Recognizing and Working with Client Dysregulation: Quick Tips for Therapists

Think of the nervous system as the system that tells all the other systems what to do. It oversees our survival by orchestrating our body’s response to the world into fluid but discrete autonomic states. These states play a big part in shaping how we think, feel, and interact with others.

For therapists, being more aware of our clients’ autonomic states at any given moment in a session can make each session more impactful and meaningful.

In my latest book, I Want to Connect: Rewire Your Nervous System for Stress Resilience and Secure Attachment, I unveil a chart that demystifies what this would look like, offering a polyvagal-informed map to identify and understand dysregulation. This tool is designed to simplify the complexity of our nervous system’s responses, providing clients and therapists with a clear roadmap for understanding dysregulation.

Blog Map

For more explanation of these states, including how to recognize each one, check out Demystifying Dysregulation: Navigating Your Autonomic States.

Why does this matter? Recognizing when a client is dysregulated is crucial because in those moments, logic and reason take a backseat, and any learning that can happen revolves around danger and survival. Here are the telltale signs of dysregulation to watch for:
  • Speech and tone: Speech speeds up or slows down, becoming either frenzied, monotone, or stilted
  • Physical presence: Restlessness, stiffness, or a slumped appearance
  • Breathing patterns: Shallow, chest-heavy breaths or moments when breath seems to be “stuck”
  • Relational cues: Shifts towards hostility or indifference
When dysregulation is present, the goal of therapy in that moment becomes restoring connection and safety. Here are some ideas of what you can do:
  • Foster connection: Introduce some gentle humor and a warm smile. Reflect on what you’re observing in a way that shows empathy and understanding. You want your facial expressions to signal non-judgment and friendliness.
  • Introduce somatic exercises: Guide your client through grounding techniques, such as focused breathing or mindfulness, to help their body find its way more toward the calm/connected end of the chart.
  • Encourage autonomic awareness: Helping clients recognize what state of dysregulation they are in can empower their self-awareness.
By adeptly recognizing and addressing a client’s dysregulation in every session, we can work more efficiently as therapists to help clients orient toward safety and build resilience so that they can get the most out of therapy. If you want to learn more about this approach and encourage your clients to develop this essential awareness themselves, check out my new workbook: I Want to Connect: Rewire Your Nervous System for Stress Resilience and Secure Attachment.

Rewire Your Nervous System for Stress Resilience and Secure Attachment
Havening Techniques® for Treating Trauma, PTSD and Anxiety
In I Want to Connect, a follow-up to the popular The Attachment Theory Workbook, expert relationship therapist Annie Chen explores how your nervous system directly impacts your relationships and what you can do about it. Weaving together insights from Polyvagal Theory, somatic practices, and relationship co-regulation skills, this workbook addresses a range of issues through a central connecting point: that the state of our nervous system either primes us for resilience and connection or pushes us toward defense and shutdown.

Online Course:
Integrating Attachment Science to Maximize Treatment with IFS, EFIT, Polyvagal Theory, EMDR and More
Revolutionize your practice through the power of attachment! This online training brings together leading experts in attachment science, including Dan Siegel, Dan Hughes, Claire Mellenthin and many others. Discover today's most popular, evidence-based approaches in psychotherapy - Emotionally Focused Individual Therapy (EFIT), Internal Family Systems (IFS), Expressive Therapies, and more – so you can help clients of all ages loosen the grip of attachment ruptures, restore sense of self, and develop the ability to connect and repair.

Meet the Expert:
Annie Chen, LMFT, currently runs a private practice in Berkeley, CA, where she counsels individuals and couples on all relationship matters. She helps train fellow therapists in PACT, a couples therapy modality grounded in attachment and somatics, and collaborates on a research team studying the model’s effectiveness. Annie holds dual master’s degrees in counseling and psychology, where her passion for the clinical applications of neuroscience is reflected in two thesis projects. She is the author of The Attachment Theory Workbook, published in 2019.

Learn more about her educational products, including upcoming live seminars, by clicking here.

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