It seems to me that there’s a public perception, which assumes that going for mental or medical care is like taking your car to an automobile shop. They assume that humans, like cars, can be diagnosed and fixed. There’s very little understanding of the dynamics of the relationship with the therapist, which, more than any method or procedure, is the most important thing going on.
What can therapists do to build on their natural abilities to create an atmosphere of safety with clients?
Porges: When I was an adolescent, I was a clarinetist. What did I learn from that? Among other things, it taught me a lot about breath. When you play the clarinet, you’re basically exhaling slowly, controlling the muscles of your face, and listening. It’s similar to what goes on in Pranayama Yoga. Slow exhalation increases the calming vagal influence on the heart. It also increases the neural tone of the facial muscles, while you regulate the viscera. It’s a totally integrated polyvagal experience that involves the interaction between the vagus and the facial muscles—basically, recruiting the entire social-engagement system. And that’s what music is about. When I’m asked for tips to help therapists feel calmer and more in control, I sometimes tell them to take up a wind instrument or singing lessons.
What’s the biggest contribution you think Polyvagal Theory has made to clinical practice?
Porges: I think my biggest contribution is helping therapists understand how the transition through evolution between reptiles and mammals, from isolation to increasing social interaction, is central to understanding what goes on in psychotherapy. Humans when threatened are similar to other mammals: they shift states to defend, become more reptilian, and lose access to their social communication skills. By understanding this adaptive reaction to danger, we’ve uncovered a neurobiological mechanism that enables us to better understand and treat mental disorders. Even in the intimacy of the clinical encounter, the relevance of evolutionary adaptation is being played out in therapists’ offices every day.
What’s been the most important lesson for your own life that you’ve drawn from your work on the polyvagal system?
Porges: It’s actually learning about the importance of listening. Once you understand the importance of role reversal and reciprocity in healthy relationships, you realize that listening is usually much more therapeutic than talking. It also makes life a lot more interesting and entertaining.
Mary Sykes Wylie, PhD, is a senior editor of the Psychotherapy Networker.