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By Teri Watkin, Aug 25 2016 12:23PM

You often hear therapists talking about boundaries – so what are therapeutic boundaries and why are they so important?

Boundaries are anything that is part of what creates the ‘therapeutic space’ and will include…

Confidentiality – when we share our problems with a friend we have no guarantee that what we have discussed will not be gossiped about with others. Therapists are bound by confidentiality which means that we commit not to discuss what is shared with us.

Why is this important? It’s not hard to see why confidentiality is important – who wants to have their problems aired with other people? Confidentiality provides the sense of safety that is needed before it is possible to share deep issues.

Supervision – The one person that therapists will talk to about what is happening with their clients is their supervisor. This is also a relationship that is bound by confidentiality.

Why is this important? We can’t function properly as therapists without regular supervision. It provides the space that we need in order to consider what is happening with our clients and as such it enables us to feel safe which in turn will enable us to help our clients to feel safe too.

The room itself – is it private and quiet? Is it warm and comfortable? Are you able to use the same room each week?

Why is this important? It’s hard to feel safe enough to talk about things that might be upsetting if the room isn’t comfortable, private and quiet. Being in the same room each time you meet gives a sense of stability.

The time – Therapists try to keep to the same time and day each week.

Why is this important? Keeping to the same time gives a sense of security that the therapist has a space for you in her/his week and this in turn enables you to believe that there is a space for you in the therapists mind – they are able to think about the issues that you bring and give you the emotional space that you need.

Starting and finishing on time – Therapists try, within reason, to start and finish the session on time.

Why is this important? When we start on time we are respecting that this is the time that we have set aside for you in our week. Finishing on time gives you the confidence that you will not be ‘trapped’ into staying for longer. You are able to pace how you use the session with the confidence. Often clients will drop a ‘bombshell’ at the last minute knowing that it is now out in the open but will not be talked about until they are ready to bring the subject up again.

Payment – this is an odd one because you can of course get therapy on the NHS without paying – and that’s great but not always available.

Why is this important? Paying for therapy yourself means that you are in control and are able to decide for yourself whether or not you are in need of therapy and, within the constraints of your budget, you are able to continue for as long as you feel you need. You are not a passive recipient of ‘charity’ but are giving something back to the therapist which means that you are being given the dignity of taking responsibility for your own life.

So…to sum up…

Therapeutic boundaries are there to help you to feel safe, confident and secure during what can be an unsettling process; to show respect for you and to give you a sense of dignity in the midst of what may be a challenging and difficult time.

By Teri Watkin, Aug 25 2016 12:22PM

One of the reasons I’m interested in neuroscience and brain development is the insight it gives us into what happens to a baby who has numerous changes of carer and so doesn’t form a strong attachment bond. Healthy attachment to a loving, trustworthy, reliable and constant caregiver is vital in enabling strong, healthy neural pathways to develop. And as I mentioned in the previous posting, a baby who has unreliable or abusive experiences will develop neural pathways that say that ‘life is dangerous – not to be trusted’

The ‘Strange Situation’ experiment

In the 1970’s the ‘strange situation’ research revealed compelling evidence that the first eight months of a baby’s life is the crucial time for healthy attachment to take place. Through this research an understanding of different attachment types was developed. About two thirds of us develop healthy attachments but for a baby whose caregiver is distant and unresponsive, healthy attachment is jeopardised and the baby is likely to develop what was termed avoidant-insecure attachment ie. the child will view all relationships through the lens of ‘there is no-one there for me, I cannot trust anyone’. It’s not hard to see how that child will go on to become rather distant and to form adult relationships where they have no expectation of people being trustworthy or of someone being there for them.

On the other hand the research found that if the caregiver is sometimes available and sometimes not then the baby will develop what we call ambivalent-insecure attachment ie. in adulthood they will have a tendency to blow hot and cold in relationships – they will sometimes be distant and sometimes ‘clingy’. This is perfectly understandable when we look at it in terms of the childhood experience of unreliable parenting, as this will have conditioned them to try to ‘hold onto’ relationships for fear that if they don’t then the relationship will no longer be there. Read about Mary Ainsworth’s Strange Situation experiment on or

Growing up in care

Now think about this in terms of a child/adult who is growing up/has grown up in care. Sadly the experience of children in care is often one of being moved around from one foster parent to another and it’s not hard to imagine that the child’s ability to develop a strong attachment will be severely affected as a result. Nowadays, social services are much more aware of attachment issues and will try to keep young babies and children in fostering placements for as long as possible so hopefully, these children will have a more stable experience and be more able to develop healthy attachment. But what about all the children who grew up in care and are now adults and who had a very disrupted start to life? Often they find themselves unable to maintain relationships and they may have a tendency to bounce from one relationship to another. They may seek the ‘solace’ of losing themselves in substance abuse which just perpetuates the problem.

The ‘rejection’ of adoption

We used to think that babies don’t remember anything but now we know better. Even adults who were adopted as small babies and have had a positive experience of being parented may find that they have a sense of rejection which is a result of having been removed from the parent that they ‘knew’ in the womb. These people don’t ‘remember’ in the way that we normally understand memory, but they ‘remember’ at some level and can be deeply affected by their experiences.

By Teri Watkin, Aug 25 2016 12:21PM

I’m fascinated by neuroscience because it gives us a better understanding of how therapy works. However, as I’m not a scientist I do struggle to understand it so I have to reduce it to simple terms in order to make some sense out of it.

So…here goes! When a baby is born its brain is pretty much unformed-it has the basic level of functioning that is necessary to ensure its survival. It is said that a baby can express 6 basic emotions – sadness, happiness, anger, fear, disgust and surprise – these are the emotions needed in order to ensure that the caregiver is motivated to keep the baby fed and clean and safe from harm. How the brain develops from here depends upon how sensitively the caregiver responds to the baby’s communication.

Every interaction that happens between the baby and the caregiver will stimulate the firing of neurons within the brain – these are like small electrical charges which, having been fired from the neuron will then connect with another neuron to form a neural pathway. Each time the interaction is repeated it strengthens the neural pathway.

So…if each time the baby is hungry, or uncomfortable, or frightened the caregiver responds in a sensitive way the neural pathway is strengthened and (simply put) the baby will come to expect that life is safe and predictable. If on the other hand the baby’s needs are not met by the caregiver, different neural pathways will develop which will cause the baby to expect that life is uncertain, even threatening. In this way a ‘template’ is formed into which all future experience can be fitted.

When I first began to understand the importance of the early years I remembered the times that I let my own children down – but I’ve learned not to give myself a hard time about it because that’s part of life too. We will never be ‘perfect’ parents and in fact it’s not even desirable to be the ‘perfect parent’ (but that’s a subject for a different posting).

Even for those whose experiences have taught them that life is uncertain and untrustworthy all is not lost – new neural pathways can be built through more positive experiences with friends, teachers, colleagues, partners – and through therapy.

How can therapy develop new neural pathways?

As an example – many people in our culture have been taught not to show ‘negative’ emotions and as a result they will have suppressed their feelings. In therapy the person has permission to express these negative emotions, and as these are responded to in a positive way by the therapist so new neural pathways that convey the message “it’s ok to express emotions” will be formed. I often describe the formation of new neural pathways like this…

Imagine a field with a gate in one corner, and another one in the diagonally opposite corner. As the path is walked regularly it becomes well defined (this is like the neural pathways being strengthened) so that it’s an easy path to follow. Now imagine that the gate in the diagonally opposite corner is closed off and a new gate is opened. At first there will be no path to the new gate and it will not be easy to walk through the long grass. What’s more, the old path will look very temping because it is well walked. However, with repeated walking the new path will become more and more defined and the old path will become overgrown (but will never entirely disappear). This illustrates the growth of new neural pathways and the fading of old ones. At first the going is tough but gradually, over time it becomes much easier until the stage is reached where new neural pathways have been formed in the brain and old ones have faded. It is these new neural pathways that enable the person to view life in a different way.

By Teri Watkin, Aug 25 2016 12:20PM

We all feel anxious at times. For example, it’s normal to feel apprehensive before a driving test and these feelings of apprehension will be accompanied by physical changes – we may feel sweaty, or have butterflies in the stomach, or make agitated movements. A certain amount of anxiety in life is helpful – in fact it’s essential. In the driving test example, anxiety will cause us to practice more and to study the Highway Code carefully and this will make us more likely to pass the test.

Anxiety protects us from potentially dangerous situations. It keeps us safe when we’re crossing the road, or out in the city at night. It protects us when we’re walking in the hills or swimming in the sea.

So when does healthy anxiety become anxiety disorder?

When these feelings of fear and apprehension and the accompanying physical symptoms become long-lasting and are provoked by situations that other people seem to take in their stride, then we are said to be suffering from an anxiety disorder. Some comment types of anxiety are chronic worry, health anxiety, post-traumatic stress disorder, social phobia and agoraphobia.

What causes anxiety disorder?

Of course, everyone is different and each person’s anxiety will have a different cause from the next person. However, often anxiety begins with a trigger event. For some people this may be obvious – they can remember the particular traumatic event which caused them to start feeling over-anxious, but for other people it will be less obvious – it may be the result of emotional or physical needs not being met in childhood; or something said by a friend or a teacher etc. The ‘trigger event’ will have enabled unhealthy beliefs about life to develop and it is these unhealthy beliefs that enable anxieties to develop and be maintained.

Through careful exploration in therapy, the unhealthy beliefs can in time be replaced by thoughts and beliefs that are more realistic in the particular situation, and as the healthy beliefs are assimilated the anxiety will lessen.

By Teri Watkin, Aug 25 2016 12:19PM

At any one time, almost one in ten people will be experiencing depression of some kind ( Of course, we all experience ‘feeling a bit down’ and that usually passes quickly and is part of life. It’s when those feelings last for more than a couple of weeks and start to interfere with life, causing difficulty in concentrating and distress in relationships that depression becomes a problem. At the most severe end of depression it can be life threatening because it causes many people to experience suicidal thoughts.

What are the main symptoms of depression?

Feeling down, or depressed or feeling hopeless about life is the obvious one but there are many more signs. Loss of interest in normal activities and a sense of weariness is often experienced. Sleep disturbances are common – either sleeping too much or suffering from insomnia – as is a change in appetite with weight loss or gain. Difficulty in concentrating, negative feelings about yourself and suicidal thoughts are other common symptoms.

What can I do to help myself?

Regular exercise is really helpful because it stimulates the release of endorphin, which is often called the ‘feel good’ hormone. Making the effort to keep connected to other people will also help you to feel better and will give you a reason to make sure that you take care over your appearance.

How can counselling help?

Counselling will help you to discover the root causes of your depression. You may have negative beliefs such as “I’m no good” or “everything I do turns out badly” or “no-one likes me”. Counselling will help you to test out the validity of these beliefs, to put them in perspective and to replace them with more truthful beliefs such as “I’m pretty good at…(whatever we discover you are good at)” Many people squash down their feelings without realising it and the effort of keeping them squashed down may result in depression, so counselling may also be a process of discovering what the squashed down feelings are and talking about them, which has the effect of ‘de-fusing’ them.

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