How to Maintain and Regain Composure in Session

So your life outside of work has hit a rough patch. Maybe even a spike-filled moat of a rough patch. Usually, you are present in your work. Focused on the client and productive with the between-session preparation, correspondence with clients and colleagues, and notes. But not today. Today, your personal life is on fire and it’s burning through your professional veneer. What’s a therapist to do?

As the saying goes, “The best time to plant a tree was 20 years ago. The second best time is now.” In therapy speak, that means prevention and intervention.

Prevention

Rewind back to before the rough patch hit. This is where management of everyday stress and self-care should be operating at maintenance levels. You deserve to feel calm, relaxed, fulfilled, and sustained regardless of the level of crisis going on at the time. Was it an easy week? Go for that walk still, because you don’t need to earn good things by suffering.

Prevention and maintenance before the crisis hits really comes down to honoring your inherent value as a person. There is no special trick you need to perform, no number of billable hours you need to hit, no personal or professional achievement you need to unlock before you qualify for general stress management and self-care. You’re you and that’s enough reason to do the things it takes to keep you cared for and running well. Make your self-love unconditional. Don’t be a fair-weather friend to yourself. Be there for yourself when times are good and bad alike. If deep-down you don’t really believe you have inherent value or are deserving of unconditional self-love and the treatment of yourself that follows from that belief, therapy for yourself should probably be a part of your prevention strategy.

So what are some ideas for preventive stress management and self-care? Here’s a non-exhaustive list:

• Sleep well regularly
• Eat and drink water enough to sustain your health
• Move your body
• Maintain connections to your loved ones and community
• Engage in enjoyable activities and hobbies
• Get outside
• Keep your home and desk at work organized enough that it is not an additional source of stress
• Do whatever your self-care is. Whatever gets you to a better mental and emotional state is what your self-care is. Do you feel better when you leave work before 9pm? That’s your self-care. Do you feel better when your laundry is put away? Putting away laundry is your self-care.
• Practice mindfulness

Great, but what about the moments when the stress breaks through despite my prevention efforts? Then it’s time to intervene in the moment.

Intervention

So your best prevention efforts are not cutting it today. You’re staring vacantly at your screen while no notes are being typed. You’re vibrating with stress and anxiety in sessions and meetings. And your next client arrives in 15 minutes. What can you do now to show up as your best professional self?

Between Sessions or Meetings:

• Take 2-15 minutes to do deep breathing, meditation, or a relaxation exercise. It may only take several minutes to take the edge off! 
• Move your body: get out of your head and into your body. Transition into the next session or meeting before your thoughts and bodily sensations can return to your personal crisis.
• Ground yourself.
• Practice opposite emotions: Feeling sad or somber? Watch a clip of your favorite stand up comedy and laugh for a bit. Feeling vulnerable and insecure? Do something you know you’re good at. Make yourself your favorite snack or lunch. Send that dumb meme you know will make your friend cackle. Do something that makes you feel like you’re the authority on something. Send your child client’s parents a few tips for this week and remind yourself that you’re the expert on this. 
• Drop Anchor – This is the ACT method of resetting yourself and defusing from painful thoughts by (in a nutshell) wherein you acknowledge your thoughts, feelings (emotional and/or physical), come back into your body, and engage in what you’re doing (i.e., the ‘ACE’ acronym.)

During Sessions or Meetings

• Immerse yourself in your client’s challenges or your colleague’s supervision dilemmas instead of your own.
• Breathe deeply and slowly.
• Press your feet into the floor, your hands or arms into the arms of your chair, and keep a quiet reminder of where you are in the present. 
• Move your body subtly: change your posture, walk over to the window to adjust the blinds, grab something off the desk. When you feel the distress breaking through, make a subtle move to disrupt the process.
• Come back to the room as often as needed. We all drift off sometimes. You can always come back again.

But what if your client’s problems are triggering your own? What if your stress is still very close to the surface?

• If your client is also experiencing high stress, maybe you both could use a relaxation, meditation, or grounding exercise right now.
• If your client is experiencing similar stress or challenges, use sense memory and emotional recall (acting techniques) to enhance your insight and empathy in session. Sense memory involves recreating the sensory experience of a feeling (e.g., what you see, hear, smell, taste, and touch/feel during a particular emotion.) Emotional recall involves thinking back to a time you felt that emotion and using the sensory and emotional content of that memory to inform your sense memory. Rather than recreate your own emotional experience, you would use your emotional recall to recreate what you think your client felt like in the experiences s/he is discussing. 

Case Example

I personally used sense memory and emotional recall with a client. It was my first day back at work following a medical emergency. My client was discussing recovering from her own recent illness and the impact it had on her functioning and mood. She became tearful and remarked, “I don’t know why I’m crying about this now, it happened a week ago.” I had been close to tears myself that day and had realized I was in survival mode when I was sick. I hadn’t had a chance to acknowledge how stressful the illness was until I began to recover enough that I could move past simply surviving. I recognized my client was describing a similar delayed reaction and used my own sense memory and emotional recall to provide emotional support and psychoeducation about delayed reactions. I observed my own stress, my body’s exhaustion, the welling of tears in my own eyes in the moment and imagined my client feeling these things in order to enhance my empathy and understanding of her similar experience. 

Calling Out Sick

Some personal crises are too big or serious for prevention or intervention. If you find your level of distress is not responding to your usual stress management, self-care, and coping skills, you may need to take time off from work. Riding out the peak of an emotional wave can consume all your focus and energy. Giving yourself the time and space to feel whatever you’re feeling and access support may be your best option.

Now that you’ve reflected on ways to handle moments when personal emotions break through at work, I hope reading this article provided some self-care. Consider this the tree you plant today.