“She won’t tell me what’s wrong, but she’s been crying for hours and she can’t catch a breath,” said Lisa, the mom of one of my adolescent clients. The client, Anne, lived out of town and was unable to attend an emergency office visit, so a phone session was the only option.

I asked if Anne was suicidal or if she had tried to hurt herself. “No,” Lisa said, “but she won’t calm down. She’s hyperventilating. She refuses to talk to me. She won’t talk to anyone. I don’t think she’ll talk to you,” Lisa said tearfully.

“It’s okay. Put the phone on speaker, and place it by her door,” I instructed.

My first intervention was to empathize.

In a gentle, slow, and compassionate voice I said, “You are hurting. You are hurting a lot. It feels really bad. I can tell.” Anne’s crying softened. “I bet you feel helpless and hopeless. I get it. I’m here,” I said softly. Her sobs slowed down. “I bet you are scared, huh?” Anne muffled, “Yes.”   “I know. It’s hard right now,” I said empathically.