Therapeutic First Aid: Step 1

When treating an emotionally aroused client, the first thing you need to do is calm them

“There is no hospitality like understanding.”

— Vanna Bonta, writer and actor

To me, being a therapist, counsellor or coach is akin to being a good host. Now bear with me on this one!

If our guest is parched, we give them a drink. If they’re aching with hunger, we offer them food.

This is a basic duty of hostship. And the same principle applies to the client suffering stress (and how many aren’t?).

Don’t get me wrong, calm empathic listening can help turn back the swelling tide of cortisol. But sometimes clients need immediate help. Their level of stress has become nothing short of an emergency. And until you apply first aid, other diagnostics and treatments have to wait.

Just as it’s useless (and cruel!) to try to get someone who is dying of thirst to think about their long-term finances, you won’t get anywhere by attempting to help a stressed person until you cater for their need for calm.

But why do our clients suffer stress in the first place?

People become stressed when they don’t meet their needs, or fear their needs will stop being met. (What if she leaves me? What if I lose my job?)

Emotional stress is a signal that needs are not being met adequately, just as thirst is a physical stress signal that the body is dehydrated. Knowing how to deeply relax your stressed clients – offering ‘psychological first aid’ – is a prerequisite skill to make any other therapy or coaching even possible.

Thirst things first

Using talk therapy or getting all analytical when someone is crippled by stress is like giving salted food to a terribly dehydrated guest. Quench their urgent thirst first, then work out how you can help them in the long term.

Stress is the one thing almost all psychological conditions have in common.

Depressed people always have more of the stress hormone cortisol in their bloodstreams ⁽¹⁾. Addicted people are stressed because they aren’t meeting their needs, and they try to ameliorate that stress through the escapism of addiction ⁽²⁾. People develop panic attacks when they’re generally stressed. Emotional problems are caused by stress, but in turn cause more stress.

So, to me, it seems almost unthinkable for any therapist not to be exquisitely skilled in the art and science of relaxation. And this is why I say all people helpers should be able to heal through calm – and why I have always trained therapists to do this.

Here are three reasons why it’s not just ethical but essential to know how to relax your clients deeply.

1. You can’t help your client until they’re relaxed and ready

Simone looked brittle, as if she could crack at any moment. Her facial muscles were stiff as a board, and the haggard creases across her face betrayed habitual tenseness. As she sat before me she breathed heavily, as though she were walking briskly – and yet she seemed frozen in place. I could see she needed help.

But crucially, as I tried to engage her in conversation I found that she didn’t seem to be able to think. I’d ask her a question but her mind would slip and slide off focus. She did tell me one thing though.

When I asked her what she wanted, she looked up, and just for a second I held her focus. Deep lines carved their way from the corners of her mouth up to her restless eyes as she croaked, “Not to feel like I’m dying inside!”

She told me she “never relaxed”. But relaxation was just the antidote she needed! Natural, mind-clarifying relaxation, that is – not the inebriating drug-induced inertia she was used to.

We know that depressed brains are stressed brains. Simone was depressed because her needs weren’t met. But the double bind was that in order to help meet her needs, she needed to become less stressed.

Long-term stress inhibits the function of the left prefrontal lobe, which generates feelings of enjoyment and satisfaction ⁽³⁾ and facilitates calm cognition ⁽⁴⁾. To put it simply, stress inhibits cognitive function. We can’t think or learn when we’re highly stressed.

Without wanting to thrash the analogy too hard, you can’t teach someone calculus whilst they are crying out for water! And good luck trying to do cognitive therapy with someone whose thinking brain is disabled by anxiety.

I gave Simone what she needed in that first session, which was deep rest and relaxation. She was like a different person: clear, calm and hopeful. I didn’t just tell her she could feel different. I showed her. She now had some space in her mind to really think about what else she wanted from therapy.

Continual stress and failure to relax makes people feel hopeless, disassociated from their personal resources, and therefore helpless. And from there, it’s not long before they reach crisis point.

Of course, we can’t disentangle body from mind – it’s a false dichotomy. Helping your clients relax will also greatly help their physical wellbeing.

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2. You can’t help the body without helping the mind

A counsellor or coach should be able to improve the physical health of their clients by quickly improving their emotional health.

High levels of stress are correlated with increased risk of obesity and diabetes ⁽⁵⁾, and can damage immunity ⁽⁶⁾ and working memory ⁽⁷⁾. Prolonged stress (ongoing activation of the sympathetic nervous system or ‘fight or flight’ response) also increases inflammation in the body ⁽⁸⁾, which can adversely affect digestion ⁽⁹⁾.

Stress-induced inflammation is also implicated in the onset of some cancers ⁽¹⁰⁾, heart disease ⁽¹¹⁾, and the physical manifestations of depression ⁽¹²⁾. This is hardly surprising, as depression is essentially a sense of nervous exhaustion from the stress of unresolved worry and rumination ⁽¹³⁾.

On the other hand, good immune function, clear thought, and feelings of wellbeing can all be promoted through an amazing mechanism that is closely tied to the relaxation response. Let me explain.

What happens in vagus…

As a therapist or coach, your job is to help people feel better, to give them the calm and confidence to pursue their goals. When the mind is troubled, the body is troubled – and vice versa. Fortunately for us, there’s something we can use to dramatically improve mental and physical health and reduce inflammation throughout the entire body. It’s called the vagus nerve.

The vagus nerve is a meandering bundle of nerve fibres that passes from the brainstem, through the neck and thorax, and finally to the abdomen, where it supplies the gut. This is the widest nerve distribution of any nerve in the body.

The function of the vagus nerve is closely tied to your health, both mental and physical. It interfaces with your parasympathetic nervous system (relaxation response) and controls the healthy functioning of the heart, digestive tract and lungs.

Low ‘vagal tone’ has been linked to higher levels of inflammation in the brain and body ⁽¹⁴⁾. Conversely, when the vagus nerve is stimulated and strengthened, inflammation is lowered throughout the entire body.

Social connections ⁽¹⁵⁾ and healthy diet ⁽¹⁶⁾ both stimulate the vagus nerve, but perhaps the most important and practical way of stimulating the vagus nerve is by practising deep relaxation. In fact, just the simple act of breathing slowly in and out (the exhalation needs to be a little longer) activates the vagus nerve ⁽¹⁷⁾.

Relaxation helps our clients feel healthier, not ‘just’ physically but mentally too. Relaxing distressed clients is not just dealing with the symptom – it’s also helping alleviate the cause. When people improve their vagal tone they become more able to make emotional, cognitive and behavioural changes.

But as well as all the benefits of relaxation in and of itself, the relaxed state offers a perfect medium for psychological change. It’s during relaxation that we can best help our clients by treating the cause of long-term distress – and here’s how.

3. Relaxation primes your client for inner work

I recall a client coming to see me who used to have Jungian analysis. He recounted how the ‘therapy’ would make him feel so stressed (with all the health implications that entailed) because the practitioner would ask him to emote in the sessions – to focus on all that was and had ever been bad in his life.

He would schedule the sessions on Fridays because he’d tried other days but found he had to take up to three days off work to recover from the ‘therapy’!

This is crazy. Our clients should feel better after every session.

Simone found that, after months of building stress, the simple act of relaxing was incredibly therapeutic in itself. But we needed to deal with the reasons for the stress to prevent it happening in future.

All coaching and counselling uses inner work. What I mean by that is that even if you just ask a client what they want or ask them to think about the past, you are inviting them to go inward, to forget the room for a little while and enter a kind of light trance.

As a therapist, counsellor or coach, you are using a kind of trance focus whether you know it or not. Relaxed trance (and note that not all trance is relaxing) is the gentle medium through which change work can be done more powerfully and quickly. The relaxation part of your session is also the perfect time for the client to psychologically process earlier work.

People make intuitive leaps when they are relaxed and the unconscious mind has a chance to form new possibilities and solutions. Sometimes a reframe won’t take when a person is too stressed, but can be offered and digested in the mind during a state of deep calm and rest. It’s during deep relaxation that we can encourage real insight by having the client calmly use their ‘Observing Self‘.

You can help your client inwardly rehearse new positive behaviours by talking to them gently while they are deeply calm, resting with their eyes closed. This kind of rehearsal makes it more likely your clients will actually carry out the behaviours required to help them toward their goals. But there’s more.

Relaxation is also the medium through which severe PTSD and phobias are lifted. The brain works through association but sometimes, as with phobias, addictions or low self-esteem, those associations can be harmful. We can use relaxed trance states as a way to unhook damaging pattern matches.

To put it another way, relaxation isn’t just the part of the medicine that makes it ‘taste good’. This natural and wonderful mind/body medicine also packs a real ‘nutritional’ punch!

Simone learned to relax herself once I’d helped her do it a few times. We used deeply relaxed hypnosis to not only help her vagus nerve adjust to a new, more generally relaxed Simone, but also to de-traumatize an old memory so that her flashbacks stopped and her nightmares faded away fast.

It was during deep relaxation that I helped her rehearse new, healthier behaviours to help her meet her needs better in future. What she said as she was leaving the last session was priceless:

“I never knew therapy could be so enjoyable – even fun!”

This is why I strongly feel every counsellor, coach and therapist needs to know how to deeply, easily and conversationally relax their clients.

Never let a client leave a session thirsty!

Learn how to relax clients deeply and use relaxation to promote inner work during your sessions with our online Uncommon Hypnotherapy course.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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