Category Archives: Mental Health

Trans adolescents and adults in a therapeutic setting

Many therapists are fearful of the idea of working with trans adolescents and adults in a therapeutic setting. I was recently invited to take part in a study designed to investigate how psychologists and psychotherapists who see trans adolescents in their practices assess their clients’ capacity to make decisions about their treatment and how to approach this subject in an ethical manner. Inevitably it got me thinking…

Is gender exploration any different to any other area in therapy?

No client, adolescent or otherwise, voices questioning their gender if they are not. No one can be made trans simply by talking about possibly being trans. I approach this area as simply as I do with any other; I trust the client knows themself better than anyone. I attune (hopefully) to what they are expressing. We explore together how they feel, when they first felt this way, what their understanding of themself is. I affirm who they say they are in the same way I would affirm someone who tells me they have experienced a bereavement, an assault or anything else. I educate myself so I have the most current knowledge about different identities and all the different biological possibilities.

Many possibilities

My client will be one of the many possibilities in terms of biology, identity and expression. It’s our work to discover who they are at that time, knowing that identity and expression can change during the life span along with everything else. Adolescents are rarely given the opportunity to have surgery or take cross-sex hormones before they are emotionally mature enough to make that decision (in the same way they are mature enough to make a decision to join the army, for example). Puberty blockers are designed to buy time and play a valuable role. See High Court Ruling blog.

Looking for certainty

Often, it’s parent’s and/or therapist’s attitudes that generate fear and friction. Often, they’re looking for a level of certainty that cannot be provided. Some clients will explore and decide they want to press forward with further treatments and others will decide not to. In many ways it’s really that simple. In terms of process, the long waiting lists provide copious time for reflection, pausing if needed or even halting the process altogether.

What clients need is to be heard and seen for who they are now and into the future.

Whilst clear ethical guidance is essential in working with trans adolescents and adults in a therapeutic setting, there is no need for fear. Just an open mind to the range of possibilities.

Please get in touch for further information via the contact page or here.

The benefits of ‘second chance study’ or how I learnt to change my spots.

Will Davies 24 Feb 2022

Change and counselling go hand in hand. Clients attend counselling to change and the changes they undergo change their lives and often the lives of their families, friends and colleagues too. The life of a counsellor can sometimes be changed irrevocably by working with a specific client. It’s part and parcel of counselling and powerful stuff.

Resistance to change

But often the client can be resistant to change and one of the reasons for this may simply be that, unconsciously, they do not believe they have the capacity to change. It’s been drilled into them that change is for children and once you’re an adult, then you’re stuck with yourself. Leopards can’t change their spots, old dogs can’t learn new tricks and people once of adult age need to just stay the same and not even contemplate changing or improving. It’s confusing and knotty stuff but in counselling we address it, work with it to understand it and often, once the client recognizes and starts to entertain that they have the capacity to change, the work can take flight.

Carl Roger’s, the founder of the Person-Centred approach, considered that all humans have the capacity to achieve their full potential, he called it self-actualization. Notice he uses the word humans not children. In order to achieve this potential, Roger’s believed that we all just need the right conditions, the right amount of light, water and soil to allow us to flourish.  

Old Dog, New Tricks

I remember thinking that I hadn’t achieved my full potential when I was considering re-training as a counsellor and psychotherapist. I also remember wrestling with the idea of being too much of an old dog to start learning something new again. I’d worked in the creative industries for nearly two decades, changing spots just wasn’t on the cards, was too much effort, too unknown and new.

But I found a course in Leicester at the Vaughan Centre for Lifelong Learning that became my soil, sun and water. Over the course of the four years, it allowed me to realise my potential and start to do what I think I was always meant to do. And the learning didn’t stop there, since graduating, I’ve participated in gender, sexuality and relationship diversity courses, group therapy workshops and multiple CPD sessions. All experienced as an adult, all contributing positively to my life and in some cases that of my family, friends and colleagues. The ripple effect of adult learning can be considerable.  

So now, thanks to adult learning, I counsel adults of various ages to help them understand themselves and make the changes that might enable them to lead the future they want. I also teach counselling to adults so, like me, they can achieve their career potential in helping others.

And this year I want to give back to Vaughan, now renamed Leicester Vaughan College, but still dedicated to the needs of part-time learners and to those wanting a ‘second chance’ to study. I’m getting involved with their Spring series of low-cost personal and professional development workshops by delivering a series of psycho-educational sessions aimed at anyone who wants to better understand and change themselves, their relationships or their relationship with anxiety and stress. The programme is being curated by Tina Holt, who taught me at Vaughan, and my Baines-Ball & Associates colleague Dr Mish Seabrook, study peer Rosie Craven and old lecturer Patrick Crawley (it’s a small counselling world in Leicester!) are contributing CPD sessions for counsellors and those working in the caring and helping professions on burnout, trauma, working with LGBT clients and working with children and young people respectively.

So if you’re a leopard that’s been told they can’t change their spots or an old dog that can’t learn new tricks, take a look at the programme and maybe take the chance to invest in yourself and make that first step towards change.

Happy New Year!

I’m struck by my inner conflict so early in the year. As part of winter festival celebrations, we often wish each other a “happy new year” and, as the song goes, “hope it’s a good one”. Yet, as with most experiences in life, the year will inevitably be a mixture of good, bad and indifferent.

Splitting the good vs bad

We so like to box our experiences into the positive and negative and in so doing I feel we lose much of the nuance of a situation. There are so often gains and losses in any experience. I wonder how we feel about letting the gains, losses and neutrals sit side-by-side?

I’m mindful of the holidays many of us have just had. Was it good? Was it bad? I imagine there were highlights and lowlights within the time off. What didn’t go to plan? What went better than anticipated? What was within our sphere of influence and what wasn’t?

When we are experiencing a lowlight, is someone else able to benefit from that in a way they wouldn’t usually get the opportunity to? Whilst on a walk over the holidays I got talking to a neighbour who is a teacher. They were talking about the negative impact of covid-19 on the exam system. Alongside offering some empathy and understanding for those impacted students I wondered aloud the potential positive impact for students who sitting exams is tortuous and unhelpful, hard working though they may be. I wondered about the potential positive impact on future workplaces to potentially have colleagues they may otherwise not have had – continuous assessment rather than exams having given them an opportunity they otherwise might not have had. The teacher said they hadn’t considered this position. Sad, I thought. When we are not able to do something we want to we understandably get upset, frustrated etc. Can a curious attitude help us to see not only what we might have lost and gained alongside what someone else might have lost and gained in turn?


I think we can all benefit from getting curious about what we feel entitled to and why…and is everyone entitled to the same thing…if not, why not? Whilst you are getting curious about what is helpful to you and to others you will be building resilience to face whatever lies ahead.

So, whilst wishing you all a happy new year I also wish you a curious one, where good, bad and neutral can sit in the same year and all be learned from.

And then it happened to me…

Paula Fowle 23 August 2021

I was on it

Having worked as a counsellor for a long time with a keen interest in bereavement support and anticipated loss support, feeling that I was ‘On it’ and could cope, little did I know!!! Recently my world was tipped upside down when hearing ‘the news that nobody wants to hear’ (see previous blog)

My ‘tailspin’

My dearest friend of very 30 years has been fighting various types of Cancer for the last 15 years, we have been together through scans, treatments, good news and bad. But recently hearing that ‘there was nothing else to be done’ apart from palliative care and ’End of Life Plan’ through me in a tailspin.

Where did all the things that have learnt in my training go?

Sitting in the chair supporting a client over the years has been a privilege, giving support to patients and their families whilst preparing death bed wills to ensure that those last-minute wishes are taken care of, ensuring that what ever can be achieved on the ‘Bucket list’ can be done is taken care of too. Seeing the path of acceptance and that final letting go of life when the patient feels their work here is done.

The patient knows best

I guess one thing that I have learnt during these special journeys is that the patient knows best, the patient is always the one in control, yes, the medication and pain relief help but the final decision to let go belongs to the patient and I know that the journey that my friend and I are on now will be the same.

What does dying feel like?

It is heart breaking watching someone so close slipping away, spending hour after hour in bed, waiting and wondering what is to come next and how it will feel. As we have joked about on many an occasion since the news broke, its not as though you can ring someone up and ask’ hey what does dying feel like?’

Finding the continuing bond

I have searched for things to help and things to make this manageable, but I feel now that there is nothing. I know when the time come it will be hard for me as it has been hard for my clients’ families to see but like them, I will get through it and what I have learnt will stand me in good stead. I just need to confidence to reach out for it and like others learn to create my ‘Continuing bond’

Finding the inspiration

A real inspiration for me has been the book ‘Languages of Loss ‘written by Sasha Bates. In the book Sasha takes the journey to fight with her grief following the sudden death of her Husband. She shares her struggle with her ‘professional self’ and her’ emotional self’. The death brings into question everything she has ever learned and believed would help her clients along the path in their grief journeys but amazingly she gets to a place of peace and understanding and slowly starts finds a way back….

Courage and time

I hope and I know that I will be the same, it will take time, courage but I will always have my memories of all that my Friend, and I have shared, nothing will ever take that away.

On hearing those dreaded words – ‘I am so deeply sorry we have done all that we can’

Paula Fowle 03 August 2021

Hearing the news

How many of us have been in this position, seeing a much-loved family member, a dear friend or colleague heroically fighting illness. Trying cope with every type of medication, treatment and advice thrown at them. To then receive the news that despite attempting every known route possible there is nothing more that the medical teams can do.

This is when the imaginary food mixer in the tummy kicks in!!!

Everyone around us is trying to cope and understand what has been said and what the future holds. none of us like uncertainty.

What are we supposed to do?

Each one of us will react in a different way and it may be hard to understand what others are feeling and saying. There will be a lot of questions that come to mind as together we all search for the answers.

What is the impact on us and those around us?

The impact on a family is huge when such news is received. There may be a lot of uncertainty about how much time is left, who do you need to share this information with. You may feel overwhelmed with fear and sadness.

How do I tell my children, what will they want to know?

If there are children involved each one will want information that they can digest and cope with; their reaction may be difficult for you to understand and leave you feeling more isolated that ever.

You may be wondering who is going to support you.

There will be a lot of questions after hearing the news for the well parent. this can be a real dilemma and a physically and emotionally exhausting time.

One of the hardest parts of all of this may be the disruption of the family routine and the change of roles within the family unit.

If poorly parent is a stay-at-home parent taking care of the children, the family home, and the dog, suddenly this is about to change. Few of us like change at any time but especially not in such circumstances as this.

Who is going to do the school run?

Who is going to do the washing and ironing?

Who gets the dinner and who will walk the dog?

Introduction of Others

The disruption may mean that others are stepping in to help either professionals or other family members or friends.

This may lead to the children feeling vulnerable and unsure possibly displaying actions and talking in a way that you have not been heard before, it is important to remember that everyone is hurting.

We all hurt in our own way, not all of us are able to reach out, some retreat into their shells.

Retreating into our shell

I have the image of a tortoise being unsure of a new route to take and withdrawing his head into their shell. These reactions can be hard to take particularly when you are feeling under pressure to hold things together and be there for everyone else.

The impact on the well parent is huge. The news may leave them confused, both physically and mentally exhausted. Although there may have been a lot of doubt about the future until these words are spoken there is always hope and a place for denying the truth.

Why wouldn’t you?? It is so hard to let go of someone special someone you love isn’t it.? To see the plans, the hopes and the dreams that were made for the future be swept away.

You may well be feeling, yesterday was a happy day … today I am not sure what type of day it is…

It’s all different now suddenly there are feelings of sadness, fear, and anger. There may also be feelings of wanting the suffering to stop but not being able to let go invoking feelings of guilt at ‘choosing the easy way out’.

Reaching out for support

There is no easy way to face such a situation but by seeking support from a Bereavement Counsellor you may feel be able to find your way. You will find acknowledgement in a non-judgemental way of your worries, your fears, and the stress of living with many uncertainties.

Trying to find your strengths … they will still be there

The support offered will give you an open space to communicate the fears and feelings that you may not want to share with others, it will help you to explore your strengths and encourage you to use them. It will give you a place to explore your fears for the future and to celebrate the good times in the past.

Making a plan

The time spent can offer an opportunity to plan what you need to say to your children, you know it will feel uncomfortable and will be distressing, think about what you might want them to know, what questions they might ask, it might be tricky dealing with the questions that come back at you, hopefully some of the time spent with your Counsellor can prepare you for this.

None of us are perfect

The one thing to remember with all of this, is we don’t always get things right. This situation will be different for us all; there is no right or wrong way.

Allow time for the news to sink in. Grant yourself the thinking time. By seeking support for yourself you will find the strength to support those suffering around you too.

A final thought:

Reaching out at a time of loss is the hardest thing to contemplate. A listening ear can offer you a safe place as you try to weather the storm.

See part 2

Young people and mental health

When I was asked to write about teens and young people’s emotional and mental wellbeing I wasn’t sure where to start. It’s such a vast topic. Then I got thinking.  There is a quote that has stuck with me for the last 23 years, from an essay I wrote at university: “Childhood is a Cultural Invention” Discuss. (Kessen, 1979: from The American Child and Other Cultural Inventions). I was fascinated when I wrote this assignment.  I read studies on children as young as five years being left in charge of camp, fire, cooking and younger siblings whilst parents went off foraging and hunting. I read of three year olds using a machete to chop food and gut fish. Later I watched programmes where young kids swam in waters far deeper than them, hunting for fish: diving down to tie and untie nets.  It has always intrigued me; how different societies treat their young – and the correlation to wellbeing. 

Mental Health Crisis

In this country (and other Western countries) now, we are facing what is being termed a ‘mental health crisis’ in our youth (and all ages) and many people are asking why.  My thoughts are this: Life has become so fragmented. If we think about key things that we need to keep us sane and happy: a sense of community of purpose and of belonging are high up the list.  Yet we live lives where parents go off to work, kids to school and very often we have little time outside of that to spend together. We may be busy with clubs, activities, chores etc, but often our lives and those of our young are quite separate. Then there is pressure for ‘quality time’ which often, in a capitalist society, can be translated into day trips or restaurant visits.  The slow daily ‘togetherness’ is lost.  The doing chores together, teaching our young as they work alongside us, to cook, clean, care for animals, build, or just communicate is lost too.

Family Environment

An acquaintance was talking to me once about the ‘domestic load’ on them, alongside full-time work.  I suggested they get their teenager to cook a couple of times a week. They looked at me, bewildered and said that their teen couldn’t cook. They had ‘never had time’ to teach them.   So here we can see clearly defined ‘roles:’ Mum ‘cares’ for EVERYONE.  She is therefore exhausted and quite possibly resentful.  Teen, practically, has an easy life – but they don’t feel like a real PART of the family. They also don’t learn the responsibilities of adulthood in a safe and supported environment. Mum has little time for anything other than chores, because they do all the caring and organising: therefore there is no ‘together while we work’ time, OR much ‘quality time’ together. She possibly feels the anger of ‘I do everything for you. You do nothing.’

Involving children in daily activities

How can this model possibly work? And yet it runs throughout our society. Young people have few responsibilities, which can lead them to feeling a bit useless … which can eat into their self-esteem.  My suggestion: involve your kids. Enjoy the chores together. This gives you time together, just being. It gives them a sense of pride, community, belonging and of being a useful and important part of something bigger. They develop skills, they gain your respect (and you theirs) and they build their self-esteem. You can chat through your day – and build connection.  

In the early days – it can feel like hard work, yes, but I promise you the rewards are worth it. Kids are capable of far, far more than we give them credit for in our society. I truly believe that it is in holding them back, that frustrations arise. When kids are little, all they want to do is help their parents. Often we tell them no: it seems easier to do it yourself. But think on this: if you don’t let them hoover or wash up when they are 4 (and I know, it can be frustrating and they may break things) – well, how can you expect them to help when they are 14? (this was my mantra when mine were small – through gritted teeth sometimes, as jobs took hours and had to be re-done!) 

I recently had a week off work with my husband and we built a cabin in our garden.  My kids helped.  It took us longer, because we had to teach them how to use tools and work with wood; to follow instructions, but … we had fun and they learned. They hammered in floorboards, screwed in roof boards, laid roof tiles … and when one was feeling off-colour, she cooked the meals, kept us hydrated and walked the dogs. Now: every day we can look outside and see what we built, together. Remember the fun and the learning. Have a sense of achievement. Yes, it took longer to do it this way, but as well as saving a significant amount of money by doing it ourselves, we learned together, talked together, had fun together, achieved together and also saved money on ‘activity days out’ during half term.  We have a communal sense of achievement, togetherness and growth – and a daily visual reminder of that. This kind of togetherness: being together, doing together, achieving (and not) together is,  I believe, fundamentally important to the overall wellbeing of everyone, but particularly for young people who are just finding their way in the world. They may seem ‘grown up’ and they may push us away – but what they really need is to feel like they truly belong with us, so that they can venture out with confidence.

Nicola Sinclair 10 June 2021

Equality Inclusion & Diversity

I was talking recently with an organisation I provide professional support to about Equality, Diversity and Inclusion (EDI) within the workplace. What struck us was that the one common thread on every single job description within this varied organisation was a sentence about EDI. However, none of the staff are ever questioned about EDI performance during their annual appraisal.

It’s got me thinking – how can we move from a position of tick box, mandatory training (that many don’t engage with) and automated assumptions to actual engagement, a desire to increase awareness because we want to rather than because we have to?

For me, this is about moving from a place of treating everyone as the same to treating everyone as different, unique and wanting to understand their place of difference rather than smooth it over and pretend it isn’t there. I see this as both an individual task and an organisational one. Then what about membership bodies such as BACP and UKCP? How can they, and should they, make EDI training mandatory and accountable? How do they/we balance freedom of speech with a profession of expected non-discrimination?

My membership is with BACP and for this I complete a training expectations and outcome document annually. I have added an element to mine so that EDI awareness is there as part of my ongoing continual professional development arrangements. I don’t lose sight of it this way. Each time I’m at the planning stage I ask myself which area I feel I need more awareness of, Whilst I need to keep up-to-date on gender, sexual and relationship diversity (one of my areas of expertise), I also need to make sure that my knowledge around race, disability or sex work, for example, doesn’t get left behind. I can’t know everything about everything but I invite myself to become better informed each year and therefore a better ally to those who are disadvantaged in different ways to me, both professionally and personally.  I actively want to know more and to understand more about the areas where I have an advantage, those areas I don’t have to think about every day.


I have noticed that it can feel challenging and exposing to grapple with the idea that we have advantage over another. As therapists this can feel very uncomfortable and we can get defensive when questioned or invited to expand our thinking. I think it’s important to separate the ‘I wasn’t aware of that’ from ‘I am a bad person’. Once we have awareness we can chose to do something different. Similarly once we have awareness about a relationship or behaviour that isn’t helpful for us we can chose to respond differently. Once we have awareness that our inner critic is having a field day we can learn to be kinder to ourselves and others.  


Many therapists come from a place of early wounding, hence the phrase ‘wounded healer’. I wonder if we can learn to respond to EDI and inherent advantage/disadvantage from a place of curiosity rather than a place of fear?

gardening as metaphor

Gardening as metaphor

As the temperature finally increased this year following a long winter it made me think about the impact that gardening and being outdoors can have on our mental health and how we can use this as the metaphor for nurturing ourselves. Being in contact with nature has the potential to calm the soul so it can be a good tool for our mental health first aid kit.

As those first signs of distress appear, where’s your go-to place? Where do you feel safe? Where feels restorative? During this last year of lockdown (see Weathering the Storm) many have craved green spaces and simply being outdoors. I have made it a priority most days to get out even for a local walk.

There’s something also about the very act of nurturing seedlings and plants that, for many, represents the nurturing of the self that may have not been present in early life. It can become a way to nurture ourselves as well – gardening as metaphor. Does anyone else find themselves talking to seedlings…urging them on? It won’t have been a coincidence that compost was hard to get hold of at certain points during the pandemic.

Following the long winter, we then had an unprecedented dry spell making the ground hard as rock. When the rain eventually came, the ground struggled, at first, to absorb what it most needed. It made me think about how difficult it can be for some clients to absorb ‘the good stuff’; it can get rejected repeatedly until a time when it might feel safer to absorb it. Many struggles for ‘water’ may have come and gone in the meantime. Looking at the garden, the signs are good; the grass looks rejuvenated from the water and there are more shades of green reappearing.

So, with gardening as metaphor in mind, how do we respond to both nurturing others and receiving nurturing from others? What do you notice in both your mind and body? What feels comfortable? What feels more challenging? Is there the potential for noticing and potentially an alternative way of being?

So, even if you are not into gardening or don’t have a garden, what’s the ‘nature’ part of your first aid kit? How do you restore your soul? I wish you peace, however you do it.

US Election 2016

As we woke up to the news that Donald Trump had become the next president of the United States of America, I thought about the impact on so many people across the world. For some, it will be a time for celebration. For others it will be a time of fear and despondency; not unlike post-Brexit here in the UK. One thing is certain for all of us; that we are living in a time of great uncertainty. America is a big place and has influence on the rest of the world.

Fear was already very present post-Brexit and now post-election. Both elections have been heavily influenced by fear of difference rather than consciously finding a path forward for everyone, irrespective of where they are born, what’s on their birth certificate and how much money they have.

Uncertainty brings with it anxiety and so I am mindful of the damage that can be caused when we act out that anxiety. We saw a rise in hate crime following the EU Referendum and much of this is about acting out those fears.

I wonder if we can all be more mindful of what we feel and why we feel it so that we can engage with people who hold different, sometimes opposing, views to ourselves. The more we can be aware of our place of privilege, the less hurt we cause to those oppressed by our privilege. For both the US Election and the EU Referendum, race has been at the heart of the results. The thing is that when we are in a place of privilege we are often not aware of it so it takes some honest thinking about. It takes putting ourselves in a vulnerable position.

So, following the US Election result, can we be more mindful of who will gain from the result and who will likely be negatively impacted? Can we find more compassion for those in need? Can we hold them in mind alongside thinking about our own needs? Can we make choices that enhance equality, inclusivity and diversity? Can we collectively focus on humanness rather than race, gender, sexuality, dis/ability, wealth?

If you have been affected by the election and would like someone to talk to, please do get in touch.