Emotional First Aid
Most good 'therapist' skills are just good relational skills. Any idiot can apply a Band-Aid or an ice pack, and any idiot can also learn to respond to human suffering without freaking out.
Last week, I wrote about this increasingly common phenomenon:
Ever opened up about something you’re struggling with, or disclosed something awful that happened to you, and triggered the following automated response?
“You should really talk to a therapist about this.”
Uh-oh! You’ve hit an emotional support paywall.
Here’s the TL;DR version:
Therapy is becoming more popular as emotional support and care are becoming more scarce, and these two things feed into one another.
If grief is an issue only ‘for the professionals’, then we’re going to increasingly come up against “I’mma stop you there” when you need a shoulder to cry on, when you need someone to see you in your moment of greatest human frailty.
People get anxious and uncertain around emotions. People get resentful and snotty about being expected to perform emotional labour for you. The few people who are prepared to be human with humans get increasingly sought out and burnt out, because we are collectively starving and scratching in the dust, drinking the last few puddles dry.
Basically, if there’s something people badly want and that thing is only really accessible through expensive and unwieldy ‘official channels’, two reasonably predictable outcomes occur:
Black markets, snake-oil grifting, and poor quality knock-offs emerge to take advantage of peaking demand and diminished access. We can see this in the rise of people using large language models for emotional support and validation, the proliferation of social media support groups and subreddits, and the popularity of pseudospiritual thought leaders Nathalie Martinek PhD helpfully labels “gurupreneurs”.1
Everyday people re-learn how to create the thing for themselves and share that knowledge with others, creating a certain level of self-sufficiency at a layperson level. Once alcohol becomes punitively expensive, people start brewing in their garages. In remote areas without basic healthcare, people learn how to disinfect and stitch wounds, splint broken bones, help with home births.
If people need something that’s paywalled2, they find a way to get it — and human support, connection and love are not nice-to-haves. To exist without them too long is incompatible with life.
I don’t care how much of an introvert you are or how much you share ew, people memes. Don’t look at me like that, I don’t like it any more than you do. It’d be great (in a way) to be able to order everything that makes a girl feel genuinely fulfilled on an existential level from Amazon, but that’s not how it works. Biology doesn’t care how much people have proven disappointing to you. You’re a social creature, it’s woven into your very you-ness, and you can’t slice that need out and throw it away.
At least a little, at least some of the time, we need meaningful contact with other minds to bear the emotional weight of our own existence, especially when we’re in pain.
Beating the Emotional Support Paywall
If we’re serious about collectively improving the situation, we have some control over choosing Option 2 and getting better at being with one another.
I’m hopeful about this because (terminal optimist that I am) I tend to think the Emotional Support Paywall’s prevalence has more to do with people lacking skill than anything else. There is no elite therapist cabal scheming in a mahogany-panelled office somewhere that smells of whiskey and books, brainstorming world domination. If you doubt this, look at just about any psychotherapist’s website and marvel at the 2001-ness of it. We are not organisers, and in my experience therapists that do seek power for unclean reasons tend to think petty and personal.3
No, we got here because somehow we still tend to trust ‘the system’ more than one another, and because people want to do the right thing when someone comes to them with their suffering.
I heard “you need to to talk to a therapist about this” plenty in my young life when I really just needed somewhere to put the corpse-sized weight I was dragging round everywhere down for a couple of minutes. But in hindsight, nobody said it to get me to shut up and go away (or at least, not entirely). They did it because they were freaking out, had no idea how to respond to me, and wanted me to be OK.
Many ‘therapist skills’ aren’t actually therapist skills but good relational skills. Things anyone can get better at. Things everyone should know, for the overall safety and wellbeing of everyone.
Think of it like learning emotional first aid.
Emotional Triage
So, someone you care about comes to you and they’re suffering from their mind and/or circumstances (or most likely, a combination of the two). Now what?
To be clear, there absolutely are situations where people not only should but must be directed towards professional support. One hard line should be when someone is thinking of suicide. The more planned-out an attempt is, the greater the danger (think in terms or plan and intent, if there is a notable amount of either this person needs assessment and treatment). Do not worry that you’re going to put the idea in their heads, do not concern yourself with softening your language or using euphemisms, say kindly but clearly: I have to ask, because it’s important: have you been thinking of ending your life?
If the answer is yes, this person needs crisis services.4 That doesn’t mean you treat them like an unexploded mine, nor that you need to put on an emotionless HAL-9000 poker-face (please don’t). They’re still the same person they were to you five minutes ago, and your ability to relate to them like a normal human means everything in these situations. Imagine they’ve sliced their foot open and need you to drive them to the hospital, then channel however you’d act in that scenario.
Now, assuming the suffering in question is painful but not currently life-threatening, what can you do to be supportive instead of invoking the Emotional Support Paywall?
Below, I’ve written up some general rules that I offer to people in my practice and personal life, and I also threw the question out to the brilliant community of therapists and therapy-adjacent people on Substack.
Many minds produce the best collections of ideas, especially on issues this important, and although this is a long piece I highly recommend you read them all.
Yes, I can appreciate the irony. But still.
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I am deeply grateful for the generosity and goodwill of my subscribers, whose support allows me to continue writing and expand my focus into important areas of psychotherapeutic work for which I do not receive funding. Since I gave up my public system work for ethical (and sanity) reasons, Substack has become an increasingly important part of my income.
Three simple rules
There are only three rules you really need for good relating when you want to support a suffering person:
Show up.
Don’t lie.
Don’t punish.
This sounds easy. It isn’t.
Showing up means you can’t phone it in. You need to offer your full presence and attention. The good news is, it’s possible to do this without actually saying much of anything at all. Honestly, like the first three months of therapy school is just learning to get out of your own way (admittedly I may have taken longer than average because I am not constitutionally disposed towards shutting up).
Being with a person in pain is very simple. It’s just that it’s also really hard to do, because most of what you will feel drawn to say and do will be aimed at getting them to stop emoting so you can feel more comfortable. Supportive noises are good. Reflecting back what you’re hearing will do just fine. I’m serious.
“Explain it like I’m five” version:
Don’t lie also means no empty platitudes. It means no promising things you can’t really deliver just because you feel compassionate (and helpless) in the moment. Trust and honesty are vital, the subtext of this entire conversation is I need to know someone else is actually there, that I’m real, that this matters.
“I don’t quite know what to say, but I wish I did because I care about you. Please keep talking” works fine. It’s not about words, it’s about presence. Do not delude yourself into attempting an eloquent, overweening speech full of fancy bullshit that’s really about you getting to feel like a Smart and Helpful Person.
Don’t punish means you don’t get pissed off, witholding, cold or mean in any way if the other person doesn’t respond how you’d like them to. Yes, it’s nice to feel helpful. You’re allowed to have feelings about it if your care and attention isn’t accepted in the way you’d like, but you’re not allowed to take it personally and spit it back at the other person. Also, letting someone just be angry/despairing/sad without trying to change it is its own sort of kindness (as per the Inside Out video).5 More on that soon.
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Over to the Therapists (and Therapy-Adjacents) of Substack:
“Therapists of Substack: What are some ‘therapist skills’ anyone can (and probably should) learn?”
The always-excellent Sorbie: I think that cultivating a sense of spaciousness is key to emotional depth/presence in relationships. This entails an ability to notice what’s going on in yourself and keep it separate from what is going on in front of you, and THEN choose what to do with it. I don’t just mean “don’t react in anger” and “don’t take things personally when they aren’t”, though I do mean that. You have to the slow the fuck down before you can even discern that you are about to react in anger.
This is, of course, a sophisticated skill that takes a lot of practice. If you are looking to give people more 101 level stuff (as I guess the plaster metaphor implies), maybe a good place to start is practicing being in physical proximity to people when they are hurting. Like literally go to someone’s house or invite them to yours. It matters less what you say and do for the most part (though I guess I would advise, based on my experience of both receiving and giving care under these circumstances to varying degrees of resonance, that less is often more).
When you are trying to be there for someone, don’t be scared of breaking people by doing the wrong thing. People are tough. It’s condescending to assume weakness, and it’s grandiose to assume you have power to break someone in one interaction.
Lastly, having a sense of humor is good. I will never forget the time that I somehow disclosed to someone whom I didn’t know super well that I was in a really dark place. He told me that he would prank me out of suicide, that he would replace all the ropes in my house with silly string, all the knives with prop knives, and if I were to have a gun, he would replace the bullets with prank snakes. that was many years ago and he is my best friend now. I’m not necessarily suggesting anyone try precisely this, but I think what was so effective about it was that it conveyed that he was not afraid of me or my darkness. I was just some girl he kind of knew, and it was, I think, the best intervention i’ve ever experienced.
Trysa Shulman: To not fall into a polarization trap. When someone (especially someone you care about) makes an extreme statement or takes an extreme action (or inaction), they are often recruiting the people closest to them to play out the other side of an inner conflict. If you fall into that trap, the extremes often entrench. Instead, recognize that we go to extremes when we feel the need to. But greater emotional maturity and capacity come from owning both sides of an internal conflict. Two (or more) opposing feelings, thoughts, truths can exist at the same time.
J. Daniel Sawyer: Two big ones: (1) Learn nonverbals. Being able to read them well is a superpower. (2) Understand before having an opinion. Most people miss most of the insight they might gain (in every domain) because they rush to judgment. It is more useful to understand than it is to render judgement.
Adam Fisher: Basic reflection to make sure you understand and the other person feels heard.
John Williams PhD: Learning how to listen really well. The old foreign policy adage never persuade before you understand kind of thing. To resist the urge to reply to what they are saying until you both agree that you understand it. I train people in this all the time and it’s actually a lot harder than it looks.
Pestle: Speaking as a former patient the habit of maintaining the stiff upper lip in this scenario is routine, but is not appreciated, and feels humiliating. Just be human, supplicate them. Ugly crying to a wall really drives home that this is a transaction, and you’re revealing your self to a professional. Hierarchy naturally assumes itself.
Grainger: I remember learning that immediacy was a core counselling skill. It didn’t seem so to me. Reading body language tells us as much of the story as the words they’re saying. In fact, research says 7% of our communication are the words we use. The other 93% is everything else. We simply have to care more about what they’re saying than we care about we are going to say next. Everyone should be doing that.
GasDocLawDropout: This from Kryptogal (Kate, if you like). I can’t restack the quote because she puts some of her best stuff in notes. I also want to raise my glass to the therapist who helped me find my way from group one into group two of the following quote:
“To my view, we should be taxing the hell out of the guys/gals who feel no pleasure in life other than the temporary lifting of displeasure they feel when they set a new high score on Strava or get the highest productivity report. And funneling it straight to the guy who hosts a big backyard BBQ every week that everyone leaves with full belly and sleepy from laughing so hard. The non-enjoyers just want points and gold stars anyway, so they can be compensated with some type of public recognition points.
If you have a friend who’s really funny or great in bed but presents insufficient ROI in your view, send em my way, bc I know plenty of people who will enjoy the hell out of them and require no further ROI than the pleasure of their company.”
Having a big guy gathering this week and anyone who leaves hungry or not laughed to exhaustion did it of their own free will and choice. The brisket will be amazing.
Some final thoughts from me:
Make sure the person you’re trying to support doesn’t end up having to look after you. This sounds obvious, but in reality it’s vanishingly rare to talk about something fucked up that you’ve experienced and not have to backtrack or paste on a smile and lie about how you’re OK Though, Actually. People stutter and clear their throats, look at the floor, mumble awkwardly and chatter nervously in ways that make you feel like you’ve just vomited on them and need to apologise. It makes you feel even worse than if you’d just kept it to yourself, and in time you learn to.
These tend to be the things that calcify and fester internally, and ultimately end up needing professional intervention to treat.
In a way, vomiting isn’t the worst analogy when considering how to respond to someone talking about upsetting material. You’re caring for someone who’s ghastly sick and they need to get it out, so try to channel a sort of kind, nonplussed unflappability when they do (even if your first instinct is to recoil).
Own what’s yours. Simple, but important: if you want to be helpful, especially over the mid to longer term, don’t treat your emotional responses as something the other person is ‘doing’ to you. Label ‘they’re too much for me’ as ‘I’m feeling overwhelmed’. Label ‘they’re being really annoying’ as ‘I’m feeling irritable’. This prevents everything collapsing into a doer-and-done-to dynamic, where relating starts to feel like a zero-sum game.
Boundaries, ‘put your own oxygen mask on first’, ‘pour from the saucer not the cup’, etc etc. The Internet does not need more words about this, but if I don’t write them I’ll inevitably get comments telling me I’m setting people up for burnout. Only offer support if you have sufficient emotional bandwidth, otherwise the outcome tends to be worse for both of you than if you hadn’t tried at all.
Let people have their feelings. This is especially relevant if the feeling in question is anger. Most of our media depictions of depression, grief, relationship breakdown etc involve a sort of quiet, morose sadness. Lots of low mood, crying, longing, staying in bed, etc. Often it’s like this. Just as often it’s not — and when it’s not, people tend to get uncomfortable and resort to trying to get the other party to display the ‘correct’ emotion (at an acceptable intensity).
It helps to remember that they would very much like to not be feeling what they’re feeling, they’re not doing it to deliberately perturb you. And that sometimes, simply bearing the presence of such feelings helps far more than you could imagine.
When someone else can survive us, perhaps it’s possible to believe we can survive ourselves.
If you enjoyed reading this, please support my work by taking out a premium subscription.
I am deeply grateful for the generosity and goodwill of my subscribers, whose support allows me to continue writing and expand my focus into important areas of psychotherapeutic work for which I do not receive funding. Since I gave up my public system work for ethical (and sanity) reasons, Substack has become an increasingly important part of my income.
UPDATE: I’m writing a book on therapy culture! If you’re a publishing-type person and interested in getting in on the action please email me skyesclera@gmail.com and I’ll tell you all about it.
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Recovered Memories: The Floater in Your Eye
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This post was written and edited without the use of AI.
Yes, I know psychotherapy is far from perfect emotional care and at its worst can encapsulate all sorts of harm. I write about this sometimes and there are plenty of other people on Substack who make complaining about it their entire personality. However, I am not one of them. Please assume a best-case scenario for today’s purposes and let me cook.
There’s a whole other argument about how much therapy is, or should be, about the kind of ‘emotional support’ you can get from your friends or mom or hairdresser, but let’s agree to accept that a not-small number of people currently seek therapy for emotional support because they can’t find it in the world (and the longer this goes on, the more unwell people get).
I keep meaning to write about this at some stage, but also wonder if it’s irresponsible to talk about how even in helping professions those that rise to the top are very often those that probably shouldn’t be there.
In addition to this person needing crisis services, it’s important for YOUR wellbeing that you are not the only person holding knowledge of a potential suicide. Ideally there will be a whole network of people both personal and professional, a wide safety net. But as a minimum more than one person must know and at least one of them must be in a position to offer clinical support.
Yes, I am aware that Bingbong is arguably even more annoying than Jar Jar Binks as a character, but the scene is still a good (and very literal) example of the utility of sadness and the offensiveness of toxic positivity (especially the kind that is really about one’s own agenda).
Excellent post, as usual. I just had occasion to be the support guy for an 18-year-old student who seemed merely like a guy with an attitude problem, but a hallway convo with him revealed a whole world of hurt and a surprising vulnerability. Mr. defiant too-cool-for-school had tears in his eyes. Life was much more complicated for him than I would ever have guessed.
I love your writing. It really helps me understand people in my world.
And hey, just found this posted in a random comment thread about nothing in particular, no idea who generated it, thought you might like it. I have memorized it. It actually reads like something you would write:
"I regret to inform you that personal growth rarely comes from acquiring new knowledge and almost always from:
- getting humiliated
- showing up terrified and doing it anyway
- admitting you might be the problem"
I am not a therapist, but my own (autistic) experience of what my favorite therapists do: ask clarifying questions. I love to be asked clarifying questions, even when I’m really, really upset. I feel like the person who is listening to me really wants to understand, and it helps me sort through what I’m feeling and understand it better myself.