When it comes to treating trauma, we’re often working with clients who have a low tolerance for distress.
And when faced with traumatic memories or difficult emotions, they may respond by slipping into a state of hypoarousal to defend against the pain.
So in the video below, Janina Fisher, PhD shares how she helps hypoaroused clients come back into their window of tolerance.
Have a look.
Helping a hypoaroused client connect to affect usually results in the client becoming more numb, more hypoaroused. So what I do, and this is really a Sensorimotor Psychotherapy way of thinking, is I increase the activity level and activation level in the room. I laugh a lot. I swear a lot. I’m irreverent, and I see clients who are very numb start to have a little more energy.
Or I’ll say, “Let’s stand up. I’m really tired of sitting.” Because to a hypoaroused client, if I say, “Maybe you’d be less numb if we got on our feet,” that might not work because that client’s numbing is a body defense against more feeling. It’s not going to help if I say, “Let’s stand up so you can feel more,” but if I say, “I’m so tired of sitting. Would it be an imposition, would you mind if we stood up?” Clients usually are very willing to stand up. Then, once they’re on their feet, they have a little more energy.
Or I’ll ask them to switch chairs with me. I say, “I know this is a really crazy request, but could we switch chairs?” Then they could sit in my chair, and they say, “Wow. The room looks really different from here.” Then sometimes they get silly, and they say, “And what would you like to talk about today?” Then they laugh, and I laugh, but we’re not doing something that isn’t therapeutic. We’re increasing their arousal so they’re more in that window of tolerance. They can feel more, but what they’re feeling is a positive feeling. It’s not the kind of positive feeling that’s triggering like pride, happiness, giddiness. It’s a positive feeling at a level that’s not threatening.”
Having concrete strategies to help clients tolerate and process difficult emotions can be key to healing.
So if you would like to find out how the top experts in the field (like Peter Levine, PhD; Pat Ogden, PhD; Ron Siegel, PsyD; Shelly Harrell, PhD; and more) help clients build a greater tolerance for emotional distress, click here.
Now we’d like to hear your thoughts. How do you help clients who have a low tolerance for difficult emotions? Please leave a comment below and let us know.
If you found this helpful, here are a few more resources you might be interested in:
A Body-Based Approach to Managing Difficult Emotions
How to Help Your Clients Understand Their Window of Tolerance [Infographic]
Mindfulness Strategies for Dealing with Distress
Very helpful. Thank you nicabm.
This is an excellent video to show what it would take to bring the client back from external and internal reactions and to change it when dissociating. Thank you.
I can completely relate. While no diagnosis, I have noticed that the experience of a positive feeling often heighten my patients fear and feeling of being safe in social setting to in hypo/hyperarousal/ couldn’t really distinguish between the two at times. I have been told it is anxiety provoking and it could led to a mild depression. Even a reunion with a parent or a close relationship appears to be a threat. Exposure to increase the use of the positive emotions that affect them, has not seem to drop the worry and vigilance that served them so well. Learning to S.T.O.P (pause as Tara Brach has taught in many of her class) has been helpful to most of my patients and become more or less unsettled and see that the threats are not real, and thus stay within the window of tolerance and not zone out as responding in a systematic way. Some of my clients have adapted in their development into adulthood and have learned “tough love”, “don’t care” (again denial, and repressed negatives or positives emotions that haven’t been dealt with at that time) attitudes. I have found it is more difficult to work with them through their willingness to do the work. I am an intern in my third semester and try to using techniques in DBT and ACT (not very successfully) to bring my client back to their here and now and to a more relaxed place. One of my client felt being exposed to the feared situations have only made pain worsen. Thank you for this free course nicabm offers and helps in my clinical practicum.
Love using levity to get hyperarousal or at least the human quality that is really lost lately in interactions due to the masks restrictions and fear for our health. Thanks, Janina
As someone who is easily overwhelmed in this world, and I think going in and out of a frozen/numb/hypoaroused state, I really enjoyed this little video. I can see how these methods would be some good little steps to take with clients who are scared to feel. Thank you for sharing your experience with us. Delightful!
Please tell me why it’s important for you that I deal with difficult emotions. Perhaps God wanted it that because it’s the right way to be and you are causing more damage as in another money pit dr and not putting the rightful blame were it belongs unsupportive others who can’t deal with it either. Perhaps soon we will all be emotionless people. You be careful about disrespecting the sacredness of truly disturbing things And at times it’s right to let sleeping dogs lay so to speak.
You people took an oath that very few of you keep very sad what the medical profession is becoming. I’ll tell you what helped me one more time so I’m clear. Let what is sleeping lay in peace and if you can help bring it back so that it’s sleeping again we’ll consider yourself a loved professional. Deal with that crap you gotta be kidding me it’s not healthy to take on what is obviously wrong and I can prove it with my life story.
To Each Their Own Choice – It is healthy to discover and offer new ways of dealing with Human Distress. For you to be protective of change within one’s bubble of life lived – may well be wise for your-self, I am not presuming I know your trauma in life. It is sad that one needs to desire to raise suppression upon others looking for healing in ways that have been proven successful. If you have found what works for your needs – this maybe good for you. But not everyone may share your opinion.