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There are some experiences in parenting that are hard to put into words, and PANS and PANDAS sit firmly among them. One moment, you know your child. Their ways, their personality, their rhythms. Then something shifts, often suddenly, and you are faced with behaviours and symptoms that feel completely unfamiliar. It can feel like losing the child you knew, while still caring for them every day. The onset of a flare can be deeply unsettling. The intensity, the speed, the confusion around what is happening. Parents are often left trying to make sense of something that does not follow the usual rules. There can be fear, grief, frustration, and a constant questioning of what to do next. It is not just the child who is affected. The whole family feels the impact. Alongside this sits a particular kind of isolation. Support can be difficult to find, and recognition remains inconsistent. Many parents find themselves researching late into the night, advocating, explaining, and often feeling unheard. There is a sense of carrying something that is not widely understood, which can leave families feeling alone at a time when they most need support. The emotional toll of this should not be underestimated. Living with unpredictability, navigating systems, and holding hope through repeated setbacks can be exhausting. It can also bring up powerful feelings that are hard to share openly, especially when there is pressure to stay strong for your child. At the same time, there are people working steadily in the background. Clinicians, researchers, and advocates who are pushing for greater understanding and recognition. Change may feel slow, yet there is movement, and there are reasons to hold onto a sense of hope that things will continue to shift. In the midst of all of this, parents need space too. A place where the focus is not only on the child’s symptoms, but on the emotional experience of living alongside them. A place where the complexity of what you are holding can be thought about, rather than carried alone. As both a psychotherapist and a parent with lived experience of PANDAS, I understand something of how layered this can feel. The uncertainty, the grief, the resilience it calls for. Therapy can offer a space to begin to process these experiences, to make sense of what has happened, and to find a way to keep going without losing yourself in the process. You are not expected to hold all of this on your own. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here . PANS PANDAS Resources: https://panspandasuk.org/

It feels like there is always something pressing at the moment. The news brings war, rising costs, new health warnings. Even years on from Covid, that sense of uncertainty never fully leaves. It is not always loud, yet it is always there, quietly shaping the background of our days. You notice it at the checkout, filling the car, or in conversations that circle back to money, pressure, or what might happen next. There is very little space to simply settle. When the world outside feels unsettled, something shifts on the inside as well. We tighten. We focus on what needs to be done, practical and efficient. We keep things moving and get through the day. Life demands it, and it makes sense to respond this way. While we stay functional, another part quietly gets pushed aside. Not because it does not matter, but because it feels as though there is no room. The unspoken message emerges: keep going, do not fall apart, now is not the time. Holding everything together comes at a cost. It is not always dramatic, but it is there, slowly building. You might feel slightly on edge, unusually flat, or notice irritability creeping in. There can be a sense of being a little removed from yourself or from life you used to feel connected to. These are subtle signs that something is being contained underneath. Often it does not feel safe to slow down and open to it, so the feelings remain quietly contained. Therapy can feel out of reach in moments like these. It may seem optional, something to consider when there is more time, more money, or life feels a little calmer. That sense is understandable, and yet that part of you does not disappear. It adapts. It shows up in small ways: in tension, mood, or in moments where life feels slightly heavier than it should. This part does not need everything at once. It only needs a space where it does not have to hold everything together all the time. We cannot control the wider world. It will continue to shift in ways that feel fast and unpredictable. There is something quietly grounding in carving out even a few moments to pause and check in with what is happening inside. Simply noticing, without fixing or judging, can make more difference than you might imagine. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

I often picture our emotional life as a river. Something natural, steady, alive. A movement that was always meant to flow without permission or performance. Most of us start out that way. A feeling arrives, it moves through, it leaves. Simple. Honest. Uncomplicated. But somewhere along the way, many people learn that certain feelings are not welcome. Maybe anger was met with silence. Maybe sadness was brushed aside. Maybe joy felt too loud in a household that preferred quiet. Maybe the people you loved could only cope with part of you. So you built a small dam in the river. Then another. And another. Not because you wanted to, but because it felt safer. Kinder. Easier. More acceptable. The problem is that once you start building these dams, you have to keep tending to them. You have to hold back what wants to move. You have to monitor cracks. You have to brace yourself for pressure. You have to pretend the river is calm even when you can feel the force of it right behind you. And the pressure does build. It always does. Sometimes it starts with a seep. A small leak through the dam that you notice as a strange discomfort, a sense of unease that does not match the moment. Sometimes the pressure pushes harder and you feel it as anxiety, not random or irrational, but the body sensing that the river is trying to move again. Anxiety often shows up right at the point where what has been held back begins to make itself known. Other times the pressure shows up as irritability over something small. Tiredness that makes no sense. Tears you cannot explain. The dams become harder to maintain, and without meaning to, you end up living in a state of constant emotional management instead of emotional living. The thing is, the river was never the problem. The river is you. The river is supposed to flow. When something in your life increases the pressure, the water rises. A change. A loss. A relationship shift. A stress that pushes harder than usual. The river reacts instantly. It tries to move, and the dam strains in response. This is often the moment people realise how much energy they have been spending holding things back. How much of themselves has been stuck behind structures they no longer remember choosing. Letting the river flow again is not about removing every dam at once. It is not about dramatic emotional floods. It is about recognising that your feelings are not dangerous. They are information. They belong to you. They ask to be heard rather than contained. Learning to listen to that river can be surprisingly steadying. It can reduce the pressure, soften the internal noise, and create a sense of space that has been missing for a long time. The more curious you become, the more the river reveals. Patterns. History. Old rules that no longer fit the adult you have become. You do not need to navigate that alone. It can be helpful to sit with someone who understands what it means to live with these internal structures and the weight that comes with them. Someone who can think with you as the river begins to move again at its own pace. Not forced. Not rushed. Just allowed. The river is natural. It was always meant to flow. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

There is a part of parenting that often takes people by surprise. It is the way it reshapes our social world. Before children, most of us spent time with people we naturally connected with. We chose friends, colleagues, groups and conversations that suited who we were. If someone drained us, unsettled us or brought out a version of ourselves we did not like, we could quietly step away. Then parenting arrives. And suddenly, choice feels much smaller. Children make their own friends. They join activities that come with ready made groups of adults. They bring home invitations to parties where the social atmosphere can feel tense or confusing. The school gate, the WhatsApp chats, the sidelines of sports sessions. All of it comes with its own set of personalities, unspoken rules and emotional currents. And many parents find that these are not relationships they would have chosen for themselves. The quiet discomfort no one talks about Parents can feel stuck in conversations that leave them uneasy. They can feel pulled into group dynamics that remind them of old patterns from school or earlier life. They can feel pressure to get along, fit in or keep the peace because they believe it protects their child. It is common to hear parents say things such as: I would never spend time with these people if it were just me. I feel like I have to be someone else at the school gate. I do not feel comfortable but I do not want that to affect my child. This tension can be surprisingly tiring. Even when nothing dramatic happens, the small moments of discomfort build up. Trying to be polite, agreeable or unfazed becomes a kind of emotional labour, and it leaves many parents feeling drained without quite knowing why. What is going on beneath the surface From a psychological perspective, something meaningful is happening here. When we enter these new parent related circles, old relational patterns can return. It might be a familiar feeling of being on the outside. A sense of needing to prove yourself. A worry about being judged. A drive to stay small and avoid conflict. These reactions were formed long before parenting began, and situations with other parents can bring them back into focus. There is also the internal pressure to be a good parent. Many adults believe, often quietly, that a good parent keeps everything smooth. That they stay connected. That they do not upset the group. This can lead to pushing aside our own needs and boundaries in order to keep the atmosphere calm for the child. And beneath all of this sits a split inside many parents; the part that wants to protect the child’s place socially and the part that longs for genuine choice and more comfortable relationships. These two parts do not always agree. Why this matters for parent wellbeing When adults ignore their discomfort in these situations, several things can happen. They begin to overextend themselves. They doubt their instincts. They feel resentment that they do not know how to name. Or they lose a sense of who they were before parenting placed them into these social settings. This is not because they are failing. It is because they are being asked to hold emotional tensions that are rarely spoken about. How therapy can help When parents bring this into therapy, the relief can be significant because they can finally talk about it openly. From there, the work tends to involve a few steps. First, naming exactly what feels uncomfortable. Second, understanding what part of the self feels threatened or overwhelmed. Third, reconnecting with the adult identity that still deserves space and choice. And finally, finding gentle boundaries that protect the parent without disrupting the child’s world. Therapy also helps uncover why certain people or situations feel particularly activating. Often there are echoes from earlier experiences that colour the present moment. This deeper understanding gives parents more freedom in how they respond. A helpful shift in perspective Instead of thinking “I have to stay in these relationships for my child”, it can be more honest to recognise that “These relationships belong to my child’s world, but I am still allowed to protect mine.” Parenthood changes our social landscape. But it does not ask us to give up our sense of self in the process. With awareness and support, parents can stay connected where they need to, while staying grounded in who they are. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

There is a quiet shift happening in the therapy world. More platforms are offering fast access and low cost support, with sessions that are short and frequent and therapists who are encouraged to work at high volume. These services are often marketed as efficient solutions for a busy life. The message is simple. Faster is better. Cheaper is better. Convenience is king. Yet something happens when therapy is shaped around speed and scale. The space begins to narrow. The rhythm changes. The subtle parts of the process can start to thin out. When a therapist is balancing a very large caseload or when a trainee is expected to deliver meaningful work for little-to-no pay, the room for depth is often reduced. Not because the therapist lacks skill or care, but because the structure itself makes it difficult to think with someone in the way therapy truly requires. Therapy is not just a service. It is a relationship. It relies on time and attention and a kind of steady presence that cannot be rushed. It needs space to breathe. It needs space to settle. It needs the kind of pace where both people can notice the small things that shape the big things. Low cost models often offer accessibility that many people genuinely need, and this matters. But accessibility should not come at the cost of quality. A person in pain deserves more than an algorithmic match and a timetable built around output. They deserve a therapist who can sit with their story without hurrying it along. When therapy becomes too fast or too thin, people can come away feeling unheard or unchanged. Sometimes they feel like they are repeating the same patterns without any real insight. Sometimes they feel like the deeper questions are left untouched. This is no fault of the individual therapist. It is perhaps more the shape of the container they are working within. In my work, I pay attention to the pace and feel of the process itself. I aim to create a space where thoughts can settle, feelings can rise in their own time, and meaning can take shape without being hurried. The work is not rushed, and it is not automated. It is shaped by what you bring, moment by moment. Therapy, at its best, has a certain atmosphere. It feels considered. It feels steady. It gives enough room for your internal world to be explored with care rather than pushed along. My intention is to offer a place where you feel genuinely accompanied, where someone is thinking with you, and where the work can deepen in a way that is useful and meaningful for you. Therapy should not feel like you are being processed. It should feel like someone is thinking with you. It should feel like a room where your internal world is allowed to take up space. A room that is not rushed. A room that is yours. If you are looking for a therapeutic space that values depth and care over speed and volume, you are welcome to start a conversation with me. Sometimes the right pace makes all the difference. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

Life moves at a pace that leaves very little room for us to catch up with ourselves. We drift from task to task, conversation to conversation, thought to thought. Most of the time we do not notice how quickly the days carry us forward. The movement becomes normal. The speed becomes expected. Then something interrupts the flow. It might be a cancelled plan, a delayed train, an early morning when the house is still quiet, or simply a moment when we no longer have anything to distract ourselves with. The noise stops, and we arrive in a space we did not choose. At first it can feel uncomfortable. There is a slight restlessness, a sense that we should be doing something. We reach for the usual distractions without thinking. The phone. The checklist. The next small task. Anything that fills the space. Anything that lets us return to the familiar pace. But if we resist the urge to fill the moment, something else begins to happen. We meet parts of ourselves that usually stay hidden beneath routine. A feeling we brushed aside. A thought we did not give time to. A truth we already knew but avoided. For some people these moments arrive gently. For others they can feel intense or even frightening. When there has been a lot held inside, slowing down can bring us face to face with emotions that have been pushed away for a long time. Both experiences are valid. Both tell us something real about where we are and what we have been managing. These moments of stillness reveal what movement usually hides. We see what has been building. We sense what has been ignored. We feel what has been waiting for attention. Slowing down does not create these feelings. It simply makes them easier to hear. And hearing them is what allows something to shift. This is similar to what happens in therapy. There is space. There is time. There is room to notice thoughts and feelings we might miss in the rush of everyday life. Therapy does not slow the world, but it slows the experience of being in it long enough for us to meet ourselves with steadiness rather than avoidance. The self we meet in these pauses is often the one that needs the most care. The one that has been carrying something quietly. The one that is ready to be acknowledged. We do not need to slow down forever. Sometimes a single moment is enough. A few minutes of stillness. A breath taken with awareness. A decision not to fill the space immediately. What we find in those moments can be surprising. And it can be the beginning of something important. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

There are rules we follow without realising we agreed to them. Be kind . Do not make a fuss. Stay strong. Stay polite. Keep moving. Most of these rules are old, so old we no longer remember where they came from. Yet they shape the way we show up in the world every day. We notice them in small moments. When we say yes, even though something inside us leans towards no. When we swallow a feeling because we do not want to appear difficult. When we tell ourselves that exhaustion is normal or that wanting more is unreasonable. These rules stay quiet. They slip beneath our awareness and become part of the rhythm of our days. They can make us reliable, capable, steady. But they can also keep us from expressing what we actually need. Some rules protect us. Others restrict us. Most do a bit of both. It is only when life presses against them that we sense their weight. A relationship begins to feel one sided. A request at work lands with a heaviness we cannot ignore. A familiar situation suddenly feels sharper than usual. Something inside us notices. Something wonders whether these old ways of coping still fit.This is often the beginning of change, long before we consciously choose it. The work is not about breaking all the rules. It is about seeing them clearly. Asking where they came from. Asking whether they still serve us. Asking what it might feel like to loosen one of them, even slightly. There is a quiet kind of freedom in that.A way of returning to yourself after years of living by expectations that were never fully yours. And for many people, this is where therapy becomes helpful. Not because someone else hands you a new set of rules, but because you are given the space to notice the ones you live by now. Space to question them. Space to understand the parts of you that created them in the first place. You do not have to change everything at once.Sometimes the first step is simply recognising that the rules are there.And that you are allowed to choose which ones you keep. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

Intrusions into the conscious mind, whether from everyday life or the unconscious, can deliver a real sense of danger. It is coming from a system designed to protect us, but can often leave us feeling quite unprotected in everyday life, especially with external pressures that necessitate having to push on. This sense of danger can instil a panicked feeling with racing thoughts. The heart can pound so heavily that we can at times actually hear its thumping rhythm. We might find ourselves struggling to breath. This sense of danger can be debilitating enough that we might even that life is on the edge, utterly helpless and confused as to why we are experiencing such symptoms. The feelings of anxiety can make us feel entrapped in a vicious cycle that can eventually lead us to hide away at the risk of it being seen by the busy external world. Through our five senses, we take in the external world around us. We live on a conscious level. Sometimes, what we experience can trigger old stored material from the unconscious to travel into our awareness. Psychodynamic therapy can help to explore what might be beneath anxiety. Together with your therapist, it aims to gently connect your past experiences and aspects of yourself with your current experiences. Outside of the therapy room, there are some exercises which might provide some symptomatic relief from anxiety. Many of these can be found online and I have also listed some tips below shared with me by colleagues. Your GP will also be able to provide advice. Tips to help reduce anxiety Focusing on this calming activity, which makes use of the touch and sight senses, can help to reduce anxiety in the moment or at least give you a break from symptoms: Face the palms of your hands together and touch each of your finger (+thumb!) tips together, touching just at the ends. Without letting any of your fingertips disconnect, begin to move your hands however they wish to move. You can bend and flex your fingers to allow movement. You can freely adjust and alternate the pressure that you apply, pushing firmly or lightly. It can help to release some anger or frustration to press the tips together firmly for a while. The idea is that you move your hands in anyway that you wish, while always keeping the finger and thumb tips connected. Watch and focus on your hands and fingers moving around in this freestyle way and continue for as long as needed. The following will help you to increase oxygen to your brain. Often, when we are feeling anxious, we take shorter and quicker breaths which doesn't assist in reducing the anxiety. The last thing that we feel able to do when anxious is to breathe deeply, but placing your hands over your eyes can encourage you to focus on your breath and to help you feel more protected: Close your eyes and place one hand over each closed eye. Take 5 slow and deep breaths. Then breathe normally for 5 breaths. With your eyes still closed, move your hands to your forehead and repeat the 5 slow breaths, followed by 5 normal breaths. With your eyes still closed, move your hands to your temples and while gently massaging your temples in small circular motions, repeat the 5 slow breaths, followed by 5 normal breaths. Take your hands away, gently open your eyes. The following can assist in helping you to become aware of the mind-body connection during periods when you are affected by anxiety. Focusing on these parts of your body and learning to relax the muscles can feel calming and help to shift your focus. This is not a full body scan, but more of a brief exercise homing in on certain areas that tend to tense up: Focus on your eyes and forehead and let go of the tension here. If it is challenging to do this, close your eyes tightly and then re-open and release the muscle tension. Draw your attention to your jaw and try to relax this area, including your mouth and cheeks. If it is difficult to do this, focus on tensing the area before releasing the tension. Relax your shoulders and extend this relaxation down your arms, hands and to your fingertips. Take 3 slow and deep breaths. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

When we find ourselves in a position where things just can't continue as they are, we might turn to therapy. The decision has been made and, after trawling through the numerous modalities and profiles, the therapist has been selected. You walk into the room for the first session and, committing to Britain's great knack of putting smalltalk to good use, fill the space with a well-meaning "how are you?" to the therapist. The therapist smiles, but says...nothing. What on earth is going on in this moment?! Why, in every other corner of the country you would expect to get a response, but in this supposedly safe space, you are met with nothing but a smile. This is a very different type of relationship to one that you might be used to. In most of our day-to-day relationships, there is a two-way traffic in communications. You would know details about each other enough to maintain this flow. However, in the therapeutic space, things are different because the space is one that is wholly dedicated to the client. The client needs to make use of the space as their own and by the therapist not responding to questions about him/herself, it is often the best way to encourage the client to do so. In psychodynamic therapy, it is additionally important for the client to know as little as possible about the me. The reason being that I am making myself as blank a canvas to the client as I can so that I can receive unconscious projections from my clients. I am seeking to be affected by these projections in such a way that it assists me to gain an understanding of how my clients relate to others and the world. Essentially, the less known about me, the more my clients are likely to project onto me. After the therapeutic relationship comes to an end, it can often feel strange to have shared so much with someone and then essentially, to walk away. You are then left with your own take on the experience, unaffected and unchangeable by anyone but yourself, unless of course you resumed sessions with that same therapist at a later date. But there is something to be gained from an independent reflection upon the process, without checking in or keeping the connection alive. It essentially becomes yours to take away. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

When communicating what's going on within ourselves, it can be hard to find the words. This is perfectly understandable because our internal experiences are so intangible. It is very common for clients in therapy to find themselves feeling quite muted, often saying that they can't find their words or that they don't know where to start. How can we find the verbal bridges to help connect the internal and the external worlds? Something that works well in my practice is to visualise what's going on inside and to make good use of metaphors and symbolism within the session. What does it look like? What does it feel like? We are used to communicating symbolically in everyday life - the glass might be half-full, we might at times feel in pieces, the grass might feel greener on the other side and we might even feel as though we are drowning in the workplace. Pushing down feelings could be visualised as pushing an inflatable down into a pool in that it can take a lot of energy and strives to pop up to the surface again. New possibilities can arise from allowing creative visualisation into the session. When feeling a struggle to communicate what's going on inside, it might be worth considering the following questions: Can I liken how I am feeling to something that is already known of and understood? (e.g. it feels as though I am on an island and everyone else is on the mainland or it feels as though I losing a battle ) If I could draw or picture how I feel, what would it look like? You can also use visualisation to communicate how you have experienced shifts in your life (e.g. It felt as though my life and all of its contents were slipping away like sand through a sift or it was such an abrupt change that it truly felt as though I tumbled off a cliff ) If we can succeed in being as understood as possible by the other, the therapeutic journey hopefully becomes a more fulfilling one. As a therapist, I am comfortable working with visualisation, symbolism and metaphors in the sessions if my client finds this useful. I can stay with these images, help to build upon them and use them in some of my communications in response. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

Whether it is a divorce and/or a child-related case, it is not uncommon today to find oneself in the UK family courts. Walking through this unfamiliar territory, on top of the wholly justified emotions involved in separation, divorce and children, those unwanted feelings of anger, fear and sadness are all very common. There is often little readily available to support the mental wellbeing of those going through this process. When it comes to the formal and rigid formalities of the courts and the stress surrounding the communications, there is not a great deal of space to be vulnerable, to be human and to truly express feelings. Holding it together just isn't going to be sustainable for many and for the duration that cases can go on for. With such pressure to "perform" in time-limited hearings, on top of managing the communications and preparing the paperwork, even with the best possible legal support, the road is going to feel bumpy. Narcissism in the Family Courts Going through the family courts and coming up against someone with strong traits of narcissism is not going to be an easy ride. These cases can be very shocking and specific in their nature, often leading to traumatic experiences. There is likely to be the additional pressure of engaging in a system which does not encourage, or at times even acknowledge, labelling the behaviour which is happening or using the terms to explain this behaviour. This stance can leave those going through such a painful process feeling confused, isolated and vulnerable. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .

It's a misconception that the reasons leading up to therapy and that attending therapy itself are linked in any way to weaknesses. When we were little ones, in whatever circumstances we were presented with, in many ways, we would have learned to "pull ourselves together". There are many ways that a child can do this. A child eventually becomes tired from acting out, not being seen or heard and not getting what we wanted or at times, needed and eventually the coping mechanisms were built. The coping mechanisms can be seen as a way of coping with the painful emotions (namely sadness, fear, anger and shame) that came up from our early experiences. Much of the time, the way that these coping mechanisms were constructed was based on a combination of what we experienced and saw from our care-givers (often parents) and the circumstances that we grew up in (often called the environment). But let's face it, little ones don't have adult minds and it is perfectly understandable that, whatever the coping mechanisms were in those early years, these are actually unlikely to be satisfactory, relevant or even wholly effective throughout life. The conundrum often comes when the cost of continuing to use these coping mechanisms outweighs the cost of not using them at all. We can feel check-mated, trapped and with a feeling that things just aren't working anymore. The coping mechanisms can end up redundant and we are faced with those same painful emotions that we were trying to avoid in the first place. It is not uncommon to be left feeling very vulnerable and out of control when this happens. This can be a point when someone turns to therapy. Society, especially with its "do now", "do quick" outlook and the pressures that are more prevalent than ever to "look well", is not helpful to the conundrum of the defences not working anymore. Often, we feel that it is a weakness to even admit to ourselves that we are not ok, let alone to others, whether that be friends, partners, families, employers or even therapists. It takes great strength to allow oneself to be vulnerable together with another. It takes great courage to walk on the path together through what is happening and what happened. In many cases, it would actually seem easier to scrape together the same coping mechanisms and push on alone rather than to sit with the pieces and work through it. In this respect, it can be viewed as very brave to make the choice to sort things out than to press on and turn a blind eye. Hannah Downing | Psychodynamic Psychotherapist To book a consultation, please click here .