Finding a GP can be tough in some areas of France and one of the things that I think is quite similar here as it is in the UK is the misconception that mental health care must be sought through referral from a GP.  Perhaps the fear that cost will be preventative if seeking privately or perhaps the fear of not really knowing where to look and what to look for.  The additional fear of failing to be understood when you may not be fluent in the language of your therapist could be a barrier to seeking help.

Cost can be an worry for some and it is likely that seeking a private therapist might exclude insurance and certainly CPAM reimbursement.  But actually, the reality is that often counsellors don’t charge a high fee and some, like myself, offer a sliding scale or concessions for lower income earners.  Thinking about your mental health as being an important part of your living experience and as important as your physical health needs might help to put into perspective how different things could be if some of the issues that have been affecting you emotionally and mentally were processed and diminished.

English-speaking therapists in some areas of France are more common than others so how can someone go about finding a suitable counsellor/therapist when the choice may be somewhat reduced.  A google search often doesn’t give much joy but you might come across counsellinginfrance,which is a lovely little directory run by an ex-pat that lists counsellors and therapists in all the different parts of France (and Spain on a sister site).

What is most important when looking for a counsellor is that you connect with the person you’re working with and sharing very personal and sometimes painful information with.  If you can’t find a local counsellor who speaks your language or connects with you in a way that feels right you can always consider working with a counsellor online, usually over secure video call.

Often the things that need the work aren’t the aspects of living abroad but these aspects can present a barrier in seeking help for the things that you really need help to explore.  Feeling alone and sometime quite isolated can add to feelings of hopelessness and being stuck.  Knowing that there are ways to find what you need as an ex-pat – that it is often affordable and that you can have a way forward can encourage you take that step and reach out for help and the new life you deserve.

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Both Counselling and Psychotherapy in the UK are unregulated professions and the titles are not protected – this means that essentially anyone can call themselves a counsellor or psychotherapist and offer therapy to individuals and groups and those in couples (or multi-person relationships).  Whilst I actually support it not being regulated as a medical model and remain a more humanistic profession, it can be a worry because without proper training and assessment, people could be offered therapy that isn’t legitimate, appropriate, or ethical by someone who hasn’t been trained properly or gained appropriate experience.

To help manage this there are a number of “Professional Member Organisations” that appropriately trained counsellors and therapists can join when they meet the required level of training/qualifications.  There organisations provide most importantly an ethical framework for their members to follow and a complaints procedure for clients to use.  Once appropriately qualified a counsellor may apply to become a member of their chosen Professional Member Organisation and are often offered support, training opportunities, further levels of accreditation and marketing opportunities.  It is also most often a requirement of any Professional Indemnity Insurance policy that the therapist is a member of an appropriate PMO.

There are quite a few Professional Membership Organisations for the counselling and psychotherapy profession in the UK and those organisations vary in quality and usefulness too.  To aid counsellors in choosing an appropriate Professional Member Organisation and in turn help clients know that their [potential] counsellor is of appropriate training, qualification and follows an appropriate ethical framework there is the Professional Standards Authority.

Whilst the list of Professional Standards Authority approved PMO’s is actually quite long there are popular choices.  I chose the National Counselling Society (NCS) when I qualified (now called the National Counselling and Psychotherapy Society NCPS) because I really like their values and ethical framework. (I am no longer a member since I am no longer UK resident and am seeing clients outside the UK)

Many counsellors believe they MUST join the BACP (British Association for Counsellors and Psychotherapists) but this is misinformation.  Misinformation that has been shared prolifically over the years.  In fact I too thought it was the ONLY PMO to join before I researched it more thoroughly.  For years NHS jobs required BACP membership which was possibly due to the misinformation but certainly strengthened it further.

I should say at this point that many fantastic counsellors and psychotherapists are registered with the BACP and my choice and feelings about the BACP are not a reflection of those professionals at all.

So – why didn’t I join the BACP?

My big number 1 reason is that at the time and for some time since their stance on many LGBTQI+ issues were NOT OK in mine and others’ opinion.  Back in 2015 there was a Memorandum of Understanding regarding Conversion Therapy in the UK.  At the time that it was distributed the BACP dragged their feet in signing it, where other organisations were rightly quick to support and action it.  This caused some upset among LGBTQI+ friendly mental health organisations and led to key figures like Dominic Davies of Pink Therapy (a former Fellow of the BACP) to rip up his fellowship and leave the BACP, moving to the NCS as a more forward thinking and diversity inclusive organisation.

A few years later I was delighted when the BACP seemingly upped their game and enlisted Meg John Barker PhD, leading author, researcher and activist for Gender and Sexual Diversity to write “Good Practice across the Counselling Professions: Gender, Sexual and Relationship Diversity” as a guide for therapists.  I was however, then bitterly disappointed that they showed a lack of understanding for the topics it covered when they easily bent to pressure from anti-trans activists and pulled the guide for revision shortly after it was released.  Whilst it was republished after revision the message was damaging and for me confirmed their uncomfortableness in supporting gender diversity issues.

My second major peev with the BACP is their efforts to monopolise the profession.  By propagating misinformation about membership and qualification requirements of the practice and the profession and also overly monetising the pathways to conform to their own self-appointed requirements. By more forceful means circa 2017/18 when they first created the Scoped Project, which was essentially trying to push out all other professional member organisations and for BACP, UKCP and BCP alone to determine and control the competencies and training/practice standards for the profession.  Rightly so there was push-back from the NCS and other organisations and the Scoped project was forced to become more inclusive to other approved PMO’s.

I see now that the BACP are being negative about the use of Psychedelics in therapy, which as a model is gaining traction and bringing hugely favourable results and relief to many people.  I have to be honest when I say it feels like the BACP is dead set upon values that are outdated and rather backward thinking.

When I joined the NCS after qualification and still today when I look at the (now NCPS) website – pretty much everything they stand for warms my heart and aligns with my values.  They have made mistakes but they own them and are very quick to listen, respond and make changes.  If I was still a UK resident I would absolutely still be a member.  I still follow their ethical framework and support them as an organisation.

Now that I live in France and am seeing clients who are not UK resident it makes more sense for me to belong to an International membership organisation and after some research have chosen the International Institute for Complimentary Therapies, which covers all of the EU (among other global areas) and multiple modalities including counselling and nature-based therapies.  It is also supported by Professional Insurances.

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Men are significantly less likely to reach out for help.

If you, or someone you know is struggling. Whoever you are. It doesn’t have to be this way. Reaching out takes strength but you’re not alone.

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Anxiety is about worry and fear.  All humans feel anxious at times, it’s one of our survival techniques.  When big decisions or changes are to be made it’s natural to worry and stress about them.  We move from what is called our “window of tolerance” <<<< the place where we are calm, open, where we get things done and are able to communicate – into the “flight or fight” place.  The place where our senses become heightened, our brain starts to think ahead, we’re alert, we’re ready to defend or to escape, our muscles are on edge and we’re in the realm of “hyper-arousal”.  This is the place that saves us when we are threatened.

But that place – the “fight or flight” place – that is not a place where you’re supposed to reside on a normal daily basis.  That place is for emergency, for defence, for escape, for battle.  Anxiety takes hold when you’re living too much in the realm of hyper arousal – when you’re using you’re flight or fight resources….just to get through the day.

This causes your brain to constantly assess risk, fantasise about what could happen, play the scenarios, trigger your body to fill itself with adrenaline and other hormones required for flight or fight.  Your mind might feel like its speeding along at 100 miles an hour, your heart pumping, your breath forcing in and out of your body and your limbs tense or fidgeting or buzzing with pins and needles.   You might feel sick or dizzy, hot and sweaty.  The symptoms of anxiety are varied and different for individuals but often the thoughts will leave a person less able to make decisions, unable to concentrate, unable to sleep, fearing the worst and sometimes unable to leave the house.

When anxiety grasps you in an acute way it can lead to a panic attack.  Panic attacks can feel like you’re having a heart attack or that you are going to die.  This creates a viscous circle of worrying thoughts and physical responses that lead to increase the panic. It can be a truly terrifying experience.

Anxiety is exhausting.  Not just making you feel tired, but also taking it’s toll on your body and brain.  The long term effects of anxiety can include insomnia, depression, a lowered immune system, addiction, and a reduced sex drive.

The causes of anxiety are also varied but could include:

• past or childhood experiences
• your everyday life and habits
• your diet
• your physical and mental health
• any drugs or medication you might be taking
• genetics

 (source: Mind)

There are lots of ways to help with anxiety.  Medication is often used by GPs to help alleviate symptoms of anxiety – antidepressants, beta blocker, tranquillisers – but to get to the root of your anxiety and make a long-term change you are likely to need other treatments to identify the cause and make the changes that are sustainable and often permanent.  According to the National Institute for Health and Care Excellence (NICE) – the organisation that produces health care guidelines – ideally your doctor should offer you other kinds of treatment for anxiety first, before prescribing these drugs.

Talk therapy (counselling) can be a very effective way to help with anxiety.  Cognitive Behaviour Therapy is one type of counselling that can be very effective with anxiety but there are also many more types of therapy that are equally or sometimes more helpful.   It’s about finding a therapy and a therapist that works for you.  An integrative counsellor with have a number of models and techniques they can use to find a therapeutic solution that works for you.

Anxiety can feel very lonely.  But you don’t need to do this alone.  It doesn’t have to be this way.  Reach out for help.

Picture Source

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Depression is a low mood that lasts for a long time, and affects your everyday life.  In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make you feel suicidal or simply give up the will to live.²

Depression has many causes and symptoms can vary but many people describe feeling hopeless, tired, numb and low to varying degrees. It affects women, men, children, the elderly, all sexualities, and all nationalities.  Depression can lead to self-harm, eating disorders and suicide.

Depression is often treated with medication (anti-depressants) and for many people this provides a relief.  But medication isn’t always an easy route and it can take some time to find the optimum drug and dosage for you – often it takes weeks for anti-depressants to settle and work – and there are many side-effects that can affect people in different ways.  It always seems so contrary that one of the side-effects of anti-depressants can be suicide.  It’s because of the delicate balance that each person needs to find for the medication to be able to help.  It’s not unusual for feelings to get worse before they get better when starting with anti-depressants.

Some of the side-effects of medications leave many people looking for other ways to treat their depression.  Medication can provide a good “sticky-plaster” but it won’t deal with the cause of the depression.  For many people – whether they be on medication or not – exploring where the depression has come from and processing some of these things – raising self-awareness and developing skills and tools, is a much more effective and long-term solution.

When you feel hopeless and dark and your energy has gone, it may seem like there is no way for this to get better – that there is nowhere for you to go – no hope for recovery.  But this simply isn’t true.  This is part of your depression – you mind telling you things that feed into the depression – as it does…..so often.  Your thoughts are NOT YOU.  You are the person who is having those thoughts.

Many people DO find recovery from depression – many people find ways to manage their depression.  Counselling can help.   There are many different types of counselling (or talk therapy) and some will be more effective for you than others – it’s not a “one-size fits all”.  CBT (Cognitive Behaviour Therapy) can be effective with depression but there are also many other types of counselling / therapy that can be highly effective.

One of the most important things with counselling is that you can connect with your counsellor/therapist.  If you can’t relate to them, or them to you – or you just don’t like them or the way they work….your work together is likely to be less effective, if at all.  This is why many people who have tried counselling say it didn’t work for them.  It’s about finding the right counsellor – someone you can really feel comfortable with – can share your pain with and someone you trust.

Sadly, when you’re referred for counselling through the NHS you can wait many months and won’t usually get a choice about who your counsellor is or what type of counselling you can have.   Finding a private counsellor can be expensive – but many counsellors offer low rates for people on low income so do look around and don’t believe that private counselling is not an option for you.  It is an option for you.

If you are struggling with depression or you’re experiencing thoughts and feelings that you think might be depression – book an initial chat and see if counselling might help you.  The chances are…..it will.

Sources:

¹. Mental Health Foundation

². Mind

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As individuals we are complex and over time we change and develop.  All of us.  People change, relationships change.  Whether we want it or not.

Sometimes the changes are wanted and sometimes they’re not by one or more of the individuals in the relationship.  Sometimes the changes aren’t where we want them to be and actually the biggest issues in the relationship need to….but don’t ever seem to change.

Every relationship will be different but there are a number of key things that can make or break them:

• • Communication – are you able to communicate within your relationship?  Do you feel heard?  Do you listen?  How do you feel when you’re spoken to?  How do you feel when you speak?  What emotions come up for you and why?  Do you struggle to get your message across to your partner?  Do you end up yelling at each other?  Is it easier to just keep quiet?  Do you get the silent treatment?  Do you communicate well in your relationship or is there room for improvement?

• • Expectations – Understanding everyone’s expectations within a relationship and managing those expectations is really quite important in terms of sustainability and longevity.  Do you even know what you want or need from your relationship?  Do you know what your partner wants and needs from you?  Did you ever talk about what each of you expect from each other and the relationship? If expectations aren’t compatible, what does it mean?  Are the individuals in the relationship willing to accommodate each other’s needs, wants and expectations?  Of course, expectations will also change over time as your needs and wants change too.  How does that affect each of you and how will you manage those changes?

• • Contact and connection – Whether it be physical, mental, sensual, erotic, or virtual – relationships generally need contact and connection.  Individuals that have no contact or connection – aren’t in a relationship.  What kind of contact do you both need and are you able to give?  How will you maintain contact and connection?  How will you manage changes to the contact?  Is there too much demand for contact – do you feel stifled or suffocating?  Do you see yourselves “growing apart”?  What is that like for you both and why does it happen?  Is your connection healthy?

Beyond these simple questions there is so much more of course.  As individuals you are made up of who YOU are and your life experiences bring you to this relationship with everything that you are to your core.  Your fears, your beliefs, your values, your traumas, your previous relationship experiences, your family history, your education, your childhood development.  Everything that you are.  How well do you know and understand yourself?  How well do you know and understand your partner?  How do these things impact upon how you communicate, your expectations and your ability to connect?  What else affects your relationship?  Drink?  Anger?  Violence?  Sex?  No sex?  Not the kind of sex we want? Family?  Friends?  Work stress?  Health?  Addictions?  Financial stress?  Ex-partners/wives/husbands?  Children?  What kind of impact could improved communication, managing of expectations and contact have on these things in your life?

Are you ready for change?

A lot of people aren’t really ready for change.  They think they are – but change is uncomfortable, it’s challenging, it’s hard – especially when the change needs to come from you too.

If you’re ready for things to be different then maybe it’s time to reach out and accept some help.  You’ve been trying to sort things out by yourself and some things have been positive and some things haven’t.  If it feels like you’re struggling to figure out how things can change then counselling can help.  A counsellor is not there to fix anything for you – a counsellor doesn’t have all the answers.  There is no magic wand.  But having someone hear you – I mean really hear you – without judgement and without agenda – having someone see your world and be totally accepting and willing to look at it with you and work with you to figure things out – THAT is what helps bring about change.  The sort of changes that you want and need.

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