Every clinician has had the dreaded experience of struggling to stifle a yawn during a session. We’ve also sat across from clients who yawn repeatedly in session. Certainly, yawning can signal a lack of sleep. But it can also mean more than simple fatigue and may actually offer opportunities to address clinically relevant issues with the client. So let’s look at how to address “catching flies” – both when it happens to you, the clinician, and when you observe it in your clients.
The Sleepy Clinician or…?
More than one cartoon has poked fun at the psychoanalyst asleep in his chair while the patient is anxiously wide awake on the couch and completely unaware of the nodding therapist. But to a client you see face-to-face, your yawn is not going to be a joke. It will undoubtedly send them a sign you are bored and disinterested, and may leave them feeling rejected or abandoned.
Early in my career, despite my excitement at becoming a therapist, I remember I would occasionally find myself yawning uncontrollably in a session. At first, I started considering the obvious. Sometimes a yawn is just a reminder to sit up straighter, focus your attention, and choose a more alert mindset.
I also considered: Was I tense and restricting my breathing? I began to be more aware of practicing slow, full breathing during sessions. Low-level anxiety can cause shallow breathing, which reduces the amount of oxygen that gets to the brain. Yawning can be the body’s way of deepening the breath and drawing more oxygen into the lungs.
Although I am a very calm person, there was the possibility I was anxious without being aware of it, so I checked in mindfully to see if I was stressed.
When we get through a difficult event, most of us take a big breath of air and let out our stress with the exhale. A yawn may be a similar attempt by the body to achieve this stress reduction, helping us to down-regulate out of the sympathetic or dorsal vagal response into the ventral vagal mode.
I thought about how much sleep I was getting. Was I exercising enough? Was I meditating and managing my stress levels? Consider also your alcohol use, which decreases sleep quality. If you snore, consider assessments for sleep apnea. Clinicians need to maintain their overall health to bring their best, most alert and present selves into each session.
After I ruled out problems with my own attention, health, and wellness, I began to notice a confusing pattern. I could barely contain my yawns with one client, but I had been very alert in the session before and the session after. Why was I so “tired” in just that one session?
I came to learn that yawning does not merely signal fatigue and that perhaps the problem was not just with me. I discovered that we often yawn as a subconscious attempt to calm or down-regulate ourselves but we also do so in an attempt to calm another anxious person.
My unexpected yawning was perhaps my intuitive reaction to the client’s anxiety. This can be confusing because it often occurs with clients whose anxiety is very well hidden. Perhaps the client is over-regulated and presents as constricted or flat in affect. So now when I yawn in session, I check in with myself to see if it is true fatigue, or if it is a response to an anxious but emotionally constricted client.
My yawning now serves as a reminder that I should introduce a deep breathing or mindfulness practice to help the person calm down and to teach them to breathe correctly.
If you’ve considered all these options and are still yawning with a client, you may want to just admit you’re yawning and apologize to the client. After all, most people can identify your failed attempts at disguising the yawn. You may also want to reassure them that you are not bored or disinterested, merely lacking in sleep.
Most importantly, openly addressing an embarrassing situation models good shame tolerance. Your apology will model accountability, honesty, and vulnerability. Many clients are harshly self-critical, lacking in self-compassion, and struggle with vulnerability. So by modeling comfort with admitting that we all do embarrassing things and staying warmly tolerant with ourselves, clinicians can exhibit valuable self-compassion skills.
The Bored Client or…?
A client’s yawn gives clinicians an opportunity to check in on a range of issues, just as you checked in on yourself when you were yawning.
If the client only yawns once or twice, it is probably best to ignore this. But if the yawning is sustained throughout the session, repeats in every session, or is exaggerated, then it should be addressed.
You may want to respectfully check in with the client, such as asking if the room is too hot. Perhaps they didn’t sleep well last night, aren’t feeling well today, or missed their morning coffee. If nothing else, being honest with the client about observing their yawning models authenticity and compassion in therapy. It also saves them the embarrassment of trying to stifle their yawn.
If yawning and fatigue are a regular problem for a client, you may recommend that they check with a physician to address sleep quality problems and to rule out medical issues. Sleep of appropriate length and quality is essential for good mental and physical health, so educating on sleep hygiene is relevant in therapy. I find that many people today have very poor sleep habits, staying up far too late, often driven by the addictive use of video gaming or other technology. Regular sleep patterns and waking with the daylight have been proven to improve mood disorders. A recent study showed that having a light or TV on at night activates the sympathetic nervous system, which heightens anxiety and harms health.
Addressing repeated yawning can also be a great opportunity to educate your clients on deep breathing skills, as explained above.
Many clients with anxiety fidget excessively and this may give you an opportunity to educate them on the negative impact of anxious movement. Teach clients that arousal or fear travels two ways in the body. The brain can send out signals to the body to be alert, as in, “Hey, that looks like a snake on the trail. Get ready to run.” Many people don’t know that this also works in reverse. The body also sends signals to the brain to be on guard. A person who fidgets a lot or carries tension in her shoulders can trigger the brain to become aroused and fearful based only on these physical cues. Yawning may be the body’s way of signaling to the brain that excessive fidgeting has caused anxious arousal, and the yawn is an attempt to down-regulate.
After ruling out the obvious causes, clinicians should consider that many clients are yawning because they are experiencing anxiety related to their experience in session. This provides an excellent opportunity to educate that yawning may be an indicator of anxiety, not just fatigue. You may consider teaching somatic awareness skills so that the person can become more mindful of the body and the felt experience. Helping them notice muscular tension or shallow breathing as signs of stress may allow them to practice self-regulation and self-calming.
Clinicians may also want to directly address what about the therapeutic experience might be causing the client anxiety. This is another opportunity for the therapist to model accountability and good shame tolerance. Ask what you might be doing that is provoking stress. Is there something you are saying or doing that is triggering the client’s anxiety? Are you asking too many questions or diving too quickly or deeply into difficult subjects?
Alternatively, it is possible the client is bored – although they are unlikely to admit this to you. Check in with yourself: are you keeping things energized and moving quickly enough in therapy? If the therapeutic content is surface-level, the client may be signaling their lack of emotional engagement.
While it can be embarrassing, yawning on the part of the client or the clinician presents excellent opportunities to examine and address a wide range of clinically relevant information and situations that may deepen the therapeutic relationship and improve outcomes.