Self-Regulation and the PACT Therapist

By Carolyn Sharp, LICSW
PACT Level III Therapist
http://www.carolynsharp.com/

After laughing with Marty about the wonderful date they had, Peter adds, “Of course we had to go to the restaurant you wanted.” With that slight emphasis on going to Marty’s restaurant pick, they go from shared laughter to bulging eyes and hostile voices, following each other out of connection and into attack. All it takes is one wrong comment to spin into the dynamic this high-arousal and high-conflict couple came to address. My heart rate increases and my throat tightens as my mind imagines the session going out of control. With my own arousal rising, I’m in danger of losing my capacity to be helpful.

Christina and Sam stare listlessly at the floor during extended pauses after my questions and comments. Their passivity and disconnection are in charge here, and neither partner makes a move toward closeness or engagement. I feel a yawn forming and can hear every sound outside my window, as boredom threatens my effectiveness. This couple will continue to do what they always do if I don’t activate the energy in the room.

In both these cases, the couple’s work together depends on my ability to self-regulate—to calm myself in the former and to self-activate in the latter. With PACT’s embodied approach (whereby the therapist uses the live felt-experiences of a couple to help them learn new ways of being with one another), my job is to help the couple learn to co-regulate each other’s nervous systems so they can find connection and safety. Their ability to do this is central to forming a secure-functioning relationship.

As a PACT therapist, self-regulation allows me to set the tone for the sessions and to create the frame and expectations for partners’ behavior. Additionally, when I am self-regulated, I have the capacity to marshal all my resources to respond helpfully with any interventions needed. I can’t fall outside my own window of tolerance or allow myself to react from emotion. Central to the skill of self-regulation is awareness of the strengths, challenges, and triggers within my own arousal system. The volume and speed of a couple’s speech can be irritating to my system, but tone and emotion are what cause my heart rate to spike. In the other direction, the slowness of their responses can be lulling, but disengagement between partners is the cause of a drop in my attention and attunement. Being aware of these triggers is the key to my ability to notice and take action.

The use of deliberate practice and repetitive skill-building exercises to automate responses to calm or activate myself when stressed has been enormously helpful to my self-regulation (Rousmaniere, 2016). I practice resetting my system when excited or bored so I can do so in session, without pause. Developing the emotional muscle memory to calm or excite myself makes it more likely that I can do the same in times of stress or in overwhelming situations.

Two of the simplest and most reliable means of self-regulation are exhalation and simple grounding (i.e., the ability to return my attention to my body and the room quickly). Using these has proven invaluable, and I often invite couples to practice them with each other when the room goes “high temperature” or “frozen” (the vernacular I share with couples). Lastly, the PACT serenity prayer serves as a powerful grounding in my role and responsibilities as a therapist. Through self-regulation, I am present with the couple before me and I allow them to practice being in each other’s care. The skills of self-regulation were useful in sessions with the two couples I described.

Peter and Marty came to PACT to learn to head off their explosive conflicts, as well as to help each other get through those conflicts safely. Through attunement and better co-regulation they are learning to do this. My self-regulation is integral to their process as I stay present and tuned in, while fully in my own window of tolerance. With a long, slow whistle on my exhale (indicating a nonverbal “wow” to Peter’s comment about the restaurant), I catch their attention. They are immediately connected through their mutual irritation at my interruption, followed quickly by amusement as they realize I just distracted them from their escalating fight. Being tuned into the energy in the room and its impact on me allows me to use a distraction to help regulate this couple and move them back within their window of tolerance and into each other’s care. Following a repair to one another, we talk about the things they have been practicing at home to get out of these scenarios, and then they practice regulating each other.

Christina and Sam came to therapy for help reigniting the passion and connection they lost over time as they focused all their energy on things outside their connection. Helping them requires me to activate the energy in the room, so I stand up and have them join me and take each other’s hands. Sam follows my request and begins to describe Christina’s face. Tears come as Christina feels Sam’s presence. Describing him, in turn, elicits a big smile, the first he has shown today. I watch them squeeze each other’s hands and then move into a hug. I vocalize the shift made when moving to each other. The listlessness I felt when I paid attention to my own response alerted me to the direction I needed to take to help them move toward each other.

Couple therapy can vacillate between high and low energy, between conflict and disengagement. Unregulated, therapists can quickly follow clients down any number of unproductive paths. Remaining grounded and regulated is our most powerful tool in maintaining our focus on facilitating secure-functioning couples.

Reference

Rousmaniere, T. (2016). Deliberate practice for early career psychotherapists. Psychotherapy Bulletin, 51(3), 25–29.