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About the Provider
Name: Jeffi Farquharson (she/her)
Disciplines/credentials: Registered Psychotherapist
Modalities: Brainspotting, EMDR, ACT, Emotionally Focused Therapy, Safe and Sound Protocol (SSP)
Client Background
Name: Jack (pseudonym)
Gender and Age: Man, 63 years old
Program Delivered: Safe and Sound Protocol (SSP)
- SSP Core: Hours 1-5
- SSP Balance: Hours 1-5
Jack initially presented with intense anxiety a year and a half ago, following his mother’s hospitalization from a serious illness. Six months into his treatment, his mother passed away. While he was able to attend her funeral, he has had minimal contact with his father, siblings and other family members since her death.
Prior to beginning the Safe and Sound Protocol (SSP), Jack was frequently unable to sleep due to persistent worry about his mother. His anxiety led to skin-picking behaviors to the point of bleeding, struggles with being present in conversations, as well as troubles participating in daily activities because he was highly preoccupied with thoughts of his mother’s illness and subsequent death.
Jack has also been diagnosed with an intellectual disability. His history includes living with his family during early childhood, spending his later childhood through young adulthood in a large institutional setting for individuals with intellectual disabilities, returning to live with his parents from young adulthood through middle age, and residing in a community-based group home for the past 22 years. Notably, Jack experienced significant medical trauma during the first two years of his life, high levels of stress and distress due to family separation, and sexual abuse during his time in the institution.
While Jack is a beloved member of his community and enjoys his relationships with support staff, neighbors and fellow residents, he was easily aggravated by certain behaviors of the other men in his home and the frequent comings and goings of support staff. Over the years, many behavioral programs have been implemented to help him acquire and maintain life skills. In these programs, expressions of “positive” emotions like happiness and gratitude were actively encouraged and rewarded, whereas expressions of anger, sadness and fear were systematically discouraged through distraction, redirection, or the withdrawal of positive social connection.
When his provider, Jeffi Farquharson, was initially contacted, the agency staff requested a behavioral program to eliminate Jack’s skin-picking, his constant preoccupation with his mother, and his newly developed habit of following staff members while repeating, “I am upset about my mum,” and not knowing how to put his mind at ease. After meeting with Jack and understanding his history, Jeffi determined that helping him process his grief and childhood trauma — rather than implementing strict behavioral extinction protocols — would be the most beneficial clinical pathway.
Implementation of the Safe and Sound Protocol (SSP)
The SSP was integrated directly into Jack’s in-person psychotherapy sessions. Jeffi elected to administer the SSP exclusively during sessions due to concerns that, with multiple rotating support staff members at the group home, Jack might inadvertently be told to listen while dysregulated, unmonitored, or at too rapid a pace.
Jack completed SSP Core over a four-month period, listening for 10 to 30 minutes per session. On occasions when Jack did not wish to listen to the SSP, the intervention was paused. During listening sessions, Jack and Jeffi quietly engaged with LEGO blocks, an activity he thoroughly enjoys. Jeffi remained closely attuned to Jack’s body language and facial expressions, checking in at any sign of discomfort by asking how his ears, head, tummy and heart felt. Frequently, Jack would smile, state, “I feel good!” and hold the headphones closer. If he indicated, “Not so good right now,” Jeffi respected his autonomy to continue or stop for that day. Following the completion of all five hours of SSP Core, Jack transitioned to SSP Balance, completing the full five hours over a three-month period.
Prior to starting the SSP, Jeffi provided developmentally appropriate psychoeducation regarding Polyvagal Theory, the window of tolerance, and the nature of grief. To help narrate and process his history, Jack brought photos from various stages of his life to his sessions. The therapeutic process also incorporated reading books about death and grief, utilizing art therapy, and prioritizing in-session co-regulation. Jeffi framed the SSP to Jack as a tool to help his ears notice when safe, caring people were present to support him, and to help him recognize that he could experience sad feelings while remaining physically and emotionally safe.
Response
Following the intervention, Jack reported feeling significantly more peaceful inside, stating, “I miss my mum, but I am OK.” His skin-picking behavior has ceased entirely, and he is sleeping soundly through the night. While he occasionally enters a state of hyperarousal, these episodes now last only a few minutes and no longer result in self-injurious behavior. His group home support staff noted observable behavioral improvements within the first two sessions of the SSP. Staff report finding it much easier to support him in simple, concrete ways now that his nervous system is more regulated and he connects with others more easily. They also report that Jack will sometimes say, “I want Jeffi to come and bring her music to help my body feel safer here.”
Jack’s tolerance for his living environment has improved markedly. He shares that the other residents “don’t bug me anymore,” and staff notes that he is far more present during conversations. He proactively checks in with staff about their schedules, asking how long they will be there, when they leave, and when they will return, before smiling and stating, “I will miss you until next time.” Furthermore, when other residents in the home become distressed, Jack now chooses a self-calming activity rather than reacting with anger.
When looking at a past photograph from his time in the institution, Jack reflected on his progress, noting direct insight into his own therapeutic process:
“I would like to be able to feel better about other things that happened to me, too. Maybe your music will help me feel better so I can do that.”
Jeffi plans to re-administer SSP Core in future sessions to support him as he continues to process his early life trauma.
Discussion
Jeffi shared the following notes on Jack post-SSP:
“It has been powerful to witness the shifts in Jack. When I first met him, he struggled to speak of anything other than feeling upset because of his mum. It wasn’t always easy to discern when his mum was indeed at the forefront of his mind, or whether these were the only words he knew to communicate his distress. He now easily articulates when he feels sad about losing his mum, mad that people have to die eventually, worried about things happening in his house, or if he needs someone to talk to. He connects more easily with others, [and is] able to ask questions and take in their responses, expressing his feelings while doing so.
“In my experience, SSP is a wonderful intervention for people with limited cognitive abilities because it engages with them on a somatic level. … Setting a unique pace collaboratively with the client was an intentional choice on my part as a clinician, rather than setting a goal of listening to a set number of minutes on a pre-determined schedule.”
Jeffi added that allowing Jack to determine the duration of his listening “minimized the chances of him feeling like this was just one more thing being ‘done to’ him by well-meaning people who don’t really want to hear ‘no’ or ‘stop’ from him.” Additionally, the check-in process “helped him tune into his body’s signals of calm or distress,” allowing Jack to identify bodily signals, communicate his needs, and learn ways to care for himself.
Ultimately, no behavioral modification programs were utilized. Therapy focused on building a strong therapeutic alliance where all emotional states were welcome. Through this approach, Jack learned that while grief and anxiety are uncomfortable, they do not require him to lose contact with himself or his support systems. As the SSP expanded his capacity for regulation, Jack was given the safety to have “a new experience of himself.”
Jeffi added, “When feelings are overwhelming or thoughts are relentless and intrusive, SSP can help shift things and make them more manageable.”
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