Trauma and Co-Regulation
Hi, my name is Eysha Khan. I am a Licensed Master Social Worker. I graduated from the University of Northern Iowa’s Master of Social Work program with a specialization in Trauma-Informed Care. Being a therapist is something I have wanted and have been working towards since I was a child. Now that I have the opportunity to engage in my dream in real life, I feel privileged to empower my patients to heal from complex trauma and move from surviving to thriving.
In this post, I would like to discuss the importance co-regulation and a process of achieving that.
Co-regulation means being able to regulate your own emotions and the emotions of someone else. This skill can be useful for anybody who wants to be a healing presence in people’s lives. Co-regulation is essential for therapists who treat patients with trauma due to the body’s ability to sense the emotions of the people around them. By co-regulating with patients, I am able to regulate my patient’s emotions by regulating my own.
The modality that I use to achieve co-regulation in order to process trauma with patients is called Integrated Trauma Processing, a modality developed by Matthew Vasquez, PhD, LMSW. This approach includes elements of body-centered psychotherapies, mindfulness, EMDR, sensorimotor psychotherapy, and somatic experiencing therapy. For the purposes of this blog, I will only be describing the aspects of the approach that are utilized for co-regulation and will not address the portion of the modality that is utilized for trauma processing.
This work utilizes techniques such as rating scales, guided breathing, body scanning, progressive muscle relaxation, containment activities, grounding, and somatic resiliency processing including resourcing, resiliency processing, the safe place installation, the perfect parent instillation, and cognitive interweaves.
Integrated Trauma Processing
The first step is to establish a scale by which to rate the patient’s progress. This rating scale can be a sensation, emotion, or thought that is prevalent in the patient’s mind or body. This scale is utilized after every intervention to check the patient’s progress and for the therapist to ascertain whether the patient is able to connect to their mind and/or body in session.
The second step is to conduct a body scan, in which I walk the patient through noticing sensations in different muscle groupings in their body. After the body scan is complete, I will conduct a rating scale and then teach, model, and practice breathing with my patients.
In Integrated Trauma Processing, two types of breathing are utilized.
The first is called complete breathing, which is a simple three second inhale and six second exhale to be repeated at least twice but can be utilized as much as the patient needs.
The second type of breathing, my personal favorite is extended breathing, which includes a four second inhale, a five second breath hold, and a six second exhale.
In practice, I have found that this breathing technique is especially helpful with patients who experience dissociation of any kind. Complete breathing and extended breathing can be modified to fit the patient’s needs and preferences.
The next step is to engage in progressive muscle relaxation, which is similar to a body scan with the added element of relaxing each muscle group as the intervention progresses.
The final steps before entering the patient’s mind are container and grounding activities. Containment activities like the heart hug and creating a circuit assist the patient in reconnecting to their body utilizing the body’s consistency and safety. Grounding empowers patients to feel a sense of control by becoming fully aware of the heaviness and power in their bodies.
The final step for the co-regulation portion of Integrated Trauma Processing is somatic resiliency processing.
Somatic resiliency processing can empower patients to reintegrate positive emotions,
sensations, and thoughts back into their body to enable the patients to feel safe enough to release trauma from their bodies. Resourcing is the most basic form of building somatic resiliency in which the patient is guided to notice positive sensations in their bodies and are given the time and space to allow those feelings to expand throughout the body.
Resiliency processing is a technique that utilizes resourcing and memories of powerful emotions such as love, safety, competence, power, and control.
The Safe Place Instillation allows the patient to build a place in their head that is so safe that they can go to it anytime they feel anxiety, fear, anger, sadness, or other distressing emotions.
The perfect parent instillation is an extension of the safe place instillation by empowering the patient to create the perfect parent in their head to go to when they are feeling distressing emotions.
Finally, cognitive interweaves utilize the safe place created by the client to assist the patient in lowering the distress from a negative memory in order to ease the patient into trauma processing.
In my short time as a therapist, I have seen this modality work wonders for patients who have experienced acute and complex trauma learn to regulate their emotions, reintegrate the mind-body connection, and build resilience for daily life by building safety in their bodies and processing trauma out of their minds and bodies. It is a gentle approach that allows clinicians to empower their patient’s healing while ensuring that their patient feels safe mentally, physically, and emotionally.