Surfacing Hidden Suffering

How to Respond to Client Emotions

By Cindy Williams
[Classroom to Client]

COVID-19. Social distancing. Quarantine isolation. Quarantine suffocation. Sickness. Death. Loss of work. Loss of income. Racial injustice. Protests. Violence. Politics. Division. All are challenging experiences that are very real in our world right now. Add all of them together, and the resulting emotions of grief, anxiety, sadness, and fear are left to be navigated. Suffering and overwhelm are given fertile ground to cultivate and grow, sometimes unconsciously. We are all affected on some level; some clients realize it, while others do not.

As clients return to your table, the possibility of emotions rising to the surface as you come into contact with the neuromuscular and fascial structures that hold them is inevitable. How, then, can you support your clients when these emotions arise? If you are a new therapist, you might find yourself on uneasy ground or feel unequipped. You are not a psychotherapist, after all. You do, however, possess a special opportunity to shift the tide toward release and healing by using a few simple, appropriate approaches.

What You’ll See

First, it is useful to be equipped with the knowledge to spot typical signs of sympathetic dominance (the perpetuation of the autonomic nervous system’s innate response to threat and fear). Your client may appear agitated. They could also come in lethargic, which is what happens when the stress load becomes too much and the system of protection tires and/or shuts down. You might also observe dilated pupils, shaky hands, excessive sweating, elevated shoulders, clenched jaw, flushed skin, excited gestures, and shallowness or shortness of breath.

What You’ll Hear

While some clients may be able to identify with the emotions that stem from direct concern regarding the social and political climate, it is possible the emotions might come through stories of seemingly unrelated life experiences. Clients may speak of frustration, disappointment, upset, or sadness related to a spouse, coworker, boss, child, or other community member. One of my clients recently described herself as feeling “broken” without being able to point toward a specific origin for her belief.

Clients might sigh a lot, swear a lot, speak loudly and rapidly, or have a long list of complaints. As long as these aren’t directed at you, it is appropriate to listen and then simply say, “I’m glad you came today to retreat, relax, and take good care of yourself.”

What You’ll Feel

A great way to open a session is to apply a “resting stroke” and quietly feel the inner workings of the body. This involves placing your hands on the client, either cradling the head, holding the feet, or putting one hand on the upper back or neck and one on the sacrum or belly, depending on whether you begin the session prone or supine. Then, simply feel what is under your hands.

Do you feel jitteriness or shaking? How about a rapid pulse or short breath cycle? Is the skin clammy or hot? Notice anything you sense.

Be sure to identify each sensation as coming from the client and separating it from yourself. This helps create an energetic boundary while still being available to the client’s experience. There have been times when I have felt dizzy upon touching a client. Sometimes I’ve had sudden waves of emotion upon initial touch or at points during the session. These experiences are fine as long as you are clear whose emotions are whose.

What You’ll Do

The suggestions presented below are tried-and-true approaches to providing confident comfort and safety within scope of practice at any level of practitioner experience.

Hold Space with Presence

The number-one gift we can give our clients is presence. When we are present, we are with them 100 percent, taking in all that we see, hear, and feel with keen awareness.

When you notice signs of stress, you can acknowledge them without saying a word. The nervous system and the body’s biomagnetic field are highly sensitive and intelligent. When you mentally note the sign and intuitively “speak” to the client’s body, such as “I see your agitation,” “I see you are shaking/flushed/clenching/breathing shallowly,” “I hear your frustration/sadness/anger/disappointment/fear,” or “I feel your tension/rapid heartbeat/jitteriness,” the body will sense your acknowledgment. It will see itself reflected and begin to self-regulate and seek homeostasis.

Another great way to establish a place of presence and safety is to ask the client to take a deep breath into their belly, and then sigh the breath out, letting go of any built-up pressure. You might guide them to say “Ahhh” on the exhale. This invites a shift to the parasympathetic (or rest and digest) side of the autonomic nervous system. It is soothing and releasing. Finally, tell them they are literally in good hands, and you are grateful to provide a retreat from anything outside the room that is concerning them. This is their time.

Hold the Feet

I like to begin and end a session by holding the client’s feet. This creates a sensation of grounding and also directs attention away from the mind’s swirling thoughts. You can also return here at any time during the session. If a client becomes particularly aroused emotionally, you can ask them to describe what sensations they notice in their feet, such as the weight of the drape, soreness, heat, prickling, etc. It immediately redirects attention from head to feet, which is naturally calming.

It also gives an opportunity for you to feel your own feet. If sensations arise within you, as mentioned above (dizziness, waves of emotion, etc.), you can direct that energy current through your body, out your feet, and into the earth so it doesn’t land inside of you, causing you secondary distress.

Adapt Session Pace and Depth of Pressure

The general rule of thumb for adapting the session to your observations is to apply light to moderate pressure at a quicker pace if the client presents with lethargy and depression. Or, if the client presents with agitation or high anxiety, to apply deeper pressure at a slower pace.

Your best tool, however, is to trust your instincts. If you sense the need for slow and deep, give slow and deep. If you sense lighter and quicker, be light and quick. This might also vary throughout the session. Trust. And ask, “Would you like me to slow my pace or speed things up?” or “Would you like me to apply deeper pressure or to lighten my depth?” “Is this OK for you?” is too vague. Be specific. Giving clear options will give you the information you need to focus distinctly on the client’s needs.

Direct Stories Into the Body

Clients might be talkative and unintentionally use you as a counselor. It’s fine to allow clients to express themselves. However, by directing stories into physical sensations, you keep the scope of your work where it belongs—in the body.

For example, if a client is expressing distress, you might ask, “As you say that, what are you feeling in your body?” If this is a new practice for the client, you might make suggestions such as, “Is there tightness in your throat? Butterflies or heaviness in your belly? Tension in your jaw? Do you feel dizzy? Are your fists clenched?” These are common physiological responses to stress.

Then, direct the client to place their full attention on this sensation and breathe space into it. Ask them to give that spot their full focus for 30–60 seconds. Have them report when they feel a shift or change, and then empower them to use this practice anytime they have a high or heavy emotion.

Allow Tears

If emotion surfaces strongly enough for your client to release through tears (even sobbing), gently say, “Please feel free to feel. You are safe and supported here.” Then, slow your pace, place intent of loving kindness into your hands, and simply let it be. No further coaching is necessary, and it is not your job to fix anything, ask questions, or counsel them. Just be there and take slow deep breaths yourself as the emotion moves through.

The Gift of Suffering

The work we do is a gift. As we observe and touch a client’s body, we come in contact with the human spirit. In times of turmoil, we contact suffering. Sometimes this calls it to the surface, makes it conscious, and promotes healing. In the words of Eckhart Tolle in his book A New Earth, “In the midst of conscious suffering, there is already the transmutation. The fire of suffering becomes the light of consciousness.”1


1. Eckhart Tolle, A New Earth: Awakening Your Life’s Purpose, 10th ed.  (New York: Penguin Publishing, 2008), 102.

Since 2000, Cindy Williams, LMT, has been actively involved in the massage profession as a practitioner, school administrator, instructor, curriculum developer, and mentor. She maintains a private practice as a massage and yoga instructor. Contact her at