Your writing has stirred my integrity. I am not just questioning the theory or picking sides, but listening to my own process, learning how to find my own solid ground as a therapist, which is, ultimately what I am helping my clients do. I am grateful for the opportunity to step back and consider what it is that led me to embracing PVT in my work and life. And there are some questions there around supremacy and appropriation. But also there is a real fundamental thing that happens for therapists around proving one self and legitimizing through being aligned with some “expert” theory or intervention. There is a celebrity effect problem in our field that is often poking/stoking some of my intergenerational trauma story. This public exploration and argument is helping me lean towards my own health and regulation so I can keep supporting others with authentic wisdom and skill. Your engagement has helped me remain a witness to myself instead of being swept into confusion.
Hi Julianna, thank you so much for sharing what all this stirred in you. I am glad if it was helpful in some ways although maybe challenging experience. For some reason there is so much energy around this topic and I am still to fully understand why. Thank you. Ana 🙏
I’d like to go back to an earlier post you made re the amygdala and patterns of self-regulation, network activity that is all ‘sub-conscious’. And thinking of your point of ‘not shooting the messenger’, the vagus nerve is some 80% afferent, it’s interacting with myriad parts of the brain (hence the name vagus), let’s not attribute functions to it that it doesn’t have. Perhaps the key idea here is how does our system respond to ‘novelty detection’? This response is predicated on memory and its very close affiliate, predictive processing. Something Andy Clark has discussed very accessibly in his work ‘The Experience Machine’. As clinical practitioners, we have a legal and ethical responsibility to be well informed when we ‘intervene’. When someone’s experience is uncomfortable, the Vagal systems will feed into the brain that something is amiss (cue the amygdala’s hub of network interfaces) and likely the predictive meaning-behaviour we can get up to will ascribe a cause. This predictive behaviour is something both clients and therapists use to guide our ethical behaviour choices, clinicians will have a theory of what’s happening and to varying degrees, so will the client. It’s how we justify them that’s at issue not whether pragmatic interventions are available. I keep returning to an axiom a teacher once gave me, ‘learn lots and know nothing’. D.T. Suzuki’s lovely turn of phrase comes to mind here, learn to cultivate a ‘Beginner’s mind’.
It is so interesting how so many clinicians came to view PVT as synonymous with "working with the ANS". As time goes on, I would love to hear more of your thoughts on how that came to be (perhaps you've already written on this?)
As a side note, as an early career clinician who has opted to minimize institutional affiliations, it is always such a breath of fresh air to see others taking that same path while elevating our field.
Hello fellow free lancer here and nice to connect. And thank you for leaving the comment. Yeah I am totally unaffiliated and work for myself - other than belonging to the general professional body. I have some ideas re your question, but I wonder what is your take? Ana
Thank you for asking! I will admit that I am only loosely familiar with PVT. I've never felt pulled to get more specific than "the brain is a part of the body" when giving psychoed on the value of somatic work in therapy. That being said, there does seem to be something to the rule of threes. In CBT we have the cognitive triad. Fight/Flight/Freeze has a nice ring to it. The three part Ventral/Dorsal/Sympathetic is comfortably familiar through that lens. Sometimes things sound so good that they "must" be true. That is my armchair take.
I think indeed three seems to be the magic number, there is also attachment theory classification. I never thought about it! To answer your question, I have never written about this, I think there might be several strands to the explanation - one being that taking ANS into account in therapy, and when I say the ANS I mean the levels of sympathetic arousal, and I think that is a powerful addition to therapy that does not exist in more traditional approaches but it got conflated with PVT. Second, I think there is issues of power and hegemony, that I talk about a little bit in the original piece. That's my 2 cents anyways.
Hi, Ana, I'm with you all the way! While pklyvagal teaching points towards good practices, the explanation is not well supported. Neither is the idea that alcoholism is due to an allergy to alcohol. For that matter, much of the current "wisdom" about the brain anatomy of emotional problems does little to illuminate those problems. After all that, I do want to put in a plug for the way the subconsious mind processes information as a helpful explanatory paradigm. Psychotherapy seeks primarily to change how the subconscious mind processes information and generates maladaptive patterns, while therapy seeks to trade those for better ones. See my brief explanation here: https://howtherapyworks.substack.com/p/making-psychotherapy-as-simple-as?r=4hggtp.
The distinction you’re making between clinical usefulness and scientific accuracy matters. A framework can help people make sense of their experience without every proposed mechanism being empirically settled, but problems start when metaphor gets presented as biology. It makes sense that critique lands hard when a model is tied to identity or recovery, but inquiry and usefulness don’t have to be enemies.
You have handled this very eloquently. I have struggled to know how to respond to people who have argued the points that weren't actually contested, or made out it is a moot point because an alternative theory isn't offered. I've felt uncomfortable in the process, especially as I'm not in a position to argue the nuances of neuroscience. I'm going to simply direct them to your article moving forwards!
I wish I had something intelligent and considered to say... but I feel compelled to comment that that is a very cute paper tiger drawing in the cover image.
(Also, keep writing Ana! I thoroughly enjoy learning about what is, and is not, neuroscience in therapy.😄)
I like all of points except that any therapeutic modality that has been debunked shouldn’t be used no matter how meaningful someone finds it. Ana, if you would copy edit, your message would be even more powerful.
Your writing has stirred my integrity. I am not just questioning the theory or picking sides, but listening to my own process, learning how to find my own solid ground as a therapist, which is, ultimately what I am helping my clients do. I am grateful for the opportunity to step back and consider what it is that led me to embracing PVT in my work and life. And there are some questions there around supremacy and appropriation. But also there is a real fundamental thing that happens for therapists around proving one self and legitimizing through being aligned with some “expert” theory or intervention. There is a celebrity effect problem in our field that is often poking/stoking some of my intergenerational trauma story. This public exploration and argument is helping me lean towards my own health and regulation so I can keep supporting others with authentic wisdom and skill. Your engagement has helped me remain a witness to myself instead of being swept into confusion.
Hi Julianna, thank you so much for sharing what all this stirred in you. I am glad if it was helpful in some ways although maybe challenging experience. For some reason there is so much energy around this topic and I am still to fully understand why. Thank you. Ana 🙏
This is one of those moments where you can see the difference betweentruth-seeking and belonging-seeking.
When an idea becomes culturally embedded, questioning it can feel like questioning the people who found relief in it.
That’s where discussions stop being about evidence and start being about identity.
I respect your willingness to sit in that tension.
Wanting scientific clarity doesn’t have to erase compassion.And lived benefit doesn’t automatically make something scientifically sound.
Both can be true at the same time.
Conversations get healthier when we can hold that complexity without collapsing into camps.
I’m absolutely with you on this one. Thank you for reading and for engaging.
I’d like to go back to an earlier post you made re the amygdala and patterns of self-regulation, network activity that is all ‘sub-conscious’. And thinking of your point of ‘not shooting the messenger’, the vagus nerve is some 80% afferent, it’s interacting with myriad parts of the brain (hence the name vagus), let’s not attribute functions to it that it doesn’t have. Perhaps the key idea here is how does our system respond to ‘novelty detection’? This response is predicated on memory and its very close affiliate, predictive processing. Something Andy Clark has discussed very accessibly in his work ‘The Experience Machine’. As clinical practitioners, we have a legal and ethical responsibility to be well informed when we ‘intervene’. When someone’s experience is uncomfortable, the Vagal systems will feed into the brain that something is amiss (cue the amygdala’s hub of network interfaces) and likely the predictive meaning-behaviour we can get up to will ascribe a cause. This predictive behaviour is something both clients and therapists use to guide our ethical behaviour choices, clinicians will have a theory of what’s happening and to varying degrees, so will the client. It’s how we justify them that’s at issue not whether pragmatic interventions are available. I keep returning to an axiom a teacher once gave me, ‘learn lots and know nothing’. D.T. Suzuki’s lovely turn of phrase comes to mind here, learn to cultivate a ‘Beginner’s mind’.
It is so interesting how so many clinicians came to view PVT as synonymous with "working with the ANS". As time goes on, I would love to hear more of your thoughts on how that came to be (perhaps you've already written on this?)
As a side note, as an early career clinician who has opted to minimize institutional affiliations, it is always such a breath of fresh air to see others taking that same path while elevating our field.
Hello fellow free lancer here and nice to connect. And thank you for leaving the comment. Yeah I am totally unaffiliated and work for myself - other than belonging to the general professional body. I have some ideas re your question, but I wonder what is your take? Ana
Thank you for asking! I will admit that I am only loosely familiar with PVT. I've never felt pulled to get more specific than "the brain is a part of the body" when giving psychoed on the value of somatic work in therapy. That being said, there does seem to be something to the rule of threes. In CBT we have the cognitive triad. Fight/Flight/Freeze has a nice ring to it. The three part Ventral/Dorsal/Sympathetic is comfortably familiar through that lens. Sometimes things sound so good that they "must" be true. That is my armchair take.
I think indeed three seems to be the magic number, there is also attachment theory classification. I never thought about it! To answer your question, I have never written about this, I think there might be several strands to the explanation - one being that taking ANS into account in therapy, and when I say the ANS I mean the levels of sympathetic arousal, and I think that is a powerful addition to therapy that does not exist in more traditional approaches but it got conflated with PVT. Second, I think there is issues of power and hegemony, that I talk about a little bit in the original piece. That's my 2 cents anyways.
Thank you so much for sharing and engaging! You make great points.
Hi, Ana, I'm with you all the way! While pklyvagal teaching points towards good practices, the explanation is not well supported. Neither is the idea that alcoholism is due to an allergy to alcohol. For that matter, much of the current "wisdom" about the brain anatomy of emotional problems does little to illuminate those problems. After all that, I do want to put in a plug for the way the subconsious mind processes information as a helpful explanatory paradigm. Psychotherapy seeks primarily to change how the subconscious mind processes information and generates maladaptive patterns, while therapy seeks to trade those for better ones. See my brief explanation here: https://howtherapyworks.substack.com/p/making-psychotherapy-as-simple-as?r=4hggtp.
Thank you so much Jeffery, much appreciated.
The distinction you’re making between clinical usefulness and scientific accuracy matters. A framework can help people make sense of their experience without every proposed mechanism being empirically settled, but problems start when metaphor gets presented as biology. It makes sense that critique lands hard when a model is tied to identity or recovery, but inquiry and usefulness don’t have to be enemies.
This is a very good summary, and I wholeheartedly agree with your conclusion. Thank you for reading and engaging 🙏
You have handled this very eloquently. I have struggled to know how to respond to people who have argued the points that weren't actually contested, or made out it is a moot point because an alternative theory isn't offered. I've felt uncomfortable in the process, especially as I'm not in a position to argue the nuances of neuroscience. I'm going to simply direct them to your article moving forwards!
Thank you Helen 🫶
I wish I had something intelligent and considered to say... but I feel compelled to comment that that is a very cute paper tiger drawing in the cover image.
(Also, keep writing Ana! I thoroughly enjoy learning about what is, and is not, neuroscience in therapy.😄)
🫶
I like all of points except that any therapeutic modality that has been debunked shouldn’t be used no matter how meaningful someone finds it. Ana, if you would copy edit, your message would be even more powerful.
I know but I don’t know how to do it!