The use and misuse of alcohol and drugs is one of the more controversial issues in our society, and often a source of conflict between generations. Alcohol and other drugs are powerful substances with a potential to harm you and tempt you in to over-indulgence.

Alcohol is consumed by a great many people who see it as a pleasant way of unwinding after a long, hard day at work or as an enjoyable aspect of socialising with others. Alcohol helps us to relax: it gives us confidence in an unfamiliar situation, enables us to interact with others or is a means of celebrating an occasion. A moderate amount of alcohol is good for your health and as long as you do not overdo it is unlikely to cause any problems.

Having a dependency to drink or drugs are hard to break despite what others may think of you, this has developed over a long period of time. More often than not, there are nearly always underlying issues that have driven you to drink or take drugs in excess and by getting to the root cause that triggers your dependency will enable you to take control again. This can happen to anyone from all walks of life and it is nothing to be ashamed of. You are doing the right thing by seeking help.

Anger becomes an issue when it gets out of control, causing problems in relationships, at work or simply in the way it affects your quality of life. Anger Management will help you to control anger. It is difficult when you recognise that you are struggling with anger, you are probably feeling confused and have tried really hard to stop getting angry and yet find yourself again and again in similar situation of conflict, or feeling out of control.

You may have reached a stage where your relationships are under strain, or worse still your partner is thinking of leaving you. It may be that recently you have been in trouble with the authorities because of your anger. If you have a problem with anger you will probably recognise some of the common symptoms below:

• Aggressive or violent behaviour towards others
• You act in ways in which are frightening or wild
• Many people seem to frequently respond in an aggressive way towards you
• You find difficulty in your personal relationships at home or work

Anxiety and worry are very fundamental human emotions that we will all feel at times. Many people adapt to very high levels of anxiety and do not consider it a problem Anxiety has a very healthy purpose. Similarly, if we had no anxiety about ourselves in relation to others we might well behave with great insensitivity. Anxiety can make you imagine that things in your life are worse than they really are. What is important is recognising that anxiety is normal and exists due to a set of bodily functions that have existed in us from our cave-man days.

Sometimes anxiety can become excessive and unhealthy. The most common things we do when we are anxious is avoidance this is only a short-term solution though.
Anxiety can take different forms and expressions.

• General Anxiety (being anxious about many aspects of your life)
• Worry (continually thinking over a problem beyond what is needed to produce a solution)
• Specific Anxiety (anxiety over a certain situation - e.g. exams; social situations etc.)
• Phobia (an excessive fear of a particular situation or item leading to avoidance)
• Hypochondria (an anxiety about suffering illness)
• Panic attacks (a sudden uncontrollable triggering of physical anxiety symptoms)

Different culture groups have different ways of marking the death of someone they love.
Some mourn in a way, which celebrates the life of the deceased; others make a great and visible show of their grief. If there is no recognised period of mourning and often no great show of feeling, it can leave you feeling very alone in dealing with the intense personal emotions you may be experiencing. The death of someone who is significant to you is one of the hardest things you will experience in your life. Whether it is expected or a shock, the enormity of loss can often impact on you in a very profound way. Grief takes a long time to work through; there are no hard and fast guidelines for this process.
If grief is suppressed, it may well surface at some later stage. Sometimes there seems to be an expectation that you will have recovered after a certain time has elapsed, everyone has his or her own recovery time that cannot be hurried.

LOSS OF A PET - You may be surprised at the intensity of your sadness when your pet dies. You have lost a beloved member of your family and this deserves a proper bereavement. A pet can be the only source of pure, unconditional love that you will ever know and you cannot compare the pain of how you felt about the death of humans in your life to the loss of your pet. These are two very different kinds of losses, and naturally will be mourned in different ways.

Here are other types of Loss I have supported clients with:  

• Loss of a job
• Loss of a relationship
• Loss of a friendship
• Loss of a body part

Cancer can change the way you look, temporarily or permanently. Some people gain or lose weight. Chemotherapy can sometimes make your hair fall out. You may have had surgery to remove a part of your body and you may have scars. You may now have an ostomy as part of your treatment. These changes, even if only you can see them, can affect self-esteem or how you feel about yourself and at times make you feel unattractive and negative about your body. Even though the effects of treatment may not show on the outside, body changes can still be troubling because the “old body” is lost. These feelings can be difficult to cope with.

You may be anxious about going out with friends or may worry about intimacy with your partner. You may also be feeling angry, upset or sad. Changes in the way you look can be difficult for you and your loved ones, it takes time to grieve the loss of your “old body” and work through feelings about the changes and talking about your feelings can help a great deal. You may want to try a different haircut, hair colour, makeup or clothing. Programs such as ‘Look Good, Feel Better’ which are organised by Macmillan can make a difference to how you feel about yourself. This program offers tips on makeup, skin care, dealing with hair thinning or loss and other appearance-related side effects of cancer treatment for women and men.

Most of us at some time in our life feel some concern about our personal appearance. For some people this concern just affects them occasionally, maybe when other things in their life have gone wrong and their confidence is at a low ebb. For others, it is a more permanent worry and they spend a lot of time pre-occupied by the thought that they are physically unattractive.

In recent years enough people have manifested this concern and it has been given a formal title called Body Dysmorphia Disorder (BDD). Sometimes the worry is linked to a particular physical feature or to the visible traces of some ailment or accident. For other people, the worry is more general. These worries can be a source of great distress, sometimes linked to depression, social isolation or intense self- consciousness. Often people feel particularly isolated since friends and family seek to reassure them without understanding the depth of unhappiness that they are feeling.

Many people get support by talking to close family members or friends. However, your feelings may be quite confused and you might find them difficult to talk about with people close to you. It can help to talk to someone outside your family and circle of friends and having the time to talk things through often enables you to see a way forward.
The impact of a cancer diagnosis presents enormous challenges both you and the people close to you because as well as the need for timely treatment, it is important to recognise that the insecurity aroused by a life threatening condition can result in acute levels of anxiety, anger and self-reproach.

Life after treatment for cancer can be a particularly difficult time, often made worse by the feeling that support is no longer available or needed. Fears of recurrence are common thoughts and every ache or pain can be a worry, where you think your cancer is returning. It can take time to take control of your life again and your future health.

“When a child sits down with their counsellor and begins to talk about their feelings and problems, it can be the start of something that can change their life.”
BACP website

Life can be difficult at times for children and young people, older children can feel stressed from exams, hormone changes, relationships, sexuality, gender, even peer group pressures at school.

All children of all ages can feel anxious from situations in their life, like bullying, family problems, trauma, bereavement, even relocating to a new home or school.

Social media can also cause problems with body image issues and self-confidence. When social, emotional and psychological issues are not addressed, they can continue in to adulthood.

If you are a parent/guardian and concerned about your child, I am an experienced children and young people’s counsellor, who can help your child feel at ease and help them to talk about their issues. Allowing them to develop their own solutions to explore the best way forward for them and their family.

I use a multidisciplinary approach within the context of their life and support them in an age-appropriate way, planning how best to help the child or young person, as well as their family.

Everyone's experience of depression is different, and there are a wide variety of symptoms. You may feel low occasionally, or go through bad patches and for some of you, life is more of a struggle; you feel bad about yourself and your life.
At times you could feel complete despair and the symptoms of depression can be complex and vary widely.

Treatment for depression can involve either medication or talking therapies, or usually a combination of both. The kind of treatment that your doctor recommends will be based on the type of depression you have.
Making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily can improve symptoms of depression.
Here are some of the more common symptoms of depression:

Depressed mood

• Feelings of guilt, worthlessness, helplessness or hopelessness
• Loss of interest or pleasure in usually-enjoyed activities
• Change in weight or appetite
• Sleep disturbances
• Decreased energy or fatigue (without significant physical exertion)
• Thoughts of death
• Poor concentration of difficulty making decisions

Mostly women suffer from eating disorders. However, an increasing proportion of young men are also experiencing this problem. They are as much a social and cultural problem as a personal one.
We live in a society where the media constantly bombard us with images of successful people who are portrayed as thin. Women's bodies are particularly scrutinised by the fashion industry. There is often pressure to fit into a certain type of look that is currently fashionable.

• Low self-esteem
• Relationship or family problems
• Anxiety
• Depression
• Stress

The eating disorder itself is usually symptomatic of an underlying emotional or psychological issue. The underlying issues are not necessarily unusual or traumatic incidents it may be fairly commonly experienced problems that have built up over a period of time.

Each person will deal with their situation in their own way. Some people take on activities and challenges, whilst others prefer to spend their time quietly with family, friends or on their own. A terminal diagnosis is an overwhelming shock for most people and their families.
As people approach the end of their life, they are faced with tasks and decisions that include a broad array of choices ranging from simple to extremely complex.
They may make choices about how to spend their limited time and energy. Some may want to reflect on the meaning of life, and some may decide to do a final life review or to deal with psychologically unfinished business. Some may want to participate in planning rituals before or after death.

AIDS (or Acquired Immune Deficiency Syndrome) does not have such a high media profile as it did years ago. This does not mean the risk has decreased; in fact, the threat of contracting AIDS is now greater than ever since more people have the virus, which leads to it and can therefore pass it on.
There are a number of facts, which need to be known about AIDS:

• You don’t catch AIDS - rather you catch a virus called HIV (Human Immunodeficiency Virus). Some people can carry this virus without developing AIDS. Carriers can infect others.
• A person infected with HIV may feel perfectly well and not realise anything is wrong and can still pass the virus on.

There are a limited number of ways in which HIV can be passed on from a carrier to another person:

• Through unprotected sexual intercourse, anal or vaginal, without using a condom
• Through injecting drugs using an unclean syringe. Any unclean tattooing, acupuncture, ear piercing or electrolysis equipment could also pass on the virus
• Through passing on infected blood, either medically in the case of blood transplants or through direct contact from one open wound to another
• Expectant mothers can pass on the virus to their babies before birth and afterwards through breast milk

THERE IS NO RISK - from shaking hands or hugging an infected person; sharing cups, glasses, cutlery or food and drink; toilet seats, towels, baths or door knobs; sneezing or coughing; swimming pools. Fear of such safe practices thrives on ignorance and breeds’ prejudice HIV/AIDS is not restricted to homosexuals. Much of the gay communities now practice safe sex.

You may find it odd that a feature of life with which everyone is familiar with, on occasion or from time to time, is listed as a problem.
The truth is that lack of sleep may be a complicating factor in coping with day-to-day life. There is a great deal more known about sleep and some of the things that can improve or induce it without the use of medication.
Different people need different amounts of sleep. Most of you establish a pattern that is normal for you from your early adult life. However, as you become older, it is normal to sleep less. What is important is that the amount of sleep you get is sufficient for you, and that you feel refreshed. There are ranges of reasons why your sleeping pattern may change or you are suffering from insomnia:

• Stress
• Depression
• Anxiety
• Sleep Apnoea
• Stimulants
• Medication
• Health problems / illness

We all have times when we lack confidence and don’t feel good about ourselves.
But when low self-esteem becomes a long-term problem, it can have a harmful effect on our mental health and our lives.
Self-esteem is the opinion we have of ourselves. When we have healthy self-esteem, we tend to feel positive about ourselves and about life in general. It makes us able to deal with life’s ups and downs better.
When our self-esteem is low, we tend to see our life and ourselves in a more negative and critical light. We also feel less able to take on the challenges life throws at us.
Low self-esteem often begins in childhood. Teachers, friends, siblings, parents, and even the media give us lots of messages, both positive and negative and for some reason, the message that you are not good enough sticks.
You may have found it difficult to live up to other people’s expectations of you, or to your own expectations.
Stress and difficult life events, such as serious illness or bereavement can have a negative effect on self-esteem. Personality can also play a part. Some of us are simply more prone to negative thinking, while others set impossibly high standards for themselves. If you have low self-esteem or confidence, you may hide yourself away from social situations, stop trying new things and avoid things you find challenging.

OCD presents itself in many guises, and certainly goes far beyond the common perception that OCD is merely hand washing or checking light switches. In general, OCD sufferers experience obsessions that take the form of persistent and uncontrollable thoughts, images, impulses, worries, fears or doubts. They are often intrusive, unwanted, disturbing, significantly interfere with the ability to function on a day-to-day basis, as they are incredibly difficult to ignore.

People with OCD often realise that their obsessional thoughts are irrational.
Compulsions are repetitive physical behaviours and actions or mental thought rituals that are performed over and over again in an attempt to relieve the anxiety caused by the obsessional thoughts. These repetitive behaviors are meant to prevent or reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.
Symptoms usually begin gradually and tend to vary in severity throughout your life.

One of the commonest problems is the tendency to put things off until the last moment or until tomorrow. Probably every one of us has tried to avoid some unpalatable task at some time, it is a natural human reaction.
We all have our own preferred way of working. If letting the tension build up a bit before you get started works well for you, then there is no reason to change. However, if you get increasingly behind with your work and end up feeling anxious or stressed, the problem needs addressing.

Do any of the points below sound familiar to you?

• Difficulty in making a start on a piece of work or goal
• Craving diversion
• Ineffective working
• Last minute rushing
• Missed deadlines
• Do you feel you are always requesting extensions and making excuses?
• Nagging guilt
• Is your social and relaxation time spoilt by the continual feeling that you ought to be working?

If you answer yes to many of these questions, you may well have developed the behaviours and habits of putting things off.

Being raped or sexually assaulted is a very distressing experience with effects that can be long lasting. The majority of rapes and sexual assaults reported tend to be against women, very little acknowledgement is given towards male rapes and assaults.

This page relates to either gender.

Everyone reacts differently in these situations and it is not unusual for feelings to change from day to day. In particular there can be long gaps between the assault and the emotional reaction. Sexual violence is a criminal offence and you can report the crime to the police. You can do this later if you wish. However, the reason for reporting a sexual assault immediately is so that forensic evidence can be taken. When you go to the police station you can take someone with you, such as a friend or relative and nowadays the police have specially trained officers that will support and assist you through the process.
If English is not your first language the police can arrange for an interpreter to be present.

In order to cope with the trauma of the event many people will just try to carry on as normal and not tell anyone for a long time. Often distress can surface a considerable time after the event. Never feel you have to cope on your own simply because you did not report the incident soon after it happened.
People who have suffered sexual attacks describe feelings of being:

• Frightened
• Guilty
• Powerless
• Angry
• Ashamed
• Depressed
• Numb
• Lacking self-confidence

RAPE AND SEXUAL ASSAULT, WHETHER BY A STRANGER OR A PERSON YOU KNOW, IS NEVER YOUR FAULT.

Being safe with sex means caring for both your own health and the health of your partner. Being safe protects you from getting or passing on sexually transmissible infections (STIs) and an unplanned pregnancy, whether you have vaginal, anal or oral sex, it definitely pays to play it safe.
There is more to sex than sexual intercourse.
There are lots of ways to enjoy physical intimacy with your partner without having oral, vaginal or anal sex. Safe sex also includes lots of other activities like kissing, cuddling, rubbing, massage, stroking, masturbation or touching each other's genitals. Safe sex is the best way of protecting you and your sexual partner(s) from STIs, including HIV.

There are very good reasons why sexually active people need to practise safe sex including the following:

• You cannot tell whether someone has an STI based on how they look, dress, behave or who they have slept with.
• Practising safe sex provides you with peace of mind.
• Thinking ‘it won’t happen to me’ provides no protection.
• Some STIs are quite common and using condoms will reduce the risk of infection.
• People with HIV or STIs often do not know they are infected.
• STIs and HIV exist in all countries and cultures and can affect anyone.
• Condom and water-based lubricants prevent HIV transmission.
• Safe sex protects you from unintended pregnancies.

In its broadest sense, sexuality describes the whole way a person goes about expressing him or herself as a sexual being. It describes how important sexual expression is in a person's life; how they choose to express that sexuality and any preference they may have towards the type of sexual partner they choose.
Like many of our other characteristics, sexuality seems to be largely a chance product of our individual nature, which is then further developed by our early interactions and our sexuality seems to be formed by the time we reach teenage, although it may be many years later before we each understand and accept our sexuality.

Coming Out to Yourself - Before you can come out to anyone else, you have to come out to yourself. There is no hard and fast rule when this happens. You may be certain of your sexuality from a very young age, or it can happen much later in life. Accepting the conclusion that you are gay, lesbian or bisexual hopefully is easier nowadays than it has been in the past. Attitudes are more accepting and there are now more people living openly gay and lesbian lives.
The decision to come out to you can still be a very scary one and can be a period of upheaval and uncertainty.

Stress is the feeling of being under too much mental or emotional pressure.
Pressure turns into stress when you feel unable to cope. We all have different ways of reacting to stress and a situation that feels stressful to one person may be motivating to someone else. Stress can affect how you feel, think, behave and how your body works, in fact, common signs of stress include sleep problems, sweating, loss of appetite and difficulty concentrating.
Stress can be defined as the brain's response to any demand and many things can trigger this response.

There are at least three different types of stress, all of which carry physical and mental health risks:

• Routine stress related to the pressures of work, family and other daily responsibilities.
• Stress brought about by a sudden negative change, such as losing a job, being re-deployed, being made redundant, divorce, selling and moving house or illness.
• Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.

People who feel they have been born in to the wrong gender are often aware there is something wrong in early childhood. Society places great emphasis on sexual and gender classification and also on gender appropriate behaviour. A child or adult who senses or feels they are confused about their gender often feel different from their peers and uncertain about their identity. The medical term usually used to describe this confusion about gender identity is gender dysphoria.

Transgender people experience their transgender identity in a variety of ways and may become aware of their gender identity at any age, tracing their identity and feelings back to their childhood. Teenagers and young people begin to explore and experience gender nonconforming attitudes and behaviours during adolescence.
Some embrace their transgender feelings, whilst others may struggle with their gender identity, leading to confusion and creating anxiety.

I am trained and experienced in transgender counselling and meet monthly with Transgender people, their family and friends at Transforum in Manchester. www.transforum-manchester.co.uk

If you have gone through a traumatic experience, you may be struggling with upsetting emotions or memories; you may feel numb, disconnected, and unable to trust other people. When bad things happen, it can take a while to get over the pain and feel safe again. Whether the traumatic event happened years ago or yesterday, it is possible to heal and move on.
People are also more likely to be traumatised by a new situation if they’ve been traumatised before, especially if the earlier trauma occurred in childhood.

Following a traumatic event, or repeated trauma, people react in different ways, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond to trauma. These symptoms and feelings typically last from a few days to a few months, gradually fading as you process the trauma and even when you are feeling better, you may be troubled from time to time by painful memories or emotions, especially in response to triggers such as an anniversary of the event or an image, sound, or situation that reminds you of the traumatic experience. Recovering from emotional and psychological trauma takes time.