April '25 Clinical Supervision Topic: Unconditional Positive Regard (and Polyvagal Theory)
Most of us became therapists or social workers because we wanted to be a safe place for people. We wanted to offer deep presence, acceptance, and care, especially for clients who hadn’t received much of that elsewhere. In grad school, we learned about unconditional positive regard as a cornerstone of ethical, client-centered work.
But we didn’t always learn what makes it possible.
Unconditional positive regard (UPR) isn’t a personality trait. It’s not something you’re born with, or something you summon through sheer clinical willpower. It’s a physiological state. One that depends on your nervous system feeling grounded and safe enough to offer warmth, curiosity, and steadiness, even in the face of complexity, pain, or rupture.
Polyvagal theory gives us language and structure for this. It helps explain why sometimes we can access that steady, accepting presence, and other times, we just... can’t.
UPR Lives in the Ventral Vagal System
According to polyvagal theory, the part of the nervous system that allows for connection and openness is called the ventral vagal system. When we’re in this state, we can be flexible, attuned, responsive. We’re able to offer real empathy, not just because we should, but because we can.
This is the ground where unconditional positive regard can actually take root. But we don’t live there all the time. Neither do our clients.
When Our Nervous System Says “Nope”
Sometimes we move into sympathetic activation—urgency, irritability, anxiety. Other times we collapse into dorsal shutdown—numbness, dissociation, going through the motions.
In either case, we’ve left ventral. It becomes much harder to feel open or generous. We might start reacting instead of responding. We might get stuck in judgment, resentment, performing, or clinical detachment. We might feel off and not know why. And when we’re not in ventral, our clients’ nervous systems are picking up on it.
Moving out of ventral isn’t a personal failing. It’s neuroception, our body’s built-in system for scanning safety and danger. It operates below conscious awareness, and it’s trying to protect us.
What Gets in the Way of UPR?
Clients whose stories stir our own trauma
Behaviors that feel defensive, rigid, or rejecting
Sessions where we’re running on fumes
Work environments that don’t feel safe or supportive
Old countertransference that hasn’t been metabolized
Even if we want to offer unconditional positive regard, it can be hard to access in certain moments. Especially when our own system is activated, depleted, or trying to manage threat.
So What Helps Us Get Back?
The question isn’t “How do I offer UPR all the time?”
It’s: How do I return to presence when I’ve left it?
Soften your shoulders, jaw, or breath
Slow down the pace of the session
Let silence stretch for a few extra seconds
Privately acknowledge you feel distant or stuck
Use rituals or grounding before and after sessions
Tend to your body’s needs, not just your clients’
UPR doesn’t mean self-sacrifice. It doesn’t mean dissociating from your own responses in order to be a “good therapist.” It means working with your body, not against it.
A Closing Word
If you’re struggling to feel warmth with a client, or if you’ve found yourself moving into judgment, withdrawal, or shutdown, that doesn’t mean you’re failing.
It means you’re a body, a nervous system.
And your body is giving you information.
That’s not in the way of the work. That is the work.
Unconditional positive regard isn’t a fixed quality we either have or don’t. It’s a state we return to—again and again—through the pathways of our nervous system. When we’re anchored in a ventral vagal state, we have access to warmth, curiosity, and flexibility. We can see the whole person in front of us, not just their symptoms or survival strategies.
But ventral isn’t a permanent home. We lose it, often without realizing it. The work is learning how to find our way back.
And the more we practice offering that same regard to ourselves—especially in the moments when we feel disconnected, ashamed, or not enough—the more accessible it becomes to the people we sit with. We don’t offer unconditional positive regard instead of being human. We offer it through our humanity. Through our capacity to regulate, to repair, and to return.
Check out this resource (a short youtube video) and this one (a longer podcast with Deb Dana).
See previous years here.
