INJURY HANDLING: THERAPEUTIC WINDOW

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The therapeutic window (or window of tolerance) refers to the range between under-and over-activation of emotional states associated with trauma. Within the framework of the therapeutic window, the client during the session is able to think, speak and relive his experience without losing his normal sense of self, i.e. it is the “hypothetical site” where therapeutic interventions are most effective.

Interventions carried out within the therapeutic window trigger traumatic memories and facilitate their processing, but do not overload the internal defense systems, which can provoke unwanted effects for therapy. Interventions that do not reach the therapeutic window are those that avoid or systematically exclude traumatic material. Failure to reach the therapeutic window is most likely safe, but often it is wasted time and resources on both sides in situations where more effective interventions can be applied. On the other hand, “hop-off” occurs when the therapist loses the ability to assess clients' resources to regulate the emotional state and cannot keep the client from being flooded with excessive traumatic material.

Interventions that are applied too quickly often "fly over" the window, do not allow the client to adapt and reduce the sensitivity to the material that was activated before. If in therapy interventions very often "fly over the window", the client has no choice but to resort to various "avoidance maneuvers" so as not to overload the lifted traumatic material.

Sometimes therapists are overly preoccupied with "resistance" and overlook that it can be an adequate defense response in response to therapeutic errors. The client's resistance can be seen as an attempt by the client to resist the ambitious plans of therapeutic influence, the rushing and all-knowing therapist, who sees expressive working techniques as more effective than other interventions. Such work can reproduce a super-stimulating environment, from the consequences of life in which the client wants to get rid of. Therapists who need the client to feel better faster or who need to be “successful” can force the client to increase the pace of work when this is not justified, and not see the “resistance” as a signal to slow down. If the therapist does not respond to the client's signal, “I'm fed up with you,” this can lead to the end of therapy.

It is not only the therapeutic haste or the therapist's inattention that can lead to an overflow of traumatic material, but abused survivors are not fully aware of the continuum - "little-little-more-much-too much". It is difficult for them to be in the middle of the window, and therefore, to live a normal "average" life. The therapeutic task, in this sense, is focused on so that a person learns to control the experience and learns that it is possible to choose the pace of entry into traumatic complexes (psychoeducation will not be superfluous in this), that a pause during the session is his right and legitimate choice, and not just resistance and avoidance.

One of the most important tasks in working with people who have experienced traumatic situations is to keep the behavior in the middle of the window so that the intensity is not too low, but not too much, so that the client does not drown in the stream of traumatic material that he avoided and which is large. relation to the available resources of experience and coping. In other words, in the therapy of traumatized clients, one should always remember that a person who has experienced a traumatic situation must be more than a traumatic complex to be removed, worked through, recovery and assimilation, otherwise flooding and the inclusion of intensive protections cannot be avoided. Everything that is extracted must be less than the available strength of the person, otherwise the traumatic material is absorbed and the person turns out to be suppressed by it. Acute therapeutic interventions, taking into account the therapeutic window make it possible to work through traumatic memories without re-traumatization and the need to turn off the process.

Therapy for traumatized clients also requires adjusting the intensity of emotional activation during the therapy session. Ideally, at the beginning of the therapy session, the client enters the therapy process in a measured manner, in the middle of the therapy hour, a relatively intensive study of the traumatic material takes place, at the end of the session the intensity of work with the traumatic material is reduced so that the client “goes into life” relatively calmly without the need to strengthen defenses. Healing may not be painless, but it must necessarily minimize, as much as possible, the traumatic effects of the therapy itself.

The therapist needs to tune in to catch the signs that the client is “enough” and the work needs to be shifted to other areas while a piece of work is “digested”. Abused survivors are not always able to regulate the depth and pace of their immersion in their experiences. Often the environment from which they originated was highly stimulating and did not provide any choice - to digest, take a break, say "enough", slow down. The therapist can become, especially at the beginning of therapy, a "reference point", a "stress detector" in choosing the pace and intensity of work with the client's traumatic material.