I've realized over the last years of my private practice that I tend to serve a particular client's needs, and that an understanding of the theoretical models that guide my work and decision-making is helpful to those who choose to work with me. I've done a great deal of training over the years, and continue to complete training, that has informed me, along with my clinical experience, that many traditional speech therapy interventions don't meet the needs of my clients. My Clinical Experience and Training have worked together to help to identify two different theoretical models that are very congruent that tend to help my clients experience more efficacious and effective outcomes.
The first theoretic model that guides my work is the Polyvagal Theory whose main theorist is Dr. Stephen Porges (although I have done significant study with Deb Dana who partners with him). At its heart, the Polyvagal Theory relates to our lived experience, how we move through the world, and how our biology helps us navigate daily experiences. It has three organizing principles: Hierarchy, Neuroception, and Co-Regulation. Hierarchy are the three states that our nervous system takes us through many times each day, and relates to: Connection (Ventral Vagal), Mobilization (Sympathetic), and Disconnection/ Collapse (Dorsal/Vagal). Neuroception is the way the nervous system gets the cues telling it that it should move into connection or protection below the level of awareness, and has three streams of information that it is always listening to: Inside the body, Outside in the environment, and Between nervous systems. Co-Regulation is the way that we are wired to be connected with other people. It is a biological imperative to come into safe connection with other people.
You will find this quick summary here: https://www.youtube.com/watch?v=JXGy7M4kvaY
Some individuals, for reasons that I never know, struggle with the ability to come into safe connection with others. Their neuroception, instead of picking up cues of safety allowing them to come into connection, is more tuned to cues of danger (which leads them towards mobilization and fight or flight types of behaviors) and/or life threat (which leads to disconnection or collapse). In mobilized states, they may exhibit changes in prosody (or the musicality of speech), flexibility in thinking, openness to and understanding of facial expressions, attention, memory, etc. In disconnection/collapse, they may actually lose connection with cognitive states (awareness of reality), have a flatness to features, lose prosody, etc. They can also exhibit hybrid states where they become stuck between mobilization (sympathetic) and disconnection/collapse (dorsal) and exhibit the related behaviors (such as repeating the same thing over and over, being stuck on a single thought and unable to get it out of their heads, etc.). Individuals who do not have adequate ability to pick up cues of safety, so they have not developed adequate connection (ventral vagal), often can cognitively learn skills that they do not then practice functionally because they lack adequate safety in their nervous system to come into connection to do so. The primary goal then is to work with their nervous system to help it develop the capacity to come into connection
For individuals who choose to come to work with me, this can be done more directly with Polyvagal-Informed Interventions (of which there are many). For those who are brought here by others (e.g., by their parents) and it is not their choice to be here, we need to be much more careful with how we approach their nervous systems as it is easy to tip them over from stretching their abilities (what we will call being in stretch and savor) to being in a protective state (what we will call being in stress and survival). This is why we use play and don't directly bring up a great deal about what is going on at home, because it is much easier to have just the right amount of autonomic challenge without tipping them over into being in stress and survival when we are playing. The goals of individual sessions then become (Dana, 2020):
For some families who bring their children to see me, I work with parents and, yes siblings, on developing their own autonomic capacities. I do also work with parents on how to apply this model in parenting their children.
The second theoretical model that I base my practice on is Interpersonal Neurobiology (or IPNB) whose main theorist is Dr. Daniel Siegel. IPBN looks at how we develop within the context of others (which is an over-simplification). Much of Dr. Siegel's work has been in the area of attachment theory, so I have adapted it over to my work as it fits so well with the individuals that I work with. One of the results of lacking the cues of safety that I have found both in my practice over the years and in my study is something that Dr. Siegel discusses at length as a part of his Comprehensive Model of Interpersonal Neurobiology. In this, Dr. Siegel reflects that many issues can be viewed as challenges with Chaos and/or Rigidity. The clinical diagnostics may be helpful for certain therapeutics, but they can interfere at times with work of helping individuals actually reduce the Chaos and Rigidity that they experience. He looks at the work of therapy being to help to differentiate and integrate different areas of function. There are 9 domains of integration that Dr. Siegel elucidates:
I wanted to give you a more than brief rundown of my theoretical process when it comes to setting up my working with clients. Rather than just working with the teaching of skills, I attempt to work with underlying neurobiological processes of safety and integration so that individuals and families can make changes in how they interact with each other and the world.
The first theoretic model that guides my work is the Polyvagal Theory whose main theorist is Dr. Stephen Porges (although I have done significant study with Deb Dana who partners with him). At its heart, the Polyvagal Theory relates to our lived experience, how we move through the world, and how our biology helps us navigate daily experiences. It has three organizing principles: Hierarchy, Neuroception, and Co-Regulation. Hierarchy are the three states that our nervous system takes us through many times each day, and relates to: Connection (Ventral Vagal), Mobilization (Sympathetic), and Disconnection/ Collapse (Dorsal/Vagal). Neuroception is the way the nervous system gets the cues telling it that it should move into connection or protection below the level of awareness, and has three streams of information that it is always listening to: Inside the body, Outside in the environment, and Between nervous systems. Co-Regulation is the way that we are wired to be connected with other people. It is a biological imperative to come into safe connection with other people.
You will find this quick summary here: https://www.youtube.com/watch?v=JXGy7M4kvaY
Some individuals, for reasons that I never know, struggle with the ability to come into safe connection with others. Their neuroception, instead of picking up cues of safety allowing them to come into connection, is more tuned to cues of danger (which leads them towards mobilization and fight or flight types of behaviors) and/or life threat (which leads to disconnection or collapse). In mobilized states, they may exhibit changes in prosody (or the musicality of speech), flexibility in thinking, openness to and understanding of facial expressions, attention, memory, etc. In disconnection/collapse, they may actually lose connection with cognitive states (awareness of reality), have a flatness to features, lose prosody, etc. They can also exhibit hybrid states where they become stuck between mobilization (sympathetic) and disconnection/collapse (dorsal) and exhibit the related behaviors (such as repeating the same thing over and over, being stuck on a single thought and unable to get it out of their heads, etc.). Individuals who do not have adequate ability to pick up cues of safety, so they have not developed adequate connection (ventral vagal), often can cognitively learn skills that they do not then practice functionally because they lack adequate safety in their nervous system to come into connection to do so. The primary goal then is to work with their nervous system to help it develop the capacity to come into connection
For individuals who choose to come to work with me, this can be done more directly with Polyvagal-Informed Interventions (of which there are many). For those who are brought here by others (e.g., by their parents) and it is not their choice to be here, we need to be much more careful with how we approach their nervous systems as it is easy to tip them over from stretching their abilities (what we will call being in stretch and savor) to being in a protective state (what we will call being in stress and survival). This is why we use play and don't directly bring up a great deal about what is going on at home, because it is much easier to have just the right amount of autonomic challenge without tipping them over into being in stress and survival when we are playing. The goals of individual sessions then become (Dana, 2020):
- Discover: We work to continue to discover what patterns are in place and how the individual system moves between these states. At times I try to make this more plain to individuals who are brought here by others, but this can send many individuals more into stress and survival when this is done too overtly, so it must be done carefully. We want everyone to be in stretch and savor (a process of having their nervous system expand its capabilities) as much as possible during the time they are working with me (and have them build the capacity of the connection/ventral vagal system).
- Disrupt: We also work to offer new autonomic experiences while bringing connection/ventral energy to the dysregulated places (sympathetic arousal and dorsal disconnect). One key is to always work on creating the right degree of autonomic challenge. This is what we spend a great deal of time on in the different activities that we do (no matter what the actual activity is). I work to bring my own connection/ventral vagal to this, making every effort to keep myself anchored in ventral for the individual, and working to provide just the right amount of challenge to their autonomic system. When we come out of connection, then we work to repair the ruptures (a key skill that everyone's nervous system requires and is so important in relationships). This is why it can be so difficult to work on problems from home at times. These problems don't provide new autonomic experiences, and in fact bring the individual into old autonomic experiences (ones that bring them into stress and survival and protective states of fight/flight or disconnection).
- Strengthen: Another thing we work to do is to have individuals recognize is their place of ventral vagal regulation or connection. We can do this in many different ways depending upon the individual's capacity to work directly with their nervous system (which is when we use more, what one person described as direct interventions) or not (when we use more play). I am looking to help them to extend and strengthen their ventral vagal regulation through our co-regulation and over time help them to recognize their own ventral regulation. Many individuals that I work with have limited ventral vagal control, which leads them to more protective (mobilization and disconnection) responses to stressors.
- Develop: We also work with individuals to help their systems remember how to navigate the hierarchy; travel the pathways between states to create flexibility; and learn to anchor in ventral to bring safety to the process.
- Deepen: Finally, we work with individuals to use the emerging patterns of regulation, expand ventral vagal capacities, and remain in the stretch and savor continuum rather than the stress and survival continuum. This is really the goal in each session. The more time spent in stress and survival, the more the individual's system will move into protective states of mobilization and disconnection. The more we can help bring our ventral to the individual to help them to learn to use the emerging patterns of regulation, expand ventral vagal capacities, and remain in the stretch and savor continuum, the more their ventral vagal system will grow and the more they then will have the capacity to return to ventral connection after being in either mobilization or disconnection. These systems need to be grown, and because they are such new systems, they tend to be weaker and need the nurturing of others.
For some families who bring their children to see me, I work with parents and, yes siblings, on developing their own autonomic capacities. I do also work with parents on how to apply this model in parenting their children.
The second theoretical model that I base my practice on is Interpersonal Neurobiology (or IPNB) whose main theorist is Dr. Daniel Siegel. IPBN looks at how we develop within the context of others (which is an over-simplification). Much of Dr. Siegel's work has been in the area of attachment theory, so I have adapted it over to my work as it fits so well with the individuals that I work with. One of the results of lacking the cues of safety that I have found both in my practice over the years and in my study is something that Dr. Siegel discusses at length as a part of his Comprehensive Model of Interpersonal Neurobiology. In this, Dr. Siegel reflects that many issues can be viewed as challenges with Chaos and/or Rigidity. The clinical diagnostics may be helpful for certain therapeutics, but they can interfere at times with work of helping individuals actually reduce the Chaos and Rigidity that they experience. He looks at the work of therapy being to help to differentiate and integrate different areas of function. There are 9 domains of integration that Dr. Siegel elucidates:
- Consciousness: Using awareness to create change and choice
- Bilateral: Linking and balancing the right hemisphere (early developing, rich in the realm of imagery, holistic thinking, nonverbal language, autobiographical memory, and other processes) with the left hemisphere (later developing, responsible for logic, spoken and written language, linearity, lists, and literal thinking)
- Vertical: Linking together information from the body proper, the subcortical circuits (brainstem and limbic areas), and the prefrontal circuits in the right hemisphere and the cognitive awareness of the left hemisphere
- Memory: Bringing the free-floating puzzle pieces of the past (implicit memories) into explicit awareness
- Narrative: Weaving our left hemisphere’s narrator function with the autobiographical memory storage of our right hemisphere. The “we” of well-being
- State: Embracing the diverse states of being that embody our fundamental drives and needs, such as closeness and solitude, autonomy and independence, caregiving and mastery among others
- Interpersonal: ·Connecting intimately in relationship while retaining our own sense of identity and freedom
- Temporal Integration: Finding comforting connections in the face of uncertainty, impermanence, and immortality
- Identity: Awareness of being part of a larger whole; the “larger” here refers to a sense of belonging to something bigger than merely a bodily defined sense of self (as in vertical integration), or even to friends and family, as in interpersonal integration; our “self” is a part of a much larger interconnected whole
I wanted to give you a more than brief rundown of my theoretical process when it comes to setting up my working with clients. Rather than just working with the teaching of skills, I attempt to work with underlying neurobiological processes of safety and integration so that individuals and families can make changes in how they interact with each other and the world.