Non-counselors are invited to read this chapter. It contains no secrets for a closed circle. But it discusses some questions which have come up specifically in seminars I have given on EFA for counselors (which includes psychiatrists, psychologists, psychotherapists, social workers, nurses, etc.). Many counselors have an extensive knowledge of such areas as diagnosis, cognitive problem-solving, biochemistry and medication, family dynamics, sexuality, and so on. But systematic training in direct work with the emotions is non-existent in almost all schools of psychiatry, psychology or social work. After graduation the practitioner is too often left to "wing it" emotionally, and success or failure as a counselor depends on private emotional qualities which the practitioner will have had since before training. This is partly as it should be. No manual of EFA can really teach sensitivity. If the hand on the weeping client's head is hard and cold, and belongs to a contemptuous or rigid person, EFA is merely a mechanical simulation, and the client will know it. But very often the counselor's problem is not a lack of emotional responsiveness, it is a lack of understanding of how emotions work—so that attempts to guide a client through an emotional outburst or crisis may be well-intentioned but dangerously inept.

I once attended a training workshop given by a "bioenergetics" therapist whose sensitivity as a person I respect. We were doing one of those exercises, so often forced or silly, where the participants pass one by one in front of the therapist and are encouraged to explore their capacity for anger by shaking their fist and yelling "Get out of my way!" When it was my turn, the therapist adopted a particularly bland, infuriating look of disdain, and I found it easily to mobilize what felt like real anger as I shook my fist and yelled. He then said: This is not convincing. Your forehead is all bunched up. That way your anger can't get out. Open your eyes wide, and let me see the rage." I was puzzled, since I had been truly burning with anger, but I tried it his way, opening my eyes wide as I yelled. All I felt was a sense of weakness, humiliation, and for the first time a hint of fear. "That's better," he said. "But you could do some work on it."

I was left quite upset by this experience. I had never, being a rather touchy person, felt I had much of a problem with anger. But now I did. My self-confidence was shaken. Some months later I read Darwin and found that all primates, whether apes or humans, do in fact bunch their foreheads in rage. Again, all primates open their eyes wide in fear. So my teacher was simply wrong. But how many other people had had their emotional confidence shaken by his interventions?

On another occasion, in a similar workshop, I was standing near a window minding my own business when another participant came up behind me and pinched both my shoulders and started massaging them vigorously. Almost immediately I had wheeled around with my fist raised and eyes blazing, but as I saw him I checked my anger and we had a good laugh about it. He explained that he had thought I looked sad, and that massaging my shoulders would make me feel better. We agreed that I was "holding anger" in my shoulder muscles. But almost everyone "holds anger" in these muscles, since they are used in hitting out, and become tender when the desire to hit out is repressed. Pinching these muscles almost always triggers anger, and it is not appropriate in helping grief. If the other participant had been in a position of authority (as counselors inevitably are), he could have damaged my emotional self-confidence if he had told me I should not have been angry, or that I should have been trusting enough to give in to his ministrations "to make me feel better." A counselor has the power to make or break a client's emotional self-confidence, and although a healthy person may bounce back quickly, for an emotionally disturbed person the breaking of what confidence there is can be fatal.

How can EFA be used in crisis line counseling?

The basic principles can be applied verbally, although this is of course difficult without visual cues. Any of the measures suggested under the heading of Contact 2: Touch can obviously not be applied. Nor, I think, should an attempt be made to give instructions by telephone on how to set up exercises to "get the emotion out."

As crisis line workers know, telephone counseling can be likened to playing a very large but invisible fish which has only been lightly hooked: a combination of strength and delicacy is required, so as not to lose the person at the other end, who can hang up the phone in an instant. Most crisis line workers already apply some verson of the focus principle I have discussed with relation to anger, and encourage the caller to be as specific as possible, to concentrate on detail instead of panicking. They also give steady support to grief. Contact, in the case of fear, is the most difficult when not face to face, but can be partly achieved through the voice. Blocked joy is seldom presented as a problem, but the counselor can be alert to the possibility that anxiety is hiding an unbearable excitement which can be shared.

It helps to keep these key words in mind: support for grief; focus for anger; contact for fear; sharing for joy. But none of these emotions should be fanned into flame. A basic difference between crisis line counseling and EFA is that on the crisis line, talking for its own sake is encouraged, on the principle that the distressed person needs to discharge emotional tension and can do so through the sometimes long process of expressing his or her troubles verbally to a sympathetic listener. In EFA, where we are in contact with the distressed person, it is useful to try and set talk aside and work to let the emotion be expressed physically. But on a crisis line this is not advisable.

Threats of suicide can be worked through verbally by a skilled counselor who lets the person express his or her troubles, and suggests diversionary activity or further help. All this keeps the emotion low-key. Usually—although there are no firm rules—it takes energy to commit suicide. The person is bursting with pain or emotion, and the suicidal act seems a release from unbearable tension. In therapy, it becomes important to discuss how a person is thinking of committing suicide. This tends to defuse the intention, and the person may feel more understood. This should not be discussed on the telephone, in my opinion, since there is the small but terrible risk that the person may be stimulated into action instead of this being defused, and it is essential to be in face to face contact in order to monitor for this. But, here, in the interest of understanding, it is worth emphasizing that there is an emotional and physical logic to suicidal feelings. The person who wants to blow their brains out may be feeling an intolerable pressure in the head; the one who wants to jump out of a window may already be experiencing a terrified sensation of falling; the one who wants to take pills and "go to sleep" is already deeply exhausted; the one who wants to walk out into the cold sea is already cold and neglected; the one who wants to suffocate already has difficulty breathing. Often a powerful impulse is being directly blocked. One woman, who had cut her wrists when her boyfriend had left her, recalled in therapy: "When he walked out of the room, I went to the window and watched him go down the street, not looking back. I wanted so much to run downstairs after him and grab him and pull him back to me. But I took a knife and slashed my wrists." Here the turning back of the impulse is clear: instead of reaching out with her hands she "cut them off." Another woman who was not suicidal but would sometimes give herself shallow cuts with a knife, jabbing at herself and muttering "No!", eventually found herself taking a knife to her husband and cutting his arm in a quarrel, though again only shallowly: this was the last time she took a knife either to herself or him, since she understood the impulse once it was directed outward, and was able to resolve the conflict behind it.

Since so many suicidal or self-destructive impulses are in fact "retroflections"—turnings back toward the self of an impulse which is murderous or destructive-this underlines the importance of work to focus anger. Suicide is violence against the self. Even EFA can defuse this by providing a channel for the anger expression, so long as the basic guideline is observed of not trying to create anger where no sign of it exists.

This amounts to a warning to crisis line workers. Although you may feel relieved when a depressed and suicidal person begins to show some determination and anger at the other end of a line, this must be considered a dangerous situation, since you cannot see the person's face and eyes. Although the words may be angry, even relatively focused, the face may be showing panic. The person could become violent to others, or there could be a sudden switch of direction against the self again, this time with more energy behind it. Everything you can do on the crisis line must be to damp down the person's energy. Even focusing should be discouraged if it gets the person worked up. It may be more helpful to suggest ways in which the person can get some care from a friend, or give it to him or her self. More important even than discussing the other person's emotional situation may be suggestions from you which show solicitousness and care. Most desperate people have stopped eating. They need to feel nourished and mothered, to drink or eat something special (with permission to break a diet, if they are on one), or to have a warm bath and the promise of supportive contact tomorrow. They need reassurance that even their suicidal impulses are the result of natural feelings, and do not have to lead to the act. In all this, the more knowledge you have of emotional functioning, the better. But with threats of suicide, EFA measures should only be employed in face to face counseling.