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Case StudyFocus SystemSSPCo-Regulation

Improving individual nervous system regulation with the SSP and the ILS transforms couple’s relationship

🕑 5 minutes read
Posted November 21, 2023

About the Provider

Name: Kate Appleton
Disciplines/credentials: Mental health provider, Somatic Experiencing Practitioner (SEP), licensed professional counselor (LPC)
Modalities: Safe and Sound Protocol (SSP), Integrated Listening System (ILS), Somatic Experiencing (SE), Transforming the Experience-based Brain (TEB), play therapy, sand tray, sensorimotor, expressive arts, dance, archetypal psychodynamic, emotion-focused therapy (EFT), cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT)

Client Background

Name: Josh (pseudonym)
Age and Gender: 33-year-old man
Programs Delivered:

Josh presents with attention deficit hyperactivity disorder (ADHD) and has scattered focus, leading to a lack in task completion, organizational structure, time management and communication clarity. He lives in environmental chaos due to disorganization in all rooms of his home, including his work office. He is a farmer for local organizations and is overall successful at work, but struggles with the timely completion of tasks and is disorganized in managing his staff. He is routinely late and his attention gets disrupted, causing issues at work and within his marriage. 

Josh has had on-again, off-again treatment for ADHD since his teen years, with inconsistent outcomes. He has taken medication in the past but doesn’t currently. He self-medicates with cannabis and sometimes mushrooms. 

He started couples therapy with his partner to address the lack of intimacy in their relationship. Once provider Kate Appleton determined that both members of the partnership struggled with attention and nervous system dysregulation, they decided to start with the Safe and Sound Protocol (SSP) to create a stronger foundation for communication.

Implementation of the Safe and Sound Protocol (SSP) and Integrated Listening System (ILS)

Both Josh and his partner went through the SSP while supporting one another through co-regulation. As one listened to the SSP, the other would hold space by sitting with them through the SSP session. Josh’s partner began the program first, completing the first half of each hour in person and the second half remotely at home with Josh present. Upon his partner’s completion of the program, Josh began the SSP following the same delivery model.  

Josh’s partner completed a second round of the SSP following Josh’s treatment, while Josh at this point began the ILS programs. Josh continued with the ILS programs independently over eight months and, mid-way through this, his partner also began the ILS. Both Josh and his partner completed the SSP and the ILS over a total of 15 months. 

Their provider, Kate, worked with them on psychoeducation on a biweekly basis, with a strong focus on co-regulation and independent regulating activities. Josh enjoyed juggling during the ILS programs and even became an advocate for his friends to begin playful activities coupled with sound. Art and movement were used alongside the programs as well as organizational techniques and strategies. There was also ongoing communication between Kate and Josh via email and text to support the regular compliance for the ILS. 


After their completion of the Safe and Sound Protocol (SSP) and the Integrated Listening System (ILS), Josh and his partner’s communication improved, bids for intimacy developed, and clear responses to safety, needs and wants were established. He has since connected to his partner with a greater level of clarity in communicating his own needs, and is better at responding to her needs by speaking to them more directly. Josh was able to expand his view of his environments and relationships, increasing awareness and observation of both his internal and external environments and his capacity for multitasking. He became aware of the need for structure, improved his performance at work and shifted his behavior regarding tasks at home, fundamentally changing his functioning. 

He has begun thinking about future goals beyond farming, expecting greater levels of functioning to support future employment possibilities, and is considering college. He is on time for sessions and at work, modeling timely structure to his staff.

“His ability to organize his thoughts, behavioral choices and task management has improved tremendously,” Kate said. 

Kate also shared that Josh had a relapse in symptoms while she was away for two months. When she returned, she said, “We talked about what happened and as he reviewed things, he could see how important it was to stay connected to resources as he implements these new skills.”

“He chose to [repeat] the ILS program in an effort to support further outcome consistencies,” she added. 


Kate was surprised by how much change arrived in such a short time. Although Josh has engaged in therapy and has been medicated in the past, he reported that he’s never had this much success.

“He was dedicated to the ILS program in a way that I have not seen most clients show up. He worked it into his daily routine,” Kate said. He began looking forward to the sessions, which appeared to help him focus. 

His boss and coworkers were surprised by his increase in functioning and his ability to lead and manage his staff at the large-scale farm. He was able to go to bed on time, wake up, and complete daily schedules and tasks, such as organizing paperwork. He still has pieces of organization that need fine-tuning, but has come a long way in functioning. 

His partner was thrilled with the SSP, as she saw Josh “finding the dirty dishes” and “seeing the room.” She was surprised by how much he began to change, which significantly impacted their marriage. This was the first case where Kate began with individual regulation before addressing the primary issue of intimacy directly. Both Josh and his partner had reactivity in their systems; Kate felt that by focusing on individual regulation first, they might then have more capacity for facing intimacy needs in the future. 

“I believe that by both partners working on their regulation issues, they were brought to a greater level of functioning that opened up the emotional field for addressing the sensitive topics of intimacy,” Kate explained. “We are now exploring these a year later. They had been ready for divorce, but have come close together and are expanding their hopes and dreams and love for each other.”

This approach worked beyond Kate’s imagination, and has opened up many new possibilities for other domains in the couple’s lives. It allowed them to focus on their nervous system’s management of stress and threat before diving immediately into the wife’s lack of comfort around intimacy.

Kate provided a lot of psychoeducation, which fed their intellectual hunger and offered expanded depth into their understanding of the application of techniques and skill development. 

“I asked them to support each other by learning to witness the other, to pause and listen with different hearing … using sensory ways to develop interoception,” she shared as an example.

She also offered playful ways for them to connect and build alternative ways for social engagement beyond sex or home tasks like cleaning. All of these skills and activities were new for the couple; they went for walks and talked with one another, held hands, and silently observed the world around them, occasionally glancing at each other to build connections without words.

“This was a great experience for me,” Kate said. “I have introduced SSP and ILS to other adults now and many of the practitioners that I mentor.”

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