Quite often, people do not decide to start therapy because they have clearly identified an emotional problem. They come because something has become difficult to manage in their everyday life. They are no longer sleeping properly, they wake very early and cannot get back to sleep, they feel a pressure in the chest or a persistent unease in the stomach, they are exhausted but unable to slow down, or they notice that a physical symptom is taking up more and more space in their attention.
Usually, this does not happen overnight. People have often been coping for quite some time, continuing to work, maintain relationships, make decisions and carry responsibilities while telling themselves that things will settle down, that they are just going through a stressful period, or that they simply need to rest. At some point, though, the strategies that have allowed them to keep going are no longer enough. The symptom begins to interfere with sleep, concentration, work, relationships, or simply with the possibility of feeling reasonably at ease during an ordinary day. This is often when they ask for help.
When physical symptoms appear alongside anxiety, grief, uncertainty or prolonged stress, it is important not to jump too quickly to an explanation. A new, persistent or worrying symptom deserves appropriate medical attention, and therapy is not a substitute for medical assessment. At the same time, the fact that emotional distress may be involved does not make the physical experience less real. Our nervous system participates in how we respond to threat, uncertainty, loss, pressure and connection, and these responses can affect sleep, digestion, breathing, heart rate, muscle tension, concentration and the way we experience pain.
For this reason, the distinction between “physical” and “emotional” is not always as useful as it seems. A more interesting question may be: what is happening in this person, in their life and in their body, at this moment?
The distinction between “physical” and “emotional” is not always as useful as it seems.
Sometimes the body makes a difficulty harder to ignore. A person may believe they are coping reasonably well with a period of uncertainty while at the same time beginning to wake at five in the morning. Someone else may speak quite calmly about problems in a relationship or at work while describing a persistent sense of dread in the stomach. Another person may be working very long hours, sleeping too little, forgetting to eat properly and gradually abandoning the activities that usually help them feel well. They may still consider themselves functional, until exhaustion itself becomes impossible to dismiss.
There are also moments when attention becomes caught by the body. A sensation appears and, understandably, the person becomes concerned about it. They start monitoring it, wondering whether it is worse, checking whether it is still there and imagining what it might mean. Anxiety then brings more physical activation, and a loop can develop in which the original symptom is real but is now accompanied by fear, vigilance and repeated checking. Therapy in this situation is not about telling somebody that nothing is wrong, but about becoming curious about what happens around the symptom: where the mind goes, what is feared, what reassurance is sought, and what else is happening in the person’s life when the symptom becomes more intense.
Some people are also extremely good at functioning while distressed. They work, take care of others, solve problems, remain positive and continue to be useful. This may be something they have learnt over many years: not to ask for too much, not to create problems, to adapt, to manage alone, or to deal with difficulty by thinking harder, analysing more and trying to find the correct solution. These strategies may have been useful for a long time. The difficulty comes when they stop being enough.
In therapy, paying attention to the body does not mean analysing every sensation or assuming that every physical symptom contains some hidden psychological message. Sometimes it is much simpler. We may notice that someone’s breathing changes when they talk about a particular relationship, or that their body becomes tense while they say that something is “not such a big deal”. We may pause and discover that beneath a great deal of thinking there is fear, sadness, anger or loneliness.
This kind of attention needs to be gentle. For some people, especially after trauma or prolonged stress, focusing too intensely on bodily sensations can feel overwhelming, and for someone who is already monitoring a symptom closely, even more attention may not be helpful. The point is not to force awareness, but to widen it.
When a symptom has started interfering with daily life, the first question is understandably often: how can I make this stop? People want to sleep again, to stop checking, to feel less anxious, to concentrate, work and enjoy their relationships without constantly managing themselves.
Therapy may eventually introduce another question alongside that one: what has made life so difficult to manage at this particular moment?
Perhaps there has been a loss, a relationship has become uncertain, work has become overwhelming, or someone is far from family and from the people with whom they normally feel grounded. Perhaps they are trying to build a life in another country while navigating work, language, belonging, relationships and uncertainty at the same time. Or perhaps they have simply been holding things together for a very long time.
The aim is not to construct a neat psychological explanation for every physical experience. Sometimes the symptom that brings a person into therapy simply opens a wider conversation about how they are living, what they are carrying, how they have learnt to cope, and what has become too much.
And that is often where the work begins.
– Vignettes in these essays are composites, with details changed to protect confidentiality.