Therapists and 42 red flags to look out for

Red flags and therapists?

Coloured drawn image of man waving a red flag
Therapists and red flags

Have you ever attended therapy, either with the NHS or privately and was it a positive experience? Are you considering therapy? If you’ve never been to see a therapist/counsellor, perhaps you don’t know what to expect, or what to look out for in a therapist? Let me say, if you are thinking of therapy, you might want to read and consider some of the therapists and red flags listed below.

But first — this post came about after a friend (an Occupational Therapist) told me she’d had six sessions of counselling, which she accessed through her work’s Wellbeing programme. While she said there had been an improvement in her mood, she would never go to counselling again! She hated the therapist who allegedly looked bored, was too blunt, always late and talked about herself a lot of the time. “She looked like she should be in counselling,” moaned Hayley.

Getting personal

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NHS provide staff with therapy

We talked about how many other people we knew that had had bad experiences with therapists, and all for various different reasons. I’ve seen 5 different therapists over the years, and although one was excellent and a few were good (ish), the final one was so awful, I didn’t go back after the second session. My first time was arranged via my GP, it lasted over three years and my therapist was fantastic. The other four times were accessed through my NHS Trust’s Wellbeing programme and the difference between these therapists and the first one was like night and day.

In the UK, most NHS Trusts provide workplace counselling as an employee support. The service is usually short term and provides an independent, specialist resource for staff – a free, confidential, workplace counselling service. Sounds great, doesn’t it?

However, during my chat with Hayley, we both thought, how do you tell if a counsellor is any good? Why was one better than the rest for me? In hindsight, I think the problem for me was that these independent therapists tend work on a freelance basis, and although they are all registered and approved by their various governing bodies, they are not vetted by the Trusts themselves.

Then Haley and I thought, what about all those people that have to pay to see a therapist? I’ve since looked online and seen that, in London, you can pay anything upwards of £70 and often way over £100. Although I believe that counselling is a great investment in yourself, if the therapist is ‘no good’, it’s a terrible waste of a lot of money. I’d hate for that to happen to you so I’m going to share some of the red flags you might come across. But first,

Before therapy

Before you go into therapy, you may want to ask your therapist about:

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You must ask questions about your therapist too
  • their background and qualifications
  • the type of therapy they practice. If they have a specialism, as some therapists specialise in working with particular issues like abuse and violence, addictions, LGBTQ, or survivor groups
  • their experience of working with the problem you’re experiencing
  • how long the therapy will last
  • the benefits and any risks involved
  • their confidentiality policy
  • whether they have a waiting list and how long it will take to get an appointment
  • if you have a disability and need reasonable adjustments to make the sessions easier for you to attend.

Let them know if you have any preferences i.e male or female therapist or someone who speaks your first language.

Therapists red flags

In no particular order, and though counsellors and therapist might offer different therapies, I’ll use the word therapist throughout and for ease I’ll say she or they, so, if she

Black and white image young female with head in her hands
Not all my therapists were good
  1. doesn’t talk you through what will happen during counselling, like which type of therapy i.e. CBT and a short explanation about the concept and how long it will last
  2. doesn’t provide you with information about your rights as a client i.e. fees, her policies, or confidentiality
  3. constantly misses, cancels, or shows up late to appointments
  4. looks down on you or treats you as inferior, subtly or not
  5. blames your partner, family, or your friends, or encourages you to blame them
  6. doesn’t have sufficient or specific training to help with your problem and/or she tries to treat problems outside the scope of her specialism
  7. can’t or doesn’t clearly define how she can help you solve whatever problem that brought you to therapy
  8. isn’t interested in the changes you want to make or your goals for therapy, and works from her own agenda
  9. speaks in the language (psychobabble) that confuses you
  10. discloses that she’s never done personal therapy work (maybe she’s only done group work)
  11. gives no explanation of how you will know when your therapy is complete
  12. focuses on diagnosing without also helping you to change
  13. doesn’t ask your permission to use various psychotherapeutic techniques outside of what you’ve discussed already
  14. makes promises like “you’ll be much more confident after this”, she won’t know this for sure
  15. tells you that only her approach i.e. CBT works and ridicules other approaches
  16. acts as though she has all the answers and spends time telling you how to fix things instead of working with you
  17. tries to make decisions for you, tells you what to do, or gives frequent unsolicited advice
  18. focuses on thoughts and cognition at the exclusion of feelings and somatic experience
  19. focuses on feelings and somatic experience at the exclusion of thoughts, cognition and cognitive processing
  20. hijacks your session to get her own emotional needs met, instead of focusing on you and your therapy
  21. talks too much about her own issues and/or self-discloses in a manner that doesn’t help you. Self-disclosure can be used if it’s to help the client
  22. seems too emotional or overwhelmed with your feelings or problems
  23. empathises too much
  24. focuses too soon on helping you appreciate or resolve the underlying causes of an issue when learning coping skills to manage your behaviours or impulses would benefit you more
  25. avoids exploring your emotional or vulnerable feelings or
  26. pushes you into really vulnerable feelings or memories too soon or against your wishes
  27. tries to befriend you
  28. tries to touch you in a way that makes you feel uncomfortable i.e. hugging without your consent or
  29. attempts to have a sexual or romantic relationship with you
  30. tries to enlist your help with something outside of your therapy i.e. you might be a hairdresser and she asks can she come to your salon
  31. is frequently confrontational with you
  32. doesn’t remember your name and doesn’t remember what you discussed or what your issues were from previous sessions
  33. ignores how important your spirituality, religion, faith, or culture is
  34. promotes her own religion, beliefs and tries to push it all onto you
  35. allows/encourages you to become dependent on her
  36. shows no empathy or compassion
  37. is judgmental or critical of your problems, behaviour, or lifestyle choices
  38. discloses your identifying information without authorisation or your consent
  39. talks about and tells you the identities other clients, famous or otherwise
  40. doesn’t accept feedback or admit mistakes
  41. talks too much or doesn’t talk at all, just sits nodding and staring at you — too much eye contact or none at all
  42. tries to keep you in therapy when you think it’s time to stop

What to do if you spot red flags

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Re-evaluate your relationship

If any of these red flags come up during your first few sessions, you might need to re-evaluate your therapist and your relationship with her.

If you do see of these red flags, the first step would be to discuss your concerns with your therapist, telling her what’s bothering you. Say time-keeping is an issue for you. If she was only late once and had good reason, you could excuse that; she’s human too and sometimes things happen outside our control. However, if she was late for a second time, explain that it’s not acceptable, your time is valuable too, and you don’t appreciate other people being late. A good therapist will listen, understand your concerns, and make any necessary adjustments to their practice.

Most therapists have your well-being and best interests at heart, and they can make small mistakes too. However, some errors can prove more serious, such as touching you or trying to have a sexual relationship with you. If you’ve been in or are in a situation like this, you must report it to their practice manager and their governing body immediately.

Most people in therapy tend to know quite quickly whether the therapist is a good fit and whether or not they think they can work with them. But generally, I’d give it a maximum of three sessions, all being well before I decided if I needed to go elsewhere. However, too many red flags during the first and second sessions would make me hot tail it out the door.

If you feel like something isn’t right in your first phone call or initial session, this may be a bad sign. Some discomfort is a normal part of therapy, just as seeing a personal trainer isn’t always comfortable, but if you feel uncomfortable to the point of dreading or avoiding sessions, you may want to keep looking.

Ryan Howes

There are lots of good therapists out there. Unfortunately, there are lots of charlatans too. They’ll keep taking your money, even when they should have discharged you weeks, months or even years ago. Yes, years! I’ve known a few patients who’d been in therapy for five years plus, and if you ask me, they were more confused and anxious or depressed than when they first started.

Over to you

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Of course, there may be many more red flags that I don’t know about. Do you know of any that you’d like to share? What’s your experience of therapy/therapists? I’m looking forward to your comments and any questions you might have.

Develop self acceptance

Learn how to develop self-acceptance?

Drawing of head (black) saying reset your mind
Learn to develop self-acceptance — Image by John Hain at Pixabay

Do you accept yourself? Or are you full of self-loathing at times? Do you experience self-dislike or even self-disgust? You wouldn’t be on your own. Unfortunately, as humans, we have these innate and learned modes of irrational, self defeating thinking. Worse, some of us are afflicted with a hefty dose of self-downing too. Of course, we all want to feel good about ourselves and feel more self-accepting. But how is that possible when we’re constantly self-denigrating? Fortunately, there is a way. As a mental health nurse in specialist training, I learned how to develop unconditional self-acceptance (USA). Now you can too.

I mean it’s not much fun, is it? Waking up with that horrible self-loathing in the pit of your stomach. Ugh! And disliking yourself is bad enough, but hating the fact that you dislike yourself is even worse, and it’s not healthy. It can, and often does, lead to depression and anxiety, and vice-versa.

What is self-acceptance?

Rough sketch of character holding up a red heart
Self-acceptance — Image by Nick Fewings at Unsplash

No doubt you’ve heard about self-acceptance from people that study or teach personal growth methods. So what is it? Self-acceptance is exactly what it says on the tin name: the state of complete acceptance of self. True self-acceptance is embracing who you are, without any conditions.

A recent post explained self-esteem and while it’s closely related, self-esteem is how we value and see ourselves. It’s based on our opinions and beliefs about ourselves. Psychology Today wrote that “self-acceptance alludes to a far more global affirmation of self. When we’re self-accepting, we’re able to embrace all facets of ourselves—not just the positive, more “esteem-able” parts.

Unconditional Self-Acceptance

Colour image of black female throwing her gorgeous curly hair backwards
You are a fallible human being — Image by Adrian Fernandez at unsplash

As such, self-acceptance is unconditional. We can recognize our weaknesses or limitations, but this awareness in no way interferes with our ability to fully accept ourselves.”

Unconditional self-acceptance (USA) is simply acknowledging and accepting that you are who you are. And you do not withdraw your self-acceptance if you do something wrong or make a mistake. You accept that you are a complex and fallible human being that gets things wrong and makes mistakes.

However, USA isn’t about giving into apathy or finding excuses for leaving everything as it is, and stay where you are. USA isn’t about resigning the self to the things we dislike about ourselves It’s more, we acknowledge that we have undesirable traits and habits before we start off on our journey to improvement. USA is said to be the first step to pursuing self-betterment in a healthy manner.

To begin working on yourself, the first step is not just self-acceptance, but USA. It’s quite easy to accept ourselves when we just did something amazing i.e. won an award, started a brilliant new job or got a First at uni. But accepting ourselves at our lowest, with our past bad behaviours, our faults and imperfections is the real mark of USA.

Conditional self-acceptance

Colour image of little boy wearing LGBT Rainbow flag, sitting on someones shoulders
Child not loved for person he is — Image by Max Bohme at unsplash

Conditional self-acceptance is where positive regard, praise, and approval, depend upon a child, for example, behaving in ways that the parents think correct.

Hence the child is not loved for the person he or she is, but only on condition that he or she behaves only in ways approved by the parent(s). 

At the extreme, a person who constantly seeks approval from other people is likely only to have experienced conditional positive regard as a child.

Develop unconditional self-acceptance

The goal of USA is to stop reproaching and condoning ourselves if we face failure or threat, even though we really dislike these negative situations. By removing any conditions upon which we determine ourselves, selecting USA lets us change and develop yet still acknowledging that we are fallible but worthy human beings.

“Big I, Little i” technique (Arnold Lazarus), Journal of Human Development and Communication, Volume 7, 2018 [61-70] 63

While we looked at this technique in another post on improving your low self esteem, using it again here will serve as a reminder.

Imagine your boss asked you to complete a task by the end of the week and you miss the deadline. So, you’ve made a mistake. What normally happens to us when we make a mistake, is that we make an over-generalised self-appraisal of ourselves like “I’m useless!” That “I’m useless!” is a negative self-statement that implies zero value in all areas of our lives. We’ve crossed out the whole of the Big I.

However, we only made a single mistake so that’s one little ‘i’ but what we do instead of crossing off that one little ‘i’, is cross our whole selves out. Essentially we’ve crossed out the whole Big I.

This Cognitive Behaviour Therapy (CBT) technique, the Big ‘I’ and Little ‘i’ worksheet, acts as a tool to help you accomplish self-acceptance.

The Big I is you, in total. The hundreds of little i’s are all the various parts of you; your thoughts, actions or characteristics like your empathycompassion, kindness, honesty, and caring nature. The self refers to the millions of characteristics. It cannot be measured by fewer than all the traits which go to make up the self.

So whenever you make a negative self-appraisal, cross out only one little ‘i’. You can continue in this way all day and for every ‘error’, cross out another little ‘i’. I doubt you’d even be able to cross out a whole line of little ‘i’s let alone the whole Big I, which is you. So the Big I (you) remains intact because you’ve only crossed out one line of little i’s.

Healthy techniques to develop unconditional self-acceptance

Grey scale image of youth wearing a blue hat and grey hoody, sitting with his elbows on his knees, hands covering his face
Unconditional Self-acceptance — forgiving-sets-you-free Image by MotivateUs com
  1. Put yourself first — stop neglecting yourself. You won’t be much good to others if you don’t look after yourself. Learn to say an emphatic “no” to people and don’t let them interfere with your time and energy.
  2. Treat others with kindness, curiosity, forgiveness and gentleness, and many will respond in kind. If they don’t, understand that they’re not bad people, they’re fallible human beings who make mistakes. However, because you’ve developed your USA, you won’t allow them to put you down or abuse you.
  3. Accept yourself with your perceived failings if you can’t change them. Or seek support and guidance to help you reduce any flaws so that you can enjoy life without negative thoughts interfering. Be open to and prepared to improve your skills and weaknesses.
  4. Always give yourself the care and attention you would give your loved ones.
  5. Don’t let the world and his wife drag you down. You have your own perceived flaws to be getting on with.
  6. Take pride and be proud that you have the wherewithal and resources to fulfil your wants or needs, even with any perceived limitations.
  7. Be a role model, set an example of USA in yourself and help others develop unconditional self-acceptance.
  8. Remember, you can’t please all the people all of the times, it’s not necessary and it can be detrimental to your mental health. Not everyone in this world is going to like us or find us acceptable. Our demand that everybody must, creates a perfectionistic, unattainable goal. So we’re setting ourselves up to fail.
  9. Encourage your children to seek not perfection but unconditional self- acceptance.

As I’ve said many times when I’ve offered any self-help techniques, you must practice them, often. There is no point reading something once then putting it away, never to be seen or used again. I’m sure most of you wouldn’t pass your driving test if you only practised once.

Over to you

I’d love to know if you think some of these self-help techniques would be useful and even more so, delighted if you tell me you’ve practised some of them. I’m really interested in how you get on. I’m looking forward to your comments and any questions.

The Path to Unconditional Self-Acceptance, Psychology Today, 2008

Why do I attract narcissists

Empaths attract narcissists

Colour image of female holding her face, looking afraid
Image by Grace Madeline at unsplash

This is the 15th in a series of posts about My journey through anxiety, panic disorder, depression and psychosis. Read about how I attract secret narcissists. You can read parts IIIIIIIVVVIVIIVIIIIXXXI, XII, XIII and XIV for the backstory. It might make more sense.

My last post ended with “We’ll look at How to leave a narcissist in my next post.” However, I think it might be worth telling you firstly of my final relationship with an almost deadly narcissist, Andrew.

Things happened so quickly

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On Jury Duty

I’d been happily single for 9 months before I bumped into Andrew while we were both on jury service. He’d seek me out each break and at lunchtime, bringing me coffee and pastries from the canteen.

He looked so gorgeous in his expensive suits and shirts, casually open at the neck, and he smelled divine. I’d spoken about him to my friends and laughed “If he doesn’t ask for my number on the last day, I’m going to ask for his.” I’d never done that before and I’m not sure I would’ve but, in the end, I didn’t have to. He waved his phone at me with a questioning but confident lopsided smile and I melted.

He was amazing, offering to pick me up and drop me off at work then picking me up again each evening. I only lived round the corner from work but I loved being with him, even for that 3-4 minute drive each day. He asked lots of questions about me, my teenage sons and my life and empathised with my disastrous relationships.

He took me to meet his parents and family fairly early on, I liked them all and the feeling was mutual. I hadn’t yet told the boys about him so that first Christmas, we were apart, and he left to go skiing on Boxing Day. I missed him like I’d miss a limb, though he phoned every day, and on the fourth day he told me he loved me. He said he’d never met anyone like me, and I was besotted.

Lots of loving going on

I attract narcissists

Not long after, it was my birthday and we’d arranged to meet a few friends, along with my brother and my youngest son who was still at home, in one of my favourite restaurants. After a wonderful meal and many bottles of heady pink champagne later, he’d picked up the bill and had paid before anyone could argue. As we were leaving to get taxis, my youngest said, “I like him, mama.”

“Uh-huh, me too Sunshine.” The boys, my brother, my parents all loved him and vice versa. My family were delighted to see how well he treated me, with his quaint old fashioned gentlemanly ways. He’d taken me on holiday rather than the other way round, as had happened with my two previous disasters and he wouldn’t let me spend any money.

I was feeling so relaxed and happily settled and my mental state was stable for the first time in ages. I no longer experienced anxiety or panic attacks and my sleep pattern had improved ten-fold.

You had your chance and you blew it………..

Colour image female walking away from male who has his head in his hands
Leaving another narcissist

However, around this time, my ex, Mark had started texting asking me to get in touch. Can you believe it, some ten months later the b*astard who’d thrown buckets of water over me now wanted to see me. We’d just settled one evening when Mark called and Andrew could see the name so I thought it best I answer. With my heart beating out of my chest and cottonmouth, I told Mark I was seeing someone else now and not to call again before hanging up.

He called back immediately, so Andrew answered and I could hear as Mark spluttered some carefully practised words ultimately meaning he wanted me back. “She’s with me now, please don’t call again,” warned Andrew.

“Okay but let me speak to Caz first. Caz, I love you…..” his pathetic voice trailed off before Andrew hung up. Mark called me at work the next day to say he’s outside and if I didn’t come out, he’d come into my office. My heart was in my mouth and I could feel the onset of a panic attack. I should have just called security. But I didn’t. I went out to see him, and he only offered to take me for lunch. Ha! That was a first, and I refused.

Mark professed his undying love for me, bleating that he never wanted to be apart from me, and asked how could I have moved on so quickly. You’d have thought I’d hate him I’m sure. But I didn’t. I felt sorry for him.

Why do some men do this, let you fall in love with them then hurt you over and over? They deny this and tell you you’re a maniac or a psycho and that you need help. They make you so mad you eventually end the relationship — then after an age — they want you back.

From this moment……….

Colour image of couple heads together, sun shining between them
Image by Christiana Rivers at unsplash.jpg

Christmas wasn’t far away when Andrew had asked if I’d like to go skiing in France on Boxing Day. I had to say no, as it was always my time to spend with the boys. He’d said, “No problem, ask the boys if they want to come.” I’d said thank you but my eldest, Nic wouldn’t leave his girlfriend as they were at different universities and didn’t see each other very often. “No problem, see if she wants to come too.”

So off we went with a crowd of his friends and their families, my first time ever skiing. What a treat and guess who was actually quite good at it? Andrew and I went again in January and by this time I was hurtling down red runs at what felt like a hundred miles an hour. It was exhilarating. All his pals and their kids thought I was a real pro and I felt so proud. I could tell Andrew was proud too.

We went again in February, but after the first day I caught a tummy bug and there was no way I’d dare hit the slopes, so I stayed in our room. This really annoyed Andrew and he snapped at me constantly, telling me it couldn’t be that bad. Really? I loved flying down the mountains and had attempted all of them but the black runs. These have minimal ledges and no safety barrier like trees to stop you from tumbling down a sheer drop.

I see your true colours

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This narcissist just lost it

Everyone gathered in the bar after dinner each evening and I missed not being able to join in. On the last night, Andrew returned to our room rather worse for wear, which was okay — until I refused his advances. I still had stomach cramps and had to use the bathroom every 10-20 minute ffs, so I was in no fit state for intimacy.

Well, he erupted! Yelling and cursing, practically foaming at the mouth and spitting as he lurched and stomped around the little room. I was both shocked and terrified in equal amounts, and I scrambled out of bed, intending to escape. But he caught me roughly by the arms and threw me back onto the bed, still screaming nonsensical obscenities.

I thought I’d been rescued when one of his pals rapped loudly on the door telling him to pack it in, but I’m not sure Andrew heard it over his frenzied ramblings. After about 30 minutes, only when he’d literally exhausted himself, he dropped to the bed and before falling into a coma, he dared me not to leave. I lay there rigid with fear, my mouth was dry and my heartbeat pounded in my ears until early morning, when we all got up for the long drive home.

Andrew appeared to have no memory of the previous night and as we had another couple in the car, I was unable to confront him. Shaken and upset, I remained silent much of the journey, too afraid I’d say the wrong thing or burst into tears. (I think) I loved him but I knew this should be over. I’d promised I wouldn’t put myself through this again.

Once home, I told Andrew I was tired and I needed to sleep before work the next day and that he needed to go home. I really I just wanted time to think, and I did — think. I thought it was out of character for him, he’d had a little too much to drink, I’d let him down by not being out there on the slopes with him.

Andrew phoned the next day and surprised me with a two-week holiday to Florida in June. What was a girl to do? I know what I should have done.

Over to you

Big red question mark with little white character man leaning against it.

Hhhmm, what do I say uh? Okay, what’s your thoughts? What do you think of the angry outburst? I’m looking forward to your comments and happy to answer any questions.

Woohoo! Real Neat Blog Award

I’m delighted to be nominated for the Real Neat Blog Award

A humongous thank you to Nala at Dissociate that for nominating me for The Real Neat Blog Award. As everyone knows, I love and massively appreciate the blog awards. Not only do they brighten up my days, but I get to introduce some of my favourite new blogs to the blogging community. There’s plenty of room for us all, and it never ceases to amaze me how many exciting new blogs appear each week.

In her blog Dissociate that, Nala writes her eye opening story about the nightmare that was her life. She shows great courage and spirit for digging herself out of what would become a black hole. Her humility comes across in her writing, which is is open, honest and humbling. Nala’s fairly new to the blogging community but she’s certainly not without talent, so you might like to drop by to see for yourself.

Rules of the Real Neat Blog Award

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Real Neat Blog Award
  • Display the award logo
  • Thank the blogger who nominated you and post a link to their blog
  • Answer the questions of the one who nominated you
  • Nominate some bloggers
  • Ask them seven questions

Nala’s seven questions

Map of India with a magnifying glass sitting on it
A visit to India is on my bucket list
  1. What Country would you like to visit and why ? India is definitely on my list as we have a huge Indian family on my sons’ side, I’ve never been and of course, I just adore the vast array of Indian food
  2. What was the last book/film that captivated you and why? I watched a film last night called Hacksaw Ridge and didn’t fall asleep — my usual trick. It was based on a true story about Desmond Doss, a real-life war hero who became the first man in US history to receive the Medal of Honor without firing a shot. Desmond volunteers to serve his country with the caveat that, due to his personal and religious beliefs, he refuses to touch a gun. I admire the man for sticking to his beliefs.
  3. Who made you the best Dinner ever, and What was it? It’s always Christmas dinner because my sons join in (well, take over), making their gravy, homemade cranberry sauce and stuffing —and it’s always amazing.
  4. Did you ever have a Dream come true and was it anything like you imagined it to be? Not sure if it was a dream but I always wanted two boys and that’s what I got. They were a dream to bring up and I love the way they turned out.
  5. Why did you start your blog? I suppose like most people, I have a story and a mission. I’m not sure it will happen in my lifetime, but I’d love to see the stigma and discrimination around mental illness stamped out.
  6. If you could take one thing/occurrence out Of the history of Mankind what would it be? Why? War — because it’s needless and senseless. Our governments decide to send our young men out to kill others at will — would they be so keen to put their own kids in the firing line?
  7. Did the current situation around the Pandemic have any positive side effect on your Life? Can you give an example? Yes as I got to spend weeks on end at my grandchildren’s home, despite my physical disability, my mental state and fatigue — they were an absolute tonic.

My nominees

  1. Winter dragon flies
  2. Mia at
  5. Sadje at

Over to you

Big red question mark with little white character of a man leaning against it

To my nominees, I hope you’ll all participate and I’m really looking forward to reading your answers to the same questions Nala gave me. Anyone else want to join in the fun? Feel free.

For everyone, I love that question “If you could rid the world of one thing, what would it be, and why?” Come on, humour me. As always, I look forward to any comments or questions.


Posts you may have missed:

  • How to develop resilience to cope with adversity here
  • 7 easy tips to control your anger here
  • Tips to help with your anxiety and panic attacks here

What to do if your child’s been sexually abused

Why are we talking about child sexual abuse?

Black and white photo of a child who is peering from a hole, appears to be in hiding
Sexually abused child? — Image from

I’d recently posted We need to talk about child sexual abuse, and the follow-up post was to include what to do, who’s at risk and more about support agencies. So here we are. *Trigger warning: this article contains information that might make you feel uncomfortable or distressed. Please read with caution.

Discovering your child has been sexually abused must be a terribly distressing and traumatic experience.

Parents or carers who discover that their child has been sexually abused must often find themselves experiencing a range of feelings from shock, anger and confusion to grief, disgust, and betrayal. Many will feel helpless and frustrated, and some find themselves feeling a sense of numbness.

Naturally, there are no right or wrong ways to feel in this situation – the most important things are finding some ways of processing your feelings and offering effective support to your child” says Dr Elly Hanson, clinical psychologist, for

FACT — the NHS

Signs to be aware of

Grey scale image of young peron holding handing up, palm forward with the word 'stop' written in bold black ink
Knowing the signs of sexual abuse

The National Society for the Prevention of Children (NSPCC) say “Knowing the signs of sexual abuse can help give a voice to children. Sometimes children won’t understand that what’s happening to them is wrong. Or they might be scared to speak out.”

Trust your own knowledge and gut feelings about your child and note any changes to their body or behaviour.

The physical signs of sexual abuse can include:

  • getting a sexually transmitted disease
  • pregnancy.
  • injuries to private areas—mouth, breasts, buttocks, inner thighs, and genitals
  • discomfort when going to the toilet
  • inflammation and infection of genital areas
  • frequent urinary tract infections/bowel problems

The likelihood that abuse is happening increases if there is more than one sign.

Other signs of sexual abuse include:

Grey scale photo of young boy crying
Sad child, sexually abused? — image by Kat at
  • telling someone that sexual abuse has happened
  • hinting that something has happened
  • avoiding the perpetrator
  • acting out sexual behaviour with children or siblings, toys and dolls
  • explicit sexual behaviour and knowledge that is not age-appropriate
  • changes in behaviour when personal care needs are attended to e.g. being bathed, nappy changed or during toileting
  • sleep disturbances or night terrors
  • abnormal wetting and soiling problems
  • obsessive and compulsive washing
  • aggression, withdrawal or crying
  • hurting themselves
  • out-of-character behaviours
  • increased anxiety
  • loss of appetite
  • other changes in behaviour like not wanting to go to school or their school might report behavioural problems

These lists are not exhaustive and there may be other signs.

One lone sign might be an indicator that sexual abuse is happening or there might not be any indicators at all. The likelihood that abuse is occurring increases if there is more than one sign. It is also important to remember that these behaviours may not necessarily be connected to sexual abuse. They might be connected to other problems for which the child needs help.

Who’s at risk?

Colour image of lady hugging a young boy
Has this boy been sexually abused? — Image by Jordan Whitt at

According to the NSPCC, any child is at risk of being sexually abused. It’s important to remember that both boys and girls can be sexually abused.

  • Most children who’ve been sexually abused were abused by someone they know. This could be a family member, a friend or someone who has targeted them – like a teacher or sports coach.
  • Children who are sexually abused online could be abused by someone they know. They could also be abused by someone who commits a one-off sexually abusive act or a stranger who builds a relationship with them.
  • Some children are more at risk of sexual abuse. Children with disabilities are more likely to be sexually abused – especially those who are unable to tell someone what’s happening or don’t understand what’s happening to them is abuse.
  • Some abusers target children who are isolated or being neglected by their parents or carers. If a family is going through a tough time, they might not be able to give their child enough attention or supervision, putting them in unsafe situations.

Web of deceit depends on secrecy

Coloured image young boy wearing a maroon and navy striped football shirt, holding a football
A sexually abused child won’t always tell — image by Damir Spanic at

The Conversation, 2014 wrote, “Research shows offenders typically plan their sexual abuse of children with care. They may “groom” children by offering presents and compliments. The offender often establishes a trusting relationship with the family and friends of the child, tricking and manipulating them to reduce the likelihood of them discovering the abuse.

The result of this web of deceit is to divide and isolate the child from siblings, friends and especially non-offending parents. In this way abusers protect themselves, ensure ongoing access to the child and secure power over the child and others in the child’s life.

Secrecy is fundamental to the success of these grooming techniques and has powerful effects on the child.”

Why children may not tell

Grey scale image of young girl peering out from net curtains
Why children don’t tell — Image by Benjamin Voros at

There are lots of reasons why children might not disclose the abuse immediately. According to, If your child didn’t tell you about the abuse or delayed in telling you, this is normal and is likely to be for one or more of the following reasons.

  1. They have felt ashamed, or embarrassed, powerless, self-blame, or they’re afraid of the perpetrator
  2. They didn’t how to talk about it, when best to talk about it or couldn’t find a space to talk
  3. The perpetrator is a family member or known to the family
  4. They were worried about how others might respond and what was going to happen. They might have thought:
  • ‘I might be seen as different.’
  • ‘This is going to cause problems in my family/community/school.’
  • ‘ taken away from home.’
  • ‘I don’t want the police or social services involved in my life.’
  • ‘I don’t want the abuser to get in trouble’ (because of feelings of loyalty, love, fear etc).
  • ‘I’m going to be blamed.’
  • ‘Images will be found which I’m embarrassed about.’
  • ‘I won’t be believed.’
  • ‘I won’t be taken seriously.’
  • ‘He/she is going to hurt or embarrass me or my family or someone else.’

What to do

Avoiding the perpetrator – child sexual abuse?

If you are concerned about a child, you can ask questions such as: “are you okay?” or “are you worried about anything?”, and “what can I do to help/support you?”

If a child tells you that they are being abused, it’s important that you listen to them and believe them, as this is critical to their psychological well-being. They’ll need immediate comfort and support and your undivided attention. However, refrain from questioning them about the abuse and leave that for the police or other professional.

Allow them to use their own words, to take their time, and assure them that they’ve done the right thing by telling. The important thing now is to be supportive, listen and keep the child safe.

As soon as you can, write down a few notes about what the child actually said to you and include the date and time they told you. These notes will be of use if there is a criminal investigation. Remember to use the actual words they said to describe the abuse and when it might have happened. If they’re unable to speak, describe how they explained the abuse.

Do not contact the person named as the suspected abuser. Instead, contact the Police or Child Protection immediately; do not delay. The police can help to arrange a medical assessment and make sure you have all the support you need.

  • contact the children’s social care team at their local council.
  • call 999 if the child is at immediate risk or call 101 if you think a crime has been committed
  • call Crimestoppers anonymously on 0800 555 111 or online.
  • NSPCC 0808 800 5000 to report concerns about a child
  • Childline call 0800 1111 for advice and support
  • NAPAC because the damage caused by child abuse doesn’t always end in childhood. NAPAC offer support to adult survivors and training for those who support them. Call 0808 801 0331

Support for parents

Finding out your child has been sexually abused can be frightening and distressing. But there’s help for you and your family.

MOSAC supports non-abusing parents and carers whose children have been sexually abused.

Over to you

Large red question mark with little white character of man leaning against it

While this is a difficult topic to research, write and read about, it’s important that we talk about child sexual abuse, because it happens and we want it to stop. By talking and sharing our comments or opinions, we can get the message out there — that it’s not okay and it has to stop! So I look forward to hearing from you, reading your comments and answering any questions.

This is the fifth and final in a series of five posts about abuse. We’ve previously looked at:

Improve your low self-esteem

How to have healthy self-esteem

Following my recent post What you really must know about self-esteem here, I took a short break. I’d had a major issue with WordPress that took 2 full days and nights to remedy, so sleep didn’t happen and my mood plummeted! I’d been changing my URL and WordPress made a huge error so, anyone clicking on my old website mental health from the other side won’t find me.

That site is now a dead-end and I’d really appreciate if anyone with my old links would now change it to mentalhealth360, and thank you to those who already have. Even more infuriating is, in their wisdom, WordPress decided they’d add only the last twenty of my 139 posts to the reader of my new site. I could cry. Anyway, swiftly moving on:

How can we improve our self esteem?

This is what we covered in my last post (here), ending with what

White background with a circle and black writing with red arrows showing a circle of low self esteem
Low self-esteem circle
  • is self-esteem
  • is low self-esteem
  • causes low self-esteem
  • effect does self-esteem have on us, and
  • is low self-esteem a mental illness

So, I guess this is the bit you’ve been waiting for. For this part, I’m not going to reinvent the wheel, so I’ve chosen to use the following exercise number 1 from our wonderful NHS:

1. How to have healthy self-esteem.

You’ll note my comments in green.

Healthy self-esteem — Image by

This activity takes time and cannot be rushed. The purpose of this activity is to help you get into the habit of finding the positive in all things. It also helps you get in touch with the negative things you tell yourself. Remember, by constantly changing your thoughts, you will change the way you feel.

To boost your self-esteem, you need to identify the negative beliefs you have about yourself, then challenge them. You can do this by marking out two columns on a sheet of paper, at the top write Automatic Negative Thoughts (ANTs) and Positive thought replacement.

Now, in the first column, write down a few of your ANTs.

An example might be, you messed up your presentation at work and your first ANT might be “everyone thinks I’m an idiot”, so in the next column, you challenge that by asking is that true? Probably not, now look for a positive thought i.e. “The rest of my presentation went well so, no, they didn’t all think I’m an idiot”

You may write you’re “too stupid” to apply for a new job in the first column, for example, or that “nobody cares” about you. Next, write some evidence that challenges these negative beliefs, such as, “I’m really good at cryptic crosswords” or “My sister calls for a chat every week”.

Write down other positive things about yourself, such as “I’m thoughtful” or “I’m a great cook” or “I’m someone that others trust”.

Also, write some good things that other people say about you i.e. “you’re kind and really funny – you’re my best friend.” Great, she wouldn’t have you as a best friend if you had no positive attributes, would she?

It will take time to change your long-held views and negative thoughts. Just think tho’ — you wouldn’t be able to pass your driving test after just one lesson, would you? You have to practice. Be patient with yourself and do your best. Repeat as often as you can to help develop a more positive outlook on life.

Aim to have at least 5 positive things on your list and add to it regularly. Then put your list somewhere you can see it. That way, you can keep reminding yourself that you’re Okay. I used to use little colour post-it notes and stick them on my bedroom wall, so they were always visible.

2. Self-acceptance

Book cover - Six Pillars of self-esteem written by Nathaniel Branden
I have no affiliation with this book

“The greatest crime we commit against ourselves is not that we may deny or disown our shortcomings, but that we deny and disown our greatness — because it frightens us.”

Nathaniel Branden, The Six Pillars of Self-Esteem

This next exercise “Big I, Little i” is about working on self-acceptance, another way to help boost your self-esteem.

Self-acceptance is not the same as self-esteem. Though it’s related, self-esteem refers to how worthwhile and valuable we are. Self-acceptance, on the other hand, is accepting ourselves holistically. For example, we recognize our limitations and weaknesses together with our strengths and capabilities, but in a positive way. We don’t let them interfere with how we accept ourselves.

A Cognitive Behaviour Therapy (CBT) technique, the Big ‘I’ and Little ‘i’ worksheet, acts as a tool to help you accomplish self-acceptance.

“Big I, Little i” technique (Arnold Lazarus), Journal of Human Development and Communication, Volume 7, 2018 [61-70] 63

Imagine your boss asked you to complete a task by the end of the week and you miss the deadline. So, you’ve made a mistake. What normally happens to us when we make a mistake, is that we make an over-generalised self-appraisal of ourselves like “I’m useless!” That “I’m useless!” is a negative self-statement that implies zero value in all areas of our lives. We’ve crossed out the whole of the Big I.

However, we only made a single mistake so that’s one little ‘i’ but what we do instead of crossing off that one little ‘i’, is cross our whole selves out. Essentially we’ve crossed out the whole Big I. We’ve made an over-generalised self-appraisal that’s self-blaming and self-damning. Eventually, this type of over-generalising will result in anxiety, depression, and guilt.

Your turn

Coloured image - five pairs of hands, making a heart shape with a small tree growing inside
Kind and caring nature — Image by Pinterest

Now, click on the Big I, little i picture above and scroll down ’til you see the diagram. You’ll note that it’s a Big I filled with hundreds of little i’s and this is your worksheet.

The Big I is you, in total. The hundreds of little i’s are all the various parts of you; your thoughts, actions or characteristics like your empathy, compassion, kindness, honesty, and caring nature.

So whenever you make a negative self-appraisal, cross out only one little ‘i’. You can continue in this way all day and for every ‘error’, cross out another little ‘i’. I doubt you’d even be able to cross out a whole line of little ‘i’s let alone the whole Big I, which is you. So the Big I (you) remains intact because you’ve only crossed out one line of little i’s.

Just think, lying to a friend once doesn’t make you a liar forever. This is you evaluating yourself based on your characteristics, thoughts or actions rather than overgeneralising. Whenever you refer the ‘I’ as yourself, you should remember that the ‘I’ is not totally you but it’s just a part of you.

3. Build Positive Relationships

There are certain people, certain friendships and relationships—that make you feel better than others. If you have people in your life who make you feel bad about yourself, try to avoid them.

Build new/other friendships with people who’ll cheer you on, encourage you, and make you feel good about yourself. Get rid of those friendships that pull you down.

4. Learn to Say No

Coloured image of man in blue shirt and tie, head in hand looking at bills
self-assertiveness to self-esteem — Image by

People with low self-esteem sometimes find it difficult to stand up for themselves or say no to others.

Have you ever felt over-burdened at home or at work, because you don’t like to refuse anyone or anything? Yes? Did you know that developing self-assertiveness will help to improve your self-esteem?

Trust me, I know this one’s never easy. I used to look after my niece two nights a week to give her single dad a break. She’d stay overnight and I’d take her to school with my sons in the morning. However, he’d taken to asking me to pick her up from school on other days, calling later to ask if she could stay.

I’d been reading about self-assertiveness and how when you say ‘no’, mean it and don’t feel you have to give any excuses for why you said it. I’d been building up the courage to tell my brother-in-law that I couldn’t keep his daughter overnight, again!

He called to ask one Friday evening and with my heart thudding and my mouth going dry, I said ‘No, not tonight Ron.” Silence….. Then he stuttered, “Oh.” The silence was palpable and painful, but he went on “Oh, okay. What time do you want me to pick her up then?” I gave him a time and we hung up.

Oh my word, I felt awful. I wanted to call him back and say, it’s okay and that I’d do it. But as I sat down I realised that he’d just accepted it. There was no harm done, the sky wasn’t about to fall down on me.

If I’d stuttered like “Um, er…” or given excuses like “I erm, I was going to……..”, he’d have been in there, recognising my usual people-pleasing and interrupt me with “Oh, go on, just this last time?” I didn’t, I said ‘No’, and he accepted it.

See, even small improvements help develop our self-esteem and help us live better lives.


Grey scale picture of two hands making the heart shape with the sun shining through
I accept myself as a human being who makes mistakes

I like myself.

No like I really like myself.

But it never used to be this way. In fact, I used to be my least favourite person. Like many of you, I’ve hated myself for long periods of time and I’d crossed myself out totally. I’ve felt worthless, useless, hopeless, ugly, bad and any other term I could degrade myself with.

Now, with techniques like “Big I, little i”, I’m able to maintain healthy self-acceptance and self-esteem. I accept myself as a human being who makes mistakes, who has bad days or bad moods and gets p’d off with people.

I spend lots of time practising techniques, blogging, clearing my mind, reading and self-reflecting in order to become the best me possible.

Over to you

Big white question mark with little character white man leaning against  it

Self-esteem is a huge area and I’ve only given you a few techniques that might help, so I hope you’ve been able to take something positive from this post. I look forward to your thoughts on the techniques for improving self-esteem and any questions.

What you really must know about self-esteem

What do you know about self-esteem?

Red roses on a large grey slate saying Love yourself --- self-esteem
Love yourself — What to know about self-esteem— Annie Spratt unsplash.jpg

Do you or someone you know have low self-esteem, and has it impacted on your daily life? Yes? Okay, just for a few minutes, think about the question What do you know about self-esteem. Hold that thought and let’s move on.

The idea for this post began with a fellow-blogger asking for tips on books to read about mental health, and self-esteem in particular. Perhaps I can respond to her request, but first I needed to find out a bit more so I asked her the following questions.

  • Can you tell me what is self-esteem to you?
  • How do you rate your self-esteem?
  • What do you want to be able to do when your self-esteem improves?
  • How will you feel when it’s improved?
  • How will you know that your self-esteem has improved?

She replied saying “I think I’m going to have to think about this question some more”. For me, that’s really to good to hear. Sometimes I still have my mental health nurse’s hat on, and the more I know, the better I can help and support.

In the meantime, I might be able to provide some answers here, so let’s start with

What is self-esteem?

Colour image of lots of words like values, beliefs, acceptance and self control
Self-esteem, values and beliefs

But before we go any further, let’s just clear something up………..

“The terms self-esteem and self-confidence are often used interchangeably when referring to how you feel about yourself. While they’re very similar, they are two different things. It’s important to understand their roles when looking to improve your overall sense of self.

Self-esteem is how we value and see ourselves. It’s based on our opinions and beliefs about ourselves. Self-esteem starts to form in childhood by experiences with family, friends or peers, and by situations that have shaped how you view yourself today. Self-confidence is how you feel about your abilities to interact with the people around you, deal with challenges or solve problems. As with self-esteem, self-confidence can also can vary from situation to situation.

According to self-esteem expert Morris Rosenberg (1965), self-esteem is quite simply one’s attitude toward oneself. He described it as a “favourable or unfavourable attitude toward the self.”

When we have healthy self-esteem, we tend to feel good about ourselves and about life in general. It makes us better able to deal with life’s ups and downs.

What is low self-esteem

Colour image man wearing polo neck, jean Jacket and black jeans. Looks sad.
Man with low self esteem —Sorin Sirbu at

Low self-esteem is characterized by feeling badly about oneself. People with low self-esteem often feel awkward, unwanted, unattractive or unlovable. Furthermore, people with low self-esteem are “hypervigilant and hyper alert to signs of rejection, inadequacy, and rebuff,” according to researchers Morris Rosenberg and Timothy J. Owens, who wrote Low Self-Esteem People: A Collective Portrait.

We experience the negative feelings of low self-esteem when we believe that we are inadequate and less worthy than others. We tend to catastrophise all our little failures, which all roll into one long and constant stream of patheticness. We’re frequently reminded of just how pathetic we really are.

For some reason, the negative messages that you received in childhood or from ex-partners, at school i.e. you’re not good enough are the ones that stays with you.

Personal experience

My childhood life was fraught with low self-esteem. Mum and dad kept moving around and splitting up, so we moved a lot and went to so many different schools and it was difficult to fit in. Everyone always seemed to laugh at the new kid, maybe I wasn’t fashionable enough in trendy areas like London?

Even the teachers laughed at me and made fun of my different accents in front of everyone. And that’s stuck with me; even today, I don’t like my Cockney accent, formed by living in London for around 40 years.

Those negative messages plagued me for years I still felt it when I first became a mental health ward manager and had to deliver training programmes to our mental health nurses. I had to do a lot of work, but it’s definitely helped. I love me now.

I do, honestly. I love the person I’ve become.

I dare say that we’ve probably all had times where we didn’t feel good about ourselves, such as not joining in the discussions at a team meeting or in college. That’s okay. But when our low self-esteem turns into a long-term problem, it can have a harmful effect on our mental health and our activities of daily living.

Recognizing the signs of low self-esteem your own worth is an important step in gaining a healthy self-esteem. We’ll come to the how later, but first let’s take a look at

What causes low self esteem?

Coloured image of a little girl on floor with elbows on her knees. Man kneeling down, pointing at her and shouting
Child abuse, a cause of low self-esteem — image from Vedicus

Experiences you had in childhood, or maybe your current relationships with your partner or family members, all impact your self-esteem.

Some of the countless causes of low self-esteem may include:

  • unhappy childhood where parents were quick to criticise
  • relationship problems, separation or divorce
  • domestic violence
  • experiencing prejudice, discrimination or stigma
  • ongoing medical problem such as disability, chronic pain, chronic or serious illness
  • mental health problems, stigma and discrimination
  • poor academic performance in school resulting in a lack of confidence
  • being abused or bullied perhaps at school, college or at work
  • experiencing prejudice, discrimination or stigma
  • redundancy, being fired or difficulty in finding a job
  • problems at work or at school, college or university
  • ongoing long-term stress
  • financial difficulties
  • poor housing and environment
  • worries about how you look and body image

It’s possible you’ve had many of the above, or you may have had other problems that aren’t listed. It’s never just one cause, more likely, an accumulation.

An important note is that self-esteem is not fixed. It’s a continuum and it’s measurable, meaning it can be tested and improved upon.

What affect does self-esteem have on us?

Colour image of lady looking in the mirror and putting cream on her face
Look after your own needs first —Humphrey Muleba

Mind writes “The things that affect our self-esteem differ for everyone. Your self-esteem might change suddenly, or you might have had low self-esteem for a while​ – which might make it hard to recognise how you feel and make changes.

And while it might sometimes feel really hard to change, you can still improve self-esteem by understanding yourself, and the value you really do have.

Your self-esteem can affect whether you:

  • like and value yourself as a person
  • know that you deserve happiness
  • believe you matter and that you are good enough
  • show compassion to yourself, self-soothing
  • take time to look after your own needs first
  • move past mistakes without blaming yourself unfairly
  • are able to make decisions and assert yourself
  • recognise your strengths and positives
  • feel able to try new or difficult things

Is low self-esteem a mental health problem?

No, it’s not in itself but it’s closely linked. Generally people with a mental illness i.e. anxiety or depression, have a low self-esteem. And having a low self-esteem can lead to mental health problems, due to the underlying cause i.e. financial difficulties, redundancy, losing your home.

How can we improve our self esteem?

Coloured image of naked lady covered in paints the colours of LGBT rainbow
Health self-esteem, LGBT Flag — Image by Sharon Mccutcheon unsplash com

Okay, so far we’ve glimpsed at:

  • what is self-esteem
  • what is low self-esteem
  • what causes low self-esteem
  • what effect does self-esteem have on us, and
  • is low self-esteem a mental illness

So, I guess this is the bit you’ve been waiting for — but, if you’re anything like me, your attention span’s starting to wane and you’ll not take much more in.

Over to you

The question at the beginning was What do you know about self esteem? Having read this post, do you think you’ve you learned anything new?

What are your thoughts on the concepts of self-esteem? Have you experienced it or do you know someone that does? I’m looking forward to any comments or questions. In the meantime, I’ll leave you with a sneak preview of where we’re heading next, and we’ll carry on tomorrow. I’m sure one or two of you know what this?

“Big I, Little i” technique (Arnold Lazarus), Journal of Human Development and Communication, Volume 7, 2018 [61-70] 63


WordPress and my new blog name

As some of you might know, there was a massive technical blip with my blog a few days ago, and it’s not something I would have noticed. However, blogging pals Liz at My wellbeing and learning journey and Ashley at Mental Health at home were kind enough to let me know. So thank you ladies. Now peeps, I need a favour?

The incident occurred after I successfully removed my old blog name “Mentalhealthfromtheotherside” from my url and replaced it with my new name


This all went well and I was able to cancel the old name altogether. Now, this is where it went haywire and my posts were getting mixed up in “reader”.

I managed to speak to several “happiness” engineers about the problem and while they might be happy with the outcome ffs, I am not. Here’s one of their 10+ responses:

There appears to have been an issue on our end, your site was registered in the Reader with the incorrect URL. I’ve resolved that issue for you, so going forward the only new posts added to your feed in the Reader will be from your site.

Happiness Engineer, WordPress

So they resolved the issue of the reader for me, but (as above) now only any new posts would be added and visible in the reader. Mad as heck, I contacted the happy team again who agreed to add my last 20 posts to the reader!

What does this mean for Mentalhealth360?

They’ve only added my last 20, yes only 20 (out of over 120), posts to the reader, which is where the problem was. It now means that only those last 20 posts will appear in your (and any new followers) reader, making it look like I’ve only ever posted 20 articles 🙁

Also, because of what they’ve done, anyone clicking on my old name within your posts, rather than redirect them to my new name, it will come up saying “this site is parked“. Obviously, anyone seeing this message is just going to walk on by! And I’m so furious, I could cry.

Now, I ask a favour

If you do have my old blog name anywhere within your recent posts i.e. Blog Awards, would you be so kind to change my name and link to I know it’s a huge ask and I’m not suggesting you go through all your posts lol but even if you could just change one or two, I might have a chance.

I’ve had to update all other social media and having spent the last 2 days on it, I’m wound up to the max. And, I’m still fucking flippin’ p’d off with WordPress. I need to get off here before an even bigger rant, so I’ll stop now and hope you’ll bear with me while I furiously type out some new posts.

Caz x

My new blog name

I want to say a huge thank you to all who commented, made suggestions and helped me to choose my new blog name. You were super helpful and really kind, taking time to read my post, checking out my ideas and coming up with lots of your own.

My initial favourite blog name was Mental Health from all sides and some of you agreed, so I’m going to use that as part of my tagline.

However, when Sadagopan at Pointless & Prosaic came up with Mental Health 360°, it made sense to me, with several of you in agreement. So there we have it.

Now all I need, and I’m going to be really cheeky here, is to ask if you would help spread the news through any of the social media channels you use? I’d really appreciate you helping me promote my new blog name in any way possible.

Thank you also for your thoughtful comments about my content and for now, I will continue along the same lines. However, along the way, I’m happy to have any more suggestions about what you’d like to read on my blog.

My last few posts have been about Communication skills in various forms, something you might find helpful in any situation:

Update – Poor standards at 28 mental health units

Greyscale photo of woman sitting on a mental health asylum bench
Old mental health Asylum

This post began with an article published in The Guardian: Psychiatrists called for inquiry after report on private units, many occupied by NHS patients. Inspector discovered poor standards at 28 mental health units.

I’d written that this is great news. Not because poor standards were discovered, but because it’s been reported and it’s out there!


According to the NHS

“One in four of us will experience mental health problems, and mental illness is the single largest cause of disability. Yet mental health services have for several decades been the ‘poor relation’ compared to acute hospital services for physical conditions”.

NHS, Five Year Forward View

The NHS goes on to detail — “What’s been achieved in England over the past three years?” and one particular point stood out for me:

“NHS England’s mental health taskforce has agreed a detailed improvement blueprint to 2020, in partnership with patient groups, clinicians and NHS organisations”. See Mental Health Taskforce Report, which states that

“It is therefore essential that all involved in the delivery of mental health services have the knowledge and skills required to deliver high quality care and have access to education and training.”


Mental Health Nurse training

Little white character of a man holding a large poster saying Staff training
Mental health nurse training —

Now, whether this all means only for NHS staff, it’s still a step in the right directions. However, when I was nursing, it was almost impossible to get staff to attend the Statutory and Mandatory, let alone any other training.

Mandatory and statutory training is undertaken by all staff and is deemed essential for safe and efficient service delivery and personal safety. It reduces organisational risks and ensures organisations are meeting their legislative duties.

The Royal College of Nursing (RCN) write that “Continuing Professional Development (CPD) is additional to any mandatory or statutory training that an organisation may provide.

While there is no universally agreed definition of CPD, there is a broad
consensus that, in a nursing context, its main purpose is to help staff to
maintain and develop the skills they need to deliver high quality, safe
and effective care
across all roles and settings”.

Nurses must stay up to date with the latest developments, continuing to update their skills and competences to meet changing future population health needs effectively and safely.

Ooh, if I had a £ for every member of staff that refuse to attend any more training courses than is necessary i.e. Statutory and Mandatory……… This still shocks and surprises me. We had access to our local University which offered so many nursing skills and knowledge courses and — all for free!

When I was a ward manager, some staff suggested I was picking on them if I suggested courses such as Verbal and written English. Once we’d ironed out that I wasn’t picking on anybody, I now had to enforce attendance on relevant courses. If staff still refused, they would be placed on what’s called Performance Management for a period of time. It would then be a job for me and the charge nurses to manage that nurse’s performance. What a performance palaver.

I really appreciated that our Trust granted me years of extra training to support some of my specialist roles. This included working with patients and their families, where the patient had schizophrenia and Cognitive Behaviour Therapy (CBT) for Schizophrenia.

Over to you

Large red question mark with little white charater of a man leaning against it

Is it just me? I loved going on the courses to keep up to date with nursing practice. It made me feel more confident and competent at doing my job. Would you take the extra training if your Trust or company offered it? I look forward to your comments or thoughts and question.

Okay, back to where this first article started:

Patient’s fears about admission are real

Grey scale image female staring out of a window near to an unmade bed
Mental health patients bedroom. Design Pics Inc/REX

I’ve already mentioned some of the poor practice I’ve come across in other posts, but there’s so much more. Like the way some staff dismiss patients’ fears and anxieties. What appears to be a molehill for us may feel like mountains to patients.

When a patient expresses their fears about admission to an acute mental health ward, it’s extremely important to listen, so they feel heard and know that you care. It’s particularly difficult for patients who’ve been sectioned under the Mental Health Act 1985 (MHA) and almost dragged from their comfortable homes by well-meaning (or not) family, carers, Social Workers and a Psychiatrist.

During the admission process it’s essential to accept that patient fears are real for them, and not to dismiss them. Some patients are acutely unwell and can be chaotic on admission so again, it’s important to continue the conversation as many times as a patient might need. Nurses also ought to let patients know that they have the right to appeal against their Section and give them the correct paperwork to do so.

Patients also need to know about Patients Advice and Liaison (PALS), an important service, which will support them with almost anything. They can make an appointment with the team who will come to the ward if a patient has no leave.

Private sector mental health units

Coloured image lady sitting at lap top and on the telephone
Nursing administration —Photo by

While The Guardian reports “Inspectors have found 28 privately run mental health units to be “inadequate”, this does not detract from poor standards within the NHS. I only had one elective placement (which I chose) within a private unit and I would never go back. Most of the staff were agency and who probably couldn’t get permanent jobs if they tried. They were rude, authoritarian and antagonistic not just to patients but to families, colleagues and students.

They didn’t like me and the feeling was mutual. I asked too many questions and ‘cared too much’ when I ought to be doing some work i.e. the menial tasks they couldn’t be bothered doing. What they didn’t know, because they didn’t ask, was that I had been doing secretarial work for near on twenty years and I loved doing the admin, completing computerised care plans etc. I was quick and quite good (compared to them) at it, so I smiled throughout the shift – something that bugged colleagues when they disliked you.

Private sector treating patients badly

Overdose of medication — mental health nursing

One particular famous client (they were called clients in private units) had overdosed on illegal substances many times. She was on methadone, an opiate prescribed by doctors as a substitute for heroin, and she wanted to eat lunch before medication. However, on this particular day, when she went to get her medication, the nurse who’d been doling out meds had left the ward.

The other nurses wouldn’t give her the methadone and told her she’d have to wait, which could potentially trigger debilitating withdrawal symptoms like nausea and insomnia. The patient was agitated by this, and I was p’d off because I thought the nurses’ punitive actions were totally unacceptable.

I went to the unit Manager who was sitting in his plush office and asked whether it was standard practice to hold medication hostage. He tutted and exhaled heavily, put his muscled arms up behind his dreadlocked head and proffered an uncomfortable smile. “Mmm, Nancy is it? Look, she’s a pain. Man, she always think she can bend the rules.”

“Pfft, rules?” I asked. This is a healthcare facility isn’t it? I am in the right place?”

“Nancy, we only have enough staff to do the basics, they don’t have time to run after clients whenever they want.”

“Okay, but Molly’s totally distressed now so I’ll go and talk with her and document all this in her notes.” I said with a sarcastic smile and walked out of his office. He wasn’t long in chasing me down the corridor, apologising profusely; he was just having a bad day, he didn’t realise what staff were doing! He would get the medication now. I still documented this event in Molly’s notes and asked a nurse to co-sign it.

The nurse who’d declined to give out the medication didn’t speak to me the rest of my placement? Was I bothered? It was one less idiot to listen to as she did nothing but whinge about the job, moan about various patients and kiss her teeth throughout her shifts. She spent more time on the computers, googling hairstyles and nail art, not realising that somewhere in Head Office, the tech guys could easily follow what she was doing, see how much time she spends online and could report her for time wasting.

Did no one care?

Coloured image of black man sitting at his desk in front of a computer
Mental health nurse playing online games – Photo:

Much of the time on this elective placement I felt so powerless and could totally empathise with patients. No one wanted to listen and no one cared! Staff appeared to find everything a chore and it seemed they only came in to earn money. See, nursing isn’t just a job. Being a professional nurse means the patients in your care must be able to trust you, it means being up to date with best practice, it means treating your patients  and colleagues with dignity, kindness, respect and compassion.  It means understanding the NMC code of conduct. It means being accountable. Katrina Michelle Rowan, 2010.

I was able to complete several PBA’s on this placement and learnt more about how not be be a mental health nurse. I saw how poor the team’s communication skills were, both verbal and mainly non-verbal. I saw how badly they treated people, how unprofessional they were and how they lacked empathy for anyone. As much as the staff on this placement tried to hold me back, little did they know how much I gained and how much I’d grown by watching their indifference. I always say, there’s never a bad lesson.