies and reality invalidated and unrealistic expectations.

Q. What kind of shame is in your family? Has shame linked to certain areas been passed down your family tree? Does your culture instill shame over certain behaviours/values/experiences?

Shame is often a feeling of being less than an ideal/norm and linked to feelings of inclusion/exclusion. Where do you transgress social norms that you feel self-conscious about?

Q. What defences against shame do you use, with whom and in what situations? For example you may withdraw, become self-reliant, become appeasing, perfectionistic, or be grandiose or attach other. You may self-shame and blame or split off certain aspects of yourself and develop social v private self.

Q. What is your non-verbal communication when you experience shame? How does your posture change?

Exercise – write down the word ‘SHAME’ and then write down every word, experience, visual image, person, sensation that comes to mind when you think of ‘shame’.

Exercise – make a pie chart and identify the key areas that you hold shame. Here are some examples to get you started:

Cognition – Shame around lack of academic achievement, reading, bizarre ways of thinking, presenting, game playing, memory games

Body – disability, physique and how fits the norm, weight – thin shaming – depends on cultures and friends, shape of body with current norm (neutral or curvy or muscular)

Sense of self – vulnerability not acceptable, emotions not acceptable, shyness, posture, handshake/wave, what emotions are deemed acceptable or not

Sexuality – orientation, performance, STIs, virginity, puberty, mutilation, termination, circumcision or not, submission/dominance, promiscuity, preferences like BDSM/fetishes  How was your sexual script formed?

Relationship – dependence v independence, fear of abandonment and shame if have been left, parenting with emphasis to be perfect

Beliefs – religious, values – Brexit and potential beliefs (eg. Academic seen as non-Brexit and uneducated as Brexit)

Ageing – loss of potency, agency, less sharp, physical change, increasingly invisible especially as a woman, hair loss

As i searched for these images linked to shame it made me realise how particular emotions can also be very linked to shame and particular images and colours are attached to it. What image from your own life, or more generally would encapsulate your understanding of or the core of  the shame you feel?


Rising mental health referrals for young people

Consultant psychiatrist Sami Timini wrote an interesting piece that questions whether there is a massive increase in mental health problems among young people requiring CAMHS involvement, or whether as a society we are increasingly unable to tolerate our children’s expressions of distress and are too quick to want to hand them over to ‘experts’, who then medicalise, diagnose and prescribe. While there are clearly unique pressures impacting children today with social media, he makes a really valuable point that if we popularise the idea that there is an epidemic of mental health issues among young people and they all need expert help, the young people, parents, teachers and others who care for them will start to think that any display of emotion that concerns them, feels painful or annoys them or causes problems to themselves or others is a sign of mental disorder and not part of what it is to have the full range of human emotions – distress or certain idiosyncrasies become far too quickly pathologised. He argues “We are becoming afraid of our children’s emotions and behaviours. We are not allowing space for the ordinariness of unhappiness, anger, pain and suffering”. It’s best to promote caregivers and parents to be with difficult emotions, feel empowered to offer ordinary, relational ways to help and not feel an expert needs to be involved for fear of incompetency. There are of course those that greatly need expert intervention, but far too many children who are presenting with normal dilemmas, emotions and difficulties in living are being pathologised and medicalised, which will inevitably significantly shape their future.