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Knowing When They’re Ready: Navigating the Shift from Stabilization to Deeper Work in Psychotherapy

A client who has spent months in survival mode takes a breath and says they are ready to open the box. Something in most of us wants to say yes right away, and that pull is not coming only from the client.

Curt Widhalm, LMFT, and Katie Vernoy, LMFT walk through how to tell whether a client has the behavioral and autonomic stability to move from stabilization into deeper work. Drawing on DBT stages of treatment, EMDR phase two and phase three, and recent research on trauma readiness, they cover what readiness looks like in session and in the week between sessions, how to talk about pacing openly with clients, and what to do when your own eagerness is part of the clinical picture.

This is a continuing education podcourse.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and Claude AI.)

In This Podcast Episode: Assessing Client Readiness for Deeper Trauma Work

Deeper work covers a lot of ground, from small titrated experiential moments through to full trauma reprocessing, and deciding when a client is ready for any of it is one of the least standardized judgments in clinical practice. Move too early and you get dysregulation, post-session distress spikes, and dropout. Stay in stabilization indefinitely and clients stall out, sometimes feeling managed rather than treated. Curt brings the structured version of this assessment from EMDR and comprehensive DBT. Katie brings the less protocol-bound version, built over a career of clinical work with survivors of childhood trauma, where the shift happens session to session and sometimes mid-session.

In this episode, Curt and Katie discuss:

“So in DBT, moving past stage one readiness isn’t measured by a client feeling good for a few weeks. It’s measured by consistency under stress.”

— Curt Widhalm, LMFT

  • Readiness fluctuates. Bendall and colleagues frame readiness as a dynamic state shaped by environmental, internal, and relational factors, which means it gets reassessed rather than established once and checked off.
  • Stabilization is a clinical intervention. The meta-analytic evidence indicates that structured behavioral stabilization before exposure work shortens total treatment time rather than padding it.
  • Eagerness and capacity are different data points. A client can complete grounding exercises, describe their trauma fluently, and still have no autonomic stability under activation.
  • Dual awareness is the threshold skill. Clients need a foot in the present and a foot in the past, and skills practice cannot be treated as a box to check on the way to something deeper.
  • Dissociation planning belongs in the intake. Ask clients directly how they want to be brought back, and build the answer into the treatment plan before you need it.
  • Pacing agreements are co-created. Warning signs, a code word, and a pause signal keep client autonomy intact when the work gets hard.
  • Deeper work has a middle ground. Small, titrated experiential moments sit between stabilization and full trauma reprocessing, and they carry much of the therapeutic movement.
  • Your own activation is clinical information. Impatience, the wish to feel competent, and the pull toward being the hero in someone else’s story all push clinicians toward premature processing.

“There’s a difference between hearing someone’s story, being present, holding space for it, and doing the deeper work of therapy.”

— Katie Vernoy, LMFT

Readiness Changes Week to Week

Bendall, Peters, and Kamitsis (2025) treat readiness as a state that fluctuates rather than a fixed client characteristic, resting on three pillars: psychological safety, meaning autonomic and environmental security; emotion regulation capacity, meaning the active, non-avoidant ability to tolerate distress spikes without turning to impulsive behavior; and concurrence between the clinician’s pacing and the client’s own sense of timing.

Katie’s practical version: the client is more regulated in session, can stay with you when you gently test a harder topic, reports steadier weeks, and feels more capable. The absence of readiness is often easier to see. A client going home to an unsafe situation is not a candidate for deeper work regardless of how ready they feel.

Why Stabilization Is Not a Delay

Prillinger et al. (2024) found that structured behavioral stabilization before exposure shortens treatment rather than prolonging it. Curt puts it in terms clients understand: five extra sessions of skills work can buy a session actually spent processing, instead of two months where eight minutes of activation is followed by fifty-two minutes of bringing someone back into the room. Katie adds the framing that makes this land, which is that skills genuinely do make people feel better and exposure work, at first, makes people feel worse.

Micro-Markers and the Collaborative Pacing Conversation

Two presentations come up often. In the first, the story is coherent and the client is absent from it, closer to describing a television show they watched three weeks ago. In the second, the words keep coming and the emotion builds behind them. Both get the same move: notice out loud what is happening, and when reflection is not enough, get back into the body with movement, mindfulness, or reorienting to the room.

The pacing conversation Curt describes is short enough to build in one session:

  • Warning signs. What tells you your system is slipping out of its window of tolerance?
  • A code word. If we start processing and you shut down, what brings you back?
  • A pause signal. What do we use if either of us needs to step back to stabilization?
  • A dissociation preference, set at intake. How do you want to be brought back? In years of asking, Curt says no client has ever requested finger-snapping.

Having a rehearsed script matters as much as having the agreement. Curt’s version tells the client they are not failing, names that their nervous system is showing it needs a stronger foundation today, and moves straight to what the rest of the session will be spent on.

Resources on Trauma Readiness, DBT, and EMDR

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

(Research citations are listed below.)

Continuing Education Information

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to:

Once completed, your CE certificate will appear in your profile and can be downloaded for your records.

You can find this full course (including learning objectives, handouts, and resources) here: https://learn.moderntherapistcommunity.com/courses/knowing-when-theyre-ready-navigatin-the-shift-from-stabilization-to-deeper-work-in-psychotherapy

Continuing Education Approvals

When we are airing this podcast episode, we have the following CE approval:

Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for continuing education credit as required by the California Board of Behavioral Sciences. Please check with your licensing board to confirm eligibility.

Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.

References Mentioned in This Continuing Education Podcast

  • Bendall, S., Peters, W., & Kamitsis, I. (2025). Towards an understanding of readiness for trauma-focussed therapy in post-traumatic stress disorder: A conceptual integration of empirical data and theoretical constructs. Clinical Psychology Review, 116, 102534. https://doi.org/10.1016/j.cpr.2024.102534
  • Leitch, L., & McCaw, B. (2024). Time to move forward: Resilience and trauma-informed care. The Permanente Journal, 28(1), 188–192. https://doi.org/10.7812/tpp/23.076
  • Lepistö, R., Ahmad, A., Kangaslampi, S., & Peltonen, K. (2025). Clients’ experiences of psychotherapeutic interventions addressing trauma. Psychology and Psychotherapy: Theory, Research and Practice, 98, 149–174. https://doi.org/10.1111/papt.12569
  • Prillinger, K., Goreis, A., Macura, S., Hajek Gross, C., Lozar, A., Fanninger, S., Mayer, A., Oppenauer, C., Plener, P. L., & Kothgassner, O. D. (2024). A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2406662
  • Steuwe, C., Berg, M., Beblo, T., & Driessen, M. (2021). Narrative exposure therapy in patients with posttraumatic stress disorder and borderline personality disorder in a naturalistic residential setting: A randomized controlled trial. Frontiers in Psychiatry, 12, 765348. https://doi.org/10.3389/fpsyt.2021.765348

Relevant Episodes of MTSG Podcast

Meet the Hosts: Curt Widhalm & Katie Vernoy

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

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Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements)

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Hey, modern therapists! We’re so excited to offer the opportunity for one unit of Continuing Education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test, and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.

Katie Vernoy 0:48
Once again, hop over to moderntherapistcommunity.com. for one CE once you’ve listened. Woohoo!

Curt Widhalm 0:54
Welcome back, modern therapists. This is Modern Therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that go on in our practices, the ways that we work with our clients, how we show up as professionals, and this is another one of our continuing education eligible episodes. So, if you want to get your education through us, check out the show notes over at mtsgpodcast.com or listen to the beginning and ending of the podcast. And we’re going to jump into this by saying every therapist knows “the moment.” You know, a client who’s spent months floating in survival mode comes into your office, takes a deep breath, and says, “I think I’m ready to open up that box now. And inside our clinician brains immediately start doing a victory lap. We want to queue up to the trauma vault because let’s be real, after months of teaching people how to take slow, deep breaths, our overachieving therapist souls are starving for the quote-unquote real work. Except we also know that having two stable weeks in a row doesn’t mean a client’s nervous system has signed up for long-term stability. Sometimes it’s just visiting. So this episode is about transitioning into deeper emotional processing. I’m going to talk about this from my background of being in the EMDR world, where I am not only certified in EMDR, but I’m also an approved consultant. I’m also intensively trained in DBT, and we run comprehensive DBT in my practice, Real Honest Therapy. So we’re looking for where the stages of change go from stability into the deeper work. And Katie, you’ve been working with trauma for a long time in your career, and even going back into your community mental health days. So you, you’re no stranger to this work either.

Katie Vernoy 2:55
Not at all. Not at all. I think it’s it’s interesting. I started working with trauma almost from the beginning. I think most of our listeners know that I started work pretty close to 911, and then when I was working in community mental health, there was you know there was a study that was going on on attachment, self regulation, and competency. I’ve I’ve done a lot of trainings and clinical work with with women survivors of childhood trauma and abuse, and so there are a lot of times that that transition from overwhelmed, traumatized, completely dysregulated into that that deeper work is pretty clear, and a lot of times it’s not. So I’m really excited for this episode to talk through what needs to happen and what does the assessment look like when we actually start moving forward. Your work seems more in the structured arena, which I think is good because I think there’s a lot there. I feel like in my work, there’s been more of a dynamic shift that doesn’t have that specific: we’re moving from phase one to phase two, right? So I think there’s there’s some, and I’m and I know that in practice, EMDR and DBT have some of that back and forth. So I’m not saying it’s all, you know, cookie cutter. It’s just there’s very specific things. I think for me, it’s it’s part of the dynamic assessment that happens session to session, mid session that I think are also very important things for us to consider. So I’m I’m excited to participate in this conversation and talk through the structured and less structured ways that we do this.

Curt Widhalm 4:46
So our learning objectives are identify at least three specific clinical criteria that indicate a client has reached sufficient behavioral and autonomic stability to enter deep processing. Two, apply two empirical models from recent peer-reviewed literature to evaluate a client’s dynamic readiness and dual awareness capacity in session, and three construct a four-part collaborative pacing agreement with clients incorporating explicit safety metrics, micro markers of dysregulation, and clinical scripts for returning to stabilization. So, getting into this, I think that in my experience, both as a clinician myself, in the and the clinicians that I supervise, in the students that I’ve educated, a lot of people stumble into this and make mistakes. And I don’t know anybody who has never made the mistake of going into the work too fast. Whether it be something that comes out of you know pressure from the agency that you’re working in to achieve something within a certain number of sessions, whether it’s our own internal countertransference that’s just excited to get into the real deep shit and be able to just kind of get into the work, but not recognizing the harm that can end up happening. And then on the other end is people…

Katie Vernoy 6:20
Crisis of the day, the the constant staying in that superficial “let me stabilize you forever” kind of space.

Curt Widhalm 6:29
Yeah, I was going to describe it as the people who are so scared of doing the other stuff that they never actually get to the real work because they’re afraid of going too far, too fast. So…

Katie Vernoy 6:42
I think there’s that too, but I think there’s also the clients who have so much going on that stabilization feels pretty daunting, and so that that stabilization seems to go on forever. So I don’t know about fear of the deep work, more overwhelmed by the the stabilization.

Curt Widhalm 7:02
So there are a lot of arbitrary timelines that we find ourselves pushing against. We can’t just say do this for X number of sessions, or waiting for a client to say that they feel ready. And sometimes even the clients that say they feel ready can start to decompensate, and the real benefit for you as clinicians is this prevents early dropouts. And when we’re able to find some of the markers that clients are actually ready to move into the deeper work, some of it can be very prescribed. Some of it can be things that just naturally feel like clients are there, and we’ll also in this episode talk about some of the things that we might still want to be able to communicate to our clients that “hey, you know, you say that you’re ready, but we actually are looking for some other markers for you to be ready.” So, one of the articles that I really like in prepping for this episode is by Sarah Bendall, Wilma Peters, and Ilias Kamitsis. This article is titled “Towards an understanding of readiness for trauma-focussed therapy in post-traumatic stress disorder: A conceptual integration of empirical data and theoretical constructs.” This was in Clinical Psychology Review from 2025, and this is really one of the articles that I’ve come across that deals with what is readiness, and particularly in my EMDR type work, where EMDR is an eight-phase protocol. We’ve talked about EMDR in some of our previous episodes. We can throw some references up in our show notes if people are interested more. But essentially, phase one and two of EMDR is introduction of EMDR and grounding stabilization skills. And sometimes for clients that are really well adapted, really well grounded, those can take just a couple of sessions to be able to get through history taking and assess for readiness. Other clients might need a lot more preparation, and phase two work can take quite a bit of time. And a number of factors might go into that. Client stability inside and outside of session. This is not an EMDR episode. We’re not going to train people on EMDR here, but there’s a lot of clinical factors that say phase two can be readily apparent, or it can take quite a while, and sometimes being able to communicate with clients about both how they feel in ready to move to the part that people describe EMDR as just being magic fingers is both the client readiness, but also the clinicians’ understanding about what the client’s readiness actually demonstrates. So we’re going to talk about quite a few of the factors here that are described in this Bendel et all article, but really, Katie is-we’re kind of starting to introduce this. Just a gut feeling. What are some of the things that you look for when you know that a client is ready to move beyond stabilization into some of the deeper work?

Katie Vernoy 10:39
When a client comes into session and they’re more emotionally regulated within session, and I do some a little bit of testing, taking it into some of the topics that are a little bit more challenging, or or even start touching on some of the things that could go deeper, and they’re able to hang with me. So they’re they’re stabilizing within the challenging conversations. I think that’s one piece. I think when I’m hearing that they’re having more productive or stabilized weeks, and they feel more capable. I think that’s another another sign. I think sometimes it’s easier to describe what’s not, when they’re not ready because it’s kind of the opposite. And so I’ve had clients where they weren’t in a safe space, and so even if emotionally they felt like they were ready, their physical surroundings weren’t, they weren’t conducive to it. They were going back into a situation that was traumatizing or or unsafe. They didn’t have stability in their day to day life. Where I felt like they were coping with it, they were moving towards that space, but it was pretty precarious, and so I wouldn’t want to go into deeper work then. And then I think there’s also a client feeling ready, and potentially even asking to go into things further, or getting to that point of kind of talking about the the wanting the next step, or or feeling a little stuck and wanting to to do something different than just cope and stabilize and and resource, and so I think to me it’s it’s both my assessment but it’s also what the client’s saying at the same time, I think is how I’m I’m where I start getting to that point where I want to, where I’ll do more specific testing and specific contracting and and those types of things that we’ll get into in a minute. For you, what are the things that you’re looking for?

Curt Widhalm 12:51
So I’m not going to kind of ramble and reiterate what you just said, but you know, there’s kind of a feeling about things, and I think that part of that feeling is having been honed by working with trauma for the last more than a decade at this point, and so I’m going to point to the research where it actually puts things into these really wonderful packages that I just am appreciative of when people have a way with words. But from Bendall et al, they talk about readiness as a state and not as a trait. That rather than readiness being a fixed characteristic, it’s a stable client. For example.

Katie Vernoy 13:36
Yeah.

Curt Widhalm 13:38
It’s more of a dynamic, fluid state that can fluctuate from week to week based on environmental, internal, and relational factors. In other words, it’s not the clients who are just coming in and saying, “You know what? I’m ready today. I have decided that I am a ready client.” This is more the clients that are able to kind of track themselves and to be able to communicate that there are fluctuations in life, life changes, life is things that are going well, and they’re kind of able to deal with it. And that dealing with it may still require a lot of support from you as the therapist. But being able to track and fluctuate from a week to week and be able to operate is this readiness as a state and being able to participate in therapy. And this leads to what Bendall’s model of readiness is, which has three pillars to it. First and foremost is psychological safety. The client has autonomic and environmental security. So, in EMDR, we talk about is a client resourced both within session and outside of session. Are they able to kind of start to conceptualize talking about trauma without feeling like they need to run out of the room? And when we do talk about things, are they immediately leaving session and decompensating after session? Like they can white knuckle it through a session, but they go home and it ends up just becoming super exhausting for them. So, autonomic and environmental security is something that happens physiologically. It’s something that happens in their environment. It can happen socially. You know, it’s really hard to do EMDR with a client when they’re then going home to the person who’s abusing them and causing their trauma as well.

Katie Vernoy 15:29
Exactly.

Curt Widhalm 15:31
So, these are the psychological safety aspects. Then there’s also the emotion regulation capacity. So the client’s active, non-avoidant capacity to tolerate distress spikes without resorting to impulsive behavior. So they’re not engaging in maladaptive coping mechanisms, whether that be substance-related, whether that be self-harm related, whether that be just completely engaging in any kind of self harm, whether that be self injury, whether that be anything else.

Katie Vernoy 16:08
The challenge I see with some of that is being able to identify what’s adaptive and maladaptive, because there’s a lot of judgment that can happen, and so I think just being able to have the conversation with clients around the coping strategies they’re choosing is really important. Because while for someone scrolling may be maladaptive, for another person it could be adaptive, and so I think it’s it’s those types of things where there’s going to be a lot of nuance in these things. I think the other thing, and I don’t know if this fits here or somewhere else, Curt, but I there are times when someone is processing emotionally, and I think being able to identify how deeply they can go into that in session and what works for them, I think, is another piece to this. So it’s not the work I’m doing, but my client is deeply impacted by what’s happening to them, and they become very tearful. And so the the emotional dysregulation and processing and and those types of things, I think, are another type of depth. Where and and maybe you do this differently, but there are times, especially early in treatment, that I provide autonomy and and empowerment to my client to be able to talk about what they want to talk about. But I also try to titrate it so that it’s not so overwhelming before I I see the resourcing. And so I think that’s a mild distinction. And so maybe this goes later, but I wanted to comment on that because I think there’s this element of we start with coping strategies, and I’ve had some clients, especially when I was working in community mental health, where if you start with coping and how are you stabilizing and all those types of things, they may be ready to have some of that emotional processing and feel like they’re being cut off or they’re being dismissed if you if you’re titrating too harshly.

Curt Widhalm 18:10
So I think both of your points are wonderfully brought up because the third pillar of Bendel’s model is a concurrence between the therapist pacing and the client’s subjective capacity. So I think that you are completely spot on. And the other thing that they bring up in trauma work is that there is a big motivational factor that goes into this. This is the actual willingness of the patient to engage in trauma-focused therapy. And they propose a number of different things, including what’s the actual emotional burden of this going to look like? You know, for something like EMDR or something like distress tolerance in DBT, that it’s going to be, I am going to be challenged in in therapy, whether the patient perceives that the therapy model is suitable for them, you know, if people are coming into therapy and you’re proposing something completely else, this is going back to just good therapeutic alliance, and that deals with the next point, which is: Do clients expect it to work? So outcome expectancy. Some of it is going to deal with the current level of suffering. So DBT has their four stages of treatment for clients who are actively self-harming, actively suicidal. You know that’s stage one DBT kind of work that is not going to be ready to get into the deeper trauma processing aspects that would be more appropriate for stage four. The perceived competence, the belief in their own ability to handle therapy, coupled with the strength of the therapeutic relationship with the provider. So again, we’re talking about therapeutic alliance here. Number one thing that I suggest to people when I am supervising about trauma work is how much autonomy does the client feel? What kind of available social supports do they have, and do they have the ability to recognize problems as they’re coming up? So this is the list of motivational factors that really can impact whether or not a client is ready to move into some of that deeper work.

… 20:31
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Katie Vernoy 20:31
Looking at it from kind of a practical, philosophical standpoint, when someone begins treatment with you, there’s the absolute importance of establishing rapport and creating the relationship, and creating safety within the relationship, as well as making it very clear, especially for traumatized clients, the the level of autonomy that they have. It’s looking at working initially on stabilization, coping strategies, grounding techniques, and even you know the word that keeps coming up is titrating the the processing and the emotional responses to to what’s happened or what what’s bringing them into treatment, and being able to get to a spot where there’s enough safety with you, enough trust in the relationship, and the client has sufficient capacity and a willingness and understanding of what’s going to happen that they can then consent and do the the appropriate contracting and preparation for the deep work.

Curt Widhalm 21:37
Yes, well summarized.

Katie Vernoy 21:40
So I think it’s it’s important to to identify a couple of things where someone’s not ready, or they think they’re ready and they’re not. I think at any point, if if there are life threatening behaviors, if there’s any point at which they are dissociating, and you don’t have special training in dissociation, or the work is not-they’re not able to pull themselves from the work, and you’re not able to to regulate the activation and regulation to keep them in more of a a change space. I’m I’m using some words from Jules Taylor Shore, who we talked about, talked to earlier this month. But I think there’s there’s a lot of signs that even if you’re even if you think you’re ready or even if you’ve started, where you know stepping back or or holding back would be important. I think one of the questions I think that’s that you brought up before the the before we hit record that I think is important to talk about is when clients feel they’re ready and you don’t think they’re ready, and so I’m cueing that up. But I also want to add another one, which is where clients feel like they have to be ready, even if they’re not, and they’re pushing themselves into a space that they think they have to go. They don’t think they have a choice, especially depending on the type of traumatization, where they just they just barrel forward, and it’s really up to the therapist to keep an eye on them and also be, to a certain extent, the first protection related to readiness.

Curt Widhalm 23:29
You’re bringing up some really interesting things, and I think that this is where the continued therapeutic relationship is actually the most helpful. There’s an article by Lepistö et al. “Clients’ experiences of psychotherapeutic interventions addressing trauma.” This is from Psychology and Psychotherapy 2025, and I always like when the data backs up what I am already doing in my practice because then it you know a little bit of a stamp of approval, but for some of this is when clients are pushed too deeply and they’re processing prematurely, they report a breakdown in the therapeutic alliance and they get a lot worse post session distress spikes. There’s urge to drop out, there is dropout, and so the core findings from this article is that the client’s perceived safety and explicit open discussions about readiness are the strongest protective factors against making these kinds of mistakes. And so back to your questions, and if I forget one of them, bring it bring it right back up. But sometimes for the clients that are being, you know, the extra good client, the ones who want to win therapy and are, you know, getting out in front of themselves, just having an open conversation with them that says, “You know, you seem to be ready. You you’re you’re ready for the model that we’re working on. We both agree that you’re a good candidate. The evidence points to you are going to be doing really really well with this. But you’re moving in two weeks to not only a new job, but also to a new living situation, and you’re going to be having a lot of chaos in your life with a lot of instability. Here’s things that we can do while we’re dealing with these additional outside pressures in your life, so that way we’re going into this as successfully as possible and not putting you into a more distressful situation.” Having just open conversations about some of the concerns deals with approximately 95% of the issues that I’ve run into when it comes to these kinds of things that you’re bringing up.

Katie Vernoy 25:56
I think another spot that that needs to to deepen this conversation, for just another minute, is an intake, especially when someone’s coming to therapy due to a trauma. I have a lot of clients that are in the legal in have legal involvement, and there’s there are going to be reports to write and different things, and there is that expectation of when you ask the question, “What brings you into therapy?” And I find for myself being able to touch lightly, give a lot of autonomy, try to get as zoomed out as possible, so it’s not a trauma reprocessing session while they talk through their story and whatever level they’re able to do. I think that’s that’s a very challenging one for a lot of folks. And I think what I’ve done in the past is explicitly say, “I need a little bit of context. We don’t need to go through the whole story, but you can tell me whatever you want. If this starts getting really hard, we may need to stop, and we’re going to be able to, and we’ll work on on getting some coping strategies on board. So it’s it’s we’re able to do what we need to do here. But it’s very challenging, and and I think this is one of the things that we’ve talked about the pressure, the outside pressures of what what do we need to do? I think it’s making it very clear that even if you’re sharing information, you don’t have to share information that pulls you out of your window of tolerance or your window of capacity. And I think that’s mind blowing, especially to folks who’ve been in the legal system in some way. There’s a whole bunch of non-trauma informed people that have just said, “So then, what happened? And what happened next? And what are we doing? You know, and so there’s this this element of compliance. Not even I want to win therapy, but I don’t know what I’m empowered to do and not do. I’m not. I’m. I don’t know what I can. What’s possible? And so I think I want to just keep reiterating: we are the the the protectors of that, because clients don’t know. This is not their area of specialty. And even if even if you have a therapist who’s a trauma specialist who’s coming in for trauma therapy, it’s not their responsibility to make sure that they have the capacity to navigate the stages of treatment, that’s still a therapist’s responsibility.

Curt Widhalm 28:30
And I think that depending on the level of dysregulation that a client’s bringing in, as much as we are trying to give client autonomy in this, it’s our responsibility to show them here’s the autonomy within the appropriate level that you’re at. And and I know that there’s a big movement within all of our field to defer to clients and and their expertise in themselves, and I stand behind that, and we’re still the professionals in the room because if you know, I’m going to switch over to the DBT hat here for a moment. If clients are engaging in a lot of life-threatening behaviors, suicidality, non-suicidal self-injury, we have to eliminate those Category One behaviors before we can start managing Category Two behaviors. That we need to be able to respond to the actual crises that are going on, and to let clients know this is the stability that we’re looking for. So that way, we can then move on to non collaboration. We can move on to dealing with other therapy interfering behaviors that are more appropriate at that time. Because if we’re tasked with helping keep people alive.

Katie Vernoy 29:46
Yeah.

Curt Widhalm 29:47
That is going to be something that we need to do before we can really move into category three and category four behaviors, and getting to you know the Winnehan language, moving out of out of, out of control misery into quiet desperation and being able to do things more in a quiet internal emotional processing rather than kind of an outside management when a client’s life is actively on fire.

Katie Vernoy 30:16
With some of this, I think looking at readiness as they’re not, life-threatening behaviors are not present. Therapy interfering behavior is absent or or minimal. There are not practical safety issues. There’s the ability to have some emotional stability. You know, kind of the balance of activation and regulation. I think the the the other one that you’re kind of inferring is being able to use their skills in DBT. It’s DBT skills, and others it’s just you know vanilla coping skills. Other things that I think are are really important is being able to get outside of yourself, Jules Taylor Shore calls it observing mind, witnessing mind, and you had also talked about for EMDR dual awareness, and so maybe you can talk a little bit about what that looks like and how that’s prepared for.

Curt Widhalm 31:19
At its simplest, dual awareness is being able to be in the moment and be able to revisit trauma in the past, and you know this is

Katie Vernoy 31:31
And hold both, both at the same time.

Curt Widhalm 31:33
And hold both, yeah. And a lot of this is straight out of the research on classic PTSD. So people who are at risk for going into reliving an experience is what we’re ultimately hoping to treat. But if people are not able to really approach that without the tools to be able to ground with themselves, bring themselves back to the moment, that ends up becoming where you need to prioritize your treatment is working on those skills, so it’s having a foot both in the now and in the past. And sometimes clients who are really motivated to be able to get through therapy, I have all of the love and respect in the world for clients who want to feel better, and I want to help them get there, but sometimes there are some of these stabilization techniques that we have to do that have to go before exposure work. And…

Katie Vernoy 32:34
And and they to be fair, they actually do make you feel better. The exposure work is going to make people feel worse, at least initially. It’s it’s it’s the long game. The short term game is that are all these skills.

Curt Widhalm 32:49
Well, and there’s an article by Prillinger et al. “A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder.” So I know that you brought this up within EMDR, but I think, at least my reading from both of these worlds, this applies to both. But they talk about that stabilization has to precede this exposure work, and while it feels like it’s going to take more time, the ultimate research ends up showing that structured behavioral stabilization. They’re talking about DBT, but I’m talking about it as phase two work and EMDR, also, before the exposure, it doesn’t prolong therapy unnecessarily. Instead, it actually significantly lowers how long therapy is going to take by having a good stability before the exposure work. So, taking time to stabilize a client is an actual clinical intervention in and of itself. It’s not delaying things, even at your client’s insistence that they want to be able to move on. And this is part of that open conversation with people that is, you know, if we spend an extra five sessions working on skills to be able to stay within the work, that might yield session six to be able to actually have an entirely trauma processing session. The other alternative that you’re describing is that we can spend eight minutes of each session for the next two months absolutely traumatizing you, and then spending the other 52 minutes working on being able to help bring you back into the room, and you’re not actually getting as much use out of your therapy time by not practicing some of these skills up front.

Katie Vernoy 34:44
Yeah.

Curt Widhalm 34:46
So far, what we’re talking about is kind of the simpler, straightforward presentation. So there’s another article by Steuwe et all, 2021, that gets more into some of the complex presentations, comorbid BPD, complex PTSD. The exposure protocols in this kind of complexity is going to affect a lot of the baseline regulation skills. And anybody who’s worked with any of those types of clients is probably listening and saying, “Duh. But really, what we’re wanting to do is a collaborative treatment that doesn’t trigger something that needs a crisis intervention or a psychiatric rehospitalization. So we are still trying to integrate a lot of ideas and being prepared for that good treatment planning, good preparation, and ongoing and collaborative treatment planning with clients helps to alleviate a lot of these client insistences on pushing too fast into treatment. But it also helps us to slow down on our end as clinicians and to be able to step into treatment with your client and having that open discussion to be able to say, okay, we’re going to do this skill and we’re going to do this skill, so that way we’re building towards being able to do prolonged exposure or EMDR or whatever your trauma focus theory is at that time.

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Katie Vernoy 36:21
The side benefit of that is this consistent and ongoing consent, and for someone, especially if they’ve been traumatized in a way that their control was taken from them, and and not just controllable life, uncontrollable life circumstances, but sexual trauma, assault-you know the things that people are violated and and controlled by other folks. Establishing a relationship with them where they know they can opt in it out at any point, they can make decisions about direction of treatment. Which coping strategy am I learning first, even? Which one feels more effective to me? I think it’s the side benefit is that’s also part of the work, and I think that you can even be transparent with that. Your control was taken from you, and so I’m going to ask you, maybe even more than you want me to, if this is okay with you, and and which direction do you want to go, and what’s more effective for you, and I’ll provide options that I think are are effective, but there’s not one path here, and and this is something where we need to collaborate on this because it’s more effective, but also because you had a lot of your choices taken from you.

Curt Widhalm 37:47
And also as clinicians being grounded in good theory that gives you also the capacity to be able to say “not yet” to a client.

Katie Vernoy 38:01
Yeah.

Curt Widhalm 38:02
And that isn’t the same thing as taking away options for a client. Because, say for example, you have a 28-year-old client with borderline personality disorder and severe childhood trauma, and they come to a session after three weeks of no self harm, and they say, “You know what? I feel great. I handled my breakup fine. I’m ready to talk about my childhood abuse now.” Now, therapists could mistake that client’s very temporary mood elevation and desire to get it over with as readiness for moving into stage two DBT work. They can help their client launch into the trauma narrative, even with permission. Hey, you say that you’re ready. This is you opting into it. But if that client two sessions later is absolutely flooded and doesn’t have good deep distress tolerance practices, that client’s at risk for relapse. And in this scenario that I’m making up now, the client is engaging in severe self injury and missing the next appointments because they can’t handle that. We as the clinicians have to be able to look at what is intellectual eagerness from clients with the behavioral capacity for change.

Katie Vernoy 39:22
Yeah.

Curt Widhalm 39:22
So in DBT, moving past stage one readiness isn’t measured by a client feeling good for a few weeks. It’s measured by consistency under stress. You know, I’ve asked clients before: Did you have a good week because you handled things well, or did you have a good week because there was no stressors and you weren’t challenged at all?

Katie Vernoy 39:42
That’s a good question. I think even if a client comes to me when they’re saying I’m ready to go, if there are any indicators that they’re not ready, we talk about that. But even if it’s looking promising. I don’t necessarily jump into it in that session. There’s, I feel like, a lot more preparation and contracting and and understanding that would need to happen at that point. Now it seems like there may have been some pre-work that’s already happened in EMDR, and so even if that were the case, I feel like I would want to revisit it and say, okay, let’s prepare and make sure we’re ready to to get started next session if things still look good, and and spend the session talking through how do we make sure that you’re resourced. You know, what is it going to look like? What are what what would it be? How will we know if this is too much for you? Those types of things. So it feels like the impulsive need to just say, “Okay, let’s do this. I’m super excited. We’re ready to go.” I feel like that can be shifted if there’s this whole kind of pre-work that that stays in your back pocket, no matter if they’re ready or not. Does that make sense?

Curt Widhalm 41:00
Yeah, it does, and that’s not just on the client side either. Because engaging in deeper work, now, I recognize for people who are not working with EMDR or DBT models, fit this into your own models as far as…

Katie Vernoy 41:19
I oftentimes use like narrative or other other types where you’re there’s a lot of pre-work for all of these models typically.

Curt Widhalm 41:28
And for a lot of these models, when there’s crises going on, the crises is going to trump whatever model it is that you’re doing in the first place anyway. But sometimes our own eagerness can end up moving us too quickly. Now, Francine Shapiro, EMDR, and all of the EMDR training stuff; the phase two work often includes introducing a couple of ideas about some basic grounding stuff: peaceful place, container exercise, light stream, and as clinicians, we can get really excited into moving into you know doing the work. Let’s let’s get to the trauma. But we can’t treat some of these skills as just check boxes either. That we actually have to get through some of the work because I’ve had clients that can sit there and they can do the dual attention with a peaceful place, and they say, “You know what? That was a really wonderful guided meditation, and the buzzer just felt so good, and I’m wonderful now. And there’s just something that says, “You know what? This client still doesn’t have the capacity just because they can do peaceful place. They don’t have that capacity to stay present in the room. That tells me that moving into actual reprocessing for their trauma is necessarily ready, especially when we go back to talking about whatever their target memory is, and you can just kind of see all of the autonomic, you know, nervous system kinds of responses. So we can’t just go through the box checking either, and we have to be able to model that to our clients too.

Katie Vernoy 43:13
You have someone that’s stuck in their story; they’re flooded, they’re overwhelmed. They come into session, and even though you’re still in stabilization, they keep going to the story. How do you handle that? I have the way that I deal with it, but what are the things that you do when someone is is stuck in the in focusing on what has happened to them?

Curt Widhalm 43:36
I reflect back to them how they are describing the story. Now, for a lot of the clients that I get, and typically there’s one way that they show up in EMDR. There’s another way that they show up in DBT. But for my EMDR clients, a lot of times the feeling that I get, and I reflect this back to them, is asking them, “Hey, when you’re telling the story, how are you feeling? Because the way that it sounds like to me is you’re going through the story, and the story makes sense, but it’s kind of like you’re trying to describe a TV show that you watched three weeks ago. Like you’re not really present in the room, you’re you’re telling me what happened, but it’s just kind of missing something. And a lot of times, what it’s missing is you in in your telling of the story, and that’s what I want to help you with as we move on. So that that’s one way that I end up helping it. On the other end is the clients who get a story going, and I tend to see this more in in the DBT side of my practice, is the clients who get going, and then it’s kind of like this freight train where it can’t stop, and it’s just the emotions are building up behind it. And largely in a similar way, I say, “Hey, what are you noticing in yourself as you’re telling about the story? Because I’m noticing that the words keep coming and it feels like they can’t stop, and I’m noticing your body activating in this way. So largely, I’m doing the same thing. It’s just more, you know, helping to contain things down as opposed to bringing things up.

Katie Vernoy 45:18
The way that that you’re describing it is, it’s bringing it more into witnessing mind, trying to lower the activation and help them observe themselves, so that they can make more conscious decisions about what’s going on. I think early on, I feel like it can be very daunting when it’s so emotionally charged and they’re not ready to to really process it, and so I think the the things that I do similarly, I do a lot of reflection. Sometimes I’ll I’ll actually go to a place of “it seems like this is really overwhelming to you, and I’m not sure if we’re in a space where it’s it’s the right time to process this. Can we can we shift gears a little bit and help you to cope with what’s coming up for you right now?” And looking at shifting it just enough, especially if they start dissociating or they’re so emotionally dysregulated that they’re not able to engage in the work. And so I feel like that can be very challenging because for folks sometimes they’ll jump onto it, jump onto it and say, “Hey, this is their their processing. Let’s go for it.” But I think it’s being able to to distinguish between is this someone who is stuck in the story and overwhelmed by it and potentially even dissociated, or is it someone who’s ready to actually do some of the trauma processing?

Curt Widhalm 46:39
And if cognitively playing it out to somebody doesn’t work, what I’ll ask somebody to do is, hey, let’s get back into our bodies here for a moment. Let’s move around. Let’s you know take a stretch. Let’s do a mindfulness activity. Let’s reorient ourselves to the room where we’re at now, and doing it in a way that’s really supportive to be able to help people notice where they’re at within their window of tolerance.

Katie Vernoy 47:04
Yes, I like all of that, and I want to just comment that not done well, it can sound like “Shut up, I’m not ready to hear this.”

Curt Widhalm 47:13
Oh, absolutely.

Katie Vernoy 47:17
And so, I think being able to have a lot of a lot of transparency from the beginning around this is is so important. Because there’s a difference between hearing someone’s story, being present, holding space for it, and doing the deeper work of therapy. And so, being able to walk that line, being able to to create some stabilization from the beginning, you’re not going to always be successful. Let’s be honest, but I think being able to have that in your sights and have the skill set to do that is really important. Because when you’ve got some really serious life-altering trauma that that needs processing, I think it’s really important to be able to slow the client down, even when the words are coming out like a freight train.

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Curt Widhalm 48:10
There’s an article in the Permanente Journal. This is from 2023 by Laurie Leitch and Brigid McCaw, called “Time to Move Forward: Resilience and Trauma-Informed Care,” and a lot of this article is talking about just kind of the larger systems around resilience and trauma informed care. They have the resilience and trauma informed care model that they’re trying to encourage through the medical field about how trauma and toxic stress negatively impact health, and we’ll get to them talking about the resilience piece of this. But a lot of their focus ends up coming around just being able to build autonomic nervous system resilience, and that way, clients as they’re entering into hyper or hypo arousal states during processing can return to baseline without external intervention. You know, and for all of you who are very trauma informed, this is where we want clients to be: is to be able to track, and this is what good trauma work ends up looking like, and is probably not a surprise to anybody who’s done trauma work before. But expanding that window of tolerance through self regulation as a goal takes us as clinicians to be able to help our clients integrate that. Now, this is EMDR as far as hey, here’s what a window of tolerance is, here’s what a subscale is.

Katie Vernoy 49:47
Yeah.

Curt Widhalm 49:48
And so you know any kind of being able to sit with more for longer ends up being something that can be really helpful. But you know, so many of my trauma clients have, have told me over the years, I don’t want to be told anymore that I’m brave, you know, as other people have heard my stories. I don’t want to be told more, you know, that I’m so resilient. You know, these are really commonly used terms, and a lot of clients are sick of it. But what I do like about this article is talking about resilience as the capacity to bounce back, and that is something that is not a fixed state either. And I think that that’s what these clients are talking about: is that that can wax and wane depending on a number of of factors, and so we want to be able to help clients build that bounce back capacity for themselves, not just because they need to show up to somebody else afterwards. And this includes, you know, psychoeducation about the process, but it also includes being able to help clients track that during session as the first space to be able to work on these skills in a supported environment, so that way you know they’ve got a good capacity to be able to communicate what’s going on, and if we trace this all the way back to the beginning of the episode, relies entirely on a good therapeutic alliance.

Katie Vernoy 51:19
It’s so interesting because a lot of this interweaves with a lot of the other episodes we’ve done, and we’ll link to bazillion of them in the show notes over at mtsgpodcast.com. But when I think about the ability to bounce back, the the emotional regulation skills, the the distress tolerance skills, and even some of the other pieces, the support system, the the feeling of competency, the the different pieces that I fold into the work that I do. There’s there’s a lot of it that we can really work with, and there’s some stuff that’s just out of our control. I think about support system. I think about things to live for, that kind of stuff. We can help them find those things, but they don’t necessarily exist. And and I’m tying back to the the suicide episode that that you led a number of years ago around protective factors for suicide. And so it’s it’s something where I feel like it can it can be a moving target a lot of the time. Do we have do we have these things in place, and and the reason I say moving target because they can have a bigger window of capacity, they can have a a a higher level of a capacity in sitting with distress, and then another trauma happens, or something challenging. You know, they lose their job, or they have to move, or some of the other things that you’ve talked about, and it can feel endless. This this journey towards “is the client ready to do this deeper work?” And so I think there’s there’s ideal, and then there’s also that that gray area where I think there may be some testing supported deep work that can happen that’s not overwhelming to their system, but helps them move a little bit more before they have all of the pieces lined up that you’re talking about.

Curt Widhalm 53:26
And I want to just add to your brilliantly timed moving target because this can change within even a session.

Katie Vernoy 53:37
Yeah.

Curt Widhalm 53:37
This can change moment to moment, and you know, part of the you know radical acceptance of doing this kind of work and modeling it with clients is “Okay. Things are things are changing now. We’re going to deal with things as they change” because I know that there are moments with, say, for example, a client who presents with complex PTSD that is going into EMDR, and in phase three, you know, you know, this is the assessment. And right before we’re getting into working on the initial reprocessing, client, you know, is going to be asked to, you know, think of your negative cognition, think of your target memory, and they’re going to get asked, “What are you noticing in your body?” And if a client says, “I feel like I’m floating above my chair,” you know, a clinician might say, “Well, they know where they’re at,” and proceed with reprocessing. That’s bad. Don’t do that.

Katie Vernoy 54:40
Don’t do that.

Curt Widhalm 54:43
But…

Katie Vernoy 54:44
“I feel like I’m on fire.” Oh, good. You at least know how you feel. We won’t put the water on you yet.

Curt Widhalm 54:51
But if your client is losing that connection to the present moment, that anchor into the present as well as into the past before an EMDR, as I’m describing it here, before that bilateral stimulation even begins, then as the clinicians, this is one of those kind of moving targets where it’s like we have all of this momentum going, and we’re going to pivot here, and we’re going to do it in a supportive way. That’s just kind of okay, and we’re going to take a moment here, and we’re going to adjust something and be able to help come back into the moment.

Katie Vernoy 55:25
And it’s it’s really important to be able to do that. I like that you said in a way that’s not shaming, or I don’t remember the words that you said, but it’s something where you can do it very transparently. Hey, it sounds like you’re dissociated. Let’s let’s dial back here and and see where we can get today, or it can also be more nuanced and and organic. All right, so let’s let’s stay with that. Okay, let’s you know how do we how do we pull you back into your body right now, and not hey you’re not ready, so we’re stopping and this is what’s going to happen, right? So I think it’s it’s client by client, you’re going to decide how you have these conversations, but it’s so important that you’re in the driver’s seat at this point.

Curt Widhalm 56:10
And to your point earlier, this is done with good assessment up front, good history taking. Hey, you dissociate. Let’s talk about dissociation.

Katie Vernoy 56:21
Do you even know what dissociation is?

Curt Widhalm 56:23
Yes, and once you talk about it, is asking clients their preferred way to be brought back from dissociation. And in all of my experience, zero have ever said, “I want you to snap your fingers in my face and clap in my face and bring me back.”

Katie Vernoy 56:40
Ooh, ooh, that sounds awful.

Curt Widhalm 56:43
What most of them say is, “Bring me back, you know. Ask me gently. Ask me to notice where I’m at. You know, invite me back into the room.” And so this is all done collaboratively, and this is that ongoing communication that makes it really, really good. And I’m realizing that I’m going to point out at this point in the episode that what we’re talking about is if you’re not sure if a client is ready to move on to the next phase or not, make the decisions together. That really, what we’re talking about is not the really clear cut black and white cases where some clients are absolutely ready, some are absolutely not. But there is space where you’re going to run into some issues that don’t fit neatly into either of those other two boxes.

Katie Vernoy 57:35
I think there’s there’s a point to be made here about what deep work looks like separate from deep trauma reprocessing, because I think there’s a middle ground there that I’m sure happens in DBT and in EMDR. You know, I think you said the you know peaceful place or something, but in the the experiential work that I’m starting to do, it’s it’s clear that there are times where moving into mini moments, mini experiences, mini m-i-n-i, small moments, small experiences, and helping someone to to process a smaller thing or to experience a a larger emotion, but in a smaller way, in a very titrated way. I think I would I would consider that quote unquote deeper work. It’s not stabilizing, and it’s not this big decision of okay, we’re going to your worst memory, your most negative thought, and we’re we’re doing the thing, right? And so I think the way that I see the work is that it’s constantly this assessment of: Do I need to push them a little bit more into the current moment? And push is a bad word to to guide them more into the current moment. Do I need to to help them get more in touch with their feelings? Do I help them need to pull them out and get them more regulated? You know, it’s it’s it’s looking at both what’s happening in the moment as well as the proactive coping and and and capacity strategies that are maybe more psychoeducation from the beginning, and then it moves into this more experiential place pretty soon, that that helps them to be doing more of that work, but not with that the high risk that can happen when you’re when you’re diving into a fresh or or particularly potent trauma that’s that’s kept them lost and overwhelmed.

Curt Widhalm 59:50
So I just want to close this out as far as some of the conversations. Way that this sounds is: Asking clients, what are warning signs that your system is slipping out of its window of tolerance? If we start trauma processing and you shut down, what is our agreed upon code word signal to pause? You know, and just normalizing some of the pacing checks that can end up happening with clients. What I really want to close out with, though, is that some of these traps that therapists have, we counter transference is that we can get impatient and we we can pick up on our our clients’ desires to get done with therapy that can impact how we end up pushing things, and in order to feel productive, in order to feel competent, and or or in some cases even feeling like the hero in in somebody else’s therapy story, and just monitoring yourself for that, and recognizing and modeling to your client, hey, I’m I’m noticing this impulse on my side, I want to check in with you on where you’re at. You know, it’s a way of being able to bring that back into the the work for your client. You don’t want to put all of that emphasis on the client, but done well, what you’re doing is you’re modeling to your client. Everybody’s systems can get activated, and there’s steps that we can use effectively. We also, when a client is rushing into you know that eagerness to just hurry up and do the trauma work, recognizing that that might be a client’s cognitive defense of not being ready to deal with some of the emotional aspects that come along with that, and so we talked about that in that DBT example earlier. As far as being able to monitor that what clients are doing is congruent with how they’re actually presenting, and that can be a pitfall that you can run into. And another variation of that is confusing intellectual insight into somatic processing. That for clients who can fluently analyze their trauma cognitively versus clients whose nervous systems are just on fire whenever they’re you know being faced with any kind of an emotion, and…

Katie Vernoy 1:02:19
And I think there’s also folks who don’t have the language to describe their emotions. I mean, that’s a whole other episode. But there’s, you know, whether it’s alexithymia proper or folks who just don’t have the vocabulary. And so I think being able to create language and assessments of the emotional experience can be really important because it looks very different in different people.

Curt Widhalm 1:02:43
Absolutely, and sometimes what it sounds like for clients is it almost sounds as if they’ve just done really good CBT work where they’re describing everything and giving all kinds of caveats and explainers for why something happened, but they’re never dropping into any of the kind of how the process was for them, how they’re feeling in the process now as they’re describing it. So they can be therapy pros, but it just comes across as this very intellectual insight into the why of everything.

Katie Vernoy 1:03:18
Yeah.

Curt Widhalm 1:03:19
And lastly, I would suggest get a couple of scripts for yourself in order to kind of pivot to, so that way you can still be very supportive to your clients in these moments. As your nervous system gets activated, you want to be able to kind of rely on some practiced, “you know, hey, you’re not failing. We’re we’re just at a point today where your nervous system is showing that it needs a stronger foundation, and there’s skills that we can practice for that. So let’s spend the next part of this session. Let’s plan for our next session to be able to work on some of these skills. I can give you some homework in between sessions, so that way you can work on them between sessions as well. You’re you’re at capacity today. You’re not failing.”

Katie Vernoy 1:04:08
I want to add just a couple more things because I feel like it’s relevant here. The comment that you made about your own nervous system, I think, is a really important one to pay attention to as well, for two reasons. One is this: the the capacity to sit with hard things, and so we’ve got other episodes to talk about it. But if you’re noticing for yourself that you’re not tracking as well, or you’re not able to assess where the client is as well because of your own internal responses. I think that’s valid, and I think it’s important that you use all your skills and you bring yourself back to the room and potentially slow things down. I think the other thing is potentially through mirror neurons or some other piece, you may be picking on up on on a different. It’s a different kind of information that you’re gleaning from your client, especially if if you’re in the room together. Where I think being able to trust, hey, I’m feeling something pretty intensely here. Is this mine? Is this the client’s? What is this information? Because I think that can be another space where you notice. Hey, wait a second. This feels a little strange. This is an opportunity to check in, even if the client hasn’t shown the typical signs or or been able to communicate that they’re overwhelmed or dissociated. Because I think we have kind of that sub sub cortical understanding of of what’s happening in the room that we just need to be able to to trust and listen to.

Curt Widhalm 1:05:55
You can find our show notes over at mtsgpodcast.com You can get your CE credits at moderntherapistcommunity.com. You’ll also find that information in our show notes. Make sure that you follow us on social media. Join our Facebook group, the Modern Therapist Group, to continue on with this and other conversations. And until next time, I’m Curt Widhalm with Katie Vernoy.

… 1:06:18
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Katie Vernoy 1:06:19
Just a quick reminder: if you’d like one unit of continue education for listening to this episode, go to moderntherapistcommunity.com, purchase this course, and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.

Curt Widhalm 1:06:34
Once again, that’s moderntherapistcommunity.com.

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