Feelings of shame, helplessness or even “unlovability” can underpin many everyday issues. Photo / 123rf
From failing relationships to feeling unhappy at work, one expert advises on the everyday issues he encounters in the treatment room.
People tend to come into therapy with the most “respectable” version of their story. The problem they start with isn’t the real issue. For example, someone might start off by saying “I want to work on public speaking and confidence”, but once I get to know them, they may also be dealing with issues around self-worth – or “imposter syndrome” – where they wonder whether they are good enough, or will be “found out”.
It’s rare for a therapist to be shocked by a client’s story: we’ve heard it all. That’s not to say we’re immune, however, and sometimes a person’s story can bring up something from a therapist’s own past. This isn’t necessarily a bad thing – the best therapists in my opinion are those who have walked the walk.
Mostly, our job is to “be alongside” the client and help them understand their story, their symptoms, where they have got stuck and how to find a way through. Hope is at the centre of everything.
Feelings of shame, helplessness or even “unlovability” can underpin many everyday issues. More often than not, these relate back to adverse childhood events, or some degree of trauma that’s never been dealt with.
Anxiety has always been common, but these days I am seeing more of it. Diagnosable conditions such as panic disorder, OCD, PTSD and generalised anxiety disorder have been around for years, but an increasing number of people are reporting what I’d call more chronic everyday anxiety – feeling overwhelmed, burnt out, or struggling with uncertainty. There’s a risk that if this chronic anxiety isn’t dealt with, it can lead to a more serious acute condition.
Even a statement like “I’m feeling anxious about the climate” usually has a link to the person’s own story – “am I safe?”, “can I cope?”, “I don’t know how to manage the uncertainty”.
Here are the five most common everyday problems I see in my treatment room.
When a client starts the conversation with a statement like this, my job is to try to unpick it. “What does this look like?” I’ll ask – and am usually met with a list of the factual things that are going on, such as: “I’m too busy at work, I’ve got too much on, I’m worried about paying my mortgage.”
Of course, everyday life events can contribute to feeling stressed, but it’s the person’s internal reaction to these events that’s the important thing. Many people struggle with uncertainty and not knowing how things are going to turn out. The adrenaline from this is making them feel on edge or perhaps making it hard for them to sleep.
There are two approaches that can help. The first is practical: to try to break down the contributing problems, to make them feel more manageable, to prioritise and focus on what small next steps would be useful.
But the second, deeper part is to challenge the person to look at their beliefs about how things “should” be when they are proclaiming that life “isn’t fair” or “it’s all too much”.
Perhaps it would be more helpful for a person to have a more flexible approach to their problems. Maybe it’s okay not to know what’s around the corner, that it’s acceptable for things to be a bit untidy and that it’s okay to ask for help. The client is probably contributing to their problems more than they realise and it’s the act of trying to take total control that creates more internal turmoil.
Whether they are referring to their intimate relationships or broader interactions with friends or colleagues, it’s not unusual for people to struggle. Relationships are the one area where we can be “hit” quite strongly, and they can often hold a mirror up to parts of ourselves we don’t like.
There’s another layer in that relationships can also be conflictual, and each person will have their own version of events as they go on the attack or run to their own defence.
We’re all familiar with the blame game – “he did this, she did that” – but the trick is to notice the feeling evoked in yourself when a person does something you don’t like.
“He makes me angry,” a client might tell me. I will respond: “no, you are angry. You are responsible for your own emotions. You can’t rely on another person’s behaviour to dictate whether you feel rejected, not seen or not heard.”
All this can be difficult to acknowledge. The first step is to be aware of the above, and the second is to ask yourself whether you are willing to take some responsibility in the conflict. (I’m not talking about situations such as domestic violence, abuse or coercive control when responsibility may lie with the other person).
My suggestion in any relationship challenge is a four-step process:
I once worked with a client who was going to end her relationship with a boyfriend because he didn’t call her for three days while he was on holiday. She was convinced he was seeing someone else, and was moments from leaving him a voice message to end the relationship. The day was saved when she received a call from him, informing her he was in hospital with a burst appendix.
“So why are you staying?” is always my first question. What my client really wants me to say is “oh, that’s terrible” so they can go into every tiny detail of how awful their job is, but we could sit there for the next 10 years doing that.
People tell me they stay in horrible jobs because “someone has to pay the bills”, but the real reason is that they are stuck in their mental state. Again, it comes back to the need for stability and security: people don’t like to make changes, and they like predictability, even if it’s bad.
Earlier in my career, I worked with patients who were dying. This, more than anything, made me realise that life is short. If something is making you miserable – in this instance, your job – then it’s not negotiable.
There will be an alternative role out there for you that pays the same amount, or possibly even more. Don’t use your fear of change or attachment to the old routine as an excuse to remain unhappy.
I advise my clients to do a cost-benefit analysis about the factors that might make them leave or stay. Yes, understand that change is scary, but how does that stack up against five more years of misery? It’s just possible a new job will make you happier than the one you have now.
Plus, if you do find a new role, the realisation that the process wasn’t so bad after all will give you invaluable confidence and resilience to help you in the longer term.
We aren’t necessarily entering the realms of addiction here; this situation could refer to any behaviour that becomes unhelpful and which comes at a cost. It could be drinking or drugs, but it could also be too much sex, shopping or work. Psychologists call these “maladaptive coping strategies”.
An example might be the person who finds it impossible to perform well at work after a bottle of wine at night but feels they “need” the alcohol to relax and fall asleep. The first thing to realise is that this might be a way of coping, but it may also be creating more challenges and difficulties.
My role is to understand what the person in front of me is trying to soothe, repress or avoid. And when I ask my client what that is, most people can answer the question quite easily. Many agree when I suggest they are mostly “trying not to feel”.
“Do you think it might be useful to start to feel?” I will ask the client. “Are there other ways you can self-soothe and ease some of the pain in your life?” These are different for everyone: some people might go to the gym, others take long walks, take up painting, join a book club, meditate, but there are invariably alternative solutions.
Clients often complain that their relationships aren’t progressing, their jobs aren’t fulfilling and that life was supposed to be better than it is.
Of course, none of this is helped by social media, which leads a person to the assumption that everyone is doing better than they are, which almost certainly isn’t true. People rarely share a sh-- day or put a rubbish photo on Instagram.
The upshot of this is that many clients internalise their dissatisfaction and blame themselves. They start to believe that if only they had loads of money, a better job, a bigger house, or were thinner or more beautiful, they would be happier. But the truth is, I rarely see this happen. If you try to use the external world to heal internal wounds, this just won’t work: it’s a bottomless pit.
The first thing I do as a therapist is to challenge these beliefs. I ask clients to recall a time when they received the big promotion, the expensive car – and to ask how long the subsequent feelings of wellbeing lasted. The answer is usually: not long.
Once the person is aware of the evidence that none of this worked, they are able to start exploring how they really feel about themselves and begin working on the things that are really standing in the way of their happiness.
As told to Miranda Levy
Owen O’Kane worked as a nurse in palliative care for 10 years before retraining as a psychotherapist. He eventually rose to become a clinical lead for the UK NHS. O’Kane now works in private practice and is the author of four books including How to be Your Own Therapist and Addicted to Anxiety. He appears as an expert on BBC One’s Change Your Mind, Change Your Life.