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Deb Dana, LCSW, is a clinician and consultant specializing in working with complex trauma and Coordinator of the Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University. She developed the Rhythm of Regulation clinical training series and lectures internationally on ways in which polyvagal theory informs work with trauma survivors.
NPT: How has an understanding of neurobiology helped you in your practice/research?
DD: I’ve always been drawn to neurobiology, naturally curious about the ways our brains and bodies work. I’m happy reading research, and my colleagues affectionately call me a “neuroscience nerd”. I have been fortunate to collaborate with scientists who are generous in sharing their expertise and in turn are interested in how their research is impacting people’s daily lives. Being in the histology lab holding a human brain in my hands and watching the sectioning process was a powerful experience—the cortical and limbic landmarks we think about in our work with clients were suddenly there for me to see and touch. The mystery of how we humans think and feel and dream is no clearer, but I have a new reverence for the organ that helps create those experiences.
As my knowledge of neurobiology has deepened, I am even more convinced of the essential need for therapists and clients to understand the basics of brain biology and the organizing principles of polyvagal theory. In my therapy practice, it’s vital for me to understand the impact my work has on my clients’ neural networks and autonomic pathways, and equally important to understand how my own neurobiology is woven into the therapist–client relationship. I find that clients are eager to learn about the “vehicle they are driving through life”. Understanding the science underneath their behavior and beliefs reduces shame and makes room for curiosity. Neurobiology brings a humanizing, normalizing, and reassuring presence to the challenges of working with complex trauma.
NPT: You’ve written a book titled The Polyvagal Theory in Therapy. Where are you directing this book?
DD: The Polyvagal Theory in Therapy was written in response to the many requests I receive from clinicians who come to my workshops and are looking for a book that explains polyvagal theory in easy to understand clinical terms. I wanted to offer clinicians a road map for integrating these concepts into their clinical work.
I wrote the book both for clinicians to use with clients and for them to explore their own autonomic nervous systems. As with most learning, polyvagal theory is best understood “from the inside out”, and my encouragement to clinicians reading The Polyvagal Theory in Therapy is to try out the experiences themselves before bringing them into their clinical practices. Regulating our end of the clinician–client relationship is the starting point; the exercises in the book are equally relevant to both sides of that equation.
My wish is that this book will change the ways clinicians practice and also their ways of seeing and being in the world. My personal experience, and similarly my experience of teaching polyvagal theory to clinicians and clients, is that there is a before-and-after quality to learning this theory. Once you understand the role of the autonomic nervous system in shaping lives, you can never again not see the world through that lens. So, in my hopeful, ventral vagal state of being, I like to imagine the book beginning a ripple effect of polyvagal–informed practice.
NPT: How have you implemented the programs and practices you talk about in the book?
DD: As I reflect on this question, it is interesting to trace the path from my first exposure to polyvagal theory to exploring how to apply it in clinical practice and finally bringing my work to book form. This book is an outcome of the programs and practices I created to use in my clinical practice and for teaching in my Rhythm of Regulation training series.
When I first learned about polyvagal theory, the world suddenly made sense in a new way. I began looking at everything through the lens of the autonomic nervous system—not just my clinical work but collegial, friend, and family relationships as well. I could see the relevance of polyvagal theory everywhere I looked. I likely drove my colleagues a bit crazy in those early months as I tried to figure out what this transformative theory meant to me. My first foray into bringing polyvagal theory into everyday conversation was writing the brief Beginner’s Guide to Polyvagal Theory, which I shared on my website. That is where the autonomic ladder—the foundational metaphor for my clinical application—was unveiled. The response reassured me there were other people out there who were interested in a polyvagal perspective.
Over time, and with much experimenting, I found ways to apply the organizing principles of polyvagal theory in my clinical work. My clients were willing to trust my belief in the power of polyvagal theory to bring a new dimension to our work and joined me in trying out worksheets and experiential exercises. Their input was an important part of the process of fine-tuning the practices that are included in the book. I then created a variety of Rhythm of Regulation workshops to teach other clinicians and see if my ways of working could be laid out in an organized approach.
Now, from a belief that the autonomic nervous system is the foundation for all of our lived experience, what I do with clients (and what I teach clinicians to do in my training programs) is to bring the foundation of polyvagal theory into therapy at the first meeting. This sets the tone for the therapy, and all other therapy models sit easily on top of this platform. Right from the beginning, therefore, awareness of the autonomic nervous system is the “ground” for the work. Our work is guided by bringing curiosity to exploring the autonomic needs for safety, moment to moment. The three maps of the basic mapping sequence lay the groundwork and can be completed in the first few weeks. These maps help clients answer the questions: “Where am I?”, “How did I get here?” and “How do find my way back to ventral vagal safety and connection?” As clients begin to map and track their autonomic movement, we incorporate a variety of the neural exercises presented in the book to begin to gently shape their systems away from protection toward connection. These steps constitute a polyvagal-informed process of creating safety and stability in the initial phase of trauma treatment.
On a personal level, polyvagal theory has become the linchpin of my daily life. My husband suffered a stroke several years ago, and we navigate the world of stroke recovery through the lens of polyvagal theory. There is ongoing research into the role of the vagus in post-stroke treatment, and Bob and I are experimenting with ways to support the function of his ventral vagus and invite energy back to his social engagement system. The world of stroke rehabilitation is a confusing and often limiting one. Using the science of polyvagal theory as a guide continues to bring small shifts and keeps alive the hope that is the necessary ingredient of rehab and recovery.
I have great respect for the way Steve (Porges) developed this brilliant theory and invited clinicians to generate their own clinical applications. I have created an approach to bringing polyvagal theory into therapy and continue to experiment with new practices. My invitation to colleagues around the world is to use my work, adapt it to fit your needs, and use your own experiences to create new practices. The world of polyvagal-informed therapy is a welcoming one.[Content protected for subscribers only]