Do I Need to See a Therapist?: How to understand your emotions and make therapy work for you

By Donna Maria Bottomley

Why is the idea of asking for professional help still so taboo?
Why are we afraid of our emotions?

Do I Need to See a Therapist? provides insight into how we can acknowledge and overcome the fear of being thought mad, weak or helpless.

In this empathetic and practical guide, psychotherapist Donna Maria Bottomley examines these anxieties and argues that therapy should be just as acceptable as seeing a GP or booking your car into the garage and needn’t be our last resort.

• Language: English
• Publisher: Legend Press
• Release date: May 22, 2021
• ISBN: 9781800316850

Donna Maria Bottomley

Donna Maria Bottomley is a psychotherapist and writer based in Wales, UK. She has been a therapist for over 20 years and currently runs her own private practice (DMB Therapy). As well as providing CBT/EMDR and Brainspotting therapies she also offers therapeutic and expressive writing. Donna also trained in creative writing and songwriting and her personal work explores themes related to mental health and neurodiversity.

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DO I NEED TO SEE A THERAPIST?

ILLUSTRATION

Hero, an imprint of

Legend Times Group Ltd, 51 Gower Street, London, WC1E 6HJ [e-mail] |www.hero-press.com

© Donna Maria Bottomley 2021

The right of the above author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. British Library Cataloguing in Publication Data available.

Print ISBN: 9781800316843

Ebook ISBN: 9781800316850

Set in Times. Printing managed by Jellyfish Solutions Ltd

All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

CONTENTS

Disclaimer

Acknowledgements

Preface

Foreword

List of Figures and Tables

Introduction

Chapter One

The Fear of Therapy

Chapter Two

The Trouble with Emotions

Chapter Three

Why Am I Upset? Part One

Chapter Four

Why Am I Upset? Part Two

Chapter Five

Will Talking about My Feelings Make Them Worse? And if So, What Can I Do to Make It Easier?

Chapter Six

When Should I See a Therapist?

Chapter Seven

Finding a Therapist

Chapter Eight

What to Expect from Therapy

Chapter Nine

The Trouble with Therapy

Chapter Ten

Cyber Therapy, Blended Therapy and, er… Forest Bathing?! Alternatives to Standard Therapy Approaches

Chapter Eleven

Does Therapy Work?

Conclusion

References

Appendix

To my husband Mike and daughter Tilly. Thank you for being so patient over the past year as I stressed about this book! You are my world and I love you very much.

I would also like to acknowledge the clients I have had the honour of sitting with over the years. You may think I have forgotten you but I have not. I often think of you and wonder how you are.

DISCLAIMER

There are many therapies, directories and organizations listed in this book which I hope will help to show that you do have choice when it comes to therapy. I have tested each link as of September 2020 and have provided as much information as possible, but neither I as the author nor the publisher of this book can guarantee the complete accuracy, efficacy or appropriateness of any of these suggestions for you personally.

Without knowing your personal situation, it is impossible to give a guarantee that any of the suggestions described in this book will work for you. If you find that any of the material is triggering for you and makes you feel worse, please leave that part of the book, look at the appendix for the helpline numbers or seek the personal support of your doctor, therapist or someone you trust and who can support you.

For some people the fear of emotions and the fear of bodily sensations can go hand in hand. I want to help you with this, but as with any fear it is important to take a graded approach and not flood yourself with feelings. So only do what feels right for you. Please seek support if you are struggling.

ACKNOWLEDGEMENTS

Thank you so very much to Christian Müller, my editor at Hero. If I had to write a wish list of everything I wanted in an editor, it would be you I would use as my model.

To my clinical supervisors, Colin Howard, of Howard Psychology Ltd, and Elizabeth Doggart, of Elizabeth Doggart Associates Ltd, for introducing me to several exciting neurobiological developments in psychotherapy that have given my practice a new dimension. It is an exciting time for therapy as we are increasingly seeing the science behind what we do in practice.

Also, thank you Clare Mackintosh for your words of encouragement about this book when we met at Monty Lit Fest in 2019. Your words reached me at a time when they were most needed.

I also acknowledge – with a mixture of emotions – lockdown, home-schooling, and Zoom, because, despite the struggles, I am heartened to see that the pandemic experience has placed mental health (or emotional health as I prefer to call it) front and centre. It doesn’t seem unusual to speak about emotions on TV or social media at the moment and this is a huge step forward from where things have been in the past.

PREFACE

I started writing this book in 2017 as a CBT therapist of seventeen years who had recently qualified as an EMDR (Eye Movement Desensitization and Reprocessing) therapist and was incorporating this new method into my practice. In EMDR the instruction to notice that an emotion has been activated and to place it somewhere in your body, was the start of a significant change for me in my psychotherapy practice. EMDR threw a light on how unprocessed emotions and negative beliefs about the self could be released and processed through the body, and not just processed cognitively by the thinking brain.

Much has changed since 2017 for me personally, and of course much has changed in the world too. In my therapy work I have now travelled deeper into the science of emotions and the connection between the nervous system and midbrain and its role in emotional health. Polyvagal theory has shown me the key role that the vagal nerve plays in our feeling-states. ‘Heartache’ and ‘gut feelings’ are real, and we now have a way to describe how they happen and what they are. When we notice our ‘gut feelings’ we are in touch with the interoceptive network that travels from body to brain and back again.

I am now a ‘brainspotting’ therapist as well as an EMDR therapist. Brainspotting is a slightly gimmicky name for an extraordinarily powerful therapy. It was developed by David Grand and grew out of his EMDR practice. It involves not only noticing what is happening in our body when we feel emotionally activated, but also noticing where our gaze falls. The place where our eyes look when we are experiencing a strong emotion is part of that feeling-state and is connected to activity in our midbrain. By combining eye gaze with interoceptive awareness we can gain insight into what is happening in our brain and nervous system and learn how to tolerate and process our feelings. Notice where your eyes look when you are thinking about a memory.

As I used these processes more and more with my clients, I began to see that the reluctance to start therapy and the issues that people described, often coincided with a wariness about emotions themselves and either losing control or being overwhelmed and worrying about not being able to cope. I realized that, in writing this book, there was an opportunity to offer what I had learned to more people than I could see one-to-one in practice. It felt too important to keep to myself. So, in this book I have set out to combine the fear of therapy with the fear of emotion and offer my methods as to how you can understand and master your feeling-states by developing your interoceptive awareness.

Now, my journey along the way has also given me my own parallel process to deal with. Through researching sensations and the processing of information by the brain I started to realize my own sensory processing differences. My ‘spiky profile’ shows that I am ‘neurodivergent’, and many things make sense about my life now that I have discovered this. I have also come to realize the key role that interoceptive awareness plays in my own emotional health, and I am so much better at identifying what I am feeling as a result.

I have learned that my body will give me the pure truth of a feeling if I listen to it, whereas my thinking brain is so busy trying to predict what is happening that it often gets it wrong. By understanding that this thought activity is a prediction, not the truth, and by noticing what my body is doing, I can work out how to soothe and level things out.

This is a blend of meta-cognitive awareness (noticing) and appraising interoceptive/body information in a non-threatening way. It is not the only solution to everything, but it is an important tool for emotional health. I deliberately use the term emotional health rather than mental health, because I believe it more accurately represents the vital two-way connection between brain and body. Mental health as a term still seems to split body and brain. It no longer makes sense to do this.

FOREWORD

I wanted to include the thoughts of my clients as well as those of my clinical supervisors in the foreword of this book. My practice has been and continues to be influenced and informed by them and their perceptions matter to me a great deal.

Two of my clients very kindly agreed to comment and I asked them the following questions. To protect their confidentiality their names have not been published.

* * * *

1. Did you feel anxious about coming to therapy in case it made you feel emotions you didn’t want to feel?

Client 1: My understanding before therapy was that my thoughts and feelings needed to be kept under control, shut away. That I could train my brain to think and feel the negative stuff less and that therapy might bring all the ‘bad’ memories back to the surface. I also thought therapy might help me control my brain. I didn’t trust or understand my emotions a lot of the time because they didn’t make sense to me and I felt they often worked against me. I felt like therapy would be like letting someone into your mind and I was scared to do that: it didn’t feel safe to be vulnerable. At the same time as these worries, I believed therapy could help me with the right therapist.

Client 2: I wasn’t so much anxious, rather I felt I’d failed, and that accepting I needed to see someone for support was a sign of that failure and the fact I couldn’t cope. I also felt embarrassed that maybe people would judge me for needing to see a ‘head doctor’.

2. Did you have a sense of what you thought would happen if you let certain emotions come out?

Client 1: I felt so full of anger and sadness that I didn’t know how to release it, but worried if I did that it would pour out of me uncontrollably and I thought I might not be able to stop. I guess it was unknown to me what might come out and how it would look; it was unknown territory for my mind, and I don’t like to feel out of control.

Client 2: Again, it was worry that I was failing or conceding defeat by needing that support. If I broke my leg or had the flu I would have no issue seeking medical help. Yet the fact it was a mental issue made me feel I was weak and had failed in some way. I was worried I would be judged, not so much by a therapist, but by colleagues and friends. That it might change their perception of me and make them trust me less.

3. Did any of these fears/worries come true?

Client 1: My worries and fears didn’t come true. I smile at myself for the imaginative extremes I went to and how different that was from my experience. I asked a lot of questions and started understanding thoughts and emotions until I felt safe and able to let things start to come out. I never felt pushed and trusted that nothing bad would happen to go to certain places in my mind, remember and feel what I had been carrying round for so long and was finally, bit by bit, able to let it go.

Client 2: Once I overcame my own hesitations I quickly realized that asking for help was actually a sign of strength and courage, not weakness. From our first session I felt comfortable, yet I perhaps was guarded at first, as I had barriers up to protect myself mentally from further anguish and didn’t want to fully accept how poorly I was. I wanted you to give me a quick solution and then I could get back on the treadmill, whereas what I needed was a sustained period of mental support and rest to truly reflect on where I’d got to and how I wanted to move forward. Far from being unsupportive or judgemental, my colleagues and friends rallied round me and made me feel loved and cared for. I even achieved a top performer rating for 2020 despite being poorly during it. People actually admired my acceptance of needing help and it inspired them.

4. What would you say to someone who is struggling, but worries that seeing a therapist will make them feel overwhelmed by their emotions?

Client 1: To someone who is fearful of being overwhelmed I would say: ask questions, talk through what your fears are and what will happen. I learnt to trust in my emotions.

Client 2: I would say that things likely won’t get better until you get help and give yourself some kindness. That the brain is a critical part of your body that needs just as much looking after as your heart, your kidneys or any other organs. Mental health is something we all have and nobody is able to be mentally healthy all the time. Therapists are not there to judge or scold you, they are there to work with you and teach you different coping strategies that make you a stronger, more capable person. People will actually admire you for getting help and it may in turn give others the courage to seek help themselves so you are not only having a positive impact on you, but others too.

* * * *

I also wanted to ask the views of my two clinical supervisors whose practices both sit in the cutting edge of psychotherapy and neuroscience and whom I have learned so much from. This book feels very much like the culmination of their teachings, and it felt very important to me to include their thoughts in this book.

Colin Howard, Howard Psychology Ltd

This book is a refreshing review of the latest therapeutic modalities, and neurobiological research, and Donna has provided the information in a way that makes it accessible to the layperson. This is incredibly helpful and allows the reader to make a truly informed decision about starting their own therapeutic journey. Donna has combined information that is relevant to those who are interested in understanding how the mind and body combine to store, and process information, as well as the interruptions to that process. Donna has also addressed the core fears and misconceptions that people can have about starting therapy. This book will be an incredibly helpful resource for those who are considering entering into therapy, and will provide the reader with a clear and informed awareness of the latest approaches.

Elizabeth Doggart, Elizabeth Doggart Associates Ltd

Working in the helping professions it has been my pleasure to know Donna through our professional relationship, for many years. In that time, I have watched her grow and develop an extensive knowledge and experience in the world of counselling and psychotherapy.

The world of counselling and psychotherapy has undergone considerable growth since the pioneering work of Freud in the 1890s, and that process of development has in turn brought with it increased knowledge, understanding, but also a high degree of complexity. Indeed, there has been such an emergence of paradigms each purporting to help the troubled individual address their adversities by different methods, that there are now over 400 psychotherapeutic ‘routes to Rome’ (Prochaska and Norcross, 1994). The dilemma then, for the client, is that in finding themselves in a time of crisis or distress, a time when it can itself be very hard to make decisions, is that they need to choose from the many treatments on offer, exactly which will be the right one for them. Of course, there are many approaches that have made more of an impact through the media than others and have slipped into common language. For example, there is cognitive behavioural therapy (CBT), psychodynamic therapy, Gestalt therapy, integrative psychotherapy, and client-centred therapy, to name but a few. Such popularized ‘talking therapies have focused very much on the role of our thoughts, or our feelings, or our behaviours, as almost discrete entities. But if we look to simply talking through our thoughts to try and cope with our distress, are we perhaps being guilty of committing Descartes’s error (Damasio, 1995)? Perhaps it is not sufficient to declare ‘I think therefore I am’, believing that simply talking through our problems and changing our thoughts will find the solution we need. Science tells us we are physical beings, our mind, which is housed in a highly complex neural network of cells (our brain) and is an extension of our central nervous system, is part of our entire body. Thoughts, feelings and behaviours are in fact interrelated and interdependent of each other (Ellis, 1994). Recently, newer approaches have emerged that focus on the whole person, approaches such as eye movement desensitization and reprocessing (EMDR), somatic experiencing and also the lesser known but very effective brainspotting (BSP). Such approaches have been guided by developments in neurosciences, increasing our understanding of our cellular biochemical-electrical being.

So far I have only touched on a few of the developments in the field of counselling and psychotherapy and choices on offer, and it’s clear that there is a wealth of choice, and we can run the risk of succumbing to ‘information overload’ when we ask questions such as: what kind of counselling should I have? What is out there? How will I benefit? Who do I turn to? How will I know that this is the right therapy for me?

‘Do I need to see a therapist?’ It’s a question people may ask themselves in times of stress and confusion and then may not be sure or may even be fearful about what might be the next steps to take. This book will help the reader find the answers to these questions. Donna has set out in a clear and precise way an informative and valuable guide on how to navigate through the maze of services and approaches, bringing a much-needed torch that will illuminate the way forward for clients and may also be of benefit to therapists. Donna has achieved this with a critical but compassionate eye, her focus always being to help the client, and with refreshing clarity. Counselling and therapy is about making choices and this book will help to determine your choice from a much more informed position.

LIST OF FIGURES

AND TABLES

Fig. 1 Formulation of an instance of pride

Fig. 2 Dial of arousal, safety and connection

Fig. 3 Dial of fight, flight and freeze

Fig. 4 Client formulation example 1

Fig. 5 Blank formulation template

Fig. 6 Client formulation example 2

Fig. 7 Choosing a mode of therapy

Fig. 8 Where to look for a therapist

Table 1 Same situation, different interpretations

INTRODUCTION

Imagine placing a lemon onto a chopping board and slicing your knife through the bulging yellow belly of the fruit. You cut the lemon in half, and then half again. Then you pick up one of the quarters and bring it to your lips, biting into the sharp flesh and sucking the juice. Pause there. What do you notice in your body right now? Is there a little bit more saliva in your mouth? Did you move your lips slightly, or pucker them? Did your upper body pull back at the thought of biting into the lemon? Notice these small events that are happening in your body right now.

Where is the lemon? It doesn’t exist: you imagined it; you visualized it. Yet your body reacted as if it were real.

Your brain just made a ‘simulation’. It represented what you deliberately imagined and what you know about lemons to simulate the experience of biting into that slice of lemon. You may have had other thoughts or memories pop up. For example, I’ve just had a memory of throwing out some bad lemons that were green and powdery. But when I wrote the first draft of this paragraph a tasty memory of the smell and feeling in my mouth of warm lemon drizzle cake came up for me. Today though, a newer memory of the bad lemons was triggered first instead of that lovely lemon drizzle cake.

Now, bring up a memory of a time when you felt proud. Did you manage to get through a whole day at work despite having very little sleep the night before? Did you have an interview for a job and manage to get through it, even though you felt so on edge just before that you thought about cancelling and not going through with it? Or have you finally finished that degree after several long years? If you got through it, whatever your ‘it’ is, say to yourself now, ‘I did it!’ Repeat, ‘I, did it.’ Say it again: ‘I did it!’ What happened in your body as you said this? Did you smile? Did you look upwards, or to the side? Did you lean back, or straighten up your posture? Notice that shift in your body, and where your gaze went to. Each of these micro-expressions (Ekman & Friesen, 1974) are connected to the feeling of pride that is connected to that memory. When you feel proud in other situations, notice if you have the same sensations and shifts in your body.

ILLUSTRATION

Fig. 1. – Formulation of an instance of pride

Let’s try this again with a different memory. Bring up a time when you made a small mistake. Maybe you accidentally said ‘luv you, bye’ to the guy from EE on the phone (me), or tripped over, recovered then slipped again and face-planted in the mud in front of the other parents at school pickup (also me). OK, that’s not really a mild embarrassment! But what memory comes up for you? Let your mind flick through, and when you settle on one, notice the moment in the memory when you felt the most embarrassed. See the image of that moment. Now, notice what your body is doing right now. Are you frowning? Looking down or clenching your teeth? Do you notice any gripping or tension anywhere?

These are some of the bodily expressions that are connected to the feeling of embarrassment for you. Notice how your body is reacting to what you are visualizing.

Now do a quick scan of your body. Check that your shoulders are not hunched forwards. Notice if you’re clenching your toes or holding tension anywhere else. Take a slow, deep breath in, then let this breath