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In fact, I believe there are times when so-called "lay therapists" can have a greater impact on a person's life than a licensed professional due to them having greater boundary flexibility and more time. Unfortunately, however, when untrained lay therapists intervene without knowing what to say (and more importantly, what not to say), they can do more harm than good, which is why many people solicit the help of a licensed psychologist in the first place.
Like most psychologists, I spend about an hour a week with my patients, but the time that each of them spends with family and friends can range from 10 to 100 hours per week. As a result, when a crisis hits, it's usually a friend or family member that's first on the scene to provide the emotional first aid they need to survive a difficult situation. For this reason, I have long felt compelled to offer lay therapists a short primer of tips on how best to help their friends and family during times of crisis.
1. Don't just do something, sit there.
A close friend of mine who is a veteran of Al-Anon, a support group for family members of those with alcoholism, often reminds me of an idiom often recited at meetings: “Don’t just do something: sit there!”
So often when we see our friends and family members in pain our first instinct is to do something, without even knowing what we should be doing. And sometimes, when we try too hard to help, it leads us to do the exact wrong thing.
The advice here, borrowed from Al-Anon, is to not do something. It is amazing how powerful just sitting with someone can be for them. Sharing the same physical space with someone quietly communicates to them that: a) they are important enough for us to willingly give them our valuable and limited free time; b) we are willing to make ourselves fully aware of their suffering; and, c) we are not unduly burdened by their suffering or afraid of being “tainted” by it.
Just sitting with your friends and family members means that you listen more than you speak. If you do need to speak, remember, less is more. This is not the time for a deep exploration into the causes of a person's current mental health crisis, nor is it the time to offer any immediate solutions. As such, this is the absolute wrong time to do any of the following:
- Recommend major life changes
- Constructively criticize any of the individual's life choices
- Blame the individual for his/her own suffering
- Put pressure on the individual to "get better" quickly
- Ignore, avoid, or abandon the individual
2. If you must do something, validate their experience.
In lieu of offering unsolicited advice, the best thing that a lay therapist can do to help their friends and family members is to validate their pain. In my career as a psychologist, I am continually amazed at how powerful validation can be. Validation is not only an important tool for lay therapists to wield but experienced professionals as well. I can think of numerous occasions when I have offered a patient a thoughtful psychological analysis (and thinking I was "brilliant" at the time), only to have that analysis rejected because what the patient needed most was a simple statement of validation.
So often when we have powerful tools in our toolbox we feel compelled to use them, even when they might not be the right tools for the job, and we overlook the more basic tools we have that actually suit the job perfectly: this lesson, which I have learned the hard way, transcends mental health and is applicable to so many areas of life.
Statements like, "That must feel awful;" "I can't believe how much you are going through right now;" and "That really sucks!" are much more helpful than we realize. Even saying something as simple as, "I understand" or, "I get it" can be a salve to heal emotional wounds.
Though validating statements like these might not sound like much, and may even seem cliché, they still work. When we make validating statements like these there's a subtle form of meta-communication happening under the surface. When we say to someone in pain "Wow, that must be awful!" what we are actually communicating, in-between the lines, is:
- "I am aware of your pain, I am not ignoring it."
- "Your pain is real, not imagined."
- "I am affected by your pain and I have compassion for you."
As a lay therapist, though you may not have the training of a licensed psychologist to provide your friends and family members with a solution to their struggles, validating their pain will help you to stop the emotional bleeding.
3. Serenity now! Focus on problems within your control.
Of all the phrases that Seinfeld bestowed upon American culture, my favorite is "Serenity now!" The phrase comes from an episode in which Frank Costanza and Kramer repeat the mantra as a means of calming themselves down after getting upset.
"Serenity now" as a mantra was meant to be a nod to the famous Serenity Prayer that is often recited at the meetings of various 12-step programs. The simple three-line prayer is:
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
In many ways, I see the work of a psychologist as helping individuals to implement the wisdom of the Serenity Prayer. After listening empathically to a patient and assessing the main problems to resolve, a psychologist's next task is to help the individual sort the problems into one of two categories:
- Problems that are largely outside the patient's control
- Problems that are largely within the patient's control
We are all prone to wasting time on problems that are largely outside of our control. Problems in this category may include anything related to a past event (e.g., getting cut from a team); or problems concerning the behavior of somebody else (e.g., your best friend being interested in dating your ex); or anything over-hyped in the media surrounding current events, politics or problems in the world beyond your control (see my article "The Great Flattening" for a more detailed discussion about this).
Whether you are a lay therapist or a licensed professional, when addressing problems that largely reside outside of someone's control, the best we can do is help these individuals to "accept" the things they cannot change. Admittedly, this is easier said than done, even for licensed psychologists, and I would warn all lay therapists to avoid pushing too hard. Accordingly, when your efforts to help foster acceptance lead to any kind of conflict, it is best to stop right there and retreat back to Tips 1 & 2: just sitting there and validating.
On the flip side, sometimes the problem to be resolved is one that is largely within a person's locus of control. If a friend hates his boss and his job, he may not have control over how the company is run or how the boss operates, but he does have control over whether he chooses to stay at the job or find a new one. In a circumstance such as this, we can best assist our friends and family members by helping them to find "the courage to change the things" that are under their control. How can you help someone else to find courage?
My experience has taught me that one of the best things you can do is continually remind a person that they can always count on you to sit, listen, and validate them. When a person trusts that you will be there to provide them an emotional safety net if they should fall while stepping outside their comfort zone, they will be much more inclined to do the things they fear (e.g., getting a mammogram or a colonoscopy; finding a new job; or leaving an abusive relationship).
4. Know your limits.
Throughout this article, I have detailed the ways in which everyday people can serve as lay therapists to their friends and family, and I have even conceded that there are times when lay therapists can provide more extensive help due to them having greater boundary flexibility than licensed psychologists. However, there are also times when all lay therapists must recognize their limitations and defer to a licensed professional.
Here are a few signs that the problems of a friend or family member are beyond your scope and require treatment with a licensed professional:
- Your efforts to help are leading to conflict or to the individual feeling worse.
- You are feeling overwhelmed and unsure of what to do.
- The individual you are trying to help is a victim of abuse or is having thoughts of hurting themself or others.
Remember, discretion is the better part of valor, and there is no shame in knowing your limits. Furthermore, while your ability to help someone will vary from situation to situation, you want to ensure that in each case you abide by one of the foremost precepts of medicine, paraphrased in the Hippocratic Oath: "First, do no harm;" that is, it is better to do less than risk hurting someone in your attempt to help more.
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