An evolution in my thinking about iLs, SSP, RRP, and extremely sensitive nervous systems.
I haven’t talked nearly as much about Integrated Listening Systems (iLs) as I have about the Safe and Sound Protocol and, more recently, the Rest and Restore Protocol.
Lately, however, my thinking about where to begin has been shifting. This is partly because of my own iLs journey.
I have increasingly been considering whether some of my most complex and sensitive clients might benefit from beginning with iLs before attempting SSP or RRP. This is not because I believe iLs should routinely come first. For many people, I would still recommend beginning with SSP. For others, RRP might be the most promising starting point.
I began thinking more seriously about iLs first because, in my clinical experience, it has carried little to no apparent risk of dysregulation - even among people with extremely complex and sensitive nervous systems.
The more experience I gain with highly complex nervous systems, the less convinced I am that responsible sequencing can be reduced to a simple decision tree. New information does not necessarily overturn what I previously observed. Sometimes it reveals another possible path.
That is what happened here. I still believe iLs may be the best starting point for some highly complex people. I now also see a different way of introducing SSP that may allow some of those same people to begin with SSP more comfortably.
SSP and RRP can sometimes be dysregulating, even when we begin with extraordinarily small amounts. Most of the time, careful pacing, support and adjustment allow us to find a manageable path. But occasionally I work with someone who is already functioning at the absolute limit of what their system can manage. Even a temporary worsening could have serious consequences for their ability to sleep, eat, work, communicate, care for themselves or remain emotionally stable.
For those individuals, I have found myself asking a different question:
Instead of continuing to search for the smallest possible amount of SSP or RRP, would it be better to begin by building more regulation through iLs?
I still believe that is an important question.But a recent consultation introduced another possibility - and reminded me that my thinking is continuing to evolve.
I recently consulted with Unyte about an exceptionally complex client and my thought that iLs might be the best place to begin.
Ann suggested that we could still begin with SSP - but approach its sequence differently.
This is actually an approach I had previously wondering about myself and have intended to try but somehow kept forgetting to test it out.
Instead of necessarily beginning with hour 1 and proceeding directly through hours 2, 3, 4 and 5, we could begin with a short portion of hour 5. From there, we might work gradually backward through the program until reaching hour 1. After completing hour 1, we could turn around and proceed through hours 2 to 5 in their usual order.
Another possibility would be to try a very small amount of hour 1 first and move to hour 5 if hour 1 did not feel smooth.
In my work with highly complex clients, hour 1 is often the most challenging part of SSP. That is not true for everyone.
Occasionally, even a very complex person finds hour 1 particularly easy. Nevertheless, it is uncommon enough in my practice that I am interested in exploring whether a later-hour entry point might offer some clients a gentler introduction.
This is not something I would suggest that people attempt independently. SSP sequencing and pacing should be individualized in consultation with a qualified provider who understands the person’s history, sensitivities and responses.
What interests me about this approach is that it may offer another option between two apparent extremes:
A carefully modified SSP sequence may allow some complex people to receive what they are seeking from SSP while reducing the likelihood that hour 1 will feel like too much, too soon.
I had begun to see iLs as an increasingly important starting point for people who could not risk even a temporary increase in dysregulation.
I still do.
What has changed is that I now see another possible way to make SSP accessible to at least some of those people.
If beginning with hour 5 and working backward allows an extremely sensitive nervous system to receive SSP smoothly, I may not need to recommend iLs first as often as I had begun to anticipate.
On the other hand, one successful experience will not establish that modified SSP sequencing is the answer for every complex client. Some people may still be better served by building more regulation and neurological organization through iLs before attempting either SSP or RRP.
This is why I do not want to turn any emerging clinical observation into a new rule.
The answer is not:
SSP should always come first.
It is also not:
Highly complex people should always begin with iLs.
The more useful question is:
Which program, sequence and entry point is this particular nervous system most likely to receive well right now?
iLs is also, of course a wonderful approach all on its own.
Both SSP and RRP often need to be carefully titrated. With sensitive clients, listening may be reduced to very small amounts - sometimes minutes or even seconds.
For many people, this and things like increasing co-regulation or adding in slow gentle moving during listening, is enough to make the program manageable.
However, some people become temporarily dysregulated even from micro amounts. Their responses may be immediate or delayed, and the intensity of the response is not always proportional to the amount of listening.
This does not mean that SSP or RRP is inherently too difficult for complex people. Some highly complex clients respond beautifully to one or both. A person who struggles with SSP may do very well with RRP, while someone else may tolerate SSP much more readily than RRP.
The name or intended purpose of a program cannot tell us exactly how an individual nervous system will experience it.
For someone with adequate reserve, a temporary increase in symptoms may be relatively unconcerning. We can pause, provide support, adjust the listening plan and allow time for integration.
But some people have no such margin.
They may already be using almost all their available capacity to manage pain, sensory overload, autonomic symptoms, cognitive demands, sleep disruption, emotional distress or the basic activities of daily life.
For those people, “start with a tiny amount” may not always provide sufficient protection. We may need either a different starting program or a substantially different way of entering the program.
In my clinical experience, iLs has little to no apparent risk of causing dysregulation, including among many extremely complex and sensitive clients.
That does not mean that no person could ever respond poorly to iLs. It means that the difference I have observed in my own practice has been striking enough to affect my clinical decision-making.
iLs combines treated music and bone conduction with movement and sensory-motor activities. Rather than asking the nervous system to make the same kind of relatively rapid physiological shift that may occur with SSP or RRP, the work unfolds gradually over a much longer period.
For someone with very little reserve, this may offer a way to begin supporting regulation, sensory-motor organization, coordination, attention and executive functioning without creating a significant destabilizing response.
Beginning with iLs does not mean deciding against SSP or RRP. The intention may be to help the nervous system become sufficiently organized and regulated that SSP or RRP can be introduced later with considerably less difficulty.
In that sense, iLs may serve as a bridge.
People with a history of concussion or other brain injury may be particularly important candidates for an iLs-first approach.
Brain injury can leave someone with a lower threshold for stimulation and change. They may experience headaches, cognitive fatigue, sensory sensitivity, impaired attention, vestibular difficulties, sleep disruption, emotional lability, autonomic symptoms or difficulty recognizing overload until they have already exceeded their capacity.
Their responses may also be delayed. Something can appear well tolerated during a session but lead to a marked increase in symptoms later that day or over the following days.
This does not mean that someone with a brain injury cannot benefit from SSP or RRP. Many can. It does mean that the possible cost of getting the timing, sequencing or dose wrong may be particularly high.
For some people, modified SSP sequencing may provide a sufficiently gentle entry. For others, iLs may still offer the more appropriate way to begin building capacity.
RRP remains a genuine third possibility.
While helping with the RRP pilot study, I worked with some people who had already begun SSP. We paused their SSP listening while they completed RRP. When they returned to SSP afterward, they were able to listen at a faster pace than they had before doing RRP.
That does not mean RRP should always precede SSP, or that RRP is invariably the gentler option.
For some people, RRP may be profoundly restorative and gentle. For others, even a very small amount can be dysregulating. The same program can land very differently in different nervous systems.
My decisions about where to begin have therefore never been based on a simple formula in which SSP does one thing, RRP does another and iLs does something else.
I look at the person’s entire presentation and try to determine which program - and which sequence - they are most likely to respond to well.
Clinical fit is not the only consideration.
Beginning with iLs requires specialized headphones and an activity pack. This represents an additional investment for the client, including the cost of the equipment and shipping.
For those residing of the US there may also be customs and duties fees to pay when receiving the Unyte equipment.
These practical considerations do not determine which program is clinically best, but they belong in the decision. If a carefully modified SSP sequence provides an equally suitable and more accessible starting point, that matters.
If iLs genuinely offers the best margin of safety for a particular person, and/or their best possible improvements, its equipment requirements are definitely worthwhile. The important thing is that clients understand both the clinical reasoning and the financial implications before deciding.
I am not withdrawing the possibility of beginning with iLs.
I am also not ready to say that modified SSP sequencing will remove the need for an iLs-first approach.
I am holding both possibilities.
For many people, beginning with SSP will remain the better and more efficient choice. When SSP produces a relatively rapid improvement in physiological regulation, it can create a stronger platform for iLs, RRP, neurofeedback, psychotherapy, rehabilitation and other therapeutic work.
For some people, beginning with RRP may make a later experience of SSP or iLs go much more smoothly.
For someone with almost no margin for additional dysregulation, iLs may build enough regulation and neurological organization that SSP or RRP becomes tolerable later.
And for some highly complex people who might otherwise have begun with iLs, entering SSP through a later hour and working backward may offer another gentle and accessible path.
The questions I am now asking are:
Which program is this particular nervous system most likely to receive well right now?
Would changing the SSP sequence make it substantially easier?
How much capacity does this person have to absorb an unexpected or temporarily difficult response?
Which sequence is most likely to make the next step easier and smoother?
What financial, practical and accessibility barriers also need to be considered?
Good sequencing is not about defending a preferred order. It is about solving the puzzle of what this particular nervous system is most likely to respond to well - and finding the gentlest, safest and most accessible path toward where we hope to go.
My thinking about that path is continuing to evolve. I believe being transparent about that evolution is more useful than pretending I have reached a final answer.