ADHD in the Therapy room with Aspire Autism Consultancy.

Therapy for ADHD, slide from training presentation on ADHD

I have recently finished some enlightening training on working with ADHD in the counselling room with the lovely Deborah & Ruth at Aspire Autism Consultancy. I have done alot of training courses over the years, and this has felt like one of the most important.

I often work with queer, trans or LGB clients who either have diagnoses or identify with the traits of ADHD and Autism.

Mainstream counselling training does not often account for neurodiversity in the same way it doesn’t account for sexual and gender diversity and so my process over the last few years has been one of un-learning and re-learning.

One thing I was really struck by is that (according to the training) adults can often be mis-diagnosed with things like Borderline Personality Disorder or bi-polar disorder because there is an overlap of traits between these conditions and ADHD. For some of the people who shared their stories during the training, finally landing on the more accurate diagnosis of ADHD and access to the right treatment brought a sense of life finally making sense.

I am not so much interested in the diagnoses element, but rather my interest in doing this course is to better support my clients, to understand how traits of ADHD may come into my work with clients so I am able to adjust and be flexible around a clients needs.

More information on Deborah & Ruth’s work can be found on their website: https://aspireautismconsultancy.co.uk/

Dr Meg-John Barker-Fear/Shame & the anatomy of a trauma response.


  As I have mentioned before in earlier blogs, I am a big fan of the work of Dr Meg-John Barker. Their website rewritingtherules.com contains many useful writings and resources that can help with understanding our identities and the mental health challenges we humans can sometimes face. They are a queer, non-binary psychotherapist, lecturer, author and zine maker and I feel their contributions to the field of counselling, psychotherapy and mental health in general benefits greatly from their perspectives on life.   

I wanted to share this recent piece of writing from their blog entitled ‘Fear/Shame and the Anatomy of a trauma response’. In it they discuss how when something has set off their flight, fight, freeze, fawn response, they have noticed that the underlying feeling is a combination of fear and shame in response to feeling like their either have to choose between themselves or other people.

You can find the blog post here. It’s well worth a read!

Internalized homophobia

Internalized homophobia (or queer, bi, and transphobia) is a phenomenon that effects LGBTQ people in varying degrees. Internalized homophobia is ‘internalizing’ of negative messages from the environment around us (media, politicians, family members, schools, religious figures) and turning this negativity towards ourselves. It is what happens when negative voices that start outside ourselves are absorbed and turn into something that sounds like our own internal voice. This voice is critical and unkind, can make us feel shame about who we are and can manifest in shame driven behaviours.

I have some things to say on internalized homophobia, and in particular how counselling can help shine a light on the shame and help clients untangle their sense of self from it, which will follow in later posts.

For now I want to share this great resource from Revel & Riot on where internalized homophobia comes from and what can be done about it.

Why learning to be a better friend to your self might be the best thing you can do for your mental health…

This article originally appeared in GNI magazine May edition, link below: https://issuu.com/lambpromotions/docs/gni_mag_51_print

Mental Health week, which runs from 9-15th May each year, is an opportunity to reflect as a society on how to increase good mental health and wellbeing and look at some of the things that contribute to poor mental health in our population.

As counsellor, I am always interested in the most useful and effective ways to help my clients.  There’s an idea that I have become increasingly interested in that feels relevant to promoting good mental health, both for individuals and as a collective society. I have seen it make a positive difference in the lives of some of my clients, and it is also has a body of research and evidence behind it backing up its effectiveness.

The idea? Self-compassion

I was introduced to the idea of self-compassion by Art Therapist Lisa Kelly while working on a Therapy group for LGBTQ teenagers at The Rainbow Project. Self-compassion is not a new idea, in fact it’s been around for a long time. Self-compassion, like Mindfulness which has become a popular concept in mental health over the last couple of decades, has its roots in Eastern Buddhist philosophy. In today’s world, self-compassion it is gaining traction as an effective tool in increasing wellbeing and good mental health thanks to the work of Dr Kristin Neff. Neff is a US based researcher, professor and self-described ‘pioneer of self-compassion’. Neffs work has also been elevated into public awareness by author, shame researcher and all-round legend Brené Brown (and what’s good enough for Brené is good enough for me!).

So what is self-compassion?

To understand what self-compassion is, we first must understand compassion. Think of a time when a friend has come to you for support. Imagine, for example, that they made an of error of judgement of some sort in their job or relationship that had a negative outcome.  When your friend comes to you, you will (hopefully) respond with kindness, support, and reassurance. You might tell them that they aren’t a bad person, that what happened to them could happen to anyone, that we all make mistakes and so on. Ultimately, you want to help reduce your friends suffering in their time of need. This is a compassionate response.

Simply put then self-compassion is treating yourself with the same gentle, accepting, supportive kindness that you would give to a friend.  

This can be harder said than done. Often our go-to response in our more negative moments is self-criticism and judgement. Being imperfect and having flaws is what makes us human and we can understand this when it comes to our friends and loved ones, but sometimes we can struggle with applying this to ourselves.

An important element of self-compassion is identifying our ‘critical inner voice’.  This is that little voice in that back of our minds that’s ready to jump in with the criticisms and judgements anytime we put a foot wrong (It might sound like “I can’t believe I did that, I am so stupid”, or “no one will want to listen to what I have to say, I am not interesting” etc.). Understanding the types of things we are saying to ourselves helps when it comes to practicing being kinder to ourselves (when doing this work with clients they often remark that if they spoke to their friends the same way they spoke to themselves they might not have any friends left!).

We all have a critical inner voice to varying degrees and it often comes from our experiences in childhood or as teenagers, or from other difficult life experiences.  For LGBTQ people the critical inner voice can come from internalizing negative messages from society, school, unsupportive families etc. We may feel we have to hold ourselves to higher standards to prove our worth and so therefore can be more self-critical.

This is why I think self-compassion is especially important for LGBTQ people. Neff describes self-compassion as a radical approach, and I completely agree. To treat yourself with kindness, love and acceptance for all that you are in a world that would have you think otherwise is both powerful and empowering.

Self-compassion is good for our mental health. I have seen first hand the positive difference it can make when a client begins to be a little more kinder to themselves. But it’s not just anecdotal, the research backs it up too. People who introduced more self-compassion into their lives were shown to be less critical and had less experiences of anxiety and depression which lead to greater life satisfaction overall. Self-compassionate people were also more likely to be optimistic about the future and experience better mental wellness. In a study that focused specifically on the experiences of LGBTQ people, self-compassion was linked to increased mental resilience in the face of stigma and minority stress. This really is important stuff.

So what can you if you want to introduce more self-compassion into your life?

A good place to start is to try and get into the habit of treating yourself like you would treat someone you love. In those moments when the go-to is usually self-criticism for something you have done, try to take a moment and think of how you might respond to yourself in a kinder way instead.  

You might also want to spend some time trying to identify that critical inner voice. This can be helpful to do in the safety of the counselling environment where you have the support of a counsellor.

Neff’s website (self-compassion.org) has many useful resources including the ‘Self-compassion scale’ for measuring levels of self-compassion and breakdown of what self-compassion is and what it isn’t. There are also guided meditations and journaling & creative writing exercises designed to help increase levels self-compassion.

One idea I really like is the ‘compassion-break’-checking in with ourselves to see if there is anything we need when we are going through something negative (Am I hungry? Am I thirsty? Do I need a change of scenery?).

Being self-compassionate is more of an ongoing practice than a one-time deal. It is like a muscle that needs to be built and maintained. If you stop the exercise, you lose the muscle. So it’s about trying to introduce a little more self-kindness each day, building it up until it becomes second nature. Also, you might not do it perfectly every time, and that’s Ok too. The good news is that the more we practice the easier it becomes. And the more we start to treat ourselves kindly, the more we will want to continue to treat ourselves kindly.

One final thing to say is that it is not selfish or self-indulgent to start treating yourself better. As Neff says, being self-compassionate is the opposite of selfishness because it improves our mood and feelings of wellbeing. This means that self-compassion is more likely to open us up and expand our capacity for the other relationships in our lives, whereas self-criticism will shut us down. It just makes sense that if we are increasing how compassionate we are to ourselves, then we are also going to be more compassionate towards other people.

So this mental health week, maybe try to think about how to introduce a bit more self-compassion into your life. As the saying goes, the relationship we have with ourselves is the longest one we will ever have, so we may as well treat ourselves like the beautiful, unique, fallible beings that we are.

Belonging.

“When I get to be myself I belong, if I have to be like you I fit in”.

Belonging and connection are themes that are often appear in counselling. It sometimes feels that most often at heart of what clients bring to counselling are feelings of not belonging and not connecting. This can be with themselves, with their families or with the world at large. This is a common feeling for many people, not just clients in counselling. Disconnection is almost the defining feature of our time. The more I work with themes of belonging and disconnection, the more I feel it is an underlying force in self-esteem and self-acceptance and overall satisfaction in life.

We are a social species, with a hard wired need to form groups and be included by others. But we are also hardwired to need deep feelings of belonging and acceptance for who we are. Sometimes those two things can be in opposition to each other.

I read something recently about belonging in Brené Brown’s new book Atlas of the Heart which really blew my mind and has made me rethink the whole concept of belonging.

Brown discusses how belonging and fitting in are not the same thing. In one section some primary school aged children are asked to describe the difference between belonging and fitting in. The answers are the kind of honest, simple insights that can only come from kids. This one really stood out…

“When I get to be myself I belong. If I have to be like you, I fit in”.

Brown goes on to say that experiencing deep feelings of belonging contributes to feeling healthy, happy and satisfied and can reduce feelings of isolation and loneliness. But here’s the rub; we can only experience deep feelings of belonging when we are free to be ourselves. If we are changing or editing our behaviour, acting in ways that are not true to our selves and our values in order to fit in, then we cannot experience deep feelings of belonging. Changing ourselves to fit in is a blocker to true belonging.

I just think about how much we can fall into the trap of editing ourselves, in small or big ways, because what we want is to belong. This is something we learn in school, be like everyone else, don’t stick out. To be socially excluded in our primary and secondary school years is the worst thing that can happen to us. So we learn that to be our individual selves is dangerous and might leave us vulnerable to exclusion and isolation. And I think this carries over into our adult lives.

And this is what I am taking away from Atlas of the Heart: That we have a want and need to feel like we belong. But sometimes in an effort to feel like we belong (to a group of people, a club, our families) we will change our behaviour, so that what we are actually doing is fitting in. And we cannot experience deep feelings of belonging while simultaneously changing ourselves to fit in.

This is why I feel it is so important to find your tribe. Find those people, or that one person with which you feel most comfortable to be yourself. Where you know you can let it all hang out and you will be celebrated for who you are. Work out who those people are, and where they hang out. It is also about trusting that you can bring your whole, unedited, messy self to the table and that it will be ok. It can take time for this trust to build and that’s ok too.

We all deserve to belong, and not just fit in.

Hell Yeah Self-Care; a zine by Dr Meg-John Barker

“Caring for myself is not self-indulgence it is self-preservation and that is an act of political warfare”-Audre Lorde

I am a big fan of the work of Dr Meg-John Barker. One of the things that they do really well, that I love, is taking abstract or difficult to understand academic concepts on philosophy, psychology and mental health and turning them into really understandable and relatable comics.

This one, Hell Yeah Self Care, is one of my favourites, and I wanted to share it on the blog. The link to access the Zine is below:

Other zines and resources can be found on Dr Barkers website rewriting-the-rules.com

Anxiety; sometimes it’s hard be to be a human (and how counselling can help).

“You may come to counselling believing that something is wrong with you when you are experiencing anxiety. However anxiety is as much a social issue as a personal one. We live in a world full of pressures and obligations. So if you come to therapy with high anxiety, the first step is to help you realise that your anxiety is part of a bigger social picture that you operate in, and secondly that deep down anxiety is often a symptom of something else…”

Sometimes it feels like there is an abundance of things to feel anxious about in our current times. Money, housing, relationships, our kids, family, work, living up to expectations (both other peoples and our own), the environment…the list could go on to infinity.

Sometimes that anxiety can be event or time specific…for example living through a global pandemic! At the minute I see a lot of people (including myself) experiencing conflicting feelings and anxiety about life returning to ‘normal’. Worries that now we have had an opportunity to live in a different way over this last year, that we don’t want to go back to exactly the way things were before.

At other times, we can feel anxious for no particular reason that we can identify at all. Even in times when on the surface everything is going well.

Anxiety is often about uncertainty and feeling out of control. The anxious mind craves certainty. It wants to know exactly what is going to happen at all times. If you’ve ever found yourself playing out future scenarios, in your head, or paralysed about making decisions, you will know this all too well.

Whenever I read anything about anxiety, the consensus is generally that some amount of anxiety in life is normal, standard and common. It’s when that anxiety becomes a preoccupation and prevents you from doing the things you would like or indeed need to do, and sucks the enjoyment out of life, that’s when it is a problem. When anxiety significantly impairs your quality of day to day life , that’s when it slides into the territory of potentially being an ‘anxiety disorder’.

So in summary, Anxiety; it’s a thing. People experience it. It can be related to things about our social environment, about feeling out of control, uncertainty, rigid expectations, or deeper, existential fears such as loneliness and our own mortality. All of us live with some degree of anxiety, but for some people, at some times it can range from a feeling of general unease (often described by my clients as a ‘sense of impending doom’) or it can be utterly debilitating.

How can counselling help with anxiety?

Well, I really like this article from the Awareness Centre on how counselling can help with anxiety (the quote at the top of this post is from this article). It sums it up pretty well.

I think one of the most helpful things about counselling, especially when it come to anxiety, is that it can create a feeling of safety. This is counter to the feeling of unsafety that is often a feature of anxiety.

In this safe place, clients can then begin to try to understand the causes or triggers of anxiety, and work on techniques such as self soothing and grounding to try and help dampen and anxious thought pattern before it spirals out of control.

I really like the part in the article about understanding the bigger social picture that we are operating in. As I have mentioned in my earlier posts, I am big on understanding the context in which we live our lives, and in which our mental health operates and I think this is also helpful in developing a greater self-awareness about our experiences of anxiety.

I also really like and wanted to share this NYT article, which specifically address anxiety related to the pandemic, and the ‘re emergence’ anxiety that a lot of people seem to be feeling right now.

Mental health in Northern Ireland; thinking about the context of our lives.

My aim in counselling is to understand my client as fully as I can. Understanding goes hand in hand with empathy. The better I can understand a clients life, experience and perspectives, the better I can imagine what life might be like for them.

For me, part of that work is understanding the context in which a client lives their life. So on one hand, tuning in to and responding to the client as they sit in front of me, while at the same time zooming out to get the macro view of their life.

We all live within in structures, societies, histories, communities, social rules and constraints. Some of the effects of these on our lives are obvious, and others are harder to spot. Some of how the society or context we live in can effect our lives can have everything to do with other parts of our identity. Two people can live in the same geographical location but be having very different experiences in life depending on their ethnicity, gender expression, social class..and so on.

All of that is to say, I have been thinking alot recently about the context in which we lives our lives in Northern Ireland in an effort to understand what effects our mental health. Although I do work with clients in other parts of UK & Ireland, the majority of client are based in Northern Ireland.

I came across two studies of interest on the subject; Mental Health Foundation: Mental Health in Northern Ireland: Fundamental Facts 2016 and Review of Mental Health Policies in Northern Ireland by Professor Siobhan O’Neill, Professor Deidre Heenan and Dr Jennifer Betts in conjunction with Ulster University.

There is ALOT of information in both documents, pointing to a complex issue with lots of different areas for consideration and I’m not even going to try to summarise it here. However there were a few things that jumped out at me.

The first, and probably most obvious one, that is mentioned alot in correlation to poor mental health here, and that the effect of living though conflict, and/or living in a post-conflict society (depending on how old you are now).

Transgenerational trauma. Living through events that are disruptive and traumatic has an impact on mental health. But also living in a society that has been though a traumatic event in it’s recent history, even if you were too young to really understand what was happening, or weren’t born yet, can also have an impact on mental health.

Best illustrated in The Body Keeps The Score by Bessel Van Der Kolk, the idea is that trauma can be stored in the body and stays there until the person can find a way to release or discharge it. And that trauma can also be passed down on a genetic level, to the next generation of people. So even if they didn’t experience it directly, or weren’t even alive at the time, they can still feel the effects.

This is widely accepted as a huge contributing factor to the overall picture of mental health in Northern Ireland.

Other factors highlighted in the reports as contributing factors to poor mental health are lack of funding and investment in NHS mental health services and community based services which leads to difficulties in accessing help, higher levels of deprivation and social need, austerity, chronic stress, living in a polarised and divided society and the fear of difference.

On a personal note, I could add into that our frustrating and depressing political landscape, the lagging behind on womens, LGBTQ and BAME rights. And actually I would maybe also count the weather, I always feel the mood and spirit of the place lift on a sunny day.

One of the things I found really interesting about reading the documents is just how much we don’t know, and are still to find out about the experiences of older people, younger people, women, peri natal experiences, the LGBTQ population and the Black and Ethnic minority population. There are gaps in the knowledge of the mental health experiences of large sections of the people that make up our population.

So I guess my point is that it feels helpful to understand all of this when working with clients. And maybe it’s helpful, reassuring even, to place mental health in a societal context rather than to any lack or failing on the part of an individual. And here in Northern Ireland, there definitely some things that are specific reasons for where we are with our mental health, and so many gaps in the experiences of a diverse range of people that are still to be understood.

Languishing…maybe one of the most relatable moods of this last year?

“The absence of wellbeing..languishing is the vast, meh-coloured desert between flourishing and depression, a general condition of non-thriving”

You know you are languishing if you experience burnout, you feel numb, it’s hard to focus and your mojo has disappeared. And most important, it is a rational reaction to a very irrational year.

What to do about it? Small, but achievable challenges to relight your fire (according to the article).

Guardian article links to a NYT article hidden behind a paywall (if, like me, you’ve already used all your free views) which links to Corey Keyes original 2002 article on languishing “The Mental Health Continuum; From Languishing to Flourishing in Life”.

https://www.theguardian.com/society/2021/apr/20/not-depressed-or-flourishing-how-languishing-defines-modern-life

On Connection

“We are empathic beings who feel for each other. Our very success as a species is rooted in our ability to be aware of each other’s needs, to notice each other’s pain and to experience deeply felt physiological and emotional empathy.”
― Kae Tempest
, On Connection

I recently read the beautiful book “On Connection” by poet, performer, writer and playwright Kae Tempest. The book had a big effect on me, and as soon as I had made it to the last page, I immediately went back to the start and read it all over again.

I think for the first time in my life I really understood what a poet is. There was something in the way that Kae was able to put words and imagery to the experiences that we as a collective group of people have been going through, that connected to some deep place in me.

The book is about lots of things. What I took to be the overall message is that we have found our way into a state of disconnection, both from ourselves and from other people (and also from nature) and this is what defines the time we are currently living in. And the way out of this place is re-connection.

I think this is something that many people can relate to and has been highlighted even more with the year that’s been in it.

Shortly after reading the book for a 2nd time. I was out for a walk by the sea listening to some of Kae Tempest’s performance poetry through my headphones. I experienced a profound feeling of being able to put the weight of the world down, just for a second. Their words made me feel seen and somehow in that seeing made the tension in my shoulders release and relax for a moment.  

As I progress along in my counselling career and move further away from the time spent doing my formal counselling training, the more I am crafting myself into the kind of counsellor that makes the most sense for me to be. I find at the minute that what influences my practice the most are authors, artists, other counsellors and friends expressing their humanness.

I have come to understand that one of the most beneficial things I can do for my client is to sit with them in their pain and discomfort. Not try to rescue. Not try to fix. Not offer interpretation. But just to notice their pain and sit with them in it. To help them feel seen. With the hope that if my client feels seen, then they can feel like they can put down the weight they carry, even for just a moment.

But it can feel tricky sometimes, unnatural even to just sit with someone’s pain. We are not always very good with other people emotions. Sometimes they can scare us or feel too close to home. Sometimes we can feel that something might happen to the person if we don’t take action, give advice or intervene in some way (which in some cases can be true). Like everything, it can be a balance and judgment call. But in that moment when we are thinking of solutions, it moves to being more about us and less about the other person.

This is part of the practice.

In another part of the book, Kae Tempest says that the harder you try to connect with someone or something, the further away from connection you get. That you cannot force connection, it either happens or it does not.

But what you can do is to create the right kind of conditions, in your life and in yourself, so you are open and available to connection if it does appear;

“I can’t summon connection down from the ether and expect it to land in my lap. But I can do everything in my power to create a welcoming environment for it when it does decide to turn up”

I have thought about this a lot, about how to create the right kind of conditions for connection, that “collaborative and communal feeling” to appear in my work with clients.

Sometimes I try to get my thinking brain to take a back seat and become more aware of my body and emotional experiences, I try to stay open, and notice where and when my tendencies to close down are. I chip away it, daily over long periods of time with experimentation, experience and efforts to get to know myself as well as I can. Always knowing that it might happen, and it might not, and both of those things are ok.