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After sessions I can sometimes feel a real mix of pride, frustration, sadness, and compassion around what has been discussed. And so, as the year is rounding off, I wanted to write a public letter to all my clients - past, present, and future. To my current clients, I am so glad that you have chosen me to let into your life, to trust me with the really difficult 'stuff' and the really positive 'stuff'. Even though I try, I don't think my words will ever be able to encapsulate how utterly humbled I am to (metaphorically) walk beside you and be invited into seeing your life from your world view. I have so many hopes for our work together, wishing you the best in every situation, but most of all I hope that I can hold you where you are and offer you somewhere safe to just be you. There may be some bumps in the road, there may be times where you don't want to face our sessions because of the challenges it can bring, there may be times where you are angry, frustrated, or even dislike me for exploring certain emotions and situations with you, but I believe you can get through all of this, you can make it out to the other side, to learn how to cope with obstacles in your life without needing me anymore, and to realise your worth, your validity, and how deserving you are of love. To my past clients, I hope that you're doing well, I wonder if you still think of the skills, techniques, and processes we talked about in sessions. Some of you stayed with me for many sessions, we worked through some really deep and difficult situations, emotions, thoughts, and feelings. We brought our sessions to a close and allowed our final session to model a healthy ending, which for some of you was a first and allowed us both to share our learnings and appreciation of the time spent working together. Some of you left after only a few sessions and without letting me know. All of you stay in my thoughts, still held with compassion and curiosity of how life is going for you. To my future clients, you will benefit from all the work previous clients have done, with each session I do, I learn and grow to be a better therapist for you. I'm not sure yet why it is that you have found me and why you might make contact, but I want you to know I'm here. I don't know what difficulties we will face, but once we start the work, we will face it together. I can't necessarily help you, but I can manage your expectations of what I can do, which is to hold a safe space for you to explore whatever it is you need to, to manage and role model healthy boundaries, and to offer some consistency with the sessions. To all of you, thank you. Thank you for being you, for showing your vulnerability and trusting me with the most painful parts of your life, thank you for showing up and coming back to sessions each week.

Before we get on to the reasons to have counselling, lets first take a look at what counselling is. Quite often counselling can feel like such a daunting prospect. To open up, talk about your deepest and most vulnerable experiences, let out the emotions that come with those experiences, and explore how to process it all... Then to be doing this with a stranger who you know barely anything about. What comes to mind for you when you think of counselling? Speaking to friends and family some words that come to mind for them were concerns around being judged, how they were going to open up and trust this person, if it would help them, and that it would feel intimidating. Counselling, or therapy, was often thought of as something only 'unstable' people needed; those with something wrong with them, outcasts of society. It was seen as something 'to fix' someone who was broken in the eyes of society. The stigma around receiving counselling is changing and more people are accessing therapy off their own initiative rather than it being a last resort, however it can still feel quite challenging to access therapy whether it's through the NHS, a Charity, or finding a Private Therapist. For me, as a therapist, counselling is a process that anyone can access to look at their ways of coping with difficult situations, mental health, or wellbeing and so is open to everyone at any point in their lives. So why would you have counselling? What can you use it for? There are an unlimited amount of reasons to have counselling... In a crisis - it may be that you are really struggling to cope with everything going on in your life. Sometimes clients may be at breaking point and can't see a way out - this may or may not involve thoughts of suicide, having a mental health condition that isn't being managed, having a health problem that isn't being managed. When in a crisis for the first time, it is likely you will be accessing counselling via a mental health professional or GP and so will be referred to short term sessions through a funded service. If you have experienced a crisis before it may be that you find your own therapist, but this can be overwhelming when already in a state of despair. Often sessions will be very in the moment focused to begin with to look at immediate support for the short term to help manage the crisis, from this you can then go on to look at more long term support/coping skills. Struggling but not in crisis - this may be for things such as bullying, discrimination, a dip in mental health, relationship struggles i.e. something that is going on for you in the present which is having an impact on your wellbeing in some way. A change in life - it may be that a big change is coming up, or maybe you're already going through a change. This could be events such as wedding, divorce, break up, new relationship, job promotion, change in career, moving town/country etc. Maybe you want to look at putting plan in place and explore how you can cope with these changes. Maybe you need a different perspective or some time to offload your thoughts and feelings about the change. Facing a difficult decision and want an outside perspective to work through what you want to do. You may have noticed a pattern in your own behaviour that you want to explore in more depth. You may have noticed your mental health dipping and want to look at more coping skills, self care, or ways of managing your mental health going forward. Something from your past that you haven't quite worked through yet and now feel ready to explore - this could be something a trauma that happened, it may be a relationship that didn't last, a loss not yet explored. You could be seeking counselling for a specific reason for example: Loss/grief or coping with Chronic Illness. Maybe there's something you can't quite put your finger on but you just don't feel happy. You might want to have some guided exploration to learn more about yourself and your identity, your sexuality, your gender, the way you relate to others etc. There are plenty of other reasons to seek support in this way, all of which are completely valid. My point of view is that we all have mental health and well being, sometimes we may need to get a little bit of extra support with managing these when things are piling on. Therapy is an investment into ourselves; similarly to how we'd seek medical support for any physical ailment. What my friends and family say: "Everyone should have some form of counselling, someone to discuss your problems with" "Just go! Sometimes having a non judgmental sounding board is just what you need to help give you a new perspective on an issue" "Be clear about what you want from it, and ask for it. Don’t give up if you have bad chemistry. Be ready to do some difficult work, and be vulnerable, and to hurt a bit because it will help!" "Just go for it. You don't have to discuss intimate details if you don't want to." "Go into it with an open mind. I was always quite closed off to it, saying things like "I can barely talk to so and so about X, so how can I be expected to express my feelings to a random person?!". Counselling was helpful, and although I don't think it was the sole reason I managed to overcome the emotions I was feeling, I think it was the beginning of the end - almost, the kick-start I needed to start working through my anxiety. My advice would be not to go into it thinking "I'll go, talk, and in 3 sessions I'll be fixed". I'd say you'd need to go to it with the expectation that you'll need to work through things independently alongside the counselling." Where do we go from here? There is still a lot needed to go into our mental health providers so that everyone can access counselling quickly and within our means. Services & Charities like the NHS, Mind, The Mix, Kooth etc. are great places to start but majority do only offer short term sessions so will only go so far. Finding a Private Counsellor/Therapist is the best bet in getting long term support however this can be costly and comes with the risk of going through a few counsellors in order to find someone you feel comfortable with. My Recommendation? If you're at school or university and haven't had counselling before there may be services you can access via your educational institution for free so speak to someone from the pastoral team for more information. If you're under 18 and you want counselling without your parents/guardians knowing you can access short term sessions via the organisations below: https://kooth.com/ https://www.themix.org.uk/get-support/speak-to-our-team/the-mix-counselling-service I would suggest if you're an adult who hasn't had counselling before and you're unsure if it's something you feel comfortable with - speak to your GP or look to go to a charity for free sessions to try the short term. If you find you want to explore more of what comes up for you, you can then look into longer term support. Where to look? https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/counselling/ https://www.mind.org.uk/about-us/local-minds/ If you've had counselling before and you are looking for a private therapist then there are some places to look that show therapists are trained and verified to rule out finding someone who hasn't done any training. Where to look? https://www.counselling-directory.org.uk/ https://www.bacp.co.uk/search/Therapists https://nationalcounsellingsociety.org/counselling-directory https://www.psychologytoday.com/gb/counselling/

A stereotype of the New Year is to have things that we are looking forward to, aspirations and maybe even goals we want to strive towards, however it can also be a time when we reflect and look back on all that has happened in the previous year(s) and what, or who, we have lost. This year is certainly no exception, with a pandemic that has taken so many lives and impacted on every single one of us in one way or another, negatively or positively. 2020 was full of uncertainty for most, if you lost someone this year you had to find a new way to be able to get the closure that would normally be on offer to you, many weren't able to see their loved ones in the last moments of their lives, or even get chance to say goodbye with funerals being limited to the most immediate of family members. To then come into a new year with all of this still hanging over us is quite a feat, and never an easy one. So how do we move forward? How can we look to this new year as a chance for positivity and a fresh start when everything is still so uncertain? I wish I had the answer but there are definitely some things that help people move forward, that could still be of some support now. Some bits about grief/bereavements to keep in mind first of all: Losing someone doesn't always provoke the same reactions in everyone that is 'expected'. Someone may be devastated to lose someone close to them, some people may be relieved that someone has died, some people may find peace in the fact that they are no longer suffering in times of illness, some people may even be happy when it comes to no longer having someone who was such a negative figure in their lives - these reactions could all be about the same person and all of them are valid to each individual experiencing them. Pet bereavements are also 100% valid in having an impact on peoples lives. This is an area that needs far more visibility and understanding as losing a pet is just the same as losing a family member to most pet owners. Pets give us unconditional love, affection, they are there for us in our lowest moments and in times when we experience change, to then lose that constant companion can really shake us to the core. In fact, it feels an disservice to call them 'pets' rather than a member of our family. Pet bereavements can also have other layers to the death too, especially when it comes to having them put down as this is such a difficult decision to make, even if it is suggested as the right one for them by the vets we trust. From first hand experience I struggled putting my first dog down - even though he had kidney failure, arthritis, toxins from the failure causing abnormal nerve responses and brain damage - I was still wracked with guilt over what could have been if that wasn't the outcome... what if he could have had an extra few months? Did he know that this was going to happen? Was he really that bad that he wouldn't have a good quality of life? All of these thoughts, and more, flooded my brain for weeks and months after losing him - these questions would never have answers, but we can only do what we feel is best for a being fully dependent on us in those moments, without communication, and in their most vulnerable state. Not only was I grieving his loss, I was also questioning my choice, feeling overwhelmingly guilty, and feeling like the worst human alive. We can still grieve people/members of our chosen family or those we knew for many years. Typically grief has stages that we are taught in theory, however these stages aren't linear or time limited. We may still have moments years down the line where something reminds us of the one we have lost and it can bring back a wave of grief just as fresh as we first felt it. It is totally normal for us to have these moments no matter how long after we have lost someone important to us. Children will experience grief differently in general, this may be due to age and lack of understanding around what death means, it may also just be that they need longer to process what it does mean for them and thus you. Someday a child may be withdrawn, lonely, sad and others they may act as if nothing has happened. This can be painful for us to be around but it is natural for children to find a way to process and then cope with the loss. Seeing New Years as a fresh start can sometimes be damaging to ourselves and those around us - we can't package up the past and leave it there as much as we may want to. The past will always be with us in some form, we can not change what has happened but we can look at how we are feeling in relation to it and how we want to be going forward. Emotions and unprocessed grief can show themselves in physical illness and come out later in life unexpectedly. Experiencing a loss of someone that was unexpected through an accident or via suicide can have a big impact. It can leave us with existential questions of why did this happen? What was going on for them? finding someone to blame for the grief and loss you are feeling. This adds another layer to the grief you experience as it holds questions that can't always be answered and similar to pet bereavement emotions based around blame such as anger and guilt. Saying goodbye & coping Religion or beliefs- Different religions will have different ways of saying goodbye and bringing closure to the loss of somebody and to allow the person who has passed passage into their next life. COVID and 2020 has been difficult for many in this respect as ceremonies allowing people to do this have been delayed/cancelled/restricted thus bringing change to how it would 'normally' be - this has been particularly impactful for those of region where there is a time limited process after the persons passing. There has been some level of adaptation with hearses driving past family members homes to keep them included in the ceremony or even video links for people to be able to virtually attend a service for those they have lost. Rituals in saying goodbye - Whatever your belief there is deemed some importance in being able to have your own ritual in saying goodbye to the person lost for your own emotional and mental well being. Letter writing - This is a commonly used way of being able to address, process, and accept our emotions, thoughts, and feelings towards a person or situation. To be able to sit down in a quiet and comfortable space and write out what it is would would want to say to the person you've lost. You can then either keep the letter in a safe space , maybe in a place that meant something to you and the person lost. You could burn the letter in a way to symbolise letting go of what was said in the letter and anything that may be 'holding you back'. If you don't feel comfortable burning the letter you could tear the letter up/shred it. Alternatively, you could write a poem, song, story, draw it out ..... in a way that feels like it is representative of you. Stone use - Using stones in therapy is often a great way of identifying emotions and thoughts that are on the surface of our subconscious, but they can also be great in using objects to bring a physical element into processing grief. This practice is to find a soft stone, a jagged stone and an in-between stone. Whilst holding the soft stone in your hand you can squeeze it and think about all the good memories you had of the person you have lost, you will notice the way the stone feels, how it is smooth and not too painful. Whilst holding the jagged stone you can squeeze this in your hand and remember times that were more difficult or painful of the person you lost, again noticing how the stone feels and may be uncomfortable to experience. Whilst holding the third stone you can again squeeze this noticing it doesn't really hurt but it's also not really smooth and think about all of the day to day memories of the who you lost. You can then take all three of the stones and hold them together, bringing all of those memories together remembering that whilst there were bad memories, there were also the general day to day and some happier memories too. It is useful to remember that no one is perfect. This exercise brings back the normality and humanity of who we have lost , allowing us to experience all of the memories we have and that each of them are still with us. Jewelry making - this is similar to the above and is about having a representation of who we have lost . To get 3 colours of beads to represent the good/positive, normal, and difficult/negative memories/qualities of who we lost. Each time you pick up a bead associate it with a memory of that person. You can then wear the jewelry, having a whole representation of that person with you. There are many other ways of having your own way of processing the grief and saying goodbye. Maybe you have a tradition with that person that you can uphold in a different way to honour their memory. Maybe you have a day dedicated to self-love on their anniversary - this can be particularly useful for those who suffered abuse as it can be a way to have power over your life and your body. Moving forward Whatever you do and however you experience your grief, know that it is valid and normal for you. It will take time to be able to adjust to the grief you feel, and whilst it may not get easier, you will begin to be able to cope with the days as you go. If you feel worried about someone going through grief, talk to them, don't assume, and really listen to what they are saying. Ask them questions about what it is they feel they need rather than jumping to solutions that may not be wanted or effective. Be kind to yourself! What you are going through is difficult, whether the loss happened in the last week or the last decade, it can still be hard to manage and cope with. I believe that people never leave us as they leave an imprint on us - whether negative or positive - but it's what we do with that imprint that makes the difference. If it's a negative one, how can we stop it from controlling us, what do we want from our life. If it's a positive, what can we capture from that and make our own to then influence others. Most of all, talk to someone you trust - whether it's a friend, family member, your GP, a counsellor, a helpline etc. Put the words that express how you're feeling out there, it is scary as it makes it real, but voicing it takes the weight of those words swimming round in your head, out of your head and body; it can give you a little bit of relief if only for a few seconds.

If you read and had a go with my flowchart post you will have seen that there are a fair few different approaches to therapy, with slightly different ways of working with you as a client. Some research suggests that more important that the approach used is the relationship that is built between a client and the therapist for a positive outcome i.e. you may initially choose a therapist for the way they work, but the relationship offers more to the outcomes of the session than how they work. This isn't to say the approach doesn't matter, but maybe it's not the most important factor when considering therapy. CAMHS ( Child and Adolescent Mental Health Services) put together a brilliant drawing below showing the qualities that we may look for in a therapist that will allow us to grow and develop in a safe and supported way. There is a question of if you were to have these skills in your therapist, would the approach used really make a difference to what you're looking at? In this sense, it comes down to what it is you as a client are looking for from therapy, what are your expectations? what do you hope to achieve? would you like something that can be ongoing and open to exploring other situations or do you want to focus more on one thing you're currently having problems with? It's good to remember that as a client you are able to choose your therapist - you are the one in the vulnerable situation who is going to be sitting in that chair - so you are the one who will know if your therapist is a good fit for you, someone you can trust, who shows they are listening and have an understanding of your situation. This post isn't so much of an informative post, but more of a point for reflection of what you feel is most important to you when sharing this part of yourself with a professional and getting support through a difficult time. What else do you look for in therapy or your therapist?

I have been thinking a lot lately about how we interact with each other and ourselves, and one theme I keep seeing or thinking about is the notion of self care and being kind to yourself. You are the only one who is going to live your life, experience your experiences and feelings; prioritise yourself! Most of my career paths, roles and even my personality have been based around trying to get people to reflect, consider and explore what choices they have. Part of this is about compassion for others and for themselves, learning to be kind to yourself and noticing what it is you need, not just in the moment, but in the long-term. Like I have said to many people I have worked with - you are the only one who is going to live your life, experience your experiences and feelings; prioritise yourself! Self-care is a term that has been thrown around a lot lately in counselling settings, social media, news articles, TV shows etc. but do the people 'preaching' about and spreading the message of self-care, know what that is for themselves? Is there a definitive thing that is "self-care"? In other words, what do we mean when we say self care? A lot of the time, when I've talked through self care goals, they relate to small, manageable things that are easily done and can make a difference in that moment. This is something that, I feel, everyone can do at least one small thing for themselves each day to care for themselves and have a positive effect - we all know life can be intense, difficult, testing and down right awful at times. For me these small things can be as simple as:  • taking a bath  • listening to new music or my favourite artists/genres  • Going for a walk with the dog alone and without distraction so my thoughts can ruminate and allow for reflection.  • Exercise, even 10 minutes, can make me feel like I've achieved something.  • Cleaning and tidying the house. After doing one of these in my day it allows me to wind down, I've actively chosen to do something I enjoy and appreciate that can make me feel better in some way; feeling better about myself because I've been productive, feeling better because I'm relaxed and have had a moment of quiet and reflection or better because my surroundings feel more manageable and calm. These little things all make a difference in that moment on that day. However, what if these small things each day aren't enough? Or you're doing so much that you can't possibly carve out any time for anything like this? Or what if life and responsibilities are just too much that even something to do for you feels like a chore? In an ideal world we should be working to live not living to work. Possibly taking a day or two just hasn't done the trick like normal either, in which case, maybe it's time for something more drastic and pertinent, why should there be so much to do for everyone else that you can't have a fraction of time for you; In an ideal world we should be working to live not living to work. Self care can also be about the long-term and the decisions that impact on your well being in the upcoming months and years, not just in the moment. Look around you at what is going on in your life right now and imagine where you would like to be, what you would like to be doing (or not doing!) - are there any achievable changes that could be made, that would have an impact on your mental or physical well-being - this for me is long-term self care. Is that job really worth it? Could a job be available closer to home for less money but makes you feel like you have more time for you. Could you change your route, allowing your to explore different scenery or even change the mode of transport? Are you able to start cutting back on spending and save a little more each month to allow for a financial buffer? Or even start spending more on yourself and your environment so that you feel comfortable in your environment. How do your feel about your physical appearance? Is there anything you've been wanting to do to help give confidence in how you feel? Change up your style? your haircut? Swap sugary snacks for fruit/veg/nuts? Get up 30 mins earlier and go for a jog? Notice that you're unsure of anything to change but aren't feeling comfortable, content, happy, confident - can you only think in negative sentences? Try speaking to someone (a GP or counsellor) to help gain understanding on what that negativity derives from to look to implement tools to overcome and cope with it. You are worth that effort, investment and support! Saying 'no' to opportunities or events when you're starting to feel overwhelmed with activity. My recent example is a mixture of all of the above, having people to speak to is self care for my emotional well being, looking to exercise and make healthier choices is long term self care for my physical well being, and I have recently left my job which included a 3 hour round trip daily which is self-care for the long-term of my overall well being - whilst I loved my job and the people I worked with, after 16 months of the travel following a location move, it was beginning to take it's toll and my health was having a hit too - this step was necessary for me to take so I could focus on myself and what was most important to me. Whatever you do, do it for you! A lot of time the long term self care is forgotten about as we get into such a routine that it feels difficult to imagine life any other way. Both short term and long term self care is important to practise to maintain and keep our well-being (of all aspects) in a positive frame. If long term change for self care feels like too much right now then starting off small with manageable chunks of care and being kind to yourself is still worthwhile to get you through the hour, day, week.....but whatever you do, do it for you! Mind - every day care for your well being NHS - tips for well being Another article on what is self-care?

This is a literature review taken from my Case Study submitted to UEL on 15th June 2020 as part of my MA in Counselling and Psychotherapy. Working with transitioning clients and taking my thoughts around my work to supervision, it was clear that many LGBTQ+ clients may be under represented and even not understood by their counsellors as through supervision all of my supervisors didn’t have much first-hand experience of working with transitioning clients. Therefore, I used a literature review as a chance to explore what reading is available to counsellors to expand on the knowledge of working with gender questioning clients, especially for those counsellors who haven’t had experience of working or even knowing anyone going through this transition. As I began to research for studies, articles and journals relating to people’s experience of counselling when questioning their identity and even counsellors approaches, it became clear that there is not enough research being done in this area and most of my research came from BACP articles from singular case studies of counsellors. There is a lot of debate about the history of the transgender movements and process within societies along with what can be done better within the mental health professions, but not much about what to do in the here and now with clients or how we can move forward as a profession to offer a safe space to people who do reach out at any stage of this transition. Understanding It is true that the understanding of terms within the LGBTQ+ community are continuously developing and expanding, and so research has struggled to keep up with clients within this community. The BACP themselves didn’t make a change to their Ethical framework to include sexual orientation until the last 20 years and so gender dysphoria is still catching up in this regard too – though it is implied within the ethical framework that no harm or ‘correction’ of being should be forced upon clients. Even the terms used to describe the questioning and transition of genders has only recently changed from a ‘disorder’ to a ‘dysphoria’ in the DSM-52 to recognise that transgender isn’t a pathology but an identity (NHS, 2016). As counsellors it is important to update our knowledge, understanding and own self-awareness of our gender, where we are with this and our sexuality. If we see ourselves as cisgendered & heterosexual when working with someone with gender dysphoria who may be gay, bisexual, asexual, etc. then we need to try to understand how the client may feel in this scenario and address the potential power imbalance in the room as early on in the relationship as possible (BACP article, 2013). It needs to be recognised within mental health professions that ‘coming out’ whether this is with gender identity or sexuality is a repeated event with different people in the individuals life that needs to be considered and evaluated as to whether this will cause harm – therefore this is a scary and uncertain time shrouded in fear of rejection for most (BACP article, 2016). All that has been mentioned above, aligns with Erikson’s model of development (1968) – An individual is likely to suffer when there is a crisis of optimal identity which can lead to poor mental health and well-being. It is well documented however that clients who are questioning their identity or sexuality are among the clients being most at risk of self-harm, suicidal ideation, substance abuse along with high levels of anxiety and depression (Maguen & Shipherd, 2010; Shipherd et al., 2010) as a result of low self-esteem and discrimination due to ‘social norms’ (Bockting et al., 2006; Wylie et al., 2007: Livingstone, 2008). Data Looking at the data around gender identity and sexuality within school, the Stonewall report (2017) found that 92% of trans young people in UK schools had thoughts of suicide in comparison to only 25% of the general population. This is also true that these feelings have come about due to reasons mentioned such as bullying, social exclusion, feeling isolated and even a lack of acceptance within the family. A BACP article in 2019 reported that there has been a proportionate 552% increase in the amount of clients reporting issues of gender identity showing that there is a need for increased awareness and knowledge within the counselling profession and the mental health profession on a whole. Prejudice and harmful approaches: The lack of knowledge and understanding can be more harmful to clients that is realised; Gagne et al. (1997) found that Male to Female transsexuals often felt pressurised by their counsellors into wearing femme wear or coming out to family members without considering the harmful impact this could have economically (where people have lost jobs), emotionally (rejection and harassment) and psychologically (they may not have been ready for this stage of their transition). In addition to this Fagan et al. (1994) found that there are some counsellors who have the belief that “transsexual people are fundamentally homophilic but cannot consciously accept their sexual orientation”. This suggests that it’s not only about changing counsellors understanding and knowledge around gender dysphoria, sexual identity and any other LGBTQ+ terms that they have not yet researched, but to also address the prejudice and ideas that counsellors hold towards people going through these dilemmas. Carroll et al. (2002) suggests that “We do not think any of us in the majority who fit into the normative gender categories of male and female can imagine the paradoxical situation of being very obvious and yet invisible at the same time” again referring back to the power that the counsellor holds in the room. A BACP article written in 2017 suggests that, before working with anyone from the LGBTQ+ community or who may have gender dysphoria, a substantial amount of self-reflection into beliefs and prejudice is carried out otherwise these can creep into the counselling room when working with the client. How can we work with clients in transition? Jackson (2017) suggests that working with individuals questioning their identity can be very complex as it is often intertwined with other factors such as personal beliefs, experiences, age, race, religion, culture etc. and that this topic is often underrepresented in counselling and psychotherapy training and education. There is also mention that, as discussed, it has take a substantial amount of time for the medical and law institutions to recognise that questioning gender identity isn’t a disorder and so there is a feel of doubt but also urgency that something more needs to be done within the mental health institutions to recognise what we can do better when supporting these individuals. It can be seen that quite often there is a mismatch of needs for individuals questioning their identity leading to an internal crisis; Bridgman (2017) believes that often being there for a client offering a space for them to be ‘heard, acknowledge and validated’ is quite often all they are looking for, at least as I believe in the beginning. The most promising study I found was by Wester et al. (2010) which looked at how counsellors could use GCR (Gender role conflict theory -O’Neil et al., 1986) specifically with MTF (Male to Female) clients and how this can be used as an approach to understanding the process that an individual questioning their gender identity may go through and how we as professionals can help hold that process in the counselling room. In addition other psychologists & research counsellors have suggested that a directive but holistic approach to the individuals journey called “cognitive flexibility” is recommended when working with transgender clients allowing them to explore their own narrative (Ettner, 1999; Carroll et al., 2002). Summary: I initially started off wanting to find ways for counsellors working with transgender clients, or those in the initial stages of questioning their gender, to be able to understand and adapt their approach in order to hold the client in a safe and contained way, however as I started researching this review found that there still isn’t enough research out there to be able to do that. As it has been discovered, the LGBTQ+ community are underrepresented in the counselling and psychological research sector, especially when it comes to transgender clients. It can be seen that there is a massive increase in the amount of clients coming forward reporting issues of gender dysphoria however the knowledge and understanding of counsellors needing to meet these clients in an effective way doesn’t seem to match up, almost as if there is a lag in research being done in this area compared to what’s happening in the real world. I wanted to leave this review with research and comment that I feel sums up this area lacking in understanding – it is recommended by Laird (1999) that when working with clients with gender dysphoria, we should “behind her own cultural biases and pre-understandings, to enter the experience of the other” (p.75), but also that we as therapists should be advocates for clients bringing their stories and experiences to us in the political arena and to professional literature so that we can develop the understanding and awareness of our peers. References: BACP children, young people and families journal, 2019. Gender identity and suicidal ideation . [online] Available at: [Accessed 12 June 2020]. Bardlow, J., Bartram, F., Gusap, A. and Jadva, V., 2017. School Report: The Experiences Of Lesbian, Gay, Bi And Trans People In Britain’S Schools In 2017. . [ebook] UK: Year of Stonewall. Available at: [Accessed 12 June 2020]. Bockting, W., Knudson, G. and Goldberg, J., 2006. Counseling and Mental Health Care for Transgender Adults and Loved Ones. International Journal of Transgenderism , 9(3-4), pp.35-82. Bridgman, 2017. Gender Mosaic. Private Practice , [online] Available at: [Accessed 12 June 2020]. Carroll, L., Gilroy, P. and Ryan, J., 2002. Counseling Transgendered, Transsexual, and Gender-Variant Clients. Journal of Counseling & Development , 80(2), pp.131-139. Denny, D., & Green, J., 1996. Gender identity and bisexuality. In B. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority . Thousand Oaks, CA: Sage. pp. 84–102 Erikson E., 1968. Identity: youth and crisis. New York: Norton Ettner, R., 1999. Gender loving care: A guide to counselling gender-variant clients . New York: Norton Fagan, P. J., Schmidt, C. W., & Wise, T. N., 1994. Born to the wrong sex [Letter to the editor]. The New Yorker , pp. 7-15. Gagne, P., Tewksbury, R., & McGaughey, D., 1997. Coming out and crossing over: Identity formation and proclamation in a transgender community. Gender & Society , 11, pp. 478–508. Jackson, C., 2017. Putting gender on the agender. Therapy Today , [online] Available at: [Accessed 12 June 2020]. Laird, J. (1999). Gender and sexuality in lesbian relationships: Feminist and constructionist perspectives. In J. Laird (Ed.), Lesbians and lesbian families: Reflections on theory and practice . New York: Columbia University Press, pp. 47–89. Livingstone, T., 2008. The relevance of a person-centred approach to therapy with transgendered or transsexual clients . Person-Centred and Experiential Psychotherapies, 7(2), pp. 135-144 Maguen S & Shipherd J.C., 2010. Suicide risk among transgender individuals. Psychology and Sexuality, 1(1), pp.34–44. NHS. 2016. Gender Dysphoria . [online] Available at: [Accessed 12 June 2020]. O'Neil, J., Helms, B., Gable, R., David, L. and Wrightsman, L., 1986. Gender-role conflict scale: College men's fear of femininity. Sex Roles , 14(5-6), pp.335-350. Private Practice , 2016. We need to talk about gender. [online] Available at: [Accessed 12 June 2020]. Shipherd J.C., Green K.E. & Abramovitz S., 2010. Transgender clients: identifying and minimizing barriers to mental health treatment . Journal of Gay and Lesbian Mental Health , 14, pp. 94–108. Therapy Today , 2013. Listening to transgender voices. [online] Available at: [Accessed 12 June 2020]. Wester, S., McDonough, T., White, M., Vogel, D. and Taylor, L., 2010. Using Gender Role Conflict Theory in Counseling Male-to-Female Transgender Individuals. Journal of Counseling & Development , 88(2), pp.214-219. Wylie, K., Hainsworth, K. and Ryles, S., 2007. The Support Needs of People Awaiting a Primary Assessment at a UK Gender Reassignment Programme. International Journal of Transgenderism , 10(2), pp.91-98.

Something that annoys me more as I grow older and learn more about the meaning behind the terminology, is how misused it all is in everyday language. Sayings like 'the weather is bi-polar today' or 'That makes me depressed' or even 'My OCD makes me do it' are said fairly frequently yet when I am left to reflect and think on these terms the more degrading and disrespectful they feel. The MHFA cited a study by BUPA from 2018 which states that even though over half of UK adults are more aware of mental health needs and mental health disorders, there are still 49% who use words such as ‘schizophrenic’ and ‘autistic’ to describe themselves and others incorrectly. It was found that whilst Women are more likely to use these terms to refer to themselves, Men were more likely to use them by describing others in a negative and insulting way. Whilst this may seem like a very minor point to make, trivialising terminology in this negative way, can actually have impacts on those who may seek help by delaying them making the decision to see a GP as it creates/enhances the stigma around mental health disorders. It can also have other impacts such as leading to casual diagnosis of ourselves or others which is ineffective and can lead to misdiagnosis in a formal setting due to the human nature of googling symptoms related to a 'casual diagnosis'. Most importantly, misuse of these terms can undermine the actual diagnosis of those with a mental health disorder. If you have ever experienced living with a mental health disorder then you will understand the debilitating effect they can have on our lives, and so someone then flippantly joking about someone being 'schizophrenic or psycho' is really offensive. https://mhfaengland.org/mhfa-centre/news/new-bupa-research-mental-health-terminology/ https://www.healthpartners.com/blog/mental-illnesses-terms-to-use-terms-to-avoid/ https://spiremagazine.com/2019/10/29/misuse-of-mental-illness-terms/ So what do the terms actually mean? "That makes me depressed / That's so depressin g" Depression is a condition that comes with many symptoms, many of which are physical. It is a condition that people live with daily and fight against daily, it infiltrates all aspects of your life and already holds it's own stigmas in society. What is better to say? This makes me feel sad, low, down, unhappy, heartbroken, numb.... There are so many other words to use as an adjective in place of 'depressed/depressing'. "You're so OCD with your cupboards" OCD - Obsessive Compulsive Disorder is not a behaviour or way of doing things; it's a combination of obsessive intrusive thoughts derived from anxiety and compulsive behaviour is carried out alongside this. OCD again is something that people will battle with daily and in severe cases can disrupt life completely. What can I say instead? How about - "your cupboards are so neat/tidy/organised". "My anxiety is acting up" Anxiety is living with the critical voice in overdrive. It can make us overthink anything and everything we want to do or say, it can make us scared of speaking out incase we cause conflict; it is our brain on irrational thought overdrive, but not always knowing which thoughts are rational or not. Living with anxiety can make us feel like a burden to all those around us. Anxiety is also not the same as feeling anxious. Everyone will feel anxious at some point in their life, and some more than overs, but anxiety disorders take over your life and thought processes. What is better to say? I'm feeling really anxious today. "Your clothing is so schizophrenic " Schizophrenia is often confused with multiple personality disorders. Schizophrenia, as with all mental health disorders, are different to each person living with it, but generally it will affect your ways of thinking, disrupt your perspective, and also impact the sense of self. Some forms of Schizophrenia can include psychotic episodes including delusions. What can I say instead? As with using 'depression' as an adjective, there are so many other phrases and words that could be used here - "your clothing is so eclectic/interesting/unique...etc." "Wow, they're psychotic " Psychosis can be a sudden and impactful onset of paranoia, euphoria, delusions, restricted emotions and distortions in thinking and perception. It can be so overwhelming and cause people to push all of their support system away. What to say instead? Well, to me this is going to be an insult either way, so I would say it's better to say nothing, or check in with the person you were speaking to or about with how they're doing. "The weather is bipolar today!" Bipolar can cause so much disruption in the person's life as it can be fairly unpredictable when getting to grips with the condition. People will often have mania (manic episodes) which can be where they are filled with increased levels energy, emotions, activity and creativity, which are then contrasted by periods of bipolar depression which can be virtually the opposite of the mania - low moods, low energy, feeling hopeless. Not everyone with Bipolar disorder have both the mania and the depression, but this is what is more commonly diagnosed. What to say instead? "isn't the weather unpredictable" or "the weather can't make it's mind up". https://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/data-and-resources/key-terms-and-definitions-in-mental-health Children and these terms: A study in 2007 looked at how children and adolescents referred to people with mental illness and the stigma that is presented to them. It cites that " the stigmatising attitudes and beliefs held by young people towards mental illness and people with mental illness may deter them from seeking help". The study, whilst very simplistic and having a small sample size, did find that media like newspapers and TV programmes or the film industry, music, and the people surrounding them (friends and family) were the influence behind how the participants viewed mental health disorders. What is the relevance of this study and the terminology described above? The study had 2 main findings: The participants in this studies understanding of mental health disorders is rather low, which also correlates with the note that recognising mental health disorders was difficult for many. The negative emotions and terms that the participants related to mental health disorders correlates to the idea that people may be put off seeking help for fear of stigma amongst their peers. This reinforces the ideas as stated above that even though we may absent mindedly use terms that are said in a lighthearted and throw away manner, they can still create a negative stigma of the mental health disorders they relate too. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925070/ The Takeaway from all of this? No one is perfect, so I do understand that we may not realise the full impact of our words when saying them, however, I am hoping that the takeaway from this post is that we are more mindful of the language we use in our day to day life, maybe we take some time to reflect on what we are saying and what it could mean or how it could impact those around us. Our words are powerful, and it is our responsibility to use them to the best of our ability. What are your thoughts around this? What other terms do you know of that could be rephrased?