Using The Window of Tolerance

The Window of Tolerance

Learn how to assess your client's resiliency with effective somatic tracking. The "Window of Tolerance" is a useful lens to help you monitor your client's nervous system moment-by-moment and better pace the work.

5.5. CE Credit Hours awarded upon completion of lectures, quizzes and evaluation. Click here for full CE details.

The window of tolerance is "a range of resiliency in which the intensity of emotional arousal can be processed without disrupting the functioning of the system." - Dan Siegel (1999).

Learning Objectives

Full description below:

Improving EMDR Outcomes by Assessing Resiliency Using a Somatic Approach with the “Window of Tolerance”

Abstract Summary

Therapeutic effectiveness is enhanced when the therapist can accurately assess the client’s “presence” on a moment-by-moment basis. The Window of Tolerance identifies a workable range of resiliency for productive therapy. This presentation will address the value of using a more somatic focus to give the therapist real-time data about whether their client is within the “Window of Tolerance.” Using the Window of Tolerance as an active lens can guide the therapist’s assessment of the optimal time to use bilateral stimulation -- at the start of therapy, the start of any given session, as well as throughout each session.

Introduction

Innately, we all have a natural drive for completion - cognitively, emotionally, and on body and nervous system levels. Yet, we are capable of interrupting that drive when overwhelmed internally or externally. It is these interruptive dynamics that keep us from completion, as understood by the AIP model. Because the disruptions are holding back a natural drive, there is tension, always creating somatic components. These are rarely described in our client’s presenting problems, but they will keep coming up anyway. Ongoing nervous system reactions to the disrupted drive for completion go unattended. We often leave the “Window of Tolerance ” in the moment. Resiliency is diminished. We cannot process well from there.

On the other hand, tracking these dynamics, and working with them, can make a huge difference in therapy. We will explore ways to slow the interruptive process and use bilateral stimulation to further “fatten” these moments. They become more amenable to being reprocessed. When attending to the disruptions, the therapist may need to take a stronger lead. It is the somatic data that informs the therapist’s decision of whether or not to intervene. Close tracking of gross body movements, as well as the most subtle internal nervous system responses, helps the therapist assess the live dynamics of how and when clients interrupt that drive.

“Awareness” is the strongest facilitator for engaging in the drive for completion. Sustained somatic awareness helps clients stay with nuances of sensations that further this engagement. Prudent use of bilateral stimulation can take this a step further still. Clients can take advantage of all of these aspects of our their own nature.

When therapists primarily track cognitive responses from the client, or only track somatically on a cursory level, it is very difficult to know when the client has the momentary ability to be present and is resilient enough to truly process anything. There are subtle forms of dissociation that occur in everyday sessions that go unnoticed. It is easy for clients to be in “override”. They may appear competent and well-functioning, but there are dynamics at play just below the surface, where the real work needs to take place. If we don’t track closely, this compromises the therapy, and neither the therapist nor the client are aware of what is really going on. However, hyper- and hypo-aroused states can be noticed, and worked with effectively. Some understanding of how the nervous system works is helpful, and can help the therapist to engage the client, enabling them to begin to see their own Window of Tolerance.

I have been giving 4-day trainings on “Integrating Somatic Psychotherapy with EMDR Therapy” for the past 4 years. In the 14 trainings (plus 10 follow-up trainings) a major benefit therapists have reported is their increased ability to accurately track resiliency, and to notice clients’ subtle dissociation in their everyday work. They are seeing how their therapy had been limited by trying to process material with their clients when there was not sufficient resiliency. This changes the work. Therapists further report that adopting the lens of the Window of Tolerance as an active, ongoing assessment tool has helped them feel more confident about staying engaged in the process. My experience using the Window of Tolerance, as well as the feedback I am getting from the therapists in my trainings, has led me to create a 5 hour course on this topic: Using the Window of Tolerance. It is an online video/workbook training that will be released in the next couple of months.

It is my opinion that the general efficacy of EMDR could be increased by training therapists to assess resiliency and utilize more of a somatic focus through all phases of the therapy. This would help to pace the work more effectively, and thus to build resiliency organically. As clients learn to “notice” their own somatic responses, this facilitates awareness on every level. This “bottom up” approach exposes dynamics that often do not have verbal language. My experience is that this helps clients and therapists truly understand their own nature, as well as trust their own process.

The orientation that has evolved in my practice comes largely from my years of ongoing trainings with experiential approaches to therapy. So, while writings have been important, these moments in the trainings have taught me more than any text. My clients have been my greatest teachers. My meditation and spiritual practice have also guided me. Experimenting with EMDR and different uses of bilateral stimulation, both as a client and therapist, have shown me the potential of this work.

I’ve been holding consultation groups for 20 years. As I have brought more of a somatic and process-focus into these groups, therapists have found it helpful, and have asked me to train them further in what I was finding to be effective in my practice. This was the genesis of the trainings I offer.

Bibliography

Kain, K. and Terrell, S., (2018), Nuturing Resilience

Lanius, U., Paulsen, S., Corrigan, F., (2014) Neurobiology and Treatment of Traumatic Dissociation,

Levine, P., ( 1997) Waking The Tiger

Levine, P., (2015) Training Manual in Somatic Experiencing

Ogden, Minton, & Pain, (2006) Trauma and the Body

Ogden, P. & Fisher, J. (2015) Sensorimotor Psychotherapy

Porges, S., (2011) The Polyvagal Theory

Schanrch, D., (1991) Constructing the Sexual Crucible

Shapiro, F., (1995) Eye Movement Desensitization and Reprocessing

Siegal, D (1999) The Developing Mind, New York, NY, Norton and Co.

Stevens, J., (1971) Awareness

Van der Kolk, B., ( 2014) The Body Keeps the Score

Zinker, J., (1977) Creative Process in Gestalt Therapy