Chronic Fatigue Syndrome (M.E.)

The day looked ordinary to everyone else and cost you far more than they could see. A short walk, a work call, a conversation that ran on too long, an appointment you pushed through. Then the delayed worsening arrives, sometimes hours later, sometimes the next day, and you are back to counting what you can cancel and what you now have to survive.

Chronic fatigue syndrome, also known as M.E., is a long-term physical condition. Its defining feature is post-exertional malaise: a disproportionate and often delayed worsening of symptoms after physical, cognitive or emotional effort, out of all proportion to the activity that triggered it. Alongside this sit unrefreshing sleep, difficulties with memory and concentration, and a profound fatigue that rest does not resolve. The exertion that provokes a crash can be very small, and the recovery can take days or longer. This is not deconditioning, and it is not ordinary tiredness that willpower can overcome.

For years, people with M.E. were offered graded exercise therapy and a version of CBT built on the idea that the illness was maintained by unhelpful beliefs and avoidance of activity. The 2021 NICE guideline ended that. The NICE guideline tells services not to offer graded exercise therapy to people with ME/CFS at all, and it is clear that cognitive behavioural therapy is not a cure: CBT is offered only if you want it, and only to help you manage your symptoms, improve how you function day to day, and ease the distress of living with a long term illness. That is the position I work from.

What support can and cannot do

Therapy does not treat the illness. What it can sometimes help with is the weight that living inside a much smaller energy envelope places on a person. The grief of work, study or friendships that have fallen away. The guilt that arrives every time you have to stop. The strain of not being believed, and of having to explain yourself to people who cannot see anything wrong. Low mood and anxiety often sit alongside M.E. without being its cause, and they can be worked with in their own right.

Pacing is central, and it belongs to you. It is a way of respecting the energy you have and staying within it, not a graduated push to do more. You are the person who already knows the difference between a manageable day and the effort that will cost you three. My work starts from those limits, not from a plan to test them.

How I work with this

Much of my grounding, as a Consultant Cognitive Behavioural Psychotherapist, came from an NHS specialist unit where I worked alongside people with M.E., during the years when graded exercise therapy was still standard, and I saw what pushing a body past its limits did to them. I do not need you to prove your fatigue is real, and I will not press you towards more activity. What I bring here is having watched the old approach fail the people it was meant to help.

I was acknowledged among the therapists involved in the clinical work behind a 2011 peer-reviewed paper on acceptance in chronic fatigue syndrome, and that experience still shapes how I work: less argument with the body, more careful attention to limits, loss, choice and safety.

Psychotherapy is not a substitute for medical assessment or treatment. I do not diagnose and I do not prescribe. Sessions are fifty minutes, online, and usually weekly to begin with. I work with adults and adolescents across the UK.

In sessions the work tends to be practical and personal. We might look at how you decide what is worth spending energy on when there is so little to spend, how you manage the guilt of stopping, how you talk to family, an employer or an education provider, and how you carry the emotional impact of a condition that takes so much from daily life. Where earlier medical or therapy experiences left you feeling blamed, we can work with that too.