New guidance for talking therapy and the menopause

Talking therapy and choice

New draft guidance from the health watchdog NICE (National Institute for Health and Care Excellence) suggests women should be offered talking therapy through the NHS to help manage symptoms related to menopause. Talking therapy might be used alongside or instead of hormone replacement therapy (HRT) to offer women more choice. NICE said women should talk to their doctor and then be able to choose which treatment will work best for them. In particular, the guidance points out that coping strategies learned through cognitive behavioural therapy (CBT) can be effective when managing menopause related sleeping problems, night sweats and hot flushes, and symptoms of depression.

Manage menopause related symptoms

Speaking on BBC Breakfast on 17 November 2023, GP Dr Nighat Arif explained how her practice already offered cognitive behavioural therapy to patients. This type of talking therapy was mainly to help manage menopause related symptoms like brain fog, irritability, anger, and low mood. ‘Some women find their symptoms are really impacting them and their sleep is also affected’, she stated, explaining that the previous NICE guidance suggested HRT should be prescribed for psychological symptoms, rather than anti-depressants.

Talking therapy waiting times

Dr Arif went on to highlight some of the controversy surrounding this new guidance, recognising it might increase the disparity of health inequality by pushing more women to seek counselling in the private sector. It seems the issue is not around the effectiveness of talking therapy, but a lack of available therapists within the NHS. She said, ‘currently, offering CBT for menopausal symptoms on the NHS is just not there’ and that ‘clinical care boards have not been offering it because of funding.’ According to Dr Arif, waiting times for NHS counselling is also an issue, with a three to six month wait even for online CBT, and that’s likely as part of a group session. ‘For face-to-face CBT we are looking possibly a year’. The low availability of some services on the NHS has long been discussed, and she suggested, ‘this guidance I feel has come around to maybe take the pressure off the demand for HRT. That’s the cynic in me!’

Mental health wellbeing

Dr Arif also shared some observations about the nature of issues presented to her as a GP in recent times, ‘Since COVID, nearly 100% of my consultations have some sort of mental health wellbeing aspect that needs to be tackled’, adding that ‘CBT is brilliant’ for patients with some of those issues. She felt it important not to oversimplify CBT as an approach however, and that we ‘need to think of CBT as not just this umbrella term because there are different layers to [it] that a woman needs, so acceptance-commitment therapy … really helps with hot flushes and night sweats. This is important she added, because up until now much of the focus has been on HRT for managing symptoms related to menopause. In addition, some women are advised not to take HRT because of pre-existing medical conditions, while others are put off because of its associated risks. ‘HRT is not a silver bullet and it’s not one size fits all.’

'The Knowledge: Your guide to female health - from menstruation to the menopause' Published August 2023
‘The Knowledge: Your guide to female health – from menstruation to the menopause’ Published August 2023

NICE guidance

Dr Paula Briggs from the British Menopause Society was also interviewed by the BBC. She believed that the guidance would be beneficial for women that can’t have HRT, as it would ‘go a long way to helping them feel recognised.’ You can find out more about the guidance at the NICE website, here.

Women with autism

I heard an interview this week with broadcaster and voice coach, Carrie Grant, talking about her autism diagnosis at the age of 58. Interviewed by Cathy Newman on Times Radio’s Drive show, Grant spoke about some of the issues women with autism face.

Grant is the mother of four neurodivergent children and has campaigned on behalf of young people with autism for fifteen years. She was prompted to get an assessment after observing her own children and realising she had some of the same autistic traits. She felt it was not so easy for women to get a diagnosis however, because a lot of the criteria for assessment fitted around a stereotypical male. Women with autism are sometimes ‘under the radar’ in terms of assessment Grant explained, because they can appear to be highly sociable and don’t necessarily have the same traits as men.

Women with autism can be extremely empathetic, they can ‘almost climb into the skin of other people’ and to a greater extent can feel other people’s feelings. Speaking about her own neurodivergency, Grant believed she shared the same heightened sensory perceptions as many other people with autism, especially around hearing. Even though this brings some difficulties (‘when I’m tired the fridge sounds super-loud!’), she also says there’s a positive benefit given the work she does. ‘When I’m listening to two hundred singers, I can point out the one that’s singing out of tune’.

Neurodivergence and the workplace

Grant goes on to discuss some of the challenges facing people with autism when it comes to employment, ‘The reason I announced my diagnosis on Auticon (a company promoting neurodiversity to employers) was they are all about the workplace and the assets that we have as autistic people’. Only 29% of autistic people are in work however, and many of those people do jobs that are ‘way below the gifts and skills they have within them. I want to be able to open those doors and say let’s have a discussion about this’. Throwing a challenge to employers, Grant suggests autistic people might need some adjustments in the workplace because everything is ‘geared towards what you’re calling normal, give us those adjustments and we can thrive’. There are clear benefits to employers where not everybody thinks the same way or processes things in the same way, not least in the disciplines of problem-solving and creative thinking. These benefits will only be realised by employers who make more space at the table for neurodivergent employees, however.

Autism and childhood trauma

Grant has been open in talking about the abuse she suffered in childhood, and about how this might have contributed to her autism going undetected. ‘One of the issues when you’re just trying to work it out for yourself is that childhood trauma can also bring some of the same traits. It can make us more sensitive; it can make our senses more sensitive’. She states how important it is to get an assessment, as this will enable a professional to strip back what might be presenting from past trauma. They can then identify the difference between trauma and autism.

Getting a diagnosis later in life

Why did Grant wait until her fifties to seek a diagnosis? One of the biggest issues around getting a diagnosis was that ‘for a very long while there wasn’t really a great assessment tool for women’, adding that some of the two-hundred families she works with via a support group would have waited seven years for an assessment. Getting a diagnosis privately used to cost between £3500 and £5000, and like most people she admits she wouldn’t have been able to afford it. Thankfully now it’s hundreds rather than thousands of pounds, with the process taking a few weeks. In the end, Grant felt ‘like this was the right time to do it’ adding, ‘women in their 40s and 50s are one of the biggest group of people who are being diagnosed as autistic.’ It’s not always a positive experience of course, because ‘for many of those women it will be a really grieving time.’ It might lead them to reflect on their childhood and think, ‘oh my goodness my entire life I didn’t understand myself’ or look back on past events with severe regret.

Being labelled as autistic

Asked if being labelled as autistic has held her back, Grant suggests ‘a label is only a problem if you have a problem with the label’. Clearly, she does not, proclaiming ‘I think I’m fabulously autistic and I think my kids are fabulously autistic, and I think autistic people are fabulously autistic!’

Carrie Grant is co-author of ‘A Very Modern Family: Stories and Guidance to Nurture Your Relationships’, published by Piatkus.

Dr Kirren Schnack’s tips for helping with panic attacks

This week I heard to a fascinating interview on Times Radio with clinical psychologist, Dr Kirren Schnack. She revealed how she had been surprised by the popularity of her short video on TikTok, ‘three ways to stop a panic attack’, which gives some quick tips for helping with panic attacks and reducing their effects.

Dr Schnack’s tips for helping with panic attacks include:

  • Breathe in and out using a straw. Breathing out for longer than you breathe in, which helps to naturally reduce hyperventilation by balancing the gases in your blood.
  • Put your face in a bowl of iced water. This creates a strong sensory diversion.
  • Do jumping jacks. Quick exercise makes a physical diversion from what’s going on mentally.

Schnack admits these three methods appear a little unconventional at first but are backed up by some sound methodology. Panic attacks can be the result of the nervous system becoming overwhelmed, but you can turn off some of its signals by stimulating the sensory system. While some people will benefit from riding out feelings associated with an attack, for others the sensations of a panic are too overwhelming. These methods can form a ‘diversion from what’s going on mentally, and from an anxiety point of view.’ This in turn can stop the escalating sensations of panic.

Schnack advises it might be helpful for people to be aware of these strategies before a panic attack starts because they can help someone in the moment. They should be seen as techniques to help you cope ‘until you are able to address the fully underlying root cause of the problem’ using therapy. The strategies can also help people alleviate distress between therapy sessions.

Reaching a Younger Audience

Reaching out to a younger audience using TikTok is particularly relevant. Reducing anxiety in young people is important at a time when pressures caused by ‘academic stress, technology, social media, and family dynamics’ are compounded by huge changes occurring within the brain. There are so many factors combining just when young people and teenagers are trying to establish their identity and build self-esteem. As levels of poor mental health amongst young people are at a record high, we would surely all benefit from more research in this field.

Tips for Panic Attacks and Anxiety: find out more

The strategies are also referred to in Schnack’s new book, ‘Ten Times Calmer: Beat Anxiety and Change Your Life’. You can find out more at Dr Schnack’s website. If you would like to know more about how therapy can help to cope with feelings of anxiety and panic attacks, please use this link to contact me.

Obsessive compulsive disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a mental health condition that can affect men, women, and children. The causes of OCD are not always clear, but it’s characterised by Obsessions (unwanted and intrusive thoughts or images that enter your mind, causing anxiety) and Compulsions (repetitive acts or behaviours in response to those thoughts).

For example, someone with an obsessive fear of contaminating themselves or others might repeatedly wash their hands. They are doing this because it feels right to protect themselves or those closest to them, and not necessarily because their hands are dirty. Similarly, people with an obsessive fear of being burgled might repeatedly check locks, doors, and windows several times before feeling safe to leave the house.

Obsessive compulsive disorder can start in childhood, but it’s causes may not be apparent. It might be triggered by a stressful change or significant life-event, or it could owe to differences in brain activity or low levels of serotonin. There could also be a genetic factor; people with a family history of OCD are more likely to develop the condition.

Seeing a therapist can help you to overcome OCD, and talking therapies can be particularly effective. Please contact me if you would like to know more. You can also find more information at OCD-UK. This charity allows people to better understand the condition. It also offers support and advice to those trying to overcome OCD.

Anxiety Awareness

It’s normal for all of us to feel anxious from time to time, but when anxiety becomes overwhelming it can have lasting consequences for our mental health, wellbeing, and relationships with the people closest to us.

Anxiety is often triggered by changes in our lives that lead to uncertainty. It can be connected to concerns about money or a job, personal relationships, or the way some social situations make us feel. With exam results being published over the next couple of weeks, anxiety can also be triggered by worries around GCSEs and A-Levels.

This year’s Mental Health Awareness Week chose anxiety as its theme. More information about the condition and strategies for managing anxiety can be found on the Mental Health Foundation website at

You might also want to seek help from a therapist, either for yourself or someone close to you. If you are looking for anxiety counselling in the Walsall or Wolverhampton area, please Contact Me via the contact page on my website. You can also call me on 07824 385338. There is no obligation to book a session and we can discuss whether counselling is the right approach for you.

A counsellor in every school in England

BACP campaigns for a counsellor in every school

Following the new Children’s Commissioner, Dame Rachel de Souza’s recent appeal for every child to have access to therapy, the British Association for Counselling and Psychotherapy (BACP) has highlighted their ‘School Counselling in England’ Campaign. Recognising that England lags behind similar government funded schemes in Scotland, Wales, and Northern Ireland, BACP is urging people to sign its petition. You can find out more about the campaign to provide every school, academy, and FE College with a paid counsellor on the BACP website.

The Association recognises how increased anxiety brought about by the unique challenges of COVID-19 have left children feeling more vulnerable than before. Professional counselling within the school environment is seen as vital in giving children and young adults the best chance of coping with these challenges.

Children’s Commissioner wants to rebuild childhood

Dame Rachel’s comments fit within her wider call on the BBC website to ‘rebuild childhood’ following the pandemic. After ‘seeing first-hand the effect of this crisis on young people’s hopes and dreams’, Dame Rachel asserts that sometimes our responses have not been good enough. She is urging policy makers to seize this moment in history, and to restructure our offer to children with the same spirit and ambition as the Beveridge report in 1942. This report went on to form the basis of the modern Welfare State in the UK after the end of World War Two, and it was as ambitious as it was popular, possibly because it was built on around individual responsibility as well as state intervention.

COVID-19 lost generation

It’s too early to see if anything so positive and transformational will emerge from the current crisis, although the Children’s Commissioner has already spoken of her commitment to ensuring there isn’t a ‘lost generation’ because of COVID. As well as calling for no reduction in Universal Credit, and the provision of free school meals through the summer holidays, Dame Rachel announced the launch of a ‘Big Ask’. This survey will gather the views and opinions of children’s reactions to the pandemic, as well as other barriers to achievement.

If you would like to know more about therapy, or you are looking for private counselling in Wolverhampton, Walsall, or the West Midlands area please Contact Me or call 07824 385338.

Registered Counsellor in the West Midlands

Louise Lalley MBACP Registered Counsellor

I am pleased to announce that having successfully completed the British Association of Counselling and Psychotherapy’s assessment of competency, I am now a fully registered Counsellor in the West Midlands. Becoming a registered member requires counsellors to demonstrate some of their skills as a therapist via a formal assessment, as well as adhering to BACP’s quality and ethical framework. This includes meeting the association’s standards in regard to training, supervision, and continual professional development.

My unique registration number is 384624. You can search the list of all BACP registered counsellors and therapists using the association’s web site at

BACP Registered Member number

You can find out how BACP maintains and promotes standards through its professional registration programme, via their web site.

What does BACP registration mean?

Being a BACP Registered Member won’t change the way I work. I am still providing a local counselling service to people in the Walsall, Willenhall, and Wolverhampton areas in the West Midlands. I’m happy to work with anyone in need of counselling outside the area, by phone or video call. Amongst other areas, I offer therapy for anxiety, bereavement, depression and stress, and you can find a list of other areas I can help with on the Therapy and Me page. My therapy sessions are face-to-face, by phone or via Zoom, and I provide counselling on a one-to-one basis for individuals, as well as helping couples. Standard therapy sessions are 50 minutes in duration. I offer reduced rates for people on low incomes, and you can find a list of fees here.

Contact Me

If you are looking for a registered therapist in the West Midlands, or would like to know more about how I can help then please get in touch. You can call me on 07824 385338, or you can find my details via the Contact Me page.

COVID-19 and mental health

Effects of COVID-19 on mental health in Wolverhampton, Walsall and the West Midlands

It’s difficult to predict the longer term effects of Coronavirus in the West Midlands region, let alone more locally in Wolverhampton and Walsall, but a recent article from the charity, The Health Foundation considers some of the longer term mental health effects of COVID-19 in the UK. The article is significant for therapists and counsellors in the local area because it highlights how groups are being affected disproportionately, based on some of the social and economic factors we see across Wolverhampton, Walsall, and the West Midlands.

Anxiety, depression and lockdown

Citing a study of ninety-thousand adults by University College London, the article points out those on lower household incomes, living in urban areas or sharing their homes with children, experienced lockdown differently from the rest of the population. Although it’s not unique to the West Midlands region, it’s clear to see how this matches the profile of some of the most disadvantaged living in the Wolverhampton and Walsall areas. The experience of lockdown included heightened and continuing feelings of depression and anxiety, even after restrictions began easing in June 2020. A similar trend was observed for younger people and those with pre-existing mental health issues.

COVID-19 affects mental health
Image by Christo Anestev from Pixabay

Factors affecting mental health

Making the case for a link between poor mental and physical health, the report goes on to detail the drivers for poor mental health during the pandemic. These include:


Around five percent of the adult population report feelings of loneliness. Although this is similar to pre-pandemic levels, a disproportionate amount of working adults have identified as feeling lonely for the first time. This is probably a result of being isolated from their work colleagues. Reported incidents of domestic violence also increased during lockdown, an indirect consequence of social isolation. Described by the UN as a ‘shadow pandemic’, it’s estimated that cases have increased by twenty percent globally.

Financial Hardship

As well as a loss of income for the newly unemployed, many self-employed people experienced varying degrees of financial loss almost immediately lockdown began. Recognised as a good scheme by slowing the increase in unemployment, furloughed employees also experienced a twenty percent drop in their income. Young people in less stable working environments seemed to have been disproportionately affected by changes in employment. 

These changes can impact on mental health in a number of ways, including increased levels of anxiety associated with real and perceived losses of income. Worklessness and unemployment is strongly linked with poor mental health for many people. Although work can induce stress for some, it is also a coping mechanism for others. So, as workers were sent home there were fewer avenues for some people to share issues or feel a sense of purpose associated with their normal working routine.


As most people were urged to stay at home during the early phase of lockdown, housing inequalities came to the fore. The report suggests one in eight of the UK population have no access to a shared or private garden, and it’s reasonable to suggest these people in this group experienced lockdown differently from those with easy access to outdoor space. Although difficult to measure, those in poor quality accommodation may have suffered from spending more time at home. Again, this factor seems to have affected some groups disproportionately – BAME people are almost four times less likely than white people to have access to outdoor space at home.

Healthcare and other Frontline Workers

The report suggests it’s too early to see the longer term effects of COVID-19 on the mental health of frontline workers, but research from previous pandemics suggest a heightened risk for workers in this sector. An increase in depression and PTSD cases can be expected, with drug and alcohol misuse emerging as a consequence.

Finally, the report highlights how reduced access to mental health services was an issue in itself. As with physical health, a report from the Royal College of Psychiatrists pointed out a marked drop in attendances at routine appointments during lockdown. As a result, there was a tendency for people to delay seeking help until a crisis point was reached, presenting with more severe issues.


The longer term effects of COVID-19 on mental health are not yet known, but the considerations  above suggest that issues created or heightened by the coronavirus and subsequent lockdown are unresolved. The Health Foundation article concludes that without proper funding, problems that are being stored for the future will remain unresolved. Not only will this limit so many people’s lives by affecting their mental well-being, but it will likely lead to declining physical health, with long-term social and economic consequences.

If you are experiencing symptoms of anxiety or depression, or if you are thinking about therapy and would like to know more, please call me on 07824 385338 or use the form on the Contact Me page.

NSPCC launches campaign to help children with suicidal thoughts

Childline charity is contacted 67 times each day by children with suicidal thoughts and feelings

The NSPCC revealed this week there’s been a sharp rise in the number of under 11s contacting its Childline support service for help with thoughts of despair, including suicide. Although most of the twenty-four thousand young people who called the charity in 2108/19 were teenagers, the NSPCC reported an almost 90% increase in the number of under 11s using Childline compared with the previous three years.

For children with suicidal thoughts contacting the charity, the most common underlying issues were linked to difficult family relationships and problems at school or college. Some callers were aware of the negative impact to their mental health and how this could manifest as self-harm (read last week’s post about Self-Injury Awareness Day), a growing issue with young people.

To help combat this trend, the NSPCC announced the launch of a new campaign called KIDS in Real Life. They are asking the public to help them improve the mental health of children, especially in the online space where there are more ways for abuse, bullying and harm to occur than a generation ago. The charity is asking people to join in with their Pledge to Protect and if possible, to support Childline’s important work in providing a service to kids in times of crisis, by making a donation. Please follow the links if you think you can help.