Habit reversal training can be used to stop a number of difficult and distressing behaviours including trichotillomania (hair pulling), nail biting, skin picking (not just scratching), thumb sucking...you name it, you can probably use habit reversal on it! I work in a context where I'm working with people who struggle with scratching their skin, so that's what I use it for the most.

The itch-scratch cycle

​If you have an itch, you scratch it, right? That's a normal, expected human behaviour, and for many of us it solves the problem right away. If you've got a skin condition like eczema however, then scratching can cause even more difficulties over time.

Eczema itches because of a number of different things. One is inflammation, which stimulates nerve endings in the skin and causes irritation. Another, lesser-known cause of itching is psychogenic itch - put it this way, how many times have you scratched your skin since starting to read this article? Itch can be stimulated by a number of things, including stress or just because it's become habitual to scratch at a certain time of day. Heat can also make things more tricky, and make you itch more.

When you have eczema and you scratch, this can damage your skin - often intense scratching is needed to feel relief. This kind of skin damage can lead to broken skin, which can become even more irritated - leading you to scratch more to feel less itchy. This intense scratching can also cause thickening of the skin, which can take a while to fade.

This "itching - scratching - irritation - more itching" cycle is called, unsurprisingly, the itch-scratch cycle.

Things to do as well as habit reversal

It bears saying here that if you've got eczema and you're struggling with itch, there are things that you can do to help. Seeing a dermatologist can give you a range of options in terms of medications, and moisturising your skin with an emollient can help prevent water loss from your skin (as dry skin is likely to also be itchy). Reducing stress is also helpful, as is trying to stay cool - especially at night, as this is often the time that skin becomes more itchy and can make sleep more difficult.

Habit reversal

Habit reversal is a way of starting to take note of all the times that you scratch your skin, and then systematically tackling them. It's not about "just stopping scratching," as most people are likely aware on some level how much they are scratching and can't just stop.

The first step is to note how many times a day you're scratching. Most people think they've got a good handle on this - and most people are also shocked when they actually start to keep a tally. The easiest way to do this is to get a click counter (the kind of thing that bouncers use to count people into nightclubs) and click every time you scratch. One "click" equals one episode of scratching, no matter how long it is - and you can't "click" at night if you're scratching in your sleep, as you're not aware of how many times you've scratched. Once you have an accurate count of how many times during the day you're scratching, then you can start to pair this with what's going on.

Example

"I've found that I'm scratching a lot on a morning before work, especially when I think about the day ahead. I'm absent-mindedly scratching at lunchtimes whilst eating, and I'm also scratching more on an evening because I'm getting warmer and it really itches then. My partner also noticed me scratching when my cousin called me last week; whilst I was on the phone I was scratching the back of my neck and I didn't even realise!"

Competing stimulus, urge surfing and distraction

Once you've noticed how much you're scratching, you can try to use a competing stimulus to help combat the sensation of wanting to scratch. This can be anything (pinching your skin, clenching your fists, placing a hand over the area that itches) but you need to do it consistently until the urge to scratch goes away.

Often people think that the urge to scratch will climb and climb until it becomes overwhelming and unbearable. This is often not the case. Learning how to "urge surf" (or, sit with the itch and just notice it until it starts to subside) can be really helpful to prevent scratching. For those times when you just can't be mindful, distraction also works well. You can learn more about urge surfing in this short meditation here.

Ultimately, none of this is easy - but neither is living with broken, itchy skin all the time. Habit reversal won't stop the itching completely - but it helps you respond to it differently, and that can help you to stop scratching, which helps skin to heal up. This in itself can reduce itch over time, although of course you'll still have the eczema to manage.

Conclusion

Habit reversal training can be really helpful for a number of different things, and in this whistle-stop tour we've looked at eczema specifically. If you think that habit reversal might be helpful for you, there's lots of information about it online or you can ask your GP to refer you to a health-related psychology service which may be able to help.

I hope you've found this interesting - let me know in the comments!

So, the last blog post I wrote was in June, and a lot has happened since then!

I've stopped working for Mindler. They're an absolutely fantastic company and I feel that the work I was doing there did make a difference, but I was doing it on top of my full-time NHS job. This meant that I was doing two evenings a week on top of a full day of work, and it wasn't sustainable for me any more. Part of self-care is knowing when you're struggling, and I'd be a bit of a hypocrite if I didn't take my own advice. So, I scaled back on the working, which means I'm not doing any private work currently.

I've also changed my hours in the NHS, compressing my work into four days rather than five. That means that I can do things like write blog posts at 11am, as I'm not working Mondays from now on. This is a relatively new thing, but I have to say I'm enjoying it so far!

"But Sarah," I hear you say, "are you just going to spend Mondays lying in bed, reading books and eating toast?!"

Well...that sounds pretty good, now you mention it!

If I wanted to do that, I'd be well within my rights to - however, I took this decision so that I could focus more time on writing. I want to write short stories, and longer stories, and to do that I need a dedicated space to write, which is going to be my Mondays. That means that I might be writing more blog posts (although probably not one a week, maybe more like one a month), and if I do write anything else that's published, I'll link to it on here.

All of this is part of my focus for this year, which is on writing and personal growth. As I said, this is just a brief little blog post to update the focus of this blog, but I hope that whatever you're focusing on this year, you've had a brilliant winter so far and that the best is yet to come.
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I've always been a keen gardener, learning from my mum about plants and then growing my own when I moved out of home. Over the years, it's been something that I've managed to keep doing throughout house moves and general life stress, and it's something that I genuinely enjoy (apart from when the slugs eat all my dahlias or there aren't enough ladybirds to keep on top of the aphid population!)

You might not know this even if you're in the UK, but gardening is something that the NHS has been prescribing for people (via social prescribing initiatives) since 2019. There's a significant body of research suggesting that being out in green spaces is supportive of health and wellbeing, and that includes mental health and wellbeing too!

Making space
One of the benefits of gardening is that it gives you time out from the daily grind. There's no real way to "hurry up" the process of planting, tending to and growing plants, so you have to be patient and make space in your life for seeds to turn into seedlings, and for those seedlings to turn into beautiful plants. It encourages you to slow down and savour the moment - and these days, that is an important skill to cultivate.

Dealing with disappointment
Aside from the previously mentioned slugs and aphids, there are a million ways that gardening can go slightly wrong - if the weather is too wet, dry, or simply too much at the wrong time, if the ecosystem in your garden isn't balanced so that you end up with too many of one insect and not enough predators/prey, if you go away for a long weekend and we end up with a surprise heatwave - all these things and more can lead to your plants withering and sometimes dying before you've even realised that there's a problem. Gardening helps you to realise that there are often disappointments in life, but that you have the skills to cope with them - plant more seeds, keep on top of the weeding, or try again next year. Better days are coming.
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Engage your senses

Gardening is a naturally mindful activity - as we've said, it encourages you to slow down and notice what's happening around you. But it also encourages you to engage all of your senses in doing so, which allows you to fully immerse yourself in the experience. Do you know what an apple tree smells like when it's in blossom? Have you ever stopped to watch a bee collecting pollen from a flower? Can you tell the difference between a magpie call and a starling call? Spend a bit of time in your garden, and you soon will.

Accessible to all

Not everyone has access to a garden, or to any green space that they can call their own (my last house had an entirely paved back garden where nothing would dare to grow unless it was in a pot), but most everyone has access to a windowsill, a small pot of dirt where you can put some marigolds, a friend who can get you £1 daffodils from the supermarket in Spring. You don't have to have a huge garden - you don't even really have to get outside, although if you can it'll be better for you - but anyone can grow something, from houseplants to basil for sprinkling on your pasta. Gardening is a really accessible hobby.

My favourites

Everyone has a favourite plant - if you're looking for some interesting things to grow in order to set off your passion for gardening, here are the plants I enjoy watching grow in my garden:

• I have a miniature apple tree in a pot, which I've had for a few years now - I've never had an edible apple from it, and it's looking like it might have a case of the rust now, but every Spring it's covered in lovely pinky-white blossom, which makes it worth keeping around.
• Stocks (matthiola) are one of my favourite annuals - really hardy, with masses of colourful flowers, I always have some to hand. Some of them smell amazing, too!
• Nicotiana - I grow this as an annual, and I read somewhere that it helps attract bats to your garden due to the evening smell being attractive to moths. I don't know if that's true but we did have a bat flying around last year, so I'll be trying it again this year!
• Alliums - giant purple globes which attract the first of the year's bees every Spring - they're long gone by the time the summer comes in, but planting bulbs in Autumn is such a lovely, hopeful idea that I do it every year if I can. 

Do you like gardening, or do you want to learn? Let me know in the comments!
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Today has sucked. It started off well, and then a series of misunderstandings and a growing sense of overwhelm has threatened to tip me off balance. It doesn't happen often, but when it does I rely on my self-soothing strategies to get me through the rest of the day.

What is self-soothing?

Self-soothing is actually a term that we tend to apply to children in the first instance. It refers to a child's ability to soothe itself (e.g. to stop crying) rather than relying on an adult caregiver for external soothing. When babies are very small, they need us to cuddle them, feed them, distract them from their distress. As they get older, they can do these things themselves - calm themselves down instead of becoming overwhelmed and upset.

What happens as we grow up?

As we get older, we learn some ways to manage distress when we're around others, and some ways to manage it when we're alone. Not all self-soothing strategies are created equally, and some can do more harm in the long term than good. But the important thing to note is that the need to soothe yourself to manage difficult feelings never goes away - it's something that toddlers learn to do, but it's something that adults also need to do (and adults have a wider range of options available to them than toddlers!)

What are some examples of self-soothing?

Anything that you do that helps you to manage feeling of distress can be classed as self-soothing. Things that soothe the difficult emotions in you might not soothe the same emotions in others; it's a highly individual thing, often based on things you learned as you were growing up. Presented without judgment, some examples of self-soothing behaviours are:

• Going for a walk or a jog
• Squeezing a stress ball
• Skin picking, or biting your fingernails
• Hitting a punch bag
• Talking to a friend about how you're feeling
• Taking a bath
• Having a cup of tea
• Smoking or vaping
• Drinking alcohol
• Mindfulness or relaxation strategies
• Self-harm

As you can see, there are lots of different ways to self-soothe - and, whilst there's no judgment here, some of the above are likely to be better for you in the longer term than others.

How do you self-soothe?

As I'm writing this, I've got a cup of tea to my right hand side, which I'm occasionally remembering to sip on. I've got a hot water bottle on my back, because it makes me feel calmer and more relaxed, and I've been doing some deep breathing, which always helps me to feel centred. I spent a bit of time earlier venting to my partner, and in about 20 minutes I'm going to watch a rugby match and yell at the TV, which always makes me feel better! Sometimes, I go for a jog. Sometimes, I eat too much chocolate. I hope that they cancel each other out.

How should I self-soothe? I don't know what I'm doing!

Don't panic - I can guarantee you that you do know what you're doing, or at least you know a little bit about what makes you feel better. Naming your emotions can be helpful if you're not sure what's going on (e.g. "I feel sad today" or "I'm feeling overwhelmed") and that can help you to decide on a strategy for self-soothing - for me, running doesn't work if I'm feeling overwhelmed as it's just another thing I have to do. Relaxation doesn't often work for me when I'm angry, as I just need to talk it out. Chocolate works in all situations, which says more about me than it does about the soothing powers of chocolate! Once you've decided on a strategy, you may need to try it more than once to see if it does make you feel a bit better - and don't be afraid to ask friends and family how they self-soothe, to get more ideas.

What if my self-soothing strategies are bad for me?

Let's be honest here - alcohol, cigarettes, skin-picking and other things that alter your consciousness in some way or force you to stop thinking about the thing that's distressing you are popular options because they work. If they didn't have a pay-off (e.g. I don't have to feel distressed because I don't feel much of anything) we wouldn't use them. Unfortunately, they also have downsides, and come at a cost to your health, both physical and mental, with over-use.

If you soothe by using strategies that you know deep-down aren't helpful for you, then therapy can help you to replace those strategies with things that are less harmful. I never suggest stopping a self-soothing strategy immediately unless it's posing a serious risk to your life/health, as if you haven't replaced it with something else, you may turn to even more harmful strategies to manage distress. It's better to learn some healthier methods first, whilst gradually stopping the things that aren't as helpful long-term.

So that's my blog on self-soothing. I hope you found it helpful - now, if you'll excuse me, I've got a rugby match to go yell at!

Happiness is something that we all try to hold onto, but it's often really elusive. Think of it like the weather - there are sunny days and cloudy days, and even some rainy ones (I live near Manchester; there are A LOT of rainy ones!) but eventually the sun will shine through the rain clouds, and the clouds will replace the sun. That's the same with emotions - you never really feel the same emotion singly for weeks at a time. It can feel like it if you're feeling low, but often there are small moments of good in amongst the bad. Trying to hold on to an emotion is like trying to hold on to the sunshine as the clouds roll in - it's not possible, and it's likely to make you feel sad if you try to do it.

There are some things that you can do to make yourself feel happier though - and I'm not just talking about a good cup of tea or a really interesting book! If you want to be happy, try giving up these three things:

Comparing yourself to other people

"Comparison is the thief of joy" - Theodore Roosevelt

Imagine you're starting up a new hobby. Instead of focusing on the task in front of you, all you can think about is how good the girl in front of you is at it already, or how much you want the same watch as the person next to you. The more you focus on others, the less likely you are to be happy with what you have.

Comparison steals your ability to be content with what you've got, and robs you of being able to feel joy in the longer term. It makes you feel inadequate - we rarely compare ourselves to people when we think we're better than them - and stops you from feeling happy. Do yourself a favour - next time you notice that you're comparing yourself to others, stop and focus on something else instead. You're likely to find over time that you feel a little more content, and a little happier.​

Living the way others want you to

As humans, we're social creatures - we spend a lot of time doing things for others and hoping that others will relate to us in the ways we want them to. But putting too much pressure on yourself to live your life according to other people's opinions of you is only going to cause confusion and frustration. We've all done it - continuing piano lessons because it makes our parents happy, not going out with a friend because your partner wants you to stay home - and sometimes it's okay if you're getting something out of it too. But in therapy I've seen too many people who went to University to do a degree that someone else wanted them to do - and most of them dropped out after a year or so. Living the way that others want you to does not make you happy. It might give you relief for a short time, because you're not fully expressing your needs and therefore avoiding conflict, but in the long-term you're going to be unhappy and unfulfilled, and nobody wants that.

​Overthinking everything!

I know it's hard not to go over exactly what you said at your friend's house last night in minute detail, looking for any reason that she might be mad at you today, but I promise you it isn't making you happier! Again, because we're social creatures, sometimes our brain gets the wrong idea about protecting us from social rejection and amps everything up to 11 in terms of anxiously scanning conversations or situations where there might be conflict. It's a good idea not to be around people who aren't our cup of tea, but that doesn't mean that everyone hates you, and it certainly doesn't mean that you can manage your anxiety by overthinking everything. It won't work, and it won't make you happy. Try to relax, and do something else instead.

Are there any other things you think we should give up in order to be happy? Let me know in the comments.

It's been a few weeks since my last post - I'm still trying to get consistency in posting on this blog, but between my NHS and online work, it can be a challenge! In my last post, I said that I'd spend some time in this post discussing how to set boundaries more effectively.

If you know what boundaries you have, but are finding it difficult to implement them effectively, there are a number of communication strategies you can use.

Clear and direct statements
I've been a clinical psychologist for over a decade, and one thing I've definitely found to be true is that lots of people think their communication is clear and direct when it couldn't be further from those things! To be clear and direct myself:

• Hinting (e.g. "oh, that table needs putting together") is NOT clear and direct.
• Assuming telepathy ("she should just know!") is NOT clear and direct.
• Agreeing with others and ignoring your own needs ("I don't know, whatever you want to do") is NOT clear and direct.

Being clear and direct involves stating specifically what it is that you need - you might not get it, but at least you know that your communication wasn't the reason for that. Examples might be:

• "I know you want to go out tonight, but I'm too tired so I won't be joining you."
• "Can you help me put that table together on Sunday afternoon please?"
• "I'd like pizza for tea but I'm open to other suggestions!"

Something to note is that when you're used to a more passive style of communication, being clear and direct (being assertive) can feel like you're being aggressive. It's also easy to "over-correct" and actually come across as aggressive! I'd recommend practicing what you want to say and the tone you want it to come across in before you actually try to set a boundary, in front of a mirror if needed, so that you know how you sound and are more able to discuss things calmly.

Using "I" statements
It's often easy to blame others for how we feel, even if we don't mean to. This puts the focus back on the other person, when it really needs to be on your boundaries and how to assert them. Using "I" statements shows that you're willing to focus on how you feel, and to take responsibility for that - as long as the other person does the same. Some examples:

• Instead of "you always leave the dishes in the sink!" try "I need you to give me some reassurance that you'll do the dishes tonight, because I feel frustrated when I have to ask you twice."
• Instead of "you don't care about me," try "I feel like you're ignoring me, and as though I'm not a priority."

Beware of "I" statements that are really just watered-down "you" statements, e.g. "I feel like you're really disrespectful and aggressive" - you've added "I feel like" but really the statement isn't about your feelings, it's about the other person being disrespectful and aggressive. It takes some time to focus on your own feelings about a situation and to own those, but it can really help in setting boundaries effectively.

Broken record technique
This one is a favourite of mine because it's so easy and SO difficult at the same time! Sometimes people think that if they just keep asking in a different way, they'll wear your boundaries down and get what they want. And sometimes that works. But it doesn't work if you're using the broken record technique - continuing to say almost exactly the same thing, and making it really boring to try to argue with you:

"I'm too tired to go out tonight, so I'm going to stay home."
"Oh come on, you never come out with me!" (this is an invitation to argue)
"Sorry, like I said, I'm going to stay home."
"You're being really boring!" (this is also an invitation to argue)
"Nevertheless, I'm still staying home tonight."
"Fine, if you don't even care enough about me to come out tonight" (this is, unsurprisingly, also an invitation to argue - sucking you in so that you explain how much you do care and at some point in the conversation also agree to go out)
"I don't know what to tell you - I care about you and I'm still staying home tonight."

This is a technique to use with people you care about who just aren't getting the message. For that person in the bar who won't leave you alone, I don't recommend any technique that continues communication, including broken record. Just walk away.

Setting consequences
As we established in my last post, actions have consequences. If you smoke a cigarette near me, I'm likely to leave. My presence is conditional on there being as smoke-free an environment as possible. Having consequences for actions helps to establish appropriate boundaries, and it's helpful to use an "if - then" format - for example:

• If we go to see your parents and your mother makes a comment about my weight, then I will leave.
• If you feed the children sweets before dinner, then you will be the one putting them to bed tonight.
• If you are coming home late and don't tell me, then I won't wait to eat with you.

The absolutely fundamentally crucial thing about setting a consequence is that you HAVE TO FOLLOW THROUGH ON IT. You HAVE TO. Don't set a consequence if you don't think you'll have the ability to follow it through when the time comes, as all that does is teach the other person that your boundaries are negotiable at best, ignorable at worst. Consequences can be graded, you don't have to go to the highest option first (e.g. it might not be leaving first, it might be going to sit in the car for a bit, or leaving the house for an hour rather than leaving permanently). But I can't stress enough, do not set a consequence that you can't follow up.

So that's my post on how to set effective boundaries. There are loads more ways to do so, and they might form another post in future - for now, if you've got any good ways to set boundaries, let me know in the comments.

What do you think of when you hear the word “boundaries”? Do you think it sounds really physical, like an actual wall or line in the sand separating you from other people? Well, I’m actually talking about “boundaries” as a metaphor, to describe the kinds of behaviours that you’re willing to tolerate from yourself and other people – if it’s good, it can stay in the boundary, and if it’s not good, then it’s “out of bounds” and therefore not acceptable in your relationships.

Often the people I work with in therapy really struggle with the idea of boundaries. Sometimes, people have been brought up to believe that anything they want for themselves is selfish, and therefore they put everyone else’s needs before their own. Or, they think that if they try to establish a boundary then the people close to them will reject them, and they feel that it’s easier to put up with poor behaviour than be alone. Those things may be true, but I often wonder whether being on your own is really worse than being around people who minimise your feelings, constantly do things that hurt you, or make you feel bad. Often, the answer is no.
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A boundary is just a line for behaviour that you will or will not tolerate. That’s it. It’s not inherently “manipulative” (although certainly can be used that way if people try to make their boundaries about other people’s behaviour, e.g. “I only want to be around you if you’re going to be 100% positive all of the time” – they can hold that boundary, but you can’t possibly live up to it and if you try, you’re going to fail and feel bad). If people tell you that they feel manipulated by your boundaries, that may be because you’ve never set any with them before and they don’t like having to face consequences for their actions.

I’ll give you an example. I don’t smoke cigarettes. I’m happy for other people to do whatever they want with their lives, but because I don’t smoke, I don’t want to be around people who do in a confined space. If I’m sat outside a café and someone lights up, I’m going to move. That’s MY boundary – I’m not going to stop you doing what you want to do, but I don’t want to be part of it. If someone feels upset by that, then that’s their issue, and I’d encourage them to think about why my willing participation in breathing in their second-hand smoke is so important to them – but I’d be encouraging them from a distance, because I won’t be sat next to them!

I don’t think that’s a particularly extreme boundary to have. I also don’t think it’s extreme to have boundaries around the following:

1. Who does and who doesn’t get access to your time or affection – if you want to hug me, and I don’t want to hug you, I can say “no, thank you.” If I don’t want to spend time with you, the same thing applies.
2. Who does and who doesn’t get access to your physical space – who you allow into your home. If you come to my house and make a huge mess, you’re probably not going to get invited back. When you come up against a boundary, actions have consequences.
3. The things you talk to people about – for example, if your work colleague knows that you’ve had a bereavement and asks you about it, but you don’t want to talk about it at work, it’s reasonable to say “I’m sorry, I can’t talk about that right now.” It’s also reasonable to leave if they won’t stop.

These are just a few examples, but generally, boundaries are flexible and change over time based on new information. A friend who you were close to when you were younger suddenly starts to drink a lot of alcohol and becomes aggressive when drinking? You’re allowed to have a boundary around when you interact with them (e.g. not when they’re drinking). You might not have had that boundary before, but you might need it now because their behaviour has changed and your feelings about that are different.

A lot of the things above people might not view as boundaries – “they’re just the natural consequences of people doing things you don’t like,” you might say. In that case, I’d say “well done for having reasonable boundaries!” A lot of people don’t have ANY boundaries and would allow that friend to be around them when drinking, even if they became aggressive and hurt them, or would sit next to a chain-smoking person outside a pub because they didn’t feel comfortable to move, or hug that person who has always been horrible to them because it’s “polite.” The idea that you can put your own personal comfort above “politeness” is often life-changing for people who haven’t been allowed to do that before, and just establishing one or two clear boundaries, based on their values, can really help.
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So, that’s my thoughts on boundaries – next week, we’ll look at how you can set boundaries more effectively, including a couple of techniques that can help you to feel more confident in sticking to your own boundaries. Let me know what you think in the comments section.

It can be challenging to get back into the swing of things, especially when you're feeling down and unmotivated. However, there are some effective ways to beat the post-holiday blues and return to your regular routine with renewed energy and enthusiasm.

Plan Something to Look Forward to
One way to beat the post-holiday blues is to plan something to look forward to. Whether it's a weekend getaway or a night out with friends, having something on your calendar can help you feel more motivated and excited about the future. But don't pack your schedule too full after you get back, otherwise you'll roll straight out of "holiday mode" and straight into "treadmill mode," and after about a week you'll wonder if you ever had a holiday at all!

Get Back into a Routine
One of the best ways to beat the post-holiday blues is to establish a routine again. This can help you feel more grounded and in control of your life. Start by setting a regular sleep schedule (because post-holiday jet lag is no joke!), eating healthy meals, and scheduling in some exercise. Again, don't change everything overnight, but feeling a little bit more in control really does help with some of the mood changes that can occur when you get back from a vacation.

Reach Out to Friends and Family
Connecting with loved ones can help you feel less isolated and more supported. Make an effort to reach out to friends and family members, even if it's just to chat for a few minutes - I'm sure they'll want to see your holiday photos (maybe not all 300 of them on a slide show, but a few pictures of sunny skies doesn't hurt!)

Take some time to reflect
Part of the post-holiday blues can be because we've found something whilst away from the world of work and home which we've been missing. That could be something that connects you with your values, or something that excites you about life (speaking a different language, or cooking different foods, for example). If you feel like this, then spend some time thinking about what you gained from your holiday, and what you'd like to try to keep hold of as you transition back into "normal life" - you probably can't sit around a pool all day drinking margaritas, but you can learn how to make a really good margarita yourself for Friday nights, and take up swimming as a hobby! Knowing why those things stuck with you will help to decide where and how you want to focus your efforts.

In conclusion, beating the post-holiday blues requires intentional effort and self-care. By planning ahead, establishing a routine, connecting with loved ones, reflecting on your goals and taking care of yourself, you can overcome these feelings of sadness and anxiety and return to life feeling like you've had a good break.

Have you got any other tips for managing the post-holiday blues? Let me know in the comments!

As with all the other therapies I use, I've been using EMDR in my NHS work and also my private work. I'm not fully trained yet, which my clients know, but so far people have been happy to come along on this journey with me (and of course, we wouldn't use EMDR if they weren't happy about that). I wanted to reflect a bit on my experiences of EMDR as a therapist, and also what I'm hoping to do with this (new to me) therapy in the future.

Just notice that...
The first thing you notice with EMDR as a therapist is that it's quite different to "usual" therapy. You're asking for really brief answers from your clients between sets, and I've found this difficult at times. I very much understand the rationale for keeping things brief (when processing trauma we want to keep the person in "processing mode," for want of a better phrase, and longer discussions knock you out of that mode) but if you know me, you'll know that I like to talk and I'm interested in hearing what people have to say! That combination makes it challenging for me to shut up, and I also have to work hard to make sure I'm not coming across as rude when I'm shutting longer conversations down.

Making new connections
That said, I'm actually really enjoying using a new therapy modality with people. It would obviously be unethical of me to mention anything specific about the work I'm doing, but EMDR is used most commonly for trauma and that's what you're encouraged to focus on after the first block of training. The people I've used EMDR with so far seem to have found it incredibly helpful, and whilst I think they all found it a bit daunting at first, have been keen to give it a try. It really does seem to be helping their brains to make new connections related to trauma, and to help them to process their difficulties.

Processing will continue
Whilst you do a lot of work in an EMDR session, your brain doesn't just "switch off" after a session and come back online at the same time next week! During training you're taught how to explain to people that EMDR processing is likely to continue and that you just need to let it happen, but that you might experience different symptoms following a session. Most commonly, people report to me that they're really tired after our sessions, and that's definitely a sentiment that I share! I find working with EMDR invigorating, but a few hours after my clinical work finishes I'm definitely more tired on days when I've been using EMDR than days when I haven't.

Past, present, future
So far, I've really enjoyed learning more about EMDR and practicing it in a clear, contained way. It's a really structured therapy, and I'm already seeing significant benefits for the people that I work with.

I've got more training to do, and I'm looking forward to integrating it into my practice with the other therapies that I use (CBT, ACT, and CFT mainly) so that I can use it flexibly. But I'm still learning, so I imagine that will take a while. I've also heard good things about the use of EMDR for physical symptoms such as pain, and as I work in a physical health setting most of the time, I'm interested in how that might work.

This blog post might feel a bit self-indulgent, but I like to reflect from time to time on my own experiences as a therapist and how they affect those around me. If you have any experience with EMDR, both as a therapist or as a patient, I'd love to know about it in the comments section.

As we discussed last week, grief is complicated. There's no one "right" way to grieve, and people are entitled to come to terms with their loss in their own time. That said, there are a few things that might help if you, or someone you care about, is struggling with grief.

Give them time
It might sound obvious, but generally as humans we don't respond well to emotions that we see as "negative." If someone is sad, we often want to "fix" it so that they feel happy again, but with grief that's not really possible and is likely to make the person feel misunderstood or worse, make them feel that they can't grieve in the way they need to. It's okay for people to be sad after someone has died, and it's okay for that sadness to come in waves and last for a while. The more you push yourself (or your loved one) to "get over it," the longer it's likely to take them to process their loss - or they'll just shut down and not talk to you about it.

Offer concrete help

How many times have you texted someone "you know where I am if you need me" and then assumed that they'll reach out if they want something? Now think about how hard it might be to actually reach out for the kind of help that would be the most useful after someone has died - talking about how you feel, or looking after the kids so that they can have a break. Not easy.

Instead of a blanket offer of support, try to make your offer a bit more specific and concrete - for example, "why don't you come over tonight and I'll cook some food," or "do you want me to bring you any shopping over?" People are often grateful for the offer and, if it misses the mark, it helps them to say what they actually need ("I don't need shopping thanks, but it would be good to see you - coffee?")

Prioritise the basics

If you've read this blog before you'll know I'm a big fan of the things that sound quite basic, and that's because they're usually really effective. Making sure that you're getting enough food, water, a bit of outdoor time and enough sleep can help to keep you going through times of crisis and often, they're the only things that help to get you back on track. Encouraging someone to eat or have a cup of tea, even if they don't think they want it, or managing to get them out of the house for a couple of hours, can have a really powerful effect.

Comfort in, complain out

Ring Theory, developed by Silk and Goldman, is a nice, simple way of understanding what might be helpful in a crisis. Imagine that the person most affected is at the centre of a series of concentric rings (for example if you lost a child this might be you and your partner, then your extended family, your friends, the child's school friends, etc). We don't want to be complaining too much to people closer to the centre of the rings (e.g. "you're upset, how do you think I feel?") and we want to offer comfort if possible, but we also need to be able to talk about how difficult we're finding things to people who are maybe a bit less affected by it. Life often isn't super neat in this way, and there are often multiple people who might be at the centre of the crisis, but a general rule should be "comfort those in rings closer to the centre than you are, and complain/discuss how hard it is with people in rings further away than your own."
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Sources of support for people struggling with grief

If it's been a while and you're still struggling with grief (you find yourself bursting into tears at random times, for example, or you just feel that you could do with a bit of extra support) then the following are UK-based sources of support:

• One good place to go is to your GP - they can refer you for talking therapies on the NHS that can help you to cope with bereavement.
• Cruse offer support for people who are struggling with grief, and their website is also a helpful source of information about bereavement.
• SOBS (Survivors of Bereavement by Suicide) is a specific source of support for people who have lost someone to suicide.
• The Good Grief Trust provides support to anyone who has been bereaved, and is run by people who have been bereaved themselves.
• The Childhood Bereavement Network helps support bereaved children.

If you have any further resources that might be helpful for people, let me know in the comments. Dealing with grief isn't easy, but know that you're not alone, and it does get better.