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By Carolyn Sharp, LICSW
PACT Level III Therapist
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.
Rousmaniere, T. (2016). Deliberate practice for early career psychotherapists. Psychotherapy Bulletin, 51(3), 25–29.
by Stan Tatkin, PsyD, MFT,
In PACT, we talk about various strategies for emotional and arousal regulation. Auto-regulation is a process of self-management that is internally focused, energy conserving (because it doesn’t involve interactions with people), and somewhat dissociative. It is a non-social strategy in the sense that it does not require another person. For instance, when I manage myself by self-stimulating and self-soothing; others are not required or even wanted. Some people find using mindfulness practices for auto-regulatory purposes to be a better strategy than constantly seeking to be left alone.
Self-regulation, on the other hand, is a pro-social strategy that focuses on self-management. In other words, I manage myself so I can better maintain social engagement with others.
Mindfulness practices can be used effectively for self-regulatory purposes. I suspect this is one of the reasons behind their recent popularity.
In fact, the term “mindfulness” carries various subtle shades of meaning, reflecting different schools of practice. For example, when I studied Morita and Naikan (two forms of Japanese psychotherapy) with David K. Reynolds (1989), mindfulness was emphasized differently in each. Morita required me to pay continuous attention to the outside world while accepting my thoughts and feelings as outside my conscious control. Because thoughts and feelings cannot be controlled by will alone (like the weather), the smart thing to do is to accept them “as is” and focus on one’s purpose. So I learned to be mindful and centered on purpose (not on feeling or thinking). The initial result of such a practice was intense existential angst, but eventually it disciplined me to appreciate details in the world around me while being less hung up on my internal world. Naikan required a continuous attention on what I received from people, what I gave to people, and the trouble I caused people. The initial result of that practice was strong feelings of guilt and remorse, but it also led to profound, pervasive feelings of gratitude. Naikan practice helped me see what I got from people and what I continually get from people despite my attitude, my greediness, my envy, and my self-centeredness.
When I learned vipassana (a form of Theravada Buddhist meditation), also known as insight meditation, from Shinzen (Stephen) Young, mindfulness meant continuous, moment-by-moment attention to body sensations, thoughts, emotions, impulses, and urges as they arose and soon faded. The two-part technology of vipassana (attention and equanimity) taught me to manage my internal world. Notice and allow. Notice and allow. I could learn to handle physical pain, as well as mental and emotional anguish, without suffering. Wow. Talk about self-regulation! Vipassana was (and is) a mind-blower.
Each of these—Morita, Naikan, and vipassana—is an example of mindfulness practice. Each is powerful and quite different from the others, yet each yields benefits for only as long as the practice is maintained. Stop the practice and the benefits stop, too.
These practices can be done either alone or with a partner. For instance, my wife and I can decide to practice vipassana or any other mindfulness practice together, in the same room at the same time. Nice.
We can also face each other and practice mindfulness meditation while in each other’s eyes (simultaneous attention to both inside and outside). Practicing in this way cultivates interactive regulation (sometimes referred to as co-regulation or mutual regulation). Because it involves use of the near senses (e.g., vision, voice, or touch), interactive regulation is like a dance between two nervous systems, two minds, two bodies. It is a social-emotional balancing act that requires attention, presence, and equanimity. Each of the following suggestions emphasizes mindfulness and equanimity as a two-person, interactive regulatory practice.
Using Morita, mindful attention is placed onto the outside world. That includes your partner! We pay attention to each other’s eyes, facial expressions, body movements, implicit signals and bids for attention. We accept feelings and thoughts, both positive and negative, “as is,” without judgment or complaint. Instead, we focus on purpose, such as providing each other relief, anticipating each other’s needs and wants, and attending to what needs to be done rather than on what we feel or think. For example, my wife and I can decide to have an entire evening of nonverbal interactions—on purpose, of course. We can make and eat dinner, relying solely on nonverbal communication. We have to anticipate each other’s moves; interpret each other’s signals (e.g., “pass the salt”); and work together cooperatively.
This practice of noble silence can continue through the evening and into bedtime, as well as during our transition to sleep. An adventurous couple could try this for an entire day or maybe even a weekend. If you’re in a couple, see what it’s like. Pretend you can’t talk and can only use nonverbals.
Another Morita mindfulness exercise could involve giving one another a massage. The massage should be like a mindfulness meditation in which the giver pays moment-to-moment, purposeful attention to the act, while accepting all thoughts and feelings “as is.” The Morita reason for giving a massage is that it needs to be done with full attention! The good thing about massage, like eye contact, is that the receiving partner can always tell if the giving partner’s mind is drifting.
In Wired for Love, I suggest that couples do bedtime rituals. One such ritual is to do a loving kindness meditation. Variations of loving kindness practices include those stemming from vipassana. Naikan also has a loving kindness practice that can be done at any time of day. For instance, make a list of people who gave you things today, whether or not you wanted the gift, whether or not they intended to give it to you, or whether their attitude was good or bad. Take a piece of paper and draw three columns, with the first entitled “What he/she gave to me today.” Both partners should spend considerable time on this particular column before moving on to the next column, which is entitled “What I gave him/her/them today.” The third column should be entitled “The trouble I caused him/her today.” This last column should also receive proper attention to detail. Reading this list aloud to one another can become a Naikan loving kindness practice.
Alternatively, a couple can give their best wishes to those people past and present, living and dead, as the partners drift off to sleep at night. This mindfulness practice of attending to others in a loving way can provide an internal social connection for those who feel alone, lonely, abandoned, or isolated.
Whether doing vipassana, Naikan, Morita, or any other self-enhancing mindfulness practice, the purpose should be to increase one’s presence. It should not be a means to avoid, space out, trip out, self-soothe or self-stimulate. We are social creatures and mindfulness should be a means toward becoming more connected to ourselves and others.
Reynolds, D. K. (1989). Flowing bridges, quiet waters: Japanese psychotherapies, Morita and Naikan. Albany: State University of New York Press.
© 2003-2013 Stan Tatkin, PsyD – all rights reserved