There are times when a client may get triggered and overwhelmed in the middle of difficult trauma work.
For some clients this can look like anger, irritability, a rapid heart rate, and other signs of hyperarousal.
But for other clients, you might see them become less and less responsive as their arousal drops. And this unresponsiveness can limit the types of approaches we might normally take with a client.
So in the video below, Eboni Webb, PsyD shares some insights about how she works with hypoarousal.
She’ll tell us how she keeps herself regulated when a client is hypoaroused, and then walk us through a sensation exercise that can help clients come back into their window of tolerance.
Have a look.
And it’s honestly, in some ways, can be very punishing to the clinician because you’re just not sure where to be. And so I think it’s important to discuss various strategies of how do you, as a clinician, resource yourself with a client that’s numb, because they’re not going to give you a lot of feedback when you’re asking them kind of what’s happening or “I don’t really know.” Right? “I don’t know what I’m feeling.” And there’s a flatness to it.
And so what I have found to be very important as a clinician is to have my own grounding techniques, to be able to stay present, to notice when and tracking in my own behavior when I’m starting to get really lightheaded and kind of turning into the observer. And what I found to be really helpful is honestly having… I have like a little pillow in my chair that I kind of press against my chest sometimes and just kind of ground myself; ground down into the floor. And I often lean a little bit more in with my client.
So in general, when I work with clients that are more numb and disconnected, I tend to kind of close a little bit of the proximity to the client. So I actually sit a little bit closer. There’s a little bit of leaning in. Now, we negotiate this at the beginning of our work together, but I often find that my checked-out clients are less checked out when I am in closer physical proximity to them than when I’m farther away. The farther away I get, the more that kind of disconnection kicks in. The reverse is for a client that is more agitated and hyperaroused. I give them more space, which allows them to come down. But a hypo-aroused client I lean in. And we talk about that ahead of time, which helps them ground as well. So it’s kind of modeled grounding, modeled presence that starts to work with that challenge.
So I think it’s important to think about what are the interventions with someone who has in many ways embodied that hypo-aroused response, and that their whole body is collapsed. It’s drawn in. It’s disconnected. So right away, I start working with clients deeply in movement. I want them moving, even just extending their joints and really sensing that. Right? I’m just looking at this extension and feeling that in the body. I spend a lot of time with a hypo-aroused client or a numb client just experiencing sensation. Right? I literally, with one client who was completely disconnected, I went to my… I have a little break room. And I boiled some water and put it in a coffee mug and had her hold in one hand that coffee mug to sense heat. And then, I had some popsicles. This is always a great reward for people with sensation exercises because they could have the Popsicle at the end.
But placing the Popsicle in the other hand and sensing how cold and heat and feeling the dissipation of heat in that sensation. Right? Really helping them learn about how their body responds so that even to be curious about what numb is like, like what numb truly feels like in the body versus kind of the cognitive numb. And so, like holding something really cold for a long to, “Ah, that’s what numb is,” because something that initially starts as numb starts to get painful in some ways. Right? And then, trying to pair an emotion with the sensation. So we do a lot of embodied movement exercises for people who are hypo-aroused and to start dropping the narrative because it’s the narrative that keeps that survival defense activated and we bring more environmental and body stimulation into the healing space.
According to Eboni, working through the body and movement can be key when a client is hypoaroused.
Now we’d like to hear from you. Do you have a client who might benefit from this exercise? What are some other techniques you use to bring clients out of hypoarousal?
Let us know in the comments below.
Extremely useful exercise. Thank you very much.
Thank you for your insightful and interesting tips on proximity and pairing the emotion with a sensation.
Dear Eboni,
Hypoaroused clients have been a challenge to me. There are times I have given up on them, or vice versa! The techniques that you have elucidated are really handy. Moreover, the grounding you have underlined: omg, I almost ignored it and worked like destabilized. Thanks a ton!
Vinod Chebbi, Bengaluru, India
Thank you. That was extremely motivating in terms of potential explorations to collaborate on, with clients who disconnect etc..
Very insightful and useful information. Thank you!
Thank you for this insightful video!
Another technique I have used is to have the client put one hand on their heart and the other on their belly and then have them focus on the rhythm of their breathing and on their body sensations: Are they experiencing any change, what can they notice? How is it different for them when they are able to slow down their breathing and take deeper and longer breaths. They generally feel calmer straight away.
I also have them move or just stand up and feel the weight of their body on one leg, focusing on one foot and then shift their weight to the other leg, focusing on the other foot, just to help them ground some more. That has also worked very well.
Good idea! Stimulate awareness of sifferent senses is helpful.
Very interesting and useful.
Loved listening to her calm, informative information on hypoarousal. Thank you.
Got the right topic for me! It very interesting to hear how Eboni goes into this important topic! Medication also can cause either of these conditions as well as the diagnosis! Thank you Eboni!
Very helpful. Thank you!
Thanks Dr Webb for this technique. I have really been appreciating your DBT presentations.
Excellent suggestions here. Tuning into hot and cold objects is something I’ve not thought of. Thank you.
Very helpful talk, thank you. Since my work is hands on, Energy Medicine, I feel I have many techniques available. First is placing my hands on a clients feet, simultaneously grounding, entraining, and balancing my energy with theirs. Another excellent technique is placing one hand on their heart chakra and the other hand on my heart chakra and intending pure love for my client. Often this client will have a healing release.
Very helpful. Brilliant lady. Thanks
If you are a male therapist working with a traumatized female client, would you still recommend sitting closer and leaning in?
Curious, how is this adapted when your clients are all online?
Very useful, love Dr. Webb’s energy and approach, would be interested in seeing more of her work, any chance she might be offering training at some point?
I like the idea of physical proximity to the client when they are in a hypoarousal state. I agree 100% that it is a lot easier to work with hyperarousal as there are many strategies we can use. I saw with my client who appearred to be passive in the session, I stood up and dragged the chair to be a bit more closer to him, sitting next to rather than against. His engagement was observed improved.
Hypoarousal and its effects on a person are less often addressed than hyperarousal.
I appreciate both the attention paid to the condition and the practical skills a clinician can use to address when it occurs in session, to re-engage awareness by introducing somatic sensation, for both the clinician (via grounding) and for the client (with guided attention to hot and cold).
So very helpful. Thank you! I had not thought about temperature, but what a great cue (and reward, as you mention).
Wonderful speaker!
Ruth, thank you for the introduction to Ebony. Look forward to reviewing her work.
– Wendy Hinch, LCSW