We met Kayla at the end of the last chapter. Her rapid downhill spirals into panic about ending her life lled our initial meetings. These emotional storms blocked her ability to feel safe, to re ect, to explore-all things she needed to make use of therapeutic work. Understanding how to rein in Kayla’s runaway symptom was of necessity our rst order of business. We needed to interrupt her spiraling and restore her trust and focus so that she could partner with us in developing her therapy plan.