Turns Out Remote Therapy is possibly not as effective as Face to Face – Neuroscience Research

It was my feeling during the Covid Pandemic, and my conviction since, that talking to someone on a screen lacks a certain something, and that face to face therapy is still the gold standard when it comes to healing and growth.  There are some studies that suggest minimal differences between the two, but the neuroscience tells a different story.

Zoom Conversations vs In-Person: Brain Activity Tells a Different Tale – Neuroscience News

A study by Yale researchers found significant differences in brain activity during in-person versus Zoom conversations. Advanced neuroimaging showed more suppressed neural signals during online exchanges, while in-person discussions resulted in heightened and more coordinated neural responses. These findings suggest that current technology does not engage our social neural circuits as effectively as face-to-face interactions. The study indicates the importance of live interactions for social behavior, as digital representations of faces do not access social neural pathways in the same way as real-life encounters.

I am glad I didn’t ditch my therapy room during the pandemic and glad I can still offer in person therapy sessions to those who want to talk to a human being in the same room, sans glitches and “Remoteness” in more ways than one!

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Nice to see I’ve been reviewed on a Website reviewing all things Manchester!

In the huge range of professions, there are some that tend to remain anonymous, working diligently behind the scenes without ever basking in the glow of recognition. I’ve always found solace, meaning and reward in my work, knowing that I’m making a difference to people’s lives, even if it goes unnoticed and under the radar of most people. However, I recently got quite a lift when I was featured on  local Manchester review website, Master Manchester. This unexpected recognition shed light on my otherwise obscure profession and reminded me of the joy that comes with being acknowledged for one’s skills!

Ironically the one downside of the review was the acknowledgement that sometimes my availability can be low and sometimes I have to operate a waiting list – I guess this is one of the downsides of being an established, experienced therapist and being very good at what I do.  Word clearly gets around and it’s lovely to get a small amount of public recognition from a local review site.

You can read the review and more at:


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Coronavirus and the Stages of Grief and Loss.

Whatever you are feeling right now is normal.  How can that be, you say!  Life right now is anything but normal, we’re on lockdown, the news is like a horror movie, everything has changed and I am feeling the strain (or perhaps, you are feeling strangely relieved or elated!).

While the times are unprecedentedly abnormal and out of the ordinary for us 21st Century humans, our reactions to the change are as old as humanity itself.  The only difference is that these reactions are on a colossal, global scale, and pretty much everyone is going through them at the same time, albeit at a different rate, which might make it even harder to understand and can put profound strain and stress on relationships as everyone is out of sync in their reactions.

This article will attempt to explain these feelings, and try to help you understand what may be happening to your mind in the midst of this emotional turbulence.  Sometimes, knowing that you are not going crazy, that you are experiencing a normal human reaction, can help you to feel better, and may help you adjust more quickly.

I am quite confident that what you are experiencing is loss and grief.  While this may be the grief of losing  a loved one to Covid-19, and if that is the case I am truly sorry, the grief I am talking about is more the widespread sense of loss of our way of life, the loss of our freedoms and pleasures, loss of our ordinary routines, of our social contact, our sports, our leisure activities, our workplace and ways of working, our plans, our dreams, our hope and sense of safety in the world, the loss of the future we thought we were heading into back when Coronavirus was a word only scientists had heard of.

All of these, in many ways, have been taken away in the blink of an eye, a sudden death, if you like.  With little warning, one day our lives were just as they had always been, the next we were told to stay in our homes and the news became a relentless horror show (incidentally, the world isn’t ending, and this isn’t the apocalypse, as much as it might feel like it at times!).

If you are not reacting to that, then I applaud you, and envy you, as you are a more unflappable person than I am!

Yet these reactions can be so different.  Look at any scene from the last few weeks.  People in face masks, hopefully doing their duty by believing a facemask will protect others if they have the coronavirus (but more likely hoping that the mask will prevent them catching the virus – it won’t!). The looting of loo roll. The gradually emptying trains and buses and streets as some souls bustle about and carry on as normal with a smile on their face wondering what all the latest fuss is about. Even the politicians, from gung ho business as normal to dour faces and promises that the suffering will increase before it gets better.

To the trained eye, all these reactions are perfectly normal, and trackable through a quite simple model, something that I use in my work as a grief counsellor. This is variously called “The Stages of Grief”, “The Cycle of Grief” and “The Loss and Grief Curve”. This idea was coined by Elisabeth Kübler-Ross, an American psychiatrist who worked in hospices with the terminally ill.  Her observations were originally based on the processes of people who were dying, but her model has since become more widespread and can be applied to many more situations such as the loss of others and any significant changes we experience in our lives.

In short the stages are Denial, Anger, Bargaining, Depression and Acceptance.  While it may sound like “stages” presents a neat way of dealing with something in an ordered fashion, I must emphasise that this isn’t the case – think of the stages like paint thrown into a mixing tray – you might be able to see the different discrete colours, but they will mix and blend with each other and some will stand out much more than others until well on in the mixing process.  The stages, or cycle of grief, describe a process that takes some time, does move in a forward direction, but can also hit stalls and roadblocks.  It can also be envisaged like a curve (and sometimes feels like a roller coaster)

Let’s take a look at some of the stages in more detail and how this cycle may work in the context of Coronavirus.


You have probably already heard of this one, it’s a staple of all fiction and TV dramas that include a psychiatrist or therapist.  Clichés and stereotypes often have some truth in them.  Maybe you have known someone who lost someone important in their life, and the next day they were up and about like nothing ever happened, carrying on working, smiling and saying they are just fine. Sometimes this can include, counter-intuitively, feelings of relief or elation.  That’s one way it can work out.  This stage may also include shock and numbness – someone may not be able to move from their sofa or get out of bed, they go into survival mode, doing only what’s necessary. They may feel very afraid of the impact of the event, and try to shut it down, avoiding any talk or acknowledgement of the loss or change.

In terms of Covid-19 there has been plenty of this stage on display.  The people heading into work, unworried about the fuss, the last few people eating in the restaurants, the British revellers raising their pints in Spain and laughing in the face of adversity. The people diagnosed who carry on travelling, ignoring the advice to self isolate.  Perhaps the elation and relief of those who get a week working from home, or asked to take their holidays, the elation of those who feel like this might be a positive change, the ones who bemusedly look on as others loot toilet roll in a desperate panic.  A general sense of “this isn’t or can’t be happening”, the surreal feelings, the disbelief, the fear of what’s coming next, and the constant need to distract – the books, the games, the TO DO list, the drugs and alcohol.


This can come quickly on the heels of the first stage, or it can be a slow burner that smoulders throughout the grief process.  It can be the first sign of movement and is normal.  The previously placid person who has been fine, is totally unfazed by everything, seems to be coping well – when suddenly they slam a door hard enough to smash the glass, or snap at their partner, or scream and shout, or attack, physically or verbally, that person with the last loo roll or the last package of pasta. Sometimes anger can be apparent from the outset, a reaction to the denial.  Very often, the trigger may be totally unrelated to the loss event, it might be a simple thing like being cut up in traffic, or a phone or laptop crashing.  Anger can be the flower that has its roots in the grieving process, and often comes from a desperate, yearning need to control something, when the main problem seems so overwhelming and so out of control.


This too, is something that can happen early or take a while to happen.  It is a sense of “if only” and sometimes can be related to denial.  For example “I have always wanted to work from home” becomes a bargaining chip in the grieving process – if only I can reframe this and make it feel different than it is, I will feel better, so I’m going to see this as a blessing in disguise.  Or it could take the form of beginning to reach out to others, to struggle to come to terms with the situation, either alone or with other people.  A sense of trying to accept things. It could involve helping others – for example, maybe I can make this better if I only put others before myself (there is nothing wrong with helping others, mind!) or if I give away all my money (that might not be prudent!). Religious and spiritual ideas can be a part of this – for example praying to God and promising to be a good person forevermore, if only things can go back to the way they were. You may try to change the past, if only you’d been known this would happen, you would have been better prepared. Feelings of guilt can arise during this stage, blaming yourself or blaming others.  As long as you do all your social distancing everything will go back to normal, won’t it?  But woe betide anyway who flouts the rules! It is very much a bridge between trying to change the past and trying to move forward into “the new normal”.


It may be too early for this stage to have fully manifested during the current pandemic and the subsequent changes, but there may be moments of it.  Depression is usually a period that comes after the storm is over, when denial, shock and numbness have settled and the anger has burned itself out, but it will be present at times.  That tearful feeling that comes out of nowhere, the sad music that makes you sob, the touching story or act of kindess that makes you weepy.  Very often you might not directly feel sad about the larger event or loss. Like anger, these moments of sadness and emotional tension have their roots in the sense of loss, often it is feeling sad about small things that offer a safe way to let out our emotion a little at a time. This is often the phase that follows a funeral, or sometimes people can go for years until one day the tears start to come and won’t stop for a while after they begin.

If you are feeling sadder than usual, this is perfectly normal, you are human and you are reacting to a profound change, you might cry at the drop of a hat at the smallest things. It is often easier, but not always, easier for women to cry than men, due to our social conditioning, but it is important to let the sadness through, not to stifle it. It is part of the healing process and there is no shame in it. I have cried at least once a day during the last two weeks at the enormity of the situation and the suffering around me, and my own grieving process.


Finally, comes acceptance.  This is a tricky word, as “accepting” doesn’t mean “it’s all OK”.  The way I like to think of acceptance is that if the other stages are waves in a chaotic ocean, acceptance is being finally flung onto the beach of “what next?”  It is where new possibilities can begin.  Some people reach this stage far quicker than other, some people may sadly struggle to ever reach it.  For some kinds of grief, such as the death of an elderly parent due to old age, there is a relatively straightforward path to acceptance. For other kinds of grief, such as the death of a child or multiple significant losses, there may only be brief stays on the beach of acceptance until the waves come in and carry them back out again.

People go through these stages at different rates, depending on the impact on them, their history and temperament.  People who have already experienced recent bereavements or significant losses in their lives will feel the impact all the more harshly, while others may be able to use their previous grief cycles to help understand what is happening to them.

In terms of Covid-19 these stages are still unfolding for all of us, no sooner have we adjusted to one thing than there is another change, another uncertainty, and this can make the process all the harder to bear.

You might also note in the diagram how needs change at different stages in the process.  Early on there is a need to sort out practicalities (yes, food, loo roll!), to seek information (the news, social media) and later to seek emotional support before finally enlisting some guidance in moving on further.  This is why bereavement counselling can often be counterproductive if taken up too soon, there is a process to go through, and the timing needs to be right.

Finally, from a neuroscience perspective, ie what is happening in your brain, it might be helpful to understand this in terms of an old fashioned chalkboard.  Your brain is effectively trying to re-write its understanding of the world, its sense of reality. But it very much wants to hold on to the picture of how things were, and how things were has been written 1000s of times on the chalkboard, every day of your life up to the event of change or loss.  Wiping it is hard work, I remember each term at school when the caretaker would appear with a bucket of soap and water to clear the deeply etched markings from the board from thousands of chalk strokes.  Additionally, we loved the picture that was on the board, and don’t want to let go of it.

Dealing with Change, Loss and Grief of Coronavirus and Covid-19

I will write a further article in more depth on dealing with grief but for now hope that understanding how this model works has helped your understanding of the many difficult feelings you might face.  The problem with any model is that it sounds great in theory, but doesn’t operate in a vacuum – you will also be dealing with stress and anxiety, financial worries, concerns about relatives and challenges in your relationships.

One thing you should remind yourself at the end of the day is that you have survived another day in the most challenging times most of us have ever known!

The most important thing is to take care of yourself as well as those around you and for everyone that will be different.

Ask for help if you need it, if you can – and if you feel able, help others. Make sure you look after your basic needs – food, water, sleep, exercise, as best you can.  If you can’t look after all your basic needs, make sure you at least eat and drink enough water.

There is hope.  You can get through this.  You are stronger than you think.


Stay Safe and Well!

If you found this helpful please consider making a donation to Age Uk, MIND or Marie Curie Cancer Care

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It’s That Time of Year – Seasonal Affective Disorder/Depression (SAD)

It’s that time of year when the summer is over, the weather starts to close in, and we face the prospect of the clocks going back, leaving us with short days, and the dreaded “going to work in the dark, going home in the dark”.

It’s enough to make most of us feel a little down, but for many people (at least half a million in the UK alone), Seasonal Affective Disorder/Depression (or sometimes winter depression) or SAD as it is commonly known, this time of year signals that start of a tough period of digging in to survive the debilitating low mood that can be caused by biochemical changes in the body/brain.

There is plenty of information about SAD, and if you believe you have this condition, or even if you just feel low mood in the winter months but manage to get by, you will probably have read about the benefits of exercise, light therapy, supplements and medication. These, or a combination of them, can be very helpful.

My own view is that this condition is not a “disorder” but is more a sign of our bodies being in touch with nature while our lifestyles are not. Many species wind down during the winter, plants lose their leaves, insects largely disappear into states of suspended animation, animals grow winter coats, or burrow down and hibernate. Our bodies are part of nature and are not immune to this tendency, and yet we are expected to be as active and productive as during the brighter spring and summer months, while cooped up in offices and factories, or at home with the children, bathed in weak artificial light. Of course we don’t have the luxury of hibernating, or sealing ourselves up in a cave for the winter – like many evolutionary adaptions (such as our appendix!) what was once useful to our ancestors can become a big problem in today’s modern world. Whatever the view on SAD, there is no doubt that there is a physical, biological component, which is why light therapy and chemical help can work. However, there is also the emotional component of how we respond to the effects.

As well as the above mentioned therapies for SAD, counselling can also be used to identify issues which might be contributing to the feelings of depression. Sometimes it is easier to brush off underlying problems when the weather is bright and and the light nights are with us, and the winter months can magnify low mood and affect how we perceive problems. Counselling may be able to help you find a way forward, whether this is by finding ways to manage the feelings brought on by winter, or gaining new perspectives on what the feelings mean and how to deal with and reduce their intensity.

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Counselling Blog – First Post

I’ve had my private practice website going for some time now, and thought I would add a blog. From time to time I’ll post some interesting news or information/updates about my Manchester counselling & psychotherapy service.

I’m really interested in the neuroscience of counselling & psychotherapy, so I’ll christen the blog with a quote from Norman Doidge, a neuroscientist and author who has brought the concept of neuroplasticity into the mainstream, so to speak:

“All of us have worries. We worry because we are intelligent beings. Intelligence predicts, that is its essence; the same intelligence that allows us to plan, hope, imagine, and hypothesize also allows us to worry and anticipate negative outcomes. (164)”
― Norman Doidge, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science

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