Play Therapy Meets Somatic Attachment Psychotherapy

Play Therapy Meets Somatic Attachment Psychotherapy

Blog by Rachael Pasemko, RSW, RCC, RPT-S

As a play therapist, Somatic Attachment Psychotherapy (SAP) has expanded my practice and become the framework I use to conceptualize my clinical practice. I understand the children, their families, and their life experiences through a lens of early attachment connections, injuries and repairs. Play therapy is an imaginal, right brained modality and therefore often ambiguous, difficult to measure or interpret, which makes it challenging to communicate progress to caregivers. Having a breadth of understanding of the Autonomic Nervous System (ANS), attachment theory and relational practice, internal working models (IWM), shame and chronic shame, embodiment, the intersubjective field, and working with the right hemisphere, makes the work more easily articulated and understood within a variety of theoretical and conceptual frameworks.

As a clinician, I favour a non-directive style of play therapy, meaning I follow the child’s lead, and we spend our time engaged in the activities chosen by the child. My work is a combination of Expressive Play Therapy, Synergetic Play Therapy, and Somatic Attachment Psychotherapy. I offer child clients an intentionally curated play space that includes puppets, sand tray therapy, a doll house, crafts, board games, art supplies and items to play house or dress up. The activity options are nearly endless as the child begins to follow their inner knowing about what needs to come next. We create what they require and sometimes find ourselves crawling through fabric tunnels into a fort made of bedsheets to enjoy a picnic lunch with our community of plush rabbits.

My role in sessions can look simple to an untrained observer; like I am sitting with a child while they play in a lovely room; however, the work is actually clinically sophisticated and nuanced. My focus is on creating a safe-enough environment and therapeutic relationship where the child can relax into themselves, freely express their inner world, explore challenges, and share what it feels like to be them. My therapeutic stance is to offer co-regulation and opportunities for relational repair, and meet their expressions with acceptance and permission. At times, we work with symbols and metaphors that need to be witnessed and held in order to be transformed and integrated. At other times, we are attending to developmental needs and stages that have not been met, and that need support to progress.

Many children have easy access to the right hemisphere and its symbolic, metaphoric, and intuitively creative expressions. As a result, I seldom have to work past a “defended left hemisphere” (Quillman, 2012, p. 5), as often therapists must do in therapy with adults, and we frequently spend the therapeutic hour in the imaginal, both embodied and in the upper right hemisphere. I work with the imaginal as taught in SAP with the addition of three-dimensional play objects such as figurines, puppets, or a family of cats in the doll house.

When a child has experienced trauma, the play can be rigid, restricted, and repetitive. Bringing healing images into the trauma narrative at the right time, in the right way, can encourage the expression needed to transform and integrate. This integration expands the child’s window of tolerance, increasing their capacity for stress and emotions, resulting in a decrease in challenging behaviours. I may offer a tiny blanket to a baby that is repeatedly stuck in the trunk of a car. I might set up a hospital, if the child can tolerate that level of care, for the soldiers that are being annihilated. This aspect of my practice uses the language of symbols and metaphors to move difficult, unconscious, or disavowed material.

Much of my play therapy practice, as in SAP with adults, is a focus on the ANS. I observe the child’s physical body for cues, notice what sensations I am experiencing in my own body, as well as the themes in play that reflect the state of the child’s nervous system state. Hyperaroused play is bigger, louder, faster, often intense, frantic or disorganized. It can include violence and aggression. Hypoaroused play tends to be slow, easily distracted, floaty, hard for the therapist to stay focused on, and could include items buried underneath the sand or dying. Co-regulating the ANS happens in a variety of ways, and remaining regulated and connected to myself to ensure I am the strongest, dominant nervous system state is often enough to help the child shift into regulation. I might use more overt body movements like rocking back and forth or getting up to walk. When appropriate, I name my body sensations or emotions and then regulate myself in a way that the child can see or sense, activating the mirror neuron system. Through these times of co-regulation, the child’s nervous system can learn regulation from mine. Additionally, I might invite the child into an activity intended to shift the ANS either down or up regulating into the window of optimal arousal. To this end, we will march the room, or go outside into the garden, or I could offer a cue to feel the soft carpet under our feet.

Relational healing and repair, much of the focus of SAP, is also much of the work in my practice. Coming alongside a child with ANS dysregulation to support them to modulate the intensity and co-regulate is relational work that tends to early attachment disruptions, whereby the therapist is the “psychobiological regulator” (Carroll and Schore, 2001, cited in Gill, 2009, p. 362). Children experience co-regulation in my play room, and I work with their family system when it is available, intending that over time the child client is able to access co-regulation outside of therapy, and eventually an increase in their capacity for self-regulation. In working towards relational repair of attachment injuries, there is opportunity to use verbal and physical reflections to mirror the child back to themselves, disrupting their IWM and over time shifting their concept of self.

Bringing SAP into the playroom also brings an awareness to my own nervous system so I can be intentional about taking care of myself in the midst of the complicated experiences of my clients. In the intensity of hyperaroused play, where we are acting out traumatic material, the child’s projections often land on the therapist. Being killed in an intense sword fight repeatedly can leave a residue of dysregulation as there are real emotions in the play- real fear, helplessness, or terror. Having a strong capacity to regulate my ANS and understand the impact of working with trauma, and how to care for one’s self are key to longevity in this career.

Integrating SAP into my play therapy practice has resulted in deeper and more rewarding work for me and the children and families I meet with. By bringing in a comprehensive focus that weaves the body, attachment and relational repair, and applying it in developmentally appropriate ways, in concert with my play therapy, I have an increased therapeutic canvas to understand and relate to my clients and their families. This comprehensive understanding of early trauma and the reparative responses needed, allows me to access the core of the child’s wounding which is often at the foundation of the behavioural symptoms that brought them to my play room initially.

References:

Gill, S. (2009). The therapist as psychobiological regulator: Dissociation, affect attunement and clinical process. Clinical Social Work Journal, 38(3), 260 – 268.

Quillman, T. (2012). Neuroscience and therapist self-disclosure: Deepening right brain to right brain communication between therapist and patient. Clinical Social Work Journal. 40, 1 – 9

Rachael Pasemko, RSW, RCC, RPT-S is a play therapist and group practice owner in Kamloops, BC. She loves working with the language of symbols and metaphors, integrating the body into the therapeutic process, and supporting children and families to find more ease. Rachael co-facilitates a neuroscience based parenting group that teaches parents what play therapists do, offers consultation to other play therapists, and can be found at www.lighthousetherapy.info

Orienting to Other

Orienting to Other

Blog and Artwork by Lana Marie Willow, MA, RCC

We are living in a traumatised world. Wars, natural disasters, climate change, pandemics, epidemics, starvation, extinctions, create complex situations that interfere with healthy functioning and relational dynamics which then continue to perpetuate trauma. Further, our world is currently run by the machine of economics and the idea that we need to keep producing more and more and grow bigger and bigger. Technology is valued over human connection. Art is becoming more mechanised. There is a notion that perfection is required in order to be of value. Value is placed on appearance, accumulating and consuming, growth and money above sharing, giving, the natural cycles of growth and decay, and connectedness to each other on the human level.

When experiences are too overwhelming to feel, comprehend and process through the psyche and nervous system, we create ways to manage. One way the western world has collectively learned to manage is by orienting to the left brain experience of the world, where things are separate and narrowly focused, and there is a drive towards an idealised and unrealistic perfection. Although this allows us to go on with our day to day lives, what we need in order to actually heal and potentially reverse the current course of destruction on this planet, is to shift our orientation towards the right brain experience of connection and embodied knowing, attending to the larger picture where everything is seen as a whole and considered as connected.

Iain McGilchrist (2009), author of The Master and his Emissary researched hemispheric differences for three decades before writing his monumental book on brain bilateralization. He explains that although both sides of the brain are active and involved in all mental processes, “each hemisphere has its own way of understanding the world” (p. 10). He makes the important distinction that,

the right hemisphere pays attention to the Other, whatever it is that exists apart from ourselves, with which it sees itself in profound relation. It is deeply attracted to, and given life by, the relationship, the betweenness, that exists with this Other. By contrast, the left hemisphere pays attention to the virtual world that it has created, which is self-consistent, but self-contained, ultimately disconnected from the Other, making it powerful, but ultimately only able to operate on, and to know, itself p. 93

Although we need both hemispheres working together to properly function in the world, McGilchrist’s research has profound implications for understanding and potentially shifting the way humanity is stuck in a toxic cycle of disembodied individualistic values and actions.

In order to be truly alive and aware of the miracle of being in a living body on the earth. what is kept inside, hidden and protected, held safely in its quivering vulnerability, needs to be known, seen and welcomed. Otherwise, how will we ever be able to fully and deeply know our own precious nature and fulfil our unique purpose in this world? Perhaps even more importantly, when we can truly feel what is alive and real inside us, then we can also become aware that we are not separate and isolated on an island of self. Our essential nature is to be loving and connected. When the blocks created through trauma have been healed, we naturally know the importance of reaching out to each other and considering the Other.

What is known through the body and intuition gets buried along with the undigested material of traumatic experience, including relational abuse and neglect. Blocks are created to protect us from perceived danger, even when the danger is long over, and we learn to rely on mechanisms that are not based in present truth to provide a sense of safety. The left brain needs things to be predicable and known, and yet to see anything that way is simply illusion. The universe is not predictable, and as much as science tries to quantify and understand the nature of life, those understandings keep getting more elusive and out of reach.

We need to learn to sit in the unpredictability of the magic of existence, to marvel at the miracle of simply breathing and being alive, heart pumping blood and moving oxygen through our bones and cells. Then we can remember that we are alive and, on the earth, and surrounded by and part of Otherness. We are more than a number or a configuration of mechanical parts.

I suggest that coming back into the intuitive realms of the imaginal, while maintaining awareness of our physical bodies and our interdependence on everything around us, is a way we can start to reverse the current devastating trajectory, opening us to embodiment, relational connection and healing. Greene (2005) states,

Although it begins with a physical sensation, it often transforms that sensation into a feeling or image so that the border between imaginal and embodied modes of experience is blurred, at which point their reciprocal relationship becomes apparent.  Both are symbolic ways of working. Each mode compliments the other. The imaginal approach to psyche needs the grounding effect of the embodied awareness to bring the intuitive insight into the present moment of actual experience. The embodied approach to psyche needs the expansive effect of imaginal awareness to allow the sensate insight to take flight into the mythopoetic dimension of experience. p. 202

Greene is essentially describing the right brain function: awareness of the present embodied knowing, along with the ability to use the expansive thinking that goes with the imagination.

As therapists we must hold the container of wholeness and stay grounded in our own imperfect earthiness and connectedness to each other as we offer our clients a relational holding that facilitates reconnection to the ways of the right brain functioning. Schore highlights the role of the therapist when he states, “we must depend on someone holding us in being while we ourselves knit together our broken parts” (Schore, 2019, p. 93 citing Ulanov, p. 60). We can further this process by remembering to include metaphor, image, sounds, smells, all the things that make us truly human, not just a machine. As we gradually bring back the ability to feel alive and to know love, we will naturally start to be able to orient to the right brain awareness of connectedness, to what is perceived as Other, and then perhaps the world will be a more livable, more loveable, and safer place for all.

References

Greene, A. (2005). Listening to the body for the sake of the soul. Spring 72, p. 189 – 204.

McGilchrist, I. (2009). The master and his emissary: the divided brain and the making of the western world.  London: Yale.

Schore, A. N. (2019). Right brain psychotherapy. New York: WW Norton.

Lana Marie Willow, MA, RCC is a therapist, artist and writer. Lana weaves creative expression, transpersonal psychology and somatic psychotherapy into her online therapy practice. www.yourtruenature.ca

What Therapists are Saying about the Somatic Attachment Psychotherapy Training

What Therapists are Saying about the Somatic Attachment Psychotherapy Training

This fall we graduated two cohorts from the Somatic Attachment Psychotherapy 2-year trainings. As we were basking in the glow of the hard and heart work, theirs and ours, we started thinking about getting an insider’s perspective to the training for the BBP blog. We asked for some thoughts, comments, testimonials, whatever people wanted to offer…here’s a few to chew on. Just a quick note to say, we are thrilled with the kind and powerful statements, and blushing just a wee bit.

This is SUCH a brilliantly designed and executed program. I could write a small book about how BBP has strengthened my practice and my life. Each intensive builds on the skills and learning from the one before as the trust and safety in the cohort strengthens. Lisa’s kind and skillful relational guidance allowed me to lean further into the material and into the field in such profound ways. I am so very grateful to have found you and this community!

I strongly recommend this program to any and all counsellors. Attending the BBP 2 yr SAP training course with Lisa Mortimore and Stacy Jensen was simply life changing for me—both professionally and personally. This is hands down the best training I have ever had the privilege to attend and I have taken a lot of training in my almost 20 years in the field! The beautiful blend of solid, foundational academic research combined with witnessing Lisa’s live demonstrations followed by an opportunity to actually practice the skills in each and every intensive made this program invaluable to me.  I have grown and healed as a person and am a more skilled counsellor because of my learning and the deeply relational approach that Lisa and Stacy stand by. You will not only gain skills & confidence but you will also become part of an incredible community of committed, skilled, compassionate practitioners. I already can’t wait for the advanced program to begin.

—Tracy Myers, MC, RCC

This training offers the opportunity to become part of a therapeutic community that is rooted in love, where all beings are held with deep respect and dignity. This two-year program offers a gentle layering of skill development and personal transformation, through the ongoing practice of integrating theory, witnessing powerful demonstrations, and practicing skills in a supportive environment. I have come away with so many more resources to use with clients and much more access to my own creativity, lightness, and ease in the work. It is rare to be in the field of such incredible skill and come away with more confidence in ourselves and our own abilities. Lisa brings deep intelligence, humour, humility, and kindness to the practice, encouraging play, experimentation and trust in our clients and ourselves. I’m so grateful for this experience and am looking forward to what comes next.

—Karen Max, MEd, RCC

A few weeks ago a man came to my office after a harrowing work event that left him wondering if he could return. We sat, deeply, tentatively, carefully, and lovingly. Together we found the space and words to heal. He is eager to return to work. 

 I am deeply grateful to have the foundational aspects of the BBP work to guide my practice, build my knowledge, and ignite the wisdom inherent between the client and me. 

Lisa and Stacy and their team offer a well researched, organic, implicit, and authentic approach that supports clinicians to develop the skills to heal clients on multiple levels. 

Essential practice. 

— Roseanne Cooper MC, AT, RCC

It’s hard to put words to all that I received from the SAP training and cohort. Part way through the training, my nervous system began to respond in new ways to my clients, and to my own internal work. I am continuing to notice somatic responses to material that arises, trusting that my body is processing in new ways with its own wisdom and truth. Integrating this transformation feels invaluable, in addition to strong and clear clinical skills I was able to develop around how to work relationally, with an attachment frame and weaving in somatic skills and practices. The facilitation team was incredibly helpful and supportive, and Lisa’s teaching is precise, deep and offers a unique perspective on the complexity of trauma, soul and spirit and deep ecology. I am deeply grateful for all I’ve received and am excited about the opportunity to deepen in the work with an advanced training. 5 stars!  

—Caitlin Colson, MA, RCC

Let’s Talk About, A Not So Private Practice Podcast

Let’s Talk About, A Not So Private Practice Podcast

Happy New Year! I spent my winter holidays mucking about with a few things—catching up on my reading (only fiction over the holidays), clearing out the attic (oh my goodness), making chocolate (with candied oranges and marzipan), taking time with friends, family and feline, and, I had the pleasure of digging into and finishing the A Not So Private Practice podcast (great title!) with hosts Laura Bull and Stephanie Davis, co-owners of Shoreline Counselling (both BBP alumni and facilitators!!!). I was also thrilled to hear a few other shoreline team members (and BBP folks) share their experience of practicing at Shoreline – Amanda Murphy (another BBP alumni and facilitator) and Millie Bata and Mariah Kingston (both currently in the BBP June 2023 cohort).

I laughed, I mean out loud more than a few times…but most of all, I felt good listening to them—talk about stimulating my ventral vagal system😊I was smiling listening to them relate and share their experience of starting, running and growing their group practice. They companioned me as I sorted through boxes of stuff from the attic, and I was entertained, my curiosity was piqued, and I learned a few things about them, about the trials and tribulations of group practice leadership and ownership, about running a clinical practice in terms of marketing, social media, grants/funding etc., and, about how much they love budgeting (who knew). All good stuff.

But, I had two favourite parts, both in the wrap up podcast (but listen to it all, it’s worth it). One, I appreciated their conversation about women and balance, in particular, women who are driven or ambitious, and, I agree, it’s less about balance and more about finding the vitality to live the life you want (and the people to partner with to make that happen – like Laura and Steph have). I also really liked how they framed their relationship—it came up when they talked about their first bad review of the podcast (I couldn’t believe they got a bad review) and that it was someone who didn’t like how much they liked one another, and I loved, I mean really loved, how they framed it, their relationship, as a love story, and it is. Who doesn’t love a good love story? (that’s right from the podcast!!). So, if you are looking for a little lightness packed with wisdom, take some time this winter and listen to season one. I can’t wait until season two!!! Way to go Steph and Laura!  http://www.anotsoprivatepractice.ca

This is what I know to be true in my clinical practice: Somatic Attachment Psychotherapists Share…

This is what I know to be true in my clinical practice: Somatic Attachment Psychotherapists Share…

I posed a few sentence stems for a free writing exercise this morning at a BBP Somatic Attachment Psychotherapy writing group. What came back was potent, powerful, illuminating, expansive, opening, affirming—you get the drift. We decided to share it…here it goes, enjoy!

I feel confident in my clinical practice… 

…when someone says something out loud that has previously been unwitnessed or unspoken.

…when my clients speak their truth, sometimes for the first time.

…when someone says, “I’ve never looked at it that way before.”

…in moments where genuine & healing laughter reverberates through my client’s system as well as my own.

…when clients see my tears in response to their hurt or pain and reflect back the experience of feeling “seen” or “not alone.”

…when clients are able to make changes in their life and relationships as a result of feeling a greater sense of internal steadiness.

…when I am able to provide clients with “a different experience” than they are accustomed to. That is, a different experience related to communication, a different relational experience, or a different experience of connection.   Amanda J. Murphy, MC, RCC

This is what I know to be true in my clinical practice: When I meet with someone clinically, I bring in the regulation of my system, my capacity to attune to them and I hold internally the strong belief that through the therapeutic relationship the work in therapy will happen. “Love is Medicine”, a powerful healing balm.   Susana Farinha, MC, RCC

This is what I know to be true in my clinical practice: What I know to be true in clinical practice is that being relationally held by another with an open heart heals. I know that the more I journey into my Self, clearing and expanding, the more stability and space I have to be present to the truth and pain of others.  If I can be with me and move through what is in the way, then I can be with you more completely.  I know the power that exists in the delighted twinkle of an eye, the soft reflection of acceptance, and the comfort of a therapist able to hold all of me.  What I know to be true in clinical practice is that embodiment, regulation, and relational connection can actually feel like magic.   Rachael Pasemko, RSW, RCC, RPT-S

This I know to be true in my clinical practice: I practice from the heart. I attach. I engage my body as the vessel of connectivity it is intended to be. I hold a space of warmth, welcome, challenge, acceptance, and high regard for innate and intimate wisdom of the soul-ular nervous system. My practice is me & I am my practice. My practice shifts & responds to the changing tides, rhythms, and movements of the Earth, stars, and cosmos, as they signal their need at the subtle energetic level tied vitally to my being. I hold lineage, ancestry, and legacy within my care. I attune to the pulse of the lived & loved ones making the beat of their existence known in the space amongst, within and between us. I play; I hold politic; I navigate complexity. Love is the medicine that awaits all ailments. Time, willingness, and presence to what emerges are the bandages that are Here2Hold & swathe us all.  Efré Laurence Divina, MA, RCC 

I know this to be true in my clinical practice: I am an advanced therapist who has grown professionally and personally in my years of practice. My commitment to my own development as a person, is an exciting never-ending exploration into the Self. I believe it is not so much ‘what I know or do’ but ‘how I am’ with clients, that can make the difference. I offer my compassionate presence, and a creative space to listen to those on the journey of being and becoming.  Dawn Sather, MSW, RSW, RCC

What is true in my clinical practice: I know that as humans, we all have a need for love and connection. We need to feel “gotten” by another, accepted and understood. I know that if I am in a state of loving presence with my clients, in a way that creates a feeling of safety, I can trust that what needs to be revealed in order for my client to heal, will come to the surface to be witnessed and transformed. As children, when our needs are not met: needs for safety, nourishment, connection and attunement, we will create blocks to our own truth and sense of worth in order to manage the incongruence. Although at some level we know that our needs matter, we learn to disavow our own needs and consequently make choices that are not in our best interests. Working relationally in the present moment, with constant attention to nervous system regulation, those blocks to knowing that we are worthy and that our needs matter, can be gradually exposed and removed, and connection to intuitive knowing restored. I know that by holding my client in a space of safety, love and acceptance, eventually, there will be a softening of the protective mechanisms that get in the way of the connection we so deeply desire. From there we can attend to the process of rewiring the patterns that form the internal working model, and be freed to live a more satisfying and loving life. Lana Marie Willow, MA, RCC

This is what I know to be true in my clinical practice: As I write this, I keep coming back to the reality that my clinical practice, and I believe all good clinical practice, is a fluid and living thing, and I can see the many ways that mine has grown and aged and matured, as I have grown and aged and matured. There is certainly bedrock that my practice is built on, (but even tectonic plates move) such as my love for my clients, and my ability to provide quiet love in the Winnicottian sense- to really recognize those who have suffered the Trauma of Non-Recognition. My practice is also dynamic, in the excitement that I feel when I learn a new piece of theory, or read a piece of clinical writing, or make a connection in a session that expands my clinical and heart understanding of why people struggle, and am reminded of the immense potential for relational repair. For me, when these threads of love and learning come together in session, they create a magic moment of possibility for connection and healing that I’m finding impossible to put into words- not wanting to trivialize or lessen the beauty and privilege that I feel for being able to witness it. And this is what I know.  Stacy Adam Jensen, MEd, RCC

This is what I know to be true in my clinical practice:  I know I can lean into my relational capacity, my ability to find connection and common ground, a meeting place. I can trust my capacity to witness, to hold, to regulate, to contain, to love – the process, the person, the story, and the work.   Lisa Mortimore, PhD, RCC

Understanding the Polyvagal Theory and how it Revolutionized Trauma Therapy

Understanding the Polyvagal Theory and how it Revolutionized Trauma Therapy

The Polyvagal Theory (PVT), developed by Dr. Stephen Porges, is a neurbiological theory that brings significant shift in our understanding of the treatment of trauma, helping therapists understand how the Autonomic Nervous System (ANS) influences our responses to trauma, stress, social interactions, and affective and physiological regulation. Most significantly, it introduced therapists (and the world) to the concept that trauma forces the ANS into a neural state of immobility by involuntarily inciting the Dorsal Vagal System (DV), the unmyelinated, ancient part of the vagus nerve that is associated with immobilisation. Prior to Porges’ PVT, trauma was (and in some cases still is) misunderstood simply as an engagement of the fight flight response of the Sympathetic Nervous System (SNS).

In speaking or thinking about trauma, we understand that the neurophysiological self responds to traumatic experience by involuntarily shifting the ANS state. This shift is incited through the perception of threat that overwhelms the ANS and psyche, therefore it is not necessarily caused by the event, but is the result of our inability to stay safe, or feel safe, during the experience. There is an overwhelm to the system and its integrative capacities which disrupts the ability for the individual to metabolise the experience at the time.

We used to understand the ANS as two systems, the sympathetic and parasympathetic, but the PVT indicates that there are multiple states (poly) within the parasympathetic. To understand trauma we want to think about two of those states, the ventral and dorsal vagal states, both part of the parasympathetic system.

The PV theory proposes that our bodies use a hierarchical system of responses, with the ventral vagal system being the most evolved and socially engaged, followed by the sympathetic system for more intense stress situations, and finally the dorsal vagal system as a last resort in extreme danger. It also includes two hybrid systems which combine states of the ANS as in play and intimacy (see image below). The Polyvagal Theory asserts that the psyche operates out of different ANS states – in the moment of experience, as well as an overall generalised pattern or tendency, and our autonomic state is “a neural platform for behavior and psychological experiences, including feelings of being safe” (Porges, 2017, p.41). We also know that our autonomic state correlates with probabilistic behaviour and psychological feelings (Porges, 2017). We use unconscious neural processes to evaluate risk/safety in our environment.

  1. Social Engagement (Ventral Vagal) System: This branch is associated with feelings of safety and connection. When it’s active, we are more likely to engage with others, communicate effectively, and experience positive emotions. It supports social interaction and emotional regulation. We use engagement of this system to downregulate or upregulate the ANS in trauma therapy.
  2. Fight or Flight (Sympathetic Nervous System): In this state of high sympathetic arousal we move into fight and/or flight behaviour.  Our heart rate increases and our body mobilises in ways to defend & protect ourselves.
  3. Immobility (Dorsal Vagal) System: This branch is associated with immobilisation – ranging from the feigning of death to the inability to mobilise a response/defend or escape and dissociation. When this system is dominant, it can lead to feelings of helplessness, dissociation, and emotional shutdown. It’s a survival response to extreme threat or trauma.
  4. Play (Ventral Vagal and Sympathetic) : This is a hybrid state, engaging both sympathetic arousal and ventral vagal, however defensive mobilisation is down-regulated through face-to-face connection or vocalisations that maintain the connection and neuroception of safety – indicating that play has not shifted into aggression.
  5. Intimacy (Ventral Vagal and Dorsal Vagal) : This is a prosocial state, a state of social/self engagement but requires a reduction in movement. When we involve the social engagement system, “we can even use the oldest system, which is immobilization, and we can be in the arms of someone we feel safe with” (Porges, 2017, p. 129).

We have to remember that these systems regulate the ANS in adaptive responses from the most recent to the most ancient – social engagement (the ventral vagal – VV), mobilisation (SNS), immobilisation with fear (DV). The PVT tells us that under threat or when unsafe, the ANS involuntarily shifts into a dorsal vagal dominant state which decreases arousal in terms of mobilisation and reflects a survival response (Porges, 2004).When the DV system is dominant, we can see a range of effects from a collapsed sense of self to tonic immobility depending on the event; the history, and the experience(s) of the person, and can lead to feelings of helplessness, hopelessness, shame, and dissociation. Porges refers to this as a portal to the death state (2017), however, when people survive the trauma (as most do), their DV often remains active in the ANS. Porges tells us that once the survival system (DV) is engaged, it “doesn’t have an efficient pathway to get out of it” (Porges, 2017, p. 106) thereby wreaking havoc in the ANS, and can create ongoing emotional, relational and physical or physiological symptoms.

Hopefully, this brief overview of the PVT has offered some insight into the workings of the ANS, particularly as it relates to trauma. Of course, understanding it and integrating it into your clinical practice are two different things. If this has piqued your interest, know that we work intimately with the PVT in our Bringing the Body into Practice trainings and workshops.

References:

Mortimore, L. (2018). Porges’ Polyvagal 5 States Made Simple Image, Somatic Attachment Psychotherapy Training Curriculum, The Savoy Clinic, Ltd.

Porges, S.  (2004). Neuroception: A Subconscious System for Detecting Threats  and Safety.  Zero to Three. 24, 19-24.

Porges, S. W. (2017). The pocket guide to The Polyvagal Theory: The transformative power of feeling safe. W.W. Norton & Company, New York.