Practices

Let what they say land in you before you answer. The word that catches somewhere in your own chest is usually the live one.

Cold. Empty. A nuisance. Take each one for a second rather than sailing past it to the reply. Then give back the one that carried the charge, and you…

When somebody says they just get on with it, take the getting on with it seriously. That is the door, and arguing with the nothing is a wall.

This happens a lot, I just roll with it, I forget about it: there is a whole strategy in that sentence and it is visible, unlike the feeling…

When someone finally gets one true word out about how they feel, resist explaining it to them. Ask what that word is like from the inside and let them find the rest.

The temptation is to say the clever thing: of course you felt rejected, anyone would. It is often accurate and it usually ends the moment, because…

If a conversation has wandered off and you have lost the thread, go back to the last thing that had real feeling in it, and go back using the words they used.

Not a summary of those words. The actual phrase: 'you said she has her standards and you will never meet them, and your eyes went red when you said…

You do not have to reflect back everything a person just told you. Pick up the part that carries the weight and say that much.

A long, careful summary can flatten what someone has just risked saying. If the heart of it is that he feels defeated and frightened of never being…

There is motion sitting inside the word emotion. Big feelings come out through the body, so if you cannot keep still while you are grieving, that is the feeling moving rather than something going wrong with you.

Think how strange it would be if someone heard they had come into a fortune and just said thank you and carried on with the morning. Joy gets up and…

Punching something to get the anger out is the piece of grief advice that gets argued over most, and the honest answer is that hitting rarely leaves a person calmer.

Plenty of good people will tell you a bag is better than a wall or a face, and there is something in that. What has not held up is the older idea…

Give the anger a room rather than a target. Music up loud, walk fast, dance badly, shake your arms out until something in you settles.

Some children's grief centres keep a padded room where a child can go in and move however they need to, with nothing to hit and nothing to break.…

Write the exact thing you are furious about on a paper plate, tape it to the wall, and throw wet cotton balls at it. It sounds childish, and it does more than swinging at nothing.

Half the good of it is in the writing. Vague anger has to become a sentence before it can go on the plate, and reading that sentence back usually…

Serotonin syndrome comes from stacking, and the second agent is usually something nobody thought to mention: a migraine tablet, a cough medicine, a herbal remedy for low mood.

Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they…

When someone says they react badly to normal doses of almost everything, take it as information about their body rather than as a personality trait.

Bodies differ in how fast they break a medicine down. Give two people the same dose and one of them may be holding far more of it for far longer,…

Try putting a sentence between you and the mood: this is what my brain is doing right now. It does not make me a bad person, and it does not mean I cannot cope. It just feels that way today.

Low mood does not arrive labelled as a mood. It arrives as facts about you, that you are useless, that nobody wants you around, and it is very hard…

When someone tells you they have been hurting themselves, keep your face steady and stay curious. Alarm closes the conversation, and you need it open.

A visible flinch teaches the person that this is not something you can hear, and the next disclosure goes elsewhere or nowhere. It can also make the…

Never come off an antidepressant on your own. The taper belongs to the prescriber, and for some drugs it needs to be slower and longer than people expect.

The moment to raise this is before anybody acts, not afterwards. If a client is feeling better and starting to think about stopping, that thought is…

A medicine that lifts drive is not the same as one that settles anxiety, and for some people the energising kind makes the worry louder.

Bupropion is the clearest example: often good for flatness and lack of motivation, often unhelpful on its own when anxiety and a racing, sleepless…

If you know something about a person's history that the prescriber may not, say it. A past eating disorder or a single seizure can change what is safe to prescribe.

Bupropion lowers the seizure threshold, and in someone who is purging, restricting or very underweight that risk climbs meaningfully. The therapist…

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

Before anyone concludes that nothing works, go back over the ordinary explanations: a dose that never went high enough, a trial that stopped after three weeks, doses missed on the hard days.

Treatment resistant has a technical meaning, which is that at least two proper trials at a proper dose and length have failed. A great deal of what…

Put something in before you take something out. Removing the only way a person has of coping leaves them with nothing, which is not safer.

In practice this looks like smaller steps than a promise to stop: cutting the frequency, changing what is used, agreeing to wait ten minutes and do…

For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.

That is uncomfortable to sit with and it changes what helps. If a behaviour is the reason someone feels understood, taking it away without touching…