Most adults are emotionally illiterate and they raise emotionally illiterate kids. The level of suffering this perpetuates is tragic and unnecessary. Whether people want to admit it or not, emotions are a huge part of the human experience.  

As counsellors we need to know how to manage our own emotional experience to remain present during sessions, and also so we can teach clients how to self-regulate. Merely teaching coping skills is missing an opportunity. Instead, if we can share a way of conceptualizing emotions, which regulation is just one part of, it can provide a broader basis for organizing emotional experience. I wrote 2 articles addressing my thoughts on this:

Part 1, this article you’re reading now, covers a way of conceptualizing emotional experience and emotional regulation 

Part 2 addresses how to process and let go of (old) emotional baggage

Emotional literacy starts with learning to recognize our emotions and what information they’re providing. The more specific we can be with labeling our feelings the better we can understand and process them. The most impactful tool for this work is usually a feelings wheel. It’s extraordinary for helping people notice how they’re feeling; I suggest people (therapists included) pick it up when they notice they’re feeling “off”. I differentiate between regulating and processing emotions, for ease of discussion:

Emotional regulation: dealing with our moment to moment or short term feelings (e.g., worried  and frustrated that a friend hasn’t called me back yet this evening)

Emotional processing: working through, accepting, or “letting go” of longer term emotion (e.g., shame and grief from a series of events 6 years ago)

Below I cover:

• How to increase buy-in for emotional health

• A visual metaphor for conceptualizing emotional experience, and a detailed script of how I explain this is available

• Common Emotion Regulation Skills for Therapy Clients

Increasing Client Buy-In

We need to get buy-in from clients before providing psychoeducation about emotional regulation. There are many avenues leading to this type of discussion on emotions, but mostly I’m listening for stress responses in client stories. The more frequent or chronic the response, the more likely I am to bring this up. Classic examples are a person who gets angry often or easily and claims not to know why, or a person who suggests they “can’t let go” of a certain feeling. Here’s how I often start:

“I know this sounds a bit strange, but I don’t speak Spanish. That’s because when I grew up, no one around me spoke any Spanish. For the same reason, by the time I was a young adult I still didn’t know anything about my emotions or how to deal with them. And that’s a pretty big problem because a huge part of the human experience is emotional, whether we notice or not. Which we’re unlikely to do, because our society stigmatizes emotions—particularly for men. 

Emotions contain a lot of energy and impact all of us, often more than we realize. The trouble is, all that energy has to go somewhere. When we’re unable or unwilling to do something with it, we avoid it. You know what happens to a person after they avoid it for long enough? Anger, addictions (usually alcohol), or depression. Or all of them.” 

This is particularly impactful when I say it at an opportune moment and can reference the anger, depression, substance use, or shame my client may have been describing. It also serves as a platform to hear more useful parts of their story as we proceed into process (rather than content). 

After the client feels understood and is looking toward change, I often draw and explain the following image of a vase. In brief, we have a limited capacity to handle emotions (the vase itself), and the water in the vase represents the emotions we’ve experienced that day. We can do some regulation to counter-act the water being added, but if it gets too high we ‘flood’ (i.e., a stress response). I wrote a detailed script here of how I explain the imagery to a client, if you want further details. Here’s some (poorly done) clip art I made of it:

This is just one approach; it doesn’t matter exactly how you situate coping skills, but people benefit from having a coherent way to organize their experience. Other options that capture emotional health and common resources I give are: Permission to Feel by Marc Brackett, which covers his RULER idea and is used in schools to teach emotional literacy. Tara Brach has many excellent resources on emotions including her RAIN acronym and guided meditations. The Language of Emotions by Karla McLaren is a another common resource, Sue Johnson’s EFT work is good, Hakomi therapy is an option, as are many forms of mindfulness.

Emotional Regulation in Therapy

When we’re able to regulate how we feel, we get some control over when and where we deal with our emotions. Further, neglecting these feelings can bring on many subsequent issues. Below I go over the emotional regulation skills I most frequently share with clients. When therapy progresses to the point that bolstering their coping skills is an appropriate focus, I almost always start with some solution-focused questions, such as: 

• What do they do now that helps them calm down

• What’s already helping

• Who do they talk to when they’re upset or worked up

• What is it about those conversations that is useful, and so on

The intention is to help clients see that they already work to emotionally regulate, and I want to find out more about their support systems. We then build on their skills, being more aware and intentional about employing existing techniques to regulate while also adding new ones. The following grounding techniques help to ‘get you out of your head an into your body’.

Common Emotion Regulation Skills for Therapy Clients

‘54321’ exercise

We’re shifting our attention onto our physical senses:

• First, notice and slowly study 5 things you can see, then

• 4 things you can hear

• 3 textures you can feel with your hand, and so on

Most people just use vision and stay with that until they’re calm, or they select whichever senses are most effective for them. There’s lots of variation you can do with this exercise, as with all of them.

Simple Breathing Exercises

‘Box breathing’: breathe in for a 3 count, hold for 1, out for 3, hold for 1, then repeat for a few minutes or at least 3 breaths. Or 2, 2, 2, 2. Or in 4, hold 1, out 4, hold 1. 

 5, 4, 7 breathing: breathe in for a 5 count, hold for 4, then out for 7. It’s more engaging because it keeps changing, and you breathe out longer than you breathe in which is really calming. 

Bubble breathing is an easy one that can also work well for kids: imagine you have a glass of water or chocolate milk with a straw in it, and you’re blowing bubbles in it via the straw. Nice long exhales.

To increase buy-in, I often share why deep breathing helps before I teach a technique in it: when we get stressed by a threat our body kicks in to high gear. It takes resources away from some bodily systems such as higher cognitive function, digestion, sexual function, and your immune system—and it gives that energy to other systems so you can run from a tiger or fight it: heart, lungs, muscles etc. In our modern world the same system can engage when we see the boss we struggle with, are in traffic, argue with our spouse, etc. So during this automatic response, the heart is pumping quickly it needs more oxygen—so we start breathing faster. We can influence the same system in reverse, which is why breathing slowly actually helps. 

Feelings Wheel

Have clients examine a feelings wheel (this link has a higher resolution version) to determine how they’re feeling, specifically. When we’re stressed or anxious it’s often because we feel out of control, and it’s worse when we struggle to understand our internal experience at that time. Many people feel calmed simply by being able to label their emotions: “I have more self-knowledge about this difficult moment, and the process of analyzing the wheel and reflecting on my current state gets my pre-frontal cortex back online, which helps me further calm down.” You and your clients can find all kinds of ways to simply ‘allow’ the emotional experience to occur then pass, or activities to release it such as exercise or art can be great too.

DBT Emotion Regulation (mindfulness + CBT)

DBT is a gold mine for therapists who like knowing lots of concrete skills to teach clients. Here are some that I use:

• Wisemind, a Venn diagram of your rational mind and emotional mind, a great tool that can be the basis for lots of work. It’s easy to find more information and work sheets on google

• ‘Checking the facts’ around interpretation and magnitude of emotions relative to the actual event

• HALT acronym: hungry, angry, lonely, tired. Improving awareness of when to use self-care or delay important conversations

• Progressive muscle relaxation (though this fits in many approaches)

• DEAR MAN acronym for improving communication (draws heavily on Rosenberg’s Nonviolent Communication). There are many more if it’s the kind of thing you enjoy, and it’s easy for you and your clients to google these skills and/or watch things on YouTube.

• Mammalian dive reflex

Journalling

Journalling is extremely helpful to some folks, and research has found that ‘audio journaling’ (hitting record on your phone and talking about the concern) is just as useful as typing or handwriting. These options all being effective often surprise clients who otherwise tell me they want to journal but ‘hate writing’ and so on. There are endless journal prompts for different issues you can give clients or collaborate to create, and ‘bullet’ journalling and any kind of structure can work well depending on the person. 

Meditation

This is a massive subject varying from single skills up to a continuous or even spiritual practice. I stay with the agnostic or skills-only side of meditation unless a client brings spirituality in to it. If people are interested, I like to get them to seek guided meditations they like, and YouTube etc has a ton of specific ones. They can just fill in the blank, guided meditations for: stress, anxiety, depression, grief, self-love, forgiveness and so on. Here are several resources I commonly suggest:

• Tara Brach and Jack Kornfield (who both have PhDs in psychology)

• John Kabat-Zinn

• Buddhism without Belief by Stephen Batchelor

• There are many good apps for meditation too, such as Insight Timer (which is free), Headspace, Sam Harris’s Waking up (it’s free if you email and ask), and many others

• Rumi’s poem Guest House, which is about acceptance and the transience of emotion.
  

CBT for Emotional Regulation

CBT is an absolute classic. I show people the unhelpful thinking styles and we do process work on it, coming up with novel ways (e.g., set reminders or timers on phone, put it on the wall and read it while brushing teeth regularly, write an indicator/reminder such as the letter ‘u’ or a ‘?’ on their hand somewhere, or on a sticky note on their work desk etc) to apply and reference it to increase their awareness. I sometimes also use thought logs in combination with the thinking styles, talking about how anxiety adds water to the emotional vase, and how quickly the unhelpful thinking styles leads to stress/anxiety. There are endless books, case studies, and YouTube clips of CBT in action.

Conclusion 

If some of this seems overly simple, that’s because it is! Some approaches to therapy dress emotional regulation up with lots of ritual and even mystique, but they’re no more or less effective than anything else. 

I prefer coping skills that are free and don’t require you have anything with you, so you can use it anywhere. Even better if other people can’t notice you’re doing it (e.g., 54321, many breathing exercises etc). Any list like the above will seem inadequately short, or else be absurdly long. 

I draw upon clients’ existing strengths and things that have helped them in the past, and I may teach one or two new skills in addition to their existing repertoire. The more skills therapists are aware of the more useful and specific our suggestions become. 

Be careful you aren’t piling dozens of new skills onto your clients. Just because one skill is good doesn’t mean 8 is better. Some of the above (CBT, DBT, etc) are easy to find lots of worksheets for, and while worksheets can be comforting to new therapists, they aren’t much use unless situated within a good therapeutic alliance, relevant, explained well, likely practiced in session, and given when the client is ready for them.

My grad students and therapists doing their licensing hours ask me for these kinds of things all the time, and they often seem happy and relieved to learn a new one that fits a given client situation. I 100% used to feel this way as well. Now I’m more focused on relationship and process, but I think this is a ‘learn the rules and then forget them’ situation. It’s easier for me to be relaxed in session because I know many tools and skills that I can reach for regardless of what unexpected thing a client brings up—not to mention behavioral exposure from doing thousands of client hours myself! I hope some of these skills are useful to you as you build your familiarity and find what works best for you.

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