The power of co-regulation in adult psychotherapy: a vital tool for emotional healing

Sally Edwards, Psychotherapist

In adult psychotherapy, co-regulation is a powerful and transformative tool for emotional healing. This concept, fundamental to trauma-informed care, involves a therapist providing emotional support that helps a client regulate their emotions. As we delve deeper into the importance of co-regulation, it becomes clear why this approach is gaining traction in mental health treatment.

Understanding Co-Regulation in Adult Psychotherapy

Co-regulation is more than just a technique; it is a foundational element of effective therapy. According to Dr Stephen Porges, a leading neuroscientist in the field of emotional regulation in mental health, co-regulation is “the neural process that enables individuals to coordinate their physiological and behavioural states with others” (Porges, 2011). In psychotherapy, this means creating a safe, attuned interaction between therapist and client that supports emotional stability.

Many adults seeking psychotherapy struggle with dysregulated emotions due to various factors:

• Trauma experiences
• Chronic stress
• Mental health conditions such as anxiety or depression
• Personality disorders

A study by van der Kolk (2014) found that up to 89% of clients in outpatient mental health services have experienced at least one traumatic event, highlighting the prevalence of trauma-related emotional dysregulation. Co-regulation becomes crucial in these cases, offering a pathway to healing and emotional balance.

The Science Behind Co-Regulation

To understand co-regulation, we must first look at the brain’s role in emotional responses. The interaction between the limbic system (responsible for emotional processing) and the prefrontal cortex (involved in executive function and regulation) is key to emotional regulation.

When a person experiences stress or trauma, the limbic system can become hyperactive, overwhelming the prefrontal cortex’s ability to regulate emotions. Co-regulation helps to restore balance by activating the prefrontal cortex and calming the limbic system through interpersonal connection.

Recent neuroscientific research supports the effectiveness of co-regulation in psychotherapy:

• A study by Imel et al. (2014) found that therapists who matched their vocally encoded emotional arousal to that of the client were perceived as more empathic by both clients and objective observers.
• Bryan et al. (2018) demonstrated that the degree of mutual influence in emotional arousal between therapist and client was positively related to a deeper emotional bond during crisis intervention.

The Role of the Autonomic Nervous System (ANS)

Co-regulation has a direct impact on the autonomic nervous system, which controls involuntary bodily functions and plays a crucial role in stress responses. According to Porges’ Polyvagal Theory, co-regulation helps shift clients from a dysregulated “fight-or-flight” state (sympathetic activation) to a calmer, more balanced state (parasympathetic activation). This process is a key aspect of nervous system regulation in psychotherapy. A study by Geller and Porges (2014) found that therapist-client interactions characterised by warmth and attunement were associated with increased heart rate variability (HRV) in clients, a marker of improved ANS regulation. This physiological change supports emotional stability and openness to therapeutic interventions.

Attachment Theory and Trauma Recovery

Attachment theory, pioneered by John Bowlby, provides another crucial framework for understanding co-regulation. Many psychotherapy clients have insecure attachment patterns stemming from early life experiences, which can make self-regulation challenging. Co-regulation in therapy offers a corrective emotional experience, allowing clients to experience secure attachment within the therapeutic relationship. This can gradually reshape their internal working models of relationships and enhance their capacity for emotional regulation.

A meta-analysis by Bakermans-Kranenburg et al. (2003) found that interventions focused on increasing parental sensitivity and attunement (similar to co-regulation in therapy) were effective in improving attachment security in children. This principle extends to adult therapy, where the therapist temporarily serves as a secure base for emotional regulation in therapy.

Implementing Co-Regulation in Psychotherapy Practice – Practical Techniques for Therapists

To effectively implement co-regulation, therapists can employ various techniques:

• Attuned listening and non-verbal cues: maintaining eye contact, mirroring body language, and using facial expressions to convey understanding.
• Using a calm, steady tone of voice: this helps to soothe the client’s nervous system and model emotional stability.
• Mirroring and validating client emotions: reflecting back the client’s feelings and experiences to demonstrate empathy and understanding.
• Breathing exercises and grounding techniques: teaching and practising these skills during sessions to help clients manage acute distress.
• Somatic awareness: both therapist and client develop the capacity to notice moment-by-moment changes in sensory experience, such as tension, temperature, or energy levels.

The Importance of Therapist Self-Regulation

For co-regulation to be effective, therapists must prioritise their own emotional regulation.

This involves:

• Practising mindfulness and self-awareness
• Engaging in regular self-care and stress management
• Seeking supervision and personal therapy when needed

A study by Norcross and VandenBos (2018) found that therapist self-care was positively correlated with better client outcomes, highlighting the importance of therapist well-being in effective therapy.

Benefits of Co-Regulation for Building Client Resilience in Therapy and Recovery

The impact of co-regulation extends far beyond the therapy room:

1. Reduces emotional overwhelm: clients experience a sense of emotional safety in therapy, allowing them to process difficult emotions without becoming overwhelmed.
2. Builds resilience over time: repeated experiences of co-regulation strengthen a client’s ability to self-soothe. A longitudinal study by Pencea et al. (2020) found that baseline emotion regulation difficulties were associated with increased PTSD severity over time.
3. Supports long-term emotional independence: co-regulation serves as a stepping stone towards self-regulation, an essential skill for mental health recovery strategies.
4. Enhances interpersonal relationships: the skills learned through co-regulation in therapy can be applied to other relationships, improving overall social functioning and support networks.
5. Provides opportunities for new experiences: co-regulation in psychotherapy offers clients new, socially learned experiences of connection, attunement, acceptance, and compassion, helping to foster emotional intelligence in psychotherapy.

The Future of Co-Regulation in Psychotherapy

As research continues to demonstrate the effectiveness of co-regulation in adult psychotherapy, it is clear that this approach should be a standard practice in mental health treatment. By emphasising the importance of the therapeutic relationship and attunement, co-regulation offers a powerful tool for addressing the root causes of emotional dysregulation and fostering long-term healing.

Additionally, mental health interventions for trauma recovery that integrate co-regulation techniques can improve treatment outcomes, helping clients navigate the complexities of emotional dysregulation with greater ease.

How do you see co-regulation shaping the future of psychotherapy? Share your thoughts and experiences in the comments below, and let’s continue this important conversation about the evolution of mental health care.

References

1. Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129(2), 195-215.
2. Bryan, C. J., Rudd, M. D., & Wertenberger, E. (2018). Individual and dyadic relations between emotion regulation and suicidal ideation. Suicide and Life-Threatening Behavior, 48(1), 18-28.
3. Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178-192.
4. Imel, Z. E., Barco, J. S., Brown, H. J., Baucom, B. R., Baer, J. S., Kircher, J. C., & Atkins, D. C. (2014). The association of therapist empathy and synchrony in vocally encoded arousal. Journal of Counseling Psychology, 61(1), 146-153.
5. Norcross, J. C., & VandenBos, G. R. (2018). Leaving It at the Office: A Guide to Psychotherapist Self-Care (2nd ed.). Guilford Press.
6. Pencea, I., Munoz, A. P., Maples-Keller, J. L., Fiorillo, D., Schultebraucks, K., Galatzer-Levy, I. R., & Rothbaum, B. O. (2020). Emotion dysregulation is associated with increased prospective risk for chronic PTSD development. Journal of Anxiety Disorders, 71, 102199.
7. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
8. van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.