Transcript for
A polyvagal approach to working with trauma

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m joined by Chris Cussen. Chris is a psychologist and senior counsellor of the Child Trauma Service at the Australian Childhood Foundation. In today’s episode, we discuss how a neurobiological perspective on trauma assists in working with children who’ve experienced abuse-related trauma. We draw on polyvagal theory and how it speaks to the importance of creating safety in relationships, as well as looking to the body for signals about the most supportive response.

[00:00:37] Thank you very much, Chris, for coming and joining me today for a conversation.

Chris Cussen [00:00:41] No worries, my pleasure.

Sophie Guy [00:00:42] I wanted to start off by asking you to tell me a little bit about your background and how you came to be working at the Australian Childhood Foundation.

Chris Cussen [00:00:52] Sure, I’ve been with the foundation for about fifteen years now, which is a long time. But I suppose when I started, we were just little and now we’re, you know, in the two-hundreds now, I think I was number thirteen when I came aboard, and we’ve expanded a lot and it’s just been a lot of opportunities. So I’ve got to work, you know, from in parenting to supporting out-of-home care placements for children in foster care and residential units to counselling, to doing some training, lots, lots of different things. Which is just been really rewarding and rich. I’ve always worked with kids and families, they’re just my favourite.

Sophie Guy [00:01:29] Can you tell us a little bit more about why they’re your favourite?

Chris Cussen [00:01:31] I think because of the way that they think that they’re not mini adults, that they have different ways of knowing that are so, just joyful and playful and they’re so tolerant and they’re so able to live in their imagination. And I love that. And I hope that bits of that rub, rub off on me I suppose, in being with them. I mean, I think that’s one of my biggest learnings when I went into working in counselling with kids in trauma was that it was, it was going to be so heavy and dark and hard and working with kids, they find ways of coping and ways of being that are through their imaginations and through that, I think they’ve got a lot to show us adults in many ways. So, yeah, that’s the main thing.

Sophie Guy [00:02:30] Parts of us we’ve forgotten.

Chris Cussen [00:02:31] Exactly, exactly. Yeah, we were all kids. Yeah, at one point, absolutely.

Sophie Guy [00:02:38] What age range is the Australian Childhood Foundation work with?

Chris Cussen [00:02:41] Kids up to eighteen (years old).

Sophie Guy [00:02:43] And it’s primarily working with kids and families where there’s abuse going on? Is that sort of…?

Chris Cussen [00:02:49] Abuse-related trauma is. [Right]. Yeah, it is our work. We also work with some kids that show problems, sexual behaviours or sexually harmful behaviours. And sometimes there’s a trauma background that comes along there, but at other times not so much. So that’s really our, our brief. We don’t just work with kids. Kids don’t come by themselves, you know, they’re a part of a broader system. And, you know, I think it’s important that we think about them in that way. So we do a lot of work with parents and carers and kind of the system, the care system around children that have experienced trauma because it’s in the between. That is where the work kind of sits, I think.

Sophie Guy [00:03:33] Yes. And that leads in quite nicely to what we are here to primarily focus on today, which is to talk about the neurobiology of trauma and what that means for relationships and sense of safety. And polyvagal theory, which is developed by a man called Steven Porges. And I wonder if you could perhaps just give us a bit of an overview.

Chris Cussen [00:03:56] What I love about it is it’s not just a theory for people that have experienced trauma. So it’s not about, you know, those people over there that have trauma that we need to help in that way. I think the polyvagal theory is about all of us. It lives in all of us. And the way we are in the world and the energy and the arousal states that flow through us are exactly the same for everybody. And that’s what I, that’s what really strikes me about this theory that we we can get it in a way. We all get it because we’ve all felt it. So Porges came up with this theory a long time ago now, and he wasn’t even thinking about the trauma field so much when he came up with it. It’s a theory really for me that’s around protection and connection. So it’s a theory that is about the layers within ourselves that we have that are organised to get us through the day, basically. So for kids that have experienced trauma, their worlds of often had more threat in them, let’s say, than the kid that’s sitting next to them in the classroom, and that’s meant that their brains and their bodies have had to shift and adapt to their worlds. So when you look at a child that’s experienced trauma, you’re looking at any kid that’s just been in a different environment than the child that sits next door to them, basically.

Sophie Guy [00:05:27] How would you explain some of the concepts that come through polyvagal theory to a child that’s sitting with you in a way that would, you think would be helpful for them to understand what’s going on for them?

Chris Cussen [00:05:38] I talk a lot about energy in their bodies. So for some kids, when they become activated, so there might be an implicit memory that comes up from something that they’ve experienced. Often that will be in a relationship with someone, and that might just be a shifting expression on that other person’s face. It might be the tone of voice that they, that that the child picked up from the, the teacher, let’s say, in the classroom. And that might mean for that child that’s experienced some hard stuff in the background that suddenly their body goes into a place of needing to protect itself. And that can often be through, say, mobilisation, which is when they get lots of energy in their bodies and they feel like they need to move around. And they’re a lot of the kids that we see in our counselling house out at Mitcham.

Sophie Guy [00:06:32] Is that like when you say mobilisation, is that what we typically think of as a fight-flight system?

Chris Cussen [00:06:36] Yes, absolutely, absolutely. [Yeah]. Yes, yes. So this is the fight-flight active freeze. This is when adrenaline is pumping into the body. We get a surge of energy, basically. All of us will have experienced this to some degree at different points. For example, those that struggle with public speaking, let’s say, as they’re standing on the side of the stage waiting for the last person to to finish, they might be feeling, you know, hot under the collar. They might have beads of sweat on their forehead. They might not being able to think of the words that they’re going to say. They might feel dry in the mouth. All of these are a tiny little taste of what children that have experienced trauma and have this kind of mobilised fight or flight response can experience in the everyday. And for those kids, what’s often happened for them is, you know, they’ve jumped up at school and run out of the classroom because something’s happened for them that’s reminded them in some way of the bad, the hard stuff that happened at home, let’s say. And what can happen for them is they get treated like they’re the naughty kid in the class, that the whole school has to stop to go and find this kid who’s running around the yard and bring them back in. And they feel like they’ve been naughty, there’s lots of shame, there’s… head goes down. And if we understand it through the lens of Porges’s polyvagal theory, what we get is this child has tried to be as as a very adaptive system. So there’s beautiful therapists like Bonnie Badenoch. And she says things like there are no maladaptive behaviours. We talk about maladaptive behaviours in children. They’re always adaptive. They’re especially adaptive when we start to learn what has happened for children in the past. These children don’t put these protective responses in place for no reason. It might have been that jumping out of bed and through the window and running up the street when dad came home was the best possible protection that that child could put in place at that time. If we use these protective responses and put them into place, not as, not as cognitive decisions, these are not decisions that we choose from, you know, our thinking cortex, part of our brain. These are decisions that our bodies make for us in the face of the possibilities around us. So, yeah, we’ll work with kids that have, for example, those kinds of fight or flight responses and they’ll come into our counselling rooms and they won’t be able to sit down and they’ll be kind of wandering around the room and finding stillness really hard. And so what we would do with them is we would honour what their bodies need to do and we try and work with them to find ways that their body can deal with that energy that’s sitting there in their bodies. So that might be if you’ve got a kid, let’s say that hits out a lot, we might try doing some ball stuff with kids or some ping pong with them or something that involves the same muscle groups they use to protect themselves. And that allows that energy to shift through them. But at the same time is kind of diverting a bit from eating out at somebody else. Because I think when protective responses like that fight or flight, there’s one that’s even more evolutionary, kind of older than that. And that is one of collapse or submission. Either of those kinds of responses are not ones that children are looking to others to help them at those points in time for them, they’re on their own and they’ve got to do whatever they need to do to be safe. Our bodies are always organised to protect us. At the same time, what we do is we continue to be there, you know, to offer that kind of support for when they’re ready to come back into connection with us. And we have to, we have to wait for that. I remember I was doing a training at one point and a student welfare coordinator was, this stuff we’re talking about the polyvagal theory and the stuff was all clicking into place with her. And she said, “oh yeah, there’s there’s been this this this child”, she said, and you know she said, “I’ve worked a lot of years in this role.” and she said, “and he was a runner. So what he used to do was he’d run other classroom and then he’d just run around the the border of the school. So just inside the fence, he’d just run and run.” And what what they would do was they would call her in as the student welfare person ’cause she had a good relationship with him. And she said, “what I used to do was I used to walk around the edge of the the school with him, but probably 10 metres away from him. So he knew that I was there, but so that I wasn’t impeding on his space”, she said. “And I just would walk along as he ran the laps of the school until he would slow down a bit. And he didn’t need to run anymore”. And she said eventually he’d go and he’d sit on one of the seats that was on the bench seats around the edge of the school. And she said, “yeah, and I’d go up and I’d sit on the opposite end of the bench and I’d just wait, I’d just wait until he was more into his cortex, more into that thinking part of his brain, more able to kind of connect in that kind of relational way.” So I thought that was a beautiful example of honouring a child’s protective response, but also offering connection at the same time.

Sophie Guy [00:11:49] Could you talk a bit about how the social engagement system and how that’s connected to our nervous system and connected to different parts of our brain?

Chris Cussen [00:11:59] Sure, the social engagement system if available, I always think about anything above the neck, okay, when it comes to social engagement system. [Right, yeah]. So the social engagement system is about our face and it’s about our tone of voice that has a giant impact as we bump up against each other and our nervous systems bump up against each other as they do in the everyday. Yeah, so Porges will talk about those things particularly and thinking about those things when we are with children and those that have experienced trauma being really focussed in not on the content of our words, but on the delivery. So the tone, the, the way we shift and we move our bodies. But he says you can tell if someone socially engaged because they’ll orientate towards you with their heads. They’ll, they’ll look towards you. They’ll, they’ll nod their head, as I can see you are doing right now. Yeah. They’ll smile, they’ll show us those signs of of warmth and connection in those kinds of ways. And if we’re open to that, enable to be in connection with with each other in that way, that’s neural exercise in many ways. And in those states, our body is able to kind of rest and relax in a way that for children that have experienced lots of trauma and have lots of protective responses come up for them. They, their bodies don’t get so much of a chance to do. So, we always kind of have to track with kids and those that we work with, that kind of level of safety between us. You know, when when does it come in and when does it leave? And, um, one of the best ways I find to do that is through tracking a child’s face. You know, as soon as they look down away from me, I start to think, okay, what might they be needing now? What is also happening at that point, too, is we have a connection of the vagus that goes into our heart. This connection they call the vagal break, vagus break. And the vagal break is a connection that slows our heart down, basically. And it’s on as we’re sitting here right now, socially engaged. You’ve got your break to your heart on. It’s useful in that way because a break is easily taken off. So if we ever needed to step into a more protective response of a different sort. If we, if we needed sudden energy to come within our bodies like a mobilised response, that fight or flight, we need the break to come straight off. And that’s what it’s, what it’s able to do. So some of our work with kids and parents and carers when we work on counselling with our kids is to think about that vagal break and to think about, you know, how are they going with that, is that still on? Because we do lots of work around the breath. Work around, relaxation and calming that can help that break to just hang in there when they might be on that edge of moving into a more protective response of a different kind.

Sophie Guy [00:15:14] Okay. And how do kids respond to the idea of something like a break on your heart. Does it make sense to them?

Chris Cussen [00:15:21] Sometimes we might talk about it, sometimes not. Going back to what I started off with earlier. That idea of energy in the body, so what kind of energy does it feel like when, and we’ll talk about when they feel relaxed at some point at home or you know, wherever in their, in their worlds and their lives. And we might talk about, okay, well, you know, what’s going on in your body at that time? What does it feel like? And then we’ll talk more about… it depends. Like, as I said, lots of the kids we work with tends to go into that mobilised response, maybe because they’re the kids that you see more, you know, because they’re the kids that are in your face or running away from you. In a way, those immobilised kids, they’re invisible. They’re you know that, that’s what they’re attempting to be in some ways or they’re not consciously again. But that’s what they’re attempting to do. That’s how I talk. I talk energy in the body because it’s neutral, because they’ve had so many people often in their past, associate, their mobilised response with being naughty or disregulated is another word that people use, which I don’t like so much. I think it’s about them being adaptive in a different way when they need to go into one of those responses. And it’s for us to understand that and adapt to that in many ways. And to, as I said, to honour that response within a child. None of us go through the world socially engaged all the time. You know, it’s it’s a matter of shifting arousal states all the time. And and that’s just being that’s just being human, because I think the other the other side of Porges’s theory as well, which is not around those lower down, kind of more protective responses of mobilisation and demobilisation, but a wonderful states of things like play, that is again, Porges will say that’s neural exercise for the brain ’cause as kids play, what they’re doing is their turn-taking and they’re looking towards the other to to check out the state that they’re in. And what they’re doing in themselves is their, Porges talks about players being a combination of the social engagement system, but also the mobilised system. Because, you know, think about a child moving around as they play. They’re practicing with that, that vagal break, that connection into their heart of allowing, allowing it to go off a little as they write, as they do a little run over to that corner of the garden or whatever. And then coming back with a ball, let’s say, to throw to, to throw to their mom or their carer or whoever. Yeah, play’s really important. Really important for that embodied brain I suppose. Yeah.

Sophie Guy [00:18:01] Yeah. I’m curious to know whether this understanding – did that start to shift the way that you worked with families and with children. Could you talk a little bit about that?

Chris Cussen [00:18:13] Yeah. I think it’s, well through these understandings of the way what we bring to sessions and what kids and and parents and carers bring into sessions. The states of our nervous systems like there’s, there’s some kids with, oh this one kid that I’m thinking of, ’cause I know I have to be extra strong in my social engagement zone. I can’t be, you know, going out towards a mobilised state at all because I know that when I walk to the wait room, the first thing that I am clocking is how’s the arousal state in this child today? What are we starting off with here today? And it starts from that point, not when that child comes into that room, but from that point. As I go out there, I have to hold in my social engagement zone as much as I can to try and help that child not slip into a protective response. And if they do, I have to go with that, not demand social engagement. I mean, this comes down to even talking with the person that that child will first see as they come into the space, you know, who sits on reception in your therapy rooms? What kind of greeting does that child receive? Sometimes when they come in with hoods over their heads, a giant big cheesy smile and a, you know, “hey, how’s it going?” Is not what that child might need at that point in time. It comes down to even thinking about the offerings that we have in our spaces for children. The built environment that children are in is always kind of the silent partner there. So our relationships and the people around them are most important. But there’s other elements that come in as well. You know, every now and then I’ll hear a mower going from a neighbour next door and I might hear it only as a small noise, but for a child that has experienced trauma, that might be starting to feel some activation. Those low predator kind of noises, low register noises are associated with predator sounds and kids that are starting to move into kind of more protective zones of mobilisation or immobilisation, they will tune in to those noises much more than the register of talk that is only a tiny zone. So thinking about those offerings is really important as well. Have we got things for children to do if they go into a mobilised state? You know, we have-

Sophie Guy [00:20:50] What sorts of things are helpful?

Chris Cussen [00:20:51] Things like big fit balls. You know, those big gym balls that kids can kind of bounce on. [Okay]. There’s some rooms that we have that are bigger than others. So there’s some kids that I will see that I’ll book them into, I’ll make sure that we always have a larger kind of space. One kid that I used to work with a lot, it was basketball for him. So he loved basketball, but also it was my cue to knowing that, okay, he’s needing to, he’s got some energy that’s coming up here, this is what he’s needing to do now, this is not, this is not talk time now, this is this is for him to shoot little basketballs until the little basketball ring that sits on the back of the door kind of thing at that point, so offerings in in those kinds of ways are important. Little fiddle toys that sit in the middle of of the room say. So most of our rooms have little sensory boxes in them so kids can have something to do with their hands. Sometimes the sand tray, even if kids don’t use symbols in it. I’ve had kids that just like to sit next to the sand tray and run their hands through it. And that can be helpful for them. Really it’s about learning the child and there’s no one-answer ever. And there’s no silver bullet. And we do the best that we can to continue to kind of join with our kids and then honour their responses, whatever they are and what they need at the time. Yeah, but it’s it’s not it’s not a perfect science. Yeah. I think that this this theory gets translated really well into the, you know, the window of tolerance, the Dan Siegel, Pat Ogden kind of concept. And lots of people have borrowed it and referred to it. It’s not actually about… a lot of people have wrongly thought about it as like it’s when you have too much emotion in your body, you know, you go out of your window in that way. But it’s more about the intensity of the feeling and the energy that we can process and integrate, basically.

[00:22:47] So for all of us, that will be different. We’ll all have different kind of bandwidths basically of our windows that we move in and out of. If we think of the window as like the same as as Steven Porges’s social engagement system. So when we are in the window, we can socially engage with others and we feel relatively calm and relaxed and socially engaged with those around us. When we kind of stray towards the edges of those windows, and head off above or below them, we lose our our sense of being with others in some ways and we are protecting ourselves in different ways. So if we go above the window, we are in a mobilised kinds of, kind of state. Too much energy, I can’t integrate it, I can’t work with others to help me to integrate it, I’m on my own here, I need to do whatever I need to do here before I can come back down into this window again. For those that are under, that’s more associated with the immobilised state. So that collapse, that submission, that lack of energy within the body, so let’s say, sometimes I’ll use that as a translation and I find that works really well for kids and will even draw it. So we’ll draw it up as this is this is what little Sarah’s window, okay? This is Sarah’s window of tolerance. Actually, I was I was doing some work with a little girl. I will call her Sarah. She was about seven a while back. And I went out to do a home visit because we always do that before kids come in to see us. And the carer and Sarah had a whole lot of cats, like heaps of cats. And some of the cats were really quite slow and sat around, and other cats, there was one cat in particular called Tiger, that never stopped moving. So as I was there, Tiger just zoomed around the room and we kind of laughed about Tiger. And then there were other cats that were kind of in the middle of that.

[00:24:39] And that was, that was an easy, beautiful translation of the polyvagal theory using the window of tolerance for Sarah because she associated being in her window with being the middle cat. The cat that wasn’t too fast and wasn’t too slow. She associated being above her window with Tiger. Tiger, who never stopped moving. And I really liked the way of thinking about that because it made complete sense to her. And that’s not saying that when you’re above your window, that’s wrong. That’s the wrong bit, you need to be within your window. It’s just saying, oh look, we’re in the Tiger zone now. I feel like in the Tiger zone now. And we made kind of just a laminated piece of paper with a picture of Tiger above the other picture of the middle cat in the, in the social engaged window and another cat in the immobilised zone. Her area to work with was that mobilised to social engagement, we weren’t, we weren’t needing to working with immobilisation at all. So we were sitting with those pieces. And what the carer would do at home was she put it up on the fridge. And every now and then, when she felt that little Sarah was headed off into a Tiger zone, she’d go and she’d put a fridge magnet they agreed upon into that Tiger zone, and that would give this little girl a sense of where she was at because for our kids that have that have a shift to have a shifting arousal states like this, it’s not, they don’t necessarily have awareness that this is going on for them. So it’s really helpful to get feedback from those around us, but in a way that they can easily take on. We worked as part of a care team with Sarah’s teacher at school and Sarah’s teacher at school took on this window of tolerance idea as well and had it in the classroom.

Sophie Guy [00:26:24] And what sorts of things in that example would help her get back into that window of tolerance?

Chris Cussen [00:26:29] Again, that building relationship with her and being socially engaged with her for longer periods. We did things like little visualisations and calming exercises to help with that kind of, that heart rate, that vagal break again. But then sometimes she would need to move, so she’d need to get up and move around the room. And she would do that and then she’d come back again. Basically, we just grew and grew in terms of the time that we could spend in that socially engaged zone. But what was really good about it, I think, was it gave a shared language for home, for school and for the counselling room that meant that Sarah’s worlds made more sense for her, all through. So everyone was giving her the same messages. It’s letting the child lead in lots of ways and following their their cues and where they’re at. So once where we found our way more solidly into that middle zone, then it was about helping her to extend her window out, that bandwidth to kind of open it up as much as we could and that look like her being able to cope with more, you know, changes in routine and stuff. In the beginning, it was really hard for her when anything was different. You know, if a teacher showed up, relief teacher, that was going to be a a hard day for this little girl. Down the line, the school and you know, we’d worked out ways to prepare her for that kind of stuff, but also her bandwidth was kind of wider and she was able to kind of integrate more of those different kind of experiences that came up for her. So, [okay]. Yeah, this is never a switch, this is a process and this is a two steps forward, one steps step back kind of proposal. And it’s a, it’s best thought of I think as a team effort, that team around the child is so important.

Sophie Guy [00:28:25] For practitioners listening to this who aren’t particularly familiar with polyvagal theory, what do you think are sort of the one or two key takeaways about it that could perhaps inform their practice or just to to learn a bit more about it?

Chris Cussen [00:28:40] One, I think that we are all organised to protect ourselves at every point so that, you know, even if a child is swinging from the rafters, that is not necessarily and probably not at all a cognitive choice that they have made. It’s, it’s a way that they’re being in the world at that point in time to keep safe, probably. So that that shift is big away from this idea of maladaptive behaviours. You know, what kids do and what they show us is adaptive and their behaviours make even more sense when you come to understand the hard things that they’ve been through in their lives. I think I think that that’s that that’s a really big one that we need to honour what kids’ bodies and the kind of systems show us that they need. On the other side of it, again, that other side, that protection being one side, connection being the other side. Don’t forget just to play, don’t forget just to find, sit and find joy with children when you can sit and draw with them, sit and follow their lead in that kind of way. If you can do that with them, that is not frivolous, that is not something that we do as a warm up. You know, before we start doing the work, you know? That is neural exercise. As Porges will say, that is helping them with their social engagement, but also with their mobilised system, that is helping those systems work together in the best possible way.

Sophie Guy [00:30:14] Great. I could easily keep talking and ask you things, but I’m going to leave it there.

Chris Cussen [00:30:19] Okay.

Sophie Guy [00:30:21] So thank you very much, Chris for coming in and talking to me.

Chris Cussen [00:30:23] Thanks so much for having me. I really had fun. Thanks.

Sophie Guy [00:30:27] Great. Thank you very much.

[00:30:29] Thank you for listening. Be sure to check out the show notes for links to further information and resources on today’s topic.

Narrator [00:30:37] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.