Polyvagal Theory: Meet Your Clients Where They Are At

By Libby Waite

“The science of feeling safe enough to fall in love with life” – Deb Dana

Applying Polyvagal Theory in psychotherapy is a powerful way to work with trauma. It means creating a circle of co-regulation between yourself and your client. It involves an interactive process that engages both of your nervous systems. It allows you to meet your client where they are at.

Polyvagal Theory takes its name from the different aspects of the vagus nerve. There are three pieces; the ventral vagal, the sympathetic nervous system, and the dorsal vagal.

When we are in a ventral vagal state, we are part of the social engagement system. We can connect with other people. We are safe, engaged, open, and curious. When we sense danger or threat, we move into our sympathetic nervous system. In this state, we can feel hostile, anxious, and hypervigilant. Many people who face sustained challenges in their lives become ‘stuck’ in this state. This can trigger anxiety attacks and other neurological issues. When we are in this state for a very long time, or when we face a mortal threat, we move into the dorsal vagal zone. In this state, we become numb, we close off, we shut down. We may experience disassociation, a sense of despair, or deep depression.

Using Polyvagal Theory in psychotherapy involves working with these different states. You work with your client to find out which state is ‘home base’ for them. Together, you then carve out new pathways back to the ventral vagal state. This is the place where your client can begin to feel safe, supported, and connected.

Staying Alive: Neuroception

All three of these states are central to our survival. It’s not that any one of them is bad, they all serve a purpose. Many times, when we experience trauma, they serve to keep us alive. Our sympathetic nervous systems mobilize and protect us whenever we experience a threat. This is the fight, flight, freeze, or fawn response to danger or triggers in our environment. Helping your clients to recognize how these responses have served them is a fundamental part of healing trauma.

Our bodies know how to keep us alive. They know this through neuroception. This is the level of awareness below cognition. It’s how the nervous system absorbs information from the environment. It’s the part of us that operates before thinking, before perception.

You can help your clients move from a sympathetic or dorsal state by using titration. This means feeling slowly and softly into the different vagal states. You can help your clients to navigate their way to safety so they reach the ventral state. You can co-create a visualization so that they feel in control of how much, and how fast, they move between states. You might have them imagine a dimmer switch, which they can slowly turn up into a sympathetic state, or down into a dorsal state. Imagining a handbrake or bicycle brakes are other ways to help your client feel in control of the process.

Imagery: The Language of the Nervous System

Working with Polyvagal Theory in therapy means learning how to resource. Before you resource your clients, you need to resource yourself. Before a session, you can ask yourself: What state am I in? What do I need to be anchored in ventral? And throughout a session with your client, keep checking in and feel: Where is the other person? What does their nervous system need, and how can I give it to them? Using images is a powerful way to help yourself anchor at the beginning of a session. They can also help bring your client back to a ventral state throughout a session. Work with your client to find images that are soothing to their nervous system. These will become the fundamental language of your reciprocal healing journey.

Using Polyvagal Theory in psychotherapy involves engaging your social nervous system alongside your clients’. It goes beyond active listening. It asks that you journey with your client as they safely explore different aspects of their nervous systems. Together, you map routes back to a ventral state. It means accepting your clients exactly as they are, and meeting them where they are at. When you as a therapist are open and receptive to this journey, you’ll find that your clients feel accepted and understood. Together, you can begin to heal trauma.

 
Dana, D., (2018) The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, W. W. Norton & Company: New York.

Raising Resilient Children: How to Support Children Impacted by COVID-19

By Libby Waite

What effect will the pandemic have on children and child development? The answers to this scary question will only reveal themselves with time. Psychological studies have shown that adverse childhood experiences (ACEs) have a negative effect on neurocognitive development. Now, we are facing an entire generation of young people who have had to deal with unprecedented trauma.

Cultivate Resilience and Become a Part of the Cure

Although ACEs can impact neurocognitive development, they are also an opportunity for growth. This growth has to be at a socio-ecological level. The consequences of COVID-19 have created an especially complex adverse experience. These will likely have a detrimental effect on brain maturation. Governments have a responsibility to create policies that will support young people. But, you also have a part to play in the collective healing of our children. Whether you are a parent, caregiver, teacher, social worker, counselor, or therapist, you are a crucial part of the cure.

There is potential for a more humane, sensitive, and compassionate generation to emerge from the pandemic. To help cultivate this, you can help children develop greater resilience. You are especially needed by children who already face intense ACEs due to socio-economic realities. If you are a social worker or therapist, you might want to think about how you can best serve these communities.

Find Our Shared Humanity

Modeling and teaching empathy, patience, and active listening are key. At school, children will be mixing with peers from diverse households. Their different values might include vaccine mandates, face masks, and our everyday behaviors. Adults also have to deal with new divisions in response to COVID-19. Different people have different beliefs, and always will. That doesn’t mean they are our enemies. Teaching children that everyone is worthy of respect will help them recognize our shared humanity. Then, children can meet their peers with acceptance, sensitivity, and compassion.

If you are a therapist or work one on one with children, find opportunities for new conversations. Why do children think other children/families behave differently? You can reach the conclusion together: it’s not because they’re bad people. Everyone is doing their best and trying to keep one another safe in whatever way we can.

Celebration: Co-Regulation and Re-learning to Learn

Children need to be in community with one another. If you are a teacher or social worker, you have the opportunity to bring diverse groups of people together. It could be for Thanksgiving, Christmas, or a casual Tuesday afternoon playgroup. Celebrations can foster a sense of belonging. They make children feel a part of their community. They create positive social interactions with peers. Children will feel safe and resourced.

The priority right now is not academic achievement. Children’s nervous systems are running on overdrive. Their capacity to retain new information has likely diminished since before the pandemic. This isn’t something to worry about. Instead, we can acknowledge this, normalize it, and help find ways for children to resource. Then, they can return to a more supportive state. A great way to do this is to find as many opportunities as possible to be out in nature. Group nature excursions will allow children to co-regulate. They will learn how to support and ground together.

The disruption, uncertainty, and isolation of the pandemic are likely to have long-term repercussions. We don’t know how these will impact the young people who have had their lives turned upside down by COVID-19. And, we won’t know for many years. The best we can do right now is to work with our children. To go into our communities. To help children feel safe and supported as they find new ways to experience childhood in a post-COVID world.

Araújo, L. A., Veloso, C. F., Souza, M. C., Azevedo, J., & Tarro, G. (2021). The potential impact of the COVID-19 pandemic on child growth and development: a systematic review. Jornal de pediatria, 97(4), 369–377.

Berken, J. A., Heard-Garris, N., & Wakschlag, L. S. (2021). Guardians at the Gate: Early Adversity, Neurocognitive Development, and the Role of the Pediatrician in the Era of COVID-19. Frontiers in pediatrics, 9, 665335. https://doi.org/10.3389/fped.2021.665335