Emotional Temperature Awareness or SUD (Subjective Units of Distress) 

First Steps When Starting Therapy

Anyone who has sought therapy, especially since the start of the pandemic, has probably found it challenging to find a provider who has availability and the skill set that you’re looking for. The process is a lot of work even when there’s not a global pandemic, and it can feel stressful and time-consuming. 

At the end of the day, the benefits of finding the right clinician are worth it. So I wanted to first offer some information about how the process works from the practice’s perspective, in hopes that more knowledge will keep you from getting frustrated when you’re seeking therapy for yourself and your family. 

What Happens Behind The Scenes At Seattle Psych Studio 

My goal with every client is to get fired. 

The whole point of my job is to teach clients skills to understand and manage their emotions so they won’t need me anymore. 

Eventually, clients will graduate from therapy and move forward with their lives, or they will taper to fewer sessions per the progress they’ve made. Most of the time, changing a client’s schedule is planned.

An example might be that a client’s spot on Mondays at 2pm is opening starting February 18th. If there’s a client on my waiting list, I’ll offer them the time slot. And if that time slot works for them, I’ll schedule a 15-minute phone call to ensure I offer what the client needs. The particulars of my practice are also discussed during this conversation. 

The first session is a standard intake session. If you’ve been to therapy before, you know the drill. If not, this is where we get to know each other. I’m trained to help clients feel comfortable while seeking details of what brings them to my office. Ideally, at the end, you have a strong sense of my background, how I can help, and the beginnings of a roadmap that will help get you where you want to be.

After that initial session, we hit the ground running. 

The way I see it, my job is to emotionally educate every client. Like I said, my goal is to get fired; to teach clients how to manage their emotions, depression, anxiety, relationship issues, hurt, self-esteem problems, etc, well enough so that they don’t need me anymore. And when they get to that point, it’s an incredible feeling. 

But in order to get to that point, we have to do some work. 

I usually start a new client with two things: 

1. The Emotional Dictionary so we’re on the same page with the definitions of our 8 primary emotions 
2. and Emotional Temperatures or SUD (Subjective Units of Distress) 

Identifying Emotional Temperatures 

Every emotion is on a temperature scale from 0-10, 0-100, 0-5, etc. The metrics don’t matter as long as the client and I are on the same page. Zero represents the most calm and content feelings whereas the highest number represents the most intense feelings. 

A SUD scale is similar to the pain scale you see at the doctor’s office:

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Regarding emotions, I break up the scale into three main categories: Mild, Medium, and Hot:

Interestingly enough, most people who come to my office don't realize there’s a medium zone. Most people know how comfortable mild is and how uncomfortable hot is, but they seem to go from mild to hot without noticing how they got there. ‍

Mild is cool, calm, and collected. You’re probably mild right now. An essential emotional insight is to observe the difference between when you’re mild vs. medium and mild vs. hot. Start by observing the differences in sensations and get familiar with how you feel in each zone. 

For instance, while mild, my heart rate is rested, I don’t have racing thoughts, and I’m not stuck in a category of thought or engaging in thought loops. My thoughts are flexible and moving. I can feel my breath going in and out. I’m not sweaty, and there’s no tension in my jaw. However, I can sense tensions in my body, like the throbbing pain in my upper left molar that may be a possible root canal. Most people don’t seek the therapy I offer if they are mostly in the mild zone. ‍

Medium is harder to identify. I think it’s because many people have brief moments of medium and spend most of their emotional energy in either mild or hot. I’ll use anger as an example. Mild to level 4 could be feeling frustrated. Maybe a co-worker did something that you’ve asked them repeatedly to do differently, but you generally communicate well with the co-worker, so you let it go. A level 5 is when you are starting to feel irritated, your thoughts are more negative — especially about why you’re upset — and you physical feel warmer in temperature. At level 6, you use absolute words like “always” or “never”. By this time, anger identifies who is at fault and your thoughts circulate with name-calling and assigning blame, even if you’re blaming yourself. At 7, you are hot all over your body, head is full of racing thoughts, you have strong urges to do something (fight, flight, or freeze). This level is likely to pass to a hot level 8 quickly.

Most people know, and others are likely to see, when they are in the hot zone. You are not angry; you are livid. Clients often describe this level as the “fuck it” zone — fuck life, fuck you, fuck consequences, “I don’t give a shit”, etc. 

During my teenage years, I spent a lot of time in this zone. And honestly, it doesn’t take much to get me here, even today. I think it’s a myth that abuse or trauma has to happen in order for people to be this way. Not always. For me, it’s a combination of physical sensations and loud thoughts. 

When I’m in the hot zone, no one can tell me I’m wrong. Any suggestion that I am feels intensely invalidating, even if deep down I know that they’re right. 

So if I’m fighting with my sister, and in my mind she’s being a b!t$h, all the times she did me wrong at age 2, 12, 22, 32, etc come back vividly to support my thoughts. You may have heard this referred to as confirmation bias, perception bias, or amygdala hijack. It’s incredibly hard to change your thoughts and behaviors in the hot zone. To those who can, great! To those who struggle, don’t worry, most of us get stuck. 

Of course, I help clients get out of the hot zone. But the real therapy is done in the medium zone; the toughest one to identify. While in the medium zone, or less, you can still slow down your emotions to keep yourself from entering the hot zone. You can still change your thoughts and behaviors, and make wiser choices. The medium zone offers opportunities, which is why it’s so essential to observe and understand the difference between mild, medium and hot.

The message here is awareness. There are different skills for each level, but if you don’t understand your levels, you’re not going to know which skills to use. 

Homework:

Start identifying your mild, medium and hot zones. Ask yourself these questions to start: 

• What are your physical sensations, urges, thoughts and behaviors in each zone? 
• What do you notice are the differences between each zone? 
• What are some behaviors you want to change when you’re in a specific zone? 
  

That last question might be a little tough to reflect on, but here are a few examples of behaviors and reactions you might want to change: 

• Do you text mean things at a level 6 that you might regret at a level 1? 
• Do you abruptly leave the situation or isolate yourself when you’re in the hot zone? 
• Do you slam doors and cabinets or damage property? 
• Do you use substances to soothe yourself? 
  

Remember, you can’t change something you don’t understand. Identifying your SUD levels will help you slow down, take stock, and make different choices.

Tips for parents: 

Using visual charts like this one can be useful in helping your child identify which SUD zone they’re in. My favorite charts are from the movie Inside Out, and can help kids engage more if they see characters they’re familiar with. But it doesn’t have to be fancy. Even something more generic will help your child learn to identify their zones. The key is to start helping them identify the medium zone as early as possible.