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  • Writer's pictureWerner Briedenhann

Common difficulties I see in therapy.

Therapy couch with coloured lemons on it

We use different words for things we struggle with in life. Words like difficulties, disorders, mental health concerns, diagnoses, problems, or worries. In the end, whatever word we use, it means we are struggling and could use some help. As a clinical psychologist, I can spot symptoms, cluster them together and formulate a diagnosis. This is usually helpful if you need additional support like medication or a targeted treatment plan for panic attacks. Using a diagnosis communicates what's going on for you when I write a letter to your GP or other professional giving input into your care. There are some struggles or disorders I see a lot of in my practice:

Mood disorders

I see our mood as a bit like the climate. It's usually consistent and predictable- that is, before the severe side effects of climate change. Our emotions are more like the everyday weather. Our feelings change as we are affected by daily experiences. But sometimes, our climate or mood changes from mostly summer to overwhelming winter when we have persistent rainy grey weather.

Man on therapy couch holding an umbrella..

We might have suffered the loss of a relationship, the death of a loved one, or become hopeless due to our circumstances that have changed and the stressors we experience. We start to isolate and become quieter, forget to take care of ourselves and feel sad most of the time. Our appetite can change; we might start eating less or sometimes eat more and gain weight. We don't want to shower, spend lots of time on our screens and feel hopeless about the future. Our sleep is all over the show, and we even think of death or harming ourselves. Or we start to worry a lot and overthink everything.

All of these changes are linked to mood disorders or what a clinical psychologist would view as depression or anxiety.

Mood-related struggles are more common than we think. I've seen hundreds of people who feel sad, lonely, hopeless, anxious and depressed. Sometimes we don't even know we are depressed until we talk to somebody and gain a bit of perspective. This is where therapy can be helpful to make a plan, provide support, and create a way of reconnecting with life.

Life problems

Depressed Emojis on therapy couch

Life is what happens while we are making other plans. Or, in short, shit happens. And it happens; relentlessly unpredictable in all directions. Even when we made the wisest decisions, planned for the unforeseen, and took steps to provide ourselves with consistency, routine, and structure.

Sometimes the world just ends.

We split from our long-term partners, or get made redundant at work, or we are diagnosed with a physical condition that impacts everything we planned. Sometimes we become tired of the way things are, and we implode a little. Or a pandemic hits, and housing becomes even more unaffordable. Or, at times, we pack our belongings and move across the world in the hope of changing our lives for the better. But we struggle to feel at home in the strange new place. There are a multitude of events that can derail us from our meticulously planned lives.

We start feeling powerless, hopeless, or meaningless. Shame and guilt may start creeping in. The wandering dread finds us and makes itself at home in our living room. We feel pent up, anxious, and on the verge of falling over from the slightest push. We've lost direction and clarity about where we are heading. We're exhausted, distressed, and miserable.

Life problems are quite a common difficulty that can be addressed in therapy. As a therapist, I can help to make a different plan, so you can forge ahead and adapt as needed. Sometimes all we need is another being to be accountable to, this can be a therapist. A person who will ask us if we did what we said we would. Therapy helps create and sustain change. My practice isn't just about surviving struggles, it's about living too.


What's normal for the spider is chaos for the fly. What you experience might not look stressful or traumatic to someone else. I might watch the news and be unaffected by the headlines, while you may feel anxious or distressed by current events. My reaction would likely be due to my background of growing up in a violent society. Each person's experience is different, and we cannot and should not compare traumatic experiences. In the end, the effects of trauma cause us to suffer.

Trauma exploding on therapy couch.

After experiencing a traumatic event, some of us develop symptoms we cluster together and call post-traumatic stress disorder or PTSD. They may have nightmares, flashbacks, or feel like they are reliving the experience. There may be agitation, irritability, and feeling on guard all the time. Traumatised people sometimes become self-destructive or socially isolated. They can experience a sense of shame or guilt about the trauma. These symptoms impact our lives in different ways.

We can experience a low mood or start self-medicating with alcohol or other substances to feel better or repress intrusive thoughts. We become short and impatient with others. We might act recklessly by quitting our jobs. Or we become unable to take care of our daily tasks.

Trauma can be caused by different experiences. It may be due to a destructive and harmful relationship with an abusive partner, being in a car crash, or in a lot of the cases I see, the trauma related to sexual assault. ACC provides a funding pathway for those who experienced sexual trauma. It's called ACC Sensitive Claims. Please see my blog for funding options for therapy.

Identity struggles

It's your life. Let's do something interesting with it and find out who you are, what you like, and where you are heading. We all have existential dread to some degree or another, or we fear the questions we have about ourselves floating around in our heads.

Do I like men, women, nobody, everybody, or am I somewhere in the middle? What is the meaning of life, the universe, and everything in between? What do I want to do with my life? What are my values? What type of work do I want to do? Who am I?

It's often teenagers and young adults who arrive on my couch with these questions. Not knowing what's bothering them, but they know something isn't okay. A lot of times, they are struggling with their identity and therapy helps to give a bit more clarity. But it's not just young adults who have these questions. We all continuously grow and change. As we grow older, we have to incorporate new ways of being and discoveries we make about ourselves. A midlife crisis is no longer just for someone who turns forty. Everyone can have a life crisis if they are aware enough to spot it.

Therapy is the place to voice our questions about ourselves. To inspect our lives and understand ourselves more.


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