The words we do not have

Specialist CBT therapy for anxiety, OCD, depression and more in West London

Sometimes a person knows that something is wrong before they have language for it. They may describe a fog, exhaustion, tearfulness, irritability, physical discomfort, poor concentration or a sense that the colour has gone out of daily life. These experiences are real, but a blog cannot decide that they mean depression, anxiety or any other diagnosis. Physical symptoms also deserve care in their own right. New, severe, changing or worrying pain, headaches, chest symptoms, breathlessness, weakness, appetite changes or medication effects should be discussed with an appropriate medical professional. They should not automatically be explained as stress, low mood or anxiety. Words can be difficult when someone has learned to minimise distress, when feelings feel unfamiliar, when a culture or family has different ways of speaking about suffering, or when daily responsibilities leave little room to reflect. Assessment can make space for what is noticed, what has changed, what support is available and what feels safe to say. It does not require a person to arrive with the right label. CBT may be considered after assessment where appropriate. It is not a self directed instruction to reinterpret symptoms, dismiss a medical concern or force someone to talk before they are ready. If behavioural work is clinically appropriate, it is planned collaboratively with a qualified clinician, consent, personal context and attention to medical advice. The aim can be to develop a clearer picture of thoughts, emotions, sensations, behaviour and circumstances without reducing a person to any one of them. Progress may include finding a more precise way to describe an experience, asking for help or recognising when another form of support is needed. There is no required vocabulary for deserving care. It may help to bring a few examples to an assessment: a recent difficult moment, a change in sleep or appetite, what happens at work or home, and what support has already been tried. This is not a test of insight. It simply gives the conversation somewhere concrete to begin, at a pace that feels manageable. Silence is also valid information, as are pauses and uncertainty too. If distress includes crisis, thoughts of self harm or an inability to keep safe, urgent appropriate help is needed. For related information, see <a href="/therapy/depression/">CBT support for low mood and depression</a>, <a href="/therapy/anxiety/">CBT support for anxiety</a> and <a href="/guides/anxiety and depression guide/">the anxiety and depression guide</a>. The Lyceum Clinic offers assessment led CBT online and in West London.