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In the old days of psychotherapy when clients found the courage to share their traumatic experiences in sessions, therapists encouraged a “full steam ahead approach.” This meant allowing clients to vent and be fully caught up in emotional expression. Therapists were reluctant to “hold clients back” or short-circuit their process. In the short-term clients felt relief and a cathartic release. But as soon as that passed many clients were left in a state of emotional overwhelm, often lacking the external support or the internal resources to get rebalanced and soothed. Unintentionally, this was a disservice to clients. They were dysregulated and at times re-traumatized. There was a high incidence of clients needing to be hospitalized after opening the door to their trauma narratives in outpatient therapy.
We've come a long way in the field of trauma treatment. We understand that clients shouldn’t steamroll through their painful histories without a “safety net.” That safety net is made up of strategies to help keep them grounded, fully present, and comforted. Without it, they are more likely to get triggered and experience a rekindling of emotions, thoughts, and body sensations that are reminiscent of their prior trauma. Working with a safety net also means bringing the concept of pacing into the treatment process. Pacing allows the therapist to track and monitor the intensity of a client’s emotional upset. It also helps increase the client’s awareness about how they are genuinely reacting to what’s unfolding in session. When either the therapist or the client recognizes that the session is starting to feel like a “runaway train” there is an opportunity to temporarily “put on the brakes.” This allows for de-escalation so the client can pause and then continue to move ahead, feeling safe in the work as they do so.
As clients gain confidence about their abilities to comfortably navigate their emotions, it will increase the sense of safety they deserve to feel as they continue to find the courage to share painful experiences.
“Putting on the brakes” needs to be handled sensitively so clients never feel disrespected or misinterpret pacing as a minimization of their feelings and experiences. A gentle way to keep the work moving ahead safely involves the use of a solution–focused technique called “scaling.” The therapist pauses the work several times and invites the client to subjectively rank from 0 (totally calm) to 10 (completely overwhelmed) their level of activation. There is an understanding between the therapist and the client that the intensity will not go above a “5.” When it gets close to a “5” introducing things like slow, deep breathing, aromatherapy, rocking or other soothing movements can help calm the body. As clients gain confidence about their abilities to comfortably navigate their emotions, it will increase the sense of safety they deserve to feel as they continue to find the courage to share painful experiences. The irony is, if the work is properly paced the process of temporarily slowing down allows the client to continue moving forward because the work stays emotionally manageable and safe. In the end, they achieve healing faster!
What kind of tactics do you employ in treatment to help your clients "put on the brakes?"
