Polyvagal theory and peek-a-boo: How the therapeutic pas de deux heals attachment trauma

Excerpt from November 2015 article in Body, Movement and Dance in Psychotherapy

Stephen Porges’ book Polyvagal Theory (2011) helps us understand the biology of attachment. When we sense that we are adequately safe, our bodies use what Porges calls our Social Engagement system. Our Social Engagement system helps us to navigate the nuanced dance of relationship. The relationship between primary-caregiver and infant has the potential to facilitate this needed sense of safety. When this relationship creates the opposite, insecurity, a therapeutic relationship can provide a reparative experience. When therapists are operating out of their Social Engagement systems, it becomes more possible to help clients navigate the process of therapeutic connection. More careful attention can be paid to the loss of connection and the seeking of reconnection, what Tronick (1989) calls interactive repair. Because the loss of connection and subsequent attempts at reconnection mimic the infant game of peek-a-boo, clients often reveal infant attachment dysfunction as disconnection occurs. When the therapist can attune to the client’s needs, the peek-a-boo aspect of interactive repair can take on a more playful quality.

Three-part hierarchical defense mechanism

According to Porges’ polyvagal theory, humans have a hierarchical, three-part defense mechanism. The three systems in this defense mechanism help us relate to our environment. If life-threatening danger presents itself, defense options are either the well-known Fight/Flight response or the lesser-known Shut-down response. Porges has proposed a third part of our defense mechanism, the Social Engagement system, which negotiates situations where threats are not so dire. Our Social Engagement system allows us to respond to the signals in facial expressions, vocal patterns, postures and gestures to determine levels of threat and to influence interactions.

Ideally, we are using our Social Engagement system when we are on the diaper-changing table and our primary caregiver interrupts diaper duties with a game of peek-a-boo. While this loss of our security figure’s face can stir the possibility of a Fight/Flight response, cooing sounds and bursts of smiles can cue us that life is sufficiently safe enough to use our Social Engagement system to regulate and from which to relate. Within a relationship that offers experiences of interactive repair, we increase our ability to cope (Tronick, 1989).

Co-regulation

Our biology is designed such that we regulate each other’s nervous systems when we relate, (Schore, 1999). Polyvagal theory helps us picture our biology in terms of its three-part hierarchical defense mechanism (Ogden, Minton & Pain 2006). We either feel a degree of safety that allows a dance of interaction guided by our Social Engagement system or we feel a level of danger that moves us into one of our responses designed for life-threatening situations. Our first choice of life-threatening defense is Fight/Flight because while it is stressful, it implies hope for survival. If fleeing or fighting does not seem an option, we begin Shut-down responses which include bowel issues, fainting, dissociation, and possibly death.

During our first intimate relationships, baby and caregiver are not on even playing fields because as babies many of our physical abilities have yet to develop. Ideally, our caregivers are capable of operating from their Social Engagement systems, signaling to us that security is possible.

When a caregiver-infant relationship does not create a sense of safety for the infant, the infant will behave in ways first observed by Mary Ainsworth (1978) in her Strange Situation experiments. In her studies, babies played in the experiment room as mother exited, a stranger entered, and mother returned. Through the polyvagal lens, the distress that the infants exhibited when they did not feel safe can be observed as variations of Fight/Flight or Shut-down.

As in the infant-caregiver relationship, client and therapist are not on even playing fields in the dance of co-regulation. The client is vulnerably seeking help. Client vulnerability can manifest in distress behaviors like those seen in Ainsworth’s experiments.

Peek-a-boo

In a secure environment, peek-a-boo can be a game that plays safely with a very destabilizing possibility. The primary caregiver disappears behind hands or blanket or door to quickly reappear, making eye contact cueing that the activity is a game. Loss of the primary caregiver potentially stirs what polyvagal theory identifies as life-threatening response. Quick return with playful eyes and cooing voice communicates all is well. This game with its huge stakes and quick recovery can encourage the infant’s developing Social Engagement system biology.

In infancy, the games that stir potential Fight/Flight response could be traumatic. Due to immobility, too much time in Fight/Flight response triggers Shut-down. If cues from the infant are missed or misinterpreted and the infant does not feel the peek-a-boo game is playful, the infant can be sent into Fight/Flight and without the ability to mobilize, Shut-down may follow. If these miscues are part of larger patterns of nonverbal miscommunication, attachment trauma occurs (Van der Kolk, 2003).

Therapists—particularly therapists using body-focused therapies—can access knowledge of polyvagal theory to help them find techniques that gently and playfully challenge the client. As in the healthy caregiver-infant dance, the therapist can use the cues of the client to find the path to connection. If the client is in Shut-down, the therapist can help the client return to arousal, moving through Fight/Flight to a sense of safety. To lead clients into these types of techniques effectively, the therapist must meet the client in a state similar to the client without similar distress.

Social Engagement cues

When we are using our Social Engagement system biology, we look for relational cues. A playful grin signals that the body’s movements that appear hostile are actually an invitation to rough and tumble play. A facial expression of concern and empathy cues that an injury was an accident rather than an attack.

Porges’ research suggests that voices with higher tones and more vocal variety are most soothing. However, vocal qualities as with all therapeutic reaction and reflection, must match the client’s need in the moment (Chace, 1975; Levy, 1988). For instance, if at some point in a client’s life higher tones and vocal variety were used to seduce the client into feeling a false sense of safety followed by violation, a therapist’s similar vocal quality could be frightening rather than soothing.

Therapeutic loss of connection and reconnection

By attending and responding to the many cues of the client such as breath patterns, vocal tone and rhythm, eye movements, posture, gesture, movement qualities and words, it is possible to establish connection. Ideally the therapist can join the client in movement and vocal qualities without joining them in distress. As the therapist tracks the client’s cues, the therapist can note loss of connection. The therapist can then seek reconnection with inquisitiveness about the disconnection. This finding and losing and re-finding connection mimics peek-a-boo. Like peek-a-boo, this dance can stir life-threatening sensations especially in those with insecure attachment styles. Seeing the relationship as an energetic dance helps therapists invite playful connection with a simultaneous respect for the seriousness of a client’s distress. We can picture ways that animals cue each other to distinguish aggression from play. Sometimes in active play a participant, whether human or animal, may accidentally get hurt. But then cues signal the mistake of that action and play can be resumed. This is another example of connection/loss-of-connection/reconnection. Polyvagal theory in body-based therapy

Therapeutic relating can give clients a reparative experience when early life was not sensed as safe enough to develop Social Engagement system biology. All relationships are experiences of co-regulation of nervous systems but in our first relationships and our therapeutic ones, we need a care provider who can attune to us. When we feel the distress that accompanies loss of connection to one who helps us regulate our nervous systems, a therapist can hold a safe space and facilitate reconnection in the therapeutic version of peek-a-boo.

Polyvagal theory illuminates the functions of each of the three defense systems to help us understand the hierarchy of their usage. When we are safe, our Social Engagement systems help us navigate relationships. When we are in life-threatening danger, Fight/Flight response invigorates us to flee or fight. If we sense that fleeing or fighting cannot bring safety, Shut-down disembodies us. An understanding of our three-part defense mechanism through polyvagal theory clarifies the biology behind attachment theory aiding our journeys towards relatedness.