Nervous system and rest
Every skill sits on top of a state. When you are settled, you can learn, load and recover. When you are on alert, the same exercise costs more and teaches less. When you are shut down, nothing goes in, and pushing harder makes it worse. I pay attention to which of these you are in before I ask anything of you, because regulation, rest, sleep and pacing are the base under all the rest.
I work with a framework called interpersonal neurobiology. In plain words, it says mind, body and relationships are one system, and that how care is offered matters as much as what is offered. For you, that shows up as pace, explanations, check-ins, and a question I keep coming back to: would you like me to explain more, show you, or pause? You do not need to learn the theory to take part. You can ask what a finding means, why I am proposing something, and what else we could try.
The framework suggests questions. It is not a substitute for an examination, a plan built for your condition, or evidence about whether an approach works. The posts filed here are about recovery, sleep, pacing and the state you bring to each session.
For clinicians
Interpersonal neurobiology, as Siegel frames it, treats integration as linkage among differentiated parts. Schore's work on implicit, nonverbal communication informs how I attend to pace, explanation and check-ins. I keep three kinds of evidence separate: a framework suggests a question, a study investigates an outcome, and the client's own report describes experience. Research on the rehabilitation relationship reports associations with outcomes; that does not show that a particular phrase or style improves a particular injury. I use the words settled, on alert and shut down with clients, and I do not name a state from posture or expression alone.
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Sources
- Siegel DJ. The Developing Mind, third edition. 2020.
- Schore A. Right brain-to-right brain psychotherapy: recent scientific and clinical advances. Annals of General Psychiatry. 2022;21:46.
- Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Physical Therapy. 2010;90(8):1099-1110.
- Panksepp J. Affective Neuroscience. Oxford University Press; 1998.