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Nancy Rubbico

By Ryan Hofrichter

An Interview with Nancy Rubbico

Nancy Rubbico, LMHC is a psychotherapist in private practice. Drawing from her studies in polyvagal theory, EMDR, Sensorimotor Psychotherapy, AEDP, and yoga, Nancy guides her clients towards understanding the biological underpinnings of their behaviors and repatterning the ways their autonomic nervous systems operate when the drive to survive competes with the longing to connect. Nancy also provides consulting and training to individuals and organizations seeking to incorporate these principles into their personal and professional lives.

We talk here about normalizing survival responses, stretching without stressing, co-regulation as a biological imperative, accurate neuroception and faulty neuroception, the nervous system response hierarchy, blended nervous system states, social engagement in the midst of a pandemic, and identifying that which leads us towards – and helps us stay within – ventral.

The following resources were mentioned in the interview:

Transcript

Ryan: I’m here with Nancy Rubbico. And today we’re going to talk a bit about polyvagal theory and how it’s relevant to both non-therapists and therapists in their work with clients. So welcome, Nancy.

Nancy: Thank you. It’s really fun to be here.

Ryan: Yeah, great to have you. So before we get into polyvagal theory, tell us a little bit about you. Introduce yourself and how you got started in this work that you do.

Nancy: Yeah. I started, actually, in the private sector, and also non-profit. And then took a little break from doing that and went back to grad school and decided that I wanted to work in the mental health field. My original degree was in social work. And so I went through grad school and started my work at a clinic, an inner-city clinic, and worked with dual diagnoses – people that have, typically, addiction issues as well as mental health issues. And they’ve been in the system for quite a while, the mental health system, and most of them have a lot of complex trauma.

And so I did that for probably eight years there, and ran groups and worked with individuals, and realized that just talking about things didn’t necessarily help improve outcomes. And I started to become curious about what other things were out there to work with complex trauma, to help healing happen, whatever that might look like. One of the things that became apparent to me is that the consistency and the connection that people felt was often a healing quality. I didn’t quite understand the background behind that and why that would be, but started exploring other modalities.

And the first one was EMDR, which stands for Eye Movement Desensitization Reprocessing, which is really bilateral brain stimulation, with the idea of – Bessel van der Kolk talks about that – he’s a leader in trauma and wrote the book The Body Keeps the Score. So stuff isn’t just held in our brain and in memories, but in our body also. So it’s a way of being able to reprocess trauma that’s being held in the body.

My next training that I went to was yoga teacher training. Because I really was curious about movement and how to work with that with clients, as well as for myself. Because I was always taking yoga and always injuring myself. So I wanted to figure out how not to get injured.

And my next training was Sensorimotor Psychotherapy, where you’re really just working with the body. You’re letting the body tell its story, and it doesn’t have words. So you’re just noticing how things move through the body and what potentially action the body had wanted to take in that moment and wasn’t able to take it.

And then after that, polyvagal theory. I took an immersion course at the Cape Cod Institute with Steve Porges – and Steve Porges is the person that proposed polyvagal theory – and fell in love with it. It just made sense to me. It’s foundational to who we are as humans, who we are as mammals. And in that course, Deb Dana who wrote Polyvagal Theory in Therapy, came in and did a talk and I immediately said, “I want to do that training.” So I did that training. And then I did some attachment training with AEDP. But what’s foundational to how I work now is polyvagal, looking through a polyvagal lens.

Ryan: So you said a moment ago that once you did that training, you fell in love with it. And I wonder if you could say more about what the draw was. Why was it so compelling to you?

Nancy: Well, first of all, it made absolute sense to me. It’s really the science of safety. How do we feel safe enough within our bodies, within the world, and with each other? And so much of my work with clients was that – they never had sense of safety, either in their bodies, out in the world, or in-between in relationships. And that tied into the next [training] that I did with the attachment training, AEDP. So this biology – always on alert, always surveilling for cues of safety and danger, and it gets patterned.

And the thing that I found so hopeful about this is that, this biology, this system that we have, can be re-patterned. And when you start talking like that with the people that you’re working with – “oh, it’s biology, we can re-pattern this” – it takes away a sense of shame or guilt: “why can’t I change my thoughts, why can’t I change my behavior, why can’t I have different emotions? Oh, first, we have to understand what’s going on with the biology, with this system.”

Ryan: So you said that in your history of working with clients, that there have been clients who have expressed they don’t actually feel safe in their body. So, why would someone be motivated to do a body-based form of therapy that very deliberately focuses on body-based experiences, that has you pay attention to physical experiences and physical sensations, if the body is not a safe place?

Nancy: So language is really important. Language can give cues of safety and danger. So when I’m working with someone that has complex trauma, I typically don’t even use the word “body.” So I might enter this work by understanding the story, or hearing about the behaviors, or hearing about the emotions. And so I might say phrases like “less tense” instead of “relaxed.” I rarely say “notice what’s happening in the body.”

Ryan: Okay.

Nancy: And when I talk about people having not had safe experiences with the body, I’m talking about inside the body, in the sense of injury or illness or insomnia or things like that. That’s what’s happening inside the body. The lack of safety with the body has been an in-between. It’s typically happened with another person.

Ryan: Yeah.

Nancy: So that’s a little bit different. So yes, I think when you’re trained to work with complex trauma, you’re very aware that the word “body” and looking at the body can be very triggering.

Ryan: Right. So the point here is that, these body-based therapies are inclusive of the body, but there are ways to approach the work that are safe, and ways that we can start to approach the body and learn how to feel more comfortable and safe in our bodies.

Nancy: Right, because a lot of the work, when you’re starting to work with people in understanding this internal system – the nervous system – the primary work is helping people notice and name. And that has to be really gentle work because it’s a new language, and the body often hasn’t been a place of safety. And that’s what I mean by – we can start to notice the story that’s coming out.

Ryan: In one of the body-centered modalities that I’ve trained in, Somatic Experiencing, there’s a very important principle that we call titration, which is just – for listeners that might not have heard that term before – that we’re really touching in, in very bite size ways, into experiences that the system can tolerate. And then we’re backing off, and then resourcing, finding ways to feel comfortable again. And then maybe touching back in again to something that may feel a little bit activating, and then backing off. So that we have this progressive experience of starting to expand what we can tolerate when we put our attention towards the body in a way that maybe previously didn’t feel safe.

Nancy: Right. And as we start to discuss the polyvagal perspective of that, you’re absolutely operating through a polyvagal lens, because you’re respecting where a person can stretch without stressing, which is what we try to do with the nervous system. We’re trying to re-pattern it, so that we can stretch more, but not stress and go into a [defensive] survival response. So that’s a beautiful piece of work, and it’s just tied into understanding this nervous system and what needs to be done for it.

Ryan: I haven’t heard that phrase before, “stretch without stressing.” I like that.

Nancy: Yeah.

Ryan: So if you could, provide a little summary of what the polyvagal theory is attempting to explain, what is its contribution to the layperson?

Nancy: Yeah. So I think at the highest level, it’s understanding the science of safety. And so it helps to find ways that the autonomic nervous system reacts and experiences and responds. That’s what it defines. But it also describes ways that the autonomic nervous system takes in information and initiates responses to that information that it’s taking in. It outlines a hierarchy of how it responds too.

What I love about this system is that it has three organizing principles as part of the theory. So it has co-regulation, neuroception and hierarchy. So if we start with those three organizing principles – we are as mammals, we as humans, are hard-wired – it’s a biological imperative that we co-regulate. That doesn’t mean that we don’t also self-regulate, but we have a biological imperative to co-regulate.

Ryan: Say more about co-regulation. What is that exactly?

Nancy: Well, the autonomic nervous system is always sending out cues of safety or danger or receiving cues of safety or danger. Our nervous system is set up – do we avoid, or do we approach? And we take a lot of cues of safety, and help regulate ourselves, from other people’s nervous systems.

And there’s a lovely video about it. It doesn’t even have to just be with humans. It can be with mammals. So there’s this video that you might want to put on your site for people to link into called Hearts Aligned. And it shows a strap around both a human and their pet dog, what happens with heartrate. There’s this beautiful dance that happens when these two mammals are together. This is going on all the time. We often use a phrase like, “that person has a great vibe,” or “I love their energy,” or, “it’s so easy to be around them.” That’s our nervous system connecting with another nervous system, and it goes on all the time. It’s what makes us mammals. It’s why we have a social engagement part of our nervous system.

Ryan: Okay. So that’s one of the organizing principles, co-regulation. And then you also mentioned hierarchy and there’s –

Nancy: The next one I’d probably talk about is neuroception, because that’s how Steve orders it. And what I love about neuroception – that’s his word that he coined – because ‘perception’ has a sense of consciousness to it; ‘neuroception’ is below awareness, and it’s always going on. It’s running and as we operate through the world and everyday life, it’s taking in: “is that a cue of safety, is that a cue of danger? Do I approach, do I avoid?” It’s just always running.

It’s surveilling what’s going on between you and me. So even through a Zoom lens, our nervous system is getting all sorts of cues – like your beautiful nodding of your head towards me is giving me a cue of safety to keep talking. It’s surveilling the world at large. So – are there weird noises going on in the environment? You know how we react when all of a sudden, a police siren turns on next to us when we’re outdoors? And then there’s the inside thing: “are we hungry, are we tired, are we ill, are we in pain?” So this is always going on.

Ryan: Below the level of awareness.

Nancy: Below the level of awareness. And what happens is, when we start to do this work, this beautiful system – which is only in place to keep us safe enough – when we start to bring awareness to it, when we start to notice what’s going on, that’s when we can start to make changes – changes at behavior level, changes at emotional level, changes in the narratives that people carry.

And then, the next thing is that it’s a hierarchical system. It starts with the most primitive part of the nervous system, and then the next part that evolved, and then the next part that evolved. So there’s three – basically three different states to the nervous system.

Ryan: Yeah, actually, if you could just explain those three subsystems and which would be considered the most ancient or archaic and which would be considered the most evolved.

Nancy: Right. So when I learned about the nervous system, I learned about the parasympathetic nervous system and the sympathetic nervous system. What’s different about Steve Porges’ theory is that the parasympathetic nervous system has two aspects to it. So when I learned sympathetic, it was fight or flight. And then the parasympathetic was rest and relax. But what his understanding is, is that the most primitive part of the nervous system is parasympathetic, but dorsal vagal. And that, I think he says [evolved] 500 million years ago.

Then the next one to evolve 100 million years later, is the sympathetic nervous system. So the dorsal part is immobilization and disconnect, and the next one is mobilization. And then the top one that evolved, I think he says, 200 million years ago, is the social engagement system – that’s called ventral vagal. And that – only mammals have that. Mammals and humans have that. Reptiles don’t have that part of the nervous system. They’re all dorsal and sympathetic.

And so to be in homeostasis, the way the nervous system wants to be able to operate, the most desirable way for it to operate, is this hierarchical system where the most evolved part is the one that’s running the show. And then if that isn’t going to work, then it goes down into the sympathetic nervous system. And the nervous system starts to mobilize, to do whatever it needs to do. And if that doesn’t work, the last resort for our nervous system is dorsal vagal, which is to immobilize and disconnect. And we often see that in the animal world easily. That’s the playing dead. Because that’s – the nervous system at that point says, this is the best way to potentially stay alive. So we have this very old system that functioned in a particular way, and still functions in this way to try to protect us. But it doesn’t always need to be functioning that way.

Ryan: Right. So you’re saying that in ideal circumstances the ventral vagal is active and engaged. And if that’s not available, we need to recruit an older system like sympathetic or ultimately dorsal. What would you say to somebody who says, “well, I’m in sympathetic all the time” or “I’m stuck in dorsal the majority of the day”?

Nancy: Right. So I’m going to address the therapist that might be listening to this.

Ryan: Sure.

Nancy: We’re often trained to think about the window of tolerance. And when we start to see people, we recognize that their window of tolerance is very narrow. And we want to make that window of tolerance larger. And then down below, it’s hypoarousal and up above is hyperarousal. That’s actually incorrect for the hierarchy of the nervous system. Window of tolerance is ventral. Hyperarousal is sympathetic – it’s mobilization, flooded with too much energy – I have one guy that calls it juice, too much juice. And then hypoarousal, which is no energy.

Most of the people that we do end up working with in a clinical environment are people that have either too much juice (sympathetic) – those are often people that are tense or they’re having difficulties having relationships with others because they’re angry, their story is often that it’s unfair, nobody gets me – and then the other population is dorsal, which can look like depression, a real disconnect. But also, dorsal is where dissociation happens, because it’s a numbing out, it’s a disappearing thing.

And because it’s hierarchical, if you’re working with someone who’s dorsal, you can’t jump them up into ventral without going through sympathetic. That is how this nervous system works. So part of the reason why it’s not correct to have window of tolerance in the middle is that I can’t get someone who’s in dorsal, hypoarousal, into the window of tolerance, unless I’ve taken them through sympathetic and brought in some mobilization for them, some energy to their system.

So when I have someone who says that, I say, “okay, let me check to see if this really is a sympathetic response, and then how can we start bringing in some cues of safety so that it doesn’t have to be alarmed all the time. So someone who is in a dysregulated state, I want to downregulate them. I get very curious about: “What are the triggers? What are the cues of danger, where are the red flags popping up? And then how to bring more cues of safety in? And that’s how you start to resource a nervous system to repattern it.

And what’s interesting about this is that it can be done in any profession, with any other nervous system that they’re working with. So this is an important thing for medical professionals to know. This is an important thing for teachers to know. This is an important thing for managers to know. This is the basic understanding of how can humans get enough cues of safety so that they’re not going into alarm. I mean, it’s just basic.

And then if I stay with clinicians, you can use this lens with any modality. You were using that lens with your SE, to make sure that you titrated and dipped in and out.

And so besides working with complex trauma and dissociation, I work with couples. One of the biggest problems – one of the first things that people come to me with is that they’re unable to communicate. They’re not being heard. They’re not being listened to. Well, if nervous systems aren’t getting enough cues of safety and they’re alarmed, they’re not going to be able to listen.

Ryan: Yeah, some part of the brain shuts down and makes it difficult to actually take in information.

Nancy: Absolutely. Yeah. So part of our social engagement system is connected to the nerves and the muscles that go around the eyes, and they go into the middle ear bones. It’s a very interesting, complex system. So everybody knows when someone smiles at them and it’s a fake smile. Everyone’s nervous system knows that. We listen to tone of voice.

So when we’re in a homeostasis, when our social engagement / ventral vagal is driving the bus, our ears have muscles that are slightly engaged, so that our ears are focused on listening to human voice. When we start to get alarmed and start to not have enough cues of safety, those muscles relax and now our ears are only tuned towards cues of danger, not human voice.

So a lot of times – people that are operating in a sympathetic nervous system, they’re hyper-tuned to every noise: “what were the footsteps? How was the cabinet door slammed? What was the tone of voice?” All that kind of stuff. And it’s just this system whose sole job is to keep us as safe as possible.

Ryan: It makes me think of the ways in which we sometimes misperceive a stimulus as dangerous even though it may actually be safe. And similarly, sometimes we perceive something as safe even though it might be dangerous. And I’m curious how you understand that phenomenon. What exactly is going on there?

Nancy: So if someone is slightly – if they’re dysregulated, they’re no longer having ventral driving the bus. Something’s happened that they’re not getting enough cues of safety, everything changes with how they look at the world basically. So a neutral face to someone who’s dysregulated will look dangerous. Whereas for someone who’s in ventral, has access to ventral, you might get curious like, “oh, I wonder what’s going on with that person?” Or, you might just see it as a neutral face, like nothing.

Ryan: Right.

Nancy: Sound changes. The whole inside of the body starts to changes. So if you’re at that first stage of sympathetic, you have too much flooding of energy. Because your nervous system might – it’s getting ready to potentially do something, so there might be a tenseness, heart racing, thoughts racing. And then the part where there’s not enough response, it’s almost like it’s dulled. There’s a dullness to the response or there’s a tremendous risk-taking, with not potentially understanding the danger.

For me it feels like there’s almost a dorsal component to the dullness of it, like a no energy thing. And then the other thing has almost too much juice. So either way, when I’m working with people on either end of those things, what I’m wanting to do is help repattern that nervous system. And part of the repatterning the nervous system is being able to stretch more without stressing. So how do we stretch this nervous system so that it doesn’t go quickly into a survival mode? Or how do we stretch this nervous system to have more access to ventral, so the risk-taking behaviors, and the dullness in response isn’t necessary anymore?

I have a couple of thoughts about how people often ignore things. One of the examples is: way, way back, when I took a self-defense course. And the trainer was saying how we need to trust our gut. That was his phrase. “Always remember that, trust your gut.” And your gut is your neuroception. And he gave the example of, as a woman alone, you’re waiting for the elevator. It opens. There’s a person in there that your gut says, “oh my God, I don’t want to get into this elevator,” but you ignore it, and you do. So part of that is learning to listen to our gut, which is our nervous system. Like why is that unappealing to us? Why is there a sense of avoidance? And figuring out if it’s accurate or not.

So when we’re talking about complex trauma, someone’s who’s grown up in a place where normally, hopefully, there would be lots of cues of safety, and there were none or very little, so basically growing up in a warzone, that nervous system is going to be patterned to be looking for alarming things, cues of danger. How beautiful is what kept that child alive in that situation. The nervous system then gets patterned to be basically hypervigilant. So when you start working with someone like that, you can’t all of a sudden say, “let’s have this ventral experience.” You have to titrate it into small ways to start letting the nervous system realize, “oh, I can go into this place where my body is less tense.” Without saying, “I want you to be relaxed.” Relaxed is dangerous for that nervous system.

Ryan: And actually inviting them to look for the cues of safety and really register that in this moment, something is different.

Nancy: And a lot of the work that you do from this, which is such a lovely dance to do when you’re doing this work as a therapist, is that I’m always curious in the moment: what’s going on for that nervous system in the moment? I’m asking questions, because I don’t know.

So something that might feel appealing to my nervous system as a way to regulate or resource may be very unappealing to another nervous system. And how nice is that for the other nervous system to be listened to!

So one of the essential elements of working this way is context, choice, and connection. Giving context to something, why we’re doing it. Giving them a choice about potentially how we do it or if we do it. And always connection. My sole responsibility with my work, and also how I like to bring myself out into the world, is to be anchored in ventral, because I know I am impacting another nervous system.

Ryan: So we’ve been talking about there being these three states. But I’m aware that there’s also hybrid states, where two systems can be engaged at the same time. And so, can we get a little bit more nuanced here and talk about some of those?

Nancy: Those are blended states. So blended states are also – it’s nice to think about the flavors of ventral. So when we talk about getting enough cues to safety, some of the flavors of that can be a sense of calmness, like when we meditate. A sense of calmness when we’re out in nature. There could be this excitement. There could be other flavors. I’m trying to think of the other flavors right now but there’s –

Ryan: Well you mentioned earlier curiosity, and I think that’s an important one.

Nancy: Right, yes. And, by the way, we can access things like clarity and curiosity and compassion and confidence and calmness – all sorts of ‘c’ words – without being anchored in ventral. So then, there’s a curiosity thing. There’s ability to have clarity and feel strong and clear. So those are all different flavors.

So one of the lovely blends is ventral with sympathetic. And that’s more energy. So you often see that with children. There’s more energy. They’re very playful. And then you see that little moment when it went too far and it’s no longer playful. You see that with dogs playing together all the time. Lots of rough and tumble, and then a little too far and they’ve now gone more into sympathetic.

Ryan: They have to kind of pause and check it out.

Nancy: Yeah. So a lot of times people will feel confused and say, well, I think I wasn’t sympathetic because I – and then I get curious and really what they’re saying is, “oh, no, I had full access to ventral in my social engagement system but I had a lot of energy.” So that’s a blend.

Ryan: Okay. Yeah.

Nancy: And then another – the most complicated blend for our nervous system is stillness, because what’s happening is the most evolved part of the nervous system is blending with the most primitive part of the nervous system. And from cues of safety, stillness can happen.

So when this – when ventral is driving the bus and this blend happens, then we can access stillness. So you find that when you’re going to sleep, you find that when you meditate. There has to have some of that happen to go to the bathroom. And think about how many people, it’s uncomfortable to go to the bathroom in a public toilet. They want their own space. That’s just cues of safety. If you have a dog – I have two dogs. When I take my dogs out to walk and they are squatting to poop, they look at my face, because they’re getting their cues of safety by how I am responding to the world. So there’s that blend.

And then there’s this blend of freeze which is between sympathetic and dorsal. That’s when the nervous system is alarmed and that’s that thing of being immobilized, but full of energy. We often use that phrase deer in a headlight. Full of energy, can’t move.

Ryan: Yeah, preceding what could be a collapse response. Just to go back to the blend of ventral and dorsal, I wanted to name another that I’ve heard of that I didn’t hear you name, which is intimacy.

Nancy: Yeah. Well, one of the ways to think about intimacy is that there have to be enough cues of safety for defenses to come down, to trust. And when that happens, you’re able to have intimacy. So if we’re talking about physical intimacy, there is an immobilization aspect of it. And that really only happens in a healthy way if there’s enough cues of safety to trust that that’s all going to work.

And then, if you go much more into it, there’s all sorts of hormones that get released and chemicals, biochemicals and all that kind of stuff. So if we stay with that circle idea of there has to be enough cues of safety for defenses to come down and trust to happen, when that starts to happen and things like oxytocin and all those love hormones that they call relationship hormones, those get released and those reinforce that pattern of attachment and safety.

So we’re just talking about the nervous system, and the whole system of how it operates, but it’s the one that actually activates all the other ones. So if you’re in sympathetic, then the adrenal is – all that adrenaline and cortisol that gets released. So there’s a lot of other things that happen too. But it’s driven by neuroception.

Ryan: So I want to switch gears a little bit and that’s just to name that we are in the midst of a pandemic and we’re talking about the importance of activating the social engagement system. So when we have limited opportunities to be face-to-face, what can we do to resource ourselves during this time?

Nancy: I think that’s a great question and I think there’s been stuff written about it. I think Steve Porges has an article on that. That people, if they want to – and I think Deb Dana may also too – and I’ll be glad to send those on to you. But we are hardwired to connect. And what I’ve realized is, doing all these Zooms, our neuroception is still connecting, even through Zoom. But what we have to question is what is appealing for our nervous system. We’re always saying, “what does our nervous system like?”

And for some people, a big Zoom call is great. They can sit back and watch all the other people talk. For other people, a one-on-one Zoom call is better. But our neuroception still experiences connection, especially because we’re getting the facial reactions and we’re hearing voice. So there’s a reason why they invented emojis for text. Because the nervous system doesn’t get any sense of what’s really going on in text. So they had to put expressions in there, so that nervous systems could figure out what was going on.

So I’ll ask people my background, what did they like about it? What did they not like about it? What feels safe? What feels unsafe? Some things I can’t change, some things I can potentially change. So, when I’m doing this work, although I’m remote, I’m still always cueing into what brings more cues of safety for them. We experiment with turning the video on, turning it off, one side, the other side – what’s that like for our nervous systems?

So there is connection through Zoom, but I do think it’s tiring. I think part of the reason why people talk about Zoom fatigue is that our neuroception has to work much harder to get the cues of safety that you – or danger – than what you would normally get if you were in person.

The other big thing that’s not happening is touch. Some people don’t want to hug, some people need a hug. That’s lacking in it. The nervous system needs nature, movement, and connection. And I always put connection in there. What’s interesting about nature, though, is that there’s been studies that you can look at nature videos online and it affects the nervous system. And what’s interesting about that is what’s appealing for you to look at in nature might be very different for another nervous system in nature.

So some people would like maybe a more closed-in thing, like trees overhanging a path. And another nervous system would be like, “oh my gosh, I need wide open. I need to look out over the ocean.” And that’s the thing that I really want to emphasize with this is that every nervous system is unique. And so, the more we check in, the more we don’t make the assumption that what works for us works for another, the better it is for the world in general.

And that’s part of the reason why a lot of people feel very down on themselves about these self-help books. So often when people write a self-help book, they’re writing about all the things that worked for them. But that might not be a resource for another nervous system. And I learned this the hard way when I was working with people. In my yoga training, we were trained to do a four-seven-eight breathwork pattern, ‘x’ amount of times and that was going to regulate the nervous system. Well, what I realized when I started sharing this lovely piece of resourcing with other nervous systems was that, for some nervous systems, that was more dysregulating. So then you get to explore with it, and get curious about, “oh, well what else could be helpful for this nervous system?”

And you can see when I’m saying all this: how effective would this be with teachers working with children? Doctors working with their patients? Having law enforcement agencies know about dysregulated nervous systems? How do we give cues of safety before it escalates into something dangerous? I mean, this is just basic biology that we all have. We all have this nervous system and the only way that these three states aren’t operating is brain damage or nerve damage. So even when we’re working with someone who says they have no access to any type of pleasure or ventral, it’s there. But when we start to explore getting there, it might be just the work that we’re doing together. Like I’m giving enough cues of safety that a nervous system can be a little less tense.

Ryan: Right, so we have to be resourced enough such that we can actually send and transmit those signals of safety. We also have to be curious enough about the person in front of us and what they actually need, what their nervous system actually needs.

Nancy: Right. And then when it comes to resilience – me, knowing all this polyvagal stuff, if my resilience is low for whatever reason, I might go out in the world and be less regulated. We don’t get to dictate that we’re always in ventral. We go up and down our ladder all day long, all of us, no matter how regulated we are. And so, part of our goal is not that we’re never going to go into a [defensive] survival response, unless we see, I don’t know, something that’s very scary and alarming coming at us. But what we want to be able to do is – if we do dysregulate – to be able to re-engage more quickly.

Ryan: So that we’re not getting stuck.

Nancy: Yes. That we can bring in enough awareness that we can say, “oh, okay. I just had a sympathetic response. I was alarmed, but I’m actually okay.” And then get back up into ventral. So it’s that stretching. So even if it stresses – because there’s no way any of us can never stress – to be able to get back into the stretch again more quickly.

Ryan: I think that one of the things that Deb Dana recommends is to keep a log as to the kinds of things that help us get back into ventral, so that in those moments when we’re actually feeling like we’ve slipped out of it, we can go through that catalog of … “those are some of the things that I know typically help me, let me try that.”

Nancy: And what’s really fun is – well, I’m going to stay with what you’re just saying and then go into the fun thing – is that when I’m working with people, we start to develop regulating resources for each of the [defensive] survival states – so for sympathetic and for dorsal. To be both self-regulating and co-regulating. So yoga, that might be a self-regulating resource and a co-regulating because you do it with somebody else. Jogging, all that kind of stuff.

People start to realize, actually, how many resources they have. And it’s fun to figure that stuff out, these resources. And then a lot of the work that I’ll do is, in the moment, I might savor something. So we have a negative bias to our biology. It’s much easier for us to stay with what we don’t like and what is unpleasant than to stay for a moment with what is pleasant. What’s a pleasurable experience? So part of the fun work about doing this, with helping the stretch- helping there be more stretch – to the nervous system, is to do things like savor. So if someone comes in and says, “Oh my God, I just had the best interaction with my boss. He could hear me, it was fantastic.” And I say, “Oh, let’s pause for a moment and savor that.” Savor can be quick. It can be three seconds.

Ryan: It can also be oriented around less dramatic moments, even just small shifts when somebody says, “Well, it’s less bad.” It doesn’t have to be this massive celebration, but just some small shift that’s worth savoring.

Nancy: And savoring can be, “I noticed the smell of my coffee this morning, and I really like that smell.” So those are the beginnings of noticing, “yeah, you do actually touch ventral occasionally.” Those very small things that are incredibly important. Because what I found with this work is that the more the nervous system starts to access little, small things, it’s not linear growth, it’s exponential. Like once the nervous system can let down some of those defenses and recognize cues of safety and figure out how to resource, shifting happens that much faster. So the work is very slow to begin with and then once the nervous system gets it, things really start to shift.

Ryan: Yeah, to reorganize. Any other examples for therapists who are looking to incorporate this lens into their work? Things that they can try with clients, just things to be aware of?

Nancy: Well, I really do think if someone wants to bring this into their work and actually actively work with somebody else, there needs to be training. And what’s interesting about this modality is that, for instance, if they go to the Polyvagal Institute and look at the first training which is Foundations I, the purpose of that training is that anyone that’s going to work with this with others needs to know it for themselves. You can’t do this work if you don’t understand your own nervous system. So Foundations I training is how to embody this yourself, and then it becomes much easier to be able to work with other nervous systems because you know what’s going on for yourself.

And there’s lots of podcasts and webinars and audios that talk about polyvagal theory with Steve Porges or Deb Dana. I do want to be clear: there’s a lot of talk about polyvagal out there that’s not necessarily accurate. So be cautious about who you’re listening to polyvagal theory from.

Ryan: But Steve Porges and Deb Dana would be safe bets?

Nancy: Yes, definitely, because it’s his theory and he understands it. But I do think that there needs to be training involved before you start using it in a way that’s useful for whatever population you’re working with.

Ryan: And are those trainings only happening in person or are there online opportunities also?

Nancy: These trainings now – through the Foundations – are completely online, and it’s an interesting model. There’s ‘x’ amount of stuff that’s recorded with Deb Dana, with PowerPoint and demos and articles that’s self-paced, and then there’s live training – remote – that goes on. There’s a lot of – if people are really interested in this, there’s Deb Dana approved consultants where they can do their own polyvagal study individually or with small groups. And they just need to get in touch with Deb Dana’s assistant when they go to her website, which is Rhythm of Regulation. They can get a list of consultants that are Deb Dana approved.

So they have done all these trainings and they’re accurate with their information about polyvagal. But I think it’s an exciting way to do work and it’s an exciting way for individuals who aren’t necessarily clinicians who just want to understand their own nervous system to be out in the world. If we all took a moment and thought about, “are we in ventral before we go out into the world,” what a nice place that would be.

Ryan: I was at a therapist training just this last weekend and I was so impressed with the amount of time that they were dedicating to self-regulation and therapists’ own nervous system state in doing the work. So I was, and I imagine many other students were, eager to get to the interventions, but they just spent a whole lot of time really focusing on how we can be better regulated as we start to step into some of those interventions. So I really got the sense that that’s foundational. What are some examples of how you take care of your own nervous system in session?

Nancy: Well, I think the first and foremost thing is that this is fun work for me, doing it through this lens. So I don’t feel tired at the end of the day because it’s this incredible dance that’s going on. I don’t have to sit there feeling like I have to be an expert in everything. I have the expertise of knowing polyvagal lens, but I do not have the expertise of knowing what’s appealing to that other nervous system, how to resource it, and all that kind of stuff.

I always take a moment before I start a session to ground myself, which might be planting my feet into the ground and noticing that, or noticing my breath. Or I have this picture behind me of a sheep. All I have to do is turn and look at that sheep behind me – and his name is ‘The Dude’ – and it makes me smile. Or I make sure I take a walk just around the house, because I’m now at my home.

Yeah, I think it’s really important – when we’re in these fields where we’re working with people that have more of a tendency to be dysregulated, to be alarmed, it’s tremendously important for us to not be dysregulated. We need to be regulated. And then to have some skills in the moment if when we’re working with someone and we start to feel it.

So in the moment, if I’m working with someone and I feel my nervous system start to drop – and it just could be me empathizing with the situation that they’re in – I will place my feet down. I mean I notice when that’s happening now. And I think we all know who are the best therapists that we’ve had, who are the best teachers we’ve had, who are the doctors we want to go to. Those are the people that are probably anchored in ventral. And our nervous system appreciates it and wants to be around that.

So I think a lot of people in our work, hopefully, have that. They’re anchored in ventral more often than not. But I also keep anchors, ventral anchors around me. They can be physical, like a stone that I like, or a picture I like, or things like that. It’s noticing those things that are helpful for us as touchpoints.

Ryan: Right. Because we’re all susceptible to slipping out of ventral and we just need to recognize when it happens and have a few tricks that can help us get back. One of the things in the training that they were referring to over the weekend is just giving yourself permission to move. So like you said a moment ago, just if you need to put your feet down on the floor or change your posture, or even get out of your chair. Or another that I liked was to allow yourself to pick up a clipboard and take some notes – and that might actually be regulating in its own way.

Nancy: So if you bring a polyvagal lens to each of those things, what would be helpful for the other nervous system is to get some context about why you’re doing that. So if you’re breaking eye contact – think about this, we’re hardwired for connection. And I think I’ve given this example before – if I look at my watch and I break eye contact with you, your neuroception will have a response to that and it will have a story. And so when I used to do this example with clients, they would say things like – “so what story came up when I did that?” – “oh, you’re bored, you want it to end, you’re a bad therapist, I don’t want to work with you.” So that’s that disconnect that happens that the neuroception feels right away.

And so that’s okay if I do that and I say, “oh, you know what, I just had to check my watch. I wanted to stay on top of things.” So when you’re writing notes, it would be nice, especially when they can’t see you, to say, “I’m jotting down some notes,” just so that you know that’s why I’m breaking eye contact.

Ryan: Yeah, good point.

Nancy: Or if you stand up and do a movement, say, “ah, my body’s uncomfortable. I’m going to stand for a moment. Would you like to stand too?” So that’s the context part of it, we’re always thinking about giving context to a potential break, a disconnect that’s happening.

Ryan: Absolutely. Yeah, that point is well taken. And I should name that this was a couple therapy training, so I think there’s a bit of an assumption that the two partners are actually doing the work of regulating each other, more so than the therapist providing that. But absolutely, we need to be conscientious of that. We’re almost coming up on an hour. Is there anything else that you want to make sure that you have a chance to name or that we get to talk about before we start to wrap up?

Nancy: I feel like we’ve talked about a lot and I really appreciate people listening through this whole thing that we did today. I have to say I feel as though it’s one of the most exciting ways that we can start to understand our world and understand others. And again, it’s just – it’s core to who we are. It’s our biology. It’s just core to us. And so for everything we do, if all of us understood this better, there would be a lot more choice in how we respond and how we interact with others and how we feel in this world. It’s very powerful.

Ryan: Okay. Well, I’m really glad to know that you’re one of the people waving the banner and drawing us in more and more. You mentioned a number of really important resources and links and I’ll be sure – on my page where I post the interview – to list those. Any other resources that you want to mention, whether it’s your own website or offerings?

Nancy: So my website – so if people are interested in seeing a little bit about me, I have a LinkedIn page. I’m working on my website right now, because I’m moving beyond just training clinicians and consulting with clinicians. I want to be able to bring it to anyone who is interested in understanding this more. So that’s where my website is at. So at some point, I could give you a link to that. But if they need to find me, I’m on LinkedIn.

Ryan: Okay. And once you do provide me with that update, I’ll make sure to include that on my page.

Nancy: Thank you.

Ryan: Nancy, thanks so much for your insights and for this really interesting conversation.

Nancy: Really fun, Ryan. Thank you for having me.