APPLYING PARENTAL CO-REGULATION First, understand that when your child is upset, they have experienced (neurocepted) a danger cue and dropped down their polyvagal ladder into a defensive state.This doesn’t mean actual danger, it’s likely to be not getting what they want. Set aside the judgment though, it’s not about us Not getting the toy from McDonald’s is meaningless to us, but for them it’s a real trigger This can be really difficult for parents to do Very likely your child may not know what the trigger is. Parents always want to ask “why” and “what happened?” Parents want to solve the problem, not necessarily understand the problem. This stems from wanting to make our kids’ lives better, yes. But also to alleviate our own state shift. Your state vs your empathy These don’t always go hand in hand. Tap into your empathy - an attunement to your child’s pain, which consequently means a shift of focus AWAY from your own concerns. This is different from our own state shift misattunement, like if a kid needs a hug, but that repulses us. The repulsion is our own thing and a misattunement to the child’s state. But we can’t react simply from empathy. Your empathy vs your compassion After tapping into your empathy, then tap into your compassion for your child. Compassion is empathy plus your desire to help - you want to help, while also understanding. This is different than solving the problem which focuses on facts and solution. Empathy is understanding the emotional impact of the problem. Compassion is working with your child to resolve the problem while honoring the emotional impact. Face-to-face interaction In a safe environment Eye contact is major - Do not force on their end, but offer on your own Smiles are important, but not fake and not constant Vocal prosody is important - Not commanding and not fake! This can sound sarcastic. SELF-REGULATE Your child’s self-regulation is built on your co-regulation, but you need to be self-regulated first. A big piece of this is to disengage from your own “stuff.” We’ve mentioned during this series that parents are human too, which means… We have our own danger cues We may or may not have learned effective co-regulation in our own childhood Our placement on the polyvagal ladder may not be Safe & Social all the time, but to be at our best as parents, we need to be able to access that state This means that, when we are actively parenting, we MUST disengage with our own stuff, our own baggage. It doesn’t go away! We just set it aside while we prioritize the needs of our children in that moment. This is really difficult to do! But, the more you practice it, the easier it becomes. Take full breaths and really slow down, self-regulate. Your kids will pick up on this and it may keep you in control of yourself. Combine your state awareness to your empathy to your compassion Example: child is up at 2am after waking up from a nightmare. Parent wakes up very irritated. They recognize they’re irritated and they are in a fight state with an impulse to yell and command the child back to bed. The parent consciously sets that aside, deciding it’s best to not say anything and to take a deep breath. After doing so, they allow themselves to become more attuned to their child and feel empathy. They tap into their own feelings of waking up from nightmares and maybe the larger context of their life. The parent listens to the child empathetically, but also brings their compassion in. They hold the child, listening with eye crinkles and give them affection, making eye contact and smiling, reassuring the child. They bring the child back to bed with affection and reassurance.

SELF-REGULATION - The ability to use coping skills, weigh the pros and cons, use thought replacement or deep breathing exercises. The ability to work your way up the polyvagal ladder on your own. Children don’t have it basically. They can build it, but need co-regulation. Self-regulation is built upon co-regulation Kids have increased sympathetic energy and nothing to do with it. Defensive states increase the heart rate and decrease the ability to think clearly. Desperation, tantrums, anger, running away High emotional volatility There’s nothing wrong with them, they’re just kids Kids naturally have a weaker social engagement system and vagal brake They need effective and consistent co-regulation CO-REGULATION This is really where the bulk of your child’s vagal brake development will come from. We are a social species. We regulate with each other Co-regulation is integral to mental and physical health Safety leads to closeness and touch Co-regulation begins in infancy Use of prosody, eye contact for bonding/soothing Ex: “motherese” - slow, melodic, exaggerated speech Changing a diaper is a great time We are constantly engaged in a feedback loop with others PIECES OF CO-REGULATION Feedback loop - Back and forth communication, two nervous systems sending cues to each other. Cues of safety = connection/reciprocity Cues of danger = disconnection/rupture Ruptures - Routine events that lead us away from safety Looking at a cell phone, looking away, internal distractions, talking over the other person Experienced as a minor cue of danger, but could also be a bigger deal for some Ruptures can easily turn into self-criticism or judgment of the other person Experienced as withdrawal or confrontation When ruptures happen, they need to be repaired, like a simple apology, being empathetic, getting on their level, co-regulation through gentle eye contact, giving space if needed Misattunement - Nervous systems in different states Might come from ruptures YOUR HOMEWORK ASSIGNMENT - Make the extra effort to show your kids your face and your smiles Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

BUILDING THE VAGAL BRAKE AS A BASIC GOAL OF PARENTING One of the fundamental responsibilities of being a parent - Building the social engagement system effectively enough to build the child’s self-regulation. They'll be better able to recognize cues of danger Make better relationship choices Make better friendship choices They’ll be less likely to be in places of potential danger or traumatization They’ll be able to handle play with others They can engage without taking things personally They can mobilize and handle the flight/fight energy They’ll be more tolerant to those that are down the ladder More likely to use dialogue as a way to handle situations More likely to use co-regulation as a way to help Individuals in a stuck defensive state are going to have a harder time utilizing their vagal brake and their self-regulation Their social engagement system has been cut off Social engagement system is the vagal brake HOW TO BUILD THE VAGAL BRAKE, versus how to change bx or “gain control” Our job, as parents, is to teach and guide, not to dictate how children should live their lives Help them learn to make healthy decisions for themselves, not what WE want them to do Through modeling What we do, what we say, how we say and do it And you know that they are ALWAYS watching They learn way more from what we model than what we say Through play Being safe/social + being mobilized Quick moments throughout the day, silly routines you do with your kids, structured activity (e.g. board game, park) Exercises moving up and down the polyvagal ladder Stronger social engagement = stronger vagal brake Through consequences Doesn’t exactly build the social engagement system, but can possibly build distress tolerance So really, a kid has to have a strong relationship for the consequence structure to be effective Through co-regulation Which is the focus of our next episode WE DON’T CONTROL OUR CHILDREN Important to let go of this idea Will aid in moving forward with everything else we talk about in this series Attempting to control our children only results in negative interactions that will accumulate into a negative relationship When children are born, they very much feel like a part of ourselves. As painful as it might feel to say, they are not. Figuratively, sure. Think of a time you broke a serious house rule Did your parents have control over you? - Nope Think of the last time your child broke one of your rules? Did you have control over them? Or did you just respond to their choice? Logical sense vs emotional acceptance Very challenging But will be very liberating and allow you to be more creative with your parenting We have a ton of influence Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

Hi, my name is Justin Sunseri, I’m a Licensed Marriage & Family Therapist obsessed with the Polyvagal Theory. This is a reading of an open letter to my Listeners. As we like to say on the podcast - put yourself first. I think this open letter is safe, but if you need to take a break from it, please do so. My hope is that you hear this and can become more compassionate toward yourself. I think you’re normal. You’ve heard me say that a number of times by now: here on the podcast or in an Instagram video. Someone wisely asked me in response - “What does it mean to be normal?” That question of course made me stop and think... The truth is, I don’t know what it means. But I know it’s true. You are normal. I think when I say you’re “normal,” I’m not exactly making a statement of fact. Like, it’s not as if I understand what the boundaries are of “normal.” It’s more of a response to what I know you’re thinking about yourself. And what you feel about yourself. That you’re different. Weird, defective, a burden, unlovable. Broken and irreparable. A failure or loser. These are the things that I hear from my clients about themselves, whether they say them explicitly or not. Often disguised in a throw away statement or tucked into something positive they achieved. The positivity being different and uncomfortable, so they sprinkle in a negative comment or two. So my response to you, is this - you’re normal. I say that as a response to what you say to yourself. I have no idea what normal means. That’s not up to me to define. But I know you’re a human being, just like me. We’re both mammals. That doesn’t discount that you’re in pain. You might be sad or depressed. Numb or in a fog. Angry or rageful. Scared, panicked, anxious or afraid. So hearing that you’re “normal,” might not do a whole lot for you. Especially since I can’t define it. So I’ll take this one step further. If you’re a trauma survivor, your reaction to whatever it was is normal. In polyvagal terms, this means that you neurocepted danger -which triggered your flight response. You needed to run away and escape, to get to safety. If you were not able to run away, this triggered your body’s fight response, to use its inner power to force the danger away, which would allow you to run to safety. And if that didn’t work, your body may have shut down, collapsed and gone numb. Or its possible your body was in a flight/fight state, but it was overpowered and immobilized and went into a more rigid freeze sort of state. And while none of these reactions are desired… they’re normal. They are supposed to happen. This is how mammals respond to danger. All of us. When we’re in danger, we run. If we can’t run, we fight. If our life is at imminent risk of death, we shutdown. This is the natural sequence of events that mammals go through in order to increase chances of survival. It’s normal. It’s also possible to be in a defensive state from other experiences: being immobilized for surgery while in a high sympathetic arousal. Or being abandoned by a parent and left with no loving and healthy attachment. The passing of a loved one. Major life changes like divorce or the stress of operating your own business. There are an endless number of paths to being in a defensive state of flight, fight or shut down. And I don’t blame you. Every single child, teen or adult I have worked with over the past decade has a history. Every one of them has an underlying reason for the state that they are in. They aren’t simply anxious or angry or depressed. I haven’t met that person yet who is born that way. Maybe that exists, but I haven’t met them. When the amazing people I have worked with begin to talk about their lives, it becomes extremely clear the reason why they feel the way they feel and think the way they think and make the choices that they make. But also, just like everyone else, there’s basic needs of connection you have. Life becomes extremely lonely when you don’t have someone you feel safe with. And that’s the key, I think. Feeling safe with someone else. Maybe it’s a pet, that’s fine too. But really, feeling safe with another human being allows your nervous system to come out of its defensive state. That’s really the essence of therapy - a safe person in a safe environment. This allows us the environment and the safety to look inward. Without that, the internal world becomes a lot scarier. Your memories, feelings, thoughts and bodily sensations are much more difficult to navigate. But what you may have ended up with and are living now is a life where you’re not connected safely with someone else AND you’re wrestling with some really painful stuff internally. Lots of people live like this, actually. Lots of people. I know that doesn’t fix anything, but I think it’s important to know. So many of us are living in a perpetual state of being defensive while also being alone. And that aloneness makes things worse. So what we do then is we do the best we can to cope. This can look so many different ways. Some people cope by turning to drugs or alcohol. Some people cope by restricting the amount that they eat. Other cope by hiding, going inward and rejecting others. Others cope by becoming more aggressive and ready to fight anyone they can. Some will attach to people who aren’t safe for them just so long as they feel protected, needed or seen. Some will become the entertainer, making everyone in the room laugh despite their own internal pain. Someone may watch TV all night in preparation for the next day, binging on a show so they don’t have to think or remember or feel. The list is endless. None of these are right or wrong. Sure, some could actually cause more harm or more pain. Some might be more helpful. But all of these can be ways of coping, not necessarily becoming unstuck. All of these can be seen as ways of attempting to simply get through the moment or the day. You’re not better off exactly, but you might be worse off eventually. But what matters is, for that moment, there might be some relief from the pain you’re in. But then the problem gets worse. Because if the way you cope is actually making your life worse, you’re going to be piling problem on top of problem. So there was the original state shift which you got stuck in. Then the way you cope with it. Then the problems that might come from the way you cope. And then, if that’s not enough - the judgment piles on too. Because you’re not going to go through all this without some self-judgment, right? So that’s what you do. We do. We all do. You evaluate yourself, your self worth and what others think of you. Somehow you know what others are assuming or judging you about. And it’s always negative, right? These aren’t positive assessments of your value or character. They’re harsh criticisms. That others think of you and that you think of yourself. But what if those aren’t accurate? Is it possible your judgments are wrong? I won’t even ask you to stop judging yourself, though I wish you would, but that’s for another time. For now, answer me this - is it possible your judgments are wrong? Of course it is. Let’s leave that where it is for now. Let’s agree it’s possible your self judgments are wrong. And the blame you place on yourself. And the criticism and your negative projections of the future. Let’s agree these could all be wrong. But we also have to agree and acknolwedge that you’re not the only one. We have to agree and acknowledge that everyone does this. Every. One. Myself included. By why? Why do we do this? Well, if you followed the steps I’ve laid out, it stems back to the state shift. There’s this beautiful little saying from Deb Dana that sums it up - “Story follows state.” This means the stories we have in our heads, including the thoughts, images, beliefs and all of it. They are there because of the state that we are in. So the judgments you have are simply a result of the state you’re in. The thoughts you have, all of them, are tied to your state. That’s why it’s so hard to simply erase or correct those thoughts. Because the defensive state doesn’t necessarily change along with it. The issue is the defensive state, not the stories you have. The way to become unstuck then, is to focus on your body in the here and now. To bring genuine curiosity to what your body tells you. That means you also need to be mindful. It’s the mindful curiousity with your body that will allow the stuck energy to become unstuck. You can do this little by little, just check in and notice how your body is doing throughout the day. Get to know it like you would a potential new friend. Someone like a coworker, student in class or another parent at your kids’ recital or game. Like, you’re not quite sure about the person, but they seem okay enough to do some chit chat with. With a new friend or acquaintance, you’re not going to start by disclosing all your stuff, right? No. You get to know them little by little. Same thing for your mind and body. Bring your awareness to your body little by little. How are your toes doing? How about your left pinky? Or your right hip? How about the area behind your ears? How about the very tip of your head? Bring some curiosity to yourself and I think you’ll learn a lot. This is how change is going to happen, in little doses when it’s safe. If you can handle more and are ready for more intensive meditation, do your thing. But start small if you need to. Point being - I do think you’re normal. And that’s really just my response to what I know you’re thinking and feeling about yourself. I could just as easily say that I think you’re amazing. Or that you’re a survivor. Or that the amount of strength and resiliency you have is at absurd levels. I could also respond to your thoughts and feelings by expressing how much belief I have in you. That I have no doubt that you’re capable of more. It’s in there. You might not feel it, but there’s something within you that wants to come out. Something that is loving, accepting, trusting, fun and ready to be connected to others. You might not even feel it. Let’s call it “hope” for now. That hope is going to grow little by little. It might be a seed right now, buried under dark brown dirt in a ceramic pot. But it will grow, it just needs you to give it a little love and attention when you can. Before you know it, there will be a beautiful green seedling poking out of the soil, ready for more nourishment. For now, recognize there is some hope within you. Please. You are admired. You are respected. Even if you can’t give that to yourself, trust that I can. I believe in you without hesitation and I have zero judgment toward you. You’re probably doubting that, but it’s true. And this is simply based on the amazing people I’ve worked with in therapy. No matter what they’ve been through, there’s hope. I do admire them. I do respect them. I do believe in them. And I know I’m not your therapist, but the same applies to you. For now, know that there is hope. And that you’re normal. Thanks for reading! You can download and listen to all 10 Open Letters from Stack 1 with a purchase of $20. You will also get a PDF download that you can read and print whenever.

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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003660/ https://www.sciencedirect.com/science/article/abs/pii/S0165032706000395 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

TO PILE IT ON… These mirror some themes we’ve talked about Don’t give advice! After telling a therapist about an upsetting conversation I had with my cousin, the therapist asked if I could “just block [my cousin’s] number.” I asked for help reconnecting with my husband and she told me to get a divorce. My couples therapist was going on maternity leave and pushed me to leave the relationship. She later called (after my divorce) to apologize for rushing a resolution before her leave. To be clear, I made my own choice, but the sessions did not feel safe at a vulnerable time. A counselor told me to sleep around to get over the heartbreak of leaving a 3 year plus relationship. Religion, negative expectations, inability to work with trauma, didn’t refer out After working with a therapist for a few months on normal teenage issues (was 16 at the time) and trauma from an abusive childhood, she threw a couple “coping mechanism” worksheets at me and then said blankly “I’ve done all I can do for you. Jesus is your only hope.” (I can laugh now but at the time it felt very lonely and hopeless.) Medication compulsion - Had one therapist say she cannot go forward with me if I don’t take medication. PS: I’ve gotten myself to a good place WITHOUT medication. One for Mercedes - He was barefoot in our first session together. Therapists don’t do this. Total Seinfeld episode. MORE BAD THERAPY STORIES Hi. I just watched the live video about an hour ago and I cried when you said that it was OK to ask for what I needed and what I thought might be helpful. I’m a pretty good communicator and I do have some ideas of what may help me. But, I have had three therapists who never made space for my requests. And of course in those times I feel like I must be doing something wrong then. I have these battles in my head where I know I am not being unreasonable, and I am being articulate, and I believe what I’m asking for is going to help me… because I know me. But based on the responses or lack, I flip back again to thinking that there must be something wrong with me. I try to figure out where I am wrong, so I can make it right. And it all makes me sicker. Why aren’t these therapists listening to the client? To “make space” for a client is exactly the point of being a therapist Reinforcing client’s negative self-image Invalidating appropriate assertiveness Therapeers, in session 1, give your clients permission to ask for what they need. “Makes me sicker.” To all listeners - you’re not sick. You’re stuck. You’re not abnormal but probably survived something that was. “For over a decade, I worked with an older female therapist that helped me tremendously in working thru my severe childhood traumas. She was beyond helpful. However, since my mother had been wickedly abusive causing me to run away when I was 16, my therapist kept wanting to actually step-in & be my new mother. I know that may sound sweet on one level, but I found it confusing & inappropriate while I was literally trying to walk thru the fiery truth of processing the horrific hurts inflicted by my real mother. I needed a therapist, not yet *another* mother. I needed to heal from the one I had. It felt like a boundary violation during a time & in a place that I needed to feel safe, so i could go deep. Instead, I felt judged & like I was disappointing her for not accepting her offer. Regardless, I am deeply grateful for her teachings & her guidance. She was imperative to so many life saving advances I have made on my healing journey. Sometimes, you just have to know when to part ways.” Therapist needs to respect the client’s pace and boundaries When a therapist pushes for their own needs to be met, it creates distress within the relationship leading to clients taking on feelings that are not their own (i.e. “like I was disappointing her”). “You just have to know when to part ways.” Yes! Don’t solve their problems. I was with my first therapist for almost two years and we were building a great relationship. I finally went to therapy to face my horrific trauma of emotional/sexual abuse and neglect from childhood. I am very disorganized in my attachments; the tension of longing to be close but not having the ability be close is torturous. My therapist was the first person I allowed myself to trust in my life. I attached to him quickly and in a way that took over my life; I thought of him all day everyday. I didn’t let him know because I knew it sounded crazy and I thought he would abandon me. After doing tons of research on transference and realizing that the intensity of my attachment was a reflection of the intensity of the trauma, and a normal response, I finally mustered the courage to want to talk about it with him. Well I did, and he didn’t take it well- he told me to email him for another appointment. After emails, phone messages and texts, he never responded again. Done. The saddest part though, is that I really love the therapist I have now, but I can’t convince myself that he cares for me at all. The same intense attachment happened with him, and he’s been completely comfortable with working through it with me. The opportunity for an amazing therapeutic relationship is just out of reach because after a year and a half with him, I want more than anything to trust him, but can’t. I just can’t stop believing that he secretly despises me is going to dump me. Thank God he’s very patient and reassuring. This client sounds awesome Research, awareness, wants help, ready for change, ready to be open One therapist’s mishandling sets the client back for the next one Come on, Therapeers! Treatment abandonment AAMFT Code of Ethics - 1.11 Non-Abandonment - Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of treatment. TREATMENT ABANDONMENT - https://www.apa.org/monitor/2009/09/ethics https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

MORE BAD THERAPY STORIES “I had a therapist who continually took 10-20mins of the time to talk about his adventures in other countries to entice me, thinking I was depressed. Which I wasn't...I just couldn't do stuff due to chronic illness 😑. Another therapist was highly afraid of me telling my story and took a good 3 sessions trying to steer me away so she didn't have to face that 😳. And my last one, where I went for trauma therapy, decided after 5 sessions, in which we had only explored but hadn’t really gotten into the trauma therapy at all yet, that I was ok to just come whenever something popped up (so she suggested every 4-5wks or so). She was done, while we hadn’t even started yet. She also was dissociating whenever I brought up emotions (she'd never ask about them) and once left me hanging, didn’t re-regulate and send me out in the streets in pure triggered and hyperarousal state...just perfect 😖” Mental health vs chronic illness. Come on. Two therapists that were avoiding someone talking about trauma. How is this real life? What did they expect the job to be like? Therapeers - get comfy with trauma. Quick. “... I didn’t have many individual sessions with her, but she regularly forgot major life events, traumatic experiences I had, (making me repeat deep wounds in an attempt to get her to understand, much less remember), she never took notes, and after 3-4 sessions said that I just “couldn’t let things go” and wanted to try EMDR to move things along quicker (without my consent mind you, she just started doing the hand movements after forcing me to tell a random trauma story and then explained what she did when she was done). You can’t just do stuff. This should all be a part of informed consent regarding treatment modalities. Include the client in the treatment. Therapy is with the client, not at or to the client! “Let things go” - what does this mean? Really, what does it mean? “I have a horrible few stories of bad therapists… but they aren’t funny at all. I have PTSD. [Bad Therapist] listened to me talk with eyes glazed over and then prescribed medications the first time and asked about my coping mechanisms and stated that what I had been through was extreme and I would likely never get over it, basically to suck it up and take pills to numb it for the rest of my life; and the second time I saw [Bad therapist] we spoke about a new traumatic event, at which point she prescribed even more medications and scheduled a third appointment. At the third appointment after only seeing me 3 times had me on 5 medications and told me that I had healthy coping mechanisms (journaling, meditation, and exercise/yoga) and she would no longer be seeing me. I’ve never gotten over any of it. I’ve just learned ways around the debilitating anxiety and afraid to try therapy again.” A therapist must be present for the client, especially at the first session! To appear to the client that your eyes are glazed over is completely inappropriate. Hopefully, [Bad Therapist] was a psychiatrist and not a therapist. Some psychiatrists also provide therapy treatment. Stated that the client “would likely never get over it”... Then why are you practicing therapy, if not to help? We can’t predict the future. How can someone have such a horrible prognosis? How can you expect so low of your patient? Only 3 sessions?!?! Irresponsible client care. Continuity of medication treatment. Should have referred to a therapist familiar with some deep trauma “I’ve never gotten over it” - New trauma and/or retraumatizing “Hi. I just watched the live video about an hour ago and I cried when you said that it was OK to ask for what I needed and what I thought might be helpful. I’m a pretty good communicator and I do have some ideas of what may help me. But, I have had three therapists who never made space for my requests. And of course in those times I feel like I must be doing something wrong then. I have these battles in my head where I know I am not being unreasonable, and I am being articulate, and I believe what I’m asking for is going to help me… because I know me. But based on the responses or lack, I flip back again to thinking that there must be something wrong with me. I try to figure out where I am wrong, so I can make it right. And it all makes me sicker.” Why aren’t these therapists listening to the client? To “make space” for a client is exactly the point of being a therapist Reinforcing client’s negative self-image Invalidating appropriate assertiveness Therapeers, in session 1, give your clients permission to ask for what they need. “Makes me sicker.” To all listeners - you’re not sick. You’re stuck. You’re not abnormal but probably survived something that was. “For over a decade, I worked with an older female therapist that helped me tremendously in working thru my severe childhood traumas. She was beyond helpful. However, my therapist kept wanting to actually step-in & be my new mother. I know that may sound sweet on one level, but I found it confusing & inappropriate while I was literally trying to walk thru the fiery truth of processing the horrific hurts inflicted by my real mother. I needed a therapist, not yet *another* mother. I needed to heal from the one I had. It felt like a boundary violation during a time & in a place that I needed to feel safe, so i could go deep. Instead, I felt judged & like I was disappointing her for not accepting her offer. Regardless, I am deeply grateful for her teachings & her guidance. She was imperative to so many life saving advances I have made on my healing journey. Sometimes, you just have to know when to part ways.” Therapist needs to respect the client’s pace and boundaries. When a therapist pushes for their own needs to be met, it creates distress within the relationship leading to clients taking on feelings that are not their own (i.e. “like I was disappointing her”). “You just have to know when to part ways.” Yes! Don’t solve their problems. THANKS SO MUCH FOR LISTENING! We’re going to ask you for a favor this week. Screenshot your phone right now and share it on social media. That’s it. 70% of new podcast listeners do so because someone recommended it. The listeners of this podcast have been absolutely amazing through small actions just like this. We are getting messages regularly from people that are finding some relief or some peace just by listening to this podcast. So please, share it and know that you’re helping to impact someone in a very positive way.

Welcome to episode 20, Bad Therapy! Mercedes and I have mostly gathered ourselves here and really dive deep into some truly awful stories of what people are calling "therapy." WE BELIEVE THE CLIENTS Sure, clients might misunderstand the therapist. There could be context issues. We aren’t getting the full stories or the other sides. But a good therapist is going to check in with a client before they leave and ask for feedback. A good therapist is going to be sensitive to these things and allow for some clarification. A lot of this seems like irreparable stuff. Thanks again to the individuals that submitted these responses. THIS IS RETRAUMATIZING - “I always thought something was wrong with me, given that I’ve had multiple bad experiences with therapists. Reading all of these replies shows me that I’m not alone. I’m sorry others have gone through this trauma as well.” This sums it up - it’s trauma or re-traumatizing You’re with someone that you perceive is more powerful, more educated, has degrees on the wall and experience. It’s the neuroception of danger, of being less than, of being the weaker one in the room. But you’re also stuck in the room, immobilized by the anxiety of hurting someone’s feelings, of not wanting to be rude Sympathetic activation + immobilization = trauma There’s a gradient here, but these are obviously incidents that are sticking with people and causing them to change their behavior, despite wanting something else. They want help, but are avoiding it out of anxiety BAD THERAPY STORIES I have two both from the same person. 1) I came due to work stress and she was friends with the VP at my work and so therefore the things I was saying about my work couldn’t be true. They were.. I'm totally open to constructive criticism, but this was blatant disregard. 2) She told me I was "pretty smart for being so uneducated". She also violated HIPPA and told me my coworker was seeing her. Therapist should openly disclose these potential issues and reassure the client and also ask their thoughts on the matter and make other arrangements if necessary. It’s not okay to insult clients or to evaluate their intelligence or education level. It’s not okay to disclose anyone on your caseload past or present. Confidentiality is basic. “The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a series of national standards that health care organizations must have in place in order to safeguard the privacy and security of protected health information (PHI). PHI is any demographic individually identifiable information that can be used to identify a patient. Common examples of PHI include names, addresses, emails, telephone numbers, full facial photos,” https://compliancy-group.com/hipaa-basics/ https://compliancy-group.com/protected-health-information-understanding-phi/ On my first (and last) visit I was told I needed to develop a personal relationship with God and Jesus, and that then I’d feel better. We can’t insert our values or beliefs into the process. On some level, this is unavoidable, sure. But for something like religion, we need to be asking first. This can be included as a part of treatment in the informed consent. “Therapist said she couldn’t help me unless I took medication for depression.” We can’t compel our clients to take medication - what if the client is against meds? What if the parent doesn’t want their kids on meds? What if the clients wants to try therapy without meds or had a bad experience with meds in the past? We can suggest/recommend they be evaluated by a psychiatrist/MD. But if the psychiatrist says it’s not necessary, the therapist should meet with the client. If the therapist feels they can’t help, that’s different. But saying, “I’ll help you only if you’re getting medication” seems really odd. “I've had two therapists (I've only gone to see 3 total) literally start talking to me about their traumatic childhoods, as though I was the therapist. Lol.” Two out of three of her therapists! Keep your stuff to yourself, Therapeers! It’s their time, not yours. Get your own therapy! They are paying you for a service. Respect that. Self-disclosure in general is a no-no. Sharing your trauma is a complete distraction from the client’s. It takes them well off their own track of becoming unstuck and puts the focus on the therapist, obviously. They are now concerned or annoyed at you, not in a safe space anymore. “I went to a first appointment with a new therapist a few years ago and she had me fill out a bunch of paperwork. There was one sheet that I didn’t fill out because it was for the parents of children seeking therapy with her (I’m an adult woman and was seeking therapy for myself). She kept haranguing me for not filling it out and telling me I had to and I kept explaining I can’t because I have no children and was there for myself. She eventually dropped it, but I already felt a bit uncomfortable. I was there to see her because I was interested in EMDR and after explaining a little of my trauma history and getting a little tearful, she told me she didn’t think I was ready to do EMDR and then questioned whether I would really follow through with coming to see her every week. I told her I had never had an issue showing up for therapy before. I left super upset and called her office the next day to let them know I wouldn’t come back. It kind of felt like she was trying to convince me not to see her? Why are we arguing with clients? This seems like such a simple issue that should have ended with a chuckle and the therapist apologizing with a smile. Therapists should be listening to a client’s interest in a modality. Questioning a client’s motivation? Someone who is there and paying? This is so odd. Clients can be very forgiving. It’s so easy to repair these ruptures that are going to happen. “Seeing a therapist to try and work through a physically abusive partner. The therapist decided it was appropriate to try and set me up with her son. Then, she obsessively emailed and called me for months. It was a nightmare. Also, a therapist that told me when my Disabled mother calls me, that I should just not pick up the phone. I have never had a therapist that I felt I could truly trust.” We shouldn’t be playing matchmaker or breaker. Of course not setting up with our adult children. Stop solving the client’s problems. Be a listener. Be supportive. Clients have the capacity to solve their own problems, our role is not to do that for them. They are the experts in their own lives and we need to trust that they will get to where they need to be Boundaries - “It was a nightmare” and recommending she not answer the phone from her disabled mother. Provide options, do some problem solving, pros/cons, process feelings about the decisions, and then trust.

(This post contains affiliate links, meaning, if you click through and make a purchase or sign up for a program, I may earn a commission. This is at no additional cost to you.) To learn more about ways to change your state and get unstuck from trauma, I highly recommend Healing Trauma and Waking the Tiger by Peter Levine. TOP DOWN THOUGHTS TO CLIMB THE POLYVAGAL LADDER Top down means from the brain to the body 80% of fibers are from body to the brain Be curious, not judgmental The judgments are serving to keep you in your state “I’m worthless” is a reflection of your state and also keeps you there Observe, don’t evaluate Notice these thoughts that come in and out of your mind Meditation apps can help Headspace Calm Aura Meditation Studio Meditations on youtube Accept where you are at Not the state that you want to be in, but what state you are actually in You will get to where you need to be Of course you want the pain to go away, but it’s not something that can be rushed Actively fighting against it will actually make it worse Accept that you are normal This is all physiological stuff in response to whatever you have been through Stories get piled on, plus judgments and beliefs and other thoughts Anyone in your situation would have responded the same way Accept that everyone is different This isn’t an issue of weakness It’s an issue of being in states of defense We all react differently in terms of intensity or length of being in different states Comparing yourself to other people will only serve to perpetuate your stories and keep you stuck longer Accept that you did the best that you could In that moment With the skill set that you had available at that time Accept that you are doing the best that you can In this moment With the skill set that you have available to you now You are continuously building your skill set, even now New Stories to take on: You’re stuck, not broken There was a real threat, or there is The state is there for a reason You got stuck, just like any of us could have or are “How do I heal?” “How do I fix it?” Your vagus nerve is probably fine, that’s not the issue Just the conduit The feedback loop is the problem Your wiring is probably fine Once you neurocept safety, you will get access to your safe/social state and the behaviors associated with it You survived, you weren’t defeated You. Survived. If a gazelle is tackled by a cheetah, shuts down and then escapes… did they survive or were they defeated? Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

Mercedes & I discuss how we personally use different bottom-up and outside-in techniques to climb the polyvagal ladder and reach a more safe & social state - music, dance, play, breathing and more.  We also discuss what it means to "allow" the process to happen in simple day to day application. Polyvagal Breakdown of Gloria Estefan's "Con Los Anos Que Me Quedan" Remember that 80% of the fibers in the vagus are going to the brain. That suggests that we can change our state from the bottom-up and outside-in. BOTTOM-UP & OUTSIDE-IN TECHNIQUES TO CLIMB THE LADDER Breath Controlled exhale extends the parasympathetic activation Noticing how your body naturally wants to breathe Touch Massages, holding hands, hugs, petting your pets! Play/Dance Noticing what forms of play work best for your body What types of movements to music feel right? Allowing yourself to feel whatever it is and not stop the process If your body wants to move a certain way, allow it to happen combined with mindfulness Noticing the thoughts that stop the process of climbing the ladder from happening Not psychological, it’s physiological Music Why do you listen to the music you listen to? Does your preferred music match your state? Do you actually notice how your body feels listening to music? You can use music to climb the ladder by bringing mindfulness to the experience of listening and noticing how it affects your body, combined with extended exhales Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

LISTENER AUDIO CLIPS TO CLIMB THE LADDER Carla-Jo from the UK Checkin, pause, think and reflect on what can be done now As a parent, better understanding for the moment to be a support Relationships with others and meeting others, more awareness of others’ states and how to interact with them to provide support Compassion, understanding and awareness Theresa From Twitter Hi Justin, I once had a trauma therapist who had a lot of pictures in her office. But they were not hanging on the walls, they stood against the wall, in corners or leaning against flowerpots. I didn't understand why she would decorate the floor like that. Then during therapy I was climbing down the ladder, my gaze dropped to the ground and into corners, and there I was welcome by colorful pictures. Most of them were painted in warm colors and showed a person being comforted or surrounded by friends or being taken care of. It totally re-activated my safe and social system, so we didn't lose connection. My current trauma therapist is specialized on severe dissociative disorders and she is training especially to stay regulated when her patients go down the ladder hard. She is wearing an HRV device on her wrist (that also tells her the time). It vibrates when her HRV drops. I think this must be so helpful with staying regulated, to have something that tells her when to take a break and take care of herself first. I have DID, so I am frequently working with child parts. We have developed our own language around the polyvagal theory. They know the different arousal systems as personified cartoon characters we created together, complete with costume and character sketch and typical thoughts and behaviors. So we can talk about 'who is visiting' right now and find a playful approach to manage the situation. In therapy we always make sure to have an anchoring situation ready. Our Therapist collects these stories, like an especially good games night, time spent down at the river with bbq and singing songs, or even events we are planning like a grand birthday party. If the topic is getting too difficult and I drop down the ladder hard the Therapist will suddenly transition to talking about our anchoring scene to engage us in safe&social thoughts again. We are used to it now and even though we know exactly what she is doing it works every time. We are now bringing anchoring scenes to her for this purpose so she knows where to go with the intervention. Emily Sometimes can feel or cannot, usually needs help with grounding techniques When felt, identify where from (head/tired/foggy/cotton/not thinking clearly) Staying grounded with the feeling through senses Rubbing fingers, describing things present, smells If the moment is gone and you’re in a new one, that’s okay! You’re still present YOUR HOMEWORK ASSIGNMENT - Use one of the techniques that you’ve heard today. Find one that works for you and do it daily. Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats

(This post contains affiliate links, meaning, if you click through and make a purchase or sign up for a program, I may earn a commission. This is at no additional cost to you.) It was an honor to have Dr Porges on the podcast. As you probably know, he is the creator of the Polyvagal Theory and author of "The Polyvagal Theory" and "The Pocket Guide to the Polyvagal Theory." I recommend both of these books, but the Pocket Guide is easier to take in, understand and apply. Polyvagal Theory as the basis for understanding and human experience. “Understanding comes from feeling safe with ideas and thoughts.” “Polyvagal Theory enabled me to understand the portals we have to optimize the human experience.” Before PVT, the focus was on events versus feelings Feelings Emotion versus bodily experience Feelings sit on top of autonomic state Inverted triangle, bottom point is the brainstem and wider point are the higher brain structures “What higher brain structures can do are in part limited by the state that the brainstem is in.” ”Many of the observables in our human behavior are not intentional.” “We have feelings and we respond to them.” Empathy vs Compassion Empathy - we feel other people's’ feelings “Empathetic pain” - If another feels pain, we may not be in a good position to support Evaluating pain, like “That’s horrible.” Compassion - respectful and acknowledging of another’s pain, but there to witness and support “People aren’t prepared to listen, to witness, in a compassionate way.” “Healing” the Vagus Nerve? Vagus nerve is a conduit Vagus isn’t the concern, it’s the feedback loop between organ and brainstem that is the concern Certain feedback loops or defense strategies can get stuck Comorbidities come along with an ANS that is in a defensive state Be careful of ‘hacking the system,’ there are more natural ways to perform neural exercises, like singing, socializing, rocking, pranayama yoga and playing Extend the duration of the exhale Other Fs… The responses are adaptive, not bad “Flop” is an adaptive response to death feign, part of the most ancient dorsal vagal circuit “Shutting down” is literally passing out, but not everyone does that, but will have immobilization features Hybrid and gradation of sympathetic along with immobilization A body that goes into immobilization features may actually mobilize in an attempt to resist immobilization Substance Use Addictive behavior is a strategy to regulate state True physical addiction is secondary to initial benefit of addictive behavior The addictive behavior is protecting the individual from shutting down Psychiatry Child psychiatry is about pharmacological manipulation Psychiatry is not looking at the social engagement system behaviors “Psychiatry needs a reeducation.” “The warmest home for the polyvagal theory… is in trauma.” Polyvagal Theory provides a narrative consistent with client reports “Drugs affect physiology,” they are looking to “down-regulate” arousal “Some drugs will calm people down and they will be isolated in their calmness.” Calmed down doesn’t mean socially engaged Vagal tone means the amount of information coming down the vagus. Psychiatric medications may remove efficiency of regulating physiological state Psychiatry needs to measure autonomic regulation of the individual on and off the drugs Dominant State Safe and social system needs to be accessible to reduce ambiguity of a cue “Freeze” is the mix of dorsal vagal immobilization plus sympathetic arousal “Shut down” is limp, “freeze” is rigid Clinical Disorders as Adaptations Adaptations are a shifting of the more global autonomic states Clinical disorders are a compromise to the social engagement system As a species, we evolved to co-regulate, if we take that out of the equation, you get self-regulatory behaviors that result in diagnoses "I think what you would find is it really doesn't matter what the diagnosis is. That they share some common features. And the common features have to do with state regulation. And in fact the manifestations... has to do with the strategies that the higher brain structures developed to regulate their state. And in a sense the personal narrative that evolved from those psychological or mental experiences." -Dr. Stephen Porges A disruptor (like abuse or traumatic event) occurs that disrupts opportunities to co-regulate with a safe other Personal Narratives PVT brings the narrative that there is a reason someone is feeling the way they feel Higher brain structures (cognitive and sense of awareness) attuned body state, it will act as a container to the feelings Narrative will change when people become attuned to their state Narrative can be a container to physiological activity Our body’s reactions were heroic attempts to save our lives Dissociative Identity Disorder & Dissociation Alters may be seen as a polyvagal state, they have autonomic components Often, DID systems have no more than three alters Dissociation can be understood as decreased blood flow to the brain Dissociation is an adaptive feature in place of passing out; repeated passing out can result in injury or death Dissociation is common and there are gradations Polyvagal theory is an evolving theory that others are adding to, it’s a framework of thought. Buy "The Polyvagal Theory" and the "Pocket Guide" at these Amazon links. Other recommended books are in my Amazon Influencer Store. DR PORGES Website - https://www.stephenporges.com/ Music & Sounds by Benjo Beats - https://soundcloud.com/benjobeats