The Pause
How to tell Act 3 crisis from a mental-health crisis—and exactly when to pause and get clinical help.
When to Pause
Transformation work is not therapy, emergency care, or clinical mental-health treatment. There’s a crucial difference between an Act 3 transformation crisis and a mental-health crisis—knowing it can save your life.
Key Idea Transformation work assumes baseline safety and stability. If you’re outside your window of tolerance, pause the work and get clinical support first. vanderkolk porges
The Critical Distinction
Transformation crisis (Act 3):
Patterns breaking, identity dissolving, training wheels failing
Difficult but purposeful; inside your window of tolerance
Distressed and still basically functional
Mental-health crisis:
Overwhelm beyond coping; suicidal ideation; psychotic symptoms
Dissociation from reality; outside the window of tolerance
Not functional in daily life
Caution Pushing through when you need clinical help causes harm, not growth. Pause the work and get assessed. vanderkolk
When to Pause & Get Clinical Help
Immediate — Stop everything, get help now
If you’re experiencing any of the following:
Active suicidal ideation with a plan/intent
Intent to harm yourself or others
Psychotic symptoms (voices, paranoid delusions)
Complete inability to function or maintain safety
Severe dissociation (losing time, not recognizing self)
Manic episode (days without sleep, grandiosity, dangerous impulsivity)
Do not try to “work through it.” Call 988, 911, go to the ER, or contact your therapist/psychiatrist immediately. See resources below.
Pause — Get assessment before continuing
Passive suicidal thoughts (no plan), severe depression, persistent panic
Flashbacks/nightmares that disrupt function
Compulsive self-harm urges; PTSD activation
ED relapse; increased substance use to cope
Next step: Clinical evaluation (e.g., meds consult, EMDR/SE, stabilization). Return to transformation work after you’re stable and supported.
Signs You’re Pushing Too Hard
Body says “stop”:
Sleep wrecked (insomnia or 14+ hours), appetite collapse/bingeing
Chest pain, constant nausea, migraines
Freeze/shutdown when you try to practice; rage/terror that won’t resolve
You’re dissociating:
Numb/unreal, time loss, “watching from outside,” memory gaps
You’re decompensating:
Can’t work, care for kids/pets, or manage basic hygiene
Isolation; relationships breaking down
Caution This isn’t “resistance to push through.” It’s your system saying, “I need different support.” porges levine
The Window of Tolerance (Quick Check)
Transformation requires the capacity to:
Feel (not numb)
Think (not overwhelmed)
Choose (not compulsive)
Pause (not spiraling)
If you’re too numb or too activated, prioritize regulation and stabilization first (polyvagal-informed therapy, somatic work). Then resume transformation practices. porges
The “I Should Be Able to Handle This” Trap
Some situations require professional care:
Trauma processing → Trauma-informed therapy
Severe depression → Clinical assessment/meds
Active addiction → Addiction treatment
Eating disorders → Specialized ED support
Psychosis/mania → Psychiatric care
Using spiritual tools to avoid proper help is bypassing. Get the care you need; do the transformation work from stable ground.
Tuesday Test (Safety Edition)
Ask: “Can I function in ordinary life while doing this work?”
Can you…
Get out of bed most days?
Meet basic responsibilities?
Maintain self-care and one supportive connection?
Stay safe?
If no → pause and get assessed. If yes → continue, with safeguards. See: The Tuesday Test
When to Resume Transformation Work
Resume after:
Crisis resolved; safety restored
Professional support in place & meds stabilized (if any)
Basic functioning back online; window of tolerance widened
Resume with:
Approval from your clinician
A support team (therapist + guide), clear safety plan, regular check-ins
Pro Tip Therapy and transformation aren’t opposites—they’re complementary. Stabilize then integrate.
How to Tell the Difference (One-Look Grid)
Felt sense
Scared but curious
Terrified and want it to stop
Direction
Patterns break for growth
Breakdown without purpose
Regulation
Dysregulated, then re-regulate
Cannot re-regulate
Functioning
Reduced, still present to life
Impaired; disconnected from life/reality
Next step
Stay inside, integrate
Pause & get clinical help
Resources
Immediate Crisis (US):
988 — Suicide & Crisis Lifeline
Crisis Text Line — Text HOME to 741741
SAMHSA Helpline — 1-800-662-HELP (4357)
Find a Therapist / Trauma-Informed Care:
References
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