How to Help Clients Tolerate Dysregulation and Come Back From Hypoarousal
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with Stephen Porges, PhD;
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with Stephen Porges, PhD; Bessel van der Kolk, MD; Pat Ogden, PhD; Ruth Lanius, MD, PhD; and Ruth Buczynski, PhD
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This was another excellent presentation! I think I will be able to utilize some of these techniques to be there present with clients and help them tap in to their own bodies and observe and listen for cues to help them realize when they are becoming dysregulated.
Not a therapist but a deep trauma survivor wishing to thank you for what you do! These summaries are very enlightening.
Yes, healing, heals others, our children ancestors and our lives!!
I would have liked more about hypoarousal. These workshops are SO good, thank you. A great reminder to OBSERVE your client – we Therapists are too often in our own heads!
I am a long-term client for treatment of childhood sexual, physical, and emotional abuse,in addition to sexual abuse in adulthood. Your webinars are extremely helpful to me! I’m beginning to get very familiar with your practitioners and wish I could have some sessions with all of them lol. They are all so knowledgeable and kind and compassionate. But my past two therapists have and are terrific! I couldn’t ask anymore from either of them. I wouldn’t be here without them. It also helps to see how educated my current therapist is in treating trauma and how we have using these methods you teach all along. Plus, I can take what I learn from them into sessions for further discussion. To all practitioners I say thank you for your work helping trauma victims! You may never know how much you impact someone’s life 💖
I am a counselor from Thailand. I am interested to learn more about trauma but doing trauma counseling here makes me feel alone sometimes. I did not have any proper learning about trauma counseling, but (with my knowledge about attachment styles) I just do my best to assess them as much as I can. In Thailand, the minimum wage is less than 10 USD per day so most of my clients are pro bono. So, having you sharing this with me is blessed. The time difference is a bit difficult for me but I will try my best to keep up and practice them more in my session. Thank you again.
This information is so helpful. It reiterates much of what I’ve learned here previously, that we are modeling and teaching our clients the self soothing skills in session that they can then apply in daily life. I think the key is catching them when they go outside of the window of tolerance and gently redirecting them into noticing, accepting, and soothing their physiological symptoms. And to remember that just our being a calming presence with them when they are disregulated can help them learn that they can feel safe.
One of the most important points of this video for me was about helping me attempt distinguishing between Bipolar and PTSD symptoms. The description resonated so thoroughly.
As for mindfulness, I use movement like tai chi walking exercises for people who do not want to sit still. (one client described that she was not going to do that sitting stuff and look like a mindless zombie to other people. I completely understood where she was coming from)
I am developing a series of hand gestures that help the breathing practices feel a bit less mysterious. (jellyfish hands, hand hugs etc) . I often use material that contains a section on Window of Tolerance. I speak more about “Window of Well-being” (a more inviting place to create) which also is characterised with “borders” (edges, sills) of tolerance for the the distressing.
I have also rendered 3D the image of the imagery of Window of Well-being by making it less either-or about hyper or hypo. I have a feeling, idea, theory that sometimes when a person has entered the window of hyper, beyond the tolerance, it is so scary that they slip out the back of that part of the window and slide into the hypo window below the Window of Well-being.
I often ask the client to spend some time between sessions drawing what their landscapes the 3 areas of their window of emotional states looks like. One person described it as dark as a coffin, not allowing her to move and not the ice and frozen numbness…
Great information, great session, as always! I am a lay person & a patient.
Everything stated by the speakers and in the research, I can relate and verify, very much!
I even dissociate during the webinars 🙂
I notice it helps when I am being gentle with myself, and not judging my dissociation, also not forcing to get back to reality, but sort of allow and accept, and see if I can come back (because I want to come back).
I am one of those patients that you(therapist)’ll think are 1. self-conscious, 2. intelligent and 3. present, in reality I am none of these (or less than what you think) and you won’t see me suffer.
I’ll describe it to you, but in a detached way. I’ll hide (even the physical) pain. And fall on the floor when I come home.
What else? I wish Pat Ogden were my aunt. 🙂
Thank you everyone at Nicabm, thank you Ruth for making this possible.
Thanks to all the contributors.
Love, Alexandra
That sounds just like me!! Collapse when I get home… I think I too disassociated during the sessions and I am grateful for your explaining or describing how it plays out for you and the idea of non-judgement and acceptance of it all rather than trying to “fix it!” (My words!) praying your find the healing you need
That is interesting. I found the recap videos incredibly helpful. The best way to learn is from repetition. As a French teacher (25 years–with a masters in French literature and pedagogy) I, too, noticed the erroneous information of the MP reference; but, also, as a counselor-in-training with a thirst for knowledge, I did not allow myself to question his credibility or that of the program…because he is not a French literature scholar.
I do clinical screenings and due to screenings being done through video conference, I have stopped focusing on the client’s movements. Thanks for reminding me how vital this is. Also to further explore sleep patterns, now that I know it helps distinguish BPDO from PTSD.
Just want to reiterate how incredible these sessions are – really clear, practical and informative content that is both engaging and manageable given the 1-hour scope of each session. I’ve read many of the authors featured and appreciate the way in which the talks “integrate” their different approaches and perspectives. The practical examples at the end also help to embed the information from the session. Really a phenomenal resource – thank you for making this available & accessible to a wide audience; it is a real public service.
I learned a new approach to help plant seeds that Acceptance is not about liking what you experience, but rather that you are learning to grow.
Or maybe you missed the forest by concentrating on one tree of correct names and places?? Undermining credibility? Only if one is an English teacher giving a prepared lesson. Lol!
Thank you SO much for these ongoing videos. So helpful to me. And I was delighted when she explained how those of us who are not licensed practitioners are welcome! I even mentioned that to my therapist and she agreed.
As a PTSD sufferer, I find learning and understanding about trauma helpfull in understanding what happened to me and what is the effect of the traumas and how they run me, so understanding of it helps in accepting it thats precursor to healing it. The expertise on here is remakable and facilitating it, pulling it together is fantastic. Ty. I just wish can afford to subscribe to have access to all so can rewatch and write notes and learn more and keep the knowledge in mind to work with it daily on myself.
This really reminded me how important it is for me to put my note taking aside and focus on what the client is SHOWING not just what they are SAYING. I have often noticed how clients will walk or engage into session and make a note of that information, but I was not always sure what to do with it, this has helped clarify that for me. I am going to use the observations to help bring the client into an awareness of the bodily information they are presenting and use that for as part of mindfulness practice. I appreciate the summary of information presented between various presenters as it helps my ADHD brain stay on track. Thank you!
There is SO much valuable information in these videos. One little thing that really stood out to me was the way to differentiate between bipolar and trauma reactions through analysis of sleep issues. SO helpful! Thank you for everything. I could say more about what was helpful, but I would be writing a book, lol!
Thank you so much, great information today
Absolutely fantastic, this simplistic clear and underpinning path to Neuroscience, should and needs to be layered into global University Modules. I cant get enough.
Regards
Janet H Willicott (FRSPH)
Excellent session today! Thank you again! In OT, we use sensory integration with young clients with Autism, SPD, and ADHD. They experience a similar, smaller “window of tolerance,” and we meet them where they are in order to expand it. How great to hear similar principles and techniques to reach people in the mental health setting or anytime we notice any of our adult clients “checking out” during their rehabilitation process! We see some similar issues with dementia. The thinking brain is damaged, but their basic needs and “feeling” brain is still online but can become overwhelmed easily. (Maybe I should write a book!)
I do have a question: Is it safe or appropriate to use touch/passive movement with a client if their systems have already disconnected? They may not hear or respond to the mindfulness questions to feel and move their own body. I have had good responses by placing something gentle in their hand (a warm or cool washcloth) instead of touching them directly, which may trigger them even more. I liked the idea of Dr Joan providing a sweater.
Another point that struck a chord with me: an important reminder for us as therapists to remain grounded, use our own resources and remain connected even if the client becomes overwhelming. We are humans too! Thank you!
I am 40 year old female and I suffer from severe childhood and adult trauma. When I was 20, I had my first psychotic episode which led to a diagnosis of Bipolar.
Bipolar is a real illness and has a large genetic component. There are people like me who suffer from severe trauma as well as bipolar disorder. I’ve tried a variety of therapies over the past 20 years now, and it feels very unsafe when a trauma therapist suggests that bipolar is a symptom of trauma. What adds to the fire is when the therapist never speaks of it again, even though bipolar literally affects every moment of my life, and living with it is a huge trauma unto itself.
I recommend a compassionate approach when working with a client who has both trauma and bipolar (or another mental health disorder). Instead of downplaying or ignoring the mental illness, which for me has always led to feelings of shame, inadequacy and being deeply misunderstood, it would be helpful if therapists educate themselves about it and not let it stay the “trauma elephant” in the room.
This was exceptionally helpful. The top down and bottom up approach reminder was helpful but also the parts discussion which happens often especially when the client is raising a child of that certain age where the initial dissociation occurred from their own childhood trauma. Wish you would address this commonality in age of the trauma victims age of their own childhood. Have quite a few on my caseload now. I can utilize my own connection from many trainings over the years, guidance from professors coupled with my own education from personal abuse history, coupled with these suggestions to help guide clients on their right path. Once again timely interventions from all at NICABM.
For some reason, this became clearer why, presently, I need increasing space for my own personal recovery each week, finally setting better boundaries than were allowed in so many internships, full licensure and daily crises interventions. This is so clear as to how agencies need to manage these transitions which can be traumatizing if not handled resourcefully.
I was lucky to have had a dean and other resources who made this clear as to the “how ” we do the work with a Rogerian method in my own interactions. Wish you might discuss this in one of the webinars. Bill Hanlon brings this up a lot. It is not necessary to reinvent the wheel when we had so many wonderful professors in our own histories. I was lucky to have been exposed to many of them. I found the doctorate program finally allowed this consolidation, why the school you frequent is crucial in your training with open, productive and wonderfully questioning professors like the ones often see on these webinars. Thank you.
As both Bessel van der Kolk and Bill O’Hanlon said, the most important for practitioners is first to know how to self regulate in order to remain calm when faced with a hypoaroused patient; to be able to stay with them and be present by paying attention to how they process the traumatic event so we can then reutilise whatever the patient has given us as clues in order to help them learn how to better tolerate the discomfort and to reintegrate the dissociated parts of themselves in a way that works best for them.
And a quote to illustrate this by the psychotherapist Irvin D. Yalom: “I believe ‘technique’ is facilitative when it emanates from the therapist’s unique encounter with the patient. Every course of therapy consists of small and large spontaneously generated responses or techniques that are impossible to program in advance.”
Thanks very much for your help in understanding trauma. Much Appreciated !!
I so appreciate the teachings and the emphasis in therapy of being present with those we work with, and especially being present with ourselves – we as practitioners need to be aware of our own internal and external responses so we can help our clients/patients. I have found mindfulness (breath, body, thoughts, feelings)/meditation/yoga/walking/running and being in nature to be my anchor – and I share these techniques is in therapy. Living mindfully in the present moment is my best teacher! Thank you for emphasizing them and the human nature of the relationships we share. We all need to be seen, heard, and listened too! Thank you.
Thanks very much for your help in understanding trauma. Much Appreciated !!
Your video give me the explainations about “why it works”. I have being practicing something Swami Prajnanpad called “Lying” with my patients for now 35 years. I know it works, but I could not explain how it impacts the brain…
So thank you !
Deep gratitude… I want to thank all the presenters for sharing wisdom, insights and experience. This was such a helpful session.
And I want to thank all of you gold subscribers! From a single mom on a social work budget, with a kid in college on a social work, helping pay for his education while committed to keep learning and growing with colleagues and leaders in this field. Many thanks!
I really appreciated learning that all hypoarousal shut-down states are not dissociative, as I had assumed otherwise. This brings light to my own responses as well as others.
I am sharing learnings with colleagues first, sharing these free links, encouraging purchase, endorsing the invaluable resources provided through the work of NICABM, noticing, being present more myself, and more. Fabulous content you make available to us.
A Huge THANK YOU.
I am a school social worker by day and a therapist by night. These sessions have helped explain from the brain point of view what techniques I use are working and for what reason. It is also giving me more ideas of what to do depending on where my clients are at. One of the biggest ideas I got from today is to talk to my Junior High counselors to let them know how and where to use mindfulness and HOW it helps in dealing with trauma. I may also re-think our CALM room to make it better for our students.
Loved this session! My now deceased first husband suffered from both childhood trauma and bipolar disorder.It was good to learn that his bipolar symptoms of surviving on 2 hours of sleep each night and feeling energized with that level of sleep was more a symptom of his bipolar disorder than childhood trauma effect. I would be interested in learning more about the connection between childhood trauma and possible development of bipolar symptoms later in life.
Thank you so much! I’ve been attending all sessions and they are brilliant. I’m a Yoga teacher and work with COVID patients and help them breathe properly. What I’m learning about the science is fascinating, helping clients through their own trauma and helping myself along the way. I am so grateful to you all who are sharing this information so generously with us.
Thank you. This provided me with very valuable info and insight into treating trauma. This will be very helpful when I work with my students who are have a narrow window of tolerance secondary to trauma.
Thank you for your wonderful sessions. I am learning alot and how to self regulate having suffered significant trauma in my life recently. I know I need therapy to completely heal. Do any of you still practice/take new patients?
Kindly,
Maryjane (maryjanewatt@hotmail.com)
Our company does not offer referrals, nor do we release any information about the practitioners who’ve participated in any of our trainings.
We can, however, recommend that you check out this database through Psychology Today: https://www.psychologytoday.com/us
Through this site, you’re able to search for therapists and support groups based on location, and filter through the results based on a variety of factors – specialties, approaches, and methods.
Alternatively, I would also recommend that you review some of our blogs or free materials and reach out to our community. Many times, both practitioners and patients will comment on our materials, which may help you with what you are looking for.
Many thanks again, Ruth to you and your colleagues for a thoroughly engaging session.
This is opening new areas of thinking for me in my practice. I will use the top down and bottom up approach and keep listening to your broadcast. Thank you for sharing.
For me, one of the incredible takeaways I heard was “getting out of the mind and into the senses.” It triggered fond memories of how I moved through trauma as a young adult and ultimately, how I found Asana and yoga. I will continue to chew on this message. Thank you so much for these conversations!
I visualize my safe place my grandmother’s house.
Thank you!
Brilliant training. It all makes perfect sense and i’ll apply it to my practice in helping my trauma clients. Thank you!
As a lay person who has lived w complex PTSD for 60 yrs, I am feeling the freedom of “conscious manifestation” because of the amazing insights and awareness your organization shares with me.
Your generosity through these free webinars has made the statement “trauma is not a life sentence” very real for me.
With all my heart, thank you and bless you, one and all.
Deborah Roszek
Managed to catch a session tonight really valuable especially the clarity and easy explanation of brain functioning.As a parent this provides an evidence base to how we are addressing trauma in our team, trauma from abuse whilst hospitalised away from family, not within family, a young adult with significant intellectual disability, his are trained in mindfulness to support and intensive interaction, searching for TIC for those with significant LD.
Thankyou
This has helped me to understand my recent experiences after a time of extreme stress. I realise I have been in a dissociative and hypo-aroused state, and reliving traumatic events in the form of flashbacks. I can still do basic everyday tasks, but cannot engage with work. I am so glad to think that I probably don’t have bipolar disorder, and that my current state most likely relates to recent trauma of the last 2 years or so. I get flashbacks of one set of events, but not the others.
A decade plus of physical danger just came to an end for my kids and I, tragically because my ex husband committed murder(attempted)/suicide(actual). Our healing is just beginning, and as an academically-focused person I’ve been pouring myself into how to best help us. So many rich points of content here and thank you – and ideas on what resources and techniques to explore. I feel like the more I know, the best I can quickly get us into the right program.
This training has been so engaging/useful. Does anyone have examples of the bottom-up approach/questions to ask? Wasn’t sure what was meant by 1. help complete defensive action. Thank you so much for providing amazing content.
So interesting! This is my first session to attend, and I recognized students who have been hyper and hypo aroused. I love the ideas of observing and describing and reflecting… but I especially like the ideas of focusing on exhalations..
I am wondering weather the use of exposure therapy in clients with complex ptsd who experience a lot of hyperarousal would be contraindicated. Any responses would be helpful.
..depends on the whether ! 🙂
Sorry I like to joke 🙂
“Lose your mind and come to your senses” was the greatest quote I have heard in a very long time. This will be one of my new mantras when working with early childhood educators. Many of the students I work with have just completed their core classes (theory) but are totally clueless and ineffective in observation, I often say “they don’t know what they are looking at”. I think by better supporting them to “really see” children and their behaviors while reassuring them that all the info they need to connect and support a child is in front of them.
Mindfulness is blooming in the early care and education community, I have been rejecting it (I’m sure as a result of my own personal trauma) but will now become more open to it’s therapeutic benefits.
Thank you again for making this information available to we lay people 😉
So, how do you help the client who find solice/comfort/connection in nature, when nature has been cut down, burned down or lost to war?
..Nature in the Mind …Read to folks about Nature 🙂
I love the direct suggestions on how to help a client to come back into their window of tolerance, such as asking them what is going on and helping them to identify the distress in their body. The rich discussion on recognizing both hyper arousal and hypo arousal was also very helpful.
Client and potential future therapist here. Great session again today, thank you for making these available to anyone. I was particularly interested to hear about neurofeedback and how activities like boxing, playing in a band, etc. can help retrain the brain. I had recently been thinking about learning to play the drums as a way to help reconnect the lower and upper halves of my body and get them to better communicate with each other… I had not thought of the benefits of playing music with others to get better in sync with people in terms of treating my trauma, however, so I am excited to hear about this added benefit and to explore this option as part of my treatment plan.
Catherine,
Bilateral stimulation has been helpful with traumatized patients: walking and drumming are two examples.