How to Lend a Hand in a Mental Health Crisis Part 3: The Process of Processing

January 1, 2019

 

This week’s guest post is Part 3 in a five-part series that looks at how to fill the gaps in our current mental health care system on an individual basis. It includes a lot of really valuable information about how to help someone work through an emotionally upsetting time. Whether your friend is in a full-blown crisis, or they’re just having a bad day, these tools are excellent for anyone who wants to be a better source of support. 

 

CN: mental health crisis’, mental health management, emotional content
 

Welcome to Part 3 of our five-part series dealing with the mental-health crisis in America. If you’re just joining us, my name’s Lucy, and I’m a trained volunteer at the crisis hotline in my home county in Ohio. The place I live is one of the geographic areas of that The United States Department of Health and Human Services has said has a severe shortage of mental health professionals. 
 

In Part 1, I talked about my personal story dealing with a mental health crisis, and my experiences on both sides of the phone. 

 

In Part 2, I went over the first elements of helping someone in your own life work through a mental health crisis: embracing a calm, compassionate mindset, setting boundaries, and assessing danger. 

 

In this post, I’m going to start talking about processing. Processing is the key to helping someone through a crisis state and out the other side into calmer waters. Processing is a big, well, process! So, I’ve broken the steps up into two articles. This post, Part 3, covers reflecting, validating, and asking.

 

Part 4 continues to explore processing by talking about educating, normalizing, and comforting. And, Part 5 transitions from processing to problem-solving, so you’ll get to learn about how to help your friend lead solution sessions and how to find resources you might not be aware of. 

 

Ready? Let’s get started! 


Processing

 

A therapist friend of mine who works with kids often talks to kids about their “thinking brain” and their “feeling brain.” Your “thinking brain” can ask questions, do research, and solve problems. Your “feeling brain” is, well, all of your emotional responses. 

 

When a person is mentally well, their “thinking brain” and their “feeling brain” are balanced, in harmony. But, when somebody is in crisis, or if someone has an anxiety or depressive disorder, their “feeling brain” completely takes over. The “thinking brain” gets muted, and in extreme cases, a person in crisis might freeze up entirely or go into fight-or-flight mode. 

 

Processing is the method crisis counselors use to help the feeling brain run its course, more or less, so it can let the thinking brain take a turn in the driver’s seat again. It allows a person to go from feeling in danger to feeling safe. Or, at least, safer-- safe enough that they can begin to start coming up with solutions to alleviate their pain and solve some of their problems.

 

It begins with the two of you sitting down and just letting them tell their story.

 

The number one mistake people make when trying to help someone in crisis is trying to rush processing. Processing takes as long as it takes. You can’t push someone into solving their problems until they’re ready: until their thinking brain has at least half the reins to the horse again.

 

But, you can definitely help processing go more smoothly by taking the following steps. 

 

 
Reflect and Summarize your Friend’s Experiences 

 

It’s important to listen to someone closely enough that you can reflect or summarize their experiences back to them. Reflecting is basically repeating what someone just said back to them, in your own words. Reflecting and summarizing is something a lot of skilled listeners do anyway, even if it’s not urgent. 

 

When your friend pauses, seems lost, or starts to repeat themself-- often because they’ve gotten a bit into the emotional weeds, or they aren’t sure you really understand the severity of what they’re saying-- these are good points to reflect or summarize what you’ve heard so far. 

Reflecting can begin with a phrase like, “It sounds like you…” or “What I’m hearing here is, when [this specific event] happened, your [person in their story] essentially….” 

 

So, for example, if your friend is overwhelmed because they’re afraid they’re going to lose their job and they’re talking about how they got sick and missed work without calling off, you can reflect the events back to them non-judgmentally by saying, “It sounds like you really wanted to push yourself to go into work, but ultimately you were too sick. And since you were having trouble thinking clearly due to being sick, you just laid back down to sleep instead of calling off. Is that what happened?”

 

Summarizing is like reflecting, but it is summing up a longer monologue in a shorter, two-to-three sentence explanation. Summarizing should always end in a question, so your friend feels free to correct you if you’ve gotten off-base about something. 

 

Validate Emotions


What does it mean to validate emotions?

 

Along with reflecting, it can be helpful to name and validate emotions. Validating emotions means expressing the belief that emotions have no moral weight-- there are no “wrong” or “shameful” emotions. Any emotional response to a problem someone has is okay.

 

How can I figure out what my friend is feeling?

 

Try to listen to their tone of voice, watch their body language, and believe them if they name their own emotion. Remember that two people who have the same experience can have very different emotional reactions. In the example from before, about work trouble, someone might feel anger at a merciless boss, anger at themself, fear of losing their home, despair at the hope of ever succeeding economically, envy over others who have good health or do well at work, and so on. 

 

That’s why it’s important to observe how your friend is genuinely feeling, rather than try to guess at how they might be feeling based on how you would feel in their situation. 

 

Also, while listening to whether or not they name their feelings themselves, also listen to see if they’re speaking “defensively”-- often, defensive body language or long explanations of why they didn’t make any mistakes or their mistakes are excusable is not a defense against you, but a defense against an intense, negative internal emotion. Usually, these emotions are embarrassment, shame, or even humiliation. 

 

 

Some emotions are more stigmatized than others; try to de-stigmatize them by thinking of them differently.

 

Any of these emotions can be difficult to admit to. Some emotions, like fear or envy, are specifically stigmatized as “bad” emotions. As a crisis counselor, it’s helpful to embrace a mindset where emotions aren’t good or bad; they just are. In many ways, emotions are a physiological reaction to external and internal stimuli. While they are different for everyone, and while there is absolutely hope to change your emotions over time, emotions themselves are about as much of a choice as digestion. 

 

When I say emotions are not much of a choice, don't get me wrong: I'm not saying that if you feel scared or depressed, there's nothing you can do about it. You do have choices!

 

But, emotional illness heals the same way digestive illness heals. In the same way a person can improve their digestion if they get diagnosed and treated for a food allergy, or are able to heal from an illness in their gut; a person who struggles with anxiety or depression can experience more peace or calm over time, with the right treatment. But, it isn't an immediate choice, and getting a proper diagnosis and treatment might take some trial and error. Sometimes improvement isn't linear, and things get better and then worse again. In the meantime, what happens, happens. 

 

Personally, I find it helpful to embrace a line from one of my favorite books from when I was a kid: “There is no way things should be. There is what happens, and what we do.”

 

Emotions are just something that happens. What’s important is what we do when we feel them. 

 

Naming and validating emotions could sound like, “It sounds like you’re pissed off at your boss for being strict and authoritarian about the call-off policy. I get that, I’d be pissed too.” Or, it could sound like, “Sometimes it feels just embarrassing when you can’t push yourself to meet your own standards for yourself. And you feel like you should be able to, right?” 

 

Even if you can’t empathize with having that particular emotional reaction to that situation, try to sympathize with how that emotion felt when you last felt it. Try to imagine how someone could potentially feel that way, even if you don’t, so you can take the crucial step of validating their emotions. 

 

If a person in crisis hears you name an emotion they’ve been afraid to acknowledge, or validate an emotion they were having difficulty articulating, they will almost always feel slightly less distressed in that moment. Often, this is when you can see your friend start to relax, as stress physically leaves their body. 

 

Once their emotion is out in the open, and they hear you say that either you have felt that way, or that you understand why they might feel that way, all the stressful, peripheral emotions around that emotion evaporate. Whether those peripheral emotions are fear (that they are “weak” or “wrong” to feel this way), loneliness (because they thought they were the only ones to feel like this), or embarrassment, naming and validating their emotional response to their situation lets those peripheral emotions go. 
  
This is often the beginning of the de-escalation of stress and into a less urgent mindset, which is how processing begins. 

 

What Validating Emotions ISN’T

 

There is one big emotional trap you do NOT want to trip over when you’re helping someone in a crisis:

 

NEVER tell someone how to feel, or how not to feel. 

 

This might seem obvious, but it can often be challenging to validate someone's emotions when a person is having a reaction that you cannot empathize with or even one that you believe demonstrates a prejudice or a bad attitude in some way. It's not a terrible sign if that happens sometimes; it's very human. Personally, even after doing this for a while now, I’ve found that I still sometimes have to intentionally circumvent my own impulse to tell someone they are wrong to feel that way.

 

Some specific examples that can crop up a lot: telling someone to calm down, or to stop crying, doesn’t actually soothe their pain or ease their fear. Worse than that, telling someone to “calm down” can have the effect of making them angrier; after all, who are you to dictate their emotions? 

 

 

It can be challenging to avoid reflexively saying things like, “There’s nothing to be embarrassed about,” or, “You have so many things to be happy about in your life.” 

 

The thing is, even if cultivating a positive outlook or mentally changing your idea of what counts as shameful or embarrassing is a helpful part of the solution, it’s just not something a person can do while processing. The processing phase can take a long time, and until someone is able to truly feel their full emotions and let them run their course, they aren’t in a mental state where they are receptive to solutions.

 

In the meantime, reflecting someone’s expression and naming and validating their emotions is the first step in processing. 


Ask Open-Ended Questions

 

Sometimes someone will be in crisis and they’ll want to open up, but then they’ll falter or stop speaking altogether, even though they aren’t done. Sometimes a person in crisis has trouble beginning to speak at all.

 

If your friend is having trouble speaking, it can help to ask, “Would it be easier to write it down?” The answer is yes for a surprising number of people.

 

However, usually, the issue is they feel stuck. If your friend says something like, “I’m not sure how to say this,” or “I don’t know where to start with all this,” then it can be helpful to respond with, “That’s okay, take your time; no rush.” 

 

Even feeling reasonably open, though, sometimes you realize you need to prompt them to say more, or to figure out what their underlying issue is. In that case, it’s good to ask open-ended questions.

 

Open-ended questions have more than two possible answers. Close-ended questions are binary: yes/no, A or B. While close-ended questions are useful for figuring out if someone is in danger or not, open-ended questions are better in almost every other circumstance. 

 

 

So, instead of asking, “Are you upset because Amy cheated on you?” you can open the question up by asking, “What’s upsetting you right now?” 

 

Or, if your friend seems to have a lot of stressors, you can ask, “What stressor is having the heaviest impact on you right now?” or, possibly, “What are you afraid the worst-case scenario might be?”

 

If you aren’t sure what emotion your friend is feeling, it can help to ask, “How are you feeling?” or even something a bit more metaphorical, like, “What’s your emotional color palette right now?”

 

I want to note here again how important it is to NOT jump to suggesting solutions when you ask questions while someone is processing. Sometimes helping a friend goes badly because the friend in crisis begins to feel bombarded with close-ended questions that are thinly veiled suggestions.

 

“Have you tried______?” isn’t open-ended

 

If you feel yourself beginning to start a question with, “Have you tried____?” STOP. The phrase “have you tried_____?” gets you off track, it increases the stress of the friend in crisis, and it disrupts the process that will, ultimately, empower your friend to come up with their own solution.   


Rephrase questions to sound as non-judgemental as possible.

 

While we’re on the topic of questions, another important thing is to rephrase “why?” questions as “what?” questions. Even if you’re aiming to be non-judgemental, “why?” questions can put someone on the defensive. 

 

So, for instance, let’s say you wanted to figure out why your friend hasn’t brought a personal issue up with her husband, even though it’s affecting him and he could potentially help her out. You don't know whether it's because their relationship is not supportive, she fears he won't be supportive due to how she's been treated by others in her past, or because she believes she doesn't deserve support. You want to find out the reality of the situation. 

 

If you ask, “Why haven’t you told your husband yet?” your friend is much more likely to get defensive and shut down the conversation. “Why haven’t you--?” has the connotation of an accusation. She will likely fill in the blanks of whatever she’s afraid of being accused of and will answer in a way to defend herself against that accusation rather than answer as honestly as possible. 

 

It’s a simple change to make it into a “what” question: “What is preventing you from telling your husband?” 

 

It might seem like not much of a difference in theory, but it is surprisingly significant in practice. Without the word “why,” people feel more like you genuinely want to understand them, rather than judge them, and nine times out of ten they answer more honestly.

 

 

Whew! That’s a lot to think about. Don’t worry if you slip up when you try to help your friend, or if you’ve made some of these mistakes in the past. The important thing is, if you’re motivated to do this good but challenging work, you can always pick yourself back up, practice on your own or with a buddy, and try again. 

 

In fact, the next time you have a low-stakes, non-stressful conversation with a friend, why not try reflecting, validating, and asking open-ended questions? See how your conversation flows differently. What happens? How do you feel afterward?

 

While you’re doing that, I’ll be working on Part 4: Educate, Normalize, and Comfort

 

Read on to learn what else processing entails, and learn how you can transition from processing to solving problems.

 

About the guest blogger: Lucy Merriman is a poet and artist living with her friends in Ohio. Her poetry has been printed in Pif Magazine, and her personal blog, Welcome to Tree City, is a fun place where she interviews artists, posts contemporary art criticism, and is generally trying to figure the big stuff out. You can also find her on Instagram on @merriman_lucy. She likes people! She probably thinks you're pretty neat.

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