I found this website today. It's very funny. Check it out.

The current debate about socialized health care in America is currently raging and while I’d implore all Americans to get behind it, it’s made me aware of a specific difference between healthcare provision there and here. The vast majority of Britain’s have absolutely no personal choice when comes to deciding who they see regarding their health care, be it physical or mental. So if you come for therapy on the NHS, you get who you get. But if you decide to go privately, you can and should shop around (remember, a lot of therapists have slots for low fee paying clients, do ask about this).

Let’s think about this in terms of the numbers – by far the most influential decider as to whether or not you’ll find therapy helpful is down to you. Do you want to go? Are you committed to change? Are you there because it’s what you want or is someone forcing you to go? A whopping 40% of a successful encounter with a therapist is down to you, the client, and is completely beyond the ability of the therapist to influence. It doesn’t matter how many brilliant, sparkling observations I make or how oozingly empathic I am, all of that will count for nothing if you profoundly don’t want to be there.

The second most important factor in a successful block of therapy (block? There has to be a better noun than that…!? Anyway) is down to the relationship that develops between you and the therapist. My first ever therapist, Dr Sara Dryburgh puts it this way : “Therapy is fundamentally about a relationship with the therapist. Qualifications, training, theoretical knowledge and mastery of specific techniques are of course essential, but not sufficient in themselves. The essential thing which makes therapy effective is the quality of the relationship that you form with the therapist”.

If you don’t like your therapist, look for another one. End of story. I can’t stress enough how important this is, imagine opening up and revealing the most secret things about yourself, remember how you felt the last time you had a good cry, think about coming face to face with the things that really matter to you. Now think about doing all of that in front of someone you don’t really like. See what I mean? So shop around, be fussy, think about whether or not you’d like to see a male or female therapist, even if all you can afford to pay is £10 per week, therapy is a major commitment in terms of time and emotional energy. You owe it to yourself to pick someone who you feel can accompany you on that adventure.

Guilt. Like sitting in a rocking chair, it gives you something to do, but it doesn't get you anywhere.

Actually, I've altered that quote from the original which is "anxiety is like a rocking chair, it gives you something to do but it doesn't get you anywhere" and it's from a very silly movie called Van Wilder: Party Liaison. In fact I agree with both, and I am clearly over-simplifying the issue but for me guilt is such a wasted emotion.

For starters, guilt often isn't a surprise emotion that sneaks up on you, I've found you usually have some awareness of the things that make you feel guilty. Which begs the question...why are you still doing/not doing whatever it is that makes you feel guilty?

Feeling guilty about something is often preceeded by one these two words - should or ought. "I should tidy up", "I ought to call my mum" followed by "but I can't be bothered" which leads to "now I feel guilty".

Should and ought (let's call them ought-isms) imply you don't have choice in the matter, when of course, you always have a choice. So don't tidy up and don't call your mum but make a firm choice in the matter and get rid of that guilty feeling.

That's not to say that you have free reign to neglect your responsibilities to others...flatmates/boyfriends/girlfriends/partners get annoyed if you don't tidy up and mum's like to hear from their kids, so acknowledge you need to do those things and make a promise to do them when it suits you better. How about this statement - "I need to call my mum, but right now I'm tired and grumpy and I know I'll end up bickering with her. I will call her tomorrow after a good night's sleep".

As a follow up to my post about boundaries, I spotted this today. Useful-ish advise, although I personally don't find that many of these tips particularly empowering. Actually learning to say "no" in an assertive way is an important part of setting and maintaining boundaries.

Ignoring people, smiling and nodding, literally not being there isn't actually saying no. How about experimenting with saying no on some smaller things, see who you go and then once you realise the consequences aren't as bad as you thought they were, you'll have a bit more courage to start saying no on some bigger things. Trying "no...but" can also work well. A friend asks "are you free for a drink this evening" during a crazy week where you've been non-stop and really a night to yourself, try saying "no, not tonight but how about next Tuesday". It can help with that most pointless of feelings - guilt. But more on that one later!

Healthy boundaries. What does that mean? Well first let’s take a look at what unhealthy boundaries are and how people violate them

• Trusting no one - trusting anyone - black and white thinking
• Telling all
• Talking at intimate level on first meeting
• Falling in love with a new acquaintance
• Falling in love with anyone who reaches out
• Being overwhelmed by a person - preoccupied
• Acting on first sexual impulse
• Being sexual for partner, not self
• Going against personal values or rights to please others
• Not noticing when someone else displays inappropriate boundaries
• Not noticing when someone invades your boundaries
• Accepting food, gifts, touch, sex that you don't want or aren’t comfortable with
• Touching a person without asking
• Taking as much as you can get for the sake of getting
• Giving as much as you can give for the sake of giving
• Allowing someone to take as much as they can from you
• Letting others direct your life
• Letting others describe your reality
• Letting others define you
• Believing others can anticipate your needs
• Expecting others to fill your needs automatically
• Falling apart so someone will take care of you
• Self abuse
• Sexual and physical abuse
• Food abuse

It seems to me that our society doesn't really support healthy boundaries. This is reflected particularly in popular culture, here are a few examples:

*Saying "no" might hurt someone's feelings (so you need to take care of their needs rather than your own)
*TV and Film don't model healthy boundaries – unhealthy boundaries seem to make for better plot lines…Grey’s Anatomy anyone?
*People who have firm (not rigid) boundaries are often tagged as mean, bitchy or needy - particularly women.
*Sexuality is often portrayed as a manipulative tool to get what you want as opposed to a loving expression between two adults

Healthy boundaries are about knowing where you end and the other persons begins and respecting that. It also means assertive communication. It isn’t needy to ask to have your need met in a clear, straightforward way. Everyone has needs, that doesn’t make you needy. What makes you needy is how you communicate. Hinting at what you’d like and then sulking when you don’t get it is not a way to assertively communicate your boundaries!

Last week I got the chance to be part of a focus group looking at the effects that cold sores have on sufferers. I was there to provide a mental health angle on the discussions and something that came up in all three of the groups that were sharing their experiences on cold sores was that what immediately preceeded the outbreak was a period of intense stress. Some group members said they knew the cold sores where a sign that they need to slow down, take a break and start making a real effort to look after themselves.

That got me thinking about the clues our bodies give us that we need to slow down. I don't know about you, but I frequently ignore the signs my body is giving me that I need to chill out and I've come across both friends and clients for whom the same is true. At some point, our bodies will just hit the over-ride button, as if to say "you're not in control of this operation any more and we're shutting it down!". Cue a bout of flu that has you bed ridden for a week or worse, a trip to the hospital.

We aren't floating heads that happen to have a life support system underneath us. Our heads (by that I mean our inner world of day dreams, big ideas, everyday worries, major stresses etc) and our bodies are connected, they work symbiotically. We do need to tune in to what our bodies are telling us and then take action, largely because our bodies can't do two things at once. I'm referring to the sympathetic and the parasympathetic nervous systems in our bodies. The former controls things that need to happen quickly - the fight or flight/stress response and the latter, things that take more time - digestion all the way through to sexual activity. Our bodies can't power both systems to run at full capacity at the same time.

So, if you're stressed a lot of the time, your body simply doesn't have the spare power to do things like fight off infections, digest meals properly, support active sex life...see where I'm going with this? Listen to your body, do what it's telling you. It evolved that way!

Where is it? I'm sure the more astute among you will have already guessed it's a northern hemisphere country, and it's Greenland according to this article here.

It's the world's largest island but the least populated. Very sadly, those most at risk are teenagers and young people, opportunties for the future of Greenland's youngsters seem limited and perhaps that leads them to think that their only way out is to take their own lives. Something about that sounds familiar to me...rising unemployment, fewer jobs, a huge number of recent graduates with no jobs to progress into...that's all happening here in the UK. This is seems to be high on the politicians' agendas at the moment, but in the short term I think there's a lot that could be done to bolster our teenagers' and young peoples' self esteem and sense of self worth.

First up, a confession...my Sunday morning guilty pleasure is slumping on the sofa with a copy of the Style section of the Sunday Times. I flip through ooohhhing and aaahhhhing at the nice clothes and then I start to race toward Sally Brampton's Agony Aunt column. I think she gives great advice. This past weekend she wrote a great piece about finding a therapist, something that's a major bugbear of mine which I'll be posting about regularly. You find the piece here:
http://www.timesonline.co.uk/tol/life_and_style/health/mental_health/article6863131.ece