We have a rich vocabulary for too much feeling. Emotional dysregulation, affect intensity, rejection sensitivity, flooded nervous systems that cannot find their way back to baseline. It fills our training, our formulations and our caseloads, and it should, because distress is what brings people through the door. But, there is an opposite presentation, and it's one that is much harder to find words for, precisely because it's about what doesn't show up. The person who's experi

One way to define moral injury fits neatly into existing clinical frameworks. A person experienced or perpetrated something that violated their moral code. They feel guilt, shame, and/or a corrosive sense of having become a different kind of person. Treatment involves processing the memory, challenging distorted cognitions, and working toward self-forgiveness. The internal wound, addressed internally, heals. This account is not wrong, but is incomplete -- and the part it miss

There is an assumption that runs through a lot of clinical work because it feels self-evidently true: if a client keeps coming back, something useful must be happening. It is not an unreasonable assumption. Therapy is effortful. Attending requires time, sometimes money, and a degree of willingness to engage with difficult material. Surely, the reasoning goes, people would not keep doing it if it were not doing something for them. That last part is correct. Therapy is almost a

One of the things I find most interesting about supervising ACT therapists is that the model itself tells you something about what the supervision should be like. ACT is not a set of techniques sitting on top of a generic therapeutic relationship. It is a coherent framework with a particular account of what keeps people stuck and what helps them move. That framework applies to the supervisory relationship just as much as it applies to the clinical one. What this means practic

Moral injury is defined, in the ACT framework Walser and colleagues have developed, not by what a person has but by what a person does in response to moral pain. In other words, moral injury is the way in which a person responds to their moral pain in such a way as to leave them disconnected from their own deeply held moral values. This functional orientation shifts the clinical question from symptom inventory to behavioural analysis: what is this person doing in response to

Most people who grew up with childhood emotional neglect don't usually arrive in adulthood thinking: I didn't get enough emotional attunement as a child, and now I struggle with intimacy. But often they do arrive thinking: I don't know why relationships are so hard for me. I don't know why I keep ending up with people who aren't really there. I don't know why closeness feels threatening, or why I push people away when they get too close, or why I feel so alone even when I'm w

Everything was fine on paper. Your parents were there. The bills got paid. You were fed, housed, kept safe. Nobody hit you. There was no obvious crisis, no dramatic rupture, no single moment you can point to and say: that's where it went wrong. From the outside, and often from the inside too, it looked like a normal family. And yet something was off. Something that is difficult to name precisely because it was never about what happened. It was about what didn't. This post is

Most therapists choose a supervisor the way they might choose a plumber. You check they're qualified, you check they work with your client group, and if they seem reasonable in the initial conversation you say yes. The decision is often not more deliberate than that. This matters, because the quality of supervision has significant consequences for your development as a clinician, and not all supervision is equal. The evidence is clear that the right supervisor can deepen your

Something happened in childhood. Or more precisely, something didn't happen — and that absence has shaped you in ways that may not have been fully clear for much of your life. Many people might struggle to even find a story to tell. There is no single incident. No obvious wounds. Childhood wasn't necessarily bad, and it's hard to point to anything specific that was wrong. Indeed, you know other people experienced much worse. Which is actually the point, It is not so much w

Most therapists I speak to describe their supervision in one of two ways. Either they're getting something genuinely useful: sessions that leave them thinking differently about their clients, more confident in their formulations, clearer about their clinical direction. Or they're getting something that functions more like a caseload review: a structured run-through of who they're seeing, what's happening, and whether anything needs escalating. The second type isn't bad superv

If you've ever found yourself asking a partner the same question twice in one evening — "but do you think it's definitely fine?" — or checking a symptom on the internet, feeling better for twenty minutes, and then checking again, you've experienced the reassurance seeking cycle firsthand. It's one of the most common patterns in anxiety. Most people who do it know, somewhere, that it isn't really helping. What's harder to understand is why it keeps happening and what to do ins

Most couples who consider therapy have been thinking about it for a while before they do anything about it. The difficulties have usually been present for months, sometimes years, but the decision to seek help might come after something has shifted — a specific event, an argument that went further than usual, or simply a recognition that things are not going to change on their own. By the time they arrive, most couples have also formed some ideas about what therapy will invol

A man sits on his couch thinking about action. There is a particular kind of frustration that comes from understanding yourself very well and still being stuck. You know why you do what you do. You can trace the patterns back to where they came from. You understand the mechanisms maintaining them. You may have spent months or years in therapy, or reading, or reflecting, developing a clear and accurate account of what is going on. And yet the thing you want to change has not c

We all carry a story about who we are. Not a conscious narrative we have deliberately composed, but a working account of ourselves that operates mostly in the background: the kind of person we are, what we are capable of, what we would and would not do, what we deserve and do not deserve. Most of the time we do not experience this as a story. We experience it as simply knowing ourselves. It feels like accurate self-knowledge rather than a constructed account, and that is prec

Grief is not a problem to be solved. It is the natural consequence of loving someone and losing them, and it does not have an endpoint. The idea that grief should fade to nothing, that there is a finishing line after which you are supposed to be "over it," does a great deal of harm to people who are simply doing what humans do after significant loss. Sadness after bereavement is appropriate. It may last years. It may never fully go away. That is not a sign that something has

Generalised anxiety is exhausting in a way that is hard to explain to someone who has not experienced it. Not the acute fear of a panic attack or the specific dread of a phobia, but a chronic, low-level vigilance that never fully switches off. A mind that is always somewhere else: anticipating, rehearsing, scanning for what might go wrong. A body that is permanently slightly braced. Most people with GAD have tried to manage it. They have reasoned with themselves, sought reass

If you have ever been told to "just get out more" or "try to think positively" when you are depressed, you will know how unhelpful that advice is. Not because the people offering it do not care, but because it misses something important about what depression actually is and how it works. Depression is not a single experience with a single cause and a single solution. It is a pattern, or more accurately a collection of different patterns, that can look quite different from one

After a traumatic experience, most people expect that time will help. And for many people, it does. The intense distress that follows trauma, the intrusive memories, the fear, the hyper-vigilance, does tend to reduce naturally over the months that follow, as the mind gradually processes what happened and the sense of danger slowly settles. But for others, that natural settling does not happen. The symptoms do not fade. They persist, or in some cases intensify. Months pass, so

If you have health anxiety, you have probably been told, at some point, that it is "just anxiety." Perhaps a GP has checked you over, found nothing, and said there is nothing to worry about. Perhaps a friend or family member has pointed out, gently or less gently, that you have been convinced you were seriously ill before and you were fine then too. And yet the next time a symptom, or unwanted sensation, appears, the fear comes back just as strongly. You know, in one part of

Social anxiety is one of the most common and also most limiting of the anxiety difficulties. It can also one of the most misunderstood, both by the people who experience it and sometimes by the treatments offered for it. Many people with social anxiety know, at some level, that their fears are out of proportion. They know that the presentation probably went fine, that most people are probably not scrutinising them as closely as it feels, that the conversation they are still r