Author: Natasha Page
There can be many reasons why a client may find it difficult to access therapy sessions and make full use of the relationship they so desperately deserve to build with us as their therapist. Research has concluded that People from BAME backgrounds can face more barriers to getting help, including-:
- not recognising they have a mental illness because mental health was stigmatised or never talked about in their community
- not knowing that help is available, or where to go to get it
- language barriers
- turning to family or friends rather than professional support, especially for people who don’t trust formal healthcare services
- financial barriers, such as paying for private counselling
- not feeling listened to or understood by healthcare professionals
- White professionals not understanding their experiences of racism or discrimination (Mental health.org 2022)
So, accessing therapy is not always easy, in fact many BAME people find the prospect of coming to therapy very daunting. As we know our clients often come to therapy with a myriad of difficulties and issues such as past trauma, attachment difficulties, which can lead to lack of trust and an inability to open up in the therapy sessions. They may have experienced relationships that held power that was abused and developed strategies for suppressing emotions. We deal with these complexities in our work on a day to day basis. Some clients may even present with the condition known as alexithymia a condition marked by lack of feelings, it can be difficult to recognise the symptoms of alexithymia. Since this condition is associated with an inability to express feelings, an affected person might come across as being out of touch or apathetic. (Healthline online 2021)
We know from research that suppressing emotions can be detrimental for our mental health and overall wellbeing. “Suppressing your emotions, whether it’s anger, sadness, grief or frustration, can lead to physical stress on your body. The effect is the same, even if the core emotion differs,” says provisional clinical psychologist Victoria Tarratt. “We know that it can affect blood pressure, memory and self-esteem.”
Research by Bessell Van Der Kolk found that people who had experienced trauma had a change in the left frontal lobe area of the cortex (The Broca area) which showed a significant decrease in activity in this part of the brain. Broca’s area is one of the speech centres of the brain, which is often affected in stroke patients. Without a functioning Broca you cannot put your thoughts or feelings into words. Van Der Kolks research found that the Broca area went offline whenever a flashback was triggered, therefore demonstrating visual evidence of the effects of physical wounds similar to the affects a stroke can have on the brain. (Van der Kolk, 2015)
As we know from our experiences of working with clients of trauma years later after an event people often have enormous difficulty telling other people what has happened to them.
So, how can therapists help clients to explore their feelings and emotions when they don’t have the words to do so? We can utilise creative ways of engaging and support nonverbal expression through art, music, sand tray and chair work. One resource I’ve found particularly useful is mood cards, which are essentially cards that list different emotions, to help clients explore that emotion further.
Why mood cards?
I have used mood cards to good effect, but sometimes they didn’t go far enough. Sometimes, just helping the client to identify an emotion was not helpful. I wanted to enable clients to identify themes that they may be struggling with, and this seemed to be missing from the resources available. So, I decided to create my own resource called My Little Therapy Box. The resource is made up of 40 cards which identify things clients might be struggling with, such as relationships, problems in work/education, what people think of them, low self-esteem, sibling rivalry and self-harm. Sometimes we have clients who don’t know where to start or what to talk about and they just feel uncomfortable. The cards can be used as an aid to start a difficult conversation and reach those young people that struggle to know how to use the therapeutic space. Having something that is visual can really help. Each card contains question prompts on the back, as well as words of encouragement and self-care tips. I also feel the cards help to break down barriers making potentially hard to discuss subjects easier for the client to open up about. (BACP CYP Journal 2022)
The cards can also be used during the assessment process as they cover a range of real themes all of which I have worked with in therapy. It can be a helpful way of helping the client feel comfortable about opening about some themes that may be hard for them to start a conversation around. The visual nature but light-hearted approach of using the cards is really helpful for engaging clients young and old in the assessment process.
They are also useful for solution focussed, short intervention work. Because by using the cards you can hone in on the key issues that people are struggling with and prioritise what they feel is the most important issue for them to work through in therapy.
Clients can also use the cards on their own, between or instead of therapy sessions as a form of early intervention. My Little Therapy Box is being used in different settings since they were launched such as by a sexual abuse charity, other mental health charities and some local schools in Nottingham, thanks to funding from the People’s Postcode Lottery.
Natasha Page is a B.A.C.P Accredited Counsellor/Psychotherapist and qualified social worker with over a decade of experience supporting clients. She runs a private counselling practice named This is me counselling and Psychotherapy CIC and is also founder of My Little Therapy Box. Her therapy work is her passion, and from her passion supporting others she has utilised creative ways of supporting clients and from this she has and created resource My Little Therapy Box. Natasha has a specialism in working with young people from her five years’ experience in a children and adolescent mental health service and she is also trained to provide Critical Incident stress management briefings where she responds to people after a traumatic event.
BACP CYP Journal 2022
Healthline [online] All about alexithymia or difficulty recognising feelings (accessed November 2021).
Mental health.org 2022 (accessed April 2022)
Page, Natasha My Little Therapy Box ™ resource 2020