What Happened to You? The Neurosequential Model with Diane Vines

What Happened to You? The Neurosequential Model With Diane Vines

In this powerful conversation, Janine sits down with Diane Vines, a seasoned clinician and Neurosequential Model practitioner whose work bridges trauma, brain development, family systems, and real-world healing.

Diane has worked with childhood abuse victims and subsequent developmental trauma since 1988. Her approach is far from prescriptive, and she is an innovator when it comes to creative and specific therapeutic treatment.

At the center of this episode is the Neurosequential Model, developed by psychiatrist and neuroscientist Dr. Bruce Perry. Perry’s groundbreaking work helped bring a crucial question into the mainstream: not “What’s wrong with you?” but “What happened to you?” His research and clinical model connect early experience, brain development, stress response, relationships, and healing.

Diane explains why the Neurosequential Model is not a treatment by itself. It is a framework. It helps clinicians understand what parts of the brain and nervous system were shaped by early life, what remains disorganized or underdeveloped, and what kind of support may help create new pathways. For Diane, a once-a-week approach with talk therapy seems like too little time to change your life. So she deeply questions how to keep her patients learning the other 167 hours in a week.

Diane talks about the brainstem, limbic system, cortex, and the importance of working from the bottom up in therapy contexts. She brings new tools to therapy to prevent dysregulation. She also describes how a person’s survival tools may look like symptoms later in life, even though those tools once made perfect sense.

 Janine and Diane also discuss dissociation, psychosis, bipolar disorder, shame, developmental trauma, and the hope of neuroplasticity.

Inside the conversation:

Why the brain is a survival organ

•  How early stress shapes later functioning
•  Why “regulate, relate, reason” matters
•  Why talking may not work until the body feels safe
•  How trauma can affect trust, empathy, connection, and isolation
•  Why relationships are central to healing
•  How therapeutic support can include rocking, rhythm, animals, movement, weighted blankets, occupational therapy, family mapping, and community care
•  Why understanding your history can bring grace instead of blame

 Diane’s work makes the Neurosequential Model feel practical, alive, and compassionate. She shows that treatment does not have to be one-size-fits-all, but it can include the whole person.

This is an episode for anyone who has ever wondered whether their symptoms make sense. Diane’s answer is clear: yes, they may. The brain adapts. The body remembers. And with the right support, new patterns can form.

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Transcript

[00:00] Trauma Through a Life Timeline

Diane: So one of the really cool things about the neurosequential model is we are really encouraged to look at where have you been, what have you lived through, what happened, at what age, and who was there? Were they supportive or were they the source of the problem? And that makes a big difference.

Janine: Yeah, absolutely.

Diane: Because that's the lens and framework through which I see everything, really, everything. Myself, other people.

Janine: Diane is a longtime clinician in private practice. As a marriage and family therapist, she provides both individual and family therapy. She has worked, trained, and specialized in the areas of childhood sexual abuse, incest, and childhood trauma since 1988, and she frequently provides community trainings and case consultations. Ms. Vines has served on many boards, including the Youth Protecting Other Kids board. The term neurosequential model may sound familiar to you. It was created by psychiatrist and neuroscientist Dr. Bruce Perry. Perry teamed up with Oprah, and together they released the book What Happened to You. This was somewhat controversial, proposing the concept that early trauma clearly impacts the developing brain.

And if you can understand anyone's brain development more fully, steps to recovery become more clear, honoring the whole patient. Diane and Dr. Perry extend the neurosequential model beyond young minds. And today we'll talk about how we can get to know our brain at any age.

Diane: My pleasure.

[02:09] What the Neurosequential Model Means

Janine: So perhaps I would just love a simple, I don't know if that fits, but you know, a simple term definition of the neurosequential model, and then perhaps what a healthy developing brain would be like.

Diane: So the neurosequential model is not a treatment. People think it's a treatment. Regulate, relate, and reason: that is the sequence of engagement and it's related to the sequence of processing. The neurosequential model really looks at the interplay of early experiences, that's both good and bad ones, and the people who were there. So the relationships you were in, both good and bad, and neuroscience and neurodevelopment.

So what parts of the brain and nervous system are developing at what times and how, and how all of those together help you develop your stress response system, which has huge impact on lots of areas of functioning in your life, including how you get along with other people, keeping a job, your immune system, all kinds of stuff is related. But that's essentially what it is. And then we look at that and we look at what parts of the brain are developed and organized normally, and what parts are either disorganized or dysfunctional or not developed, underdeveloped. And then your treatment planning targets and mirrors natural organic neural development. So from the bottom up and from the inside out. So your treatment does the same thing.

You go to the lowest part of the brain with the most dysfunction, and you work your treatment plan is designed to work on that. And then when that gets better, then you move up.

[04:39] Bottom-Up Brain-Based Treatment Planning

Janine: So you are moving up from the brainstem and then up into the cortex?

Diane: Eventually, yes. So the way we look at it, and you know, your brain is not a layer cake with these layers, but the neurosequential model uses heuristics. So that's there's simplified tools to help us understand complicated problems. So we look at brainstem, and then there's the diencephalon, which is just above that, and your brain's thalamus is in there, and then the limbic system, and then the cortex. So that's the way your brain develops from the brainstem all the way through those to the cortex. And so when we do a neurosequential assessment, and we look at, okay, so if they are having problems, say in the diencephalon, that's the area where we need to do the most work and do the most treatment planning.

And it's not just for that client, it's we start with a therapeutic web. So who's around them? I mean, who are their teachers, their coaches, do their friends, do they have a faith community they can work with, scouts, any of that? We start there. Then we look at the family. What do the parents need to do, caregivers, and the therapeutic web is also teachers that's included, siblings in the family, any extended family that's there often. Then finally you get to the client. Because when you think about therapy, that's one hour out of 168. The brain needs repetition in order to change. So there's another 167 hours a week where you can be doing things. And sleep is an important part of that because you need to be well rested to do the other stuff.

But I remember working at the child advocacy center, and some of these kids came from some of the most dysfunctional homes, and they were still there. So there's your one-hour therapy a week, and then they go home back to the dysfunction and undo what we just did in that hour. So, you know, you that's why you need everybody working. And then we also have to look at the dose of the interventions that we recommend because you don't want to overwhelm someone. Sometimes a therapeutic dose is, you know, 10 minutes, but it's 10 minutes several times a day, depending on what it is. I think it's really interesting, is that the neurosequential model doesn't just mean therapy. It could be, you know, some things are therapeutic, and that's what we recommend.

You know, sometimes it's a good idea for you to be in martial arts. Sometimes it's a good idea to just get a dog or horseback riding. There's all kinds of I've I've done manicures and sessions with people, but I we play spa manicure, but it's for the therapeutic touch. Oh, okay. So yeah, so there's it you get to have a lot of fun and be very creative. And you have to think about, oh, a lot of times we'll recommend occupational therapy. So what you do depends on what the metric report tells you needs to be worked on, then what they have the resources, time, and interest for, and then you create from there.

[07:38] How Early Stress Wires Survival

Janine: It's amazing. The first two months, there's so much wiring going on. And if the love connection and is not happening, that you're really at a disadvantage in your childhood and potentially your entire life, and that the first six years are so critical to development. So I'm curious about what happens when the stress response and something goes wrong with the stress response.

Diane: So the first thing to think about, this you know, organization development of your stress response system is that your brain is a survival organ. That's why you have it. I mean, all the things it does is keep your body alive. It is designed to make sure it stays alive. And that's why you have a stress response system. And stress isn't necessarily bad, it's simply a demand on a system. If you're thirsty, that's a stressor. So your brain says, we don't want you to hydrate it, that'll kill you, drink something. And so you do. So it's it's the level of stress that determines whether something is traumatic.

The stress response system starts developing in utero, really, and it is organizing itself around the type of environment in which it expects to live or in which it does live. So if you're a baby that is born into a chaotic, a violent household, your whole stress response system is going to be designed to survive in that household with all that madness. Once you're out of it, those are the tools you've developed. And so you look a lot different than someone who came from a peaceful, calm environment. And they really have a broader set of tools because they've been safe enough to develop them. You have not. So you've just had tools for survival. So they look very different.

And the other thing, too, is that it starts very early because in early development, your brain has lots more brain cells, neurons than it's going to need. And there's a process called apoptosis, which happens later. That's cell death. So you get rid of your unnecessary ones, but the ones that you keep are wired together. So the cells that fire together wire together. So if you are in an environment of constant stress and threat and violence or neglect, your brain will wire itself to survive in that. And you wind up jumpy or with neglect. You know, people are just not safe for those people at all. The interesting thing is they need people because we all have an innate need for relationships because humans are social.

That's how the species has thrived. It's it's how we've even evolved in from hunter-gatherer clans. We need each other. And you need the skill to be able to negotiate a lot of different relationships simultaneously. So when everybody in your environment is potentially threatening, you have a whole different stress response profile than someone who can trust other people. And the healthiest people are interdependent. And for you, that's you can't do that because those who you don't know, you can't tell the difference between someone who's safe and someone who isn't. And you wind up doing things on your own. No one's been empathic to you. So you're not that empathic toward them because you don't even know what that looks like.

And it's and you've not experienced it. So there's a whole other way that you present yourself in the world that other people don't. And when they look at you, they're wondering why you're acting crazy. And you're not. There's nothing wrong with your brain, really, when you think about it. It is organized perfectly for the environment from which you came. So what you need are that's what therapy should be, are opportunities to gradually shift and make new neural pathways that are strong enough to override most of the time the previously laid ones. So those brand new ones, it's like pouring wet cement. And then, you know, if you need to make a design or do something else, you can because it's still wet and pliable.

Once it's solid and formed, you need a jackhammer to change it. Well, or it's a lot harder. So that's why the first years are so formative, because that's wet cement. And so therapy, you really have to work at you, you almost, it's almost like erosion in a way. Wear it down gradually, sand it down a little bit until you get what you want. Does that make sense?

[11:55] Why Talk Therapy Can Shut Down

Janine: Yeah, it does make sense. I'm just thinking in comparison to the model that I know better, which is psychotherapy. And you're still going back and looking at looking at your childhood pretty deeply, and certainly trying to get some answers about your life and your worldview and when that started. How would your therapy be different?

Diane: Okay, so first of all, with psychotherapy, it requires you to talk. Now, here's the problem: speech and language are cortical processes, those are at the top of your brain. When you get dysregulated, upset, your brain starts to shut down and function less efficiently, starting at the top, where your speech and language areas are and where you're doing your therapeutic work. So you really need to have a good relationship with your therapist for that to work at all, really. Because the minute your brain says, I've worked with so many traumatized people, and I'm as transparent as I can possibly be, because that helps them stay better regulated.

So I'll ask a question and I can see already, but just by the way they present themselves, facial expression, body language, eye contact, they're trying, they're figuring out, -oh, what should I say? I want the truth. But for them, just thinking about thinking about saying something that feels so vulnerable to someone who could judge you, with a neurosequential model, you will do things like a lot of times we'll do animal-assisted therapy. There's a an organization in Illinois, Gateway Family Services, and they do equine-assisted, trauma-focused, and they're NMT trained. And they use horses so that people can learn how to be in relationship, maybe for the first time or again. So things like that, occupational therapy, because, and I love OT.

I think that stuff's magic. I'm a marriage and family therapist, I have to talk. I'll do things like I love genograms. Those are family trees, and people have to tell you, they have to talk to you, but I'll just ask, well, tell me about your family and you know, how many siblings, who's the oldest? Did your parents have favorites? Was it you? Was it somebody, you know, all the all the things where they live, who got along the best. And it's interesting, it's disarming. It's not people don't feel like I am busy looking for problems. I'm just trying to get to know them. And the way I do it is I sit on the floor. So that changes the feeling of the hierarchy.

I'm not this authority that's telling them or it's gonna judge them crazy or not, because I'm not gonna judge you crazy.

Janine: For children and adults, you sit on the floor? Or just for the children? Both? Okay.

Diane: Mm-hmm. I'll sit on the floor. I have a coffee table in the office, and I have that flip chart paper, and I'll put that either on the floor or on the coffee table, and we'll do a genogram on that. Yeah, but I sit on the floor. I let my clients sit wherever they want in my office. Oh, that's another thing: I have a rocking, rocker, glider, swivel chair in there for people who get really dysregulated because that pattern repetitive, rhythmic, motor, sensory movement you can get from rocking is soothing. That's how EMDR works. So it is soothing and regulating, and it helps them bring their cortex back online. So I'll do stuff like that.

I have a weighted blanket in my office because that level of that deep pressure that a weighted blanket will give you is reminiscent of the intrauterine environment where you're, which is this is fascinating too, where you're always regulated because you're fed first. You're and nobody's bothering you. You're never hungry, thirsty, cold, wet, no one's bothering you really, basically safe and well fed, and you're in the fetal position because you're a fetus and you're rocking because of the maternal heartbeat and the aorta pulsating. And all of those inputs get encoded in the brain as regulated. And because they're in the brainstem, and the brainstem is extremely hard to change because of what it does, and you want it to be difficult to change.

You want to be able to eat dinner, go to sleep, and digest your meal. Brainstem takes care of that. You want to be able to keep breathing and have your heart keep beating. Your brainstem takes care of that. You don't have to, you know, it the small children say, I'm so mad, I'm holding my breath, and you're gonna breathe because your brainstem makes you. So it's hard to override. But when the sensory information from the environment goes into your brain, it arrives low for processing. Do we need to worry about this or not?

And if your lower parts of your brain, like where your brainstem and diencephalon are, say, -oh, then that starts a cascade of events, starting with the shutdown of your cortex, which will talk you out of survival, and you start moving into survival mode. So the locus of control in the brain shifts lower and lower and lower to help you get through and past the threat. Whether or not the threat is actually there.

[17:16] Dysregulation and Fast Ways Back

Janine: I just want to define again, because it's kind of almost like a pop psychology term to be dysregulated. I find it's just kind of thrown around. How would you define dysregulation?

Diane: Okay, so yeah, it's that trauma is another one of those words. There's several of those words where they're so overused, they don't mean anything anymore. Dysregulated means when you are, well, basically you're not regulated. So you are not calm enough to pay attention, pay real attention to what's going on outside of you and inside of you, and not be overwhelmed by it. So when you become dysregulated, it's really you start to worry about, -oh, are we gonna survive this? What do I need to do to survive this? And it's not a um, it's not an explicit thought. It's implicit, and your brain just detects something is wrong and we might need to do something, or something is definitely wrong, and we definitely need to do something, and that's dysregulated.

So, and it and the intensity depends on what's going on.

Janine: Are there some steps there to be regulated again?

Diane: Well, you know, the just like a lot of other things, prevention is worth a pound of cure, ounce of prevention is worth a pound of cure. But so you try to create an environment that is not so stressful that people are dysregulated all the time. So that's prevention. But to get regulated, and people will, you know, the interesting thing is a lot of people organically know what to do initially, which is to get away from a source of the dysregulation. They're sensitized to this sort of thing and they get dysregulated very easily, and they're in a classroom where it's getting noisy and looks like two students may get in a fight, they'll get up and leave. They may just leave. And some the teacher's like, hey, get back here.

I remember working with a kid who and she had a sexual abuse history, and she was 14. They were talking about sexual abuse in class, and she told me that the students around her were saying, Oh, well, I that wouldn't happen to me. I would do this. And she thought, No, you wouldn't. I don't know, I'd do that and I'd do the other. And she kept saying, No, you wouldn't, no, you wouldn't. And she got more and more upset. And then she told the teacher, I need to go to the bathroom. And the teacher said, No, sit down, and she left anyway. So she got away from it. I've seen kids literally run out the door just to get outside. They don't go anywhere, they just sit down, but they're away from that. People walk away from arguments.

Not a bad idea, not a good idea to chase them and keep arguing, but you know, people will do things like that. So the first thing is to get away from the source of the threat. Then, and there are other, there's various things at work, taking a walk, deep breathing. But I know personally for me, I can hyperventilate. So bubbles work though. Bubbles are fun.

Janine: Like animal talking? Okay, so for kids, blowing bubbles. Or do you have adults do that too?

Diane: No, they're fun. Think about how silly it would feel to be blowing bubbles as an adult. Right. And it's playful, it's regulating. So blowing bubbles, let's see what else have I done. I've told people I've seen them about to have a flashback. It's like, oh no, no, go sit in that rocking chair and don't talk anymore. Just rock. Just rock. And I've seen them calm down, and then we can talk about it. There's lots of different things you do. So, but usually it's patterned, repetitive, rhythmic, motor, sensory. It's anything in that realm. And usually a couple of minutes will do it. But the first step is to get away from whatever's setting you off, if you can.

[21:08] Mapping History, Function, and Support

Janine: Yeah, and rhythm is supposed to be very huge. Even dancing, just really being in your body. Do you have to still diagnose people to treat them?

Diane: The interesting thing about the neurosequential model is the way the assessment is divided up is you have part A, which is adverse experiences, starting prenatally and working up to your current age. And then relationships, relational experiences. So who was there? Starting prenatally and then all the way up. You know, even was the pregnant mother supported? Did she even want the baby? That kind of stuff. Then you look at part C, which is current functioning. So parts A and B are historical. Part C is current functioning. And we look at things like your cardiovascular functioning, your neuroendocrine functioning, your attention, suck, swallow, and gag, all these lots of things. And you look at how have they been functioning in the past two weeks?

How well Is this working? And that gets compared ultimately in the report gets compared to a neurotypical person. And so you can see where the differences are and you work with those differences. And then part D is current relational health. And we look at that because who's going to be around to help you do this?

[22:43] Dissociation, Bipolar Questions, and Hope

Janine: Right. Yeah. I mean, who's going to be there the other hours beyond the one hour? Yeah. I mean, sometimes it's almost unrealistic. Like who really is going to have the support system to do it? I think about a lot of just, you know, adults that are struggling don't have that interconnectedness, which is really the path to full healing. So when I started to learn about this, I went, oh, wait, I know there's trauma here. I know I was managing it in high school. And then I know the depression and the psychosis hit in college when I was 20. But when I think back to it, a lot of my mood disorder symptoms were dissociative. And that's how my first psychosis began.

It just was, I was dissociated and I thought I was in a movie and I walked through campus for months believing this. And so I so then I began to think, well, could bipolar just be an expression of different trauma responses that are kind of just rearing their head? Like, is it really, you know, maybe it's just a cluster of these responses. Is could that be? So I got very curious about that. And perhaps that's not great for people to no, I think it is. It's worthwhile thinking about. At the same time, I know the label and the medication, it's all very helpful, and we should all stay on our medication when you're listening to this podcast.

But could this, I started to think the more I did this bipolar podcast, I started to feel less bipolar, if that makes sense. Like I yeah.

Diane: Yeah. No, it does make sense. And again, you know, the symptoms of a lot of different disorders overlap. So the source of them depends on basically your development, really. And what and that would be the source of them. I mean, I don't know enough about your situation to know, you know, to be able to argue with you about it. If you say you're bipolar and you've been diagnosed and your meds work, cool, that's great. And if you have side effects of your medication, then you talk to your doctor about it. And so they can get you on something different. But I think dissociation is very interesting from the standpoint that especially when your trauma is early, like you're a baby, then response in the brain is can we get away from it?

So we fight, flight, or flee. Initially, what we'd really like to do is get away from it, flee first. But if you can't, because you're a baby and you can't go anywhere, you can't get out of a crib, or you can't leave the house, or whatever, any number of things. And what you're undergoing is painful from the standpoint of it literally hurts, or this just this being ignored is so emotionally painful that I can't even be here, then you will dissociate. And if you have to do that often enough to avoid the discomfort of being that dysregulated, that eventually becomes your go-to. You can get there fast. Just I'm gone, I'm gone, I'm gone. And feeling dysregulated enough, you could have a site, what appears to be a psychotic break.

Janine: Wow, this is so much information. This has been so great. And I just, for me, what has been is really hopeful is that it's not, oh, just you know, sitting in the trauma, revisiting it, especially for adults. There's almost this idea that it's bad to go there. I don't believe that, but I think what is exciting is that there is the neuroplasticity that can happen and that we can really change and how so much of it is through personal relationship.

Diane: Absolutely. And you know, the whole reason for going through the trauma is to give you some grace. It's not blaming, it's to give you some grace and then help you not feel so you know, okay, so I'm not crazy. You know how many people have told me that? I'm not crazy. No, you're not. And then to understand how you got where you are, so that now we know how to get you out of this and overcome it. You know, I don't want to prescribe something, even an activity for you that was the source of your trauma. Why do that? And to help you understand, well, of course, this is where you were. If when you go through what you went through, it would be really weird if you didn't end up here.

So the only way to be able to truly say that is to they tell you what they went through. It's like, wow, I'm impressed you're here. That is amazing. That's a testament to your strength and your, you know, what. And so then we have to, then you look in the environment for people who will give you a different set of experiences. And that's the next step is you got to connect with people you can trust and who will accompany you on this journey of healing. Not just me, I'm an hour a week, but you know, you need people out there for the dosing. And you need a different experience of people, as many as you can get, that is a lot more healthy and positive. So you can put the onus of the source of your problem where it belongs.

It was your crazy aunt that you lived with who raised you. It's not that you're so awful that you had to be treated that way. She now, and I do believe this too. She probably did the best she could with what she had. Her best sucked, but it was the best she could do. So it has nothing to do with you. That's a reflection of her, not you. You just have the outcome. So now let's fire her. She shouldn't be running the rest of your life, and let's find some other people that will show you who you really are. Because it's not that. That's the whole point of going through the history to me.

Janine: Right. And that's where the hope lies is with the connection. And so it's very hard to connect if you're if you isolate or have shame around these illnesses. So I'm even interested in routes to being more connected to others. Thank you so much. It's just wonderful to talk about. And I was just thrilled to even like, you know, to get to speak to anyone that's in the network. So I just I'm really, really grateful for that.

Diane: No problem. It's a pleasure.

Janine: Thank you.

Diane: You're welcome.

[28:58] Sharing, Donations, and Tapping App

Janine: Thank you so much for listening to this important conversation with Diane Vines. Please do like and share if you know someone who needs a story today. Just a reminder to sign up for my writing class at bipolarshe.com. I haven't yet released dates, but you'll be the first to know. And also, as I mentioned before, Bipolar She is accepting micro donations to help keep the show going. So please visit buymeacoffee.com/bipolarshe. This episode is brought to you by the Sorba Tapping app created by EFT coach Amy Linsa. For two years, I've been using Amy's app to tap myself to sleep, and it works.

If you're navigating anxiety, trauma, or just trying to feel more grounded, tapping can calm your nervous system and you know get rid of that emotional weight you've been carrying. Visit the Sorba Tapping app and the Apple or Google Play stores and start your journey towards freedom.