Our nervous system is constantly scanning the world looking for cues of danger or safety. Neuroception is our nervous system’s ability to distinguish situations as either safe, dangerous, or life threatening and operates completely outside of our conscious awareness. And man, our bodies are working hard! I have seen statistics anywhere from 11 million to 400 billion bits of sensory data that our bodies take in PER SECOND!
What we also know about our nervous systems is that they can “talk” to one another and provide a co-regulatory capacity with one another. In her book The Polyvagal Theory in Therapy Deb Dana states that “it is through reciprocal regulation of our autonomic states that we feel safe to move into connection and create trusting relationships”. In essence, it is the foundation of safety, which is the foundation of a trusting therapeutic relationship.
OK – so how the heck do we do this when we are not meeting face to face, but screen to screen?
I strongly believe that we can still provide co-regulation and safety cues from afar. Just like when I felt safe and cared for when I entered the world of Mr. Roger’s neighborhood as a child, how I instantly calm at the sound of my mother's voice on the phone or hearing my favorite song OR how I feel as though I am literally going to DIE when watching a horror movie – I believe that we can also take in cues or danger or safety through our screens and at a distance. Below are my tips on how I create safety for my clients I see virtually!
Create A Secure Space
Guarding the safety of the Tele-Play space is crucial. I explain to parents and children that we are going to treat our time together the same as we would in office. Just like a parent would not come into my office to drop off laundry during our play therapy session we need to orient families to take the therapy time as serious and sacred when we are engaging virtually.
I know I definitely would not feel safe if my brother, mother, or grandpa were wondering around in the background of my intense therapy session. Creating a safe secure space comes from orienting clients, creating expectations, and brainstorming – what do they need to feel safe? What kind of room do they need to meet in? For some clients they may need to be on a different floor, in a room different than their own, or in a room that is locked (when appropriate of course). Oh – and sometimes they need a nerf gun, to be under a table, or in a blanket fort. All of this is wonderful!
One of my favorite statements from my training in Trauma Focused Cognitive Behavioral Therapy was “trauma is chaos – structure is healing”. In her book, Lisa Dion also refers to “the unknown” as one of the four threats of the nervous system. With creating structure we are making the unknown known. Creating structure means beginning and ending your sessions in the exact same way each session so the child knows exactly what to expect. My in-office sessions have this structure, so much so that when I am doing CCPT and making my entry to the playroom statement my clients will say “I know already”. I smile and take this as a huge victory that I have created predictability and structure.
I attempt to create the same structure as I have in my office of a check in and then transition to whatever play therapy modality I am using. The 5-minute warning of our play time being over again serves another anchor point for structure. In Tele-Play sessions I have created an ending ritual of containment of toys and the “wave off” where the child goes to get the parent and we wave as we end the session. In office this usually looks like the consistency and structure of picking from my treasure box, the walk to the lobby, and the wave goodbye. Whatever this looks like for you in Tele-Play create a structure so strong that your clients can read the script for you!
Just like in office therapy – if we are not present and we are out of our window of tolerance our clients will feel that and also become dysregulated. Incongruence is also a cue of danger - we can't just fake it – when you as a therapist are frustrated, anxious, or out of your window of tolerance and trying to say that things are “fine” or put on a smile our clients know that something is off and will start to become anxious or dysregulated. This is also what Carl Rogers would refer to as genuine – a core condition of therapy!
So make your best attempt to figure out what you need in between sessions and during sessions to regulate your nervous system so you can be regulated and genuine. Lisa Dion is fantastic at emphasizing the importance of connecting to and feeling your body as well as discharging nervous system energy through body movement during sessions.
So - does regulating yourself mean eating something crunching between sessions? Swaying and moving during your time with the child? Stretching and going for a quick walk after you click off? Deep breathing or meditation exercises? The great news is there is a gigantic buffet of regulation skills options out there – find what works for you!
Send Social Cues of Safety and Co-regulation
This Co-Regulation Quick Guide is ahhhh-mazing. If you don’t know Justin Sunseri and The Polyvagal Podcast – you need to! Sending out what he refers to as “safe and social cues” is really just good therapy and what most of us do outside of our conscious awareness. BUT doing therapy screen to screen you might need to up your game and your intentionality. The good news is that most of us can see ourselves on camera and we might need to check in once and a while to see what signals we are sending our clients! Sometimes we need to over emphasize a bit so they can pick up our gestures or expressions OR raise our hand gestures so they are on the screen.
So the first safe and social cue I love is vocal prosody – making sure your vocal range goes up and down. In short it is what I talk to parents about having a “kindergarten teacher voice”. A flat monotone voice can actually send a cue of danger. This is why a lot of our clients will say that their parents are “yelling” at them, only to have their parent come back stating that they were simply “asking” them to do something. That monotone voice can really feel like yelling to a lot of the young people we work with.
Other safety cues that are really applicable to Tele-Play are smiles, eye crinkles, and head tilts. Hear me out here – if you are in danger your eyes will be wide open, you will have pursed or flattened lips, and your head will be upright and alert. Definitely ready and activated to take on danger. Relaxed, engaged, and congruent facial expression is a cue of safety – BUT only if you actually feel this way. Remember incongruence is a cue of danger. Also a forward leaning posture can send a social cue of connection, so you may need to figure out how much of your body needs to be seen on camera for clients to pick up these social cues. Lastly - safe, soft, and empathetic eye contact (as opposed to a piercing stare) happens staring directly into your computer's camera. A bit awkward as it prevents you from fully taking in your client's social and facial cues BUT really important for them to see you looking at them.
Because our nervous system takes in so many bits of sensory data per second (see above) visual clutter can be overwhelming. Make sure what your clients see is neat and tidy and if you can go with a wall color that is light and soothing like greens or blues and stay away from bold or activating colors (like orange or red). Tapestries are also an awesome and inexpensive way to create the scenery you might want to hang in the background. Any elements from you can bring in from nature are a huge bonus and if possible use natural light. Art is also really important and pictures of water or nature will have a regulatory effect!
So that’s a wrap of my favorite ways to create safety in Tele-Play sessions directly from Mr. Rogers, The Polyvagal Theory greats, and trial and error! What are your favorite ways that you are creating safety in Tele-Play sessions with clients? Drop a comment below!
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I'm Ann Meehan, an LPCC,