[Soul_Glo]

I have worked for the NHS as a Cognitive Behavioural Therapist for more than 10 years now. Prior to that I also worked as a counsellor in the voluntary sector. Even a Mental Health Nurse.

I have even suffered from depression myself way back as a teenager.

Feel free to ask me any questions about depression, anxiety etc. I will do my best to answer them.

Rules. Don't air your personal mental health on here if you don't feel comfortable doing so. No competition with anyone else as pain is subjective. If you use examples don't make anyone identifiable and try not to use personal examples.

I can offer advice/answer general questions the best I can but no quick fix or cures. For a personal response drop a PM - sorry I can't provide online counselling. I am sure that would be against forum rules anyway.

[mob17]

Whats the most depressing story you've heard from a patient?

[Soul_Glo]

This one lady I worked with last year suffered from PTSD. She had fled Syria and sought refuge in the UK. On her journey to the UK she was trafficked as a sex slave. She eventually broke away from the gang by moving to a different part of the Germany and then making it across the French border. She reported that in prison in Syria she was made to watch her daughter being raped (12 year old). The next day her daughter was sold in a sex trade market for $5,000. She was separated from her family when she fled - the family became split when the village was under attack. She managed to escape from prison.

We worked together on her PTSD and we were doing well until session 3. She told me that her friend had made contact and her entire family bar one... two sons (6 and 9), daughter 17, husband and grand parents had all been killed in a dirty bomb blast when the village they were hiding in was attacked. She never managed to find her 12 year old. Meanwhile her nephew had been captured and was being taught how to behead people. He was 17 and he ended up taking his own life because he could not bring himself to kill others.

In the UK, she had no recourse to public funds and was sofa surfing. She was relying heavily on donations from her local mosque for food and clothing.

This story almost broke me and I had water in my eyes when she told me but no tears. I asked her if I could hold her hand and she agreed (interpreter was present). It humbled me so much... one day you can have your family safe and the next day they are gone. You never know what life will throw at you. I'm blessed... I get to go home to my wife but you never know as life can be short... anything can happen in the blink of an eye.

A good friend of mine is out there right now doing some relief work and putting his life on the line. I take a little comfort in that fact.

[mob17]

Its sad that all of this stuff goes on. We really do have to be grateful for what we have, that our families are safe.

Must be hard to make them feel better when the story is that depressing.

[imy]

The stories above really make me sad when individuals question what sort of invovlement we should have on foreign issues and immigration. BUT that is another topic entirely.

Good for you on the work you do. My Mrs is about to start her masters in therapy although she is struggling to decide which direction to go in. Stories like the above really make me worry about what sort of impact it would have on her - although i believe therapists also have therapy.

[Soul_Glo]

She wanted to address the flashbacks and nightmares so that is what we were working on. Granted we cannot change the past but can try to find ways of coping with the present or learning how to live with it.

@ Imy. Yes some therapists do have therapy. When I trained we were encouraged to hold on to a client for at least a year but I broke from this because if someone is better then why keep them coming back? There are a horror stories of therapist and clients becoming so dependent on one another. There was a case recently in Italy where the therapist kept the client on for 20 years and both therapist and client are so dependent on one another the therapy is continuing- neither one can let go.

Otherwise therapy for therapists because they are working with difficult cases is not uncommon. We also provide/attend supervision which is a safe forum to discuss how we have been moved by cases such as the above. Supervision is a must have and I wouldn't have made it this far without the great support from different supervisors.

[TripleBlack]

Hi,

Is it true that the overall majority of people actually have at least one form of mental illness but at different levels? From something severe that is life debilitating to something lower that affects 'normal' behaviour and reactions. e.g. constantly defensive behaviour, the need to always be at the centre of attention, etc?

After going through depression myself and not getting the support that I felt those around me could have provided, I have learnt to be more aware of peoples behaviour and be supportive where possible whilst asking them to think about why they do certain things. Maybe not the right way to do it, but I feel that if someone had taken the time to do exactly that for me and to talk to me about me, I would be strides ahead in life right now.

What you said about the therapist's and client's becoming dependent on each other is quite interesting. What did these dependencies fall under? Emotional and sexual relationships resulting in cheating? Or was it along the lines of being able to book the time, trust and confidentiality of someone on a regular basis, things that aren't exactly guaranteed with a friend or family member?

Lastly, what would you say that your sessions have taught you about:
People in general?
Men?
Women?
Relationships?
Life?
And do how do you use this knowledge to benefit yoursef?

[makkan00]

Originally Posted by TripleBlack

Hi,

Is it true that the overall majority of people actually have at least one form of mental illness but at different levels? From something severe that is life debilitating to something lower that affects 'normal' behaviour and reactions. e.g. constantly defensive behaviour, the need to always be at the centre of attention, etc?

After going through depression myself and not getting the support that I felt those around me could have provided, I have learnt to be more aware of peoples behaviour and be supportive where possible whilst asking them to think about why they do certain things. Maybe not the right way to do it, but I feel that if someone had taken the time to do exactly that for me and to talk to me about me, I would be strides ahead in life right now.

What you said about the therapist's and client's becoming dependent on each other is quite interesting. What did these dependencies fall under? Emotional and sexual relationships resulting in cheating? Or was it along the lines of being able to book the time, trust and confidentiality of someone on a regular basis, things that aren't exactly guaranteed with a friend or family member?

Lastly, what would you say that your sessions have taught you about:
People in general?
Men?
Women?
Relationships?
Life?
And do how do you use this knowledge to benefit yoursef?

Makes me laugh on your comment about becoming dependent. It cannot be sexual as your professional registration and whole career is at risk.

You cannot have affair / relationship with any of your patient legally.

[makkan00]

OP, one question though.
I see lots of patients with biopsycho-social paradigm disturbances where they subjectively complaint of pain but objectively all investigations are negative / NAD. Mostly, these are on benefits or trying to get on the ladder or potentially mental health issues.

I refer them back to GP with a recommendation of onward ref to MDT pain services including CBT. Do you have any experience with such patients and would be interesting to know what you do with those patients?

[AWSAWS]

Originally Posted by Broken_Gearbox

This one lady I worked with last year...

What are your views on patient confidentiality?

Don't bother writing back. It's a joke. I know you haven't named names etc...

[Chappers 71]

Everyone enjoys a good bit of gossip

[Soul_Glo]

Originally Posted by makkan00

OP, one question though.
I see lots of patients with biopsycho-social paradigm disturbances where they subjectively complaint of pain but objectively all investigations are negative / NAD. Mostly, these are on benefits or trying to get on the ladder or potentially mental health issues.

I refer them back to GP with a recommendation of onward ref to MDT pain services including CBT. Do you have any experience with such patients and would be interesting to know what you do with those patients?

Yes we have clients who want a letter for the council. I have had people say they are too depressed to work. People say that they have not worked in 18 years so it would be overwhelming. Years ago when benefits were due to be changed we had many angry clients fearing they would have to go back to work. I had one client say to me: "fk the therapy." She said so because I couldn't provide her with a letter stating she could not work. She didn't even want to give it a chance. We don't provide such letters or reports so we can only give the information we have to the GP. Clients then obtain supporting letters from GP's and I am guessing that is why they charge for the privilege. Many GP's are fed up with this. We are now moving toward a link worker system. The link workers are social workers or community psychiatric nurses. The link workers will be easing such burdens on the GP's.

For those that we do see who require input on pain... CBT can be used to challenge negative cognitions of when clients focus on what they can no longer accomplish due to pain... CBT shifts the lens on to the positive and asks what clients can still do. We then build them up further. The pain tool kit is a useful resource. As are books such as Full Catastrophe Living by Jon Kabat-Zinn. Sometimes clients need input on accepting their condition so counselling is often more appropriate.

[Soul_Glo]

Originally Posted by AWSAWS

What are your views on patient confidentiality?

Don't bother writing back. It's a joke. I know you haven't named names etc...

I take it very seriously. I know people who joke about clients regularly or talk about them with their friends. When I come home... I disengage from work and I'm in husband mode. I am the Information Governance guardian for our Trust. I disciplined one member of staff for a breach of confidentiality last month. This member left client sensitive data in our waiting area. Thankfully staff found these and no damage was done except to the staff members reputation. The Trust talks about going paperless and we have... so people really shouldn't print things other than appointment letters.

Yes no names, changing details such as age, country, gender... so no one can be identified.

[TripleBlack]

Hey... I thought my questions were quite relevant and seeing as 'Broken_Gearbox' was looking to discuss their experiences, I thought they would know of some people that broke the rules for the aforementioned reasons.

[Soul_Glo]

Originally Posted by TripleBlack

Hi,

Is it true that the overall majority of people actually have at least one form of mental illness but at different levels? From something severe that is life debilitating to something lower that affects 'normal' behaviour and reactions. e.g. constantly defensive behaviour, the need to always be at the centre of attention, etc?

After going through depression myself and not getting the support that I felt those around me could have provided, I have learnt to be more aware of peoples behaviour and be supportive where possible whilst asking them to think about why they do certain things. Maybe not the right way to do it, but I feel that if someone had taken the time to do exactly that for me and to talk to me about me, I would be strides ahead in life right now.

What you said about the therapist's and client's becoming dependent on each other is quite interesting. What did these dependencies fall under? Emotional and sexual relationships resulting in cheating? Or was it along the lines of being able to book the time, trust and confidentiality of someone on a regular basis, things that aren't exactly guaranteed with a friend or family member?

Lastly, what would you say that your sessions have taught you about:
People in general?
Men?
Women?
Relationships?
Life?
And do how do you use this knowledge to benefit yoursef?

Sorry for the late reply... having trouble with the iPad app. Changed password and cannot log into bimmerpost so have to use the interweb off a laptop...

Great questions but not sure if I have the best answers... I will try...

The dependency was this relationship that became like a mother-daughter type relationship... I guess it is like when we meet someone and say... "You are the son I wish I always had" or "i Wish I had a mother like you." When they were meeting one another so regularly it felt not normal when they did not meet... something did not feel right... the client wanted to feel secure emotionally... and the therapist provided that comfort... so the emotional attachment formed. When someone has not had that secure attachment in life like a father figure then they may yearn for it internally... if someone has been bullied a lot and they find a friend in their therapist then that becomes the best friend they never had...

Men: are less forthcoming and less likely to seek help. Call it a 'man thing' if you will but for a man to admit that he has problems is big... and when they do it is humbling... I have met with 6ft tall sportsmen who have broken down into tears... and sometimes it has been challenging because not all of them want to open up but need help. I have been involved in several projects to raise mental health awareness for men. This is one of my personal things... I once referred a man to a domestic violence helpline run by men for men... and the operator laughed... now we don't know if he had heard something funny before answering the phone or whether he was inexperienced... either way... my client felt it was downright unprofessional and felt laughed at... there is a lot of work to be done. Some older men don't do emotions... it is a no go zone... feelings... what is that? Call it old school if you will. Some men don't want to make a change but want everything to change around them...

Women: tend to be more cautious... when I get them to try and take a chance or a risk it is hard for them to do e.g. dating again after a heart break... they are more open about their problems and often I don't need to ask questions because the flood gates open... there are more self-esteem issues in comparison with the men I have worked with but let's not read into this and say it is a woman problem... also from my experience I would say anxiety is most common amongst women but whether there is official research I need to find that...

Relationships... there are all sorts of weird and wonderful relationships... some temporary, symbiotic and, long-term... relationships can be hard work especially when there is one way traffic... sometimes relationships fall apart because one party thinks they are right or cannot communicate properly... sometimes people talk down to one another and get stuck in these "modes" of communication... like a partner talking to another partner as if they were a child... so things begin to fall apart... it is all about the way we communicate... if we can talk to someone as an adult rather than as a critical parent then there is a better chance of a healthy relationship...

Life: life is short, when all is lost all is left to gain, you have to enjoy life and sometimes if you take things seriously you can end up holding yourself back, you never know where life will take you... the grass might be greener on the other side contrary to the popular saying... life can be beautiful, life is a mystery, a gift, a blessing... life doesn't end when we think our life is over but it might feel like that after a blow like a job loss... there are ups and downs... but if you can look after yourself in some small way you can make it... life can be taken a day at a time... live your life or it will live you... and you are never too old to try something new in life. I have met with 80 year old's who have learned the guitar and 90 something's who went swimming for the first time...

How do I apply it to myself to better myself? I am open about my difficulties to my family and friends (the ones I have a good rapport with). Many guy mates gave me advice on to be a strong man and never tell my wife if I was feeling down... I encourage the same from my partner... Relationships take work/compromise and while it is not okay to talk to your partner as if they are a child sometimes it is helpful to keep in mind that you might need to treat them like one. I am not saying cut off their freedoms or mollycoddle them... I mean if your partner is upset then to ask them: "Why are you upset?" When a child is upset and throws it's toys everywhere we think little of it... we think... he or she might be hungry, cold, ill... we don't expect any better but when it comes to a partner snapping... we can read into it and think: "Oh he hates me... he has no sense, he is always making comments about my parents..." but what is really going on? Sometimes we need to stop to understand... Working with clients I have realised life is too short... sometimes you don't talk to someone because you are upset with them but the next day that person might be gone... having said that it is important to surround yourself with as many happy and healthy relationships... while you cannot always avoid toxic people the less of them the better for life.

[AWSAWS]

How common is it for stress conditions to manifest themselves as physical conditions?

Rashes, itchiness, hair loss, weight loss, etc...

[Soul_Glo]

Originally Posted by AWSAWS

How common is it for stress conditions to manifest themselves as physical conditions?

Rashes, itchiness, hair loss, weight loss, etc...

Very common. At least 1 in 6 people have some physical complaints or symptoms they realise. Symptoms range from unexplained bruises, sore muscles like after a gym workout, hair loss, jelly legs, blurred vision, stress rash, eyes feeling like a rabbit in the headlights... I could name at least a hundred off the top of my head that I've encountered in the last year with clients.

[AWSAWS]

Originally Posted by Broken_Gearbox

Very common. At least 1 in 6 people have some physical complaints or symptoms they realise. Symptoms range from unexplained bruises, sore muscles like after a gym workout, hair loss, jelly legs, blurred vision, stress rash, eyes feeling like a rabbit in the headlights... I could name at least a hundred off the top of my head that I've encountered in the last year with clients.

Yes you see those people who climb tall structures and hang over huge drops.
I love how my brain makes me unbalanced, dizzy and sweaty palmed. All the things I'd need to survive on a sheer edge where just not falling over or slipping will keep you alive.