When a client becomes emotionally escalated during a telehealth session, it can be challenging to know how to respond in a way that is both clinically effective and grounded in compassion. Research shows that clients experiencing emotional dysregulation benefit most when therapists maintain calm, offer clear structure, and introduce evidence-based skills in the moment. (Linehan, 2015; Najmi et al., 2021)
This guide is here to support you in stabilizing clients safely and effectively in a virtual setting, whether they’re experiencing panic, dissociation, anger, or fear.
Regulation Begins With You
Therapists’ nervous systems play a powerful role in co-regulation. Your calm presence is a clinical intervention. In moments of client distress:
- Lower your voice
- Slow your pacing
- Regulate your own breath
- Simplify your questions or feedback to the client
- Maintain a warm, compassionate, collaborative tone and approach
Step-by-Step: How to Stabilize a Client in Distress
1. Notice and Name What You See
Gently acknowledge the shift in emotion. This offers validation and helps reorient the client:
“I’m noticing it feels like something’s coming up really strongly right now. Let’s slow down together for a moment.”
- Look for signs of dysregulation: rapid speech, tearfulness, withdrawal, agitation, flushed face, clenched jaw, or changes in breathing.
- Pause clinical content and shift to regulation.
2. Guide the Client Toward Grounding
Grounding has been found effective in acute distress, especially for trauma survivors (Bremner et al., 2022; van der Kolk, 2014).
Examples:
- 5-4-3-2-1 grounding (sight, sound, touch, smell, taste)
- Temperature change: invite the client to splash cold water on their face or hold a cool object
- Movement: invite gentle stretching or pressing feet into the floor
- Breathing: co-regulate with paced breathing (e.g., inhale 4, hold 4, exhale 6)
3. Offer Language That Validates and Centers Agency
Emotional regulation isn’t about “calming down”—it’s about helping the client feel safe and empowered.
“Your body is having a strong reaction, and that makes sense given what we’re talking about. You’re not alone in this.”
- Use non-pathologizing language.
- Reflect strengths even in the distress: “You reached out instead of shutting down- that’s resilience.
- Empowering self-talk can also decrease rumination and distress; encourage the client to try: "I am safe right now."
4. Co-Select a Coping Skill or Anchor
Choice-based coping improves distress tolerance and therapeutic alliance (Neacsiu et al., 2014; Norcross & Wampold, 2018). Offer 2–3 options and let the client choose what might help.
Options to suggest:
- TIPP skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) from DBT
- Safe place visualization
- Body scan or “inside check-in”
5. Reassess Readiness and Regroup
Once the client is more settled, assess if it’s appropriate to return to clinical material.
“How are you feeling now? Would it feel okay to continue, or would it be better to stay focused on regulation today?”
6. End with Strength, Safety, and Clarity
Use the final minutes to reinforce coping, preview next steps, and confirm the client’s sense of safety.
“You did something powerful today- feeling big emotion and staying present. Let’s talk about what support you might need between now and the next session.”
Consider co-creating a brief “coping with distress plan” that the client can reference in the future.
From Distress to Danger: Knowing When to Act
If the client is not responding to your interventions and you're concerned about their safety:
- Engage in a risk assessment
- Utilize Rula’s H.E.L.P. guide
- If needed, initiate emergency services and document steps taken
With the right tools, support, and intention, you can walk with your clients through this difficult period and help them find safety again.
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