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Co-regulation - The Importance of Practitioner-Regulated Nervous System 

Co-regulation - The Importance of Practitioner-Regulated Nervous System 

Co-regulation is an essential part of childhood development, but what about in adulthood? A practitioner with a regulated nervous system can provide an opportunity for co-regulation and greater self-regulation.

Bit by bit, our people begin to embody the change anticipation of being cared for and treated with kindness and respect. Part of what strengthens this new way of being comes from us having co-internalised one another. We continue to be their reflective companion on the outside, and they will also feel how we continue to carry them with us in our inner world” - Bonnie Badenoch 1

Challenging times call for increased co-regulation and self-regulation. For many of us, calling on practitioners from a range of disciplines for support is one of the kindest and most effective things we can do for ourselves. During a consultation, difficult, even traumatic subjects can and do come up. Having a practitioner that recognises the need to co-regulate in a consultation is a deeply valuable and important skill. Thankfully, most practitioners know the importance of tending to their nervous systems regularly. 

Read on to find out more about co-regulation and why it’s so vital for practitioners to maintain a regulated nervous system. 

What is co-regulation?

We are social animals - and this is a fact of our evolution that keeps us safe. Co-regulation is something we humans learned to do during our evolution. As humans developed a ventral vagal complex, as discussed in my previous article Polyvagal Theory 101 - a blueprint for your nervous system, we began to require social engagement to survive. 

“Social communication and the ability to co-regulate another, via reciprocal social engagement systems, leads to a sense of connectedness, which is a defining feature of the human experience” - Stephen Porges

Co-regulation highlights the importance not just of survival, but of how crucial the relationships we build are to our wellbeing. While we are individually responsible for our emotions and actions, we are still constantly influencing, and in turn, being influenced by the people we interact with.

Co-regulation most famously happens with children and their primary caregivers, but co-regulation can also happen in the context of a relationship, friendship and therapeutic relationship throughout our lives. We can practice co-regulation through a number of actions, many of which you may notice we often do naturally when a loved one needs comfort. 

Co-regulating actions:

  • Using a calm, soothing voice
  • Light touch, i.e. lightly rubbing the arm
  • Hugging 
  • Sustained eye contact 
  • Sitting across from one another and placing one hand on each other’s heart space and deep belly breathing for several minutes.

How does co-regulation work? 

Before we learn to self-regulate, we must first learn to co-regulate. Co-regulation begins not in childhood, but even further back than that - in the womb. Hearing our parents talk to us in the womb leads to the connection of parent and infant outside the womb. In infancy, the sound of a parent soothing their baby vocally or physically through touch, swaying or rocking, smiling (and in turn learning to smile back) are the earliest efforts of co-regulation.3 Many of us do this with children without even thinking. 

In childhood, co-regulation requires the calming and soothing presence of a reliable caregiver. Caregivers can practice co-regulation through a calming tone of voice, acknowledging the situation that is causing overwhelm or distress and practising awareness of shifts in the child’s emotional state in order to respond in the moment. While this need for co-regulation will be present for life, self-regulation can be called upon in adulthood - but only where co-regulation has been consistently practised in childhood.4

Children who learn co-regulation become adults who are able to self-regulate. Self-regulation looks like the ability to live cooperatively in our social groups and society at large, achieve important life goals and maintain mental and physical wellbeing. Through self-regulation, we can make plans and control harmful impulses and social behaviour.4

What happens when we don’t learn co-regulation?

A lack of co-regulation leads to an inability to self-regulate. What does a lack of self-regulation in adulthood look like, exactly? Lack of self-regulation or even a lapse in your usual abilities to do so is at the core of many mental health issues.4

When we can’t self-regulate, we find ourselves unable to move past temptation, bad moods, acknowledge our current lack of inner resources or have lapses in self-control. It’s thought that around 40% of deaths can be attributed to a lack of self-regulation in modern society - including due to addiction, obesity and financial struggles.4

Co-regulation in the patient-practitioner relationship 

The broad and sometimes lifelong impacts of complex trauma can lead to struggles with self-regulation. This is why many forms of treatment and trauma therapy have a major focus on co-regulation as a core principle of the therapeutic relationship. 

If you didn’t develop co-regulation and self-regulation in childhood, it’s not too late to begin working on that within the context of a healthy, trusting relationship - including with caring practitioners. 

For practitioners of all kinds, the therapeutic relationship is a sacred one. Being invited in by a patient to share in vulnerabilities, traumas, fears, anxieties, even the stress that long-term health issues can bring about is a privilege. 

As trust develops over time together in consultations, it’s important for the practitioner to maintain awareness around opportunities to practice co-regulation with their patient. For example, patients who move into a state of hyperarousal while discussing something distressing need a practitioner who can pick up on this, changing tone of voice, tempo and helping them to feel more grounded in the moment. 

A common theme that can come up during a consultation is a past history of being dismissed or invalidated. The role of the practitioner is to acknowledge that the patient’s pain or trauma is absolutely valid. This can be done both verbally and non-verbally, including through slightly increasing the intensity of the response and energy.

For practitioners, it’s also vital to recognise that there is a window of tolerance’, particularly for patients with a past history of trauma. A window of tolerance refers to the intensity and range of emotions that a patient can tolerate before their nervous system becomes dysregulated, leading to either hyper- or hypo- arousal.5

The importance of the practitioner-regulated nervous system 

Of course, for practitioners to practice co-regulation with their patients, they must possess a regulated nervous system. A regulated nervous system allows for a greater sense of empathy, presence and an ability for the practitioner to act as an anchor in the consultation. 

For practitioners, recognising their own triggers and traumas and working on self-regulation isn’t just necessary for their wellbeing, it’s vital to the success of a consultation. We have all heard the term by now ‘you cannot pour from an empty cup’ - and this is absolutely true. In terms of co-regulation, I would go a step further in saying that you cannot be an anchor if you yourself are untethered.

Thankfully, most practitioners are aware of the importance of a healthy, flexible nervous system. Many practitioners come to this work embodying the archetype of the wounded healer’; this doesn’t mean they can’t be of service, in fact, it often makes for a more empathic healer. The focus for the ‘wounded healer’ practitioner is to continue to self-regulate, prioritise strengthening their own nervous systems and maintain awareness of their own emotions, limits and triggers.6

Recalibrating the nervous system and reducing feelings of overwhelm are an undervalued and underestimated part of the physical and emotional healing journey. This is why I’ve felt called to nervous system regulation and recalibration work. For more information on how to recalibrate an overwhelmed nervous system, check out my previous post here

If you’d like to dive in deeper, I will be regularly running my workshop, How to Regulate An Overwhelmed, Fearful & Anxious Nervous System. Sign up for my newsletter if you haven’t already so you can be updated on the next workshop dates. 

For a soothing daily check-in with your nervous system, try the Apotheca by Anthia Hypnos Naturopathic Sleep Tisane - a caffeine-free blend featuring oat straw with lavender, hops and chamomile flowers to calm the nerves and alleviate acute stress.

References: 

  1. Badenoch, B. (2017). The Heart of Trauma: Healing the Embodied Brain in the Context of Relationships. New York: WW Norton & Co. 
  2. Porges, S. (2017). The Oxford Handbook of Compassion Science. Oxford University Press. P.195.
  3. Relationship Restoration. (2021). The Co-Regulation Effect. Accessed November 2021 from https://relationshiprestoration.org/2021/04/12/the-co-regulation-effect/
  4. Heatherton, T.F. & Wagner, D.D. (2011). Cognitive Neuroscience of Self-Regulation Failure. Trends Cogn Sci, 15(3):132-139. 
  5. Complex Trauma. (2021). Window of Tolerance. Accessed November 2021 from https://www.complextrauma.org/glossary/window-of-tolerance/
  6. Frith Luton. (2021). The Wounded Healer Archetype - Jungian Definition and Practice. Accessed November 2021 from https://frithluton.com/articles/wounded-healer/