Therapy and the Polyvagal Theory / episode 23 show notes

Updated: Mar 27



4 FACTORS THAT INFLUENCE THERAPY OUTCOMES from APA


1. Things that happen outside of therapy -Not a ton we can do about that. Plan, give homework and coping skills but ultimately it’s out of our hands


2. The effects of what we expect to help or not help - Placebo, it helps because we expect it to. We’re in a healing environment, we’re with a licensed professional and their degrees on the wall. Evaluation, diagnosis, assessments, discussing expectations all have this inherent value. Just do the fundamentals of therapy, be compassionate, have positive expectations, work with the client, be welcoming, be the expert


Placebo

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003660/

  2. https://www.sciencedirect.com/science/article/abs/pii/S0165032706000395

  3. https://psychiatrypodcast.com/psychiatry-psychotherapy-podcast/2018/11/19/understanding-placebo

3. Specific therapy techniques - Modalities, techniques, all the acronyms. Don’t just wing it, use the techniques appropriately, discuss their uses and benefits and potential drawbacks for the client, be transparent


4. “Common factors" - the “Main curative component” based on “decades of research” is the therapeutic relationship. This is “the foundation” of everything else we do. Empathy, Warmth, Therapeutic relationship. “Common factors” associate more highly with positive therapeutic outcomes than specialized interventions. The relationship is absolutely essential. The polyvagal theory is the science of relationships. Not just danger cues, but also safety and building relationships


HOW THE POLYVAGAL THEORY APPLIES TO THE THERAPY PROCESS


Need to provide a safe environment first, but there are often limitations

  • The school environment is a lot different than outpatient county, which is a lot different than private practice in affluent communities, which is a lot different than the juvenile hall, which is a lot different than substance abuse

Co-regulation second

  • This can dampen the effect of the environment significantly

  • Providing listening with safe and social cues: Eye crinkles, Smiles, Prosody, Curiosity and genuine interest, Compassion to show you care versus empathy

Modeling appropriate bx

  • This goes a long way with kids (“But why didn’t you get mad?”)

A willingness to work with your clients

  • Be humble

  • Be open to changing your style

  • Be open to learning from your clients

  • Be transparent: “I don’t seem to be helping” can be a great conversation starter

They will build their vagal brake through basic therapy skills

  • Repeated small exposures to safe and social cues builds their tolerance and resilience, which builds their ability to handle distressing content, not the other way around

  • This is partially why delving into trauma stories isn’t super necessary

“Predictability is a metaphor for safety” -Porges

  • Therapy should be a predictable experience: Start and end on time, Be a safe person in the same place, Tx follows what was originally discussed or changes when discussed again, Being a part of tx is the norm and tx px is discussed regularly

  • Feedback is a regular part of tx: ORS and SRS bookends

  • Staying within the ethical and legal and moral framework




Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

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