Sarah Lewin - Inner Smile TherapiesCounselling and Psychotherapy in Nottingham

Blog. Library Image: Counselling

Who is Therapy for?

For a long time now, we have seen counselling as support for those people who are in a dark place. Those who are depressed, or have severe anxiety and panic, personality disorders, or are addicted or suicidal. Counselling is seen as something we do when we are at our lowest and can’t cope.

That’s how I saw it too, but since I became a qualified Psychotherapist, I now realise that each and every one of us can benefit from Counselling.

The reason I now realise this is from having years of personal therapy myself.

I dabbled in it before I trained. I saw Hypnotherapists as well as counsellors for short term therapy when I was in my late 20’s and early 30’s because I just felt lost. I was just not happy with my life and I wasn’t sure why. I wasn't depressed, I just wasn’t happy, and I had no real reason to be unhappy, I just didn’t know where I was going in life, and how can you expect to reach your destination when you have no idea where you are going?

It was part of my training to pay for ongoing Counselling through the full 3 years of my course, which was definitely more than I needed, so I was glad to stop. However, I have since gone back to it as I have found myself going through a tricky time lately, due to some relationship difficulties and bereavement.

What I realise from my own counselling, and counselling others is that we all have times in our lives when things don’t make sense to us, when we might need some support. We might experience a life transition, such as retirement, redundancy, or the end of a relationship, or loss of a loved one.
Importantly, counselling isn’t always about talking endlessly, but also about problem solving and awareness. Enabling you to better understand who you are and to realise your strength and strengthen your resilience. It can last a few weeks or a few months, and thats up to you.

What Counselling offers is a relationship like no other. Though it does take a while to build that relationship, it can be so refreshing, liberating and healing to share and explore life and ourselves with a trusted, unbiased other.
Some are lucky enough to have this person in their lives. Someone to share their deepest fears and darkest worries, hopes and dreams, and insecurities, and not fear judgement or criticism. But many of us don’t have that person.

I have realised how important this relationship is. Ok, it may not be not free, but its genuine. There is warmth and understanding, confidentiality and most importantly, no judgement.

Contrary to popular believe, Therapy is not for the weak. It takes courage to be vulnerable, look hard at yourself, and to make changes, Most of us hate change, but as Albert Einstein said “If you keep doing the same thing, you will keep getting the same results”, so without committing to making changes you will stay stuck. Embarking on therapy itself is proof that you are ready to look at what’s working in your life and what isn’t, and how to make changes to get the most out of life for yourself and those you love.

Sharing our secrets with a trusted other means we can let it go, it really is a weight lifted, and once it is out, in the room, it can be viewed from a different perspective. To be able to untangle all of those thoughts and beliefs that have been holding you back and to see them for what they really are.
Counselling has allowed me to offload my mind and connect with my heart and to understand what it really means to be understood. To have someone sit by your side, to walk the same path and catch your fall. That’s worth paying for because, for me, that is priceless.

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What is Anxiety?

What is going on in my body when I experience feeling of Anxiety?

That’s a good question, and the answer is, a lot. But in this blog I am going to keep it very simple and generalised. I will delve deeper into each section in further blogs for those who are interested in knowing more.

Some may not be so interested in what is going on but just want to know how to get rid of it. I know that is how I felt about my anxiety, but I found the more I knew and understood, the better able I was to take control of it. I also found it fascinating to learn what an amazing organ our brain is and how its sole purpose is to keep us safe and alive.

So, what is going on?

Fight, flight, Freeze Response

Early humans were exposed to the constant threat of being killed by other tribes or wild animals. Therefore, since time began this has been our natural, survival or stress response. It’s automatic and allows us to react quickly without even thinking.

When we feel threatened and afraid, the amygdala automatically activates the fight-or-flight response by sending out signals to release stress hormones that prepare our body to fight or run away or freeze.

What’s going on in the body

It all begins in the amygdala, where signals are then sent to the hypothalamus, which stimulates our autonomic nervous system (ANS).

The Autonomic Nervous System consists of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system drives the fight-or-flight response, the parasympathetic nervous system drives freezing. How you react depends on which system dominates the response at the time.

When your ANS is stimulated, your body releases adrenaline and cortisol, the stress hormone, which prepare your body to fight or flee. These hormones are released rapidly, causing numerous physiological changes within the body.

• Your heart beats faster to bring oxygen to your major muscles.
• Your breathing becomes faster and shallower to deliver more oxygen to your blood. In the freeze response, you might hold your breath or restrict your breathing.
• Your peripheral vision increases so you become more aware of your surroundings.
• Your hearing becomes sharper.
• Your blood thickens, preparing your body for injury.
• You may sweat and shake
• Your hands and feet might feel cold as the blood is forced to your major muscles in case you need to run.
• The sensation of pain reduces.

That’s a lot of changes going on isn’t it, and how you respond to these reactions will depend on how you usually react to stress. You might also shift between fight-or-flight and freezing, but this is very difficult to control. Usually, your body will return to its natural state after 20 to 30 minutes.

Cerebral Cortex

The Cerebral Cortex, also known as the frontal lobe/s, is the rational, part of the brain system, where thinking, decision-making, and planning happen.

The Cortex allows you to decide upon a logical response. Unlike the automatic response of the amygdala.

When you sense danger, your amygdala wants to automatically activate the fight-or-flight, while, at the same time, your Cortex/frontal lobes are processing information to determine if danger really is present and the most logical response to it.
When the threat is manageable, the frontal lobes override the amygdala, and you respond in the most rational, appropriate way. However, when the threat is strong, the amygdala acts quickly and automatically triggers the fight-or-flight response or amygdala hijack. Its complicated isn't it. who would of thought that your brain is doing all of this in a split second.

How can you stop your amygdala being hijacked?

This may take some practice and persistence. You can start by beginning to take notice of your thoughts and your reaction to them (emotions). At times when you are not in full amygdala hijack (fight or flight) take time to notice your thought process. Become aware of the kinds of thoughts you are having. Are they rational or not.

Once you notice the fight-or-flight response has been activated, your goal is to calm down and take control. Remind yourself that what you’re feeling is an automatic response to fear.
A good way to get calm and stay calm is to pay attention to your breathing, and I will write another blog specifically about the power of the breath. Think about the pace and rhythm of your breathing and focus on what’s going on in your body as you inhale and exhale. Try to breathe out a longer breath than you breathe in. This eliminates carbon dioxide.

How to prevent an amygdala hijack

It is worth considering these methods to help you gain control of your anxiety and promote relaxation. I can help you to do this as we can do them as part of the sessions.

Mindfulness - This refers to staying in the present moment by focussing on what you are doing right here, right now. It gets your out of your thinking mind.
Focus only on the current moment, not future tasks or past problems.

Mindfulness takes practice, but it can be done at almost any time. When you’re waiting in the car or going for a walk, take time to focus on and become aware of your immediate environment.
At first, your mind will quickly start to wander. With more practice, though, it’ll be easier to stay in the moment.

Breathing: Another way to stay in the present is to focus on your breathing. Notice the air moving in and out of your nose and how it changes between inhaling and exhaling. Try to visualise a balloon in your belly, expanding with every breath. If its easier to count then count, this helps you stay focussed.
As mentioned earlier let the out breath be longer so breath in for say 5 and out 8.

Meditation. By relaxing your body and mind through meditation or deep breathing, you can change your brain’s focus from responding to a threat or stress to inner peace and calmness. The are plenty of videos and recordings on You Tube and you may find Apps such as Calm and Medito helpful.

Reasoning. This means you use your frontal lobes to think the situation through, review the possible options, and choose the most rational and logical way to respond.
The more you practice these techniques when you’re not experiencing an amygdala hijack, you will be prepared to use them the next time you’re in a stressful situation, and with practice your response to the trigger will become more manageable.


The modern world is full of stress. We often feel this psychological stress when we see things on the news or social media, such as dangerous events and natural disasters.
Your amygdala can’t tell if these threats are real or imagined, so it responds to this stress as if it’s a real physical threat to you, and triggers your fight-or-flight response.
You can prevent or stop an amygdala hijack by breathing, slowing down, and trying to focus your thoughts. This allows your frontal cortex to regain control. You can then choose the most reasonable and appropriate way to respond to the situation.

Practicing these techniques regularly can help prepare you for stressful situations.

(Adapted from information on

Inner Smile Anxiety Clinic can help you to take control and find inner peace and calm when you didn’t think it existed. We will use techniques such as breathing and guided visualisations as well as Neuro Linguistic Programming to help you master your thought processes and your physical responses to threats in 4 – 6 sessions typically.

You can email me for more information via my website or at

Blog. Library Image: Embrace the Day

How to cope with Anxiety

As anxiety is a survival mechanism, it is unrealistic to expect we can ever be completely anxiety free. What would be helpful though is if we only experience anxiety when we are faced with real life threats rather than everyday situations.

Deep Breathing

Deep breathing is a simple technique and your first line of defence against Anxiety and negative thoughts. Its so simple in fact, that people think it couldn’t possibly be powerful enough to help them get rid of anxiety and panic attacks.
It is fair to say if you never practice deep breathing then its probably going to be the last thing you will think of when having a panic attack, but learning and practicing breathing techniques on a regular basis is probably the single most helpful thing you can do for your anxiety, and to begin to take control of it. You will soon begin to notice that anxiety affects you less and less. So I would definitely recommend you begin doing this as soon as possible. So where do you start;

Lets go.

How about right here, right now. When you have read this paragraph put this to one side and practice. I am sure you will be surprised how good it feels.
So, close your eyes and focus on the breath. That’s right. Breathe in and notice the air flowing in through your nostrils and notice how that air fills your chest and your stomach. Make sure that you breath deeply enough to notice both your chest and your stomach rising as they fill with air. Now exhale. Breathe out gently through your mouth with your lips puckered as if breathing through a straw, or just through you nose. See which feels most comfortable for you.

Once you get into the idea of breathing, you do not always need to focus on the rise and fall of your chest and stomach, that is just to begin, so you get into the habit of breathing beyond the top half of your lungs, as most of us regularly do.
As you do this you will notice those little pesky thoughts popping into your mind. Let them. But this time, do not give them any attention. Watch them come and let them go, and they will. Don’t try to stop them, just watch them. If you notice yourself giving attention to a thought, and it will happen, then just bring yourself back to focusing on your breath.
Good. That’s all there is to it.

As you begin to practice this over the coming days. You may want to set a timer for 5 mins to start, then 10 minutes, going up to 15 then maybe 20. All in your own time at your own pace.

Progressive Relaxation

As well as deep breathing the progressive relaxation technique is really helpful to allow your whole body to experience deeper relaxation. I learnt this technique when I did my Hypnotherapy training as it was a good technique to use as an induction to Hypnosis, and I’ve used it with many of my clients for Anxiety.

This time, as well as breathing as before, rather than focus on the breath, focus on your muscles, one muscle group at a time, So;
Notice the muscles of your feet and toes. Become aware of any tension in those muscles and just let it go. Imagine the tension draining down through your toes and out through the soles of your feet into the ground below.

Now bring your attention to your legs and notice any tension in those muscles, and imagine that tension draining down through your legs and out through the soles of your feet. Do this with your buttocks, lower back and stomach. Then focus on your arms and hands and this time imagine the tension leaving your body through the tips of your fingers. Focus on your chest and upper back and shoulders and imagine this tension flowing down through your arms and out through the tips of your fingers.

Now your neck, face and scalp and then notice all this tension being released through the top of your head and imagine the tension as grey smoke leaving your head like a chimney.
This can take 10 – 15 minutes, or as long as you like.

As part of my Anxiety clinic we do practice these techniques so I can guide you through them and I also send you a recording so that you can use this in between sessions if you prefer being guided.

“Nothing exists outside of the present moment but memories and expectations” – Medito

The Power of Imagination

The next coping method for Anxiety is our imagination. We can use it for our greatest ben
efit or our worst fears. Our thoughts can change how we feel in a instant, and as someone who struggles with anxiety it is true to say your thoughts are generally negative and fear producing.

So, now we are going to think of something really calming and relaxing. Imagine yourself being somewhere that would evoke these feelings, such as by a stream, in a garden, your bedroom, or on a beach. Now really get into visualising this and focus on all of your senses.

Ears – What sounds can you hear around you. The sounds of gentle waves or birds singing?
Eyes – What do you see. A clear blue inviting sea, a garden full of flowers?
Skin – What do you feel. A soft breeze on your face. The warm of the sun on your skin?

Really immerse yourself in all of those senses and try to make it feel as real as possible. Do this for 5 – 10 minutes and really escape. This can be your safe place where you can go anytime you need to relax.

Focus on the positive

The more we allow ourselves the think negative, scary thoughts the more our body will react as if it were true.
Its important to challenge what you think. Don’t believe that because a thought pops in your mind that it must be true or you have to give it attention.
Refuse to focus on negative thoughts. Becoming aware is the first step. Then taking action by challenging these thoughts.

Ask yourself if these thoughts are helpful to you?

Are they true?
Do I need to be focussing on this?
Is it accurate?
Is it based on fact or feelings?
How likely is it to come true?

So have a practice at these coping strategies. I am sure you will find them helpful. I also teach these in my Anxiety clinic along with relaxation and stress management techniques.

Sarah Lewin - Psychotherapy/Hypnotherapy/Coaching - 07938 537146

Blog. Library Image: Depressed Person

Relationships -Healing after a relationship with a Narcissist

It’s hard to not be aware of the recent trial between Johnny Depp and Amber Heard as they bring their turbulent relationship to the public arena.
For me as a Psychotherapist, it brings up questions of what we all see as acceptable in a relationship and how much we are willing to put up with in that relationship before we say “enough”.

I see clients often who are dealing with the breakup of a relationship. All break ups can be painful, especially if children are involved, but the most painful has to be a relationship with a narcissist. The abuse experienced in these relationships is insidious. It creeps up from behind and slowly chips away at you, breaking you down before you even realise what has happened.

During my Psychotherapy training there was a lot of emphasis on relationship and especially the therapeutic relationship. It is the therapeutic relationship that is the healer and change agent in therapy, so it is really important that we, as therapists, understand what people need in relationship. To be honest it turned my head around as I realised that I was not being met by Rogers Core Conditions (1961) in my relationships. These Core Conditions are empathy, unconditional positive regard (acceptance), and authenticity. The question is how many of us are experiencing these Core Conditions in our everyday relationships. Certainly not someone living with a narcissist.

How do you recognise you are in a relationship with a narcissist?

The chances are if you are regularly criticised by your partner, if you walk on eggshells trying but failing to please them. If they manipulate you into doing what they want by being super nice, but then change back to their usual critical self once they have what they want, while speaking highly of themselves and how wonderful they are, how lucky you are. If they tells lies, and expecs to always come first then you may be living with someone who is on the narcissistic spectrum. If your partner is on the lower end of the spectrum, you may feel you can cope, but if they are at the higher end, you may need some support to leave the relationship for your own mental health and wellbeing.

What other personality traits should I look out for?

Narcissists believe that they are special and should be treated as such. The truth is that they are so incredibly insecure that they have to exhibit these personality traits to hide the lack of self-worth they feel inside. However, it would not be advisable to confront a narcissist about their lack of self-worth, as they are not only hiding it from you but most likely from themselves. Narcassists do not like to be challenged or to show weakness.

Dating a narcissist

You can’t be blamed for being drawn in by a narcissist. They are incredibly charming, probably successful, and lots of fun to be around. They may indeed make you feel more special than you have ever felt before. When we are in a vulnerable position, not feeling our best self then this can be intoxicating and incredibly exciting. They may be sharing their deepest most self with you, telling you that you’re their sole mate. You may be talking about moving in together, though you have only known each other weeks and discussing the future you can enjoy together.
There is a term for this stage in Psychology, its known as love-bombing. One of the narcissists tactics is to love-bomb, to draw you in, which of course is to elevate themselves that they are attractive and desirable, but it is nothing more than manipulation. It can feel really intense and really pleasurable. During this love bombing phase, they will also be doing a lot of information gathering. Showing great interest in you and asking lots of questions, which you can guarantee they will use against you at a later date, especially if you let on what makes you insecure.

The love-bombing phase is usually pretty short lived. Maybe around 3 - 6 months. Following on from all those romantic gestures comes the devaluation stage, this is when things start feeling less exciting. They will start criticising you and blaming you. If the relationship starts to break down at this stage, it will be all your fault and they will take no responsibility for any of it.
Dr Ramani, a clinical psychologist, says in her blog on dating a narcissist, "It's as though, as soon as the narcissist has you captured where they want you, they're no longer interested in you," she says. "It's like a kid fighting for a toy, getting a toy and then throwing it in the corner, because they just wanted to fight, the game of winning."

If you continue in the relationship, then expect the criticism and devaluing to continue.
The narcissist will often make comments like “you don’t know how lucky you are to have me, look how much I do for you, you couldn’t cope on your own”, “no-one would look at you will a belly like that”. Over the years and as the victim gets worn down by the comments, they come to believe what they are being told, which makes it difficult for them to leave.
The more they put you down, the better they feel about themselves, and knowing that they instilled all the beliefs they need to be sure you stay in the relationship allows them the knowledge that, for them, that self-eteem will be provided forever.

The next most common tactic of the narcissist once they have drawn you into their lair is gaslighting. This in itself is emotional abuse and part of the devaluation process. The idea is to chip away at your self-esteem, causing you to question your own sanity and doubt yourself. They will criticize everything about you, mock you. They will focus on your mistakes and your insecurities and minimise your accomplishments.
The gaslighter might say they told you something which they didn’t, they may say you said something which you didn’t, to cause confusion. They will deny that they told you something which you remember but will say “I never said that”. They will dismiss and trivialise your emotions. They will say something hurtful, then say “I was only joking”. They will call you to other people, telling them you are depressed or crazy, when you are not. They will lie at every opportunity.
This puts the narcissist firmly in control. It is likely that it may take years for you to even notice the gaslighting in your relationship, as it can be difficult to spot, and you may of course doubt that you are being gaslighted.
Gaslighting is a weapon of manipulation and control. The feelings that gaslighting instills can last long after the relationship has ended as it strips away your confidence and self-worth.

Narcissism in Therapy

A narcissist would rarely ever show up to therapy. That’s because they consider themselves to be perfect. To them, there is nothing wrong with them. They don’t need or want to change. This is because their narcissism is protecting them from the feelings of insecurity and self-loathing they are so trying to hide, even from themselves.
As Dr Ramani again says, “Narcissists survive and maintain their own delusions of superiority by pulling down the individuals around them”.
However, the ones that show up to therapy are the victims of the narcissist. They arrive at therapy as they try to recover from the effects of being in relationship with a narcissist. These clients are both men and women, and though either sex can be a narcissist it is more common in men than women.
Sometimes these clients aren’t aware they are in relationship with a narcissist. They just know that something doesn’t feel right, they are not happy, they lack confidence, and they know something needs to change. If they are still in the relationship, it might be difficult for them to see a therapist, depending on how controlling the relationship is.
Quite often the client turns to therapy once the relationship is over. They are usually quite distraught, wondering how they never managed to do enough, were never good enough to save the relationship. They blame themselves and wonder how they could have done things differently. It is only through the course of therapy that they see how unhealthy the relationship was and how they are better off out of it.

The healing then begins…….
Following a relationship break up with a narcissist it is important to surround yourself with those that you love and who love you, unconditionally. It will take time to rebuild the self-esteem that has been eroded during that relationship, but it can happen. It is important to be kind to yourself, to remind yourself always that it was not your fault, that there was nothing you could have done differently that would have changed who they are. They will never see how they have hurt you and that in itself can be deeply hurtful.
You may well experience some form of grief over the ending of the relationship, and still miss certain aspects of it. It’s important that you allow yourself to feel all of these emotions as part of the healing experience.
It will take time to learn to trust again. Narcissists are in the minority and next time you will hopefully be aware of the warning signs.
In his brilliant book “Recovery from Gaslighting and narcissistic abuse”, Don Barlow goes into much detail about the recovery process, he highlights the steps.

Looking after yourself

Focus on healing

Rebuild yourself

Do the deep work

Find a therapist

It’s also important to state that a narcissist is not always a romantic partner, but could be a friend, a boss, a parent, or a sibling. These relationships can be especially difficult to separate yourself from. If you do find yourself in a toxic relationship, I hope you can find the strength and courage to leave and to be in a position to have some therapy to better support you through the difficult time of separating, leaving and healing. If you do decide to stay in the relationship then understanding narcissism and being aware that is is them and not you can be empowering, but it would still be beneficial to keep some distance between you.

You can find many helpful videos by Dr Ramani on Narcissism on You Tube.

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