How to Help a Client Come Back into Their Window of Tolerance

The window of tolerance is such an important concept when we’re working with trauma and dysregulation.

For clients who have experienced trauma, that window often becomes quite narrow.

They may space out and dissociate, or get too angry or anxious to focus. Or, they might fluctuate between hyper- and hypo-arousal. When they’re too far outside the window, it makes it difficult to continue the work of healing.

So what are some ways to help clients expand their window of tolerance and come back into it?

Ruth Lanius, MD, PhD and Bessel van der Kolk, MD offer some of their insights in the video below. Take a look – it’s under 5 minutes.

You can hear more from Ruth and Bessel this Wednesday, together with Stephen Porges, PhD and Pat Ogden, PhD. They’ll be my guests in this week’s free broadcast of the all-new Treating Trauma Master Series.

We’ll be focusing on How to Help Clients Tolerate Dysregulation and Come Back From Hypoarousal.

It’s free to watch at the time of broadcast; you just have to sign up.

Now we’d like to hear from you. What have you found effective in helping clients learn to self-regulate? Please leave a comment below.

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88 Comments

  1. sam says:

    thank you- great practical suggestion- I work with kids and we practice breathing with bubbles and pinwheels- lots of fun- I tell them when they need to “gets the grumps out of the tummy” they can make believe they are making bubbles or making the pinwheel spin

  2. Har'el Kate says:

    Thank you!

  3. K says:

    I’m really loving this series. I am not a professional, but a would be client. I am educating myself as much as I can to aid my self in my recovery. For someone who is stuck is hypo arousal and suffers extreme dissacosiate, what would the best method for this person to monitor their self and bring them selves out of it? I find that if I can bring myself out I go straight to hyper arousal. I have window of tolerance but I’m rarely in it and the tricky part is catching the hyp arousal and dissacosiation in the first place which is difficult what is the best method to catch yourself instead relying on a therapist for this

  4. Elsa says:

    My thing (as a prof and writer, not therapist) is to bring the focus to thinking, to look at logical consequences when people’s “window of tolerance” does not include tolerance of disagreement. “So what you are saying means . . . “

    • Elsa, not sure if I understood you correctly….?

      I’ve had chronic complex PTSD since I was a child, then again as a teen, young adult, again in 1986, 2007 & 2017 & I can tell you as a thinking educated mature woman, that someone in a full blown PTSD reaction/relapse has absolutely no ability to think or exercise logic.

      When the fight/flight response kicks in the autonomic response completely takes away all control & higher executive function shuts down.

      When I’m having a PTSD flair, NOBODY can reason with me, let alone say, “So what you are saying means…” because I’m either running away in shock, wanting to attack someone, or end my own life.

      PTSD is a horrible curse that attached to my life & robbed me of being able to function in any normal capacity. I cannot tell you how much I’ve suffered, however….

      Yesterday November 1, 2017 was the 1st ray of hope I’ve had while watching the video claiming PTSD was not a life sentence, and that neuro-feedback is sound treatment. I’m very thankful to be taking this course because yesterday was I finally have hope that I CAN get my life back, even at this late age/stage of 61, to hopefully lead a more normal stable happy life. THANK YOU to all the presenters who’s dedication to this field & platform led to my miracle! Which I can now pass on to others!

      The emotional & psychic pain when PTSD is fully activated is beyond description & ability to bare, beyond the ability to tolerate, beyond the capacity for most to want to live through. It completely overwhelms the person. The ONLY successful treatment I’ve found is neuro-feedback long for 3 months every day, which helped me re-connect my shattered self, back into my body/mind/emotions so I could begin to function once again. However that treatment doesn’t last forever, if the person is retriggered, they need it again.

      I’ve tried EVERYTHING to overcome this relentless beast, and the ONLY treatment I’ve found with ANY success is neuro-feedback &/or bio-feedback.

      All the drugs/alcohol to numb or knock you out, so you don’t kill yourself to escape the unbearable pain is only a temporary bandaid to get you through that particular PTSD crisis.

      Unless a person has experienced PTSD for themselves, they simply cannot grasp the catastrophic impact in the person’s life & those around them. I understand why people take their own lives when they have PTSD. Without help they are doomed to a life of painful torture.

      • Gina Donovan says:

        Terry, I, too, have chronic Complex PTSD, and indeed, it is a horrible thing. But there is HOPE!

        I’ve tried EMDR, neuro-feedback, acupuncture, and scores of other things, not to mention medications. The best modality I’ve found is Phoenix Rising Yoga Therapy (PRYT). You don’t need to know yoga postures or be physically flexible.

        Just as Dr. van der Kolk and many others state, trauma is held in the body. PRYT works with the body. I can’t express enough how amazing PRYT is. It has helped me so much, I’ve gone through two years of training to help bring this work to others with PTSD. If you’re interested in this modality, you can go to PRYT.com and find a Phoenix Rising Yoga Therapist in your area.

        Sending you all my best on your healing journey.

        • Thank you so much Gina for responding with this helpful information about Yoga therapy.

          I will make a decision to incorporate this into my lifestyle.

          Thank you again for mentioning it.

          • Gina says:

            You are welcome, Terry. I hope the modality is as helpful for you as it is for me.

            Wishing you the very best,
            Gina

  5. Jacquie Karaca says:

    Feeling the painful emotion on the in breath and blowing it out and leaving it in the room on the out breath. Finding the client’s own self comfort movements. Progressive muscle relaxation. Opposition movement, so practising moving the body in a way that is opposite to hypo/hyper arousal, e.g. opening out the body.

  6. Elizabeth Steinle PA-C says:

    Supporting the patient’s efforts to “change the things I can” is a well-worn principle of self-regulation. It puts the focus on what the patient can do in a simple practical way, getting back into authority over her day to day circumstances.

  7. Tina says:

    I find the stability ball helps likes to regulate. Holding ice can be affective for some as well. Throwing and catching a ball.

  8. I like to incorporate some movement, so I meet them where they are at and then co-regulate them back into their window of tolerance. I work a lot with children so I need to rely more on the non verbals!

    An example I use with children and parents if they are hyperaroused is a yoga breathing technique I call “Woodchopper” it’s great because it combines movement and breathing together. You lift up your arms on the inhale and on the exhale swing down like you’re chopping wood releasing a loud sound as you can! It often makes people laugh too which is a great way to discharge excess energy and connect. It’s nice to hang out with head between their legs at the end of their exhale as this switches them into their parasympathetic nervous system.

    Hope this helps! I’m enjoying reading the comments and learning others tips too! Thanks for hosting this series :)

  9. Rosalind Feldsher says:

    Often do breathing exercises during a session, and have used throwing a ball back and forth.

  10. Leah Stein says:

    Firstly,I’d like to thank you for this series.I am really enjoying it and learning alot. In my practise I help clients do mindful breathing ,being in the moment , notice their thoughts as a neutral observer and with compassion. I help them retrieve memories of soorhing images ,whether it’s a beautiful place in nature or a loving person or pet , I help them locate their anchor in their body that’s the most planted in their chair. All the while I go back to the breathing.i help them get contained in a safe place .we imagine an invisible forcefield around themselves that’s protective of them . After a short while they’re breathing deeply , limbs feel heavy ,and they’re in a very calm peaceful state . It’s from this place that healing begins as we explore the different physical sensations in their body. We identify constructions and expansions and pendulate between the two. Interception and self awareness follows.

    • Leah Stein says:

      Forgive typos. Constriction ,interoception

  11. Helen Carruthers says:

    Deep breathing

  12. Kay Distel says:

    I love ‘the window of tolerance’ notion
    I feel as if I’m among friends and love how the work now has come full circle and the body is acknowledge I feel the work is validated from my original four year body psychotherapy training 30 odd years ago with Gerda Boyesen ‘Biodynamic Psychology’..
    Then as now I listen to the peristaltic gut sounds which indicate the freeing of the emotional stress The quality of the gut sounds is another way of viewing ‘the window of tolerance’ and wyhen working with an individual using touch can monitor the progression and strength of the response. It is an acquired art from that original training which I still use but now more generalised to with facilitating training work with a group.
    Watch for breathing is a fundamental.,At a time when I see the breathing is changing, people may talk about being hungry. Another way is I ask people exaggerate there breathing by blowing out as they drop their shoulders.Using a soft ball underarm to catch the ball – hands out ‘soft hands’ like the cricketers and do it non verbally. this can bring a switch of hemsipheres, help hand/eye coordination and improve regulation quickly.
    Yes play dough or modelling clay is also very powerful. I have one child who hardly ever expressed her creative play other than babbling,can now explain what shes doing while she develops her models.\

    • This explains the increased “passing of wind” when a child is shifting and relaxing in session haha! Biodynamic psychology sounds really interesting. Thanks for sharing

      • Tammy Harris says:

        I am in the process of my PTSD/developmental trauma recovery journey. And, with my SE therapist we have expanded my window of tolerance. A huge indicator for me knowing when my body is again regulating itself now has been the return of & activating of peristaltic sounds/movement. The first time I heard/felt it I was shocked, as I realised it was many months since I had heard that! (After being in a crisis state). And now, when I noticed I’m “off” and “out of sorts” I lay still and in my mind say “I’m here body. I’m listening”. And after a period of time, I feel my nervous system “start up” and go through a series of movements (body initiated) and once I start to hear my tummy grumble I know we’re “away”. And things are settling. And the fearful/dread/anxious tone to my whole being (thoughts and body sensations) is lifted and dissipates. And I feel relief and calm again. And yes…I again start passing wind. Which makes me giggle that my body farts to calm itself. Hehe!

        • You’re not alone LOL! I can relate personally speaking but also professionally I work with children and the play room is nearly always with a faint aroma of farts after sessions. And you can’t get more authentic than children! Thanks for sharing your story. I enjoyed reading it. Inspiring & funny! ;)

  13. Such fun reading all the comments about beach balls! I just finished offering a 3 day professional accreditation training in EFT/tapping in Toronto, Ontario, Canada where we integrated a majority of what this video spoke about. I’m enjoying how this field is becoming more and more integrated. Thank you NICABM, I know that you have contributed greatly to this integration

  14. Elizabeth Scheide says:

    Wonderful information and ideas. Thanks so much. When I was working with children I used kneading and molding of clay as a grounding non-verbal communication by modeling whatever clay shape the child made: round balls, snake shapes, etc. With older children I used Baroque music or coloring books with crayons while I modeled their breathing and then slowed mine (to slow theirs). With agitated or anxious adults I modeled deep breathing while avoiding eye contact and moving my swivel chair rhythmically. I wish I had heard these ideas about the “window of tolerance” and how to expand it back then. How much more helpful I could have been!

  15. Debra Dunbar says:

    never underestimate the power of playdough…especially with children!

  16. As a Primal Therapist we have used exercise such as light jogging to either bring people down into the primal zone by running off excess tension or bring people up into the primal or feeling zone by elevating their repressed or lowered vital signs.

  17. Valerie Feeeley says:

    My initial go to activities include: 1.Thirty second self-calming activities like three long exhales, tensing and releasing set of muscles, sipping a hot beverage. 2. Grounding (right now I see, hear, smell, taste, feel). 3. Diaphragmatic breathing. I find it’s important to get them to practice in session each visit as well as encourage daily practice.

  18. Winona says:

    Mindfulness Meditation

  19. t. shaffer says:

    Perhaps in Buddhism they say “return to the moment” or “follow your breath” to return to the window (or open the window) For instance : Tara Brach uses R.A.I.N. and Pema Chodron uses C.A.L.M. to return to the moment and regulate the breathing of panic.

    My son inadvetently bastardized their acronyms into P.I.N.E. : Pause the panic…Inhale slowly…..Notice the panic…..Exhale slowly and “let go” of or “accept” (panic?).

    For some it is easy to notice that you are no longer in the moment (large window). For others it is impossible (small window). Perhaps meditation is the “exercise” that strengthens the “muscle” that either opens the window or squeezes us through the smallest opening. Or maybe meditation just helps us remember our favorite acronym.

  20. Bonnie says:

    Working with cancer patients I find breathing exercises to be helpful. I also borrowed a technique from a psychiatrist in Wisconsin who has his patients participate in a breathing exercise which calms them and offers an opportunity to discuss issues more thoughtfully rather than emotionally.

  21. Julie says:

    A big soft cushion or even a very big cuddle-able teddy bear can help expand the rib cage and allow more expansive breathing while safely hugging something to protect the threatened abdominal area/viscera/core.

  22. Pamela Blunt says:

    There are so many ways to bring people back to a space that is both present and tolerable. Some clients really lke the em-wave/Heart Math work so much that they buy the device, but even without it the basic approach and practice is very helpful. Autogenic progressive relaxation is a simle method that is easy to learn. Lots of different yogabreathingvtechniques tha clients can reinforce and practice at home with plenty of toutube videos to help them. The main work I offer is different than these though: Sensory Awareness work as taught by Charlotte Selver. It’s focus is more on what is happening versus trying to change it. More about first becoming aware of how we embody any given state in any given moment, following it versus trying to control it and discoverng how it unfolds on its own. How breathing is happening and how we might allow itmore fully in a natural way. Also our relationship with gravity that lets us feel our own weight and the support under us—how mch we are anle or not to let ourselves literally be supported. Also arts-based seems to get us out of a ‘head’ experience that is separate from the rest of our bodies. We tend to get more to the core emotions I think and the arts themselves create a container that crystallzes our experience in very unique ways. Visual imagery, music, movement, sounding, poetry, story-tellng, dramatic play—one or some or all can be explored in spontaneous and dynamic expressions that bring something new into the room. There is a natural window of tolerance that comes when a person chooses what structure feels the safest for them.

    • Pamela Blunt says:

      Excuse the one-finger typing typos!

  23. Mary says:

    Elizabeth thank you for your encouragement.
    If I could just get to a point of being regulated more days than not, I’d like to write a book to therapists. I would tell my life story of trying every possible type of therapy, every possible modality, self help book, workshop, course, retreat, support group, … I’ve “flown to the moon” and back countless times in pursuit of a life worth living.
    By some miracle I’m still alive. Everyone I know has urged me to be a writer. Perhaps my story is worth telling? Perhaps therapists ( and others) would be fascinated by the resilient thread that has kept me trying and trying and trying incessantly all my life? Despite multiple traumas in utero, during infancy and throughout my life?
    I have told myself that I could only write a book once I’m “cured” so as to offer the world my magic potion solution. Yet as I realize more and more, trauma never goes away, it only perhaps gets managed, with hard work and practise. So maybe a spellbinder book success could be achieved by enticing the audience with all the ways I tried and managed to save my own life, one dorsal vagal shutdown at a time…….The cat with a thousand lives.

    • Julie says:

      Mary, you may already have a title there: The Cat with a Thousand Lives.

  24. Roby says:

    I’m a student in a certification program through ROOTS Institute, the education arm of One Heart Wild Education Sanctuary. a 501c3 nonprofit in Silverdale, WA, training to become a certified practitioner of Animal/Equine Assisted Self-Regulation and Self-Development. There we have learned that the basis of our work with clients is the Window of Tolerance, working with a client to understand what that is, giving them tools to figure out where they are in their own Window of Tolerance at any given moment, how they would describe what that feels like, where they feel that in their body, and give them tools to help them come back into their Window when they are feeling dys-regulated, such as breathing exercises, or grounding exercises, or something as simple as taking a walk in nature and asking them to notice and say 5 things they can see, 4 things they can hear, 3 things they can touch, 2 things they can smell, 1 thing they can taste. This gets them out of their thoughts, and into the present moment, after which they can do a breathing exercise to ascertain where they are in their Window, and begin to move forward. Or working on the ground with a client and an animal with whom they resonate, asking them to notice things about the animal, and how that makes them feel as they learn to touch the animal, and breathe with the animal. Often, they walk with the animal, or talk to the animal, or just hug and pet the animal, and sharing the intimate relational moment with another being is so calming that one can see that they have become regulated. At that moment, I ask how they feel and what changes they have noticed in themselves, and ask them to remember how that feels, and suggest that they take a picture of that with their body and their mind and make it a touchstone, an anchor to which they can return when when they are feeling out of tolerance. We have found that this works quite well.
    We use the works of many of the speakers in this series as our textbooks in our curriculum, especially Bessel Van der Kolk’s, The Body Keeps the Score.
    Thank you so much for creating this series as it is so important to understand the neuroscience of trauma….and so much of it also translates to other species! Almost all of our 30+ animals have been adopted/rescued from traumatic situations, and they are healing along with our clients! We also have a trauma-informed, trans-species psychology-informed certification path for Animal/Equine Assisted Psychotherapy clinicians.

    • Julie says:

      Roby,
      So true about other species.
      My husband and I adopted an 11 month old rescue dog two years ago tomorrow. We were told she had a loving home but was relinquished because of her barking in a suburban area (she’s a beagleXfoxhound!)

      From a Day 1 she was utterly hyper-aroused, made no barking or normal dog communication sounds apart from growling and couldn’t bear to be touched. We’ve been on an intense and intensive journey with her, with a dog behaviourists and a local dog club to help. We had to tune into her, and to her triggers.

      We began by using a traffic light guide, rewarding social behaviours when she was in the green zone, coaxing away from triggers when she was in orange zone (we had to be super quick here, with catching green and orange zones to provide positive experiences). Red zone just had to be contained the best we could without further trauma and these were most common and it took awhile to learn what she was reacting to, because it could be a long way off.

      After a couple of months, she began to find her very loud voice and we began to see tiny muscles in her facial expressions and ears. The subtly and range of voice and body language has increased over a year or so. She began to tolerate touch, then enjoy it a bit. Now, she asks for more pats. She used to curl up in a tight ball, now she’s happy to lie on her back or spread out on her side.

      It’s been sometimes heart breaking to realise how much trauma she must have suffered but the reward is a beautiful, expressive, tuned-in dog (with attitude she is safe to express). Occasionally, she gets a fright, or sees a type of person or dog and goes into a melt-down (she isn’t aggressive, she just noisily tries to scare the boogeyman or boogeydog away). These meltdowns used to be daily, now it’s maybe every few months. Many ‘dog’ people who knew her from the start are amazed at how far she has come.

      My background is that I suffered developmental/complex PTSD and complicated grief. While therapy over decades has brought much healing, my relationship with this amazing survivor dog and learning about & tuning into her behaviours, and reading her zones and triggers, has given such rich insight and extra healing and grounding. We have had to be her advocate at times when others had no faith in her. It’s been a tough journey though…Not for the faint-hearted.

  25. I found slow deep breathing helps a LOT to calm the body/mind when a person is in a hyper-aroused state. I help people come out of their head & re-connect to their body by getting them to focus on their heart beating, to assist in self-regulation. This re-introduces them to getting in touch with their internal autonomic functions & self-regulate, after trauma has disconnected their body/mind to far out.

    I have not had success yet, with tapping. Not sure if I’m doing it incorrectly….?

  26. suzann says:

    deep breathing and MINDFULLNESS

  27. Kim McMillin says:

    I am a music therapist in advanced practice. I am a music therapist and RN an LMFT
    Like Bessel, I watch the client and match their energy before I begin. Then I make slow purposeful nonverbal intervention using elements of music.
    I use breathe, movement , singing to them/with them and Drumming.
    Sometimes I ask them to go underneath my grand piano while I play relaxing slow music. It gives them a sonic rest and neurological reset.

  28. Maida Moore says:

    Hi ,

    I am unable to sign on to the free viewing as it happens ….
    I sign up but am unable to find a email to subscribe to in my email /junk mail
    It is very frustrating as i would like to watch them .

    Thanks

    Maida

    • Lauren, NICABM Staff says:

      Hi Maida,

      I’m so sorry for the frustration. I just sent you an email to help. Please let me know if it does.

      And if you didn’t receive my email, please do reach out to us at respond@nicabm.com, or give us a call at 860-456-1153. I want to make sure you get access to the free broadcasts.

      Best,
      Lauren
      NICABM Staff

  29. Terry says:

    I love the ball backwards and forwards-I find balloons are good, especially for kids, as they are able to reach them easily and there is no fear of getting hurt, or being clumsy.
    We play balloon tennis.
    Thanks for the reminder about the window of tolerance. Great to know the ways of helping calm the primitive part of the brain to give clients those practical tips. Working with traumatised children and their carers, this is so important to keep in mind.

  30. Mike Wallace, LPC says:

    I think that breathing techniques are an excellent way to help a client self regulate.

  31. Elizabeth says:

    Mary, my heart goes out to you as you described so aptly your excruciating suffering. Many, many people have complex developmental trauma their history. You are dealing with it so well and are in charge of hurting self, even if it is hard and you need to do it (use helpful soothing techniques) time and time again. Believe me, this is not in vain. The hurt becomes less and less as you grow into a new competent self. Only the memory remains, as a wisdom to be shared. I hope you will truly find yourself when you share yourself in service to others, less fortunate and similarly suffering souls. Believe me living is by far better, and truly the only only option, as you have so much to give, and to receive form other, loving persons. Forget the blaming family. They don’t understand and don’t appreciate. Probably hurting themselves, so expecting more of others.

  32. Kathy Hughes says:

    yes with clients I use breath exercise, TRE tension release exercise (David Berceli) and meditation. I do all these myself too. Post eartgquakes in Christchurch TRE in particular is very effective at returning the body-mind to baseline calm.

  33. Srishti Nigam says:

    Body is where emotions are felt , so Breath with a whooosh sound 2-4-6 rhythm and Tapping as well as mindful walking are excellent ” Bottom Up ” techniques.
    Thanks for excellent tips

  34. Carla says:

    I work with children and we play games jenga, connect four, uno. I also have lots of tactile objects, find toys in rice, create and guess with playdough. This kind of play is non-threatening and really works to help them get into that window and open up! I’ve heard it called INCA (inherently non-clinical relational activity).

  35. Carol Khan Nicholls says:

    I work with children in class. I have found call and response rhythmic clapping is a tool to focus and delight children. Breathing, visualisations centre and calm children and clients. Listening to nature or sounds can help too.

  36. I’ve been studying Organic Intelligence (oganicintelligence.org) for the past three years which is all about human empowerment and nervous system and physiological relation. I think you would find this approach very relevant to your discussions about therapy and trauma.

  37. YES, T have found BREATH calls to BEING…A particular breathing practice, presented as the Governor Vessel Breath, is integrated with the deep relaxation of Spinal Resonance… http://apogeeacutone.blogspot.com/2016/02/spinal-resonance-entrainment-harmonics.html YES, the Window of Tolerance becomes expansive.

  38. Carolyn Marn says:

    Quantum Healing

  39. Laura Brownstone says:

    I found breathing into the belly very helpful as well as 4x4x4 breathing a nice soothing breathing exercise. I try to teach them self calming tech pretty early

  40. joanna says:

    getting them into nature or playing ball, basketball, pingpong, etc..any kind of ball!!

  41. Patricia Eagleman says:

    I enjoyed this video. I think how you describe the process is right on target. In my own life, I have experienced a window of tolerance and it is narrow for those who have experienced multiple traumas. A big bag of different techniques for helping someone learn to tolerate emotional dissonance is really important. Some techniques may work with some, but not others. Sometimes the timing can effect the effectiveness of a technique being used. When someone is outside that window of tolerance, the anxiety, grief, or anger can be too great to hear what someone else is saying, or even see what is in front of them. Even sensation can be totally absent for a time.

    Nature can help bring the intensity down through mindfulness and breathing exercises. Holding a stone or flower can help refocus on the here and now. Guided imagery can help, singing or chanting to one-self. Having the client focus on what is going on in the body when they are unaware can be helpful. Parts being asked to do things can help. It all involves education, practice, and hard work, for every person involved.

  42. Dr Tina Laczko DM MB BS MRCPsych says:

    A previously chosen essential oil;lavender, bergamot, literally ‘grounding’ themselves eg a student doctor in a anatomy dissection room (compulsory to pass her exams) with her mother just having been diagnosed with breast cancer, to focus on her feet grounded on the floor and her eyes focussed on the feeling of the dissecting tools in her hand…

  43. This approach of attention to breathing, walking, movement is exactly what dance movement therapists do.

  44. Rebecca says:

    I am not a practitioner, but a person in trauma treatment. My therapist has these squishable feather throw pillows on her couch that I really like, and that enable me to really REST into the space. If I start to dissociate in treatment, she will often initiate a short game of “catch” with one of these pillows. This is always successful in re-grounding me and returning me to the present and into my body. It is a bonus that I personally have such a fondness for these pillows.

  45. Dana longino says:

    I’m going to start the tub cage breathing at every session
    Thank you

    The area where I practice has the highest incidence of trauma in Los Angeles county so I shall pass this on to staff

  46. Lisa Pinney says:

    For some of my clients even before I do any breathing exercises I offer them DoTerra Whisper essential oil. It’s very calming. Then I can move onto the breath.

  47. Jane Everitt-Walker M.S.W. RSW says:

    I have the god fortune of including horses in my clinical practice with clients. Clients learn to breath by breathing with the horses and while physically feeling the horses rib cage expand and contract. The window of emotional tolerance is also expanded while leading clients while they are riding a therapy horse. The natural bilateral movement of the Horse helps emotional regulation as clients are encouraged to engage there sitting bones, tap to the horses natural rythmn and align head, shoulders, hips and ankles. (Allowing the body to find a place of rest) The warm physical contact with the horse activates attachment hormones which also supports an expanded window of emotionl tolerance.
    These clips are so encouraging and validating. Thank you for sharing!

  48. Doris M. Mason says:

    Thank you.

  49. Another way to use balls – I developed and teach a method of body awareness and myofascial release called Bodymind Ballwork, which is very effective at bringing clients into their body. We use balls of varying sizes and textures, and there are techniques for any part of the body, so we start with choosing one that is within the window of tolerance. The ball creates a massage-like pressure which can be very gentle at first. The client might be sitting in a chair, standing near the wall, or lying on the floor. The client is completely in control of the process, I am just the guide and witness. People experience their body in a new way, with less held protective tension and easier movement.

  50. donna says:

    I find that making direct observations in a calm direct voice and begin demonstrating in my own physical non verbal presence an observable stance for the client to follow.

  51. JANE says:

    KINDLY LEAVE THE TIME OF THE TALKS AS WELL AS THE DATE…MANY THANKS

    • Lauren, NICABM Staff says:

      Hi Jane,

      The free broadcasts are Wednesday evenings at 5pm and 6:30pm ET. We also do additional replays on Thursdays throughout the day at 10am, noon, and 3pm ET.

      Next week will be the last week in the free series, so if you aren’t yet signed up, I hope you’ll do so now! Here’s the link to the registration page: http://www.nicabm.com/treatingtrauma2017/info/?del=custsvc

      If you have other questions, please do let me know — but I do hope this helps!

      Best,
      Lauren
      NICABM Staff

  52. As a Somatic therapist, I consistently use the body as a resource for supporting clients in cultivating more awareness of sensation–of using the body as a resource for “making friends” with sensation, and learning to follow sensation, creating a flow–a dance–with their body’s natural response mechanisms, and then learning how to become “partners’ in that dance. I do this by using mindfulness exercises, sometimes movement exercises, depending on the client’s openness, breathing, and also noting the co-regulation of the therapeutic relationship–supporting them in feeling and receiving my presence as an attuned support person, and inviting them to imagine something like “training” their nervous system as if they were training different muscles in their bodies. I used to be a personal trainer (and massage therapist and dance teacher) so I use a lot of language related to strengthening our bodies as we speak of strengthening their nervous system, their heart…
    I think the reparative therapeutic relationship is also foundation of increasing one’s window of tolerance, since the original inability to regulate emotion most often occurred due to relational trauma and subtle misattunement, we need to heal “in relationship” – so the foundation of my work is also related to personally having a “strong enough” nervous system that my clients can experience the co-regulation that they should’ve felt in early relationships–the modeling that can set them up for successful regulation of their own nervous system.

    • Sibley says:

      Thank you for sharing this information. I will apply it into my practice.

  53. JOSE NAVARRO says:

    Acknowledging the response in both perception and neuroception of fear and engage in a heart centered breathing exercise to establish coherence.

  54. Debbie Davis says:

    Thank you!. I have used this beach ball concept. It is important to figure out if your client is primarily visual, or auditory or tactile. A tactile client would respond to having a blanket or s soft stuffed toy given to him or her. A visual client would respond to paying attention to different colours in the room and a primarily auditory client would likely respond to music or the therapist’s voice.

    The majority of us respond to visual cues (80 percent). Only five percent of the population is primarily auditory, but in my experience, many survivors of childhood trauma are because they had to rely on auditory cues to keep themselves safe.

    Thanks you again for reminding us therapists to respect the client’s window of tolerance.

  55. Nancy says:

    Walking in nature.

  56. Mary says:

    Counting backward from twenty, breathing slowly and deliberately with each number. If I’m very dysregulated, I add things to distract me from my unbeatable emotions of terror such as also observing and naming things in my environment, whether indoor or outside in nature.
    This just happened to me yesterday.
    I was walking home from an errand and the sun had set so it was dark in the city streets. This gave me a gloomy feeling which led me to gloomy thoughts of a future of perpetual intolerable loneliness.
    I began having a crescendo of panic thoughts arpund my extreme fear of my future and fell immediately into suicidal thinking, as often happens, and the panic became quite extreme.it felt like the thoughts themselves would kill me.
    So I began breathing deliberately while counting backwards. Then added observation of the colors of fall leaves at my feet as I walked. A grounding sense of calm wasted over my panic in such a way that I could get myself home without a total breakdown.
    I find this method works in very similar way as having a paramedic who, while helping in a crisis situation, whether for physical or mental only emergency crisis, will say things or ask questions (hopefully with caring soothing and confident voice) to distract the wounded or distressed. This can help distract from the physical or emotional pain quite effectively.
    It’s much harder to do this for oneself of course. Very very hard actually. I am only starting to learn to do thus and it’s taken a lifetime. The block to achieving a calmer state is the background voice screaming that I want to die. So there’s little left in me that actually “wants” to help my situation. Escape from the pain via leaving this painful world entirely is the loudest voice. This voice is excruciatingly terrorizing.
    Thanks for this topic.
    Thanks to all of you therapists who are working hard to help people like me.
    When are they going to change the damaging label BPD to Complex developmental trauma? I know that Bessel van der Kolk has tried but the powers that be at DSM keep blocking it from happening. I pray for the day when he finally succeeds. Then maybe my entire extended family can stop shaming and blaming me, the victim of multiple infancy traumas, including physical and psychological abuse. The label BPD only blames the victim, while the perpetrators are given free reign to blame the victim! Please Bessel, keep working toward changing the BPD label. Thank you. I’m grateful for all this new work being done on trauma.

    • Julie says:

      I agree about the label BPD, Mary. It’s an awful label which doesn’t add any valuable insight into the cluster of symptoms and why they might be expressing in that way.

      As you suggest, the label invites blame especially from non professionals who do not understand the theoretical basis of it. I’ve had this explained by a clinical psychologist a couple of times and still don’t get it.

      Also this label invites self-blame (as if that’s not already an issue!). A non-professional person diagnosed with BPD will hear the bit about personality disorder. Personality has to do with who we are, our identity, how we understand ourselves in relation to others etc. If we get a label indicating a disorder in our personality that just reinforces the sense of being fundamentally flawed and hopeless. Great! Because we really need to feel more of that!

      Now. ‘ dysregulated’ – I can see sense in that term… But not of personality…!
      Dysregulation of some primal neural and hormone driven reactions is not defining who a person is at an essential level & what they enjoy, love etc; but rather how they function in relation to an environmental/social trigger perceived at a deep level as a profound threat.

  57. For hyper aroused clients I ask them to keep their hands where they are and without moving, try to find their pulse in two different areas in their body. I then will ask them what they are currently experiencing relative to 3 minutes ago……

  58. Meg says:

    I coax breathing better — uses rib swing, upper lung as well as lower lung, full exhales — the gap between inhale and exhale. I teach the physiology of breathing sometimes, too. Using a “flat and calm” — Alexander Technique hand I help people have more awareness throughout their bodies, inside and out. I have a floor series of movements — lying on the back — that regulates the ANS. Its called the Daily Dozen and I have used it now with ages 16-90 in universities, acting conservatories, and private practice. It does calm people down, bring them into their bodies, and helps them find better alignment (posture in motion). Sometimes I use tremoring induced by deep breathing and stressed Asanas. I teach Sensory Awareness meditation and walking meditations. Sometimes I call the sensory contemplations. I share people’s books when I feel that this will help. I have found that by teaching people about their structures, their Vagus nerve system, and their brain to body and body to mind connection, they are able to make quicker and efficient and deep progress in their psychotherapy sessions. I am a somatic movement therapist, and support psychotherapy through my work.

  59. Sylvia Saade says:

    I always start a session with “what would make a client feel safe in the session” : physical safety : do they need to change anything in the environment of my office (seating , pictures that the client may find disturbing to him or her …..)
    then safety in their relationship with me as a therapist; what do they need from me…
    then proceed to mindful breathing to expand capacity of self-regulation .

  60. Marcia says:

    From the onset with their paperwork for entry I give clients a handout on handling the five senses and activities they can do if anxious throughout the week to take home. I request they try to be aware of their five senses when they leave the office and also when they come in next week. i have an office at a marina and it is a wonderful restful environment with seals, herons and seagulls to take the assignment to rebuild their connection to the outside world of nature. At the intake of course I find out what they are interested in as far as their activity level and what they are interested in. I also give them an exercise to tap slowly their thymus gland three times times three and to repeat twice again throughout the day, to introduce them to their bodies and calm that area as it often is easily aroused. I also ask them if they do any exercises or any activities or sports to begin to see if there is a physical outlet for their arousal mechanism. It seems to be affective. Of course I play these suggestions by ear depending on what is encountered at the first session. It has been pleasant as they mention it once in awhile as counseling progresses. Some clients have been cut off from their bodies for years. I have been at my office for nine years and I find that ones office is important. I have found drawing calms children down and good avenue for those who have been sexually abused. they seem to like to be drawing when talking about things that are difficult at first as long as we process toward the end, coupled with TFCBT that uses writing. I have had teenagers who have an abuse history who cannot talk about the abuse, but give them pencil and paper and they can write for 20 minutes without stopping. This technique was taught to me and my staff from the local hospital specialist who trained many for years in our area area. We use a lengthy questionnaire to score the many traumas a person has encountered in their life and even though it is focused on sexual abuse mainly, I have used it with many traumas and discover that many come in with a specific trauma but when doing this questionnaires, it is really something else entirely that they realize is the main source of their anxiety. When all else fails I ask them to go for a walk. It worked for Shapiro, and there is a lot of background of that left and right eye movement that helps them calm down, using that EMDR tool. I have always thought it has something to do not just the left and right eye movement but patterning of the arm and leg movements from neonatal work I have done with infants. Just coordinating this arm and leg movement helps with the brain as my music therapy has taught me for coordinating clients thought patterns in their bilateral movements.

  61. I have used tapping (Eft.) And had some incredible results.

  62. Patrice C Queen says:

    I do a healing drumming circle and it help self regulation by making them realize they can learn or create sounds that is calming effortlessly just by trying after learning a few tones. Thanks for the video it explains a lot

  63. GunMarie says:

    Hi, thanks for an exellent seminar.
    I mainly use Meridian tapping, and some bilateral stimulation movements to help clients self regulate.
    And the combonation with TRE, Tension & trauma releasing exercises is very helpful to work ” bottom to top”
    In order to integrate and organize with ’top to bottom’ insights.

  64. Christina heinl says:

    Thank you for this video. I agree that only when the client can feel safe work can start. In very difficult hyper arousal I find it works being quiet, taking care of my own breathing, grounding and center to allow the client to find the safe place. Discreet observation and very slowly introducing calm movements that can be copied

  65. Robert Linton Jr. says:

    Now I can explain to my partner how things are looking for me
    That was very helpful

  66. Jill Keller says:

    Reading prewritten comments about compassion and reassurance.

  67. I have used a variety of distress tolerance activities to assist clients in getting back to the present. Some of these include blowing bubbles, squeezing a stress ball, and breathing exercises. Two minutes of mindfully focusing on something else brings clients back to a tolerable level to proceed with therapy.

  68. Heart Assisted Therapy (J. Diepold)

  69. Anne Hald-McLean says:

    Throwing a ball forth and back
    stand on the floor and jump up and down
    Mention a number of things in the room that are a certain color, etc.

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