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.

RH: So when does it become a problem?

Winch: Guilt is incredibly distracting, and when we’re distracted by feeling guilty, we have trouble concentrating and enjoying life. In fact, we may consciously and unconsciously make efforts not to enjoy things. People can feel guilty for weeks and months and years, so that’s no small pickle. Guilt makes us feel punished. There was a study in which students were allowed to administer electrical shocks to themselves when they played a computer game that deprived a fellow student of a lottery ticket. The device wasn’t connected, but the researchers wanted to see whether the students would flip the switch for such a minor thing, and they did.

RH: What can we do about guilt?

Winch: First, we have to see how maladaptive excessive guilt can be. For example, parents of newborns often can’t leave the house for fear of something bad possibly happening; even if Grandma or some other competent person is there, they feel too guilty to leave. Or the people who squelch their own happiness because their lifestyle doesn’t match the values of their parents or their community, and they can’t take the guilt of living their life the way they’d like to because of what it would do to their parents. When it gets too extreme, this kind of guilt can be very damaging and maladaptive. In other words, guilt does its job when it gives us the signal to reconsider our behavior, but sometimes the signal doesn’t turn off, and we have to learn to turn it off. When we feel guilt about hurting someone, I think the simplest and most direct course of action is to issue a correct apology.

RH: So what makes a good apology?

Winch: One element is a clear statement of real empathy. If you want other people to forgive you, they have to believe that you genuinely understand what you did, that you get what the consequences of that were to them, and that you’re really taking responsibility for your behavior. For example, if you didn’t show up at your best friend’s birthday party because you overslept, saying “I’m really sorry I didn’t come to your birthday party” has no real empathy statement or expression of regret, and probably wouldn’t be well received by most people. But saying “I’m really sorry I didn’t come to your birthday party. I know you must have been very disappointed, and you must have been standing there feeling really bad and wondering what happened to me. It probably put a real dent in your evening. I just feel absolutely terrible.” If your best friend really feels that you get what you did and you’re owning it, then she’ll be able to forgive you. When we omit that empathy statement, there’s a huge piece missing, but when we include it, authentic forgiveness is far more likely.

RH: I noticed your first aid weaves together several different theoretical approaches. Was this a challenge?

Winch: Yes, that synthesis was tough. There’s so much research, and the various theories have so much to say about the various types of emotional wounds. I spent a lot of time whittling down the most relevant material to include. I drew from the narrative therapies and bibliotherapy, lots of cognitive behavioral therapy. There’s also some experiential stuff in there, even systems approaches. The apology component of the guilt piece includes a systems approach, because for your guilt to ease, you need to have the other person get the impact so they can ricochet it back to you. We have a lot of practical stuff in our professional literature. I wanted to weave in as many interesting, different ideas as possible.

I’m one of those therapists who believes that we should be able to offer clients concrete assistance. In my sessions, a notepad and pen are on always on the client’s side of the room. I tell them, “There’s the paper, there’s the pen. Write it down, or you may forget by the time you get to the elevator.”


Ryan Howes, PhD, is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. He blogs “In Therapy” for “In Therapy” for Psychology Today.

Ryan Howes

Ryan Howes, Ph.D., ABPP is a Pasadena, California-based psychologist, musician, and author of the “Mental Health Journal for Men.” Learn more at ryanhowes.net.