Emotional First Aid: Looking Beyond the DSM
By Ryan Howes
Everyone knows that a twisted ankle requires elevation and a bag of frozen peas, minor cuts and scrapes get bandages and Neosporin ointment, and colds get chicken soup, cough drops, and tissues. But what’s the common remedy for rejection, rumination, or low self-esteem?
As psychotherapists, we proudly use our expertise in evidence-based methods in the treatment of severe anxiety, depression, and relationship angst, but we rarely talk about standard protocols for everyday emotional problems that aren’t listed in the Diagnostic and Statistical Manual and that most people experience but typically don’t consult a therapist about. Ask 10 practitioners how they address loneliness, for example, and you’ll likely get 10 wildly different responses.
Manhattan psychologist Guy Winch felt an instruction manual for the emotional bumps and bruises of life was long overdue. In his book Emotional First Aid, he compiles current research and theory to provide suggestions for handling familiar issues like loneliness, loss, guilt, and a sense of failure. In the interview below, he shares his thoughts on emotional first aid.
RH: Why do you think our training as psychotherapists mostly ignores everyday issues like rejection and loneliness?
Winch: We tend to focus on the illness, because if it’s not diagnosable, clients won’t get reimbursement. So we talk about the big-ticket items and pay less attention to common, day-to-day issues. While medicine has increasingly emphasized educating the public about prevention so patients don’t have to seek medical treatment as often, psychology has been slower to move in that direction. Of course, people don’t need to run to a therapist every time they suffer guilt or rejection, but we don’t discuss the exercises people can do to recover their self-esteem when it suffers a blow.
RH: So what’s the line between when someone should seek treatment and when they can take care of these things on their own?
Winch: With medical issues, we can gauge when a cut is deep enough to need stitches, or when a cold is severe and stubborn enough to warrant a trip to the doctor to make sure it’s not bronchitis or strep throat. We tend to know the line between what we can take care of ourselves and what we need professionals to handle. Most people don’t have that line when it comes to psychological issues. For example, a friend of mine was telling me about his sister who “had stuff going on.” I asked what he meant, and he told me she’d just spent two months in bed because she was severely depressed. The thing is, no one had told her that she should see someone. That’s very sad, especially since their father is a physician. The public awareness about the kinds of psychological conditions that require treatment is generally poor.
RH: Let’s dive into one of your favorite topics. What’s your first-aid approach to guilt?
Winch: Guilt is interesting, because it’s actually one of those things that’s good in small doses, but too much or too little isn’t good. Guilt alerts us to when we’re about to do something or have done something that can harm another person; then it allows us to either not do the thing or take corrective action and issue apologies or restitution. So it’s great as a relationship preserver. That’s its primary function: to maintain bonds in small societies and social groups.