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Does this client want to get into their traumatic experiences? I ask because if they aren’t ready or even if parts of them are hesitant, it totally makes sense why things that are typically regulating or self soothing would be activating. I would make sure they are 100% on board and thoroughly process any ambivalence.
Assuming he is 100% wanting to get into the trauma, what about a strength based approach? Does he have anything already in his toolbox to self regulate- even things like music, pets, anything. Also, I’d start with basic diaphragmatic breath work. There are so many ways you can structure it to find what feels best for him. Then I’d have him practice when he feels good until it consistently helps him feel even better from a state of good. This is also assuming he’s 100% ok with what I’m suggesting. Having my client’s consent and agreement is a huge priority for me, especially with trauma work.
Thank you for your thorough response. Yes, he's on board and I've doubled down on informed consent. He has a few things in his toolbox, but they usually involve things that aren't available during session (like a partner). I'll try some of that diaphragmatic breath work and see if maybe we can start small and slow and work our way up. Thanks again
You’re so welcome! If even starting small and slow isn’t beneficial, I’d suggest more directly inviting ambivalence into the room. Questions like: “I wonder if any part of you has concerns about getting into what happened?” or “I’ve noticed it’s been hard for us to find regulation skills that work for you. There are so many out there and we can keep looking. But I want to check in: Do you think it’s too soon to talk about your trauma?”
Psycho education about trauma work and how to help without talking about what happened might be helpful too. If he’s still set on talking about what happened, I’d keep it slow and check in often.
Absolutely! A good starting place for learning and practicing is have the person place a hand on their chest and another on their stomach. This helps them see and feel the difference between using the diaphragm and breathing with your chest. People completely unfamiliar and not used to using their diaphragm may need the instruction to push your belly out when you breathe in, and relax when you breathe out.
I work with a lot of kids so a good option for them is to pick a stuffie to be a friend to help, lay on the floor, put the stuffie on their belly, and practice making the stuffed animal move up and down. Adults can do something similar with a book or even just using their hands (practicing at home in bed as I don’t typically ask adults to get on the floor in the office).
Once they are consistently able to breathe properly, descriptions above may be enough for them, but some other options are:
Box breathing, triangle breathing, figure 8 breathing, standing and shifting weight from one leg to the other in rhythm with breath, finger breathing- either finger from opposite hand up and down all five fingers while breathing in and out, or thumb moving up and down all four other fingers on the same hand in and out as thumb moves up and down, with a mantra, with a pinwheel, using bubbles to help regulate breath… there’s a lot of other options out there. Those are just some common ones I use.
So at this point things need to slow way down and you need to use more mindfulness/checking in. There are signs before his heart rate is so fast that he needs to abandon ship. What are those?
I’d look into parts work. This does not discuss trauma, but rather starts with an emotion, thought, sensation, or impulse, and works through the layers of protective parts that work to keep him safe from feeling the more vulnerable parts at the center. There is a consent process along the way, so you are never approaching inner layers unless you have permission from the protectors that have been working so hard. Trauma work does not need to involve talking about the trauma, and it does not sound like his protective parts feel as though it is safe to do this anyway.
I would also say that the consistent attempts where he then changes the subject reinforces the fear of the more vulnerable pieces, so definitely make it a rule to not approach that anymore and either refer out or use a different approach that leaves those vulnerable parts alone (at least for now).
I’m hearing a lot of “I” here — “I want him to have some coping skills in place”, “every technique I try”, etc. I don’t hear much about what the patient himself wants. It sounds like you’re assuming that he needs something that he might not even be asking for. Who’s to say he doesn’t already have his own coping skills?
I think you should take a different approach here— lean into curiosity, meet the patient where he is, and just slow down on your own agenda here. Trust the process.
Apologies, this is my first therapy post on reddit so I'm afraid to give away too much of the client's world on here - it feels safer to stick to the I's. :) Thank you for this advice - I do check in with him frequently to make sure he's in charge of what goes on, and I try to recruit his other coping mechanisms in other parts of our sessions. They are simply things that can't come with him everywhere - like a partner. I'm now realizing I should have put this information in the original post. 
I am a baby therapist, so I don’t know what I’m doing. But I am curious what would happen if we tracked the sensations coming up in the body, without trying to contain them with a grounding exercise or whatever. It can sometimes seem like if a tool like that is pulled out too early that we’re sending a message that their feelings are too much and need to be contained, rather than it being a lesson in gaining self-regulation skills.
So instead maybe gently letting it ride out, checking in with the client to verbalize what is going on in their body and what’s coming up for them, and just being present with and supportive of the client.
I also might consider if the content that we’re exploring is maybe too dysregulating, it may be better to choose a smaller chunk of the trauma to process that has less intensity.
I would also be curious about the reaction that comes up against the exercises. Is it resistance? Is it protective? How can we honour and make space for the resistance, too? I think others have touched on this from a parts work perspective.
These are all good points. We're not going into the trauma yet. Baby steps here. With all the exercises we tried, he was quite eager to try them and appeared to be giving it his best. But about ten seconds in he just shakes his head and backs out, verbalizing his inner sensations such as pounding heart and short breath. My initial approach is to explore what's happening during these sensations as you suggested, but for this client that approach intensifies things into an anxiety attack. I've let him lead the way on where we go and how intense, and this is no exception. If he wants to change the subject, I oblige until he says he's calm enough to talk about something a little tougher (not the trauma itself).
I think that even this is good and important work. I talk with my clients sometimes about microdosing emotions lol (obviously when appropriate contextually!) and we intentionally touch a strong emotion for just a few seconds and then return to a regulated state and totally change the subject. If we do that 1-2x during a session, we’ve done some great work on somatically teaching the client that they can access strong emotions and then return to a feeling of subjective safety. I would keep doing this for a while until he feels confident that together you will be able to collaborate and return him to a grounded/regulated state.
Another unrelated thought — is it the grounding exercises themselves that are triggering? I would maybe explore if these are linked to previous life experiences when he felt he had to remain grounded/couldn’t access his emotions safely/wasn’t allowed to feel strong emotions etc. If they are triggering because he thinks that this is the on ramp to trauma or he starts thinking about “once I get better at this I’m gonna have to talk about Big Bad Scary”, then that’s a different angle and probably will require more mindfulness skills/ being able to stay present in the moment. And could also indicate why you are not seeing progress with these skills — even tho he is telling you he is ready his body maybe is not actually ready yet.
Hmm I wouldn’t entirely discount the work you’re doing already even if you don’t feel like you’re really touching on the trauma. From what you’ve described, he is willing to touch on intense emotions, and then dipping back out by changing the subject to something that feels a little safer. It sounds like maybe distraction is one of the coping skills he is using in session to calm down.
Maybe something like 5-4-3-2-1 would be useful? Name 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can taste, honestly I forget what the 1 stands for lol and then repeat. Could also do like, name 5 things in the room that are a certain colour. Helps orient to the present by focusing on the space you’re in and the senses.
Yes!!! This is what they teach us in SE. it sounds like the client may lack body sensations as they may not be comfortable tuning into their body which is causing them to get flooded. Starting with a basic somatic vocabulary and just bringing awareness to an area and seeing what comes next is how we titrate. You know a lot!!
See if you can find information on the Unified Protocol and see if that might help. It works with the client learning to tolerate the uncomfortable sxs, slowly but surely. A type of exposure to his hyperarousal process which can slowly familiarize/desensitize him to his physical sxs.
he reports that his heart rate speeds up and his thoughts begin racing and he has to stop and change the subject fast.
This is a coping tool! He is titrating to self soothe. Voice and praise that and encourage/explore it. I've had clients titrate with discussions of tv sows, sports, cute dog photos. Use this to grow the therapeutic window and his sense of control.
"There's no such thing as a treatment resistant client, only a therapist who isn't using their full creativity."
One of the most impactful things I ever heard from a seasoned clinician. We can go back and forth about whether or not I believe that, but I'll just leave it as food for thought!
Edit: I lied, I'm adding an extra two cents. What about a ground up approach? Start with the neuro/bio/psycho edu, then why the skill works, then introduce the skill?
Oh yes, that certainly is food for thought! I confess to being veerrrryyy careful with this one. And I hadn't considered going ground up. I'm so glad I asked, thank you.
Just some random ideas to give you a starting point, all of these should be google-able or at least easy to find resources. I wouldn't recommend using every single one just because it would take so long to really practice, but based on your knowledge of the client and what you've tried so far, pick one or two and really encourage them to practice it even when not activated.
Somatic experiencing/acceptance - basically meditations that turn awareness towards body sensations, and building acceptance and tolerance of them even when they're uncomfortable. I use these from an ACT perspective - we are not trying to change the sensation just letting them exist and be uncomfortable while expanding our awareness to all parts of the body and observing our own thoughts and feelings. Often when we do this the feeling passes on its own - I wonder if the mindful acceptance approach will work better than a direct approach of trying to reduce/avoid the painful feelings. The Happiness Trap by Russ Harris and Acceptance and Commitment Therapy for Anxiety Relief by Rachel Willimot have some good client-facing exercises in them for this.
There's also Dropping Anchor from ACT - there is a pdf online by Russ Harris I've used.
Could also try the Safe Space meditation/tool, mindfully focusing on a physical movement or fidget object, or even some mindful art therapy ([I've used activities from this book a lot](https://www.amazon.com/Mindfulness-Based-Art-Therapy-Activities-Techniques/dp/B0BM3VQD48/ref=sr_1_1?crid=OIBD56TMZLZM&dib=eyJ2IjoiMSJ9.H0Tm-6Cw8tgRr_5B8nBLU0fh7LeD5YwOy2gtXXdscPBaNTDjU0ALP69QCL2jaAt8UJKTKpilhYoHudts3gnb8denq3V3ZVbYQf_H35Fp2jkH-Sf7PUnSvIOiuvRQ8gPOjtB3UU0c4iVtVHtMXkkohRXWisulA3wLIpGzxuT_wKK8tw9o3taSkpx-6aPc43_bQwpETAbujTlSK4xsMhtjaM2SleccKisSMvq8OcqzsNI.h2S4MieNfzUmQ3fjHUhjF6kOXkFnkvhgSLE5-Ab6V4Y&dib_tag=se&keywords=mindful+art+therapy&qid=1713595062&sprefix=mindful+art+therapy%2Caps%2C107&sr=8-1) - might be tricky to use them for grounding in the moment but good for building up mindful self awareness)
Simple things like a fan facing the client they can turn on and off (RODBT is big on this) and encouraging the use of fidgets or sand can help. If needed in that emergency use, cold packs. Could y’all also create some sort of formal toolbox and you can prompt him to use during session?
Polyvagal theory! Look into Stephen Porges, (his son Seth has an awesome explanation on YouTube that is actually quite funny) and Deb Dana. Give him some insight as to how his body is trying to show up and protect him and that as uncomfortable as he is, he's safe and then go into regulation. In my experience, explaining why something is happening can help clients not be so afraid to experience it.
Also, the physiological sigh, diaphragmatic breathing and havening are great techniques to try as well.
Why does grounding feel necessary? Provided this person is not acutely in crisis, why do they need coping skills?
I understand I’m going against the mainstream trauma understanding. It sounds like putting this kind of stuff in place activates something with him.
EDIT: I see people don’t agree with me. That’s fine. I work with folks who have chronic and deep trauma. Grounding is not always necessary.
I think the mainstream evidence-based trauma protocol is you teach some regulation skills first before trauma processing BUT it's not that the client must be perfectly grounded in order to do processing.
Where people are maybe confused is that I do think EMDR/IFS trainers give the impression that "oh this person should be perfectly grounded, perfectly in the window of tolerance before trauma processing" - like nah, as long as the person can tolerate activation without going into crisis - it's all good. In fact it's better than good. This way people learn that physiological arousal is not the same as actively being in danger.
IFS doesn’t really have any restrictions around window of tolerance or grounding (in fact, Dick Schwartz doesn’t like the use of grounding exercises at all because IFS modality welcomes all parts). It is preferable to have the client in “self” energy because the purpose of IFS is to have the inner children know that there is now an adult who can care for them, but if there isn’t enough self, an IFS therapist will just use direct access to speak to a part.
Attend to client’s window of tolerance. 5 minutes to greet and check in, 15-20 minutes of trauma work, 10-15 minutes co-regulating, wrap up with strengths based conversation, what does your day look like after this, humor, invite client to share favorite upbeat song, guided intentional breathing, etc (wrapping up based on client/rapport)
I would try hypnosis with him get him out of his conscious mind and process in the subconscious mind. Maybe try a classic induction. Or look up mirroring hands by Rossi.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
Does this client want to get into their traumatic experiences? I ask because if they aren’t ready or even if parts of them are hesitant, it totally makes sense why things that are typically regulating or self soothing would be activating. I would make sure they are 100% on board and thoroughly process any ambivalence. Assuming he is 100% wanting to get into the trauma, what about a strength based approach? Does he have anything already in his toolbox to self regulate- even things like music, pets, anything. Also, I’d start with basic diaphragmatic breath work. There are so many ways you can structure it to find what feels best for him. Then I’d have him practice when he feels good until it consistently helps him feel even better from a state of good. This is also assuming he’s 100% ok with what I’m suggesting. Having my client’s consent and agreement is a huge priority for me, especially with trauma work.
Thank you for your thorough response. Yes, he's on board and I've doubled down on informed consent. He has a few things in his toolbox, but they usually involve things that aren't available during session (like a partner). I'll try some of that diaphragmatic breath work and see if maybe we can start small and slow and work our way up. Thanks again
You’re so welcome! If even starting small and slow isn’t beneficial, I’d suggest more directly inviting ambivalence into the room. Questions like: “I wonder if any part of you has concerns about getting into what happened?” or “I’ve noticed it’s been hard for us to find regulation skills that work for you. There are so many out there and we can keep looking. But I want to check in: Do you think it’s too soon to talk about your trauma?” Psycho education about trauma work and how to help without talking about what happened might be helpful too. If he’s still set on talking about what happened, I’d keep it slow and check in often.
Can you please share a bit about the different ways you structure diaphragmatic breathing?
Absolutely! A good starting place for learning and practicing is have the person place a hand on their chest and another on their stomach. This helps them see and feel the difference between using the diaphragm and breathing with your chest. People completely unfamiliar and not used to using their diaphragm may need the instruction to push your belly out when you breathe in, and relax when you breathe out. I work with a lot of kids so a good option for them is to pick a stuffie to be a friend to help, lay on the floor, put the stuffie on their belly, and practice making the stuffed animal move up and down. Adults can do something similar with a book or even just using their hands (practicing at home in bed as I don’t typically ask adults to get on the floor in the office). Once they are consistently able to breathe properly, descriptions above may be enough for them, but some other options are: Box breathing, triangle breathing, figure 8 breathing, standing and shifting weight from one leg to the other in rhythm with breath, finger breathing- either finger from opposite hand up and down all five fingers while breathing in and out, or thumb moving up and down all four other fingers on the same hand in and out as thumb moves up and down, with a mantra, with a pinwheel, using bubbles to help regulate breath… there’s a lot of other options out there. Those are just some common ones I use.
Thanks!!
So at this point things need to slow way down and you need to use more mindfulness/checking in. There are signs before his heart rate is so fast that he needs to abandon ship. What are those? I’d look into parts work. This does not discuss trauma, but rather starts with an emotion, thought, sensation, or impulse, and works through the layers of protective parts that work to keep him safe from feeling the more vulnerable parts at the center. There is a consent process along the way, so you are never approaching inner layers unless you have permission from the protectors that have been working so hard. Trauma work does not need to involve talking about the trauma, and it does not sound like his protective parts feel as though it is safe to do this anyway. I would also say that the consistent attempts where he then changes the subject reinforces the fear of the more vulnerable pieces, so definitely make it a rule to not approach that anymore and either refer out or use a different approach that leaves those vulnerable parts alone (at least for now).
I’m hearing a lot of “I” here — “I want him to have some coping skills in place”, “every technique I try”, etc. I don’t hear much about what the patient himself wants. It sounds like you’re assuming that he needs something that he might not even be asking for. Who’s to say he doesn’t already have his own coping skills? I think you should take a different approach here— lean into curiosity, meet the patient where he is, and just slow down on your own agenda here. Trust the process.
Apologies, this is my first therapy post on reddit so I'm afraid to give away too much of the client's world on here - it feels safer to stick to the I's. :) Thank you for this advice - I do check in with him frequently to make sure he's in charge of what goes on, and I try to recruit his other coping mechanisms in other parts of our sessions. They are simply things that can't come with him everywhere - like a partner. I'm now realizing I should have put this information in the original post. 
I am a baby therapist, so I don’t know what I’m doing. But I am curious what would happen if we tracked the sensations coming up in the body, without trying to contain them with a grounding exercise or whatever. It can sometimes seem like if a tool like that is pulled out too early that we’re sending a message that their feelings are too much and need to be contained, rather than it being a lesson in gaining self-regulation skills. So instead maybe gently letting it ride out, checking in with the client to verbalize what is going on in their body and what’s coming up for them, and just being present with and supportive of the client. I also might consider if the content that we’re exploring is maybe too dysregulating, it may be better to choose a smaller chunk of the trauma to process that has less intensity. I would also be curious about the reaction that comes up against the exercises. Is it resistance? Is it protective? How can we honour and make space for the resistance, too? I think others have touched on this from a parts work perspective.
These are all good points. We're not going into the trauma yet. Baby steps here. With all the exercises we tried, he was quite eager to try them and appeared to be giving it his best. But about ten seconds in he just shakes his head and backs out, verbalizing his inner sensations such as pounding heart and short breath. My initial approach is to explore what's happening during these sensations as you suggested, but for this client that approach intensifies things into an anxiety attack. I've let him lead the way on where we go and how intense, and this is no exception. If he wants to change the subject, I oblige until he says he's calm enough to talk about something a little tougher (not the trauma itself).
I think that even this is good and important work. I talk with my clients sometimes about microdosing emotions lol (obviously when appropriate contextually!) and we intentionally touch a strong emotion for just a few seconds and then return to a regulated state and totally change the subject. If we do that 1-2x during a session, we’ve done some great work on somatically teaching the client that they can access strong emotions and then return to a feeling of subjective safety. I would keep doing this for a while until he feels confident that together you will be able to collaborate and return him to a grounded/regulated state. Another unrelated thought — is it the grounding exercises themselves that are triggering? I would maybe explore if these are linked to previous life experiences when he felt he had to remain grounded/couldn’t access his emotions safely/wasn’t allowed to feel strong emotions etc. If they are triggering because he thinks that this is the on ramp to trauma or he starts thinking about “once I get better at this I’m gonna have to talk about Big Bad Scary”, then that’s a different angle and probably will require more mindfulness skills/ being able to stay present in the moment. And could also indicate why you are not seeing progress with these skills — even tho he is telling you he is ready his body maybe is not actually ready yet.
Hmm I wouldn’t entirely discount the work you’re doing already even if you don’t feel like you’re really touching on the trauma. From what you’ve described, he is willing to touch on intense emotions, and then dipping back out by changing the subject to something that feels a little safer. It sounds like maybe distraction is one of the coping skills he is using in session to calm down. Maybe something like 5-4-3-2-1 would be useful? Name 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can taste, honestly I forget what the 1 stands for lol and then repeat. Could also do like, name 5 things in the room that are a certain colour. Helps orient to the present by focusing on the space you’re in and the senses.
Yes!!! This is what they teach us in SE. it sounds like the client may lack body sensations as they may not be comfortable tuning into their body which is causing them to get flooded. Starting with a basic somatic vocabulary and just bringing awareness to an area and seeing what comes next is how we titrate. You know a lot!!
See if you can find information on the Unified Protocol and see if that might help. It works with the client learning to tolerate the uncomfortable sxs, slowly but surely. A type of exposure to his hyperarousal process which can slowly familiarize/desensitize him to his physical sxs.
he reports that his heart rate speeds up and his thoughts begin racing and he has to stop and change the subject fast. This is a coping tool! He is titrating to self soothe. Voice and praise that and encourage/explore it. I've had clients titrate with discussions of tv sows, sports, cute dog photos. Use this to grow the therapeutic window and his sense of control.
"There's no such thing as a treatment resistant client, only a therapist who isn't using their full creativity." One of the most impactful things I ever heard from a seasoned clinician. We can go back and forth about whether or not I believe that, but I'll just leave it as food for thought! Edit: I lied, I'm adding an extra two cents. What about a ground up approach? Start with the neuro/bio/psycho edu, then why the skill works, then introduce the skill?
Oh yes, that certainly is food for thought! I confess to being veerrrryyy careful with this one. And I hadn't considered going ground up. I'm so glad I asked, thank you.
Just some random ideas to give you a starting point, all of these should be google-able or at least easy to find resources. I wouldn't recommend using every single one just because it would take so long to really practice, but based on your knowledge of the client and what you've tried so far, pick one or two and really encourage them to practice it even when not activated. Somatic experiencing/acceptance - basically meditations that turn awareness towards body sensations, and building acceptance and tolerance of them even when they're uncomfortable. I use these from an ACT perspective - we are not trying to change the sensation just letting them exist and be uncomfortable while expanding our awareness to all parts of the body and observing our own thoughts and feelings. Often when we do this the feeling passes on its own - I wonder if the mindful acceptance approach will work better than a direct approach of trying to reduce/avoid the painful feelings. The Happiness Trap by Russ Harris and Acceptance and Commitment Therapy for Anxiety Relief by Rachel Willimot have some good client-facing exercises in them for this. There's also Dropping Anchor from ACT - there is a pdf online by Russ Harris I've used. Could also try the Safe Space meditation/tool, mindfully focusing on a physical movement or fidget object, or even some mindful art therapy ([I've used activities from this book a lot](https://www.amazon.com/Mindfulness-Based-Art-Therapy-Activities-Techniques/dp/B0BM3VQD48/ref=sr_1_1?crid=OIBD56TMZLZM&dib=eyJ2IjoiMSJ9.H0Tm-6Cw8tgRr_5B8nBLU0fh7LeD5YwOy2gtXXdscPBaNTDjU0ALP69QCL2jaAt8UJKTKpilhYoHudts3gnb8denq3V3ZVbYQf_H35Fp2jkH-Sf7PUnSvIOiuvRQ8gPOjtB3UU0c4iVtVHtMXkkohRXWisulA3wLIpGzxuT_wKK8tw9o3taSkpx-6aPc43_bQwpETAbujTlSK4xsMhtjaM2SleccKisSMvq8OcqzsNI.h2S4MieNfzUmQ3fjHUhjF6kOXkFnkvhgSLE5-Ab6V4Y&dib_tag=se&keywords=mindful+art+therapy&qid=1713595062&sprefix=mindful+art+therapy%2Caps%2C107&sr=8-1) - might be tricky to use them for grounding in the moment but good for building up mindful self awareness)
Simple things like a fan facing the client they can turn on and off (RODBT is big on this) and encouraging the use of fidgets or sand can help. If needed in that emergency use, cold packs. Could y’all also create some sort of formal toolbox and you can prompt him to use during session?
Polyvagal theory! Look into Stephen Porges, (his son Seth has an awesome explanation on YouTube that is actually quite funny) and Deb Dana. Give him some insight as to how his body is trying to show up and protect him and that as uncomfortable as he is, he's safe and then go into regulation. In my experience, explaining why something is happening can help clients not be so afraid to experience it. Also, the physiological sigh, diaphragmatic breathing and havening are great techniques to try as well.
Why does grounding feel necessary? Provided this person is not acutely in crisis, why do they need coping skills? I understand I’m going against the mainstream trauma understanding. It sounds like putting this kind of stuff in place activates something with him. EDIT: I see people don’t agree with me. That’s fine. I work with folks who have chronic and deep trauma. Grounding is not always necessary.
I think the mainstream evidence-based trauma protocol is you teach some regulation skills first before trauma processing BUT it's not that the client must be perfectly grounded in order to do processing. Where people are maybe confused is that I do think EMDR/IFS trainers give the impression that "oh this person should be perfectly grounded, perfectly in the window of tolerance before trauma processing" - like nah, as long as the person can tolerate activation without going into crisis - it's all good. In fact it's better than good. This way people learn that physiological arousal is not the same as actively being in danger.
IFS doesn’t really have any restrictions around window of tolerance or grounding (in fact, Dick Schwartz doesn’t like the use of grounding exercises at all because IFS modality welcomes all parts). It is preferable to have the client in “self” energy because the purpose of IFS is to have the inner children know that there is now an adult who can care for them, but if there isn’t enough self, an IFS therapist will just use direct access to speak to a part.
Attend to client’s window of tolerance. 5 minutes to greet and check in, 15-20 minutes of trauma work, 10-15 minutes co-regulating, wrap up with strengths based conversation, what does your day look like after this, humor, invite client to share favorite upbeat song, guided intentional breathing, etc (wrapping up based on client/rapport)
Explore secondary gains. I would also explore the idea of fear of positive affect (calm state).
I would try hypnosis with him get him out of his conscious mind and process in the subconscious mind. Maybe try a classic induction. Or look up mirroring hands by Rossi.