Why does SSP sometimes cause such extreme “adverse reactions”? Why is it so transformational for other people?
Emma Ashfield, Neuro-developmental therapist specialising in children and founder of Move2Connect explains…
This post contains vital information for remote clients of the Safe and Sound Protocol as well as for those researching the programme.
If you are looking for information on what the SSP is, please refer to this post – Safe remote trauma therapy: the Safe and Sound Protocol Digital – Move2Connect
As you probably already know, the Safe and Sound Protocol is a five-hour listening programme, based on Dr Stephen Porges’ Polyvagal Theory.
When we work with the nervous system, less is always more. “More” is like stretching a perished rubber band to breaking point – you’re bound to see side effects as a person grows into their “more”, whereas with less, a person can still grow into a more settled system, but gradually.
The analogy I tend to give my clients is that doing the Safe and Sound Protocol is marathon training for your nervous system, and the speed we work at all depends on your nervous system’s starting point: a couch potato who lives off deep fried mars bars and coca cola will need to spend a lot longer preparing to get fit before they even start marathon training, and marathon training itself will need to be slow and steady, as otherwise they could suffer injuries.
The Safe and Sound Protocol is designed to help a person process trauma as well as improve social engagement, language and cognition. The protocol was originally intended for children with developmental trauma as well as to improve social communication for children with autism, but it is in widespread use by psychotherapists and other trauma therapists globally for complex trauma in adults, as a powerful non-talking intervention that helps people to process trauma effectively.
Your practitioner NEEDS to be trauma-informed and it is essential that they also that they understand how to work with the nervous system. This means they need to be trained in trauma and understand both trauma and the polyvagal theory in depth. This doesn’t mean simply banding the word “trauma” around or citing a couple of books they’ve read. A practitioner MUST have a thorough knowledge of how the SSP works and they must work with you to ensure that they understand exactly how much listening you need every day as well as the volume you should use, whether to complete in clinic or digitally and so-on.
A thorough administration of SSP involves a lot of preparation and support on the part of both you and your practitioner, and success is equally dependent on you fully engaging with what you are doing as it is on your practitioner working ethically and knowledgeably with you.
Carol Ann Rowland of Halton Therapy & Neurofeedback in Georgetown, Ontario is an esteemed colleague and valuable member of the SSP practitioner community. I asked her to encapsulate why it is so important to find the right practitioner with the right level of experience and sensitivity – rather than focussing on price:
People looking for an SSP practitioner are often tempted to go with whoever has the lowest rate. Unfortunately, practitioners who strive to offer the lowest price are often cutting corners in how much time they are investing in their clients’ processes. At best this may lead to the process being much more difficult than it needs to be. At worst, there is the potential that, if dysregulation gets big enough, that improvements may either be reduced or sabotaged completely. In some cases the process will end up costing even more when intially taking a budget approach as it may become necessary to then find another practitioner who is able to help repair where things went wrong. Worst of all, someone who has a difficult experience with SSP may never be willing to repeat it again, which is heartbreaking given that SSP can be life changing for many. With SSP I often see shifts that usually would have taken decades of hard work before showing up. It is well worth investing in a quality practitioner who will ensure that you have the best and gentlest possible experience, while maximizing the potential for signficant improvements.Carol-Ann Rowland
Let me give you a couple of case studies – one positive, one negative, in order to illustrate my point further about the importance of being trauma-informed.
Adverse reaction to SSP in a 6 year old
William, aged 6 did SSP last year at home with his parents. He had a history of lengthy hospital stays and trauma. It is worth mentioning that our health and social care system in the UK had not identified the link between invasive early childhood hospital stays and behaviour, and hence William had been placed on a diagnostic pathway for autism and ADHD.
His practitioner advised starting with 15 minutes of listening, but unfortunately his mother decided that because he was looking relaxed and happy while listening, she would leave him to listen and play with Lego while she went to do the dinner. She forgot he was listening, and he did a full hour. She admitted this to the practitioner, who took a deep breath re ignoring instructions, and said it would be wise to give it a break the following day. Unfortunately, this advice was not heeded, and so William did a second hour-long session the following day… after which he threw a cat down the stairs, kicked a hole in a shed door and threw his mother’s mobile phone in a fish pond. When his mother asked the practitioner whether this was a normal reaction, the answer had to be very measured considering the fact that all instructions had been completely ignored.
It took William FOUR months for anyone to see any benefits. By this time, he was on a final warning at school for violent outbursts. However, once he had settled, his progress was fantastic: he was able to verbalise the reasons for his anger so much better, and in the meantime, sleep settled right down too.
Since the initial round of SSP, William’s mother has also done SSP for herself and he has had a repeat of days 3-5.
In fact, the above is still a positive result, despite appearing to be an adverse reaction. In fact, William was merely responding to his environment after being overwhelmed by too much challenge to his nervous system in one hit. It is also worth mentioning that the reason why an experienced practitioner may suggest that a parent also completes SSP themselves is that it is essential for parents to connect deeply with their children during this process. Leaving them to play Lego while they listen is not going to provide the magic bullet they think they are paying for, and neither is completely disregarding carefully given instructions.
A client rescued from a bad experience with a cut-price SSP experience with a practitioner, who did not offer any support during the programme
A mum contacted Emma, desperate for help with her teenage son, who had got to day 4 of a third round of SSP and was suffering from extreme sensory overwhelm.
When asked when the previous rounds had been, Emma was alarmed to find that this parent was sharing physical SSP equipment with another 5 families – and using SSP once every 6 weeks! Given that SSP continues to take effect for up to 8 weeks post SSP, repeating quite so often is ill-advised.
Emma decided to complete day 5 of SSP, but VERY slowly (5 minutes every day or two, depending on reactions), and incorporating external (bodywork) support for the vagus and facial nerves.
The mother then followed up with a course of cranial osteopathy.
The teen went from being totally shut down (eyes tightly closed, hands clasped over ears, non-verbal, distressed, sleeping all the time), to smiling, relaxed facial muscles, laughter and expressing desires in language. A fantastic transformation!
Please beware of cut-price SSP practitioners, lack of supervision and lack of nevous system and titration knowledge.
A wonderful experience for an adult with PTSD
Annabelle, a 40 year-old with PTSD following survival of a terrorism incident, first did SSP in December in clinic, following many years of talking therapies, EMDR and somatic experencing.
She completed the SSP in half hour slots on a Monday and Friday over 5 weeks. Even after her first half hour, she noticed incredible gains in terms of ability to connect with strangers. After completion of day 3, she had a job interview and got the job, where she remains happy to date. She completed the five-day protocol and reported a fantastic shift in terms of anxiety. However, she decided to undertake a booster of days 3-5 remotely using the Digital SSP in April 2020 due to stress over the Covid-19 situation, which she reports to have made her feel noticeably calmer and better able to sleep through the night without 3am wake-up-and-worry sessions.
What has happened, and why was this so successful? Annabelle fully engaged in the process. She researched SSP and the Polyvagal theory thoroughly in advance and engaged with her practitioner every single day to give the required feedback so the programme could be tweaked if necessary.
So, how do we avoid having a William situation, and ensure a peaceful Annabelle situation?
- Research your provider.
- How long have they been qualified to deliver SSP?
- What is their background? Is it relevant to your reason for seeking out SSP?
- Don’t be scared to ask how many clients they have worked with.
- What kind of client they specialise in?
- Do they specialise in SSP or are they a jack of all trades?
- Are they trauma-certified?
- Do they work with nervous systems as part of their discipline? (This is EXTREMELY important)
- Ask them to explain how SSP works – can they do this clearly?
- Ask what sort of side-effects they have seen and how they deal with them.
- Do they ever refuse clients? (you want them to say yes, and explain why – you would also want them to explain that they cannot deal with those stuck in a “freeze” state, and will ideally need to see them face-to-face in clinic).
- How do they work out how to work with clients?
- Do they use all 3 pathways? If they do NOT use the Connect programme, steer clear.
- How long will your provider allow you to access the SSP for?
- How will communication take place during the protocol? (you want them to say that they are on call for you all the time by email and/or telephone).
- What will happen post-SSP? Do they have modalities compatible with SSP for continuation, or alliances with other therapists to refer to?
- What is their go-to follow up? (hint: no one modality works for everyone)
- Do they insist on you following their programme or do they have a network of other therapists they refer to?
- How will they prepare you for SSP?
- How do they use the SSP Connect Programme?
- In addition, are they strikingly cheap or strikingly expensive? (Some of my UK clients recently have told me about OTs charging in excess of £2000, which is, in my opinion as a far more experienced practitioner than nearly every OT in the country, absolutely extortionate, and totally contrary to Dr Porges’ vision of this being accessible to those who need it).
- Do they have a website? Have a good look – see if all the materials are theirs or lifted from other sources. You can quickly get an idea of experience levels by the way SSP is described and whether materials are original or copied. (I say this as someone who has spotted my work embedded on so many websites – some SSP practitioners think they shouldn’t need to “reinvent the wheel”, but the fact is that the wheel NEEDS to be reinvented for each individual…)
Emma has been providing SSP for almost five years years, and have worked with in excess of 500 clients, with a variety of presentations and different nervous systems.
Emma conducts 1:1 workshops and case supervision for anyone recently trained in SSP who is wishing to incorporate SSP into practice, and regularly advises and collaborates with Unyte-iLs on training/clinical practice.
For any questions about the Safe and Sound Protocol, either as a client or a practitioner, please contact me.