Sam Cox

We all have times when we feel sad, but depression is something that affects your daily life, making it hard to find enjoyment in day-to-day activities. We take a look at what depression is, its causes, and how counselling/therapy can help. 

What is depression?

Depression is a mood disorder that can take many forms: some days you may find it impossible to get out of bed, while other days you may feel more able to go about your normal daily tasks. Living with depression can be incredibly difficult, both for those suffering and those around them. Due to the nature of the condition, however, seeking help can often be delayed.

Do I have depression?

For some, an obstacle to them seeking help is understanding whether or not they actually have depression. Before we go into the symptoms of depression, it’s important to point out that if you are struggling with your emotions and feel unable to cope, it could be worth seeking support. You are worthy of help, no matter how trivial you may perceive your problems to be.

What does depression feel like?

If you have depression, you are likely to have at least five of the following symptoms.

You may feel:

• worthless
• like life isn’t worth living
• constantly anxious, tearful and worried
• like you can’t concentrate
• indecisive
• irritable and intolerant of others
• you are not getting enough enjoyment out of life
• you have a lack of self-esteem
• you have excessive and inappropriate guilt
• you have no motivation or interest in things you used to enjoy

You may experience:

• changes in sleeping patterns – broken nights or oversleeping
• changes in eating patterns – loss of appetite or overeating
• tiredness and a loss of energy
• persistent headaches and/or stomach upsets
• chronic pain
• a slower speaking pattern than usual
• loss of libido
• changes to the menstrual cycle

You may also:

• neglect hobbies and interests
• isolate yourself from friends and family
• take part in fewer social activities
• notice your productivity falling at work

In some circumstances, you might not even notice that you have developed depression, especially if it has been a gradual process over several weeks or months. Sometimes it takes a friend, a family member or a partner to point out that you may have a problem.

Why do we become depressed?

Sometimes it’s instantly apparent what the cause is, but other times there isn’t an obvious reason why you feel so down. It could be that you’ve lost something or someone, or it could stem from disappointment or frustration. Usually, there will be more than one reason why you suffer from depression, and these reasons differ from person to person.

Common reasons behind the development of depression include:

Distressing life events

Distressing life events can take their toll on us. Divorce, family problems or losing a job are all momentous in our lives that can alter our mood.

Bereavement

Losing someone close to you can increase the risk. It’s not always just the loss that causes depression, it’s the way we deal with it. If you don’t grieve or express your feelings properly, they can build up and contribute to depression.

Childhood experiences

Your childhood experiences can affect you in adult life. If you were physically or emotionally abused, or not taught to cope with troubles that enter your life, it could lead you to have problems as you grow up.

Anger

‘Frozen anger’ is a term that’s closely related to depression. You may have gone through something that caused you to become angry, but at the time you couldn’t express your feelings properly. This type of anger becomes suppressed; it can then build up and become a cause of depression.

Circumstances

Feeling like you’re alone, stressed, physically exhausted and/or have no one to talk to can all contribute to the condition.

Alcohol

Regular heavy drinking can make you more susceptible to developing depression.

Physical illness

Some types of physical illness can make people more prone to depression:

• hormonal problems, e.g. an underactive thyroid
• viral infections, e.g. glandular fever or flu (prevalent in younger people)
• painful or lasting illnesses, e.g. arthritis
• life-threatening conditions, e.g. heart disease and cancer
• chronic conditions, e.g. diabetes and epilepsy

Types of depression

There are several different forms of depression, including: 

Mild depression – When depression symptoms have a limited impact on daily life. Generally, sufferers of mild depression will experience a persistent low mood and spirit. They may find it difficult to motivate themselves to do things they normally enjoy.

Major (clinical) depression – A more severe form that can lead to hospital admission. Symptoms will be more prominent and interfere with daily life. They can affect eating habits, sleeping, and other day-to-day activities. Some sufferers may feel suicidal and that life is no longer worth living.

Bipolar disorder – A form of manic depression characterised by extreme highs and lows. For example, a period of hyperactivity where sufferers are excited and planning overambitious tasks is followed by a period of severe depression.

Seasonal affective disorder (SAD) – A form that’s closely related to the length of days. It typically occurs in the autumn and winter months when the days are shorter. Symptoms tend to alleviate when the days get brighter and longer.

Postnatal depression – A condition that can develop in anyone who gives birth or their partner following childbirth.

When to get help for depression

If you experience depression symptoms for most of the day, every day, for more than two weeks, you should seek help from your GP. If your feelings start affecting many parts of your life, this is a sign you may need professional support. The parts of your life that depression can have a negative impact on include, but are not limited to:

• relationships
• work
• interests
• an overall sense of happiness and enjoyment

Thoughts of suicide and self-harm are also warning signs that your condition is getting worse. If you experience these, you should look to seek professional support.

For many, being treated for depression can seem an impossible task, but the sooner help is sought the better. In some cases, the illness can disappear without treatment. This is not always the case however and there is a danger that living with the condition will put significant emotional and physical strain on your health and well-being. Therefore, many people with depression opt for treatment.  

In the initial stages, your GP will look to diagnose the condition by conducting tests to rule out other health problems such as an underactive thyroid. They will then ask various questions about your general health and how your feelings are affecting your mental and physical well-being. From here, the appropriate treatment options will be pursued. These will depend on the nature of depression and your personal circumstances.

Depression treatment and support

Speaking to a professional, whether that’s your GP or a counsellor, can help you understand what you need. This can range from self-help tips and breathing exercises, to psychotherapy and/or medication. Everyone is different and will need differing levels of support.

Depression is a treatable condition, even in its most severe form. A range of treatment options should be provided. The two most common forms offered are counselling and medication. These are often used in combination – particularly in more severe cases.

Depression counselling

Depression counselling is often recommended as a combination treatment plan. Talking therapy can help you identify, address and manage negative, self-defeating thoughts that may affect the way you behave with depression. The following types of counselling and psychotherapy have been proven effective in treating depression:

Cognitive behavioural therapy (CBT)

According to guidelines issued by the National Institute for Health and Care Excellence (NICE), cognitive behavioural therapy is among the recommended therapies for treating depression. This therapy is based on the premise that the way we behave and think affects the way we feel. People with depression tend to have self-defeating thoughts that can lead to negative behaviour. CBT aims to help sufferers identify and address their negative thoughts and their unhelpful behaviour patterns.

Counselling for Depression (CfD)

CfD is a model of psychological therapy recommended by NICE for the treatment of depression and approved for delivery within the Improving Access to Psychological Therapies Programme (IAPT). Counselling for Depression is one of the therapies recommended in addition to CBT.

Mindfulness-based cognitive therapy (MBCT)

This type of talking therapy is specifically designed to help those who suffer from recurring depression. Mindfulness-based cognitive therapy combines elements of cognitive therapy and mindfulness techniques (breathing exercises and meditation) to help break or change your relationship with negative thought patterns. 

Interpersonal therapy (IPT)

Interpersonal therapy focuses on how our mental health affects our relationships and how our relationships affect us. The thinking behind it is that psychological symptoms, such as depression, are typically a response to the difficulty in our communication with others. The symptoms gained from this can also cause communication to deteriorate, thus causing a cycle. IPT works best with those who have identifiable problems.

Psychodynamic therapy

Psychodynamic therapy aims to find out how a person’s unconscious thoughts affect their behaviour. This type of therapy can help individuals understand and unravel their deep-rooted feelings and experiences.

Group therapy

Although the term ‘group therapy’ can be applied to many talking therapies, it’s mainly used with those that work best within a group dynamic. One of the main benefits of this type of therapy is the support network of peers going through the same sort of issues. It aims to encourage you to share your experiences and work on understanding yourself better.

Art therapy

Art therapy uses artistic mediums to help individuals explore their emotions in a new way. It uses art as a form of communication – this is especially good for those who find it difficult to verbalise their feelings.

Medication

Alongside counselling, medication may be prescribed by GPs to help sufferers who are experiencing moderate to severe depression. Antidepressants can help to ease common depression symptoms such as poor sleep, low mood, and poor concentration. They can help sufferers function better and even increase their ability to deal with difficult situations if they arise.

Such medication, however, is not effective for everybody and does not tackle the root cause alone. This is why counselling for depression is recommended in combination with medical intervention.

We all start life with a family, whether that family is blood relatives, adopted parents, or a foster family. Our families influence almost every aspect of our lives, from our first moments to our last. Families go through lots of changes throughout life, so it’s normal to experience some problems. Counselling can help you overcome these difficult times.

Will counselling help my family?

Counselling can help establish the events that have led to the family needing help. These might include life events, transitions or repeating patterns. Family problems might be mapped out to show their history and development and allow members to feel clearer about the problems and how they might have arisen, reducing blame.

There should also be an opportunity to define the relationships, as people see themselves and as others do. This can lead to greater awareness and insight to allow any necessary changes. It can also offer the opportunity to see the abilities and difficulties that are available within the family group for dealing with problems and change and how they might be used.

Counselling might clarify a new pattern of being together after a marital breakdown or remarriage. It can also help to process feelings of being excluded or rejected,  such as being misunderstood, which might otherwise be acted out in disruptive behaviour. Communication might be repaired or established for the first time and family members may feel supported and encouraged to manage changes.

What does it mean to be a family?

We often think of families as people who are always there to support one another and, whilst they can be, for the majority of people, family life isn’t always perfect. Problems may not always be present but issues can arise from time to time.

Family dynamics

Our family dynamics change considerably over the course of our lifetimes. Birth, death, marriage, divorce – there are many types of transitions that families go through together. And each family is unique, even within its own culture. Every family has its own beliefs and values and, within each family, there may be differences of opinions about a wide range of issues.

Factors in our lives can affect our family relationships and, equally, our family relationships can impact the rest of our lives. Our families absorb many of the stresses and strains from the outside world – and the pressures can sometimes boil over. Personal problems can overwhelm a family, so much so that it can feel as though there is no clear way forward. Other times, changes within the family leave other members confused, angry or hurt.

Particularly as children, we spend so much time with our families, and these people have an undoubted impact on what makes us who we are; we develop our expectations of others, communication skills, outlook on life, as well as many other traits from our families. As a result of the impact our family lives have on us as people, it’s important to try to resolve problems within family life, to prevent ongoing issues.

What are family problems?

Families can be a source of support, encouragement and love but, sometimes, relationships within families are put under strain. Perhaps you’re a parent worried about your child’s behaviour or how a divorce may impact your family. You might be part of a stepfamily and need help adjusting, or you may be arguing with parents or siblings and need support communicating with each other.

Every family is different but many face similar issues. Common problems include:

• disruption as a result of separation or divorce
• problems with stepfamily life or when a new partner moves in
• money problems such as debt or redundancy
• changes in family structure, as the result of a bereavement or illness
• problem behaviour with adolescents or older children
• children leaving home
• unwanted pregnancy

Generalised anxiety disorder (also referred to as GAD) is a long-term condition that causes sufferers to feel anxious about a variety of situations/issues, rather than one specific situation.

What is generalised anxiety disorder?

Those with GAD will feel anxious most days and often catastrophise situations. For example, if their partner is late home from work, someone with GAD may think that they have been in an accident, rather than any other likely scenario (e.g. stuck in traffic).

Other characteristics of GAD include an inability to focus, loss of concentration and racing thoughts. If you have GAD, your day-to-day life will be affected by your anxiety, which may impact your sleeping habits, your relationships or even your ability to hold down a job. As soon as one issue has been resolved, another one will rear its head, making it difficult for you to feel relaxed and at ease.

The condition is persistent and there may be occasions when you don’t understand why you are feeling anxious. When it comes to diagnosing GAD, it can be difficult to differentiate those with GAD and those who have a naturally nervous disposition. As a rule, however, GAD is diagnosed if the symptoms of the condition are persistent and affect your day-to-day activities.

Who is affected?

GAD is considered a relatively common condition. According to the mental health charity Mind, in any given week in England, six in 100 people are diagnosed with GAD. While the NHS claims it affects more women than men, and is found to be more common in those aged 35-55.

What causes GAD?

The cause of GAD is largely unknown, although experts agree that there is likely to be a combination of factors at play. Research into the condition has revealed the following potential contributing factors:

• overactivity in the parts of the brain associated with behaviour and emotion
• an imbalance of mood-regulating brain chemicals serotonin and noradrenaline
• genetics – if you have a close relative with GAD, you are more likely to experience it
• suffering from a long-term health condition, such as arthritis or chronic fatigue
• a history of major stress or trauma can trigger the condition
• having a history of drug or alcohol misuse

While the situations listed above may contribute to the development of GAD, many people develop the condition for no apparent reason.

GAD symptoms

Generalised anxiety disorder causes both psychological and physical symptoms. The severity of the symptoms experienced will differ from person to person – one may feel all of the listed symptoms, while another feels just one or two. Regardless of how many of the symptoms you relate to – if your symptoms are causing you distress and are affecting your everyday life, you are advised to seek professional support.

Psychological symptoms

GAD usually causes a change in the way you behave as well as the way you think and feel about things. This can result in the following symptoms:

• a sense of dread
• feeling ‘on edge’
• feeling restless or unable to relax
• difficulty concentrating
• feeling irritable
• racing thoughts
• intrusive thoughts about worrying scenarios

These symptoms may cause you to avoid certain situations in order to prevent yourself from feeling anxious. This may see you withdrawing from your friends and family or from social contact altogether. Your symptoms may also make work difficult for you as it can trigger stress and anxiety, causing you to take time off. These actions can cause further worry and a low sense of self-esteem – continuing the cycle of anxiety.

Physical symptoms

Extreme anxiety can also lead to a number of physical symptoms, including the following:

• feeling lightheaded or dizzy
• feeling lethargic
• heart palpitations
• dry mouth
• muscle aches
• shortness of breath
• tension headaches
• digestive problems
• nausea
• difficulty sleeping/insomnia

These physical manifestations of anxiety can often cause further worry in those with GAD, perpetuating the ongoing feeling of unease. If you’re worried that your physical symptoms are not related to your anxiety disorder, please contact your GP.

Our sexuality and gender can form a big part of our identity and those who don’t fit society’s heteronormative ideal can come up against more challenges. Those who identify as LGBTQ+ can be seen as ‘different’ by some, facing discrimination, bullying and a lack of understanding which can lead to mental health concerns.

While things in society are slowly moving forward in terms of acceptance, we still have a long way to go. Incredibly, the World Health Organisation only removed ‘homosexuality’ as a formal psychiatric diagnosis in 1992.

The fact is, being LGBTQ+ does not lead to mental health problems – dealing with other people’s adverse reactions does. Because of this, those who don’t identify as heterosexual are more likely to experience mental health problems. Here we’ll explore sexuality and mental health in more detail, where to find support and coming out concerns.

Sexuality and mental health

LGBTQ+ people can be at a greater risk of developing a mental health condition than those in the wider population. According to the Mental Health Foundation, a survey carried out by Stonewall found that half of LGBTQ+ people experience depression and three in five experience anxiety.

The reasons for this are complex and not entirely understood, however, most mental health problems experienced can be linked to discrimination, bullying, homophobia, biphobia or transphobia.

If you identify as LGBTQ+ and you’re struggling with your mental health, know that you’re not alone. You may be particularly prone to:

• Depression – when you experience a low mood for a long period of time.
• Anxiety – when you feel especially anxious or worried for long periods of time or at a high intensity.
• Self-harm – when you hurt yourself on purpose to cope with difficult emotions.
• Suicidal thoughts – when you feel very low and as if there is no way out.

You may experience rejection from those around you, including friends, family and work colleagues. Other factors may also complicate things, for example where you live, your ethnicity and religious background. Understandably, this can all have a big impact on your sense of self-worth and your confidence. You may feel the need to hide this part of yourself from others, and this can be damaging in itself.

Some people may find they turn to alcohol and drugs to help them cope with difficult emotions. If you’re worried about the way you’re using alcohol or drugs, your doctor, a counsellor or an addiction helpline can offer support.

LGBTQ+ counselling

Speaking to a counsellor can help with some of the difficulties you’re facing, such as:

• finding it hard to accept your sexuality
• coping with other people’s reactions
• low self-esteem and low self-confidence
• fear of violence or abuse in public places
• effects of bullying and discrimination
• feeling as if your body does not reflect your true gender (gender dysphoria)
• transitioning

If you develop a mental health condition, talking therapies can help you find new ways of coping and either overcome or manage your condition. What’s important is for you to find a counsellor who you trust and feel able to talk to openly about your experiences. For this reason, it can be helpful to check your counsellor has experience working with LGBTQ+ people and/or has had appropriate training.

If at any point you feel uncomfortable with your counsellor, remember you have every right to stop your sessions and find a more suitable counsellor for you.

Other forms of support

Aside from talking therapy and counselling, many LGBTQ+ people find it helpful to connect with others in the community. You may want to join a support group online or connect with campaigners. There are a number of organisations and charities that support and campaign for LGBTQ+ people, Mind has an excellent list of resources.

Discrimination – what’s the law?

Attitudes in the UK towards the LGBTQ+ community do slowly seem to be improving, however, there are still some people who discriminate against others based on their gender and/or sexuality. There is a law against this at work and in wider society – The Equality Act 2010.

This protects gay, lesbian, bisexual and trans people and anyone who experiences discrimination because they associate with LGBTQ+ people. You can find out more about what the Equality Act 2010 covers and includes on the gov.uk website.  

Coming out

The term ‘coming out’ is often used to describe when you tell people about your sexual orientation and/or your gender identity. For some, it can take a long time to feel comfortable to do this. It’s important to know that you don’t need to come out at a certain time, you simply need to do what feels good and right for you.

Having these conversations can be difficult. You may experience unpleasant reactions and even rejection in some cases. This can make coming out an emotionally trying time. And sadly, for many, coming out isn’t a one-time thing. Every time you meet someone new or start a new job, for example, you may need to consider when or how much of your identity as an LGBTQ+ person you want to share.

Despite what may sound like negative repercussions of coming out, this doesn’t happen to everyone. Many people are supported and understood by those they’re coming out to.

Hiding who you are, however, can be an incredibly difficult thing to do and can be damaging to your mental health and well-being.

Everyone will ‘come out’ in different ways. For many, it’s a series of conversations that take place between the LGBTQ+ person and the people in their life they want to tell. It’s important for you to come out in a way that feels right for you and your circumstances.

Telling someone you trust and believe will be supportive first can be a good idea. They can then provide you with some support as you tell others in your life. Picking a time when you can talk through any concerns and worries is also recommended.

Try to keep in mind that although this is likely something you have known about yourself for a long time, for others, it may be a surprise. Initial reactions may be laced with shock, and they may change over time.

Creating a support network, whether that includes friends, family members, online communities or professional support (or all of these!) can be incredibly helpful when taking this step.

Over time, low self-esteem can have a negative impact on our mental health. You may also find having certain mental health conditions impacts your self-esteem. Here, we will be looking into self-esteem more, discussing what can impact it, how it links to our mental health and how counselling can help.

What is low self-esteem?

When we have low self-esteem, we can see both ourselves and the world around us in a negative light. We may feel unhappy and find it more difficult to cope with challenges when they come up.

What is self-esteem?

Self-esteem is the way we perceive and value ourselves; essentially, it’s the opinion we hold of ourselves. This can be influenced by lots of different things, from past experiences and our childhoods to life events. While these beliefs can be misplaced, they can feel very difficult to change.

If you have low self-esteem, you may struggle to value yourself. This can affect your life in a number of ways. You may find it difficult to like who you are and struggle in relationships. Low self-esteem can make it tough for you to believe in yourself, so you might struggle to try new things and take risks.

If you make a mistake, you might take it to heart and find it hard to move on. Your self-care may suffer and you may prioritise other people’s feelings and needs above your own. Self-esteem can however be built, so if this is ringing true, please know that it doesn’t have to stay this way. 

When you start to accept, value and like yourself, these struggles start to ease. You may feel more confident socialising and communicating in relationships. When new opportunities present themselves, you’re more likely to push yourself to go for them. You’ll find it easier to learn from mistakes and move onwards and upwards. Self-care can become a priority, allowing you to look after yourself better and thus, be better able to support others.

What are the signs of low self-esteem?

There are a number of different signs that you could have low self-esteem. You might exhibit some or all of these. They can include (but aren’t limited to):

• saying or thinking negative things about yourself
• being self-critical
• feelings of sadness, depression, anger, anxiety, shame or worthlessness
• blaming yourself for things that go wrong (even if they are out of your control)
• repeatedly joking about yourself in a negative way
• ignoring your achievements in favour of focusing on your mistakes or self-perceived negatives
• avoiding challenges due to fear of failure
• believing others are better than you
• thinking you don’t deserve to have nice things or fun experiences
• refusing to accept compliments
• feeling overly upset by any criticism, disapproval, or negative feedback

What are the causes of low self-esteem?

Everyone will have different things in their life that affect self-esteem. For some people, self-esteem changes suddenly (for example, after a stressful life event) while, for others, low self-esteem may be something they’ve lived with for a long time.

Often your opinion of yourself is built in your early years. You may have experienced authority figures who were disapproving. Being criticised a lot in childhood can lead you to form the opinion that you’re ‘not good enough’. Being bullied in childhood can also have a lasting impact on your sense of self-esteem, long after the bullying stops. 

Other life events that can affect your self-esteem include:

• experiencing abuse (of any kind)
• experiencing discrimination or stigma
• having relationship problems
• ongoing stress
• difficulties at work/school
• body image worries
• problems with money or housing
• losing your job, of finding it hard to get a job
• physical health problems
• mental health problems

It’s also important to acknowledge the influence of society and the media. With social media especially, more of us than ever before have access to other people’s lives, thoughts and opinions. As no one has created a ‘truth’ filter for this information (yet), much of what we see is curated, perfected and… false. 

All of the information we receive, including societal expectations, beauty ideals and gender stereotyping is presented as fact and it can be difficult for us to unhook our self-worth from these notions. The fact that more and more young people are using social media could also be a cause for concern.

While this is worrying, it’s worth noting that social media can have the power to improve both body image and self-esteem, when used in the right way. Making feeds more diverse and following inspiring and uplifting accounts can help.

Understanding the source of your low self-esteem can help you understand yourself better and start taking steps to build it up.

Self-esteem and mental health: What’s the link?

If you have low self-esteem for a long time, you may find it affects your mental health. It can lead to conditions such as depression, anxiety, self-harm and eating disorders. Some of the signs of low self-esteem, like feeling worthless and blaming yourself can also be symptoms of these conditions.

You may find low self-esteem makes it difficult to socialise which can lead to isolation. Feeling isolated and lonely can make you feel worse mentally. Some people will turn to unhelpful habits and behaviours to try and cope with low self-esteem, including drinking too much alcohol and abusing drugs.

If you have a mental health condition, you may also find that your self-esteem is affected. For example, depression can often make those with the condition feel worthless and anxiety can lead to people thinking they’re not ‘good enough’.

How a counsellor can help?

Building self-esteem and navigating the mental health implications can be difficult to do alone. Working with a trained professional such as a counsellor can help you understand where your opinion of yourself stems from and how to challenge limiting beliefs. Developing more awareness of your personal history and how this impacts who you are today can be eye-opening. Finding a counsellor who you feel comfortable with is key, it helps to be as open and honest as possible.

There are several different therapy types that can help here, including cognitive behavioural therapy (CBT) which helps you notice and change patterns of negative thinking. Compassion-focused therapy can also be very helpful for those struggling with self-esteem, helping you to let go of the self-blame that often comes with negative thoughts.

Arts therapies may be a good approach to consider if you find it difficult to articulate how you feel. These therapies use mediums like art, music and drama to help you process feelings and express yourself.

How do you fix low self-esteem?

As well as getting professional support, there are things you can do yourself to help improve self-esteem. What’s important for you to remember here is to try and not put too much pressure on yourself. Building up your self-esteem can be a long process, but small steps lead to big changes.

Here are eight ways you can try to help raise your self-esteem:

1. Reflect on your values and beliefs

Try using a journal to get to know yourself a little better. Make a list of your values and beliefs, what do you value in others? What are your beliefs? 

2. Challenge your inner critic

When that voice in your head tells you something negative, for example ‘I can’t do X’, get into the habit of challenging it. Ask it ‘why not?’. Imagine what you would say to a friend who said this to themselves and try to treat yourself as you would a friend. 

3. Use positive affirmations

This can be difficult at first, but many people find it helpful. Once you’ve challenged your inner critic, try telling yourself something positive, for example ‘I am perfectly capable of doing x’ and repeating it to yourself often.

4. Get out of the comparison trap

It’s natural for us to compare ourselves to others, especially those we see on social media. When you notice this happening, say ‘stop’ out loud and remind yourself that you are only seeing other people’s highlights. If it helps, try taking a break from social media and the online world from time to time.

5. Step up your self-care

Looking after yourself is something that can be pushed down the priority list when you struggle with self-esteem. Try to schedule self-care into your diary and challenge yourself to prioritise it. The act of taking care of yourself can help to reinforce that you are worthy and deserving of care which can improve self-esteem. 

6. Challenge yourself

Taking small steps outside of your comfort zone can feel very hard, but once you see that you can do it, you gather evidence that will bolster your self-belief. Try something very small at first and remember to celebrate every single win. You may also find it helpful to reflect on past achievements and make a note of them somewhere.

7. Learn to accept compliments

Instead of brushing off or dismissing compliments, get into the habit of smiling and saying thank you. This will make both you and the compliment giver feel better. 

8. Lean on your support system

When you’re feeling down about yourself, reach out to friends, family or your counsellor for support. You may even want to use a support group or talk to friends online. Know that you’re not alone and you have people in your life who care about you.

The journey to rebuilding and improving self-esteem can feel difficult at times, but the opinions and beliefs we have about ourselves are learnt. This means, with the right support and some self-work, we can unlearn them. Nothing is set in stone and you always have the opportunity to change your story. 

What should I be looking for in a counsellor?

Choosing a therapist can be daunting, but it’s important to spend some time reviewing counsellors, their areas of specialities, their personalities and speaking to them beforehand.

Having some questions prepared for your initial consultation can be helpful in deciding whether they are right for you. Ask yourself, “What do I want from counselling? Will this person help me to explore my individuality?”

There aren’t regulations regarding the level of training a counsellor working with someone with low self-esteem needs, however, there are several accredited courses, qualifications and workshops available to counsellors to improve their knowledge of a particular area.

When researching therapists and therapies, take your time and get to know their background. Don’t be afraid to ask for more information if you need it.

When we talk about mental health, there is often a misconception about what it is and who it affects. First and foremost, mental health is not the same as a mental health issue or illness. We all have mental health – it doesn’t come and go, it’s with us throughout our lifetime.

The term mental health is often used interchangeably with emotional health and well-being. Our mental state is certainly a key part of our overall well-being. It refers to how we are aware of our abilities and how well we cope with the ups and downs of life.

If we are physically unwell, say, with a cold, it may go away on its own within a week. But, the same cannot usually be said if we are mentally unwell. Good mental health can be maintained with self-care but, if we experience a problem, it may not go away on its own. We may require further help, for example, through talking therapies such as psychotherapy and counselling.

Types of mental health conditions

Mental health issues can have a profound impact on how we think, feel and behave. They can range from worries we all have from time to time, to long-term conditions that require treatment to manage effectively.

According to the Mental Health Foundation, traditionally mental health conditions have been divided into two categories; ‘neurotic’ (which is now more frequently called ‘common mental health problems’) and ‘psychotic’ (where symptoms interfere with your perception of reality).

Labels and categories can be helpful for professionals to diagnose and treat a problem, however, there are controversies surrounding this with some believing generalisations and assumptions interfere with individual care. Some people may also experience a combination of neurosis and psychosis, therefore, distinguishing between the two may not always be useful.

Signs of a mental health problem

When you get a physical illness like a cold, you may experience symptoms such as a sore throat and a blocked nose. These signs tell you that something is wrong so you can take medication, or rest in bed for a few days. When it comes to our emotional well-being, the signs aren’t always so obvious. 

One thing to remember is that there is no set list when it comes to the signs and symptoms of mental health problems. Each condition varies and, of course, each individual is different too. If you are worried about your mental health, you should visit your GP for advice on what could help.

What causes mental health issues?

Mental health conditions are complex and can have a wide range of causes. Often, it is not known exactly why someone develops symptoms. There are, however, certain factors that are thought to play a role in triggering problems. These are:

• psychological
• physical
• social and environmental

Psychological causes

A ‘psychological cause’ is something that affects the mind or emotional state.

Traumatic experiences such as the loss of a loved one or a road accident can trigger mental health issues. A traumatic event can change a person’s perception of the world, and as a way of coping, they may experience feelings of anger, helplessness, fear and guilt. Over time, and without the right support, unhealthy behaviours can emerge.

Internal triggers may also play a part in the onset of mental health concerns. Internal factors such as loneliness or social isolation, self-criticism and low self-esteem or self-worth, and long-term or severe stress can, over time, be detrimental to a person’s mental well-being.

Physical causes

A ‘physical cause’ is something that affects the body on a biological level, such as:

• Genetics. Experts believe some people are more at risk than others; they have a genetic ‘predisposition’ because of genes passed down from parents.
• Early development. Some studies suggest that a baby is at greater risk if its mother takes drugs or contracts a virus during pregnancy.
• Head injuries. Sometimes, after a serious head injury, psychotic symptoms can develop.

Social and environmental causes

The things that happen around us can have a big impact on mental health. Social and environmental causes include:

• where you live
• where you work
• the relationships you have with family and friends
• experiencing discrimination or stigma (e.g. racism, ableism, homophobia, transphobia)

Mental health support

Mental health support covers a range of things designed to manage symptoms and improve quality of life. The most common types of treatments include talking therapies and medication. 

If you are concerned about yourself or someone else, it is advisable to speak to your GP. They will be able to diagnose any problems and recommend treatment options. It is important to note that all appointments and topics discussed are completely confidential.  

Talking therapies

One way of managing the effects of a mental health problem is by talking about it. Whether you are living with a mental health problem, or know somebody else who is, it is important to talk about your experiences and the stigma associated.

Counselling involves talking about your problems with a trained mental health professional such as a counsellor or psychotherapist. Talking therapies allow you a space to talk freely, without fear of criticism or judgement, and help you understand what may have caused your problems and how to manage them.

There are many different types of talking therapy that can help. These include:

• Cognitive behavioural therapy (CBT)
• Cognitive analytic therapy (CAT)
• Creative therapies, such as art therapy, drama therapy and music therapy
• Family therapy
• Dialectical behaviour therapy (DBT)
• Person-centred therapy
• Psychodynamic therapy

The type of therapy that will work for you will depend on what you hope to achieve from counselling, and the counsellor themselves. It’s always worth asking questions about the therapist’s way of working and discussing any concerns you have about a particular approach – together, you can work out whether you are the right fit.

Medication

Medication is sometimes prescribed to help reduce the symptoms of mental health conditions. Sometimes medication can help to improve the quality of life and make people feel less overwhelmed by their condition. 

Depending on the type of mental health problem you have, you might be prescribed:

• antipsychotics to reduce symptoms of psychosis (i.e. hallucinations)
• antidepressants to reduce the symptoms of depression (i.e. loss of emotion, low moods)
• mood stabilisers to moderate extreme changes in mood
• benzodiazepines to reduce anxiety

Self-care for mental health

Prioritising self-care is something we can all do to help maintain our mental health. This can be as simple as taking any prescribed medication and showering to setting boundaries, carving out time for yourself and doing activities that make you happy. 

When we look after ourselves, we give ourselves space to become more aware of our emotional well-being, so we can notice any signs that something’s wrong.

Challenges of living with mental health issues

Mental health issues are complex. Unlike a cold or cough, symptoms do not clear up after a course of antibiotics and some people have to learn to live with their condition. They may find everyday situations, such as work and socialising, particularly difficult.

Social stigma

Unfortunately, the social stigma attached to mental health still exists. According to the Mental Health Foundation, nine out of 10 people with mental health issues are affected by discrimination of some kind. Other people’s ignorance and lack of understanding can make it hard for people with certain conditions to maintain stable relationships, and find work or suitable housing. Some may find themselves socially excluded from mainstream society.

Research and a greater understanding of some conditions have helped change views of mental health. However, sensationalised films, news articles and stories mean misconceptions still exist. In order to tackle damaging stereotypes, more needs to be done to broaden communication between people with mental illness and the wider community to help spread awareness and understanding.

Attending work and school

Statistics show that one in six workers is dealing with a mental health issue at any one time. Certain problems can be caused by work (usually stress and anxiety), while some mental health conditions can impact our ability to work productively.

Many people are reluctant to speak about mental health in the workplace because they fear they may be penalised or judged for it.

Young people in school worry they’ll face criticism, alienation or bullying if their peers know they have mental health issues. While it can be difficult to talk about their emotional well-being with peers, colleagues and bosses, keeping an open dialogue in school and the workplace is important. It could help alleviate stigma and prevent problems from escalating.

Relationships

Some mental health issues can make it difficult for people to build healthy relationships. When problems emerge after a couple has been together for some time, new challenges can lead to difficulties. Frustration and lack of understanding can cause tension and arguments. 

Relationships are a key part of our lives. They bring happiness and support, but that doesn’t mean they’re easy. When we encounter problems in our relationships, it can be difficult to know where to turn. Talking to a relationship counsellor can really make a difference.

Relationships – whether romantic or platonic – can bring us a great deal of happiness and fulfilment. Strong connections with our loved ones, friends and even our coworkers allow us to be at our happiest, healthiest and most productive.

For many, these relationships offer an important source of advice, guidance, love and support. Research has even suggested that our relationships can significantly impact our well-being, with proven links showing that relationships can lower our rates of anxiety and depression, make us more likely to experience higher self-esteem and greater empathy, and can even lead to us trusting more. A strong, healthy relationship could even help you to live a longer life. 

However, fulfilling and supportive relationships don’t come automatically. They require good social skills and a great deal of work, time and energy to last and stay strong. Sometimes our most meaningful relationships can break down, and this can be due to a number of reasons. But the loss of this connection can be difficult, leaving you feeling lonely, disappointed, or even confused as to what may have gone wrong.

In some cases, our relationships may not be meeting our expectations, which can impact our happiness and life satisfaction. For others, they may crave companionship yet find it very difficult to come by. Whatever the relationship issue, there is help available.

Relationship counselling is an option you can undertake together as a couple, or as an individual. It provides a space where you can talk about your concerns and needs, as well as explore what you want from your relationships. Many relationships can be improved by counselling, even if there is no clear problem or issue.

Through speaking with a professional relationship counsellor, you can learn more about yourself, your partner, your friends, or your relationship. You can gain a better understanding of each other’s needs while receiving support and guidance that can help enhance and even strengthen your relationship. 

Why do we need good relationships?

Humans are naturally very sociable. We enjoy the company of others and crave positive interactions and meaningful friendships. To some extent, good relationships are just as important for our survival as food and water, which can explain why when our relationships suffer, our health and happiness are also affected.

Having good relationships in your workplace with colleagues, as well as others within similar professional circles can boost your productivity and act as a valuable tool for developing your career. Being on good terms with your manager or boss is not only great for productivity and fostering a positive work environment, but it can also mean that you may be more likely to be considered for new opportunities such as promotions when they arise.

Good relationships can create a sense of freedom. Rather than spending time and energy overcoming obstacles that arise due to relationship issues, you are able to focus more on the task at hand, enjoying the time that you spend there.

What defines a good relationship?

What makes a good relationship varies greatly from person to person, relationship to relationship. Each individual may value different aspects of their relationship to a different degree. However, many people agree that mutual respect and emotional support, companionship, shared sexual expression, and a level of shared economic security are common, important parts of a healthy, adult relationship.

All relationships are unique, and that’s part of the beauty of them. But, there are several characteristics that generally are a sign that you have a strong, healthy connection with someone. These may include:

Trust – Relationships are built on trust, which is essential for good communication and forming strong bonds with people. Without trust, relationships are unlikely to survive.

Mindfulness – If you’re mindful of what you do and say, and of the other person’s needs, you’re more likely to maintain strong relationships. Issues can arise if you let your negative emotions affect others, or if you aren’t thinking of them. Remember, it’s a two-way street.

Mutual respect – As mentioned above, strong and supportive relationships rely heavily on mutual respect. You need a mutual understanding of each other’s needs and values, and to consider these regularly.

Good communication – Your relationships will be richer if you make an effort to keep in contact with those around you. Being honest and open with others also allows you to connect deeply and build long-lasting bonds.

Types of relationship problems

There are many different types of problems that can arise during a relationship. These can vary depending on your unique circumstances and relationship dynamics. A relationship therapist can work with you together as a couple, separately as individuals, or with just one of you. While we may all be different, there are some common relationship issues that people frequently seek relationship counselling for.

Common types of relationship issues include:

Affairs, betrayals and infidelity

Betraying your spouse, partner, or close friend can cause a great deal of damage to your relationship by weakening or destroying that sense of trust. Whether it’s through infidelity, financial secrets, hidden addiction, or something else, betrayal can feel heartbreaking and, in some cases, can lead to relationships ending.

Affairs don’t happen without reason. Having a safe, neutral space to talk through the issues and emotions leading up to, surrounding, and following infidelity can help you to both open up about how you are feeling, what you want to happen next, and work together to decide how that’s going to happen. 

Separation and divorce

Sometimes couples will decide to separate or divorce without going through the practicalities, or considering if they may way to save the relationship. Separation counselling provides an opportunity for a breakup to be explored before a final decision is made. While not all relationships can continue, helping couples to get closure and move forward in a way that is healthy for their needs can be really beneficial in the future, particularly if children are involved.  

Arguments and communication issues 

Some couples may find that over time, the number of arguments they are having increases, or that their communication begins to break down. Frequent arguments over little things like taking the rubbish out or who’s turn it is to cook can be a sign of deeper issues that you may feel unable to express, or that you may not be entirely aware of, such as building resentment, anger, or sadness. 

Differing communication styles can also lead to issues, as one or both people may feel like the other has stopped listening to them, which can lead to assumptions being made, or fostering negative feelings. While we all know the importance of communication, figuring out how to identify where things have gone wrong, and how to make positive, impactful and lasting changes, can be difficult. 

Trauma

Traumatic life events can have a significant impact on relationships. Whether individual or shared, while some people cope by pulling together, others find themselves pushing their partner away or feeling like their relationship is being pulled apart. These can all be natural reactions to big, upsetting events. Talking things through with a therapist can help you to process things, find new ways to communicate how you are feeling with your partner, and work through your trauma together.

Sexual issues and/or lack of intimacy 

Decreasing intimacy, sexual issues, or a lack of physical intimacy can lead to miscommunication and hurt feelings. One partner may feel undesirable, while another may feel shame or guilt. Any number of different problems can lead to sexual issues and a lack of intimacy within a relationship. While some issues may need to be addressed through your GP to rule out other medical problems, there are also many common psychological factors that can lead to a decreased sex drive, such as depression, stress, and even anxiety. 

Can a relationship survive without intimacy is a question frequently asked by couples who fear that their physical and/or emotional intimacy has decreased. Working with a relationship counsellor can help you to better identify the root causes, and how you can foster a greater sense of intimacy.  

Pre-nuptial issues

Some couples seek extra support and advice on how to prepare themselves should the relationship break down or encounter difficulties in the future. Relationships are naturally full of ups and downs (we may naturally crave companionship, but we’re also very opinionated creatures). Pre-nuptial counselling can help couples to be aware of any potential stressors that may occur during different stages of their relationship, such as the birth of a child, and learn how to cope, overcome any issues and flourish.

Family issues

Our relationships with family members form an integral part of our lives, and when these become strained, they can cause a lot of pain and disappointment. In some cases, it may be one family member that is causing a rift, or it could be a previous disagreement or a number of issues that have built up over time and have never been properly dealt with. 

For couples with children, differing parenting styles, discontent with the role you have fallen into (for example, when one parent always has to play the ‘bad guy’ and one gets to be the ‘fun parent’), or even just struggling to adapt to your growing family can all cause tension and strain. 

Family counselling provides a safe and supportive environment where family members can communicate openly, listen to each other and work through any disagreements.

Cross-cultural relationships

Relationships involve two people coming together from different backgrounds to build a new unit. While for many, this process is relatively straightforward and seem very natural, for others, their differences can be too prominent to come to a compromise. Counselling helps couples to better understand each other’s beliefs and values, to learn how to work with their differences and compromise, building a stronger, healthier bond.

Imbalanced responsibilities

Some couples may find that their relationship dynamic feels unequal and that the typical adult responsibilities aren’t evenly shared. If one partner has difficulty committing to or making plans, or sharing typical responsibilities, this can be a sign of Peter Pan syndrome.

If the other partner seems to try and do everything for them by taking on more or all responsibilities and decision-making, this can be a sign of what is referred to as Wendy Syndrome. While not an official diagnosis, Peter Pan and Wendy Syndrome can lead to breakdowns in communication, feelings of resentment, as well as additional stress and worry. 

How can counselling help with relationship issues?

Relationship counselling can help you not only improve your relationship but also improve the way you relate to and understand those around you. Working with a relationship therapist can help you to break free from old, unhealthy patterns of behaviour, and to find new ways of expressing yourself and your feelings. 

As counsellor Linda Boutet explains in their article, Relationships and our sense of self, “Counselling gives us space to be the truest version of ourselves, offering us the opportunity to look at what we, as individuals, really want from our relationships.

“It offers us the opportunity to explore our past and current experiences of being close to others, whilst working to strengthen our own sense of self, so we no longer feel bewildered by the relationships we choose. Counselling can lead us to a greater sense of ourselves in the world we live in, and a deeper understanding of our relationships”

Relationship issues can be attended to as an individual, or in the form of couples counselling, a type of counselling that utilises talking therapy in a way that is designed to help two people. It really depends on you, and what it is you want to gain from counselling.

Sometimes, a relationship can leave you feeling crowded and like you’ve lost your sense of self – you may benefit from individual sessions, to have the opportunity to talk in a safe space, free from judgement. Other times, you may both benefit from talking in a zone that is out of your usual lives – somewhere private, safe and completely neutral. It may not always be an issue in the relationship, but if one of you is struggling, it could be negatively impacting your partner and in turn, your relationship.

Trust, respect and communication are three key factors that lead to a successful, happy relationship. When something happens that changes or impacts one of these factors, the relationship can start to break down. Sometimes relationships aren’t meant to be and you separate, and that’s OK. If you want to work through it and rebuild your bond, that’s OK too.

Counselling can help you work through a breakup or separation, help you rebuild a relationship and help you better understand yourself.

Almost everyone experiences stress from time to time and, while a small amount of stress can motivate us, too much or prolonged stress can be damaging to both our physical and mental health. For some people, stress causes them to adopt unhealthy coping methods such as smoking or drinking – and while this may feel like a quick fix, ultimately these are only covering the issue.

What is stress?

Stress is an innate reaction resulting from our caveman days. Humans had to deal with threatening situations, which caused our brains to release a range of ‘stress chemicals’ such as cortisol and adrenaline to provoke what is known as the fight-or-flight reaction. The fight reaction would give us a burst of energy, ready to fight for our lives, while the flight reaction would encourage us to flee from danger and protect ourselves. These days, we rarely encounter threatening situations, however, our brains continue to react in this way when we are under pressure.

Psychological trauma typically occurs after a particularly distressing event or a series of enduring events. Experiencing trauma can affect your mental health, leading to you feeling unsafe and on high alert.

There are different severities of psychological trauma, some symptoms are mild and may go away with time, while others can be more severe (such as PTSD) and will require professional treatment. When it comes to trauma, the sooner you seek help the better.

Having a traumatic experience or witnessing stressful events can have a profound impact on our psychological and emotional well-being. If you’ve ever felt that your life or safety has been put at risk, it can shatter your sense of security.

The important thing to remember is that there are many different causes of trauma. It’s not the circumstance or event in itself that signals trauma, but what your emotional experience was of the event. Trauma affects people in different ways and, for some, the symptoms take weeks, months or even years to surface.

Regardless of its source, an emotional trauma contains three common elements:

• it was unexpected
• the person was unprepared
• there was nothing the person could do to prevent it from happening

What is psychological trauma?

Psychological trauma usually occurs after a particularly distressing event or a series of events. The result of this can lead you to feel overwhelmed and unable to cope. These events are typically so far outside what we expect and what we believe that our reactions can seem somewhat unusual or even disturbing. Reactions like this are normal though and should be expected after trauma.

When you enjoy your job, it can provide happiness and fulfilment. But, when work is causing you stress and unhappiness, it can take over your life.

On this page, we’ll explore work-related stress in more detail, including the causes and signs to spot, ways to cope with work-related stress, and how counselling can help.

What is work-related stress?

A little pressure at work can be motivating, it can help you perform better and teach you ways of overcoming obstacles that may occur. But, when this pressure becomes excessive and the demands of your job are too much, it can lead to work-related stress. This is when certain demands in your job exceed your ability to cope.

Similarly, workplace bullying, harassment, unrealistic deadlines and feeling inadequate or undervalued can also negatively affect your ability to cope.

It is thought that work-related stress is more prevalent in public service industries, such as education, health and social care, and public administration and defence. However, anyone can be affected by stress, in whatever career they hold.

It doesn’t matter how old you are, your gender, or the industry you’re in – sometimes things can become difficult and this is when you need to ask for help.

Coping with work-related stress

When you’re in the thick of stress, it can feel like you’re constantly paddling to keep your head above water. This is incredibly draining and can make you feel like you’re not coping with the demands of your job.

It doesn’t have to be this way, though. Work-related stress is not something to be ashamed of and there is a way out. There are several ways you can combat stress at work, including taking time away from the situation, learning self-help relaxation techniques and changing your working environment.

Depending on the cause of your stress, you may need to speak to a colleague, manager or HR department. In the case of bullying or harassment, there are often procedures in place that will support you.

In the UK, there are over 14.1 million people with a disability, impairment or limiting long-term illness. On this page, we will look further into the types of disability. We will explore the options available to help people cope with and better manage their condition, including disability counselling.

What is a disability?

The World Health Organisation (WHO) describes ‘disability’ as a term that refers to a huge spectrum of impairments, activity limitations and participation restrictions. Around 15% of the world’s population (over 1 billion people) currently experience disability at some point during their life according to WHO, with numbers increasing due to ageing populations and non-communicable diseases.

Disability is the result of an interaction between an individual with a health condition (e.g. depression, anxiety, cerebral palsy), personal and environmental factors (e.g. public transport that is inaccessible, negative attitudes or perceptions from themselves or others), and limited social support. Environment can have a huge impact on the experience and extent of disability, as an inaccessible environment creates barriers that stop individuals from accessing parts of society that others can.

An impairment is classed as a problem in body function or structure. An activity limitation is something that causes difficulties when undertaking a task or action. While participation restriction causes difficulties when undertaking day-to-day tasks.

An impairment doesn’t have to necessarily be a diagnosed medical condition, but it needs to have a substantial, long-term adverse effect on your ability to carry out day-to-day activities. For example, stress could lead to mental impairments such as difficulty concentrating, extreme tiredness, or sleep issues. An impairment may not stop you from doing something completely, but it will make things harder by, for example, causing pain or taking longer.

Equality Act 2010

The Equality Act replaced the Disability Discrimination Act (DDA) in October 2010. The Act compiles a number of different discrimination laws into one. It enforces laws that protect disabled people from being treated unfairly and applies in many situations, including:

• education
• employment
• access of facilities
• goods
• transport
• services

Under the Equality Act 2010, you are disabled if you have a physical or mental impairment that has a substantial or long-term effect on your ability to carry out daily activities. If you have a progressive condition (a condition that worsens over time) you can be classed as disabled. However, you will automatically meet the disability definition from the day you are diagnosed with cancer, multiple sclerosis (MS) or HIV.

If you are in Northern Ireland, the Equality Act 2010 does not apply. If you would like to find out more information on the Equality Act, take a look at this article on the Disability Rights UK website.

When is the right time to seek help?

Whether a disability develops early or later in life, there are many avenues of support available, both for the individual and the family.

For those who are unable to work, there are several kinds of benefits available, as well as people on hand to help claim for them. The NHS also provides a range of support services to help manage disabilities. For those studying, universities often offer a student services team. This can help the individual get the right support throughout their studies, whether that is accommodation help or learning support.

There is also support available for those caring for someone with a disability. Particularly in the case of severe disabilities, it is important that the carer is able to have a break. There are centres all over the country, where carers can go to meet other carers and take some time out. Many charities provide support for carers, as well as people with disabilities.

Disability counselling

There are a number of avenues that you can explore to help manage your situation. Disability counselling in particular can provide support to people with disabilities, as well as their partners, family and carers.

Living with a disability can be a long journey, both mentally and physically. It can be just as tough for those who live with or care for a disabled person. Friends and family may too find it difficult to come to terms with the condition, as well as adapting to a lifestyle that involves new challenges. You may find disability counselling beneficial if you are suddenly classed as disabled as a result of an accident. Similarly, if you have a serious health condition, such as cancer, it can provide some of the support you may need.

It can often lead to low social support and financial hardship. These experiences can then be linked to mental health problems, such as depression and anxiety. Counselling can help to address these issues, as well as helping you cope better with the disability and adapting to the changes it brings. The aim of disability counselling is to provide a safe and supportive space for you to discuss your concerns and fears. A trusted professional will be there to help you explore ways of making these more manageable.

Types of disability

A disability can be any physical, cognitive, sensory, emotional or developmental condition that hampers or reduces a person’s ability to carry out everyday tasks. In some cases, people may have a combination of some, or all of those mentioned above. A disability can be present at birth or occur later in life, depending on the nature of the condition.

Physical

A physical disability can either temporarily or permanently affect an individual’s mobility and/or physical capacity. Such disabilities include muscular dystrophy, epilepsy, ME, spina bifida, a spinal cord or brain injury or cerebral palsy.

Sensory

A sensory disability can affect one or more of an individual’s senses, such as touch, taste, smell, sight, hearing and spatial awareness. Hearing loss, blindness and autism all fall under the ‘sensory disability’ category.

Mental health

Disabilities that affect an individual’s mental health include obsessive-compulsive disorder (OCD), depression, bipolar disorder and schizophrenia. These fall under the Equality Act 2010 as they can affect the way a person thinks and behaves and can restrict their ability to carry out daily tasks.

Learn more about mental health and disabilities.

Learning

A learning disability is a disorder of an individual’s central nervous system, which affects their learning process. People with a learning disability may need support to develop new skills and understand complicated information. But, it doesn’t mean that the individual is incapable of learning, it just means they learn in a different way.

Chronic

The Equality Act 2010 states that for a person to meet the definition of ‘disability’, the impairment will have had a substantial and long-term effect on the person’s ability to carry out everyday tasks. For the purpose of deciding whether a person is disabled, a long-term effect is one that has lasted at least 12 months; the total period it’s due to last is likely to be at least 12 months, or the effect is likely to last for the rest of the person’s lifetime.

What should I be looking for in a counsellor or psychotherapist?

There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat someone with a disability. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines, including:

• For patients with initial presentation of moderate depression and a chronic physical health problem, professionals must offer a choice of high-intensity psychological interventions, such as group-based CBT, individual CBT or behavioural couples therapy.
• Patients with depression and a chronic physical health problem should be informed about the national resource, self-help groups and support groups available.

Read the NICE guidelines on depression and disability

The NHS also provides information on living with a disability. This includes what care and support are available, working with a disability and caring for older relatives.

Domestic abuse (also known as domestic violence) can involve physical, emotional, mental, financial and/or sexual abuse. Usually, it happens with someone you are close to, either within a romantic relationship or family setting. Abuse can affect anyone, regardless of age, gender or social background.

According to Her Majesty’s Inspectorate of Constabulary (HMIC), the police in England and Wales receive over 100 domestic abuse calls every hour. But, because domestic violence tends to happen behind closed doors, it’s hard to know exactly how many people are living in a domestically violent environment.

Here we’ll take a deeper look into the subject of domestic abuse, including how to recognise the signs, deciding to leave, and moving on. Whether you’re reading this because you believe you may be in an abusive relationship or you’re worried about someone else – know that support is available.

What is domestic abuse?

Domestic abuse charity Women’s Aid define this type of abuse as “an incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence, in the majority of cases by a partner or ex-partner, but also by a family member or carer.”

There can be many forms of abuse used within a domestically violent relationship, including physical abuse, emotional abuse, mental abuse, sexual abuse and financial abuse.

Physical abuse

Physical abuse is when the perpetrator uses physical violence to hurt you. This may include hitting, kicking, pulling hair, controlling medication and/or destroying personal property. This is the type of abuse most commonly associated with domestic violence, likely because it can be the easiest to notice. 

Emotional abuse

This is when someone consistently uses manipulative techniques to make you feel a certain way and ultimately control you. This could involve someone putting you down, calling you names, blaming you for the abuse, controlling what you do and who you see and/or intimidating you. Over time this wears down a person’s sense of self, making it difficult to know how/when to reach out for support.

Mental abuse

Also known as psychological abuse, mental abuse is when the perpetrator seeks to distort your sense of reality. This may include gaslighting, making you think you’ve said/done things when you haven’t, and gradually eroding your sense of self-trust.  

Sexual abuse

This is any form of sexual activity that happens without your full or informed consent. This includes rape, sexual assault and sexual exploitation. In some cases this can involve someone withholding their partner’s contraception or forcing them into sexual practices they find degrading.

Financial abuse

This is when someone controls your money, including the way you acquire it, manage it and use it. Someone might spend or take your money without consent, stop you from working to earn money, build up debts in your name and/or damage your possessions or property.

The common thread running through all of these is the element of control and power that’s held by the abuser. Often an abuser will use these tactics to control you and keep you within the relationship.

One of the most important things for you to do is to recognise that what you’re experiencing is abuse and that you deserve help. 

Recognising signs of abuse

Educating yourself on the different ways abuse can manifest is an important first step in changing your situation. You don’t have to live like this. Abuse can take many different forms and every situation is unique, however, there are some common signs of abuse you may well recognise:

• verbal abuse and criticism (shouting, name-calling, threatening, mocking)
• guilt/pressuring tactics (threatening self-harm or suicide, taking away your phone/laptop, threatening to call the authorities on you, lying to friends and family about you)
• putting you down (disrespecting you in front of others, not listening or responding to you when you talk)
• isolation (monitoring or blocking your connection with others, stopping you from leaving the house, telling you where you can and cannot go)
• lying to you (breaking promises, having affairs, often blaming you)
• threats (physically or verbally threatening you)
• sexual violence (using force, threatening you to perform sexual acts, forcing you to have sex with other people)
• physical violence (hitting, kicking, pushing, restraining you)
• denial (making you think you’re imagining the abuse, saying they can’t control their anger, appearing charming/calm in front of others, begging for forgiveness)

Domestic abuse against men

Statistically, it is more common for women to be affected by domestic violence, but it’s important to note that men can be victims too. We don’t truly know how many men are affected as, with any form of abuse, it can be difficult to talk about.

The situation is awful for both women and men, however, men may face the additional stigma of not wanting to appear as a ‘victim’ or even worrying that no one will believe them. Whatever your gender identity, it’s important to know that abuse is never OK and is never your fault.

Barriers to leaving an abusive relationship

When talking about domestic violence, a question can often hang in the air: Why don’t they leave the relationship? This seemingly innocent question implies that deciding to leave an abusive relationship is easy when nothing could be further from the truth. This question also leans towards victim-blaming, when the victim, rather than the abuser, is blamed for the situation they’re in.

Here we look at some of the barriers that can hold people back from leaving relationships to acknowledge that it is not easy but also discuss how it can be done.

Shame or denial of abuse

Your abuser may be well-liked in the community and make you feel like you cause the abuse. This can lead to feelings of shame and embarrassment. Your abuser may even minimise or deny that the abuse is happening, making you feel like you’re making a fuss over nothing.

Fear of further violence

Leaving an abusive relationship can be dangerous. You might be worried that your abuser will become more violent towards you and even that your life is at risk.

Fear of being alone

Abusers often isolate their victims, cutting off contact between them and friends and family. You might worry that you have no one to turn to when you decide to leave or that you’ve become too reliant on your abuser.

Low confidence

Abusers are experts at chipping away at self-worth. This can lead you to feel incredibly low in confidence and unable to make decisions. You may be suffering from trauma too, clouding your judgement and ability to cope.

Practical reasons

If an abuser controls every aspect of their victim’s life, leaving can be practically very hard. You may not have financial independence. You may have children you are worried about or, if you have an unsecured immigration status, fear you’ll be deported.

Lack of support

A running thread through all of these barriers is a lack of support. You may feel as though you have no one who can help you, or perhaps you’ve tried to get support before but had a bad experience.

It’s helpful to understand these different barriers and show yourself some compassion. You are in an incredibly difficult position and you should not blame yourself for your circumstances. Asking for help isn’t always easy, but it’s the best way to find the support you need to make your decision.

Leaving an abusive relationship

If you decide you want to leave, know that you are not alone in this and that it is not your fault. An excellent first step is to get advice from a dedicated domestic abuse organisation such as Women’s Aid or Refuge for women, or the Men’s Advice Line for men.

When making plans to leave, take care of who you tell to ensure your abuser doesn’t find out. Women’s Aid has put together some helpful advice for anyone looking to leave a domestic violence environment (whatever your gender).

Rebuilding life after abuse

Once you have left your relationship, it’s understandable for there to be mixed emotions. You may feel a sense of loss and sadness, guilt, overwhelm and/or anger. You may blame yourself and think you could have ‘worked harder’ to make the relationship succeed or feel as if you are ‘weak’. Of course, the truth is, you have been exceptionally courageous and strong.

Rebuilding life again after relationships like this can be hard. The traumatic nature of abuse can lead you to experience flashbacks and you may even develop post-traumatic stress disorder (PTSD). Your sense of self-worth and confidence may be in tatters, leaving you feeling overwhelmed and afraid to move forward.

Counselling for domestic abuse

The reactions and emotions following abuse can be overwhelming and difficult to navigate. To gain some support through this, many people are recommended to have counselling. Remember, a counsellor can work with you at any stage of your journey, whether you’re out of the relationship or still in it.

Counsellors can work with you to help you recognise signs of abuse and help you understand your own behaviours/way of thinking. There are many different techniques and approaches that may be able to support you, from assertiveness and grounding techniques to CBT to improve self-esteem.

You have all the strength and courage within you to move forward with your life, but there is no shame in asking for a helping hand to get there.

What should I be looking for in a counsellor or therapist?

Currently, there are no official rules or regulations in place that stipulate what level of training a counsellor dealing with domestic abuse needs. However, it is recommended that you check to see if your therapist is experienced in this area. A Diploma level qualification (or equivalent) in abuse counselling or a related topic will provide assurance and peace of mind that your counsellor has developed the necessary skills.

Another way to assure they have undergone this type of specialist training is to check if they belong to a relevant professional organisation representing counsellors dealing with domestic abuse.

Self-harm is when someone harms themselves on purpose, usually as a way of coping with difficult emotions. Here we will look further into self-harming, including why someone might self-harm, how to find support and how someone struggling can help themselves.

What is self-harm?

Self-harming often begins when a person feels overwhelmed with upsetting thoughts and feelings. Harming themselves physically can feel like a release, almost giving them a sense of relief from the emotional pain they’re feeling.

This relief is only temporary though and is often followed by feelings of guilt and even shame. As the emotional pain is still present, the person may continue to rely on self-harming in an attempt to cope, continuing the cycle.

Why do people self-harm?

There are no simple answers as to why someone might hurt themselves as every individual is different. Many people who self-harm say it is a way for them to express something they can’t put into words. This may be emotional pain, loneliness or low self-esteem.

For some, there is a particular event or experience that triggers them to start self-harming. This could include: 

• being bullied
• feeling overwhelmed with school/work
• losing a loved one
• the end of a relationship
• losing a job
• having an illness (mental or physical)
• feeling stressed
• having a poor sense of self-worth
• dealing with discrimination
• experiencing abuse (sexual, physical or emotional)
• having difficulties at home

For others, there seems to be no direct cause. If you self-harm but don’t know why, you are not alone and you can still reach out for support.

There may be certain situations or times that make self-harm more likely, for example after drinking alcohol or at night time. Every person experiences self-harm differently and one person’s reasons will be different to another person’s.  

Is it just attention seeking?

Some people might talk about self-harming being an ‘attention-seeking’ act. The truth is, many people keep their self-harming private and feel alienated and upset to hear people misunderstanding their behaviour in this way.

For some, there is an element of wanting, or needing attention. They may want people to see how upset they are and offer help. Either way, self-harming should never be brushed off in this way.

What self-harming can involve

The stereotypical image of someone who self-harms tends to involve cutting. While this is a common form of self-harm, it isn’t the only way people hurt themselves.

Self-harm covers any form of hurting yourself. This can include under or over-eating, overdosing/self-poisoning and even getting into fights when you know you’ll get hurt. In some cases, self-harm can be mental/emotional. This means purposefully doing things that you know will make you feel upset.

Who does self-harming affect?

According to one recent study published in the BMJ in 2019, the prevalence of non-suicidal self-harm in England has nearly tripled over the past 10 years. As study author Sally McManus explains, “Non-suicidal self-harm is increasingly being reported as a way of coping. We need to help people, especially young people, learn more appropriate and effective ways of dealing with emotional stress.” 

Self-harm doesn’t discriminate and can affect anybody, at any age. Reports show however that the majority are aged between 11 and 25. Social pressures, discrimination and stigma can all lead to high levels of stress, making it more likely for a person to self-harm.

Getting help for self-harming

Once you get into a cycle of self-harming, it can be difficult to stop. Getting professional support can help you make changes. There are different ways to go about getting help and for many, a combination of self-help techniques and professional support is key.

It is OK to feel nervous about asking for help. It takes a lot of bravery to speak up, but remember you are worthy of support and have the right to receive help.

When asking for help, try to be as honest as you can. It may be tempting to downplay the extent of your self-harming, but speaking honestly about the way you’re feeling is the best way to get the right support.

Below we look at some of the different options for getting help:

Speak to your doctor

Visiting your doctor and telling them you want help is a great first step. They can talk through treatment options and, if appropriate, offer medication for related anxiety/depression.

Join a support group

Talking to other people who self-harm in a supportive setting can be comforting. Understanding that you are not alone and sharing your experience with others who ‘get it’ can help you feel lighter.

If you’re worried about going to a support group, you can explore online support forums. Be cautious when searching, as there are some sites that promote self-harm and these can make you feel worse.

Try talking therapies

Counselling and psychotherapy have been shown to be very helpful for people who self-harm. Counselling offers you space and time to talk about your feelings in a safe, non-judgmental and confidential setting.

How to help yourself when you want to self-harm

The urge to self-harm can be intense, making it difficult to know what to do instead. If you’re struggling with this, there are a few things you can try to help yourself.

Recognise your triggers

Try to keep a diary of when you self-harm. Note down what you were doing, how you were feeling and/or what you were thinking before you self-harm to see if you can spot any patterns.

Recognising what triggers you and how you feel before you self-harm can help you anticipate the urge and distract yourself.

Distracting yourself

Distracting yourself when you feel the urge to self-harm can help you change your behaviour. Everyone is different so be sure to try different distraction techniques to see what works best for you. Here are some ideas you could try:

• hitting cushions
• going for a walk
• exercising
• talking to someone
• tidying your room
• listening to music
• writing about how you feel
• drawing
• trying relaxation techniques

If you find distraction doesn’t work, you could also try delaying. This means waiting for five minutes before you self-harm and see if the urge is as strong. Try to build up the amount of time you can put it off.

These self-help techniques are useful for the short term, but in order to recover for the long term, you may need professional support. A professional can help you learn to understand and accept your feelings and help you build self-esteem.

Recovery from self-harm

Recovering from self-harm is totally possible with the right support. This will involve you gaining a better understanding of why you self-harm, recognising your triggers and developing new ways of coping. You may experience relapses when you fall back into old habits, but don’t be discouraged by this if it happens. You are stronger than you know.

What should I be looking for in a counsellor or psychotherapist?

Currently, there are no laws that stipulate what level of training or qualifications a counsellor dealing with self-harm needs. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:

• If you have harmed yourself, you should be offered a full assessment of your needs. This may be by a specialist mental health professional, for example, a psychiatrist or psychiatric nurse.
• After the first full assessment, you may be offered a further assessment or further treatment.
• Psychological treatment has the best evidence for helping people who have self-harmed in the longer term.

Read the full NICE guidelines:

• Self-harm
• Longer-term care and treatment of self-harm

The NHS recommends psychological treatments such as cognitive behavioural therapy (CBT).