‘Polyvagal Therapy’ is one of the highest web search terms related to Stephen Porges’ theory and will likely have gained traction as the links between the autonomic nervous system and emotional well-being are being truly realised and understood. Professionals from a range of disciplines are seeking interventions which integrate the body-mind connection. Therefore, it makes sense that concepts of Polyvagal Theory are embedded into their philosophy and practice, knowingly or not.
Polyvagal Theory (PVT) has been gaining momentum since 1994 when Porges proposed his theory about the vagus nerve and how the autonomic nervous system evolved for safety and survival. Not without controversy, arguments criticise the oversimplification of PVT in relation to complex human emotions and reactions which cannot be tested as a scientific theory. However, neurophysiology cannot be ignored with modern neuroscientists, psychologists and attachment theorists taking an interdisciplinary perspective when considering mental and emotional health. As noted by Antonio Damasio, the body-mind connection can no longer be ignored, as, ‘we are not thinking machines that feel; rather, we are feeling machines that think’ (2006).
It is important to clarify, PVT is not about emotions, is about SENSATIONS and how our nervous system responds to stimuli. How does the body respond to the environment? How does the body experience ‘an-other’? What are the somatic markers that lead to an emotional experience?
The body responds to perceived threat, long before the mind catches up as ‘this listening [for threat] happens far below awareness and far away from our conscious control’ Deb Dana (2018). In his latest book “Respark”, Graham Music discusses how protective responses occur on a cellular level, ‘When our mitochondria…… sense a threat, they shut down energy production and signal danger, so that much communication within the body between cells and organs stops’ (p.19).
Whether you refer to the work of Allan Schore, Dan Siegel, Gabor Mate or Lisa Dion, all are curious about emotion regulation, seeking to explain and explore how the body’s regulatory capacity is formed, and how it informs future relationships, perceptions of the world and the capacity to engage in society at large.
Reasons for client referrals generally relate to perceived maladaptive responses to a situation whereby the capacity for the client to regulate themselves (or not) usually leads to a therapeutic intervention.
Incongruous responses at some point in the client’s history served them well and were in effect in service to them and of them. In the past, the bodily response matched the threat, for example, a baby who learns to stop crying because the parent/carer vehemently shakes them or shouts/screams at them. Now aged five years old, the child lives with their loving grandparents, yet they are shut-down and unable to connect. In the context of the here and now where the threat has been removed it seems from an observational perspective, the maladaptive strategies still exist, and the autonomic responses continue ‘as if’ the threat is still there.
A therapist who has a good enough understanding of the Polyvagal Theory framework has an additional lens through which they can conceptualise their client’s experience of the world. There are no absolutes here, but having an awareness of the client’s felt sense ‘autonomic protective responses’, their capacity to move through the various autonomic states and return to a position of connection is highly valuable addition to the ‘toolkit’, especially when paired with the therapist’s own autonomic responses when in relationship with their client.
So, what about practitioners who do not have specific training in this arena? Let’s take play therapy as an example. Whilst many will not have been formally trained in PVT, the fundamental starting point is for the practitioner to be attuned to their client and invest in building a warm and reciprocal therapeutic relationship. The play therapist will use reflective language, mirror the child’s movements and actions, offering an opportunity for the child to explore their feelings, experiences, and behaviours alongside a regulated and authentic adult. In other words, for the play therapy to be effective, the therapist has to offer the child the experience of co-regulation, one of the core tenets of PVT. How empowering would it be for the same play therapist to have a theoretical understanding that the relationship they have developed with their client, will intentionally influence their client’s autonomic nervous system?
Modern theories and frameworks have informed psychotherapy over the past thirty years, and it feels that we are in the midst of a mini revolution in the context of PVT. The evolution of therapeutic work has moved us from a focus on behaviour to a focus on affect. Our understanding through the integration of concepts from neuroscience, biology, physics has pushed us away from the belief ‘I think therefore I behave’ and invites us to consider “I feel, therefore I behave and then I might think, if I can!”
Whatever your psychotherapeutic modality, understanding the body-mind connection is intrinsic to the work. Whilst PVT does not appear to exist as a stand-alone therapeutic model, it is heartening that professionals from a range of disciplines are seeking interventions which integrate the body-mind connection.
Returning back to the title of this blog ‘Does Polyvagal Therapy Exist?’ the answer in inconclusive and depends as to whether you are believer on non-believer. However, there is growing evidence that body-mind connections are not separate but intimately intertwined, and that paying attention to both concepts is crucial to therapy.
Information on ‘Applying the Polyvagal Theory to Child Therapy’ can be found at: https://www.pipsolutions.co.uk/child-therapy-accredited-training
(Authors: Karen O’Neill & Tara McDonald)
Published and Copyrighted by PIP Solutions: 3rd March 2023
Dana, D (2018), The Polyvagal Theory in Therapy, NY: Norton
Damasio, A (2006), Descartes' Error: Emotion, Reason and the Human Brain, NY: Vintage
Music, G (2022, Respark: Igniting hope and joy after trauma and depression, London: Mind-Nurturing Books
Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9–20