Liz Long Rottman, LPC, LMT
There is a type of client that comes into therapy who struggles with the first phase of trauma treatment: stabilization and resourcing.
Building safety actually makes things worse.
This isn’t because they don’t want to feel better, but because somewhere in their nervous system and their meaning-making system, calm has actually come to signify a threat.
This is a hallmark of CPTSD, and if you aren’t aware of it, you’re more likely to keep trying to resource this type of client and watch them fly out of their window — wondering why nothing is getting better and nothing is working.
This belief, of course, is not conscious. It’s something along the lines of: if I stop being hypervigilant and I stop intensely paying attention all the time, something bad is going to happen. Or: I’m going to be surprised and I won’t be ready. Or: feeling calm is actually irresponsible.
This makes complete sense from an adaptation standpoint. There was a time in this person’s life where calm equaled danger. This person’s system learned: stay activated, stay alive. And even if that’s not necessarily true in this person’s life anymore, that script is still running.
So what do these clients look like? Often they come in talking fast and a lot — sometimes they don’t talk at all. It’s either one or the other. But I’m going to talk about the fast-talking type.
It is really hard for this type of client to receive input. Any deviation from their narrative feels threatening.
So the first thing I do is not try to calm them down. I just let them free associate while adding in little inputs to keep them not too far outside of their window — because let’s be honest, they’re already outside of their window. That means they can really spin off into the stratosphere if we’re not keeping a little bit of containment on what’s happening.
We might hang out in this place for a few months, and sometimes for a few years. So we have to do other things while we’re stuck in this place of “it’s not safe to be calm.”
I’m going to talk about three distinct phases that get us to the place of calm — what in somatic therapy we call a yield.
Phase one: discharge first. For people who have never seen somatic nervous system discharge, it looks wild. When I’m teaching this to students, I call it “the fireworks,” and once you know how to do it, it’s actually one of the easier things to do in therapy. It just looks really dramatic.
What does it look like? There’s often a lot of shaking that starts in the core, the limbs, or the head. In Sensorimotor Psychotherapy we do something called the reinstatement of action defenses — the person might find that they want to push, or they want to run: fight or flight. There may also be something called sensorimotor sequencing, which is involuntary movement. Under the right conditions, the body will move on its own — and I don’t just mean shaking. The head will orient, the arms will move. Sometimes the movements don’t make logical sense, but they feel right to the person.
All of these expressions of movement are ways that the nervous system drains off energy.
As we’re doing this, we’re not explicitly seeking calm — though people often find themselves in at least a calmer place at the end. But that’s not the goal. At least not that day.
Phase two. We start building the logic and the incentive for the person to examine how their current mode of functioning is either helping or not helping. Often they will start to see how the amount of anxiety or intensity they are carrying is working against them and their goals.
This means working a lot on reality testing. Is this true? Is this the result I wanted? Did this action get me what I need? Do these thought patterns actually work for me in terms of orienting toward reality? Noticing how interacting with people in different ways works.
Something like: you were brutally and effusively honest with your spouse about that thing. How did that go? Did that get you the understanding you wanted — the closeness, the connection? What do you think would have worked better? Maybe finding a good time when your spouse could have actually taken it in, and finding a more succinct way to deliver that message.
When that logical framework is in place, it doesn’t resolve the difficult feelings or the activation itself. What it does is incentivize the person to start wanting to move toward calm, because they start to see how calm aligns with their goals.
Often this type of client really needs to see the cost of their adaptation toward unsafety to be ready and willing to address it. And again, this isn’t coming from the conscious mind. This is a negotiation we are doing with the brainstem — what we’ve called in the past the lizard brain. It’s a very deeply instinctual system we are working with, and instinct will always override cognition. But we can leverage cognition to start to get the instinct working with us the way we want it to.
Phase three: exposure to calm. When we think of exposure therapy, we usually think of someone with a phobia of snakes — we talk about snakes, look at pictures of snakes, bring in a plastic snake, and then go to a snake farm. It’s the same thing, but we are doing it with calm.
We start by setting up the conditions to create small moments of calm in the session. The client experiences that calm for maybe 30 seconds, and then we notice it — and that’s all we can get, because their instinct pulls them back out. But even when they return to that baseline at the upper end of the window, their system can register that they were calm for a little bit and nothing bad happened.
At that moment, I also want to get from the client what belief goes with that re-emergence out of calm. Was it “I felt calm and it felt weird”? Was it “I felt calm and then all of a sudden panic spiked — it’s not safe to be calm”? Did you feel guilty or irresponsible? What brought you back out to the top of that window?
And then again, we bring the logic and evidence system online. We start to gather evidence about the calm we’re creating in the laboratory of the therapy room. Over time, that little bit of calm starts to grow and stretch, and the client can tolerate calm for longer periods.
Phase four: the yield. This happens naturally after phases one through three. I’ve been using the word “calm” because people know what that means, but the yield in somatic therapy is really a nervous system state — a brainstem, limbic system, biology thing. Emotions and stories can accompany it, but primarily it’s what the biology is doing.
At some point, once we have really stretched the client’s capacity to remain in a calm, yielded state, they will come in one day and say: “I didn’t have anxiety for a whole day. It was such a weird feeling. I didn’t know what to do with my hands.” You can see how it doesn’t feel like themselves. Their identity really feels like the anxious or dysregulated one — so when they show up as the calm one, it feels strange. They don’t have automatic behaviors and habits around being a calm person.
This is the spontaneous yield in somatic therapy. The yield is really about implicit, instinctual trust — in oneself, in relationships, and in life.
You cannot tell a body that it is safe. You have to show the body, with evidence over time, that that is the case. And then eventually the body lets go.
And then we get to celebrate and acknowledge that this person’s nervous system is actually changing. It’s reshaping. It’s finding a new baseline.
That’s what healing looks like for this population.
It’s not a breakthrough moment. It’s not fast.
But quietly, one day, nothing bad happens — and the body finally believes it.
