I often work with young men between 15 and 30 on the spectrum. They seem to find the approach useful and it is testimony to the work that they will chose to work with me. At present I am working with a young man in his mid-teens who is most enamoured with the Polyvagal Theory. He started working with me six months ago and after finding some ground sought a therapist who was able to work in person with him, as we were working online. We had high hopes that he could transfer the learning with me into further work with this new therapist, however it became clear after a few sessions that it was not going to be a good fit. He tried a few times but eventually left disappointed and dismayed and feeling misunderstood.
It is a common complaint that ‘people just don’t understand how hard it is’. If your body has always worked for you it is almost impossible to understand the effort it takes to override the inertia of the immobilised physical system. It is not a lack of will, but rather a burnt-out will that leaves you incapable of ‘following orders’ or being compliant, even if this just means engaging with the simplest activity like moving your head up and down. Sometimes you just can’t.
In our session today this kid found he could not speak at the beginning; he could not move his head in the simplest of actions and we were left waiting to see what would happen whilst not wanting to override him or fill in the gaps. Eventually I suggested that he might like either to ‘stay on the couch and try the head exercises or perhaps your body would prefer to start with the ball on the floor, and if that is the case just move down when you’re ready.’ This was the perfect solution as he then easily moved down to the floor and began the session.
It would have been easy to see that he had choice here, and was being obstinate, or disengaged, but in reality, until we got the choreography of the session just right, he simply could not mobilise himself. It takes time. It takes attention. It takes choice and autonomy and the therapist is merely a guide to an emerging process, but a guide all the same. By the end of the session this chap was talking in sentences and was using far less effort in his legs to move the ball. It is still a work in progress, but he is finding his way.
As a therapist you have to go slow. You have to go slow and you have to be attentive to the possible needs and wants of a person who is trying their very hardest, yet cannot ‘perform’ in a way that is satisfying if you want a ventral response to your enquiries and suggestions. There is much to attend to and anything you suggest if it is not done just so will easily engage a shutdown response.
There is a fine art to holding the dynamic tension between moving forward or staying still in a session. Sometimes you think you recognise that maybe, just maybe they have found this new point of stasis – between the ventral and dorsal states– and you need to let take a step back and leave the body to know and then stabilise this new information; or whether maybe it is time to press on and mobilise the body with a gentle exercise; or whether to invite the person’s opinion on this and how would that best be done; or whether this will be too much for them to manage at this point. Sometimes people are just fidgety and bored and they need an entirely different set of engagement to get them to find that quiet place inside them. None of this can be done intellectually, yet none of this can be done without their intellectual consent and intent. Like a Buddhist buried up to her head in snow, teaching her body how to melt ice; we are similarly playing in the land of deep dorsal states. It is not for the feint hearted.
They find they can manage the world better, that they have a mind and body that moves with more ease and agility. Then they learn to play in this newness, then we work some more, it is delicate, private work. Applying a behavioural program with times and duration and intensity and therapist driven, would quickly deaden this process.
What we are looking for is not broken, but waiting in the wings. If you truly appreciate the Polyvagal Theory and the knowledge that the body will shut down and make inaccessible states that are unnecessary in times of danger, then it is perfectly plausible that they can come back online. Even if they have never seen the light of day, they are there. I am seeing a woman in her thirties with strong intellectual disability and she is finding her voice, her taste buds, her independence in ways that are astonishing to her family and support workers in a few short weeks. It’s real, but it’s not a quick ‘whip it into shape’ vagus hack that we are talking about.
For the purists; yes, we are promoting ventral states. We are trying to remind and incorporate them into the system so, as one client described ‘I can have more gears on my bike’, but we do not do so at the cost of the dorsal. We bring it with us, it informs us all along the way. It is the body who makes the decisions, and we learn to listen and attend to its demands, we build relationship and then eventually learn to become to master of the ship – but never the boss. A good captain knows she is beholden to the sea and the state of the vessel and to the wind and the stars.
Very often classically trained therapists miss the wealth of the dorsal states and what they have to offer. If they would just take a step back from their training and their need to fix what is not broken but is waiting for the right conditions to emerge; they would not only get further quicker, they would learn something magical along the way. The people I work with are brilliant. They shine, they think things that others don’t even dream of. These people have much to offer the world, but we cannot make them fit into a shiny, shallow world. They bring something with them from the deep that the world needs. We must find ways to meet them where they are and then enhance their capacity to share their gifts.
This shared with permission from the two clients who are mentioned in the article.