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.



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.