Understanding silence

Parents and carers often worry when a child becomes withdrawn, refuses to talk about their feelings, or seems overwhelmed by emotions they cannot explain. Silence can be confusing and even frightening for adults, especially when we sense that something is wrong but do not know how to help.

From a psychodynamic perspective, a child’s behaviour—including silence—can be understood as meaningful communication. Children may not yet have the words to describe their inner world, but their actions, emotions, and behaviours often express what they are experiencing internally.

Understanding what silence might mean and recognising signs that your child could benefit from therapy can help families access support early.

Why Some Children Don’t Talk About Their Feelings

Children and young people often struggle to put emotions into words. This can happen for many reasons:

• They may feel overwhelmed or confused by strong emotions such as anger, shame, or sadness.

• They may worry about getting into trouble or upsetting their parents.

• They may lack the developmental language skills to describe their inner experiences.

• They may have learned that difficult emotions are not safe to express.

In psychodynamic child therapy, behaviour is understood as an expression of underlying emotional
experiences. Some children communicate distress through behaviour rather than language because emotions feel too complex or threatening to speak about directly. Therapy can provide a safe space
where children can begin to explore these feelings through play, drawing, storytelling, and symbolic expression, which often precede verbal communication.

A Child’s Silence may be a Sign of Emotional Distress

Occasional quietness or reluctance to talk is developmentally normal. However, persistent silence or
emotional withdrawal may indicate that a child is struggling internally. Signs parents may notice include:

Sudden changes in behaviour

Children who are struggling emotionally may become unusually withdrawn, irritable, or angry.

Increased anxiety or sadness

Persistent worry, tearfulness, or low mood can indicate that a child is experiencing emotional distress.

Difficulties at school

This may include declining academic performance, school refusal, or social difficulties with peers.

Changes in sleep, appetite, or routines

Emotional distress in children can sometimes appear through physical symptoms such as sleep problems,
stomach aches, or loss of appetite.

Behaviour that feels “out of character”

For some children, distress is expressed through aggression, defiance, or risk taking behaviour. Children often experience emotional difficulties that they cannot clearly articulate. Psychotherapy can help them explore these feelings safely and develop healthier ways of expressing themselves.

What Happens When a Child Doesn’t Talk in Therapy?

It is common for children to be quiet during early therapy sessions. Building trust takes time. Research and clinical experience show that many children initially resist therapy because they feel embarrassed, anxious, or unsure about discussing difficult experiences. Once a positive therapeutic relationship develops, children often become more comfortable participating and expressing themselves.

Psychodynamic therapy recognises that silence itself can be meaningful. A child’s reluctance to speak may reflect:

○ Fear of being judged
○ Loyalty conflicts within the family
○ Difficulty trusting adults
○ Feelings that are too overwhelming to verbalise

Therapists work gently and at the child’s pace, often using play, creativity, and relational attunement to help children feel safe enough to express themselves.

Why Early Support Matters

Children rarely “grow out” of emotional distress without some form of support. When feelings remain
unspoken, they can sometimes emerge in other ways such as behavioural difficulties, anxiety, or challenges in relationships.

Early therapeutic support can help children:

• Understand and regulate their emotions
• Develop resilience and coping strategies
• Improve relationships with parents, siblings, and peers
• Build a stronger sense of self and emotional security

How Therapy Supports Children and Families

Psychodynamic child therapy focuses on understanding the child’s inner emotional world and the meaning behind behaviour.

Therapy may involve:

Play and creative expression
Talking with the child at their own pace
Supporting parents and caregivers
Exploring emotional patterns within family relationships

The aim is not simply to “fix behaviour” but to help children feel understood, emotionally safe, and better able to express themselves.

When to Consider Seeking Support

You may wish to seek professional support if:

Your child seems persistently withdrawn or unhappy
You notice ongoing behavioural or emotional changes
Your child struggles with relationships or school
Difficult experiences such as separation, loss, or trauma have occurred
Seeking support early can make a significant difference to a child’s emotional development and wellbeing.

References

Midgley, N., & Kennedy, E. (2011). Psychodynamic Psychotherapy for Children and Adolescents.
Fonagy, P., Target, M., Cottrell, D., Phillips, J., & Kurtz, Z. (2002). What Works for Whom? A Critical Review of Treatments for Children and Adolescents.
Target, M., & Fonagy, P. (1996). Playing with reality: Theory of mind and the normal development of psychic reality. International Journal of Psychoanalysis.

Anxiety is a normal and adaptive human response. It evolved to help us detect and respond to threat. When functioning well, it sharpens attention, increases alertness and motivates preparation.

However, for many people anxiety becomes persistent, excessive, and difficult to control. Rather than responding to immediate danger, the mind begins anticipating potential future threats. This process is commonly experienced as worry.

While worry can sometimes feel protective or productive, chronic worry often maintains anxiety rather than resolving it. Cognitive Behavioural Therapy (CBT) offers a structured, evidence-based approach to understanding this cycle and learning how to respond differently.

What Is Worry?

Worry is typically defined as a chain of repetitive, negatively focused thoughts about uncertain future events (Borkovec, Robinson, Pruzinsky, & DePree, 1983). It often takes the form of “what if…” thinking:

• What if I make a mistake?
• What if something goes wrong?
• What if I can’t cope?
• What if this means something serious?

Research suggests that worry is primarily verbal in nature (rather than image-based) and functions as a cognitive attempt to problem-solve potential threats (Borkovec & Inz, 1990). However, unlike effective problem-solving, worry tends to be circular, abstract and difficult to resolve.

In Generalised Anxiety Disorder (GAD), excessive and uncontrollable worry is the central feature (American Psychiatric Association, 2013). But problematic worry also plays a role in health anxiety, social anxiety, panic disorder and obsessive-compulsive difficulties.

A CBT Understanding of Worry

From a CBT perspective, worry is not random. It is maintained by identifiable cognitive and behavioural processes.

The cognitive model of Generalised Anxiety Disorder (Dugas et al., 1998; Wells, 1997) highlights several key maintaining factors:

• Intolerance of uncertainty – difficulty accepting that outcomes cannot be fully predicted.
• Positive beliefs about worry – e.g. “Worrying helps me prepare”.
• Negative beliefs about worry – e.g. “My worrying is uncontrollable”.
• Cognitive avoidance – using worry to avoid more distressing mental imagery.

Worry often provides short-term relief. When a person engages in worry, they may temporarily feel more prepared or more in control. This short-term reduction in distress reinforces the behaviour, increasing the likelihood that worry will be used again in the future.

This creates a maintenance cycle:

1. Trigger (internal or external).
2. “What if…” thought.
3. Anxiety increases.
4. Worry escalates.
5. Temporary sense of control.
6. Anxiety returns.

CBT aims to interrupt this cycle by modifying both the thinking patterns and behavioural responses that maintain worry.

How CBT Helps with Anxiety and Worry

CBT does not aim to eliminate anxiety altogether. Anxiety is a normal emotional response and plays an important protective role. Instead, CBT focuses on helping individuals develop a different relationship with their thoughts and uncertainty.

Interventions may include:

• Psychoeducation about anxiety and threat systems.
• Identifying worry triggers and patterns.
• Differentiating between productive and unproductive worry.
• Behavioural experiments to test feared predictions.
• Reducing reassurance-seeking and avoidance.
• Developing tolerance of uncertainty.
• Scheduled “worry time”.

One particularly effective and accessible strategy is the use of a worry diary, often combined with scheduled worry time.

The Worry Diary: Postponing Rather Than Suppressing

Attempting to suppress worry is generally ineffective. Research on thought suppression demonstrates that trying not to think about something can paradoxically increase its frequency (Wegner, 1994).

CBT therefore adopts a different strategy: postponement rather than suppression.

The principle is simple:

You may not be able to control which thoughts arise —
but you can influence when and how you engage with them.

A worry diary helps operationalise this.

How a Worry Diary Works

1. Notice the Worry

When a worry thought appears, it is briefly recorded.

For example:
“What if I embarrass myself in tomorrow’s meeting?”

This step builds awareness without engaging in prolonged rumination.

2. Postpone to Scheduled Worry Time

The individual designates a specific daily period (often 20–30 minutes, not close to bedtime) as “worry time.”

When the thought arises outside this period, they tell themselves:

“I will think about this properly during my worry time.”

This is not avoidance — it is structured postponement.

3. Redirect Attention

The individual gently redirects attention to the present activity. This may need to be repeated multiple times.

Over time, the brain begins to learn that worry does not require immediate action.

Why Worry Postponement Is Effective

There are several mechanisms involved:

Reduced Urgency

The brain learns that worry is not an emergency requiring immediate cognitive engagement.

Breaking Reinforcement

Immediate engagement with worry is reinforcing. Delaying it weakens this cycle.

Increased Tolerance of Uncertainty

Postponement strengthens the ability to sit with unanswered questions.

Cognitive Restructuring

Individuals experience that thoughts can be observed and scheduled, rather than cause automatic behaviours.

Research suggests that structured worry postponement can significantly reduce worry frequency and intensity (Borkovec et al., 1983; Dugas & Robichaud, 2007).

Interestingly, many people report that by the time scheduled worry time arrives, the earlier concerns feel less urgent or less believable.

Taking Back Control from Automatic Thoughts

A common experience in anxiety is the sense that thoughts are intrusive and uncontrollable. This can lead to secondary anxiety — worrying about worrying.

CBT reframes this:

While we cannot fully control the automatic emergence of thoughts, we can influence our response to them.

This shift — from reaction to response — is central to regaining a sense of agency.

Over time, individuals often notice:

• Fewer spontaneous worry episodes
• Reduced intensity of anxiety
• Greater psychological flexibility
• Increased confidence in coping

The goal is not to eliminate uncertainty or silence the mind. It is to respond in ways that reduce the long-term maintenance of anxiety.

Conclusion

Anxiety often persuades us that constant mental rehearsal will prevent bad outcomes. In reality, excessive worry rarely produces certainty. Instead, it sustains physiological arousal and cognitive distress.

CBT offers structured, evidence-based strategies to:

• Understand the function of worry
• Break maintenance cycles
• Strengthen tolerance of uncertainty
• Develop intentional responses to intrusive thoughts

A worry diary may appear simple, but its power lies in restoring choice.

Not every thought requires immediate attention.
And learning that distinction can be transformative.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9–16.

Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder. Behaviour Research and Therapy, 28(2), 153–158.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.

Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.

Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52.

Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.

Isn’t Counselling a Bit… Self‑Indulgent?

It’s a question people often think but rarely say out loud. And honestly? A counsellor might smile and reply, “I don’t know — is it?”

Because the idea of counselling as “self‑indulgent” usually comes from a deeper belief: that looking after ourselves should be quick, cheap, or squeezed into the margins of life.

But let’s explore that for a moment.

“I Already Have Ways to Cope…”

You might feel you don’t need counselling because:

• you talk to friends
• you go to the gym to burn off stress
• you take a holiday every summer to decompress
• you think things through in your own head

All of these are genuinely valuable. They help you get through life. But they don’t always help you understand why you feel the way you do.

Friends are wonderful, but their loyalty can soften the truth.  They want to protect you. They want you to feel better. They want to relate.  It’s connection, not clarity.

Exercise can release tension, but it doesn’t explain why the tension built up in the first place.  What if the stress you burn off at the gym keeps returning because the root cause hasn’t been explored?

A holiday gives you a break — but what happens when you return home and to the same patterns? Are you content wishing your life away waiting for that annual break rather than enjoying each day with all that it brings, inescapable challenges and joys to savour?

And our minds are brilliant at rationalising, minimising, pushing things aside. Sometimes too brilliant.  We can explain away stress, minimise hurt, and convince ourselves that “this is just how life is.”

When “Normal” Isn’t Actually Healthy

We all create our own version of normal. We adapt. We cope. We get on with things.

But what if your normal is quietly wearing you down? What if the stress you’ve accepted as “just life” is actually a sign that something needs attention? What if the thoughts you keep to yourself feel too embarrassing or confusing to say out loud and stay unspoken because of fear of judgement?

A counsellor offers something rare: a space where nothing you say is judged, dismissed, or brushed aside.  They offer something your own mind can’t: an outside perspective that gently challenges your reality when needed.  Not to criticise.  Not to shame.  But to help you see patterns you’ve been living with for so long that they’ve become invisible.

The Gift of Being Fully Heard

Think about the last time you spoke uninterrupted for more than a minute. No one jumping in with their own story. No one trying to fix you. No one saying, “I know exactly how you feel — that happened to me too.”

My friend and I tease each other about this all the time: “Oh, I have a story like that — but it’s more interesting because I’m in it!”

It’s human nature. We relate by sharing. But counselling is different. It’s one of the few places where the focus stays entirely on you.  No competing stories.  No need to perform.  No pressure to be “fine.”  Just space.

There are thoughts you might never say to a friend.  Feelings you might not want to burden someone with.  Questions about yourself that feel too tender to voice.  A counsellor is trained to hear these without flinching.  To listen without prejudice.  To hold your story without needing you to edit it.

Is It Really Indulgent to Understand Yourself?

We’re legally required to put our cars through a MOT every year. We’re encouraged to service them regularly — because machines need maintenance.

Yet somehow, we expect ourselves to run indefinitely without checking in.

Counselling isn’t indulgent. It’s maintenance for the mind, body and soul. It’s a chance to pause, reflect, and understand the patterns shaping your life with the hope of creating one with even more purpose and meaning.

Counsellors are trained to notice what you say, how you say it, and what sits between the lines. They work at your pace, helping you explore your experiences with curiosity.  And sometimes, that gentle exploration is the most responsible, grounded, and compassionate thing you can do for yourself.

Bibliography

1. Barlett, S. (2022) ‘Gabor Mate: The Childhood Lie That’s Ruining All Of Our Lives’, The Diary of a CEO with Steven Bartlett [Podcast]. Available at: Spotify Podcasts & Youtube. (Accessed: 7 November 2024).
2. Cozolino, L.J. (2016) Why therapy works: Using our minds to change our brains. New York: W.W. Norton & Company.
3. Finlay, L. (2025) Relational counselling and psychotherapy. London: Sage.
4. Kolk, B.V.D. (2015) The Body Keeps The Score. London: Penguin Books Ltd.
5. Rogers, C.R. (1957) ‘The necessary and sufficient conditions of therapeutic personality change.’, Journal of Consulting Psychology, 21(2), pp. 95–103.
6. Wallin, D.J. (2007) Attachment in Psychotherapy. New York: Guilford Press

Location: Fully Remote (Practice: Paisley PA1 1TJ, Scotland)

Hours: Part-time; possibility of future Full-time

About Us

Paisley Counselling offers professional mental health support with a focus on warmth, care, and open communication in a values-driven team.

Role Summary

We are looking for an organised, proactive Marketing & Office Administrator who is comfortable with technology and values workplace growth. Prior marketing or administration experience is required; interest in healthcare is a plus.

Primary Responsibilities

Marketing & Online Support

• Create and maintain online content (website, social media, blogs).
• Manage digital presence and schedule posts.
• Respond to enquiries and apply basic SEO techniques.

Client Onboarding & Communication

• Welcome prospective clients and guide them through onboarding.
• Provide clear service information and maintain confidential records (GDPR compliant).

Scheduling & Administration

• Manage session schedules and bookings.
• Coordinate calendars and handle general admin tasks.

Skills & Attributes

Essential

• Positive, willing to learn, detail-oriented, strong communication skills.
• Proficient with email, scheduling tools, and Microsoft Office.
• Reliable and maintains confidentiality.

Desirable

• Interest in mental health and wellbeing.

Training & Support

• Ongoing guidance and skill development.

Benefits

• Fully remote work, flexible hours, supportive team, and impactful role in mental health.

Apply with CV and covering letter to kim@paisleycounselling.com

and why you don’t have to face it alone

By Shaun Hotchkiss, CBT Psychotherapist

Laura

When people hear the word exposure in Cognitive Behavioural Therapy (CBT), it often brings up images of being pushed into frightening situations before they feel ready. For many, this alone is enough to create anxiety about therapy itself.

If that reaction sounds familiar, it’s important to know that this response is understandable, common, and expected. Exposure works directly with fear — and fear is something the human nervous system is designed to protect us from.

This blog aims to explain what exposure really is, why it can feel daunting, and why support matters — without asking you to do anything on your own.

Why exposure can feel so scary

Exposure involves gradually approaching situations, sensations, thoughts, or memories that have come to feel threatening. These are often things people have learned to avoid because avoidance brings short-term relief from distress.

UK CBT literature consistently explains anxiety as being maintained through this cycle of fear → avoidance → temporary relief → increased fear (NHS Talking Therapies, 2018; Warwick University, n.d.). From this perspective, avoidance is not a weakness — it is a survival strategy that once made sense.

When exposure is suggested, it can feel as though that sense of safety is being taken away. People commonly worry that:

• anxiety will become overwhelming
  
  
• distress will spiral out of control
  
  
• they will be unable to cope
  
  
• exposure means “forcing” themselves to suffer
  
  

NHS and IAPT materials highlight that these fears are a natural response to anticipating threat, not a sign that someone is unsuitable for CBT (TalkPlus, 2023).

What exposure in CBT is not

One reason exposure can feel frightening is that it is often misunderstood.

Exposure is not about being forced into feared situations.

It is not about “just pushing through”.

It is not about eliminating anxiety altogether.

Instead, UK CBT guidance describes exposure as a collaborative, planned, and supported process, usually carried out with a trained therapist (NICE, 2013; NHS Talking Therapies, 2018). The focus is on helping people feel safer engaging with life again, rather than on enduring distress for its own sake.

Letting go of the idea that anxiety must disappear

Many people begin therapy hoping to get rid of anxiety, panic, intrusive thoughts, or uncomfortable bodily sensations entirely. While understandable, this expectation can unintentionally make exposure feel like a test that can be failed.

NHS CBT resources emphasise that the goal of exposure is usually not the complete removal of feelings, but rather learning that these experiences are tolerable, temporary, and less dangerous than they feel (Plymouth Hospitals NHS Trust, 2020).

Over time, many people notice that when they stop avoiding feared situations, their confidence increases and their anxiety naturally reduces — but this happens because their relationship with fear changes, not because fear is eliminated altogether.

Why support makes such a difference

Exposure is most effective when it is carefully planned and paced, taking into account someone’s history, current stress levels, and personal values (NICE, 2013). UK guidance consistently highlights the importance of delivering exposure within a structured therapeutic framework rather than as a self-directed challenge (NHS Talking Therapies, 2018).

Working with a therapist allows people to:

• make sense of their fear responses
  
  
• agree on goals that feel meaningful and realistic
  
  
• move at a pace that feels manageable
  
  
• reflect on experiences safely and compassionately
  
  

This support can be especially important for people whose difficulties are linked to trauma, panic, OCD, social anxiety, or long-standing patterns of avoidance.

A hopeful but realistic message

Exposure is not about becoming fearless. It is about becoming less restricted by fear.

Many people who engage in CBT discover that while uncomfortable feelings may still arise, those feelings no longer dictate their choices. Life begins to expand again — not because fear disappears, but because confidence and trust in oneself grow.

If exposure feels daunting, that does not mean you are “not ready” or “not suitable” for CBT. It often means you are human — and that support could make the difference.

You do not have to face these steps alone.

References

NHS Talking Therapies (2018) The NHS Talking Therapies for Anxiety and Depression Manual. NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf (Accessed: [24.01.2026]).

NICE (2013) Social anxiety disorder: recognition, assessment and treatment (CG159). National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/cg159/chapter/recommendations (Accessed: [24.01.2026]).

Plymouth Hospitals NHS Trust (2020) Exposure and habituation. Available at: https://www.plymouthhospitals.nhs.uk/display-pil/pil-exposure-and-habituation-6611/ (Accessed:[ 24.01.2026]).

TalkPlus (2023) Graded exposure. NHS Talking Therapies. Available at: https://www.talkplus.org.uk/wp-content/uploads/2023/12/Graded-Exposure.pdf (Accessed: [24.01.2026]).

Warwick University (n.d.) Exposure and habituation. University of Warwick. Available at: https://warwick.ac.uk/services/dc/pgr/phd_wellbeing/exposure_and_habituation.pdf (Accessed: [24.01.2026]).

Post-Traumatic Stress Disorder (PTSD) is more common than many people realise and often misunderstood. PTSD can develop after experiencing or witnessing a traumatic event, and can affect anyone, regardless of age, background, or circumstances. What I find most important, and hopeful, is that PTSD is highly treatable.

As a trainee CBT therapist, I’ve developed a particular interest in structured, trauma-focused work. I’m especially drawn to how evidence-based approaches like Trauma-Focused CBT (TF-CBT) and imaginal reliving can help people process distressing experiences in a safe, supportive, and structured way. When someone is living with PTSD, they might experience flashbacks, nightmares, heightened anxiety, emotional numbing, or feel constantly on edge. Understandably, many people try to push these memories away or avoid reminders of what happened, but this can keep the trauma feeling “stuck,” and continue to shape and control everyday life in distressing ways.

What I value about structured trauma-focused therapy is that it offers a way through and opportunity to regain a sense control in their thoughts and feelings. One key part of this process can involve reliving sessions, guided therapeutic work where clients revisit the traumatic memory in a safe and controlled environment. This doesn’t mean re-experiencing the trauma in an overwhelming way. It’s about gradually processing what happened, making sense of it, and reducing its emotional grip. Over time, many people find the memory becomes less intrusive in their thoughts and their unhelpful believes about themselves following the incidents changes to more helpful and rational assessments.

Research in the UK continues to support this approach. Ehlers & Clark’s (2000) cognitive model of PTSD is a foundation of many trauma-focused CBT approaches, highlighting how unprocessed trauma memories and negative appraisals can maintain symptoms. NHS guidance, including NICE (2018) recommendations, places trauma-focused CBT as a first-line treatment for PTSD, especially when symptoms have lasted longer than four weeks.

What stands out to me most in this work is the change people begin to experience, when a memory that once felt unbearable becomes something that no longer dictates their life. Structured sessions give people space to face what happened, on their own terms, and to start rebuilding parts of life that may have felt lost.

If you’ve experienced trauma and are feeling stuck or overwhelmed, know that support is available, and recovery is possible.

by Laura Hendry

Understanding Our Body’s Reactions and Pathways to Healing

Polyvagal theory has become influential in the world of trauma therapy, giving counsellors new ways to understand and help people who have experienced trauma. Created by Dr Stephen Porges in the 1990s, this theory helps us see how our body’s automatic responses can shape our feelings of safety, our ability to connect with others, and our overall well-being. In this blog, we’ll look at how polyvagal theory is used in counselling, focusing on the fight, flight, and freeze responses, as well as new research on more complex patterns in our body’s reactions.

What is Polyvagal Theory?

At its heart, polyvagal theory says our body’s stress response is more complicated than just “fight-or-flight” or “rest-and-digest.” According to the theory, there are three main ways our body can react to danger or safety. One helps us feel calm and able to connect with others, another gets us ready to confront or run from trouble (fight or flight), and the last makes us shut down or freeze when things feel overwhelming. These responses developed over time to help us survive in different situations.

Fight, Flight, and Freeze: The Impact of Trauma

When someone goes through trauma, their body can become stuck in these survival modes. The “fight” response prepares us to stand up to danger. If that’s not possible, the “flight” response gets us ready to run away. If escape isn’t possible either, our body may “freeze” — we might feel numb or disconnected, like we’re shutting down. For people who’ve experienced trauma, these reactions can show up long after the original danger has passed, often without warning.

Counsellors are trained to spot these patterns in their clients. By using ideas from polyvagal theory, they help people feel safer and teach ways to calm their nervous system, such as deep breathing, grounding exercises, or connecting with others in a safe setting.

More Than Just Fight, Flight, or Freeze

Recent studies show that our body’s reactions aren’t always so simple. Sometimes, people feel mixed reactions at the same time — like feeling numb and restless, or shut down but also on edge. These blended reactions are common for people with complex trauma or PTSD.

Understanding these mixed states helps counsellors offer better support. Instead of seeing people’s reactions as only one thing or another, therapists can recognise that feelings can overlap and change, and they can adjust their help to match what someone is really feeling in the moment.

Using Polyvagal Theory in Counselling

Integrative counselling uses different techniques based on each person’s needs. A polyvagal approach might include mindfulness, gentle movement, or body-focused therapies, all with the goal of helping people feel safe and more in control of their bodies and emotions.

Research shows just how important it is for therapists to help clients feel safe, both emotionally and physically. When people feel truly safe, they can begin to heal from trauma, reduce anxiety, and start to reconnect with others and themselves.

References

• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York: W. W. Norton & Company.
• Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. Norton & Company.
• Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W. W. Norton & Company.
• Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218(2), 109–127.

As our knowledge grows, integrative counselling is leading the way in using polyvagal theory to help people move from just surviving to truly living—supporting recovery, connection, and hope.

Self-destructive behaviours like self-harm, disordered eating and substance misuse naturally spark concern in loved ones and care providers. 

The risks and consequences of such behaviours can be far reaching.  It makes sense then that motivation most often lies in ‘fixing’ the behaviour and eliminating the risks.

Frequently, the question posed is ‘Why the behaviour?’. However, as suggested by Dr Gabor Mate, perhaps the more pressing question is ‘Why the pain?’  (2018).

Self-destructive behaviour is an often misunderstood issue that profoundly impacts both the individual and those close to them.  Where current standard treatment approaches focus on thought and behaviour patterns in the ‘here and now’, there is growing evidence to support therapeutic interventions which explore the root causes of the behaviours.

Renowned trauma specialist, Dr Janina Fisher explains that each incident of destructive behaviour results in short term relief from psychological pain, followed by a ‘rebound effect’ which may include negative social consequences, traumatic exposure or reinforcing experiences.  This increases the likelihood that the same destructive behaviours will be stimulated again (2024).

Consultant Psychiatrist, Dr Frank Corrigan explains that destructive behaviours are an attempt to regulate a dysregulated nervous system (2010).  A cycle of re-traumatising self-destructive responses is set in motion and since the individual likely develops a tolerance to the addictive behaviour, increased or more intense attempts to self-regulate are needed to achieve some relief. 

Dr Janina Fisher explains that, despite the best efforts of health professionals, successful treatment of destructive coping behaviours is extremely challenging because the fear of their underlying pain is much greater than the fear of the risks involved in their behaviours (2024).

Self-destructive behaviours are self-protective strategies offering a sense of safety and a way to cope and regulate through deep, often unconscious pain. 

Although challenging thought and behaviour patterns is one aspect of successful therapy, it is not enough. 

I believe that much of the work is possible only as a stable therapeutic relationship begins to be established.  It is important to find a counsellor who feels like a ‘good fit’ for you.  Who can sit with you in your pain and honour the protections that have helped you survive whilst offering safety, compassion and care.  In this way, you can work together to uncover the underlying thread of pain, processing and establishing a new level of safety within and finding new, safer ways to regulate your system. 

References

Corrigan, F. F. J. N. D. (2010). Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma. Journal of Psychopharmacology, 0(0), pp. 1-9.

Fisher, D. J. (2024). Understanding Self Destruction. s.l.:Dr Janina Fisher Ph.D. for Instagram and Facebook.

Mate, G. (2018). In the Realm of Hungry Ghosts. London: Vermillion.

The Window of Tolerance illustrates the state in which we best tolerate life’s every day demands and stresses. 

When we are within our own window of tolerance, we are present and alert.  We can engage with others and respond in a calm and considered manner, with skills to self soothe and regulate our emotional state.

However, when we are dysregulated, we are pushed out of our window of tolerance into either hyper-arousal or hypo-arousal.

Hyper-arousal is a state of excessive energy.  You are likely to feel a heightened sense of anxiety, which may make you highly sensitive and reactive.  The fight or flight responses are activated and you may experience symptoms such as:

anxiety, panic, fear, hypervigilance, angry outbursts, sleep problems and difficulty concentrating.

Hypo-arousal, in contrast, is a state of very low energy as a result of the freeze response.  You may experience:

numbness, lack of energy, inability to think or respond, reduced physical movement, low appetite, excessive tiredness and difficulty processing thoughts and emotions.

For people who have experienced trauma or cumulative toxic stresses, their window of tolerance can become very narrow.  Consequently, they will often find themselves in either hyper-arousal (fight or flight) or hypo-arousal (freeze) state.

As dysregulation feels incredibly uncomfortable, we unconsciously develop protective defences to bring us back within our Window of Tolerance.  Unfortunately, they can become very problematic when, later in life they end up causing us harm.

For example, as it is intolerable for a child to believe their caregivers are ‘bad’, they internalise the ‘badness’ and develop the belief that they are ‘bad’.  When this decision has been made early in life and reinforced through cumulative experiences, it is likely that they will carry this belief and defence into adult life.  Although it helped them survive childhood, it no longer serves in the same way in adulthood.

Counselling which focuses on processing trauma and painful memories without being flooded or overwhelmed helps to widen the window of tolerance; the client sees that those defences they created are parts of them created to survive but are not helpful or necessary now.  

Anxiety is hugely prevalent in society today. Over the last couple of years, with all the uncertainty of COVID, lockdowns and associated issues, more people of all ages have been seeking help to deal with anxiety.

The nervous system is a bit like a smoke alarm.  It is supposed to be there in case of emergencies, it is part of us, and when it’s doing its job properly, it’s good and it’s healthy.

The problem arises when our nervous system becomes over-sensitive and perceives threat and danger everywhere. When this happens, our alarm system goes off, flooding our bodies with stress hormones, and causing all the horrible physical feelings associated with anxiety.

In her book, ‘Atlas of the Heart’, Brene Brown explains that, unlike fear, which is a response to current threat, anxiety is linked to the future.  Research has revealed that there is a link between intolerance to uncertainty and anxiety.  It is common and natural to want to have control over what may happen.  However, unfortunately we never really have control over the future and this striving often exacerbates symptoms. 

Once the cycle of anxious thoughts, feelings and physical symptoms has started, it’s impossible to stop it using “mind over matter”.  You cannot think your way out of anxiety once it is there.  It is in our bodies and that’s where we must start to break its cycle.

Through counselling, we can learn techniques to put our bodies back into a calmer state and feel safer again.  We can influence our brains, slow them down and reduce anxious, overthinking thought patterns.