Connection and Co-Regulation in Psychotherapy-Dr. Arielle Schwartz

Discovering Self in Relationship

Connection is at the core of all human experience. We all share the need to be seen and understood. We long to belong and to experience ourselves within the context of loving, nurturing relationships. Sadly, childhood neglect or abuse betrays our trust in others and can impair our ability to form healthy relationships as adults. A history of trauma can also contribute to ongoing experiences of dysregulation of the autonomic nervous system (ANS). The ANS is the part of your nervous system that manages how you respond to stress and allows you to relax in response to environmental cues.

Ongoing emotional dysregulation tends to interfere with our capacity for intimacy, parenting, or meaningful friendships. The concept of co-regulation, also called mutual regulation or social affect regulation, can be defined as the way in which one person’s autonomic nervous system sensitively interacts with another person’s autonomic nervous system in a way that facilitates greater emotional balance and physical health. Simply put, we humans are deeply interconnected with each other and influence each other in a multitude of ways.

“Through a healthy therapeutic relationship, you have opportunities to attend to the relational wounds from your childhood. Co-regulation in psychotherapy provides opportunities for you to have new, socially learned experiences of connection, attunement, acceptance, and compassion. Through somatic psychology we can fine-tune this exchange to find the sweet spot where our deepest healing resides.”
-Dr. Arielle Schwartz

The Original Wound

co-regulation in psychotherapy Dr. Arielle Schwartz

During infancy, your nervous system is dependent upon others to help you feel safe, connected, and calm. Your sense of self was developed through the ways in which you were touched, the quality of eye contact you received, the facial expressions or body language you witnessed, and the voice tones that you heard. If in childhood, you experienced abuse or neglect then it is likely that you suffered from prolonged experiences of emotional dysregulation.

You learn patterns of emotional expression in early childhood. For example, when you felt afraid mom or dad might have become frightened or angry. In this case, such mutual dysregulation interfered with their ability to help you calm down and feel safe. Having caregivers who were dysregulated themselves may have shaped your vulnerable nervous system. This can develop into long-lasting patterns of emotional or physiological distress that get repeated into adulthood.

Co-Regulation in Psychotherapy

Somatic Psychology Dr. Arielle Schwartz

Complex PTSD often arises from prolonged, repeated developmental trauma. These are relational wounds that require a healing relationship to help us reclaim trust in humanity. Psychotherapy that focuses solely on skill building for self-regulation can be limited because this “one-person” approach to therapy is not as transferable to the relational world we live in. We need to shift from a “one-person” approach into a “two-person” psychology (Schore, 2018).

Now, we hold the complexity of two minds and two bodies in a moment-to-moment exchange. Nonverbal communications of both therapist and client such as the body language, facial expressions, and voice tone inform this relational experience. Therapists who are not attuning to their own or their clients’ somatic micro-communications can inadvertently reject subtle longings for connection or moments of rejection expressed by the client.

A buildup of mutual dysregulation in therapy can result in feelings of confusion, frustration, or disconnection. This is the basis of micro-aggressions that can lead to the loss of faith in therapy over time. As affect neuroscientist, Allan Schore states, “Sometimes the largest source of resistance in the therapy room is the therapist’s own resistance to experiencing the emotional and somatic felt experience of the client” (2018, USABP Keynote address). Without co-regulation, these ruptures will not be adequately addressed or repaired in therapy.

Within a relational approach, therapists recognize the inevitability of their mistakes. We are all human, are we not? Through a firm commitment to the process of repair, we can successfully achieve reconnection. Co-regulation in psychotherapy invites the therapist to hold a receptive stance—accepting the client (and themselves) as they are. The result is an atmosphere of compassion that is mutually nourishing.

Co-regulation is Psychobiological

Diversity matters in psychotherapy Dr. Arielle Schwartz

The term “psychobiological” refers to the interconnection between our thoughts, emotions, and sensations. In short, the ways that we think and feel can change our physiology and the ways that we move and breathe can change our thoughts and emotions. This occurs within us as individuals; and, it also occurs in relationship.

The vagus nerve plays an essential role in the way that developmental trauma is both emotionally and physiologically dysregulating. Thevagus nerve is a major mind-body communicator connecting the brain to major systems in the body including the stomach, gut, heart, lungs, throat, and facial muscles (Read up on Porges’ Polyvagal theory). The tone of vagus nerve is learned in early caregiver relationships. When those relationships aren’t safe; the body doesn’t feel safe.

Over time, physiological dysregulation of the vagus nerve can lead to the development of a wide range of symptoms such as anxiety, depression, IBS, migraines, and autoimmune conditions. Regulation of the vagus nerve can reduce the distress associated with these concerns (Read about Vagus Nerve Stimulation).

Co-Regulation in Somatic Psychology

Complex PTSD Dr. Arielle Schwartz

Within somatic psychology, we accomplish co-regulation through the development of body awareness. Within this process both therapist and client develop a capacity to notice moment-by-moment changes in sensory experience. Both begin to pay attention to subtle changes in tension, temperature, or level of energy that provide information about how to pace the processing of a traumatic event(s).

For example, you might notice that while talking about an experience you suddenly become distracted or fatigued. Or, you might notice a pressure building in your chest. Therapists’ own embodied awareness also provides valuable insight. Perhaps the therapist notices somatic sensations that might parallel those held by the client. Rather than over-riding these signals, both therapist and client learn to slow down the process and pay attention.

The therapist offers their attention and safe, calm presence as a resource to the client. As the therapist takes in a deep breath, the client is invited to do the same. Together, they find their way from defensive activation into the warmth of a nurturing connection.

Initially, we orient to a sense of safety by looking around us in order to determine that we are safe. However, eventually it is valuable to draw our attention to inner experience. Dr. Stephen Porges identifies how a sense of safety is a precursor to trauma recovery and allows us to consciously immobilize or deeply rest into support (2018, USABP Keynote address). Through co-regualtion in psychotherapy, we soften our awareness into sensations—and reside in the sweet spot where our deepest healing is possible.

USABP Conference Presentation

Dr. Schwartz presented at the United States Association Body Psychotherapy (USABP) Conference on the Integration of Somatic Psychology with Evidence Based Trauma Treatment. Here are the handouts for this presentation: USABP PTSD Powerpoint Schwartz handouts

Heal and Learn with Dr. Arielle Schwartz

Through the end of December 2018, you can order the EMDR Therapy and Somatic Psychology book directly from W. W. Norton at a 20% discount with free shipping. The coupon code is EMDRSP18 Click here to order.

EMDR Therapy and Somatic Psychology Book Dr. Arielle Schwartz

Want to learn more about healing PTSD?

book-cover

This post offers an excerpt from my book, The Complex PTSD Workbook, now available on Amazon! Click here to check it out.

About Dr. Arielle Schwartz

Dr. Arielle Schwartz

Dr. Arielle Schwartz is a licensed clinical psychologist, wife, and mother in Boulder, CO. She offers trainings for therapists, maintains a private practice, and has passions for the outdoors, yoga, and writing. Dr. Schwartz is the author of The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole (Althea press, 2016) and co-author of EMDR Therapy and Somatic Psychology: Interventions to Enhance Embodiment in Trauma Treatment (Norton, 2018). She is the developer of Resilience-Informed Therapy which applies research on trauma recovery to form a strength-based, trauma treatment model that includes Eye Movement Desensitization and Reprocessing (EMDR), somatic (body-centered) psychology and time-tested relational psychotherapy. Like Dr. Arielle Schwartz on Facebook, follow her on Linkedin and sign up for email updates to stay up to date with all her posts.


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