CEUnits Blog

Polyvagal Theory: Meet Your Clients Where They Are At

December 7th, 2021

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.

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