Helping clients remain within their window of tolerance can be critical to healing. So how can we help clients whose windows have been narrowed by a traumatic experience?

Many great poets have described their emotional experience as an ocean, ebbing and flowing with the tide.

But when it comes to psychotherapy, the poets aren’t far off from how many practitioners are beginning to view the internal experience of distress. In fact, a wave can be a perfect metaphor to help clients understand their responses — and how they move through what Dan Siegel, PhD, calls the window of tolerance.

Take, for example, a young woman who comes to the office to work through some past trauma. A little while into the session, she begins to get agitated. Her anxiety spikes, and she starts raising her voice at the therapist. Eventually, it becomes too much, and the woman walks out. The woman had done therapy before, but never experienced that reaction, so she was confused and frightened by this sudden shift in her emotional experience.

The Benefits of Psychoeducation About the Window of Tolerance

The window of tolerance model can be an easy psychoeducational tool to help clients overcome feelings of shame after trauma.

Think about the woman from our example. Her experience was worsened by the confusion and fear she felt at her own responses. In situations like this, it might be beneficial to help her visualize the window of tolerance.

You see, when we are not in a state of distress, emotions can pass through the window of tolerance like a wave in the ocean — they will build to a crest, but ultimately diminish back into the sea. But a threat response can function like a dam. When a client enters hyperarousal or hypoarousal — the extremes outside the window of tolerance — the emotional wave builds up behind this wall of fear trying to suppress it, and the pressure can become overwhelming.

For clients with a background in biology, we might also explain this within the frame of polyvagal theory. The window of tolerance would relate to the ventral vagus and the social engagement system, whereas a hyperaroused state would be a sympathetic activation response, and a hypoaroused state would be a parasympathetic immobilization response.

In our example, the woman went into a state of hyperarousal, which is often accompanied by the fight-or-flight response. On the other hand, if she had felt particularly numb or gone into a freeze response, that might indicate a dip into hypoarousal.

Either way, it is important for her to understand that this response wasn’t something she chose. It was her body trying to protect her from harm. By helping clients understand why they react the way they do, normalizing the experience, we can ultimately reduce feelings of shame and fear which would only further a client’s distress.

How Trauma Can Affect the Window of Tolerance

When a client has experienced trauma, the window of tolerance can become particularly narrow. That’s because the past is often more vivid and intrusive than the present, making it difficult to stay grounded.

Now, if a client has a wide window of tolerance, they can often manage stress and maintain a sense of control no matter what is happening in their life. But with a narrow window of tolerance, the wave can easily crest over the edge.

When a client has been traumatized, it can be especially difficult for them to stay grounded in the present because the past is more vivid and intrusive. But someone constantly living in their past trauma is primed to detect threat — and enter into that state of defense. That means they generally have a very narrow window of tolerance.

That’s why, in therapy, the key isn’t necessarily to get a client to feel more, but rather to help a client widen their window of tolerance.

But if a client never goes to the edges of the window, they will never experience any dysregulation — which means, they can never learn to regulate. That’s why it’s so important that we guide our clients towards these edges in a safe and controlled way.

Mapping a Client’s Window of Tolerance

But before getting in-depth with the trauma work, it’s important to map a client’s current window of tolerance so we can better predict the outcome to our interventions and adjust them to the client’s integrative capacity.

Now, the DSM^[1] doesn’t provide us with a standard way of assessing how wide a client’s window of tolerance actually is, but according to Ron Siegel, PsyD, there are a few distinct clues we can watch out for.

For example, how open and friendly can this client be towards their inner life?

Some people will mention that they are always on their phones, or that they spend every spare moment watching television. If a client is often immersed in another world, and they spend very little time alone with themselves, it is likely that they are not comfortable within their own internal experience. This would be indicative of a narrow window of tolerance.

It might also be beneficial to ask about how a client has managed feelings such as anger and sadness in the past. If they express that they rarely feel such emotions, they might be rather closed-off to their internal experience as well. Similarly, if a client has a tendency to dissociate frequently, they probably have a narrow window of tolerance.

But it doesn’t just matter how wide a client’s window of tolerance is. It’s also important to know where a client sits within it.

A client who is overheated, suddenly thirsty, uncharacteristically fidgety, or running off to the bathroom unexpectedly is likely tending towards hyperarousal. If a client gets spacy, and is zoning out or just non-responsive to questions, they might be leaning towards hypoarousal.

But we don’t have to rely entirely on these clues. When a client understands the model of the window of tolerance, they often can identify where they spend most of their time — and what triggers a move.

The Window of Tolerance in a Trauma-Informed Approach

Trauma-informed care maintains that no one knows a client better than themselves – and that includes their window of tolerance. So while we can help guide clients through their experiences, it’s important that the client take an active role in their therapy.

That’s why, often, it’s easier for clients to tolerate distress when they’ve chosen their route forward.

By giving clients a model to express their window of tolerance, and explaining the pros and cons of each approach, they can make an informed decision and feel a sense of control around their healing.

Take, for example, a sensorimotor approach. There may be less emotional pain, but it will require a lot of presence in the body, which can be triggering for some clients.

By giving them a choice as to the language and discomfort they are going to experience throughout the therapy, they have essentially agreed to tolerate it, which helps prevent our clients from becoming suddenly overwhelmed.

There are also different paths we might take within an approach, depending on the client’s window of tolerance.

Looking again at sensorimotor psychotherapy,^[2] we can often identify the postures associated with negative emotions or memories. For example, a client dealing with intense feelings of shame might sit with slumped shoulders. If that client has a wide window of tolerance, exaggerating the posture can help us get a better sense of what memories, feelings, images, or words come up. But if a client has a narrow window of tolerance, exaggerating those patterns would likely push them into a state of defense. In that case, it may be more beneficial to attempt the opposite posture, straightening the spine and mindfully assessing how their thoughts or feelings seem different in that state.

Taking a trauma-informed approach to therapy means recognizing the prevalence of trauma in a number of ways — many of which we may not be aware of. So as we learn more about a client’s window of tolerance, we must constantly adapt our approaches.

How to Help Clients Expand Their Window of Tolerance

It’s clear that the key to regulation is a wide window of tolerance. But when a client has been traumatized, they often have a certain amount of reactivity. So, it can be very difficult to stay on the boundaries of their window of tolerance, not over them.

But with any of our work, there’s always the chance that a client will fall into a trauma response. So, the first step in helping clients widen their window of tolerance is knowing how to help them back into it.

So how can we help clients return to their window of tolerance?

Here are three strategies:

• • Increase the energy in the room – As humans, our nervous systems take cues from one another. So, when working with a hypoaroused client, some simple ways to signal an increase in energy in the room include increasing vocal prosody, engaged posture, and a certain amount of joking or irreverence.
  • Physical movement – Another strategy would involve physical movement, like standing up or switching chairs — however, there is one caveat. When a client knows why you are trying to get them to move, their defenses often brace against it. So rather than suggesting they stand to bring some more energy into the room, it may be more effective to say, “I’m so tired of sitting. Would you mind if we both stood for a while?”
  • Body-oriented methods to recenter – On the other hand, if a client is facing hyperarousal — especially if they exhibit a lot of anxiety — they may have trouble finding a sense of containment. In that case, certain body-oriented methods may be helpful in re-centering into the window of tolerance. Take, for example, a teenage girl who is anxious about going to college and got overwhelmed in session. By locating where she feels the anxiety in her body, she can put a hand there to feel a sense of physical containment of the feeling. If the feeling is in her waist or her belly, for example, she might even try wearing a belt in that place to give her a constant sense of containment. That way, the anxiety won’t overwhelm her entire experience, making it easier to tolerate.

Helping Clients Stay Within Their Window of Tolerance Outside of a Session

As we resource our clients to help them stay within their window of tolerance, it is also important to differentiate between state and trait-based resources.

According to Rick Hanson, PhD, state-based resources are externally provided. For example, a client might be able to better manage their emotions in the therapy office due to the environmental cues present. Even the therapist can often be a resource, providing cues of safety through vocal prosody.

Of course, clients won’t always be in our offices when they find themselves in a state of hypo- or hyperarousal. That’s why it’s so important to resource our clients with strategies they can use on their own — or, trait-based resources.

One of the classic strategies involves working with the breath, and using the mindful experience of breathing as an anchor to the body and the present. But for some clients, breathwork can actually be triggering. That’s why Ruth Lanius, MD, PhD, identified several types of imagery that can be particularly effective in bringing clients back into their window of tolerance.

Here are three effective imagery practices for grounding clients:

• • Guided Imagery – To start, in place of breathwork, a client might imagine themselves on a swing, paying attention to the internal feelings of the movement. The rocking motion of the swing actually brings the breath online in a different way, helping to circumvent certain triggers.
  • Positive Containment Imagery – An example of positive containment imagery might be to have a client imagine a chest, or whatever their choice of container might be. Then, they can imagine arranging the intrusive thoughts or images in that chest or container, and locking it securely until they’re ready to process them more fully.
  • Safe Place or Sacred Space Imagery – Finally, there is safe place or sacred space imagery — whichever language speaks to the client. They can base this place on any real, fictional, or imaginary location where they feel calm or content, and can design it at will. By giving the client an image where they have complete control, it can reduce a sense of helplessness or uncertainty in life.

Beyond imagery, sometimes state-based resources can be transformed into traits through a small shift in perspective and some repetition. For example, a state might simply be receiving compassion from another person. Now, obviously, nobody can control others, but we can foster self-compassion to fill that role from within.

Of course, the window of tolerance is just one way of thinking about trauma therapy. However you choose to approach it, remember that you have an impact.

And remember. . .

. . . when you help someone heal from trauma, you can change the course of civilization. That’s because it’s not just that person’s life that changes, but that healing can also have an impact on their spouse, their children, and their friends and colleagues. And that can ripple out to their community, to their state and then to their country, and eventually to the world. What you do is so important.

References

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders
2. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment