Therapist with client

How can counselling help physical health problems?

Sick female on sofa with paramedics and concerned friend

There are countless people suffering everyday with symptoms that are medically unexplained. They may have a label/diagnosis but insufficient explanation as to what is actually going on to fully manage it. These are often managed with medication such as painkillers or anti-inflammatories, or patients simply have to try and put up with them having received a half-hearted explanation from their primary care physician. Examples include non-cardiac chest pain, tension-type headaches, globus-syndrome, chronic fatigue syndrome, non-epileptic seizures, candidiasis hypersensitivity, chronic pain syndromes, irritable bowel syndrome.

When a patient goes to their primary care physician for a physical symptom they should, of course by investigated to see if the symptom is caused by a physical health problem. For example, if you have difficulty swallowing, the physician will first take a full history, then your throat will be examined and further tests/scans etc will be done to discover any pathophysiology . Differential diagnoses could be gastro-oesophageal reflux disease (GORD), stroke, multiple sclerosis and various cancers. But if all of these are ruled out by the time the various tests are finished the most important thing is not to dismiss the patient’s symptom! How many of us with chronic symptoms have had various tests come back as “all clear” and thought—so what next?! I’m still suffering…how do I manage my symptom(s)?!

Female on floor with blanket blowing her nose

Research has shown that 52% of adult referrals to rheumatology, cardiology, gastroenterology, neurology and gynaecology have no known pathology linked to that speciality and are therefore discharged from that speciality without a management plan. This happened to me when I was referred to rheumatology—I received a half-hearted diagnosis of fibromyalgia, was told there might be a leaflet in the waiting room I could pick up on my way out and that was that. No treatment options, no plan, no hope.

It can be very difficult to see how a very physical symptoms can have any psychological component but the mind is an incredibly powerful organ. It controls everything that happens in your body. Day-in-day-out, unconsciously, your mind controls digestion, metabolism, your heart rate and respiration. You don’t consciously think “breath-in…breath-out…” but your body just does it. However, you can choose to slow down or speed up your breathing, take a deep breath or hold your breath if you want to. It’s also been shown that being aware of your heart beat can be effective during times of anxiety when you need to calm yourself down, you can consciously slow it down.

If you want to manage physical symptoms, a helpful exercise can be to think about where you feel emotions. For example, most people feel, at least a little workplace stress—where do you feel this? Do your shoulders feel tense? Does your chest feel heavy? Do you feel a knot in your abdomen? Noticing how your emotions impact your body is an important start on the road to getting your mind and body re-connected.

Another helpful processes is to think about when you first started noticing your physical symptoms. For example, did you experience a bereavement, a period of work stress, bullying, car accident or other trauma? Once identified, considering how you managed this event is key—do you think you’ve fully processed it? Don’t compare yourself to others, everyone deals with life’s events differently. Do you think there’s a pattern to how you deal with things? Are you a stiff-upper-lip type? Or do you busy yourself with helping others? Perhaps some things feel too painful to process? Noticing these patterns and considering what impact this could be having is important. If we don’t process stressful events, the stress needs to go somewhere; the tissues in your body will hold onto it until your consciously choose to release it.

Male on side of bed with head in hand

Not processing events fully can lead to shame and guilt. Holding onto these feelings becomes a negative cycle that can impact every area of life.

You may feel that your physical symptoms come and go randomly with no connection to anything and despite trying to find triggers. The body is amazing at holding onto stress and releasing it at a later date. For other people the body provides an early warning signal that your under stress. Counselling can help you become more aware of your emotions and how you process them. It can also help you becomes more in tune with your body, which, in turn, will improve your physical health.

If you’re not yet convinced that the brain-body connection is important, take a look at this study (Suzanne C. Segerstrom, Ph.D., et al.), it shows that law students who were confident had more and better functioning immune cells than worried students. This systemic review and meta-analysis (Alan Rozanski, MD, et al.) also showed that optimism was associated with lower risk of cardiovascular events.

During these difficult times, people are struggling with all sorts of unusual experiences and are dealing with untold pressures, don’t downplay how hard you’re finding it! It’s been shown that talking is one of the most important things we can do, whether this is to a trusted friend or to a professional counsellor, making the first step will be the hardest but it will benefit every aspect of your life.

Time To Talk—The Power Of Small

Today, 4th February 2021 is Time to Talk Day and the Theme is The Power of Small. The idea is that it’s the small conversations that make a difference but I’m going to take it a step further and say that any small thing can make a big difference when it comes to mental health.

green wooden door with chain and padlock

I think it’s fair to say most people are struggling with something at the moment. Some people may be enjoying the simpler life of lockdown or it may not have impacted them as much as others but not being able to go about life as we want is really hard. Being told what we can and can’t do and when is taking its toll.

Most of us will have an unhealthy coping mechanism we turn to, it could be ‘socially acceptable’ alcohol, or it could be relatively-easy-to-hide eating too much. Or perhaps you’re someone who gets irritable and snappy with those around you? Maybe you’re someone who stuffs your feelings down, pretends everything’s fine, maybe you’re a workaholic or a exercise-addict? But none of these things work in the long term, eventually, the cracks will show, your body, your mind or your relationships will tell you something is wrong, talking about how you’re feeling is the most powerful thing we can do.

2 people chatting by a fire in a wooded area

Speaking to my therapist the other day, I was talking about how I wanted to support someone close to me but I had no idea what I could do to help because I don’t have any skills that they need. He asked “but do you need to do anything?”. As I’m a trainee counsellor, he really shouldn’t have needed to ask this question, but how often do we find ourselves desperately trying to do good things when just being with someone is all they need?

Not everyone will be able to find the words and saying “I’m struggling” can be exposing and make us feel quite vulnerable. But talking about our emotions, feelings and mental health is becoming more ‘normal’. The phrase ‘it’s ok not to be ok’ is regularly used to express an acceptance of each other’s emotional state, no matter where you’re at.

Today is the day when we highlight the importance of talking but it doesn’t just need to be today. Think about who you might reach out to, a friend, a family member, or anyone you feel you can trust.

mosquito on skin

If you don’t believe that small things make a difference, you’ve never shared a bed with a mosquito!

Control, influence or concern—understanding these circles could transform your life!

In some ways I feel incredibly fortunate to have gone through some dark times, when I’ve been mentally ill, I’ve had access to therapy that’s taught me, not only how to manage my mental illness, but how to cope with all sorts of nasty things that are thrown at us over time! Don’t get me wrong, I don’t have it all sussed, but I noticed something being passed around on social media, I’d completely forgotten I’d learnt in therapy that people might find helpful in times like these.

woman sitting in front of computer head in hands worrying

Do you find yourself worrying about other people not wearing face masks properly? Or feeling that you’re not doing a good enough job home schooling your children because everyone else appears to have it more together than you? Does it feel like you’re winding yourself up into a frenzy but there isn’t really anything you can really do about it?! This could be because you’re spending energy in the wrong place.

Everything in our lives can be separated into circles depending on how much control, or influence we have over them. Click here to see a visual representation, below is a description of why it helps to do this:

Circle of control

These are the things you have full control over; spending time and energy on these things will have the biggest benefit on your life.

Circle of influence

These are things within your influence, there’s something you can do to have some impact on the outcome but that doesn’t mean the outcome will always be in your favour. You may gain some benefit but don’t spend too much energy on these things.

Circle of concern

Most people find themselves spending time worrying most about these things but is there any point expecting energy when there’s nothing you can do to really have much influence? There’s no harm in feeling concerned that there’s a global pandemic, this is called “being human” but put the concern in the right place—you can wash your hands after you’ve been the supermarket, you can remember to wash your face masks so you have a clean one ready to go out, you can ensure you’re leaving enough space when you’re in the post office queue but you can’t do anything about the R number!

If you find yourself feeling hopeless about everything, as seems to be quite common at the moment, please be reassured that this won’t last forever. Turn your eyes to the small things you are in control of and you’ll feel more empowered. Don’t worry about the bigger picture, that can feel quite daunting.

For each worry you have, think to yourself “how much control do I have?”, if it’s something you have full control over, put it in the centre circle, if you realise you have no control over it, put it in the outside circle and let go of worrying about it. If, however, you realise that you have some influence over it, it’s ok to put it in the middle circle but keep your concern in proportion. Don’t spend too much time worrying about it if there’s not really much you can do about it.

This technique is well known to help people in the general population as well as people struggling with mental illness. However, if you feel your anxiety might be out of proportion to size of the concern, it’s impacting your sleep or it’s preventing you from going about your everyday life, it’s important to seek professional support.