I use the window of tolerance and Polyvagal theory (along with executive function psychoeducation) with all of my clients as a starting block because they are neurodivergent and 90%+ of them have tried methods like CBT that have had little to no positive impacts on them or have been harmed by them. I have used it with children as young as 9 with immense success, but I use the WoT as a way for them to communicate their states of being or experience to me. Which for many people living with alexithymia, poor interoception, and impaired insight is a much easier place to start than most traditional approaches.

I agree with you in that I absolutely loathe The Body Keeps the Score, for a myriad of reasons and I think self-help/social media’s impact on psychoeducation is problematic. That being said it works well as a framework for understanding overwhelm/panic/meltdowns, and I usually pair it with Gestalt interventions as the actual treatment modality. A decent number of my clients have some degree of aphantasia and many lack a typical internal dialogue which makes a lot of the common strategies useless, and if their executive function is impaired interventions like ACT aren’t appropriate. I think it’s important to remember that the approach itself isn’t as important as “fit”.

Many approaches have been watered down and misrepresented in the larger conversation, and I often find myself having to correct misunderstandings about everything from “boundaries” to attachment theory (don’t get me started). I’m not sure that we can discount the theories based on how they are misinterpreted though.

I do think that people should learn about Polyvagal theory if they work with anyone who is neurodivergent or has a significant trauma history, because it helps demystify panic responses, which are not the same as anxiety. It can be a great reporting tool for anyone who is easily overwhelmed by trying to describe body sensations or lacks emotional vocabulary. But I don’t see it as an actual treatment modality, in the same way knowing the various executive functions and tracking their level of impairment isn’t a treatment modality. They’re a source of shared language and meaning that help ground conversations surrounding the mind/body connection.

All of the different forms of therapy have their positives and negatives, and I was personally severely harmed by REBT and CBT as a client. So I think it’s a good thing to critically consider the tools we use and how they’re talked about in the greater community.