Moving From Misattunement to Coregulation

By Beth Newton, LCSW, LCAS
PACT Level II, PACT Ambassador
Durham, NC
https://newtoncounseling.com/

Every week I sit in my office watching couples struggle with coregulation. Coregulation is defined as warm and responsive interactions that provide support and that help someone understand, express, and modulate his or her feelings, thoughts, and behaviors (Gillespie, 2015). Through coregulation, children learn how to manage their attention and emotions in order to complete tasks, control impulses, and solve problems (McClelland & Tominey, 2014). This requires them to attune to subtle cues of distress, curiosity, bids for attention, fear, and joy. The concept of coregulation can also be applied to adult relationships.  

As a therapist, I often work with couples in which one or both partners experienced parental misattunments, neglect, or abuse. The fear and insecurity they experienced as children led to poor self-regulation (internal) and coregulation (with another) skills, resulting in stress and lack of attunement in their current relationship. Moreover, if adults experienced chronic childhood stress, their hypothalamic pituitary adrenal (HPA) axis habituated and sustains activity. This “on switch” can lead to underdevelopment of the prefrontal cortex, which moderates social behavior, complex thinking, and decision making (Kumar et al., 2014).  

As a PACT therapist, I know that when an individual is not skilled at coregulation—and by extension, self-regulation—he or she will often report that a partner is not safe. Moreover, when the HPA axis is in overdrive, the individual cannot attune to self or a partner. When a partner has experienced dysregulated parents, he or she lacks the capacity to pivot toward a choice that balances the relationship. In the PACT model, we evaluate each partner’s regulatory capacities, and then help the couple deal with compromised skills and capacities.  

I work with a couple named Bill and Diego. They have been married for 5 years and have seen at least three couple therapists in that time. Bill’s mother had depression and a personality disorder. His job was to soothe her and ignore his own needs. He reported she did not do anything for him that “wasn’t really about her.” Diego learned at an early age that his homosexuality did not fit into his strict religious household. He reported a great deal of pressure to be good and nice, with no room for self-expression. Both partners developed the belief they would be punished for expressing their own needs and desires.  

These men are locked in a cycle of fear that their needs will not be met by their partner. When one begins to talk about a need, the other interrupts with his own need. In our early sessions, they exhibited disorganized behaviors, such as over-control and mild collapse, resistance to receiving or giving compassion or repair, attacking bids for connection and repair, and numerous withdraws from each other and me. This only turned around after I recognized my out of countertransference and stepped in to become the master regulator for Bill and Diego.  

To challenge their acting out, I began setting limits for the session. I helped them see that they were rejecting me in the same way that they rejected each other. We agreed that the following behaviors would help them gain control: 

• Cooperate with therapy and their PACT therapist 
• Agree to take breaks and practice slowed breathing while on break 
• Return from break and determine readiness to receive repairs or help 
• Agree to accept regulation by the therapist in the form of (a) stopping attacking behavior, (b) coaching for repairs, (c) guidance on emotional expression, (d) encouragement, (e) accountability, (f) repetition of skills  

The structure I created each week helped me offer warmth and sincerity when things were really challenging. My ability to act as a regulated parent allowed me to attune to Bill’s and Diego’s underlying fears and to express compassion. They learned how to self-regulate during breaks, accept help, and allow coaching when they did not know what to do. My ability to step in as master regulator moved them toward greater attunement to their own and their partner’s needs.  

I still work with Bill and Diego. When they are on break, I continue to help them with breathing, tracking objects or sounds, and muscle relaxation. They work on coregulation during break by practicing statements such as “I love you. I am taking a break so I can come back to us. I promise I’ll be back in 10 minutes.” I use my ability to ground them through structure, compassion, and good-natured challenge, so they can develop coregulation and secure functioning.  

References 

Gillespie, L. (2015). It takes two: The role of co-regulation in building self-regulation skills. YC Young Children, 70(3), 94–96.  

Kumar, S., Hultman, R., Hughes, D., Michel, N., Katz, B. M., & Dzirasa, K. (2014). Prefrontal cortex reactivity underlies trait vulnerability to chronic social defeat stress. Nature Communications, 5, 4537.  

McClelland, M. M., & Tominey, S. L. (2014). The development of self-regulation and executive function in young children. Washington, DC: Zero to Three.  

Tatkin, S. (2017). How couples change: A psychobiological approach to couple therapy (PACT). In M. Solomon & D. J. Siegel (Eds.), How people change: Relationships and neuroplasticity in psychotherapy (pp. 221–246). New York, NY: W. W. Norton.