How to Help Clients Tolerate Dysregulation and Come Back From Hypoarousal
 |
with Stephen Porges, PhD;
|
 |
with Stephen Porges, PhD; Bessel van der Kolk, MD; Pat Ogden, PhD; Ruth Lanius, MD, PhD; and Ruth Buczynski, PhD
Sign up for a Gold Subscription
This is a learning community for practitioners. We can’t wait to hear what you’re going to use with your clients
But please do NOT:
- seek advice for personal problems
- ask for referrals
- post links or advertise a product
- post about technical problems
I,m Cristina, 67, from Brazil – a lay person – and would like to share an experience from 35 years ago. I was so anxious (like now) and feeling a kot in my throat and, following some instructions from a practitioner, was to breathe profoundly in a standing position 3 times a day. After some days, a deep cry came out with a sobb and from inside I “thought”… I survived! And was filled with such an energy and aliveness that didn’t know was possible, with a lot of images coming up to consciousness.
As I had lost my mother in a car accident when I was 7 I got the impression I’d just come out from the accident. The problem was that it seemed to me that I couldn’t deal alone with all the emotion stuck for so many years and started a psychoanalysis with someone not trauma informed, which was a total disaster and I froze so completely that I’m still struggle with the consequences and looking for a SE practitioner in my city or nearby.
But I just wanted to say that that breathing practice, while risky, is also liberating, and perhaps if done under a good pactitioner supervision, could be of great help.
And thank you all for keeping such great information available for free so that people like myself can have access to it!
It actually activates my bodymind when we speak of Top-down or Bottom-up
techniques. Top down is thought (mind)…and trauma was perception (body).
Cognitive behavioral therapy seems like group-think,,,it says how you’re “supposed to”
think and act. You may not want to trust or even pay attention to group-think,
supposed-to thinking. Is it always accurate? Then Bottom-up can be purely imaginative–for example,
if your trauma happened very early, you had NO “resources”. These techniques can feel
very frustrating. PTS is an effect, which you have no choice but to accept.
Avoidance can make things worse. I cannot wait to hear your discussion about this.
Overall, pay greater attention to client’s posture, breathing, gestures, engagement in session and share observations with the client and have an open discussion about it. It may also help “repair” client’s early experiences of neglect , of abandonment / not caring , not being noticed , not being taken into account, ignoring needs, etc. Will see how that impacts session.
One of the best moments in therapy is when I was listening so intently, trying to take in and remember what the therapist was saying, and I started to notice that I could not compute what she was saying. It only took her a few moments observing me to say:
‘where are you right now’ – this brought my awareness to the reality that I had drifted off, so I witnessed myself dissociating.
This was a valuable insight into what really happens in dissociative episodes. Created great understanding of myself and also why I didn’t record memory in those states. I literally ‘could not compute’.
I rely on my love of Mother Nature by observing the tiniest details & experiencing the awe sensations within. I love the advice from Pat to slow down our exhales,
Bessel’s meditate & allow small pieces of the distress in to track it in the body while staying in a relaxed state is encouraging. Increasing somatic relaxation throughout my day helps me sleep at night, but I always meditate at bedtime either a Yoga Nidra or chant So Hum/I am or Isha Krya to silence the mind and this the body.
Walking meditations are helpful too..
I’m a retired Woman’s Counsellor who drove Pat Ogden to the Vancouver Airport after taking in her one day training in Chillwack BC -an attempt to heal by being close to Pat as a safe & nurturing therapist!
This was a great webinar! I hope to incorporate more emphasis on mindfulness with my clients who have experienced trauma.
every day i walk to the mail box a 10mn walk on a dirt road. this time in place of thinking i talk loud about how much i was good to my husband dave. remembering the good things and not the things i could have done more or better for him. as loud voice i could as there is no body along the road.
Thank you for everything. Thank you subscribers. On my part, I will try to find a way to link all this, while finding inspiration for a way to ease the concept of mindfulness for someone who would 1) be hypervigilant of hus/her body and afraid (hypocondriac ) to delve into being conscious of breath and body parts, or 2) of being afraid to use positive imaging of beloved places or spaces, etc. for therapy purposes in the fear of tarnishing the memory or moments. Learning about the mechanics of integration is helpful. Every part of this series have been helpful. Deep gratitude.
Thank you Dr. Ruth for your opening message to us non-practitioners: Trauma is not a life-sentence, it does not define us. I also appreciated the examples of returning to our senses, and the story shared by Joan Borysenko, about the woman and her walking through nature and the woodlands, and her art, as a means to becoming rooted and out of her thinking self. Thank you!!
I am a counselor/therapist in NZ and have only watched today. It was so insightful and was a time to reflect on what I am doing ok and what I can add from this. The importance of being present with the client, noticing their breathing, stance etc and how valuable Mindful techniques are. Thank you
Hi! Thank you SO VERY MUCH for this wonderful information! I am a teacher in a university here in Mexico. I have several students who suffer big traumas of different kinds. They all come to me looking for more answers and help because I constantly talk to them to give them resources to heal and become a better version of themselves. Males and females open up and tell me about their pain and worries. I try not to skip any of your lectures, I consider them truly valuable! I can’t afford the golden subscription. Believe me that if I could, I would. But that is why I thank you with all my heart for letting me the access to the free talks. I will make use of this information to help this young people get better and become healthier. Thank you!!! <3
I think there is a small caveat when a client begins or sometimes suddenly descends into a dissociative state, to ask them to describe what is happening for them, what they are feeling, etc. & that is, the client feeling intruded upon or invaded, resulting in fear or anger. “I can’t tell you what’s happening” might be the verbal reaction, if they can tell you. Non-verbally however it might be a startled look, an increased freeze response, a haltered breath, a tightening of the shoulders, etc. How do you help bring a client back from this? Does this happen because the client – therapist relationship is not solid enough or there’s not yet enough trust between therapist & client?
Thank you to the Gold Subscribers & to NICABM for this/these opportunities. Trauma & it’s impact is such an important issue that unfortunately affects so many in our society. While not a therapist, to have some soft skills & by being better informed I can be a kinder, more understanding person, I hope.
Hi,
I’d like to share something from a patient perspective towards practitioners.
Although therapy is the single thing that can help a person to heal from trauma, and although I know the enthusiasm for healing and helping your clients is great, and genuine,
you have to, I think, realise and understand that for many patients, the lack, damage, trauma, is so big, vast, great and longstanding that what you can offer is not sufficient to get them to a sufficiently safe or decent place. Betterment might occur (hopefully), but that might still be far away from a ‘sufficiently safe place’ (i.e. not being in daily suffering, survival, exhaustion, fear, threat, depression, and other).
You are 1 person, you are there once a week or every two weeks, you have to be paid, etc.
You are not a parent, a caregiver, .. which is what some severely traumatised patients would need – they are still 1 year old, 5 years old,.. and have to cope daily in a society that, on every level (work, intimate relationships, neighbours, friends,..), treats them like the 20-year-old,.. 35-year-old.., 60-year-old they physically are.
I am a patient who has managed to navigate for the greater part through and beyond life-threatening trauma. Today, the therapeutic relationship I have is my safe place, the person I trust. It’s extremely valuable. So this message comes from someone for whom therapy is working very well!
I also vividly remember, all the years during which that same therapist wasn’t able to help me. If certain things outside of the therapists’ control wouldn’t’ve helped to get me to a little bit of a safer shore, I might not be alive today.
And I know this is the case for some of my friends and other patients I know.
Do not underestimate the immensity of trauma.
Do not think that your client is or thinks as you are or think. (I know that often the more experienced therapists don’t). Severely traumatised patients, as the experts in this course describe very well, have damaged brains. Damaged brains!
Often, the amount of suffering, isolation and solitude they have endured and still endure, are unimaginable to a safely attached and/or non-traumatised individual. The coping mechanisms they have developed can be misleading you – you might decode erroneously, etc. … You can’t always see it from posture, especially if a person is young(er).
I think it’s important therapists realise that many things need to happen on a societal level, too, if we want to help traumatised people, as a society!
I believe today marks the first time a parent (mother, in casu) has been found guilty of involuntary manslaughter, for the shooting committed by her 15-year old son.
We live in a society where people think even minors are responsible for their own acts and behaviour. Let alone traumatised adults..
This verdict is a step in a right direction, in how I see things. The fact that it’s a first timer, also indicates how society views interpersonal trauma and traumatisation during childhood. As non-existent. The gaslight is immense.
All that being said: Thank you for your work. It is so valuable!!
Of course, this is just a (one) patient’s perspective and a voice among others!
in place of motivating, i will observe myself. i will souse the 2yo girl, i will listen to the 10 yo telling me about what she had to do to get up to par, i will be sympathetic to the 58yo that lost her beloved dave and feel now she is by herself and now 23 years later i will let my present self tell me she can do it,she will cross to the final line saying. i made it.in good health and with “joie de vivre”.
I’m especially reminded, today, of the need to closely observe people, to begin to recognize where they are in the Window of Tolerance. I spend time every week as a chaplain playing music for a small group of trauma patients at a residential facility. Listening today, I started to recognize patterns in some of the people I see every week–both in verbal interactions and while they’re listening to/engaging with the music. I look forward to “noticing” more closely, with the goal of tailoring my interactions accordingly–especially with one woman who seems to experience a wide range of emotions from week to week.
Thank you!
Thank you for a very interesting presentation, I volunteer with a crisis text line and so the emphasis on grounding techniques and using client’s own resources to restore calm was especially helpful.
Thank you for a wonderful session,
This aligns with the yoga, meditation and breathing techniques that I am aware of to help the clients.
Thank you for today’s session. so knowledgeable as usual and especially the part about distinguishing BD vs Trauma related dysregulation.
This was a very productive session. I found it very useful and well explained for me to be able to apply the tools that were discussed.
I have a question: since observing the client is so critical in healing/therapy, can the therapist adequately observe during sessions conducted over zoom; or is there a cost to the ease and use of Zoom sessions for therapy?
Many thanks for these thoughtful/helpful lessons!!!
What excellent programs! I am impressed by how much more knowledge has been gathered in recent years about the effects and treatment of trauma. I am also impressed by the design of these programs, which are so well put together educationally. You guys are doing an excellent job with this.
I am a retired admi nistraror but formally trained counselor. I am so interested in hyposensitive. I recall a mother sending her grade 10 son to me as he was so closed off and she was worried about him being sad and lonely and not engaging. One of the questions I always asked was whether there were any significant (to them) memories of child hood they might want to share. This young man had no memories which was unusual. His body was very stiff and he had trouble turning his head having to turn his whole body to look around. To make my point… when I asked his mother about any significant event she said certainly, the young boy had a serious health problem when young that required at least three major surgeries that were very painful and caused him great fear. She recalled that to survive he immobilized himself as if to say…if I don’t move they cannot hurt me. He was locked into this behavior and his trauma even though the events had passed. I worked with the young man around this issue but now 29 years later I still think of him and wish I had the knowledge shared here today to help him further relax and engage in life in the present instead of the past.
Thank you
Thank you for these talks. The content is so concisely presented and easy to follow and understand. Observation of the client is so important. The P.S.H. healing modality is mainly a ‘bottoms up’ approach where the cause of the issues are addressed first then the symptoms generally resolve themselves.
Firstly, I’m not a practitioner, and I’m tremendously grateful for this free series. I’ve learned a lot from it and might have bought the gold subscription were it not that I’m unemployed. I found the host’s clarifying and organizing of the speakers’ content excellent. I found the pop-ups of the points she reiterated quite helpful, along with all the varying perspectives illustrated. I did, however, find the pop-ups of thoughts and ideas that were alternative to what she was saying distracted me from her words so much that, in trying to take in both I got neither. They were few, though.
Again, thank you.I’m using these sessions to learn and better understand a seriously flawed nephew, and others with what I believe is PTSD. I am retired, not practicing any more, was a LCSW, Associate Professor emeritus and I wish this information would have been available to me sooner. I am grateful that you have made these sessions free to me and others like me. I am currently dealing with personal grief and I am using some of the skills discussed. That was why I originally read Dr.vander Kolk’s book.
I liked the part about Self Regulation .. and how some are so intuitive that we do to help ourselves… someone else somewhere spoke about the self soothing choice needing to match the need and level of the emotion so I think its interesting to figure out what are safe/restorative personal high emotion regulators vs my regulators for lighter stress. I guess that not realizing when a situation is going to send my very hyper or very hypo might cause me to miss the opportunity to intercept adequately before getting stuck in a crash or hyper response.
I’m getting a lot out of this series on trauma. Basel talked about with boxing, martial arts and playing in a band as way that people get into a rhythm with other people and sync with them in the present. This had me thinking about how to move from a widened window of tolerance into what might be called a widened ‘window of action’. That is more flexible ways of being in the presence of other people and engaging with them. It would be interesting to see work that built on this area of human engagement. Taking what might be learned in bodily way from syncing and rhyming with another in the activities Basel mentioned into the realm of how people engage interpersonally on a daily basis in less overtly bodily ways, ie talking to each other, being present in social and work situations with each other. Also, with how people are with the environment.
The key aspect of what I’m thinking about is the stage after attention in the present, mindful awareness, and widening the window of tolerance where a person engages with the external world (and the internal world) in an active way, and how to increase the ‘window of flexible action’.
Thank you , thank you, thank you for sharing this for free and for all the speakers who showed for this event and spoke.
Informative
Validating
Helpful
Encouraging
Empowering
Supportive
Mindful
Careful
Kind
Caring
<3
Thank you all for sharing your expertise with us. It was useful to revisit the Window of Tolerance and the tools/insights to help clients feel safe in their own bodies.
I have always felt intuitively that simply using my sense when sitting with a client was the best way to begin to help them. But I’ve been so indoctrinated into using manualized treatments, that I’ve not always felt comfortable getting out of my mind and coming back to my sense. But I plan to do more of that from now on.
The masterclasses are so useful. Can I still join the Gold Subscription for this series next month when I have funds, even though the masterclass series will have finished?
I hope clinicians will increasingly work with peer support and parent/peer support specialist since these are specially trained people with lived experience who are skilled in the use of mindfulness.
I was reminded during the talk where the client walked in nature and it became a resource for her therapy that I stumbled on this resource, maybe intuitively, when I was working with teen aged girls placed in a children’s home due to behaviors that the families couldn’t manage. There was a wooded park across the street from the home and, having difficulty getting the girls to talk, (even eye contact was perceived as threatening), I took them to the park to walk for their sessions with me. The movement, walking, seemed to open them up and having me near, walking with them on their journey, without having the need for eye contact seemed to strengthen our connection and help them “move” into the work of healing. This talk helped me put together why this worked for the girls. Thank you.
I’m not a therapist, but the mother of a 32 year old daughter, and we live 3,000 miles apart. She has been struggling since her teen years and in and out of therapy for two decades. I have tried and, to date, failed to find an approach that feels supportive to her and in which she feels safe and seen. Her window of tolerance is very narrow – that was an invaluable insight for me. This series has been incredibly valuable. Unfortunately, I was not aware of this program until I received an email from you half-way through this week. I have only been able to watch the last 3 of the 5 sessions. I have taken as many notes and screen shots of talking points as possible, and I feel that I have a good sense of what your have been sharing. I would like to be able to watch the first two modules without having to become a Gold Subscriber, as I am not a practitioner. Please let me know if this is possible – or if you plan to repeat this series. Thank you.
Dear Ruth and colleagues, I appreciate your educational lessons very much and I loved the story of the client who was shivering and was offered a jumper.
Yes, it’s very caring indeed, but as a TRE (Tension and Trauma Releasing Exercises) Provider, I would welcome the shaking as the body is releasing stress by doing so. I was surprised that this somatic expression wasn’t welcomed or encouraged in that way. It so reminds me, and I’ll never forget, when I heard Peter Levine say all these years ago: “Nancy … the tiger …”.
I notice you’ll look into bodywork tomorrow and I look forward to joining you then.
Best regards and thanks again.
Sylvia
I found it helpful to hear the explanation of how to tell if a person is getting little sleep because they have Bi-Polar disorder versus someone who is traumatized and cannot sleep as a result. This will be particularly useful in my work on the national suicide and crisis lines. Many of these callers report difficulty sleeping, particularly those who call after midnight.
Hello all. Thank you for such a well structured presentation that feels like a personal session with each professional presenting. I will be using the information in my volunteer work with incarcerated and formerly incarcerated women. Many suffer from childhood trauma, as well as trauma from adult relationships and resulting addictions.
Healing as a ripple effect. An incentive to do one on one in a caring manner. Thank you for that ending comment.
During the session, the training to watch the body language of the person. I look forward to see how this works in the next session of the limbic system.
If dysregulated, you are not going to have much of a chance of a healing conversation and how to engage to aid in the moment changes as the sweater and shivering. Very interesting.
I am a psychology graduate student who plans one day be a practitioner. It felt like an honor to watch this presentation and learn from experts in the field! I hope to implement these practices in the future. Thank you for the work you do and for sharing this information!
Thank you, this is invigorating information to support what I already know & teach me new ways to look at & work with trauma. I work with survivors of sex trafficking & every woman we have ever worked with comes to us with PTSD. The trauma they have been through is unimaginable. This is going to help me & the other therapists on my team, as well as, others who work with us to help our clients heal. Thank you!
Great ways to identify and work with someone who is dysregulated.
Thank you.
Great information about the difference between disorganized attachement and trauma. Helpled me understand a couple of my clients better.
Thanks,
Sheila Murray
I so appreciate the opportunity to learn all that is being presented. At this point, I cannot afford the Gold Package but hope to in the future. I have thought about taking this program many times but could not afford it. Also the timing didn’t work. I hope you will continue to share & update this information for years to come. Thank you to those who are Gold Package patrons.
As a client, I am gaining insight & understanding about what is happening in my sessions. My therapist is doing what is being presented here, shy of more physical activation (eg. getting up and walking or moving around the office) when I’m out of my Window of Tolerance, which seems to happen often. I often freeze when he asks me to explore the emotions & feelings. I often wish to be making progress more quickly but he has continued to say slow is the effective way to go. I heard this in the previous segment, “How to Work with Traumatic Memory…”. He assures me that we are making progress, though to me, it doesn’t feel that way. It is reassuring to hear this in these presentations.
My therapist has taught me about mindfulness, breath work & has helped me to find ways to seek comfort & regulation both in & out of the office. While I see the benefits of breath work, it is challenging for me to use it since I relate it to the passing of my loving husband. Without consciously knowing, we did a lot of exhaling in his final decline & last days, a way for both of us to let go I suspect. He & I were always very connected & insync, often intuitively knowing what we both needed. In those final days & often without conscious thought, our exhalations were synchronized. It is therefore difficult to use breath work as it reminds me of our love, our connection & of course, my loss. I heard today how important/fundamental using the breath is. Is there a way however when it can also be a trigger? I have shared this in my sessions so we try to use other ways to return out of hyper/hypo-arousal. Wrapping a blanket around my shoulders is one, much like the use of the sweater that was mentioned. Breath work is so fundamental in mindfulness, & self-regulation that I don’t believe there’s a way not to use it. It feels like a self-fulling loop. I understand processing the grief is a part of the picture but in the meantime, I seem to be holding my breath.
Best regards to all & thank you for your contributions.
I’m having the same issue with assigned breathwork from my counselor. Im associating it intimately with trying to help my partner breathe at hospital before he passed… It takes me back to the moments of that trauma and vulnerability making me not want to practise breathing mindfully. Doing walking and sport seems to help though because the healthy breathing intuitively comes on its own without the association.