“Are you ready to move on to the next tool, Nelson?” you ask softly.
Nelson opens his eyes. He does a single nod in sync with a single blink.
“The next tool is the feelings thermometer,” you continue as you pull out a piece of paper from your clipboard. “I want you to take a guess—what do you think it is for?”
Nelson blinks rapidly, processing the question. “To measure…our feelings?”
“That’s right! Just as a thermometer measures the intensity of the temperature, the feelings thermometer measures the intensity of our feelings.”
“Does it measure when we’re feeling good, or when we’re feeling bad?”
“You can really use it for any feelings you have, but it’ll eventually be most helpful when we’re talking about your stressful experiences, identifying your feelings, and telling others how you feel.”
You hold up the piece of paper. “We can either use this worksheet, or we can draw our own. Do you have a preference?”
Nelson stares at the paper in your hand for a beat. He looks back at you. “I want to draw,” he suggests. “Is that ok?”
“Of course, here’s some paper,” you say as you hand him a pencil and a blank sheet of paper from your clipboard. “Draw a thermometer that covers the whole sheet, and then add 10 lines to it.”
Nelson sketches out a thermometer. His motion is slow and deliberate. “Like this?” he asks after he draws the final, tenth notch.
“That looks very nice,” you remark. “Now add numbers next to each line, starting with 1 at the bottom to 10 at the top.”
Once again, unhurriedly, he writes out each number.
“Great,” you say. “We can use this to measure levels of distress. The higher up you go on your feelings thermometer, the worse you’re feeling.”
“So 10 is the worst!” Nelson cries.
You smile and nod. “Yes, 10 means feeling very, very distressed, almost out of control. How do you think you’d feel when it’s at 1?”
Nelson cocks his head to the side. “Oh maybe just calm and happy.”
“Would you like to label 1 that?” you ask.
Nelson is already writing “happy” next to the lowest notch.
“Good,” you say with a chuckle. “So if 10 is, let’s say, ‘extremely distressed,’ and 1 is ‘happy,’ how would you label the others? What’s 5?”
You spend time with Nelson filling this out. He often is unsure about these intermediate ranges so you guide him through each one until, finally, all 10 notches are labeled.
“All right, we built it all out!” you exclaim. “Let’s talk about how we use it. At which number do you think you should start using a coping tool?”
Nelson shrugs. “Maybe 5?”
“Let’s actually start a little lower, when you’re just starting to be bothered.” You indicate a notch lower. “Let’s say that, if you get to 4, that’s when you should start. We have to remember that, if you get up to 10, it may already be too late.”
“Why would it be too late?”
“Because the higher you go up on the thermometer,” you say as you point up and down Nelson’s illustration, “the harder it is to think.”
“Really?” Nelson inquires, looking a bit surprised.
“Let’s use an example. Let’s say your teacher yelled at you, and then later a classmate said something mean. You keep thinking about this the whole day. You think, ‘Why was he being so mean? I want to go back and punch him,’ something like that.”
“Absolutely” Nelson scoffs.
“You’ll keep being mad,” you continue, “so we can think of the number on the feelings thermometer going higher and higher. Once it gets too high, you may be at a point where you may not be able to think of a coping tool. You may not be able to think clearly, period.”
Nelson shrinks a bit in his seat and looks down at his hands.
“Your emotions would be in control” you conclude. “But what if—”
You suddenly raise a finger which causes Nelson to look up at you. “—after the teacher yells at you, you pause and say to yourself, ‘Oh, I’m at 4 now. I can use a coping tool to feel better.’ Then, you give yourself a chance to bring yourself back down to a 1 rather than let the number keep rising.”
Nelson, mouth slightly agape, nods slowly in understanding.
“This is why we use the feelings thermometer, to catch those emotions and learn to recognize our feelings early.”
“Is it possible…” Nelson trails off. “Is it possible to not have any feelings at all?”
“Sure it is,” you answer. “Why do you ask?”
“I don’t know. Sometimes, I just feel like I don’t.”
You take a moment. It’s not often you get asked about a lack of emotion. “Do you remember fight-flight-or-freeze?”
“Yes,” Nelson replies, without missing a beat.
“There are times when people become so overwhelmed, they ‘freeze,’” you say, dramatically gesturing with your hands. “One way that happens is you don’t feel anything, which is a very common sign of too much stress.”
“Oh…that sounds familiar,” Nelson remarks.
“If that happens, we want to be like detectives. We want to be very aware of what’s going on.”
“Well, how do we do that?” Nelson asks.
“Part of what we’ll do in treatment is help you talk about these experiences and understand how you feel, how you think, and that will hopefully help you to start feeling things more.”
Nelson nods slowly again. “Okay,” he whispers under his breath.
“In the meantime,” you say with a raised voice, encouragingly, “you’ll have to pay attention and check in with yourself throughout the day—asking, ‘Do I feel anything now?’, ‘Do I notice anything?’, and then keeping aware of the intensity on your thermometer.”