On Building a Sustainable Life in Therapeutic Practice There is a kind of rhythm in life that I have come to understand cannot be rushed. It is not something I found quickly, not something I could have planned at the beginning of my work. It has taken time - years of being in practice, of adjusting, and of learning what it means to live alongside the work that I do. This has not develop in isolation from the rest of my life. Alongside my work, I have also been navigating family life, with its own demands, responsibilities, and moments that require attention and care. Over time, I have come to understand that a sustainable rhythm is not one that fits around work alone, but one that can hold the whole of life. In my work as a therapist, I spent much of my time holding others - their experiences, their emotions, and the complexities they bring into the room. For a long time, my focus was on how to do this well. Only over time did another question begin to take shape for me: What sustains me in doing this work, over time? I have come to understand that this work cannot be sustained by efforts alone. There were periods where I extended myself - working more, giving more, trusting that I would recover later. And while this was possible for a time, it was not something I could continue in the long term without noticing its impact. In the consulting room, I have often seen a similar pattern. People can continue for a long time by relying on capacity - meeting expectations, holding responsibility, and adapting to what is needed of them. From the outside, it can appear as though things are being managed well. But underneath, there is often a quieter layer - fatigue, pressure, or a sense of disconnection that has not yet found words. What began to change for me was not the work itself, but how I structured my life around it. Gradually, I began to put in place something that felt more containing. I reduced and contained my working days. I began to protect time away from practice. I allowed for regular breaks across the year. And I started to build moments of stillness into my day. These changes did not happen all at once. They developed over time, often through recognising what was not sustainable. Alongside this, something shifted internally. Beginning my day with reflection and prayer has become an important part of how I orient myself. It allows me to start from a place that feels grounded, rather than immediately entering into doing. It does not remove the demands of the work, but it changes how I meet them. In my clinical work, I have noticed how unfamiliar this can feel for many. To pause. To rest. To not be constantly responding. For some, rest can bring discomfort rather than relief. It can feel undeserved, or even unsettling, as though something should be done instead. This is something I have also had to come to understand in myself - not simply as an idea, but as a lived process. What has emerged from this is not a prefect routine, but a rhythm that feels sustainable. A way of living that allows me to move between:
Over time, my focus has changed. I no longer think in terms of how much I can take on, but what I can sustain. Work feels more contained. Rest feels less like something I need to earn. And my relationship with time feels more deliberate. This does not mean the work becomes easier. There are still sessions that feel full, complex, and emotionally demanding. At times, I leave the room holding something of what has been shared - feelings that do not belong to me, but have been entrusted to me for a time. Having a rhythm outside of the work allows these experiences to settle, rather than accumulate. I have also come to understand that sustainability in this work is not only practical- it is ethical. Because how I care for myself is closely linked to how I am able to be present with others. What I have now is not something I arrived quickly. It has taken time to build. And it is something I continue to recognise, protect, and return to. If you are finding yourself questioning how to sustain your work, your relationships, or your way of living, this may be something that can be explored - with time, and with support.
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The Christmas period is often associated with heightened affective states. Culturally, it is framed by images of family gatherings, warmth, and shared ritual. While these representations can be reassuring for some, they may also activate deeper psychological materials for others - including early relational memories, unmet development needs, unresolved grief, or a heightened longing for connection that becomes more salient during this time of year. In clinical practice, it is evident that the holiday season can amplify underlying emotions dynamics. Christmas, in particular, often functions as a reflective surface through which internal states and relational patterns become more visible. The season does not solely evoke celebration; it also evokes remembering. In this process of reminiscence, individuals frequently re-encounter formative relational experiences and longstanding intrapsychic patterns that have shaped their development trajectory. Unseen Narratives That Emerge During the Holiday SeasonThe holiday period frequently reopens internal spaces that are not often accessed in day-to-day life. Memories - at times warm, at times painful or confusing- tend to emerge with greater clarity. Seasonal cues such as lights, music, and familiar rituals can evoke longings for joy, safety, connection, and emotional attunement, while simultaneously drawing attention to the absence of these experiences. For many individuals, loneliness during Christmas takes on a particular intensity. The quietness of the season, the contrast with other's visible celebrations, and the stillness characteristic of this time of year can mobilise earlier relational wounds. Loneliness, in this context, is rarely a purely present-moment affect; rather, it serves as an entry point into earlier experiences of being left, neglected, abandoned, or emotionally unacknowledged. These recollections often become more pronounced in December, bringing into awareness longstanding pains that may continue to shape one's current emotional spectrum.
Anger is often perceived as an emotion to be controlled, suppressed, or avoided. In many cultures and families, people are taught from a young age that expressing anger is unacceptable or dangerous. However, from a psychodynamic perspective, anger is rarely just about a present situation—it is often rooted in deeper, unresolved emotional wounds, particularly those linked to trauma. In my practice, I frequently work with clients who experience anger in ways that feel overwhelming, confusing, or even frightening. Rather than seeing anger as a problem to be "fixed," I encourage slowing down, reflecting, and exploring its origins. When we understand anger as a response to trauma, it can become a gateway to healing rather than a force of destruction. Understanding Anger Through a Trauma LensTrauma, whether from childhood neglect, abuse, violence, relational wounds, or overwhelming life events, has a profound impact on the nervous system and emotional regulation. Trauma survivors often experience heightened emotional reactivity, difficulty trusting others, and a deep-seated fear of vulnerability. Anger, in this context, serves multiple psychological and physiological functions:
We all have desires we wish to fulfil and goals we aim to achieve, often requiring clear and practical steps to reach them. Yet, we frequently undermine these aspirations ourselves. Self-sabotage is one of the most puzzling aspects of human behaviour. This can range from small acts, like breaking a diet by indulging in a big piece of chocolate cake, to more significant decisions, such as entering a relationship we know is bound to end badly. At its extreme, self-sabotage can manifest in highly destructive behaviours, like self-harm, risky actions, or addiction. But why do we do this?
Why therapy work is still an on-going discussion, but when it does work - it often mirrors the attachment dynamics found in good parenting.Attachment theory, initially developed by John Bowlby and Mary Ainsworth in the mid-20th century, has had a profound influence on psychotherapy. This theory posits that the bonds formed between babies and their primary caregivers have a lasting impact on an individual's emotional and relational patterns throughout their life. In the context of psychotherapy, understanding attachment styles can greatly enhance the therapeutic process and outcome, especially when it comes to healing from emotional distress or trauma.
The perception of neediness and emotional dependency often carries negative connotation in our society: in psychotherapy; individuals, particularly those unfamiliar with the process, may hold a doubtful view of clients or patients who lean heavily on their therapist for support. There's even a cynical notion that therapists intentionally foster emotional dependency to gain an advantage. It's a prevailing belief that emotional dependency within psychotherapy is seen as undesirable.
Understanding the Burden of Shame and Guilt Shame and guilt are complex and often deeply ingrained emotions that can significantly impact our mental health and wellbeing. As a counsellor or psychotherapist at Misma Counselling Service, I believe it’s crucial to understand these emotions and explore how they can affect our lives. I think - for me, that the dynamics of shame and guilt is perhaps one of my reasons that lead me to want to study the mind, as I wished to understand the ability to undermine our pursuit of a good enough life.
In our modern society, discussion around men’s health often focus on physical wellbeing, leaving mental health in the shadows. However, it’s crucial to recognise that mental health is just as important as physical health for leading a fulfilling and balanced life. In this blog post, we’ll look into the significance of men’s mental health, common challenges they face, and practical strategies to promote mental wellbeing.
"I was able 'to sit' with my feelings and emotions. I no longer have the need to binge or purge this emotions" shared my client who worked through their eating disorders. Understanding eating disorders can be challenging if you haven't experienced them yourself. While many are familiar with anorexia and bulimia, there are lesser-known disorders like AFRID (Avoidant/Restrictive Food Intake Disorder). Diagnosing these disorders is complex due to the overlapping symptoms, and they may manifest differently at various stages of one's life.
The current pandemic is leaving many of us anxious and worried. Uncertainty and the unknown shake our basic life routines, we loose our life structures, leaving us feeling confused and lost. Confusion and loss can create a negative imagination and this is fear. The fear of contagion and the virus can impact on our psychological responses.
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AuthorI'm Misma, a psychotherapist working in both Exeter, Bristol & online. Categories:
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