Touch and the Polyvagal Approach

The Polyvagal (PV) approach to therapies was developed by Stephen Porges to describe the involuntary responses of the Autonomic Nervous System (ANS, comprised of the parasympathetic and sympathetic nervous systems) with stressors in our environment. Put simply, the parasympathetic system comprises basic regulatory functioning and is most active in relaxed states (‘rest and digest’, “safe and secure” in PV), while the sympathetic nervous system is the response to perceived danger, and is most often described as states of ‘fight or flight’ (“mobilized” in PV). In addition to the ‘safe’ and ‘mobilized’ states PV also describes a state where the ANS is overwhelmed as “immobilized”, also referred to by Levine as ‘fright/freeze’ (1), where the ANS shuts down in preparation for perceived imminent and unavoidable death, though some distinguish between these (2). The PV concept was put forth as a way to investigate and work with trauma, especially childhood trauma (see ACEs). PV posits that the ways in which these states interact are essentially the royal road to body/brain integration. It has been considered an effective approach to working with clients who experience the limitations of past traumas, even if it is untested (3).

As a psychologically sensitive bodyworker, I am capable of attuning to people’s somatic states through touch, and I can feel in my hands when someone is bringing something into the room with them that goes beyond simple physical insult. My mentor Dr. Ed Maupin, the first psychologist to publish peer-reviewed research on the practice of Zen meditation in psychology (1962), worked from the assumption that most of the thoughts that clients had were obstacles to being somatically present, and thus continuously moved to contact their more essential being, the creature beneath the chatter of the mind. Bringing this awareness of the creature into the present moment was how he negotiated with trauma in PV terms, this was the place from which an individual would begin to reregulate from the current moment of somatic awareness. As a psychologist, Ed felt his approach spoke to the traumatized being directly, circumventing the mental defense mechanisms that would seek to maintain the traumatized state of the individual, a completely novel approach to psychology at the time.

Essential to the integration of bodywork and PV is the notion of somatic states of arousal. Somatic states are experiential and embodied, and thus very much the domain of my work. Though scientifically inadmissible as evidence I can feel these states in my hands, I am aware of my own state change as my body attunes to my clients, and I can use calming deep contact to reduce the arousal of the sympathetic nervous system, inducing states of calm and relaxation even while using significant pressure with my touch. In my practice however, working with someone who is carrying the habits formed by the traumatic experiences of the past in their body in the present requires more than calming, regulating touch. Clear, directed contacts such as we perform in rolfing to reestablish facial balance and tone is insufficient alone to work with trauma as the nervous system must participate in the myofascial changes if the changes are going to persist over time. So how do we do that, while at the same time being respectful of the fact that we are not trained psychologists: how do we use touch and education to help clients engage with their involuntary responses and retrain their nervous systems to be more resilient to environmental stressors?

There are a number of techniques I use in my own practice to facilitate co-regulation with my clients. The first is to create a secure, non-clinical environment where there is warmth, relative quiet, and few distractions. This is obvious to most practitioners, but it needs to be said. The next step is in making contact as soon as the client comes through the door. One of the key limitations someone who is sympathetically activated experiences is the inability to make meaningful connections (and thus co-regulate) with others. I make contact first with my eyes, then my voice, and I pay close attention to the non-verbal cues their eyes, voice, facial expressions, movements, and posture offer to me about their sense of safety. All of this is preparation for generating a sense of intimacy in order to establish co-regulation.

In the practice of my bodywork I use deep, focused contacts to produce tangible physical changes in the myofascial system. Clinical as that sounds, changes on this level are key to finding lasting change in movement and behavior patterns that can stem from traumatic experience. The challenge is to make high-pressure contacts while at the same time maintaining the sense of calm and relaxed space where coregulation can take place. I use what I call the “yin/yang approach” in order to facilitate this. One hand/point of contact can be hard, asking for something specific, while the other equally important contact remains soft and attuned to the regulatory functions of the client. As an example, I might put a soft, full hand on the belly, attending to the breath and peristaltic movements while using more direct contact on the front of the thigh, adjusting pressure in the yang contact according to what I sense in the yin contact.

I think of somatic education primarily in terms of connecting with the movement of a client, either to bring them into a state of mobilization from the immobilized state (this is extremely rare), or more commonly into the secure state from the mobilized state; ultimately the goal is to bring awareness to the responsiveness and conscious engagement we can have with our own autonomic state. Interaction with the vagal system (where the conscious and unconscious connect) is most available to clients via breathing techniques. I spend a significant amount of my time encouraging calm and focused breathing to reregulate a mobilized sympathetic response, which can occur simply due to high-pressure contact, and reduce autonomic tone. The ability to move between states by bringing one’s focus to the breath establishes experientially that we have agency in our autonomic responses and can thus become more resilient to environmental stress. Beyond this, developing and reinforcing the standpoint of somatic experience calls an individual into a state of more conscious awareness, a resource the client can take with them outside of my office.

A final piece I want to touch on is the use of movement beyond the breath. I regularly ask for client movement in my practice, in order to more fully establish the organization of joints and balance tone across the various dimensions of movement. I also see movement education as a means of developing a therapeutic, embodied dialog where I listen and interact through touch. When engaging with the client’s movement I ask that the activity be made slowly and with attention to the interior sense of space (again, establishing parasympathetic response). Clients often discover that some part of their body (a rib, elbow, or hip for example) is held in a pattern, stiffened into a gesture or the shape of an experience that occurred long ago, and that new possibilities are available in a safer space. If the ANS is in a secure and safe state a story will often emerge, where the client shares a recollection or understanding. Another teacher of mine used to call this ‘re-membering’, that is the reclaiming of one’s own body from the experiences of our past. This is a significant part of the process of developing coregulation and the process into intimacy that adverse childhood experiences and other traumatic events often prevent. This re-membering can be introduced with careful movement coaching and gentle contacts that illuminate new possibilities for establishing movement patterns aligned with the body’s natural geometry rather than built out of the traumatic experiences of the past.

While therapy that considers PV is generally thought to be the domain of hands-off counselors, as bodyworkers we have the opportunity to be directly in the space where the involuntary experience of the trauma is located: we are in direct contact with palpable feedback from the body/brain connection. There are techniques we can employ to encourage the exploration of trauma from a safe place that highlights the experience of the client over the goals of the practitioner. Our touch and listening presence have the potential to be a profound source of insight to the client as they traverse the healing journey, in particular if we are aware of the responses of the Autonomic Nervous System and the PV approach in our work.

1) Levine, P. A., & Frederick, A. (1997). Waking the tiger: Healing trauma : the innate capacity to transform overwhelming experiences.

2) Sunseri, J. “Shutdown vs. Freeze.” Justin_Lmft. Blog post, updated 27 Mar 2020. Web. 20 Feb 2022. <https://www.justinlmft.com/post/shutdownvsfreeze>

3) Dunning, B. "The Dark Side of Polyvagal Theory." Skeptoid Podcast. Skeptoid Media, 25 Jan 2022. Web. 23 Feb 2022. <https://skeptoid.com/episodes/4816>