I have used SE within integrative mental health therapy for patients whose migraines resisted the usual combinations of triptans, magnesium, riboflavin, sleep hygiene, and avoidance lists. SE is not a silver bullet. It works best as one part of a coordinated plan that may include a headache specialist, physical therapy for cervicogenic contributors, nutrition changes, and in some cases prophylactic medication. But when you can calm the storm at the level of the body, everything else tends to work better.

The body’s alarms: why migraines behave like a whole-system event

Migraines are not just vascular constriction followed by dilation. Contemporary models blend neurovascular, neuroimmune, and network theories. The trigeminovascular system becomes sensitized, cortical spreading depression disrupts sensory processing, and brainstem nuclei that regulate arousal and pain gating go off rhythm. That science tracks with everyday signs. People with migraines often have a low threshold for sensory load on some days, then swing to relative resilience on others. Small stressors stack. One sleepless night plus a skipped meal plus a difficult conversation, and by late afternoon the nervous system is humming. The prodrome starts.

In SE terms, you could say the system tips into chronic sympathetic activation, high tone in neck and scalp musculature, then rebounds into a dorsal drop as the body tries to protect itself. Nausea, fatigue, the urge to withdraw, even depression after an attack, all fit within the polyvagal map. SE does not treat aura or vascular changes directly. It improves the organism’s capacity to move between states without getting stuck at the red line.

A quick primer on Somatic Experiencing

SE is a body based, bottom up approach to trauma therapy developed by Peter Levine. The central idea is that traumatic or overwhelming events can leave the nervous system in a loop of incomplete defensive responses. Rather than ask people to re tell their stories, SE guides them to track sensations, motor impulses, breath, and micro movements that reflect autonomic activity. The therapist helps the person oscillate between resource and activation, a process called pendulation, then supports tiny completions of stuck patterns. Over time the system finds more mid range, less all or nothing.

Migraines are not necessarily trauma, although trauma history is overrepresented among people with chronic pain. Even without explicit trauma, migraine attacks train the nervous system to expect danger. Anticipatory anxiety before a work presentation, the memory of last month’s three day attack, the neck that tenses when a child yells from the other room, these are associative learning processes. SE helps untangle those links and restores self trust in bodily signals. Within integrative mental health therapy, SE sits alongside cognitive skills, sleep regulation, and medical care, each supporting the other.

Mapping migraine phases to autonomic states

Most people can identify four broad phases, although not everyone experiences all of them each time. Prodrome, aura, headache, postdrome. Each has its own nervous system flavor, which suggests different SE tactics.

Prodrome often brings yawning, food cravings or https://www.amyhagerstrom.com/locations/delray-beach-fl aversions, neck stiffness, and difficulty focusing. I hear language like, I can feel the pressure building behind my right eye, or My upper back is bracing like I am about to lift something heavy. Autonomically, this can look like rising sympathetic tone layered over subtle parasympathetic shifts in the gut. In session, I will ask clients to track the earliest micro signs at home. How many yawns in an hour compared with your baseline. Does your right trap tighten more than your left when a meeting runs long. A small adjustment in posture, a longer exhale, a hand on the sternum while noticing warmth or coolness, can interrupt the ramp.

Aura, when present, reflects cortical network changes. Visual flicker, zigzag lines, tingling, language glitches. SE will not turn off those phenomena mid stream, and I do not try to force that. The goal here is containment and reducing the stack of additional alarms. People can often soften their overall arousal even as the aura runs its course. Tracking the edges of the field of vision without straining, noticing a boundary like the weight of the body against the chair, and orienting to three stable sounds in the room, can keep the sympathetic surge from amplifying the headache that follows.

Headache phase is where many people feel least able to engage. Noise and light are intolerable. Vomiting risk is high if they move much. Here the SE stance is minimalist. Reduce input, allow protective withdrawal, and find micro doses of settling. Some clients can lengthen the exhale by a count or two without provoking nausea. Others find that pressing the soles gently into the mattress for five seconds, then releasing, decreases jaw clenching by a degree or two. Degrees matter. If triptan timing is helpful, we defer to it. SE should not delay evidence based abortives.

Postdrome, sometimes called the migraine hangover, can last a day or two. People describe brain fog, mood flattening, bowel irregularities, and a sensation like they have run a marathon. The nervous system is often in a dorsal tilt here, undersupplied with engagement energy. We titrate back into activity with careful pacing. This is a good window for SE work that re associates movement with safety, such as gentle head and neck tracking within pain free ranges, or standing for a minute by the window to orient to distance and natural light.

A clinical vignette from practice

A teacher in her late thirties came to me with three to four migraines a month, usually peaking on Sundays or the first workday after a holiday. MRI and labs were unremarkable. She had tried three preventives over three years, each helpful for a while, then less so. She noticed that complicated lesson planning, fluorescent lights, and raised voices set her off. She also carried a history of a car accident at nineteen with residual whiplash that flared under stress.

We built a short SE sequence she could use in the 12 to 24 hour prodrome window. It started with orienting to the room by noticing two colors and two sounds, then placing one hand over the sternum, one over the upper abdomen, and waiting for the first spontaneous sigh. She learned to track a specific sensation that reliably appeared early, a pencil eraser sized knot under the right skull base. Rather than stretching hard, which had failed her, she experimented with letting the left shoulder drop one centimeter while her eyes stayed soft. We did five to ten minute practices in session to teach her nervous system that change could happen without a big push.

We also ran a short course of the Safe and Sound Protocol, which is an auditory intervention informed by polyvagal theory. It filters music to emphasize frequencies of the human voice, which can cue the middle ear muscles and brainstem pathways associated with social engagement and calm. The research base is early and mixed, but in selected patients I have seen improved sound tolerance and lower startle. We screened carefully for sensory over responsivity and paused sessions when she reported a band of head pressure. Over eight weeks, her migraine days fell to about two per month and her use of abortives dropped by half. She still had bad days, and a head cold could set off a rough patch. But the Sunday night catastrophizing settled, and she felt she had levers to pull besides white knuckling.

Why somatic work belongs in migraine care, even without trauma

Trauma therapy may sound misaligned with a neurological disorder. In practice, SE is not only for trauma. It is a method for working with autonomic patterns. That said, trauma history does matter. People with early adversity show higher rates of chronic pain, irritable bowel, and migraine. The shared pathway is a sensitized alarm system. If the body learned that the world is unpredictable, it is more likely to brace, constrict, and over interpret signals. That background hum makes it easier for a sensory trigger to tip you into migraine.

When trauma history is present, SE helps avoid retraumatization from the very symptoms of migraine. For example, vomiting that repeats an earlier experience of medical neglect can become more than nausea, it becomes a memory cue. Carefully built pendulation, resourcing, and micro completing defensive impulses, such as pushing against a wall for a few seconds, gives the body a chance to resolve echoes of the past. Done well, this gentles the terrain on which migraine episodes occur.

The rest and restore protocol, and how I adapt it for migraine

People often ask about a rest and restore protocol. The phrase is used in different ways across programs, but the thrust is the same, practices that nudge the autonomic system toward ventral vagal engagement and healthy parasympathetic tone. For migraine, the details matter. Standard long breath holds can provoke dizziness. Aggressive stretching can spike neck pain. My version uses paced exhale focused breathing, soft palatal awareness, and orientation rather than intense bodywork.

A typical five minute sequence looks like this. Sit with spine supported. Let your eyes land on something neutral in the middle distance. Exhale through pursed lips a second or two longer than your inhale, no forcing. Place a fingertip lightly at the notch of the collarbones and sense movement there as you breathe. Name one sensation that feels neutral or pleasant, warmth in the hands, contact of the thighs with the chair. Without moving your head, let your eyes sweep the room slowly left to right, then back to center. If the neck feels safe, turn the head a few degrees right and left, staying well inside pain free range. End by feeling the weight of your feet or the length of your spine.

That small arc, repeated once or twice daily on migraine free days, trains the system to find middle gears. Over weeks, many people notice that their prodrome arrives with less velocity. They still need their medications and boundaries around sleep and nutrition, but their body has more slack in the line.

The Safe and Sound Protocol, when to try it, and when to skip

The safe and sound protocol can be useful for people with sound sensitivity, hypervigilance, and difficulty settling in busy environments. It is not specific to migraine, and robust randomized data are limited. In practice, I consider it for patients who report that chaotic audio environments, cafeterias, gyms with thumping music, or family noise at dinner are reliable triggers. I avoid it during an active migraine cycle and in clients with a history of destabilization with auditory exposures. Sessions are brief, ten to thirty minutes, with the option to stop at any hint of headache pressure, tinnitus flare, or dissociation. Used conservatively within integrative mental health therapy, it can reduce the background burden of sensory threat that primes the pump for attacks.

Practical in session work that reduces migraine load

Here is a condensed progression I often use across early SE sessions with migraine patients. It is not a script. It is a scaffold that adapts to the person.

Begin with orientation. Identify three visual anchors at different distances, then three neutral sounds. Track any shift in breath or muscle tone. Add interoceptive tracking. Invite attention to one small area that feels easiest. Let sensation change without steering it. If intensifying, return to visual anchors. Work with micro movements. Encourage a slow, tiny nod, side tilt, or shoulder drop, staying under the pain threshold. Pause to notice rebound sensations. Introduce pressure and release. Press the hands lightly into the thighs for five seconds, then stop and feel what lets go. If jaw tightens, bring gentle awareness to the hinge and invite it to soften by a degree. Close with boundary and support. Lean the back into the chair, feel the head held by the headrest or hands, and let the eyes settle on something that cues safety.

We may spend entire sessions in the first two steps if the person’s system is highly reactive. Faster is not better. The test is whether daily life starts to feel a little wider.

Home practices that respect migraine physiology

Outside the office, small daily actions shift the baseline. People succeed when practices are simple, time bound, and kind.

Do two five minute rest and restore sessions on days without headache, ideally mid morning and late afternoon, not right before bed if sleep is fragile. Use a prodrome interrupt. At the first yawn cluster or neck stiffness, orient to the room, lengthen the exhale by a second, and step outside for a minute of distance vision. Track one metric for four weeks. Choose either total migraine days, abortive doses, or time from prodrome to peak. Simplicity encourages adherence. Protect neck neutrality. Set screens at eye level, use a pillow that keeps the neck in line with the spine, and limit end range neck rotations during flare windows. Create sensory pockets. Keep one dim corner or a pair of tinted glasses and soft earplugs accessible to reduce stack when environments are loud or bright.

These are not cures. They are ways to drain the bucket so that inevitable stressors do not overfill it.

Measuring progress without the trap of perfection

Migraine comes in clusters. Improvements are rarely linear. I tell clients to evaluate change in 8 to 12 week windows, not day to day. Useful markers include a drop in attack frequency, a 20 to 30 percent reduction in peak intensity, faster recovery in the postdrome, fewer missed workdays, or lower anticipatory anxiety. Sometimes the earliest sign is a subtler one. People stop rearranging their whole week around fear of the next hit. They book a dinner with friends and trust that if a migraine comes, they have tools.

Relapses happen. Travel, illness, hormonal shifts, or a string of late nights can push the system back to higher sensitivity. This does not erase gains. It highlights where to strengthen supports. Often a brief return to session based SE, a few days of disciplined sleep and hydration, and timely use of abortives settles the pattern again.

The role of physical contributors and what SE does about them

Neck and jaw tension are not innocent bystanders in migraine. Cervicogenic pain can feed the trigeminal system. Bruxism during sleep, a history of whiplash, or a workstation that keeps the head forward all day, magnify the signal. SE interfaces well with physical therapy by helping clients perform exercises inside a tolerable window. If a therapist prescribes deep neck flexor training, we might precede it with gentle orienting and end with a minute of supported rest to prevent a post exercise spike. For temporomandibular issues, micro awareness of jaw hinge position and a soft tongue resting posture, tip on the alveolar ridge, can reduce clenching reflexes without forcing the mouth open.

I watch for subtle red flags. Unilateral neck pain with neurologic changes, sudden change in headache pattern, worst headache of life, fever, or visual loss outside a familiar aura pattern warrant urgent medical evaluation. SE is not a substitute for medical safety netting.

Medication and SE, not either or

A common worry is that body based therapies ask people to minimize medication. That is not good migraine care. The evidence for triptans, gepants, ditans, and in some cases CGRP monoclonal antibodies is strong. What SE does is reduce reliance on rescue dosing and increase the effectiveness of preventives by lowering background arousal. When someone worries about medication overuse headache, we coordinate with the prescriber to set a ceiling on abortive days per month, usually under ten, while building practices that keep them from reaching that ceiling. It is also reasonable to trial magnesium glycinate, riboflavin, or coenzyme Q10 in collaboration with a clinician, but I do not stack supplements without a plan. People deserve clarity, not full spice racks.

When SE is not the right front door

There are cases where SE is not the first move. Severe depression with psychomotor retardation, active substance withdrawal, untreated sleep apnea, and unstable medical conditions need attention before or alongside somatic work. Some clients find interoception intolerable at first. For them, external orientation, nature based attention, or highly structured cognitive strategies can build tolerance. Others respond better to biofeedback or neurofeedback to start, then layer in SE once they trust bodily signals again. Good care meets the person, not the model.

Building a personalized plan

The strongest plans tend to have four threads woven together. Medical, somatic, behavioral, and environmental.

Medical care lines up abortives, considers preventives if the monthly day count is high, and screens for comorbidities like sleep disorders or anemia. Somatic work through SE targets autonomy over state shifts and reduces reflexive bracing. Behavioral rhythms support sleep, movement, and regular meals, not as rules to fear, but as scaffolding. Environment covers light, sound, ergonomics, and social load. It is common to fine tune over months. An initial sequence that looked perfect on paper might leave out one key school pickup stressor. Test, learn, adjust.

I think of migraine as a negotiation with a sensitive and intelligent system. It does not respond well to force. It does respond to respectful experiments, repeated often, in small doses. Somatic Experiencing gives a language for those experiments. Track the early signals. Resource what is already steady. Touch activation, then return to safety. If you do that a few minutes at a time, most days, the autonomic storms come less often, and when they do arrive, they pass with less wreckage. That is not magic. It is consistent attention to how bodies find their way back to balance.

Amy Hagerstrom Therapy PLLC provides somatic and integrative psychotherapy for adults who want mind-body support that goes beyond talk alone.

The practice serves clients throughout Florida and Illinois through online sessions, with Delray Beach listed as the office and mailing location.

Adults in Delray Beach, Boca Raton, West Palm Beach, Fort Lauderdale, and nearby communities can explore support for trauma, anxiety, chronic stress, burnout, and midlife transitions.

Amy Hagerstrom is a Licensed Clinical Social Worker and Somatic Experiencing Practitioner who works with clients in a steady, nervous-system-informed way.

This practice is suited to people who want therapy that includes body awareness, emotional processing, and whole-person support in addition to conversation.

Sessions are private pay, typically 55 minutes, and a superbill may be available for clients using out-of-network benefits.

For local connection in Delray Beach and surrounding areas, the practice uses 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483 as its office and mailing address.

To learn more or request a consultation, call 954-228-0228 or visit https://www.amyhagerstrom.com/.

For a public listing reference with hours and map context, see https://maps.app.goo.gl/VZTFSS2fq1YPv7Rs5.

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Landmarks Near Delray Beach, FL

I have worked in clinics that tried a light version of behavioral health integration, and clinics that embraced a full collaborative care model. The difference shows up in the waiting room. In the first, crises dominate and follow-up gets lost. In the second, you overhear a care manager coaching breathing techniques with a patient while the primary care physician wraps a warm handoff to the therapist next door. Patients still struggle, but they feel held by a team that shares a plan.

Why primary care is the pivot point

Most patients with anxiety, depression, or trauma symptoms present first to primary care. Some never see a psychiatrist. There are predictable reasons: convenience, trust built over years, fear of stigma, lack of transportation, and shortages in specialty mental health. If we design a clinic to receive this reality rather than fight it, outcomes improve. In well run collaborative care programs, rates of depression remission often increase by 10 to 20 percentage points at 6 to 12 months compared with usual care. That lift does not come from a single technique. It comes from clear roles, steady measurement, timely case review, and respectful iteration.

Integrative mental health therapy in this setting is not a single brand. It is a way to sequence and blend treatments that match what primary care can sustain. You anchor care with brief, evidence-based psychotherapies, sensible medication management, and practical skills the patient can use between visits. You add options that address the body’s stress physiology, such as paced breathing, grounding, and, when appropriate, structured approaches like somatic experiencing. You educate patients about how the nervous system works under chronic threat. You bring in the family when safety or adherence hinges on support at home. You track symptoms like you track blood pressure.

The collaborative team and how it actually works

On paper, teams look tidy. In practice, clinics are messy. Phones ring, rooms are double-booked, and the EHR claims a report exists that no one has ever found. The collaborative model endures that mess because it spreads responsibility and embeds feedback loops.

The backbone is the trio of primary care clinician, behavioral health clinician, and care manager. Depending on the clinic, add a consulting psychiatrist, a social worker with housing or benefits expertise, and allied health professionals such as a physical therapist or dietitian. Each role does different jobs.

The primary care clinician screens, engages, and makes initial treatment decisions. They handle starting or adjusting medications and watch for medical drivers such as thyroid disease, sleep apnea, anemia, chronic pain, or alcohol use. A simple move that matters: when reviewing vitals, ask about sleep and caffeine. Rising heart rates and four espressos before noon can look like panic.

The behavioral health clinician provides structured psychotherapy that fits short visits and stepped care. Brief cognitive behavioral therapy, problem solving therapy, acceptance and commitment strategies, and trauma therapy skills can all live in a 20 to 45 minute slot. If your clinic has an appetite for somatic methods, training matters. Somatic experiencing can be integrated as a gentle, titrated approach to help patients notice and regulate bodily sensations. Stay within scope, avoid aggressive catharsis, and use clear consent.

The care manager tracks the panel. This is the often invisible engine of improvement. The care manager keeps a registry of patients with active behavioral health plans, updates symptom scores, pings the clinician when a patient stalls, and calls patients who no-show. They are the one person in the clinic who can see the whole landscape of who is getting better and who is drifting.

A consulting psychiatrist or psychiatric NP reviews cases weekly or biweekly. The goal is not direct evaluation of every patient, which is not feasible, but population-based consultation. The consultant suggests medication strategies, flags risk, and recommends when to escalate to specialty care. When the panel is large, use structured case review. Focus first on patients with high severity scores, suicidal ideation, or minimal improvement after several weeks.

Physical therapists and occupational therapists can be surprisingly powerful partners. Many patients with trauma hold patterns in their bodies that perpetuate pain and fatigue. Gentle graded activity, breath-posture coaching, and movement plans aligned with therapy can reduce flares. This is not a replacement for trauma therapy, but it supports it.

The flow of a visit, without derailing the day

Integrating care should not add chaos. The core visit flow uses brief screens, warm handoffs, and scheduled short follow-ups. Start with routine screening for depression and anxiety, such as the PHQ-2 followed by PHQ-9, and the GAD-7. When trauma symptoms are likely, consider the PC-PTSD-5 or a brief PCL-5, with a clear plan for how you will respond to positives. Never screen without the capacity to act.

Warm handoffs matter. When a patient screens positive and you have a behavioral health clinician on site, walk the patient over or call them into the room. Thirty seconds of shared presence builds trust that later supports adherence. If that is not possible, schedule a first visit within one to two weeks and have the care manager call within 48 hours. Leave the patient with one concrete skill they can practice before the therapy appointment, such as a simple 4-6 breath pattern or a 3-3-3 grounding method.

Follow-up is the test of a system. Commit to measurement-based care. If the PHQ-9 was 18 last week and 15 this week, that is movement. If it is still 18 after four weeks of SSRI and basic CBT skills, change course. Do not wait three months to find out the plan is not working. Adjust medication dose, switch medications, add psychotherapy elements, or invite the consultant to weigh in.

Trauma therapy in the primary care setting

Trauma work in primary care thrives on steadiness and boundaries. Patients often arrive with fragmented care histories and mistrust. Your task is to signal predictability. Start with psychoeducation about how trauma sensitizes the autonomic nervous system, often amplifying pain, GI distress, and sleep problems. Explain this with simple, non-pathologizing language. When patients grasp that their symptoms are understandable nervous system responses, self-blame softens and motivation rises.

Not all trauma therapy belongs in primary care. That is a sentence to print and keep near your desk. Complex PTSD with active self-harm, unstable housing with ongoing violence, or dissociation that disrupts daily functioning may require specialty-level care. Still, primary care can help many patients build foundational regulation: identifying cues of safety and danger, practicing orienting and breath-based settling, and building routines that reduce allostatic load like sleep regularity and steady meals.

Somatic experiencing offers a framework for titrated exposure to bodily sensations associated with threat. In a primary care clinic, scale it down. Use brief experiments that help patients notice small shifts, such as heat in the hands after a few quiet breaths or the relief that follows naming a tight jaw. Track for safety. If the patient floods with panic or dissociation, back up, reorient to the room, and anchor with external sensory input. Document what helps and what does not. Integrate with cognitive and behavioral strategies, not as a standalone mystique.

I have also seen clinics use the safe and sound protocol, a listening intervention based on polyvagal theory. Some patients report improved calm and social engagement, while others notice little change. Evidence is still emerging. If your clinic offers it, set expectations clearly, screen for auditory sensitivities, start with low volumes, and monitor for headaches or agitation. Make it an option among options, not the centerpiece of care.

Some clinics refer to a rest and restore protocol, usually a structured routine of breathwork, gentle movement, and sensory grounding that patients practice daily. Whether you use that exact name or another, the essence is the same: repeated, brief practices that shift the body toward parasympathetic tone. A pragmatic version in primary care might include six minutes of 4-6 breathing twice daily, a two-minute orientation exercise upon waking and before sleep, and a short walk outdoors after lunch. Patients are more likely to adhere when the routine is small, specific, and linked to existing habits, such as after brushing teeth.

A week in the clinic: three brief vignettes

Maria, age 31, arrives two weeks after delivering her first child. Her blood pressure is fine, but her PHQ-9 is 16 and she bursts into tears describing relentless worry. She sleeps two hours at a stretch, checks the baby’s breathing five times a night, and cannot stop scanning for danger. The primary care physician normalizes postpartum anxiety, screens for safety, and introduces a care manager. They start sertraline at a low dose, teach a 4-6 breath pattern she can use while nursing, and schedule a brief therapy visit in a week focused on worry postponement and values-based scheduling. The therapist uses elements of acceptance and commitment therapy, tied to Maria’s wish to be present with her child. Six weeks later, her PHQ-9 is 7. Not a miracle, a method.

Darnell, age 54, has chronic low back pain and two emergency room visits this year for chest pain that never turns out to be cardiac. He has a trauma history from adolescence he rarely mentions. He sleeps five hours a night at most. His PHQ-9 is 12 and GAD-7 is 13, with a PCL-5 short form in the positive range. The team builds a plan: a non-opioid pain regimen, basic sleep coaching, and eight sessions of brief CBT focused on activity pacing and cognitive reframing. The behavioral health clinician adds titrated somatic work to help Darnell notice early signs of a pain flare and intervene with breath and position changes. The physical therapist coordinates a graded movement plan. Over three months, his ER visits drop to zero and he reports two bad days a week rather than five. Pain remains a fact of life, but it is less terrifying.

Asha, age 42, developed persistent fatigue and brain fog after a viral illness last year. She reports panic in grocery stores and gives up on her yoga class because the music feels overwhelming. The physician rules out anemia, thyroid problems, and diabetes, and screens for depression and anxiety. The team builds a simple rest and restore protocol: three daily breath practices, a sensory-friendly walk with sunglasses and a hat, and scheduled breaks from screens. A brief trial of the safe and sound protocol is offered with careful monitoring. After two weeks, Asha describes slightly steadier afternoons and fewer crashes, so the team keeps the program and adds a short CBT course for panic triggers. The care manager calls weekly to adjust pacing and helps her apply for intermittent leave at work.

These vignettes show the rhythm of integrated care: small concrete steps, tracked and adjusted, with the patient’s values steering choices.

Protocols and workflows that keep teams aligned

A clinic needs a shared playbook. Without it, every patient encounter becomes bespoke and clinicians burn out. The workflow below has served well in family medicine and community health settings.

Screen for depression and anxiety annually, with targeted screening during high risk periods such as postpartum, new chronic illness diagnoses, and after ER visits for pain or panic. Use warm handoffs for positive screens when possible, and schedule first behavioral health follow-up within 1 to 2 weeks. Care manager calls within 48 hours to reinforce the plan and troubleshoot barriers. Start with brief, evidence-based psychotherapy and basic skills training, align medication trials with measurement, and build a daily regulation routine the patient can sustain. Run weekly case reviews with a consulting psychiatrist focusing on non-responders, high risk patients, and medication complexities. Document recommendations and close the loop. Reassess at 4 to 6 weeks. If symptom scores have not moved, adjust strategy. If the patient improves, consolidate gains and set a longer follow-up cadence.

This is not fancy. The secret is consistency.

Safety nets and clear thresholds

Every integrated program needs unmistakable lines that trigger a different level of care. Primary care should not hold impossible risk.

Active suicidal intent or a recent suicide attempt requires immediate safety evaluation, often same day specialty care or emergency services. Psychosis, mania, or severe substance withdrawal exceeds typical primary care scope and needs urgent specialty input. Severe eating disorder behaviors with medical instability, such as electrolyte abnormalities or bradycardia, warrant specialty referral. Trauma symptoms with frequent dissociation or unsafe home environments need higher intensity trauma therapy and social support services. Lack of improvement after two or more adequate medication trials and structured psychotherapy may indicate referral for specialty evaluation.

Spelling these out in a one-page policy gives clinicians confidence and guards against quiet drift into risky territory.

Where somatic approaches fit without overreach

Body-based methods can enrich care, but they must be presented as options and nested within a plan. Somatic experiencing can help patients build capacity to notice and regulate sensations linked to stress. Use short, structured practices and gain explicit consent, especially when drawing attention to the body could be triggering. Document what anchors the patient - for some, it is feeling feet on the floor; for others, orienting to sights and sounds in the room. Avoid touch unless your discipline permits it, you are trained, and the clinic has a clear policy. Even then, ask permission every time.

Auditory-based approaches like the safe and sound protocol deserve thoughtful use. Some patients describe significant benefit, others do not, and a few feel overstimulated. Begin at lower intensity and shorter sessions, screen for tinnitus or sound sensitivity, and encourage patients to stop if discomfort rises. Make sure they have a grounding routine to use before and after sessions.

Programs called rest and restore vary, but most combine paced breathing, gentle mobility, and sensory grounding. Keep them simple and measurable. Patients stick with routines that take under ten minutes, connect to daily anchors like meals or commutes, and have an obvious payoff such as better sleep onset or fewer afternoon dips.

Measurement, outcomes, and steady feedback

What you do not measure rarely improves. In integrative mental health therapy embedded in primary care, the core measures are symptom scales, adherence signals, and functional outcomes. Use the PHQ-9 and GAD-7 at baseline and at least monthly during active treatment. When trauma symptoms are central and the clinic has the capacity, add a brief PCL-5 follow-up every four to six weeks. Track no-shows, medication fills, and therapy session completion. Ask one functional question every visit, such as whether the patient made it to work for the planned shifts, attended a child’s school event, or slept through the night.

Do not expect straight lines. Most patients improve in steps, with plateaus and small regressions. Teams that review a registry together learn to anticipate these patterns and can offer encouragement at the right moment. Over six months, a reasonable target in a mature program is that a solid minority of patients, often 30 to 50 percent, reach remission or a reliable change threshold, while most others show partial improvement that still matters, like moving from severe to moderate ranges and returning to key activities.

Payment, documentation, and the realities of billing

Sustainable integration needs viable billing. The collaborative care model offers specific CPT codes for psychiatric collaborative care management services. Codes 99492, 99493, and 99494, along with G2214, cover the time the care manager and consulting psychiatrist spend on registry-based management and case review. Documentation must show time spent in a given month and the key elements of management. Practices new to this approach often under-document at first. A simple habit helps: the care manager logs activities at the end of each day, and the consulting psychiatrist documents case review recommendations in the chart with clear follow-up items.

Traditional evaluation and management codes still apply for the primary care visits. Behavioral health clinicians can bill psychotherapy codes for direct sessions, depending on licensure and payer contracts. Grants and value-based contracts can further support the non-billable glue work, like staff huddles and outreach.

Equity, culture, and trust

Integration fails if it only serves the patients with schedule flexibility and reliable internet. Build equity in from the start. Offer appointments early and late in the day. Provide language access with professional interpreters rather than relying on family members. Work with community health workers who understand local stresses and resources. Ask patients about spiritual or cultural practices that support regulation and weave those into plans. I have seen patients who never took to formal meditation find deep steadiness in church choir rehearsals or dawn walks to the mosque. It counts.

Trauma therapy must respect cultural narratives. Do not assume exposure-oriented approaches are universally acceptable. Some patients may prefer skills-first methods that protect dignity and privacy, at least initially. Validation and choice are powerful medicine.

Training, supervision, and risk management

Primary care teams rarely have spare time for long trainings, so build capacity in doses. Short, focused trainings on suicide risk assessment, brief CBT strategies, and regulation skills deliver more value than sprawling seminars that no one remembers by Friday. If you use somatic approaches, ensure clinicians receive supervised practice. Titrate attention to bodily sensations carefully, avoid rapid deep breathing in panic-prone patients, and respect contraindications such as active psychosis.

Establish clear policies on safety planning, after-hours coverage for high-risk patients, and the use of adjunctive interventions. For example, if your clinic offers the safe and sound protocol, outline screening, consent, session structure, and documentation. If you use any hands-on methods, specify training requirements, chaperone policies, and documentation standards. These guardrails keep patients safe and protect clinicians from drifting beyond competence.

Getting started without overbuilding

Clinics often stall because the perfect plan outruns available resources. Start smaller than you think you should. Pick a pilot pod of two primary care clinicians, a part-time behavioral health clinician, a care manager, and a consulting psychiatrist. Run a panel of 60 to 100 patients for three months. Measure everything. Learn where you drop balls and fix one bottleneck each week. Common early wins include creating templated dot phrases for warm handoffs, setting a fixed time for weekly case review, and placing symptom scales in the EHR workflow so they print with vital signs.

As the team steadies, layer in options. Add a simple rest and restore routine to the discharge plan for anxiety and insomnia. Train the behavioral health clinician in brief somatic strategies to support trauma therapy. Consider piloting the safe and sound protocol with a handful of interested patients who meet screening criteria, then review outcomes honestly before expanding.

Integrative care as a habit of practice

Integrative mental health therapy in primary care works when it feels like ordinary care. Patients do not need buzzwords. They need clinicians who listen, coordinate, and adjust with them. The best clinics I know use a few simple rules and apply them relentlessly: screen often, respond quickly, measure change, meet weekly as a team, and carry a small set of regulation skills that everyone on the https://www.amyhagerstrom.com/locations/west-palm-beach-fl team can teach. Somatic experiencing, the safe and sound protocol, and a well designed rest and restore protocol can enrich the work when offered thoughtfully and in context. They are pieces of a broader puzzle, not magic keys.

On a good day in an integrated clinic, you watch a patient who once lived in the ER sit in your exam room and describe a week that was hard but manageable. They took their walk after lunch. They practiced their breath before a difficult phone call. They noticed their jaw clench and loosened it, then chose a different response. Their PHQ-9 moved three points, and they are back at work two more days this week. It is not flashy. It is progress that lasts because the team built it with the patient, step by step, inside the system where the patient already lives. That is the quiet power of collaborative, integrative care.

Amy Hagerstrom Therapy PLLC provides somatic and integrative psychotherapy for adults who want mind-body support that goes beyond talk alone.

The practice serves clients throughout Florida and Illinois through online sessions, with Delray Beach listed as the office and mailing location.

Adults in Delray Beach, Boca Raton, West Palm Beach, Fort Lauderdale, and nearby communities can explore support for trauma, anxiety, chronic stress, burnout, and midlife transitions.

Amy Hagerstrom is a Licensed Clinical Social Worker and Somatic Experiencing Practitioner who works with clients in a steady, nervous-system-informed way.

This practice is suited to people who want therapy that includes body awareness, emotional processing, and whole-person support in addition to conversation.

Sessions are private pay, typically 55 minutes, and a superbill may be available for clients using out-of-network benefits.

For local connection in Delray Beach and surrounding areas, the practice uses 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483 as its office and mailing address.

To learn more or request a consultation, call 954-228-0228 or visit https://www.amyhagerstrom.com/.

For a public listing reference with hours and map context, see https://maps.app.goo.gl/VZTFSS2fq1YPv7Rs5.

Popular Questions About Amy Hagerstrom Therapy PLLC

What services does Amy Hagerstrom Therapy PLLC offer?

Is therapy online or in person?

Who does the practice work with?

What is Somatic Experiencing?

What are the session fees?

Does the practice accept insurance?

Where is the office located?

How can I contact Amy Hagerstrom Therapy PLLC?

Landmarks Near Delray Beach, FL

I have supported athletes, teachers, and parents through the fog of post-concussion symptoms. For those with sound sensitivity, fatigue, headaches, and anxiety, the right input at the right pace matters more than any single technique. The Safe and Sound Protocol, often paired with somatic experiencing and other body-based practices, has helped many regain ease with sound and settle their physiology. It is not a magic switch. It is more like a series of small invitations to safety that, over time, can change how the nervous system listens.

Why concussion disturbs listening and regulation

A mild traumatic brain injury disrupts networks that coordinate attention, vestibular function, and autonomic regulation. The middle ear muscles, especially the stapedius, normally tighten reflexively to dampen low-frequency background noise and enhance the human voice. After a concussion these reflexes can delay or fatigue. The result is familiar to patients: the refrigerator hum feels intrusive, restaurant conversation dissolves into noise, and a meeting drains energy long before lunch.

At the same time, the autonomic nervous system often shifts toward a defensive set point. Some people feel revved and jumpy, others sink into fatigue and shutdown. Most move between the two. When the system no longer trusts the environment, it listens for danger first. Prosodic human voices are harder to parse when the ear is biased toward threat frequencies. This is the loop many people get stuck in after a head injury: noise overwhelms, tension rises, headaches sharpen, sleep fragments, and then concentration falls. Recovery slows.

What the Safe and Sound Protocol is trying to do

The Safe and Sound Protocol, created by Stephen Porges and colleagues, delivers filtered music designed to emphasize prosodic frequencies and stimulate a neurophysiological sense of safety. The listening is not about entertainment. It targets neural pathways connected to the vagus nerve and middle ear muscles, which together help the brainstem decide if it is safe to engage, digest, and connect.

The standard format spans about five hours of listening divided into short sessions. Many clinicians now spread those hours over days or weeks, especially after concussion, to protect against over-arousal. The technology is delivered through a dedicated app and calibrated audio. Over-ear headphones are usually preferred because they reduce environmental noise without pressing directly into the ear canal.

Research on SSP is growing but still early. Small controlled studies and case series indicate benefits for some people with anxiety, auditory hypersensitivity, and trauma symptoms. In concussion care, we have case reports and clinical experience more than large randomized trials. That means expectations must be modest and pacing must be individualized. When SSP works, people often report that everyday sounds feel softer and more organized, social interactions feel less taxing, and their body settles more easily after stress.

When to consider SSP in a concussion timeline

Timing depends on symptom profile. In the first one to two weeks after a concussion, the nervous system is already flooded with change. Most people benefit from relative rest, hydration, sleep protection, and gentle vestibular and visual support when tolerated. If sound sensitivity is extreme, starting with environmental quiet, soft voices, and basic nervous system settling techniques makes sense before adding targeted listening.

Between two and six weeks, if noise intolerance, irritability, or social fatigue persist, SSP can be introduced in very small doses. In later phases, especially for those with lingering post-concussive symptoms beyond three months, SSP may serve as a missing piece that helps other therapies take hold.

Red flags that warrant medical evaluation before starting include acute worsening headaches, repeated vomiting, seizure activity, new focal neurological signs, or concerning mood changes such as active suicidal thoughts. SSP is not a substitute for medical care. It can be a complement inside an integrative mental health therapy plan that also addresses sleep, pain, anxiety, cognition, and return to activity.

A readiness check before beginning

Symptoms have been relatively stable for at least several days, without sharp daily swings. Environmental supports are in place, including a quiet room, comfortable chair, and the ability to pause at any moment. You have basic regulation tools that already work a little, such as paced breathing, orienting to the room, or a short body scan. Headphones fit comfortably, and the app or device is tested at very low volume without discomfort. A provider or coach is available to adjust pacing and to help interpret reactions.

The rest and restore approach to pacing

Think of SSP as part of a rest and restore protocol rather than a task to finish. After a concussion, the dose that heals is often smaller than expected. I usually start with five to ten minutes of listening at a low volume, then stop while things still feel easy. The nervous system learns more from stopping on a good note than from pushing until tired or irritable.

Rest means shorter sessions, often every other day at first. It also means pairing listening with quiet time afterward. A short walk, a cup of tea, or eyes-closed rest can help the system integrate. Restore includes gentle co-regulation if available, like being in the same room with a calm person or a pet. When the body learns to downshift in the presence of safety, it stores a new reference point. That reference point is what we want to strengthen.

Most people who do well with SSP after concussion increase by five minutes per session, watching for any uptick in headache, dizziness, mental fog, or anxiety. If symptoms rise, take two to three days off and drop the session length by half when you return. A small set of individuals will need micro-doses, two to three minutes at a time. A few can tolerate twenty minutes out of the gate, but there is no prize for finishing fast.

How somatic experiencing helps SSP land

Somatic experiencing, a body-based form of trauma therapy, pairs naturally with SSP. The goal in somatic work is to track sensations, impulses, and shifts in arousal without forcing them. During or right after listening, I invite people to notice small cues of settling: a longer exhale, warmth in the hands, a yawn, the eyes softening. If a wave of activation comes, we slow down and orient to the environment. Name three colors in the room. Feel the weight of the body in the chair. Listen for the quietest sound that still feels safe, like a clock tick or wind outside. These micro-skills become the handles a person can grab when sound in the world feels too bright.

In my experience, the combination of SSP with somatic experiencing improves tolerance for day-to-day noise more reliably than either alone. The listening nudges the physiology, and the somatic practice teaches the person how to ride the changes. That is especially important for those who carried high stress or trauma into the injury. The body remembers old alarms. Gentle auditory input can surface them. Having a way to land those alarms matters.

Practical details: headphones, volume, and environment

Over-ear, closed-back headphones are typically most comfortable because they reduce ambient noise without inserting anything into the canal. Avoid active noise cancellation at first. The shifting pressure from ANC can bother some people with vestibular sensitivity. If tinnitus is present, try a short trial with one ear slightly off the cup to prevent internal masking from becoming oppressive.

Volume should start low enough that you can speak over the music comfortably. Louder is not better. The goal is clarity, not intensity. Keep the phone or tablet on airplane mode during sessions to reduce interruptions. Place the device where you cannot see notifications. The nervous system reads even small visual pings as alert signals, which undoes some of what the listening is trying to teach.

Pick a time of day when energy is decent. Early afternoon, after lunch and a brief walk, often works better than right before bed. Some people sleep beautifully after SSP, others feel alert. It is safer to discover that pattern during the day.

A gentle session arc

Arrive: Sit comfortably, feet supported, shoulders easy, jaw loose. Take two slow breaths. Orient: Name five neutral details in the room. Let the eyes rest on something pleasant but plain. Listen: Start the track at a low volume, five to ten minutes at most for early sessions. Notice: During tiny breaks in the music or between tracks, sense the state of your face, throat, chest, and belly. Only track what feels tolerable. Settle: Stop while still comfortable. Sit quietly for two minutes, then do a familiar calming practice.

What improvement looks like, and how to track it

Some gains appear quickly, others arrive as subtle shifts over weeks. The first changes people report are often about effort. The grocery store feels a little less draining. Voices stand apart from background noise more easily. The end of the workday comes with some energy left. Headaches may soften a notch or two, especially those triggered by sound or social stimulation.

I encourage simple tracking because the nervous system forgets how hard yesterday was. Rate two to four symptoms three times per week on a 0 to 10 scale, such as sound sensitivity, headache severity, brain fog, and social fatigue. If you already use a validated scale like the Post Concussion Symptom Scale, continue it. Also note sleep quality and a few sentences about daily function. https://www.amyhagerstrom.com/burnout-therapy When we look back after two weeks, we want to see a pattern of slightly lower peaks and faster returns to baseline, not perfection.

Integrating SSP with integrative mental health therapy

Concussion recovery crosses disciplines. The best outcomes I see involve a coordinated plan that draws from integrative mental health therapy. That can include sleep optimization, targeted nutrition support like magnesium glycinate at night or omega-3s if appropriate, vestibular and ocular rehab when indicated, pacing of cognitive work, and counseling that respects the body’s role in mood regulation. SSP fits into this plan as a helper for the autonomic system, not as a stand-alone cure.

For those with prior trauma, it is important to proceed with psychological support. Trauma therapy that honors pacing, like EMDR with strong resourcing or somatic experiencing, can keep the process contained. The polyvagal lens reminds us that social engagement cues, including prosodic music, can sometimes stir memories of times when safety was promised but not delivered. That does not mean we avoid the work. It means we build titration and choice into every step.

Case vignette: the teacher who feared the cafeteria

A middle school teacher in her 30s sustained a concussion in a bike crash. Three months later she could teach in a quiet classroom with the door closed but avoided the cafeteria and assemblies. Her headaches spiked with clatter and overlapping voices. She slept poorly after any loud day. Vestibular exercises helped her dizziness, yet noise remained the primary barrier.

We started SSP six months post-injury, long after the acute phase. The first week involved five-minute sessions every other day, volume just above a whisper. She learned three somatic tools before listening: feeling the ground under her feet, tracking her breath in her back, and letting her eyes rest on a neutral spot. By week two we increased to ten minutes on most days and paused for two days after a headache flare triggered by a loud fire alarm at work.

By the third week she noticed that the staff lounge felt less harsh. She could follow a colleague’s story while the microwave beeped and a chair scraped without losing the thread. Headaches remained, but the worst spikes became less frequent. After five total hours of listening over a month, she managed ten minutes in the cafeteria with earplugs in her pocket as a backup. She reported feeling less braced in her shoulders and jaw. This was not a miracle. It was enough ease to re-enter parts of her job with confidence, and it set the stage for further gains.

Titrating for edge cases: migraines, tinnitus, and vestibular issues

People with migraine, tinnitus, or vestibular dysfunction can still use SSP, but they need thoughtful adjustments. Migraine brains dislike change. Start with two to three minutes of listening at very low volume, and buffer sessions with hydration, light food, and low visual stimulation. Track triggers closely. If a typical migraine prodrome appears, pause the protocol and resume only after a quiet week.

Tinnitus can flare with any new auditory input. Use partial ear coverage at first or over-ear headphones with the cup gently lifted for five to ten seconds every few minutes. Some find that brief, regular breaks prevent the system from latching onto the internal noise. Over several weeks, as the system learns safety, the tinnitus either returns to baseline or becomes easier to ignore.

Vestibular sensitivity makes brains vigilant. Do not combine difficult vestibular exercises with SSP on the same day in early phases. Stagger them, and follow vestibular work with a rest window rather than more stimulation. A small number of people will feel woozy during listening. That is a cue to reduce session length and to add more orientation between tracks. If wooziness persists despite micro-dosing, it may be a sign to pause SSP until vestibular rehab has advanced further.

Co-regulation and the social piece

The polyvagal model emphasizes that safety is communicated through connection. When possible, pair SSP with co-regulation. This could be a trusted person reading quietly nearby, a therapist’s soft voice guiding a body scan, or even a calm dog asleep at your feet. The middle ear does not operate in isolation. The face, throat, and heart all adjust together when we feel seen and safe. People often notice their breath and posture change more during listening when another regulated nervous system is present.

I also coach families to adjust everyday interactions. Use a slightly slower, warmer voice. Reduce cross-talk during meals. Dim harsh overhead lighting in favor of more focused light. These small environmental shifts honor the work SSP is doing and prevent daily life from undoing it.

When SSP is not the right fit

There are times when SSP should wait. If a person is in acute crisis, sleeping less than four hours per night, or enduring uncontrolled pain, the system is too taxed to receive new input. Stabilization comes first. Similarly, if a person has no reliable quiet space or cannot set boundaries around session time, the protocol may create frustration. Build the container, then add the listening.

On the other end of the spectrum, a few people breeze through early concussion recovery and return to noisy environments without issue. For them, SSP is likely unnecessary. Not every intervention needs to be used simply because it exists. The art is in matching the tool to the need.

How providers can weave SSP into a broader plan

For clinicians, the decision to introduce SSP follows from a clear hypothesis. If a patient presents with sound sensitivity, social withdrawal due to noise, and an anxious or flattened affect that does not shift with standard care, SSP deserves a look. I inform patients that evidence is promising but not definitive, and that we will monitor closely. I also integrate a rest and restore protocol as a default, not an add-on. That means pre-teaching regulation skills, scheduling buffer time, and normalizing pauses.

I frequently combine SSP with brief somatic experiencing sessions, two to five minutes of tracking before and after listening. If trauma content surfaces, we slow and resource rather than analyze. For patients already in psychotherapy, I coordinate. Many therapists appreciate an intervention that helps the body receive safety messages, which can make cognitive and relational work more accessible.

The long view: repairing trust in sound

Recovery from concussion often requires repairing trust, not just in cognition or balance, but in the world of sound. Modern life is rich with sharp edges for a sensitive system. The Safe and Sound Protocol aims to reintroduce the nervous system to the human voice and to the subtle cues that say you are safe here. That reintroduction is best done slowly, with respect for the biology that protected you during and after the injury.

When SSP is offered with careful titration and integrated into somatic experiencing and trauma therapy when needed, it can shorten the path back to cafes, meetings, and family dinners. The stakes are not abstract. They are the difference between leaving a restaurant smiling or bolting for the door, between reading a bedtime story with steady breath or skipping it because your head cannot take another sound. Gentle auditory support can make those everyday moments possible again.

Bringing it into daily life

As gains appear, bring them into the world in controlled ways. Visit a small store at a quiet time rather than a big box store on a weekend. Eat at a cafe with soft furnishings before trying one with exposed concrete and metal chairs. Use musician’s earplugs that reduce volume evenly without muffling speech. Keep exit strategies kind and simple. A five-minute break outside can preserve the whole outing.

Over time, many people need SSP less and rely on their own regulation more. Some do a brief refresher a few months later if stress rises. Others do not return to the protocol at all, because daily life becomes its own training ground for safety. The aim is always autonomy, a nervous system that can listen without bracing, engage without exhaustion, and rest when it needs to.

Gentle does not mean passive. It means precise. With the right dose, at the right time, the Safe and Sound Protocol can help a concussed brain remember how to filter the world and find the human voice again. Paired with integrative mental health therapy and paced somatic work, it becomes one of the quieter yet more powerful tools we have for helping people feel like themselves.

Amy Hagerstrom Therapy PLLC provides somatic and integrative psychotherapy for adults who want mind-body support that goes beyond talk alone.

The practice serves clients throughout Florida and Illinois through online sessions, with Delray Beach listed as the office and mailing location.

Adults in Delray Beach, Boca Raton, West Palm Beach, Fort Lauderdale, and nearby communities can explore support for trauma, anxiety, chronic stress, burnout, and midlife transitions.

Amy Hagerstrom is a Licensed Clinical Social Worker and Somatic Experiencing Practitioner who works with clients in a steady, nervous-system-informed way.

This practice is suited to people who want therapy that includes body awareness, emotional processing, and whole-person support in addition to conversation.

Sessions are private pay, typically 55 minutes, and a superbill may be available for clients using out-of-network benefits.

For local connection in Delray Beach and surrounding areas, the practice uses 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483 as its office and mailing address.

To learn more or request a consultation, call 954-228-0228 or visit https://www.amyhagerstrom.com/.

For a public listing reference with hours and map context, see https://maps.app.goo.gl/VZTFSS2fq1YPv7Rs5.

Popular Questions About Amy Hagerstrom Therapy PLLC

What services does Amy Hagerstrom Therapy PLLC offer?

Is therapy online or in person?

Who does the practice work with?

What is Somatic Experiencing?

What are the session fees?

Does the practice accept insurance?

Where is the office located?

How can I contact Amy Hagerstrom Therapy PLLC?

Landmarks Near Delray Beach, FL

I have sat with people at kitchen tables and in quiet therapy rooms as they learn, slowly, how to let the body participate in mourning rather than fight it. We are not forcing catharsis or suppressing emotion. We are building capacity. When the nervous system has a bit more room, grief can do its vital work without taking the entire system offline.

How grief lives in the body

Grief is not only sadness. It carries protest, dread, love, longing, anger, relief, and stunned silence. The autonomic nervous system registers loss as a profound disruption of safety and connection. For some, that means a dominance of sympathetic activation, the go system. You might feel restless, unable to sit through a meal, breath coming high and thin. For others, the dorsal vagal branch of the parasympathetic system takes the lead, the shut down system. You might feel heavy and numb, time moving slowly, food tasting like cardboard. Many people cycle between the two.

These are not defects. They are survival responses doing their best to manage an impossible task. In trauma therapy across different modalities, including somatic experiencing, we respect those responses. We aim to help the body complete what got interrupted, then find a softer baseline. That often looks like a tremor that rolls through the legs after a hard memory, a warm wash of tears that leaves the face relaxed, a spontaneous deeper breath that was not there for weeks.

What somatic experiencing offers

Somatic Experiencing, developed by Peter Levine and shaped over decades by clinicians worldwide, is a gentle, body-first approach to healing stress and trauma. In grief work, we use SE to help the nervous system digest the stress load of loss. The method is deceptively simple.

We track sensations. We slow down the narrative enough to notice micro-signals. We build and return to resources. We let the body move a little, then rest. Two key principles guide the work:

Titration, meaning we touch difficult material in small doses, then step back to safety. Big, overwhelming catharsis is not the goal. If a wave is too high, we step out, orient to the room, sip water, and wait for capacity to return.



Pendulation, meaning we move between states, from activation to ease and back, on purpose. This back and forth helps the nervous system learn flexibility. Over time, the pendulum swings with less whiplash and more grace.

An SE session might include orienting to the physical space, experimenting with postures that invite the body to settle, or letting a hand press gently against the chest where the ache sits. Sometimes we work with impulses to move, like the urge to curl forward, or a desire to push against something firm. Other times we do very little, letting quiet do the heavy lifting while we track tiny signs of settling.

A glimpse inside the room

A composite example: Ari, 42, lost her father after a surgical complication. She walked in with a headache and a stubborn lump in her throat that had not budged for two months. When she spoke about the hospital, her hands clutched her scarf. In SE, we slow that down.

I asked her to describe the lump without pushing for a story. On a scale from 0 to 10, she called it a 7, tight and cold. We spent a minute orienting to the room. Her eyes landed on a photograph on the wall. She exhaled without noticing. The lump eased to a 6.

Then she felt a hot surge of anger about the consent form. Her breath went shallow. Instead of diving into detail, I invited her to push her palms into the armrests of the chair. She did, and her jaw trembled. After 20 seconds, her shoulders dropped. The lump softened to a 4. Only then did we let two sentences about the consent form emerge. The tears came, warm rather than choking. Another breath found her. She left reporting the headache down from a 6 to a 2 and slept four uninterrupted hours that night for the first time in weeks.

That session was not dramatic. It was precise, and it honored the body’s pace. Over several meetings, Ari learned to recognize early signs of spiraling, to ground her feet, to let the tears move when they wanted to. Her grief did not disappear. It fit in her life in a new way.

The power of orienting

When grief surges, the visual field often narrows and the body braces. Orienting is one of the simplest SE tools. It reintroduces the present moment to a nervous system caught in a loop of memory or dread. You can practice this at home.

Let your head and eyes move slowly to look around the room. Name three objects silently. Allow your neck to move at the pace that feels pleasant. Notice colors and shapes. Let your eyes land on something neutral or slightly pleasing, like a plant or a patch of light. Feel the support under you. If seated, sense the chair under your thighs and the floor under your feet. If standing, feel the weight shift through your arches. Invite one deeper breath without forcing it. Exhale through pursed lips if it helps. Check your body for a small sign of settling, such as warmth in your hands, a sigh, a yawn, or saliva returning to your mouth.

Five to ninety seconds of orienting, repeated several times a day, can reduce the intensity of spikes and increase the distance between waves.

Acute grief and grief that lingers

In the first weeks after a loss, the nervous system is flooded. Sleep shreds, appetite changes, days blur. In this phase, SE work must be light and conservative. I focus on stabilizing the basics and preventing overwhelm: gentle orienting, body support like weighted blankets or a firm cushion behind the back, minimal processing of memory. Think 5 to 15 minute practices, twice a day. I might schedule two short meetings or calls in a week rather than one long session.

When grief lingers past its initial storm, or when old traumas wrap around the loss, we can go deeper. That may include tracking the arcs of specific memories for short segments, letting protective responses complete in safe ways. For example, a father who could not reach his child in the ICU might work with the impulse to reach and hold, using a pillow as a substitute while monitoring body signals closely. Dose makes the medicine. If activation spikes beyond a 6 out of 10, we return to resource.

Complicated grief, often defined by persistent, impairing symptoms beyond 12 months, can come with rigid patterns of avoidance or persistent hyperarousal. Here, SE integrates well with other trauma therapy modalities, such as EMDR or trauma-informed cognitive approaches. There is no single correct sequence. The right order depends on the person’s capacity, culture, and support system.

Integrative mental health therapy and grief

SE is strongest when embedded in integrative mental health therapy. Grief touches sleep, nutrition, hormones, relationships, and work. I routinely coordinate with primary care physicians to rule out issues like thyroid dysfunction, anemia, or cardiac strain that can mimic or compound grief symptoms. Short term sleep medication, used wisely and not as the only tool, can protect a nervous system from spiraling. Light exposure within an hour of waking helps anchor circadian rhythm. Gentle movement, even a 10 minute outdoor walk, shifts autonomic balance.

Grief also disrupts digestion. Warm, simple foods, consistent hydration, and magnesium glycinate at night, after medical clearance, often support rest. If alcohol crept in as a numbing agent, I discuss safer replacements that calm without rebound effects, like nonalcoholic bitters or warm tea with lemon and honey. These are small levers with outsized effects when used alongside somatic work.

Community matters. A standing weekly dinner with one trusted friend can offer enough co-regulation to turn a week. Spiritual practices or rituals can be potent regulators if they match the person’s belief system. A candle lit at dusk, a song played at the same time each evening, a pebble carried in a pocket and touched when a wave builds. These are not trinkets. They are anchors.

The Safe and Sound Protocol, used carefully

Some clients benefit from the Safe and Sound Protocol, a listening intervention developed by Stephen Porges that uses filtered music to engage the social engagement system. In practice, I introduce SSP only when someone has a baseline of stability. The sessions are short, often 15 to 30 minutes, and we pair them with live tracking of sensations. The goal is not to feel blissful. It is to gently stimulate pathways that support connection and calm.

SSP is not right for everyone. People with sound sensitivity or a history of manic activation may find it too stimulating early on. When it fits, it can widen the window of tolerance so other grief work proceeds with less friction. I have seen clients report easier tears, a softer jaw, and fewer startle responses on days they listened, with improvements that consolidated over several weeks.

Rest and restore protocol, a practical frame

I use the phrase rest and restore protocol to describe a personalized routine that cues the nervous system to downshift, especially in the evening. It is not a branded program, just a set of practices that, stacked together, make rest more reliable.

A typical plan includes a 20 to 30 minute digital sunset two hours before bed, warm shower or bath to raise and then gently drop body temperature, low light focused at floor level, slow music without lyrics, and a winding-down ritual such as journaling three lines about the day. Some add 5 minutes of diaphragmatic breathing in a position that feels supportive, like knees-draped-over-cushions on the floor. People often report changes in sleep onset within a week. Consistency matters more than intensity.

This protocol pairs naturally with somatic experiencing. If tears arrive during the routine, let them. If anger shows up, give it a safe channel like pressing hands into a pillow for 10 seconds and releasing. The point is to give the body predictable cues that it can shift from guard to rest.

Working with the edges

Not all grief is clear. Ambiguous loss, such as dementia or incarceration, carries a particular nervous system bind. The body prepares for action, then hits the futility of no actionable target. In these cases, SE work often centers on movement that acknowledges the impulse to act without pretending we can fix the unfixable. Pushing a wall, then softening. Reaching, then drawing close. It sounds simple until you feel the relief of giving the body something true to do.

Sudden loss can carry trauma signatures like intrusive images, startle responses, and avoidance of reminders. Here, we are careful with imagery. We might build capacity for two months before touching the most disturbing images, using titration so the body does not flood. On the other hand, anticipated loss sometimes leaves people numb and ashamed they are not showing enough outward grief. In those cases, we look for micro-movements under the surface. A slight tightness in the back of the tongue might become the first doorway to authentic crying.

Dissociation complicates everything. If someone goes foggy and loses time during sessions, we back way up. We establish strong anchors in the room, sometimes co-working with a psychiatrist to stabilize with medication. Safety trumps progress every time. This is where integrative care shines, because one provider should not hold the entire weight.

What a session often looks like

Most sessions run 50 minutes. The pace is slow. We might spend the first five minutes just arriving in https://www.amyhagerstrom.com/rest-and-restore-protocol the room. A typical flow:

We check on the body right now. Not the story, just the body. Where is there tension, tingling, pressure, warmth, or absence of sensation. We choose one area to attend to. If the throat is a 7 and the hands feel neutral, we might spend a minute with the neutral hands first. Then we approach the throat, watching for signals of too much like breath holding or shoulder bracing. If activation rises rapidly, we pause and return to resource, which might be the feel of shoes on the carpet or the weight of the chair.

If a memory asks for attention, we approach a single moment rather than the whole event. If the image is the last look exchanged before the ventilator was removed, we hover at the edges, letting small pieces land. The body will often find a natural sequence, like a chest contraction followed by a tremor in the legs, then a softening. We stop not when the mind is satisfied but when the body shows a sign of integration, such as a deeper breath or a yawn.

People sometimes worry that if they start crying, they will not stop. In practice, tears tend to move in arcs of 30 to 90 seconds when supported by tracking and breath. The nervous system does not want to drown. It wants completion.

How to know you are making progress

Therapy for grief does not grade itself with a single number. You look for signs that the system is learning to move. These signals are often small and concrete: you remember to drink water without forcing it, you can sit through a 20 minute meal, you fall back asleep in 15 minutes instead of 2 hours after a 3 a.m. Wake-up, you can tell a friend a story without clenching your jaw. Someone once told me the first real sign was humming while washing dishes. Another said they could finally drive past the hospital without holding their breath.

Progress also shows up in choice. You notice you can choose to let a wave pass rather than chase it with stimulus, or you can choose to stay home when a gathering would overload you. That kind of agency does not erase grief. It changes your relationship with it.

When not to push

There are days when the right move is to do nothing. If you have a fever, are sleep deprived to the point of cognitive slippage, or feel a pull toward self-harm, do not dive into deep somatic work. Call your clinician, focus on basics, or go to urgent care. People with severe cardiac conditions should clear breath practices and intense crying work with their physician. If intrusive images lead to flashbacks that pull you out of awareness, ground first, process later. There is no prize for going fast.

Practical supports you can try this week

Start small. Choose two practices and give them seven days.

The 10 percent rule. If you track a sensation at a 7 out of 10, step out when it reaches 7.7. Let the next 10 percent wait for another day. This prevents overwhelm and builds trust with your body. Bookend grief. Pick a 10 minute window each day when you will sit somewhere safe, bring a photo or object if you wish, and let whatever comes, come. When the timer rings, orient to the room, stand, and do a brief task like folding two towels. This teaches your nervous system that grief has a place and also an end point.

Notice whether sleep, appetite, or social tolerance shifts at all over the week. Micro-gains count.

Choosing a qualified practitioner

Good fit matters as much as training. When you interview potential therapists, ask targeted questions to test both skill and chemistry.

How do you use somatic experiencing when working with grief specifically, and what does a first session look like. How do you monitor and prevent overwhelm during sessions, and what are your signs to pause. How do you coordinate with medical providers or other members of an integrative mental health therapy team if needed. What is your policy on between-session contact if I hit a hard wave, and how do you support crisis planning. How do you incorporate or respect cultural and spiritual practices around mourning.

Look for someone who answers concretely, respects your pace, and can describe body signs they watch for. Certification in SE, often listed as SEP, indicates formal training, but style and presence still matter. Trust your gut.

Where touch, breath, and movement fit

Somatic experiencing sometimes uses touch, always with explicit consent and clear boundaries. Touch might include a hand on the shoulder blade to support a breath that wants to deepen, or gentle contact at the back of the ribs to invite expansion. Some people prefer no touch at all. That is fine. Breath is similar. Forcing big breaths can make anxiety worse. We look for breath that emerges as a result of settling, not breath that is imposed on a braced system.

Movement can be therapeutic when it matches the body’s impulse. Pushing against a wall for 10 seconds, letting the legs tremble while supported, rocking gently, even a brief shake of the hands. If movement spikes dizziness, nausea, or a sense of leaving the room, we back off. The motto is less is more.

Culture, family, and permission

Grief is social. Some families want loud, communal mourning. Others hold grief tight and private. In therapy, we make room for those patterns. If cultural rituals exist, they can structure the somatic work. A weekly memorial service can be the time-bound container for deeper waves. A traditional meal can become the sensory anchor that reminds the body of continuity. If your culture discourages overt emotion, we might find subtle channels, like silent prayer, hand on heart for one minute, or walking a specific path in the neighborhood each morning.

There is no correct way to grieve. There is your way, which may shift over time. Therapy offers permission to listen for that shifting.

How SE, SSP, and ritual knit together

On a typical care plan, I might meet weekly for somatic experiencing sessions, recommend daily orienting and a rest and restore protocol for evenings, and consider the safe and sound protocol after three or four weeks if the system stays too revved or shut down. We track objective markers like sleep onset time, number of nighttime awakenings, appetite, and social engagement minutes per day. We do not depend on any single tool. The value comes from how the pieces interlock around your specific nervous system.

Over two to three months, many clients report more predictable days, less fear of their own emotions, and a sense that love and loss can coexist without canceling each other. Those outcomes do not mean grief is finished. They mean you can carry it.

Final thoughts for the long road

Grief will change you. Somatic work does not try to stop that change. It tries to keep the channel open so the change is honest rather than calcified. The body knows how to complete waves, given safe context and patient pacing. Right-size doses, regular anchoring, and compassionate company go a long way.

If you are in the thick of it, take an hour and build a very small plan. One orienting practice in the morning, one rest and restore routine at night, and a short window where you intentionally let yourself feel. Add a person on speed dial who will pick up most of the time. If professional support is available, choose someone skilled in trauma therapy and somatic experiencing who respects your culture and your tempo.

That is how we move through the waves. Not by muscling through, not by numbing, but by learning the language of the body and letting it guide us toward steadier shores.

Amy Hagerstrom Therapy PLLC provides somatic and integrative psychotherapy for adults who want mind-body support that goes beyond talk alone.

The practice serves clients throughout Florida and Illinois through online sessions, with Delray Beach listed as the office and mailing location.

Adults in Delray Beach, Boca Raton, West Palm Beach, Fort Lauderdale, and nearby communities can explore support for trauma, anxiety, chronic stress, burnout, and midlife transitions.

Amy Hagerstrom is a Licensed Clinical Social Worker and Somatic Experiencing Practitioner who works with clients in a steady, nervous-system-informed way.

This practice is suited to people who want therapy that includes body awareness, emotional processing, and whole-person support in addition to conversation.

Sessions are private pay, typically 55 minutes, and a superbill may be available for clients using out-of-network benefits.

For local connection in Delray Beach and surrounding areas, the practice uses 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483 as its office and mailing address.

To learn more or request a consultation, call 954-228-0228 or visit https://www.amyhagerstrom.com/.

For a public listing reference with hours and map context, see https://maps.app.goo.gl/VZTFSS2fq1YPv7Rs5.

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