For me, being a therapist, counsellor or coach is just like being a good host at a dinner party, because a client is a guest in my practice and they have come because they need something from me that I can give them so I invite them in.
If my guest is thirsty, I give them a drink. If they’re belly is rumbling with hunger, I give them food. This is a basic duty of being the host with the most. And in my mind, the same principle applies to a client suffering from stress (and almost every client I see is).
When treating a negatively emotionally aroused client, the first thing I need to do is calm them down.
Don’t get me wrong, calm empathic listening can take the wind out of the sail of rising cortisol. But sometimes clients need immediate help. Their level of stress has become an emergency, and until you apply therapeutic psychological first aid, other diagnostics and treatments have to wait.
It’s equally useless 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 address their need for relaxation and calm.
But why do people suffer stress in the first place?
People become stressed when they are not meeting their needs, or fear their needs will stop being met. (What if he/she leaves me? What if I lose my job?) A great visual for our needs is this image below which is an adapted version of Maslow’s Hierarchy of Needs. When these needs, starting from the bottom up, are not met we begin to suffer psychologically and then physically.
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 stressed clients – offering ‘psychological & physical first aid’ – is a prerequisite skill to make any other therapy or coaching remotely possible.
Quench That Thirst
Using talk therapy or getting all analytical when someone is crippled by stress is like giving salted food to a 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 relieve 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 unforgivable for any therapist not to be exquisitely skilled in the art and science of relaxation. And this is why I believe all people helpers should be able to heal through calm – and why I have always trained coaches and 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
Pete was clearly on the brink of either exploding or imploding, I wasn’t quite sure which one at first. His facial muscles were rigid, and the deeply etched creases in his face indicated long term tension and stress. Sitting in front of me his breath was shallow, fast and heavy, just like he’d run to my practice – yet he looked frozen in place. It was blatantly obvious that he needed help and right now.
Crucially, as I began engaging in conversation I found that he couldn’t think. Every time I asked a question I could see his mind wander off somewhere else. He did say one very important thing though.
When I asked what it was that he wanted, he looked straight at me and said “Not to feel like I’m dying inside!”
“I can’t relax, ever”, he said. Yet relaxation was precisely what he needed. Natural, mind-clarifying relaxation, that is, not the alcohol and sleeping tablet induced semi-coma that he’d become accustomed to.
We know that depressed brains are stressed brains. Pete was depressed because his needs weren’t being met. And the double bind was that in order to help meet his needs, he 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 overcook the analogy, you can’t teach someone calculus when they are desperate for water. And good luck trying to do cognitive therapy with someone whose thinking brain is crippled by anxiety.
I gave Pete what he needed in that first session, which was deep rest and relaxation. He was a different person at the end of that first session: clear, calm and hopeful. I didn’t just tell him he could feel different. I showed him how to feel different. Pete now had some clear space in his mind to really think about what else he wanted from therapy, beyond the relaxation.
Constant stress and failure to relax makes people feel hopeless, disassociated from their personal resources, and therefore helpless. From there it’s not far to go to 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.
2. You can’t heal the body without healing the mind
For me, a good therapist, 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.
The Vagus Nerve and Your Mind-Body Health
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 an incredible meandering bundle of nerve fibres that extends 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 longer than the inhalation) 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 remember a client coming to see me who used to have CBT. 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 replay in the sessions by focusing on all that was and had ever been bad in his life.
He learned to 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’. So his weekends were ruined which added more stress from frustration.
This is absolutely insane. Our clients should feel better after every session.
Pete 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 from happening again in future.
All coaching and counselling uses inner work and 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 inside their minds to find the answer, 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 any session is also the perfect time for a 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 dissociated, ‘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 a client will actually carry out the behaviours required to help them toward their goals. And 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.
Pete learned to relax himself once I’d helped him do it a couple of times. We used deeply relaxed hypnosis to not only help his vagus nerve adjust to a new, more generally relaxed Pete, but also to de-traumatise an old memory so that his flashbacks stopped and his nightmares faded away fast.
It was during deep relaxation that I helped Pete rehearse new, healthy behaviours to help him meet his needs better in future. What he said as he left the final session was brilliant:
“I never knew therapy was so enjoyable – I actually had fun!”
This is why I strongly believe that every therapist, counsellor and coach must to know how to deeply, quickly, easily and conversationally relax their clients.
Never let a client leave a session in need in any way, ever.
8http://www.huffingtonpost.com/2013/11/07/chronic-stress-health-inflammation-genes_n_4226420.htm and http://www.nature.com/nri/journal/v5/n3/abs/nri1571.html