Case Study: how The Polyvagal Theory and IFS work in individual therapy
“The way that Hetty utilizes the IFS model as well as her knowledge of the important role the nervous system plays in the way we move through the world were transformative for me in gaining important insights into my thoughts, feelings, and behaviors. With her support, I felt like I got to know myself better and gained the tools to feel more in control of my choices and my life.” - Megan*
I will never forget the first time I met Megan*. Due to some maintenance work that couldn’t be rescheduled, I had to meet with her in the attic breakroom of the house where we have our offices. Sparsely furnished with a bright, exposed window, it’s a great place for getting a quick bite between clients, but not so ideal for a first therapy session! I was nervous about starting a therapy relationship squeezed in between the microwave and the copier, and I could feel how uncomfortable parts of me felt sitting on a folding lunchroom chair and not being in my comfortable office suite. But I was also relaxed - because I knew I could help her, and I did. Want to know how? I’ll tell you!
When Megan came to me, she was sad, scared and anxious. She was in a new job and feeling overwhelmed and stressed. A close friendship had ended painfully, and she didn’t have support from her family members, who were preoccupied with their own mental health challenges. Megan didn’t like the thought of going to therapy, but she wanted relief.
During that first session, I heard Megan talk about the different parts of her that were struggling with loneliness, anxiety, and depression. She said that sometimes she couldn’t relax and that she hadn’t slept well in months. We identified goals for her therapy including feeling more confident, feeling better about herself and her body, and speaking up for her needs in close relationships.
In the next session, I taught Megan about the Polyvagal Theory of the autonomic nervous system which says that our body is always scanning for safety and threat below conscious awareness. This sense is called “neuroception.” This theory also says that we “co-regulate” with our environment, including people around us, and that our mood can be impacted by others’ moods, for better or for worse. Our moods have three basic states: a calm “safe and social” state, a stressed (or angry or anxious) alert state, and a depressed and despairing shut-down state. We can learn what triggers the dysregulated moods and what supports the relaxed mood, and build “regulating resources.” These are things that we can do on our own or with others to help ourselves feel better. When Megan heard about this and created her “Polyvagal Profile” (a written description of her unique moods and triggers), and her “Regulating Resources” chart, she began to understand herself better. Over the few weeks, she practiced ways to improve her mood and started to feel “more in control of my choices and my life,” as she later told me. She started to relax.
About a month into therapy, the topic of a loved one’s renewed struggle with addiction came up. It was upsetting to Megan, and she began to cry. I knew I wanted to help her process these feelings, and that the parts work process of Internal Family Systems therapy would help. So, I asked her if she would be willing to notice what she was feeling in her body. She closed her eyes and described some tension near her heart that felt “sad” to her. When I asked her if she had any image or impulse or memory that she associated with the feeling near her heart, she sat quietly for a moment, and then shared a memory of having anxiety attacks as a child, especially when this family member was acting chaotically. I guided her to see that little girl in her mind’s eye and to connect with this young part of her, using an image she created in her mind.
Megan was able to sense/remember this little girl who felt anxious a lot, and who also felt responsible for another person’s feelings. Megan felt compassion for this remembered part of herself, and imagined sending love and care to this little girl, who could then “feel” that love and support and be safe with Megan in the present, instead of re-living the sad and scary experiences of the past. Inside of herself, Megan imagined helping this little girl release her feelings of fear and sadness. The little girl then felt happy and began to paint a picture. Megan sat quietly, imaging the scene and sending more love to this little girl inside of her. Once Megan opened her eyes, I asked how she was feeling, in her body. She said she felt relaxed and at peace, and that my gentle guidance to connect with these vulnerable feelings inside was a totally new therapy experience for her. She came back the next week, ready for more time to connect with herself in this transformative way.
Through our work together, Megan began to explore and process other childhood events that had left her feeling alone and overly responsible for her parents’ choices. She also got to know the impact of her anxious thoughts on her self-esteem and strengthened her capacity to be curious about her moods and her reactions to them. Over time, Megan began to feel more confident and capable to establish and maintain relationships on her own terms.
Megan and I had many sessions together as she learned how to feel more securely connected to herself and her feelings. We didn’t have another “attic session,” but we laughed about that first awkward meeting as we noted how far she had come. When our work together ended, Megan sent me a note. She wrote, “I cannot thank you enough for working with me and for all of your support. I am sure that I will be back at some point given how difficult life can be, but I feel confident moving forward with the skills that I've gained through our work together. Thanks again, Hetty.”
*The names and a lot of the details have been changed, but this reflects the kind of therapy and “parts work” that my associates and I do with clients.
