Trueform Therapy

Tag: therapy

  • When Something Feels Off With Your Therapist

    Maybe it’s a small thing. Your therapist said something that didn’t sit right, and you nodded along. Maybe it’s bigger: weeks of sessions that feel like they’re going nowhere, or a sense that you’re not being understood. You notice it on the way home. You think about mentioning it next time. And then, next time, you don’t.

    Many people never say it. They keep going for a while, feeling a little worse about it each week, and then they stop booking sessions. Sometimes they conclude that therapy just doesn’t work for them.

    I want to suggest something different. That uneasy feeling is worth taking seriously. And saying it out loud, to your therapist, might be one of the most useful things you ever do in therapy.

    The Things People Don’t Say

    If you’ve ever held something back from a therapist, you’re far from alone. In research by Barry Farber, Matt Blanchard and Melanie Love, 93 percent of people surveyed said they had lied to a therapist at least once. Most often, it was out of embarrassment. But some of it was something else: wanting the therapist’s approval, or not wanting to cause problems. In other words, the same people-pleasing that brings many people to therapy in the first place can follow them into the therapy room.

    It doesn’t help that therapists aren’t as good at noticing when something’s wrong as you might hope. In one well-known study, therapists were asked to predict which of their clients would get worse. Out of 550 clients, they predicted three, even though they’d been told that around 8 percent of clients in their clinic usually did.

    So if you’re waiting for your therapist to notice that something isn’t working, you might be waiting a long time. That’s not because they don’t care. It’s because what goes on inside you isn’t always visible from the other chair.

    Why Saying It Can Help

    Here’s what I find most interesting about this.

    Researchers who study the therapy relationship, particularly Jeremy Safran, Christopher Muran and Catherine Eubanks, have looked at what they call “ruptures”: moments when the connection between client and therapist strains or breaks down, through a misunderstanding, a disagreement, or a sense of not being heard. You might expect ruptures to be bad for therapy. But their research suggests that when a rupture is noticed and worked through together, therapy tends to go better, not worse. The evidence is still fairly small, but it points in an encouraging direction.

    I see why in my own work. For many people, telling their therapist “that didn’t feel right” or “I’m not sure this is helping” is the first time they’ve ever said something like that to someone who matters to them, and had it heard rather than punished. If you grew up learning to keep the peace, to avoid disappointing people, or to hide your needs, then saying it in the therapy room isn’t a detour from therapy. It’s therapy, happening in real time.

    A good therapist will welcome it. They may feel a flicker of discomfort, as anyone would, but they’ll be curious rather than defensive. And how they respond will tell you a lot about whether this is the right person for you.

    Comfort Isn’t the Whole Story

    It’s natural to look for a therapist you feel comfortable with, and that matters. But “comfortable” can be a little misleading.

    Good therapy isn’t always comfortable. Sometimes it touches on things you’ve spent years avoiding, and that’s going to feel uneasy, at least for a while. Feeling uncomfortable isn’t necessarily a sign of a bad fit. Sometimes it’s a sign that you’re getting somewhere.

    The difference is in how the discomfort feels. Uncomfortable but safe is one thing: you’re finding something hard, but you feel respected, heard and free to slow down. Feeling judged, dismissed, pushed too fast or not taken seriously is something else. That’s worth paying attention to.

    A few questions can help you tell the difference. Do I feel listened to? Do we agree, roughly, on what we’re working on? Does the way we work suit me, or am I fitting myself around their approach? Could I tell them if something wasn’t working? If the answer to the last question is no, that in itself is worth exploring, with them if you can.

    What Experience Does and Doesn’t Tell You

    It’s easy to assume that the more years a therapist has been practising, the better they’ll be. The research is more surprising.

    In a 2016 study, Simon Goldberg and colleagues followed 170 therapists working with more than 6,500 clients over as many as 18 years. On average, the therapists’ outcomes didn’t improve with experience. If anything, they declined very slightly.

    That doesn’t mean experience counts for nothing, or that new therapists are better. Some therapists do keep improving, and specific training matters a great deal for some difficulties, such as trauma or eating disorders. But it does mean that years in practice on their own aren’t a reliable guide. It’s more useful to ask how a therapist keeps learning, how they check whether therapy is helping, and whether they’ve trained in what you’re looking for help with.

    Checking the Basics

    There are a few practical things worth checking before you start.

    In the UK, “counsellor” and “psychotherapist” are not legally protected titles. In theory, anyone can use them. The best safeguard is to check that your therapist is registered with a professional body that holds an accredited register approved by the Professional Standards Authority, such as the BACP, UKCP or National Counselling and Psychotherapy Society. You can search each organisation’s register online. Registration means they’ve met training standards, follow an ethical framework, have regular supervision, and that there’s somewhere to turn if something goes wrong.

    It’s also reasonable to expect a clear agreement at the start: how often you’ll meet, what it costs, the cancellation policy, and how confidentiality works, including its limits.

    And then there are the everyday practicalities: whether session times fit around your life, whether the cost is sustainable, and whether the location, or online sessions, work for you. These matter more than they might seem. Therapy that’s hard to get to is hard to keep up.

    One thing worth knowing: most therapists in private practice aren’t able to offer support between sessions in a crisis. If you need urgent help, you can contact your GP, call NHS 111 (in Wales, 111 and press 2 for mental health support), or call Samaritans any time on 116 123.

    If It Still Isn’t Right

    Sometimes, even after talking about it, the fit just isn’t there. That’s OK. It’s not a failure, on your part or theirs. People are different, and so are therapists.

    If you decide to end, it can help to have a final session to close things properly, rather than just stopping. Many therapists are also happy to suggest colleagues who might suit you better. And when you start again with someone new, you’ll know more about what you need, which is useful in itself.

    A Relationship Worth Getting Right

    The relationship with your therapist is one of the strongest predictors of whether therapy helps. That makes it worth paying attention to, and worth speaking up for.

    At Trueform Therapy, I offer one-to-one sessions in person in Cardiff and online across the UK and EU. I’m a registered member of the BACP, and I’ll regularly check with you how the work feels and whether it’s helping. If something isn’t working, I want to know. If you’d like to see whether we’d be a good fit, you’re welcome to get in touch for an initial conversation.

    If You Want to Explore These Ideas Further

    If you’re curious about what goes unsaid in therapy, Barry Farber, Matt Blanchard and Melanie Love’s Secrets and Lies in Psychotherapy explores why clients hold things back, and what helps. It’s written for professionals, but it’s readable.

    For a sense of what a good therapy relationship looks like from the therapist’s side, Irvin Yalom’s The Gift of Therapy (2002) is short, warm and full of practical wisdom.

    And if you’d like to look at the research directly:

    How to check a therapist is registered in the UK: Therapy Route

    Why people lie to their therapists: TIME

    Do therapists improve with experience? (Goldberg and colleagues, 2016): Society of Clinical Psychology summary

    Alliance ruptures and repair in therapy (Safran, Muran and Eubanks-Carter): summary (PDF)

  • Why Trying to Calm Down Can Keep You Anxious

    Anxiety is not a personal failing, a mindset problem, or a sign that you “can’t relax”. It’s your body’s threat system doing its job. Sometimes the visit is brief and useful. Sometimes anxiety arrives, puts its feet up on the coffee table, and refuses to leave.

    Most advice about anxiety is about getting rid of it: breathe, relax, think positive, calm down. Some of that advice genuinely helps. But there’s something about anxiety that much of this advice misses, and I think it explains why so many people try everything and still feel stuck.

    Sometimes, the harder we try to make anxiety go away, the longer it stays.

    What Anxiety Is Trying to Do

    Anxiety prepares you for danger. It makes you more alert, tenses your muscles, speeds up your heart and your thinking. That’s very helpful if you’re stepping out in front of an oncoming car. It’s much less helpful when you’re lying awake at 2am replaying a conversation from 2017.

    It shows up in the body as much as the mind: restlessness, tight shoulders or jaw, a churning stomach, a racing heart, shallow breathing. It shows up as irritability, as trouble concentrating, and as a kind of tiredness that surprises people. Anxiety is exhausting.

    For some people, it settles into more persistent patterns, such as generalised anxiety, panic attacks, social anxiety or phobias. These have different names and look different from the outside, but they share a common thread: a threat system that has become very good at spotting danger, and much less good at standing down.

    The Trouble With Getting Rid of It

    Here’s the part that often surprises people.

    When anxiety rises, it’s natural to do something to make it stop. We leave the situation. We avoid the next one. We check, reassure ourselves, distract, or reach for a technique to calm down. In the moment, it works. The anxiety drops, and we feel relief.

    But that relief teaches the threat system something. It learns: that was dangerous, and we only got through it because we escaped. Next time, the alarm goes off a little sooner.

    Psychologists call these strategies “safety behaviours”, and there’s good evidence that they play a part in keeping anxiety going. Even helpful tools, like breathing exercises, can work this way if we use them as an emergency exit: something we must do to get rid of the feeling, rather than a way of steadying ourselves while we stay.

    I want to be careful here, because the picture isn’t simple. A 2016 review by Shannon Blakey and Jonathan Abramowitz found that the evidence on safety behaviours during therapy is mixed. Used thoughtfully, some may help people approach things they would otherwise avoid altogether. So it isn’t that coping tools are bad. It’s that how and why we use them matters.

    The question to ask isn’t just “does this calm me down?” It’s “does this help me stay with my life, or help me escape from it?”

    Tools That Help, and How to Use Them

    With that in mind, there are things that genuinely help. Think of them less as ways to make anxiety vanish, and more as ways to bring your nervous system back within reach, so you can carry on.

    Start with the body. An anxious body struggles to listen to logic, so this is often the place to begin.

    Movement is one of the best-supported things you can do. You don’t need a fitness overhaul. Walking counts. Stretching counts. A large body of research has found that physical activity reduces anxiety, often noticeably.

    Sleep matters more than most people realise. A 2019 study by Matthew Walker’s team at the University of California, Berkeley found that a single sleepless night raised anxiety levels by up to 30 percent in healthy adults. It was a small study, but it fits with what many people notice. So aim for consistency rather than perfection, and be kind to yourself after a bad night. A poor night’s sleep is data, not a judgement. It tells you something about your capacity the next day.

    Regular meals help too. Long gaps without eating can bring on shakiness, a racing heart and irritability, which feel a lot like anxiety and can make it worse.

    Slow your breathing, especially the out-breath. Try breathing in for a count of four and out for six. If counting annoys you, just make each breath out a little longer than the breath in. That’s enough. In a 2023 study at Stanford, people who spent five minutes a day on “cyclic sighing”, a breathing pattern that emphasises long, slow out-breaths, saw greater improvements in mood than people who practised mindfulness meditation. The study was small and mostly involved young, healthy students, so it’s an encouraging sign rather than the final word.

    Tense, then release. Clench a group of muscles for a few seconds, then let go. Work your way around the body. This is less about forcing yourself to relax, and more about reminding your body what not tense feels like.

    Be curious about your thoughts, not convinced by them. Anxiety is excellent at presenting opinions as facts. Instead of “this will go badly”, try “I’m having the thought that this will go badly”. That small step back creates a little distance. You can also ask yourself gently: what’s the evidence? What else might happen? You’re not arguing with your brain. You’re just widening the view.

    Shrink the task. Anxiety loves vague, enormous goals. Break things into small, even boring, steps. Progress beats motivation every time.

    Moving Towards, Not Away

    Perhaps the most powerful thing you can do with anxiety is the least comfortable: gradually moving towards the things it tells you to avoid.

    This is the idea behind exposure, one of the best-researched approaches to anxiety. You approach what frightens you in small, manageable steps, and allow the anxiety to be there without trying to escape it. Over time, the threat system learns something new: I felt anxious, I stayed, and I was OK. That learning is what helps anxiety soften, not the absence of the feeling.

    Other approaches arrive at a similar place from different directions. Acceptance-based therapies encourage making room for anxiety rather than fighting it. And the existential psychologist Rollo May argued that some anxiety is simply part of living a full life: a sign that we’re facing something that matters to us, or stepping into the unknown.

    None of this means forcing yourself into overwhelming situations. It means small steps, at a pace that feels challenging but bearable, ideally with support.

    You Don’t Have to Do It Alone

    Anxiety tends to isolate us, and connection interrupts that.

    Talking to someone you trust can help, even if they don’t offer solutions. Being heard often takes some of the intensity out of anxiety on its own. Peer support groups can help too: there’s something steadying about hearing “me too”.

    Therapy isn’t a last resort, either. Cognitive behavioural therapy has particularly strong evidence for anxiety, and other approaches can help as well, especially when anxiety is tangled up with older patterns, with loss, or with questions about how you want to live. At Trueform Therapy, I offer one-to-one sessions in person in Cardiff and online across the UK and EU, and we can draw on whichever approaches suit you best.

    When It’s Worth Seeing Your GP

    If your anxiety is new, has changed suddenly, or comes with strong physical symptoms such as chest pain, palpitations or breathlessness, it’s worth seeing your GP. Some physical conditions, such as thyroid problems, as well as some medications and lots of caffeine, can cause symptoms that feel like anxiety. It’s always worth ruling those out.

    One Slower Breath

    Anxiety doesn’t disappear because you tried hard enough to make it go. It tends to soften when your nervous system learns, again and again, that it’s safe enough, supported enough, and not alone. Progress is often uneven. That’s normal.

    If anxiety is running the show, getting help isn’t weakness or failure. It’s a sensible response to a system under strain.

    And if today all you managed was reading this and taking one slower breath, that still counts.

    If You Want to Explore These Ideas Further

    If you’re interested in anxiety as part of being human rather than only a problem to fix, Rollo May’s The Meaning of Anxiety (1950) is a classic. It’s philosophical, but deeply humane.

    For a practical introduction to making room for anxiety rather than fighting it, Russ Harris’s The Happiness Trap is a clear, accessible guide to acceptance and commitment therapy.

    If you’d like a structured self-help approach, Helen Kennerley’s Overcoming Anxiety is a well-regarded CBT-based guide from the UK’s Overcoming series.

    And if you’d like to look at the research directly:

    Blakey and Abramowitz’s review of safety behaviours in anxiety (2016): RTI International

    How one sleepless night affects anxiety: ZME Science summary

    The Stanford study on breathing practices and mood: Simply Psychology summary

  • Can Counselling Really Help? An Honest Answer

    “Can counselling really help?”

    It’s one of the most common questions people bring to a first session, sometimes before they’ve even sat down. Often it comes with other questions underneath it. What if I don’t know what to say? What if talking to a stranger makes things worse? What if I’m not the kind of person it works for?

    I understand those doubts, because I had them too. I’ve been a client myself, and I was sceptical about whether talking to someone could really make a difference.

    So I want to give an honest answer to that question. Not a sales pitch, and not a list of reassurances, but what the research and my own experience actually say.

    The Short Answer

    For most people, yes. Counselling helps.

    The research on this is large and fairly consistent. For depression, talking therapy and antidepressant medication have broadly similar effects in the short term. A 2013 review led by Pim Cuijpers, who has spent much of his career comparing treatments for depression, also found that people were less likely to drop out of therapy than out of medication. And people who had CBT were less likely to relapse afterwards than people who stopped taking medication. The changes people make in therapy seem to last after it ends.

    There’s also UK research that matters particularly for counsellors. In the PRaCTICED trial, published in The Lancet Psychiatry in 2021, researchers in Sheffield compared person-centred counselling with CBT for 510 people with moderate to severe depression in the NHS. At six months, counselling was found to be no less effective than CBT. At twelve months, CBT had a small edge. It’s a reminder that different approaches can work, and that the full picture is rarely as simple as one therapy being “the best”.

    That said, “most people” isn’t “everyone”, and I’ll come back to that.

    What Actually Makes It Work

    If you ask people what makes therapy work, they often guess it’s the technique: the right method, the right exercises. Technique matters. But one of the most consistent findings in therapy research points somewhere else.

    An international task force led by Christoph Flückiger at the University of Zurich looked at almost 400 studies of the relationship between client and therapist, sometimes called the therapeutic alliance. Across different approaches, problems and countries, the quality of that relationship predicted how well therapy went. In other words, feeling understood, trusting the person you’re working with, and agreeing on what you’re working towards are not just pleasant extras. They’re part of what makes change possible.

    There’s another finding I find important, and it comes from the research behind the approach I trained in. Mick Cooper, who helped develop pluralistic counselling, worked with colleagues on a review of 51 studies involving around 16,000 clients. They found that when people received the kind of therapy they preferred, they did a little better, and they were almost half as likely to drop out early.

    That means your preferences matter. If you know you want practical tools, or space to talk without being steered, or to understand where your patterns come from, that’s useful information, not something to keep to yourself. A good counsellor will want to know.

    The Part People Don’t Talk About

    Here’s something that rarely appears on therapy websites: counselling doesn’t help everyone. In clinical trials, an estimated 5 to 10 percent of adults end therapy feeling worse than when they started. In routine care, the figures for people who don’t improve are higher still.

    What’s striking is how poorly therapists notice this. In one well-known study, therapists were told how often clients in their clinic usually got worse, and then asked to predict which of their own clients would. Out of 550 clients, they predicted just three.

    I’m not sharing this to put anyone off. I’m sharing it because it changes something important: if counselling isn’t helping, it’s not a sign that you’re failing at it. It might be the wrong approach, the wrong timing, or simply the wrong fit. The most useful thing you can do is say so. Any good counsellor should welcome that conversation. And if it still doesn’t feel right, it’s completely acceptable to try someone else.

    What Counselling Isn’t

    A few ideas tend to put people off before they start.

    It isn’t only for people in crisis. Many people come to counselling not because everything has fallen apart, but because something feels stuck, or heavy, or not quite right. You don’t have to wait until things feel unbearable.

    It isn’t a quick fix, but it isn’t endless either. Change usually takes time, and it isn’t always a straight line. Sometimes things feel harder before they feel easier. But it also shouldn’t feel like years of going round in circles. It’s reasonable to talk with your counsellor, from time to time, about how things are going.

    Your counsellor won’t tell you what to do. The decisions about your life stay yours. That doesn’t mean sitting in silence, though. Depending on what you want, a counsellor might offer ideas, share something useful about how the mind works, or suggest something to try. The point is that it’s collaborative, and you’re in charge of the direction.

    My Own Experience as a Client

    When I first went to counselling, I felt overwhelmed and unsure how to make sense of my own emotions. I didn’t expect much.

    Slowly, I began to understand the patterns underneath the anxiety and self-doubt I’d been carrying. My counsellor introduced things like mindfulness and journaling, which helped me step back and see my feelings more clearly. The changes were small at first: feeling calmer in situations that used to set me off, being able to say what I needed, reconnecting with friends and family in a healthier way.

    It wasn’t always easy. But by the end, I felt more in control of my life, and kinder towards myself than I’d been before. Those changes didn’t disappear when the sessions ended, either. I still draw on them today.

    What the First Sessions Are Like

    The first session or two are mostly about getting to know each other. Your counsellor will ask what’s brought you, a little about your life and history, and what you’d like to be different. You don’t have to tell your whole story at once, or know exactly what you want to work on. It’s fine to say “I’m not sure”, and to start there.

    It’s also a chance for you to decide whether this feels like someone you can work with. You’re allowed to ask questions too: how they work, what they’ve trained in, what happens if something isn’t working.

    Your counsellor will also explain confidentiality. What you share stays private, with a small number of exceptions, such as when there’s a serious risk of harm to you or someone else. A good counsellor will be clear about exactly where those limits are, so there are no surprises.

    Starting Where You Are

    Deciding to try counselling can take a long time. If you’ve been wondering whether it could help, that wondering is worth paying attention to.

    At Trueform Therapy, I offer one-to-one sessions in person in Cardiff and online across the UK and EU. My training is integrative and pluralistic, which means we’ll shape the work around what helps you, rather than fitting you into a single approach. If you’d like to find out whether we’d be a good fit, you’re welcome to get in touch for an initial conversation.

    You don’t need to have the right words. You can start exactly where you are.

    If You Want to Explore These Ideas Further

    If you’re curious about what research says about how therapy works, Mick Cooper’s Essential Research Findings in Counselling and Psychotherapy is the clearest summary I know of. It’s written for practitioners, but it’s readable and honest about what we do and don’t know.

    For a view from inside the therapy room, Irvin Yalom’s The Gift of Therapy (2002) is a short, warm collection of reflections from one of the most respected therapists of his generation.

    And if you’d like to know what therapy feels like from both chairs, Lori Gottlieb’s Maybe You Should Talk to Someone (2019) follows a therapist who goes to see a therapist herself. It’s funny, moving and surprisingly honest.

    And if you’d like to look at the research directly: