Improving your therapeutic practice thanks to Polyvagal Theory

“Being a polyvagal-informed therapist means knowing what is happening in our own nervous system, as a therapist, but also in the autonomic nervous system of our patients.” In the two previous articles, we approached the Polyvagal Theory (PVT) from an individual and personal angle, seeing in particular how […]

“Being a polyvagal-informed therapist means knowing what is happening in our own nervous system, as a therapist, but also in the autonomic nervous system of our patients.”

In the previous two articles we discussed the Polyvagal Theory (TPV) from an individual and personal angle, seeing in particular how it could help us in our relationships with others and in particular with children. Let’s see today what TPV can bring us as psychotherapists.

Let us begin by recalling that TPV is not a therapy but a theory, as can be for example Bowlby's attachment theory. As such, I think that every psychotherapist should be polyvagal-informed just as he should be attachment-informed or trauma-informed.

Being polyvagal-informed means knowing what is happening in our own nervous system, as a therapist, but also in the autonomic nervous system of our patients or clients.

TPV to help us as therapists

As a therapist, it is essential to know where we are in terms of our nervous system. Deb Dana illustrates the autonomic nervous system in the form of a scale:

The bottom of the ladder corresponds to the back, to collapse, disconnection, immobilization: there is no immediate solution, no perspective. At the bottom of the ladder, the top of the ladder seems inaccessible to us.
The middle of the scale is the sympathetic mode. We can only go up in the safety of the ventral or go down in the dorsal. There is movement, energy.
The top of the ladder corresponds to the ventral which gives us perspective. At the top of the ladder, we see what is happening around us, we can see things coming. We are calm and connected with others.

So it is essential to ask yourself this question: “Where do I stand on my scale?”

For example, you may find yourself at the bottom of the ladder, without energy, disconnected, dissociated, with the desire to disappear: "I don't know what to do with the patient in front of me, I have no more solutions, I've tried everything!" And that's normal, it happens. We, therapists, are also human beings, with our own difficulties, our own vulnerability.

Knowing that we are in a dorsal state will help us put words to what we feel and find solutions more quickly to return to the safety of the Ventral.

We will follow the hierarchy of the nervous system (Deb Dana spoke about it again in her last Masterclass, accessible in replay). To get out of a dorsal state, we must go through the Sympathetic to return to the Ventral and feel safe. And thus be fully present for our patient.

When we begin to become aware of our state and know how to move up the ladder, then we will be able to navigate it much more flexibly. Obviously, this is work that is personal to each person. We can therefore think about the actions, thoughts, objects that help us move up the ladder to regain sympathetic mobilization when we are at the bottom of the ladder in a dorsal state, or to return to a ventral, regulated state when we are in a sympathetic state.

Winnicott spoke of "the good enough mother". As a therapist, we must be good enough, just as a mother must be good enough. Supporting our patients from a sympathetic state is not really appropriate. However, (re)knowing ourselves in this mode is essential. Being a good enough therapist does not mean being in the ventral state all the time, and that is not possible. But by knowing our system well, we will be able to return much more quickly to a state of security and connection.

Polyvagal Theory to support our patients or clients

We can also use this scale with our patient: where is he? And how can I help him, as a therapist?

Deb Dana's scale perfectly illustrates this hierarchy of the Nervous System, one of the organizing principles of Stephen Porges' Theory. Deb Dana teaches us that we cannot go from the dorsal to the ventral without passing through the sympathetic. And going through the sympathetic is essentially putting movement.

If we see dissociation and collapse in the other, then what will help him or her reconnect with the energy of the sympathetic so that he or she can slowly move back up to the ventral? It could be movements or emotions, thoughts, actions…

What can we explore with the patient? For example, what are the moments when he or she is in the ventral? Not necessarily extraordinary moments. It is enough, as Deb Dana says, to have “micro-moments of the ventral” or a few “glimmers”. This is what we want the patient to understand, so that he or she can find the safety of the Ventral more and more quickly and more and more frequently.

As a therapist, no matter what tools we choose to use, whether CBT, EMDR, energy psychology or even talk therapy: by adding a touch of polyvagal understanding, we give much more strength to our therapeutic practice.

So, do you also want to become polyvagal-informed?

In the next article, we will talk about how to make TPV your own.

Series of articles “Polyvagal Theory in everyday life” by Florence Bernard.

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