Bonus—Trauma, Shame, and the Nervous System Transcript Pg.

Exclusive Bonus

Advanced Master Program on the

Treatment of Trauma

Trauma, Shame, and the Nervous System — A Polyvagal-

Informed Approach to Working with Hypoarousal
with Deb Dana, LCSW

Ms. Dana: I really think that nervous system education is the key point that I try to use with
my clients and even be proactive and talk about shame, because it's such a common response
for our trauma survivor clients.

Dr. Buczynski: That was Deb Dana, a licensed clinical social worker and an expert on Polyvagal
Theory.

As she just mentioned, for so many trauma survivors, working with the nervous system can be
key in helping them resolve deep feelings of shame.

Here’s why . . .

Ms. Dana: As I'm teaching clients about the nervous system, we're getting to know their
nervous system to kind of be curious about the shame response so that they begin to
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understand that it's a common response. We all go to shame at some point.

Dr. Buczynski: So where might you go from here? How exactly might you help patients move
out of shame and into a more regulated state?

According to Deb, the first step is to come into connection with your patient’s nervous system.

Ms. Dana: Helping a client climb out of the deep dorsal

despair that shame brings is a slow and patient process
that really requires therapists to come into connection with
“Shame is a common
their clients' nervous system. So, coming into connection,
response. We all go to
bringing your ventral regulation to your client, and letting
shame at some point.”
your client touch into that fact that there is a nervous
system that is regulated, that is safe, that is trustworthy,
that is right here in the room with them.

Dr. Buczynski: Now when patients are stuck in a dysregulated state, feeling that secure
connection doesn’t usually come naturally.

So here’s what you might do BEFORE your patient goes into that state of low arousal . . .

Ms. Dana: I encourage you to preplan that, to play around with that when a client is not in a
dorsal shame response, but to play around with it as you are getting to know your client's
nervous system and see in what ways your client's nervous system can feel your ventral vagal
regulating presence.

Then, when a client has gone to that shame place, you're going to begin to use some of those
strategies that you created with your client to help them know that you're right there with
them.

Dr. Buczynski: Now as you’re working to co-regulate with your patient, here’s the thing to
remember . . .
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Ms. Dana: The importance of having a therapist to co-regulate with is, a nervous system that
is in dysregulation is really reaching out and looking for some ventral vagal energy. Often, our
trauma survivor clients don't find it right away inside their own system, and so it's really our
job to bring our regulated system and offer that energy to our client's nervous system.

It's a big responsibility, and I think the thing that I like to remind my colleagues is that we have
to stay anchored in ventral in order for this to be of
service to our clients.
“When a client has gone to
So, when a client has gone to a shame response, has a shame response, it is
gone to that deep dorsal place of disappearing, it is incumbent on us to remain
incumbent on us to remain anchored in our ventral. If anchored in our ventral.”
we move into a sympathetic need to get the client out
of there, or have an agenda that comes across in that
mobilizing way, or if we go to our own dorsal disappearing response . . . and both of those are
not uncommon responses for therapists when we get overwhelmed by the client's shame. But
when we go to those places, we are no longer of service to our client. We have now joined
them in dysregulation.

Dr. Buczynski: So how can you make sure that you’re providing a consistent, stable source of
regulated energy to your patient?

Ms. Dana: What I like to help my colleagues really practice is, imagine that your client has
gone to that disappearing shame response. Really play with, how do I stay anchored in my
ventral system knowing that I have to anchor? And then, how do I send that energy to my
client? So there's a couple of steps there: anchoring myself and then using that energy with
my client in a way that their nervous system can make use of it.

Again, it's that notice, it's that anchoring, it's that naming out loud, “Here's where we are,
here's the process, here's what I can offer – the tracking.” And staying in that conversation
with your client's nervous system. As soon as I leave that conversation and think that I know
the way home to ventral, I've left my client behind. So, I need to stay in the conversation with
my client's nervous system. And together, the two of us are going to find the way that the
Bonus—Trauma, Shame, and the Nervous System Transcript Pg. 4
client can come home to their ventral.

Dr. Buczynski: As Deb just pointed out, it’s essential that as the clinician, you’re able to stay
grounded and self-regulated regardless of how your patient’s nervous system might fluctuate
during this process. AND despite any desire you may have to push your patient along in
treatment.

Here’s when doing this is particularly important . . .

Ms. Dana: As they begin to have a moment of mobilization – and again that's all we're looking
for, is a moment of gentle mobilization – that's our cue that their system is beginning to move
out of that depth of dorsal and head towards sympathetic.

As the client begins to head towards sympathetic, you again want to stay in close contact,
because it's that moving into some sympathetic and through sympathetic up to ventral. That's
our goal. And we can easily get lost in that sympathetic mobilizing disorganized chaotic
energy, and the client will head back to dorsal.

Dr. Buczynski: But how exactly might you prevent that budding sympathetic, hyperaroused
energy from taking over?

Here’s some specific language you might use as your patient begins to mobilize . . .

Ms. Dana: “I'm here with you. Oh, so yes, now we're feeling some of the sympathetic
mobilization – and remember we're going to keep going right through sympathetic and end
up in the safety of ventral together." Some kind of language like that. Again, I'm going to play
around with my client beforehand and see “Does that land in your nervous system or is that
something that doesn't work for your nervous system?

Dr. Buczynski: Now let’s take a step back for a moment. And let’s ask, what specific signs
might indicate that your patient is on the brink of mobilization?

Ms. Dana: When a client's in that deep dorsal immobilization, you want to look for a moment
of mobilization – that's going to give you a clue that their nervous system is starting to make
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the movement up the hierarchy through sympathetic, landing in ventral. That moment of
mobilization can be something as simple as a movement. You might notice a movement of the
head. You might notice a hand movement. You might notice a foot movement. Those are
usually the places I tend to look: feet, hands, head. Because a client usually in dorsal shame is
looking away, eyes down. You might simply notice that very subtle looking up and down, just
checking to see, are you there? Is somebody there? It might be as simple as just a small
sound.

We talk about vocal bursts, which are those non-language sounds that we all use to convey
information. So you might hear one of those non-language sounds. You might hear sort of a,
"Hmm." It's just that's all these subtle signs that energy is beginning to move in the system
again, and as soon as you hear, see, feel one of those things happening, then you want to
name it. So I will name to my client, "Oh, I just noticed that small movement of your hand,
and that's your nervous system letting us know that
it's beginning to move out of this place that's so
“That moment of mobilization
dark and despairing." Or, "Oh, I noticed that you
can be something as simple as
peeked at my eyes, and I just wanted to let you
a movement. You might
know my eyes are here for you."
notice a movement of the
head, a hand movement, or a So it's those sorts of noticing and the naming that
foot movement.”
for me as a polyvagal-informed therapist are so
important. It's not just the me noticing, but it's the
naming out loud so that my client knows that I've noticed and gets that information, too.
Then we begin to make this journey together up through. Again, I'm going to accompany my
client, and I'm going to let my client know that we're going to make this journey together.

Dr. Buczynski: That last point Deb made is particularly important. Because remember, when a
patient has been chronically stuck in shame, coming out of that state can be triggering.

But reminding your patient that you’ll be there throughout that process can provide a true
lifeline.

Along with that, here’s another way you might support them . . .
Bonus—Trauma, Shame, and the Nervous System Transcript Pg. 6
Ms. Dana: I also usually tell my client, "And remember your nervous system knows how to do
this, because we've done it many times before."

For a client who goes through a shame response, this is not the first time that they have gone
to that response. So remind them that, “Your nervous system has been here many times
before and it knows how to come back to ventral,” because, “It's also done that many times
before,” feels like an important piece of information to be also entering into and offering to
the client's nervous system.

Dr. Buczynski: Now what about when self-harm is a factor?

Ms. Dana: Self-harming behaviors come from one of the dysregulated states. The same
behavior may look like it comes from both, in which case you really want to get very granular
about when exactly does this particular form
of this behavior come to life in the system.
“For a client who goes through a
Dr. Buczynski: Here’s why this matters . . . shame response, this is not the first
time that they have gone to that
While it may seem like a patient is self- response. So remind them that,
harming in the same way every time, that “‘Your nervous system has been here
behavior may be serving a different purpose many times before and it knows how
depending on whether your patient is hyper to come back to ventral.’”
or hypoaroused.

What this means of course is that we can’t treat a given behavior the same way every time.
Instead, your treatment approach should be informed by your patient’s nervous system state,
not the particular type of self-harm.

So just like with shame, a strong first step in working with self-harm is to help your patient get
in touch with their nervous system.

Ms. Dana: The work with a client who has self-harming tendencies or self-harming behaviors
is to really help them, again, get to know their nervous system and help them understand
Bonus—Trauma, Shame, and the Nervous System Transcript Pg. 7
what happens when they leave their ventral safety and regulation and begin to move to
sympathetic. What kinds of self-harming behaviors appear there, often as a way to attempt to
regulate back to ventral?

And then, what happens when they move through sympathetic to that dorsal collapse? And
what self-harming behaviors might appear there to help them feel alive again, to feel
something? And that's that movement to sympathetic in the hopes of coming back to ventral.
But oftentimes, that creates that loop again of, a self-harming behavior gets me to
sympathetic, but never gets me to ventral. So I move between dorsal and sympathetic.

Dr. Buczynski: So you see, for patients who self-harm, it’s very easy for them to get caught
oscillating between hypo and hyperarousal. And this often keeps them from reaching a
regulated state.

“The work with clients who have
these self-harming behaviors is
really a deep mapping process,
and it's a deep sort of, let's get to
know moment-by-moment what's
happening.”
So how can you help your patient overcome
this?
Ms. Dana: The work with clients who have
these self-harming behaviors is really a deep
mapping process, and it's a deep sort of, let's
get to know moment-by-moment what's
happening.

So we slow everything down, and we keep mapping. So, "Where are you now and where are
you now on that autonomic map?" We're explorers together in some ways. We're information
-gathering. This really is the beginning work with these kinds of behaviors. It's an information-
gathering expedition that I tell my clients we're going on together. I'm not going to let you go
on by yourself, nor can I do it for you. We have to do this together and really bring with us our
curiosity, which means bringing our ventral vagal regulation with us as we go to bring some
intentional connection to those self-harm behaviors and sympathetic and dorsal.

Dr. Buczynski: Now after you’ve helped your patient return to a regulated state, there’s one
final step . . .
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Ms. Dana: As they come back to a moment of ventral – which again, we have to climb out of
shame through some mobilization into ventral – then we can take a moment and safely look
back, safely reflect and begin to understand that response in a clearer way.

Dr. Buczynski: Let’s briefly recap that polyvagal-informed approach to helping patients come
out of shame . . .

First, encourage your patient to be curious about

“As your client comes back to a
their nervous system. Exploring this can help them
moment of ventral, then you
realize that shame is a common response.
can take a moment and safely
look back, safely reflect and
Next, when your patient is regulated, talk with
begin to understand that
them about what co-regulating strategies might
response in a clearer way.”
work when they start to experience shame.

You can then use these strategies when your patient goes into that hypoaroused state. Be sure
to provide them with consistent, regulated energy throughout this process. At the same time,
be on the lookout for any subtle verbal or physical cues that they’re about to mobilize.

As they begin to move out of shame, continue staying present with them. Here’s where you
can continue using some of those co-regulating strategies from before.

Lastly, when self-harm is a factor, identify which nervous system state is driving those
behaviors. You might do this by helping patient track their nervous system moment-by-
moment, or “mapping” as Deb calls it.

Once your patient returns to a regulated state, you can then help them reflect on their shame
in a healthier way.

Thanks for watching this bonus module. And thank you for what you do, because the work you
do is so important.

Take care, and I’ll see you soon.