I remember the first time I heard the term “co-regulation,” over 6 years ago. I was working with the family of a very lively 4 year old who had tactile sensitivities, extreme seeking behaviors and high high anxiety. Screaming meltdowns, poor sleep as well as food and preschool refusal happened daily. Child-care was difficult to keep and both parents worked outside the home. A baby sibling, child #3 was on the way. Stress was high to say the least.

Hearing the word “co-regulation” made a light bulb go off in my brain! It was a word that perfectly described what I was seeing with this family. My little client had definite differences in her approach to the world as compared to her same-aged peers and these differences were causing BIG reactions and confusing behaviors, which were also causing big reactions and responses from parents in attempts to support their daughter and manage their family’s day to day. They were all caught in the same swirl.

I remember asking this parent if she had ever heard the term “co-regulation” and when she said no, I struggled to find the words I could use to accurately describe it. For me, it was an intuitive knowing and so obvious that the words I used at the time felt inadequate. Since that time, there is research on co-regulation in various fields, we know a LOT more about sensory processing and autonomic arousal, and Polyvagal Theory gives us a framework in which we can articulate the role that co-regulation plays in patterns of engagement along the continuum of connection.

The words I use now to describe co-regulation go something like this:

It is a process by which one person’s nervous system subconsciously influences another person’s nervous system by way of our sensory channels and our inherent drive for connection. The cues we give and receive from others subconsciously, inherently and spontaneously, impact our state of arousal and our capacity for regulation.

We are neurologically wired to connect and as our social engagement system subconsciously detects sensory cues from inside and around our bodies including cues from another person (a process Dr. Stephen Porges calls neuroception), our autonomic nervous system responds by shifting our state of arousal. In other words, when we are around another person we become sensory input to that person’s nervous system and vice versa; we give and receive auditory and visual input through voice, facial expressions including eye contact and body language all while experiencing varying amounts of touch, proprioceptive, vestibular and interoceptive inputs by nature of the experience we are having at the time we are with that person. Co-regulation subconsciously supports or hinders regulation but we can consciously shift the cues we are sending and be aware of the cues we are receiving to shift our own arousal level and thereby influence that of another.

I don’t say these things all at once to parents. Psycho-education takes many forms and happens in different ways over varying amounts of time. I typically build on this aforementioned information with examples relevant to my client or their particular family situation. The priority I have for sharing information about co-regulation with parents, is to establish common language and neutral ground for furthering discussion about family dynamics and the role that parents play in supporting regulation or dysregulation for and with their child. Dysregulation in a family is not anyone’s fault, but by trying to understand and by getting curious about the underlying patterns of interaction and related neurobiological mechanisms of personal relationships, we get to the layers of learning that might lead to long-term functional change.

Co-regulation is a relational support. In a recent episode of the Spirited Conversations podcast, Tracy Murnan Stackhouse, MA, OTR, co-founder and executive director of Developmental FX (DFX) in Denver, Colorado commented, “Neuroscience has shown us that relationship is no longer secondary, it’s necessary.” Co-regulation supports effective outcomes in therapy. If we are to effectively hold space for and be invited into the intimate daily moments of struggle a client and family are having in hopes of helping, we need practical tools we can use and share to actually do that. Without discussion of co-regulation and intentional ways of influencing that process with our clients and their families, our therapy remains limited to what we do with clients vs. how. How we do things, not just what we do and helping clients learn how to do the same thing but differently, is the essence of OT intervention. We discuss nuances of “how” in many of the case coaching calls we have inside the Sensory Collective Mentorship program and a common theme is, learning how to be mindful about our own levels of arousal and allowing a client to have theirs in the midst of also having interactions. Where do we start with co-regulation?

Here is a list of what I consider to be basic co-regulation strategies. I hesitate to use the word strategy, as it suggests something distinct and specific, when co-regulation is deeper and more nuanced than the word “strategy” might suggest. There is attunement and intuition needed and an attitude of exploration and being present and open to another that doesn’t get captured in a list. BUT…it’s a place to start. It gives us some common language and suggestions for how to approach this foundational concept of co-regulation in our work with clients gives us practical things we can alter to positively influence our clients’ capacity for regulation.

Here they are:

• Voice: tone, volume, prosody, intonation
• Body position: sitting, standing, lying, turning toward/away
• Pacing: pause, fast/slow, rhythmic
• Facial expression: eyes, mouth, head position
• Leadership/agency: taking action with confidence, moving forward
• Joining: share in the experience of the child

When we practice changing the way we interact with someone by making adjustments to any of the above and noticing how the other person responds, we engage in a reciprocal journey. A journey we ultimately hope will lead our clients in a direction toward easier and better function for life.

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