Regulating vs. Metabolizing

The goal of affect regulation came to the forefront of therapeutic wisdom in the mid-1990’s, primarily through the work of the neuroscientist, Allan Schore.  In his writing, he advocated that any effective psychotherapy had to address the dysregulated emotions that are stored in the right hemisphere of the brain.  Other researchers and experts (i.e., Daniel Siegel, Diana Fosha, Pat Ogden, Peter Fonagy, Marion Solomon and Stan Tatkin) translated this dictum into techniques such as mindfulness and mentalization, in which the therapist enters the patient’s experience to calm that unruly right brain with left-brain understanding.

Neurodynamic Couples Therapy certainly agrees that the regulating of affects which activate the mutual emotional triggers discussed in the previous blog post is part of the process of healing, but it is only a beginning.  The experiencing and expressing of dysregulated emotions are the sparks that help couples launch the metabolizing process which their brains have chosen each other to do.  It is the therapist’s job to help them enter the second step of the metabolizing process by recruiting their left brains to describe their dysregulated emotions with words.  This is how our human brains naturally regulate.  As the parent says to the dysregulated toddler, “Use your words.”

Healing is not yet accomplished at this point.  Partners must learn to pair verbal expression with many emotional experiences to foster complete understanding.  The historical antecedents of their emotions must be mined and articulated in ever-increasing depth to reach a level of true whole-body empathy.  Only then are their previously dysregulated emotions metabolized and absorbed into an appreciation of everything that has made them who they are.

Establishing safety at the beginning of treatment might require that the therapist assist the partners in regulating enough to be able to have a conversation about their emotions.  The necessary skill in this process is to promote discussion without shutting down the emotions that the couple’s dramas are working so hard to expose.  Dysregulated partners must be met with curiosity and a willingness to “feel with” them, instead of regulating too much or too soon because of the therapist’s anxiety.  The dysregulated affect is often sending an important message about what it has been like to be them.

The challenge for the therapist is to strike a balance in which emotionally overwhelmed partners can gradually tolerate translating their previously unspoken feelings into words, without shutting them down too soon.  There is a danger in over-regulating affect.  I have seen couples in treatment who were so tightly regulated that they had to work hard to experience and express any emotions at all.  These types of couples often need to hear the “taboo” that they have associated with their emotions understood and lifted.

Rather than an end in itself, any regulating of affect should be done in service of fostering the metabolizing process.  Regulation of all previously dysregulated affect will be a natural outcome of a successfully completed metabolizing process.


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