Therapeutic Presence: Neurophysiological Mechanisms Mediating Feeling Safe in Therapeutic Relationships

Therapeutic presence involves therapists using their whole self to be both fully engaged and receptively attuned in the moment, with and for the client, to promote effective therapy. In this paper, we present a biobehavioral explanation of how therapeutic presence can facilitate a sense of safety in both therapist and client, to deepen the therapeutic relationship and promote effective therapy. The polyvagal theory is used as a guide to explain how specific features of therapeutic presence trigger a neurophysiological state in both client and therapist within which both perceive and experience feelings of safety. The polyvagal theory proposes that a state of safety is mediated by neuroception, a neural process that may occur without awareness, which constantly evaluates risk and triggers adaptive physiological responses that respond to features of safety, danger, or life threat. According to the theory, when safety is communicated via expressed markers of social engagement (e.g., facial expressions, gestures, and prosodic vocalizations), defensiveness is down-regulated. Cultivating presence and engaging in present-centered relationships can therefore facilitate effective therapy by having both client and therapist enter a physiological state that supports feelings of safety, positive therapeutic relationships, and optimal conditions for growth and change.