Ing Says: Co-Regulation is one of the most vital skills a clinician can learn
Co-regulation is when a person approaches someone who has lost their emotional footing and uses their own nervous system to help the other person settle down. In trauma-informed care, this is some of the most advanced, difficult work there is. It is still relatively rare to see a fully embodied capacity to do it — partly because this is cutting-edge science, and partly because it takes an enormous amount of energy from the clinician.
I want to take a moment to appreciate all the clinicians who make the effort. Your effort is good enough. Keep learning and listening.
This article is a deep dive into co-regulation from the perspective of the survivor and peer.
Lessons From an Abuse Survivor
I was one of those crazy horse-teenage girls. I took the difficult horse I shared ownership with — the one known as “one end bites, the other end kicks.” Her name was Coquette.
I managed to get her trust and love, and we shared many afternoons ambling down soft forest trails, or running like the wind across a meadow.
Coquette was an abuse survivor. When she got scared and angry, it could get absolutely terrifying. I used a variety of little tricks that I believe my own nervous system knew instinctively — because I was a survivor too.
My approach always started with soft, soothing sounds. I would announce myself: voice soft, no fast movements, reading her body language to make sure it was safe to enter. If it wasn’t safe, I would stand as close as she allowed. I stood still, breathed deeply, and just used my voice to gentle her down. Eventually, her body would settle. Never moving fast around her, she would eventually rest her head on my shoulder while we breathed deeply together — or put her whole head into my stomach while I hugged her.
This is co-regulation. One nervous system anchoring another.
Three Encounters With Capacity
Over this last year of severe PTSD struggles, I met three clinicians who showed me what this capacity looks like in practice. This skill is about embodiment, not theory.
1. The Quiet Presence
After I left The Guidance Center PAC unit on a gurney, I was taken to Flagstaff Medical Center ED for a cardiac workup. Very quickly, my nurse entered the room quietly and sat down. He stated simply: “I need to know what happened.”
Then he sat quietly. No push, no judgment. Just a still presence.
I opened up almost instantly. Magically woven into that gentle conversation, he did an outstanding suicide assessment — thorough, but not interrogative. Respectful, kind, and gentle. As he left, he gently squeezed my ankle. My brain fog left almost immediately. He then made sure I ate and drank fluids, because high adrenaline drops when you can eat.
This is trauma-informed care. This is what it looks like when it works.
2. The Power Differential
During one psych hospitalization, a nurse with zero co-regulation skills and an unchecked power differential terrified me. I reacted like a wounded animal, finding a corner to wedge myself into and cry.
My own nurse found me quickly. She sat on the floor, gave me aromatherapy sticks — a brilliant use of physiological tools — and tried to find out what I needed. She did a lot right, but she was too pressured, pushing for answers I couldn’t immediately give because my words were escaping me. That push felt disorienting and made it harder to talk.
Eventually, we found a way through the impasse.
The first nurse meant well. But he needs training. He has since been made a charge nurse — and with power differentials unchecked, he is not ready for that role.
3. The Circuit Breaker
My last story is one of the most perfectly executed co-regulation encounters I have ever witnessed.
Driving through Los Angeles, I encountered dangerous mechanical problems. Stuck in the middle of a big city, I went into a major anxiety attack: crying, shaking, can’t breathe, pure terror. I called the local crisis response team.
When they found me that evening, the panic had not let up. The lead clinician tried to get me to talk, but my body was completely strung to pieces. Within a few minutes, he knew what he saw.
He stepped into my space, ran his hand from my shoulder to my elbow, gave my elbow a little squeeze, and said: “Look at me.”
We established eye contact. He took one or two deep breaths himself.
I have never been slammed so fast and so efficiently back into my body. The anxiety attack stopped right then. He didn’t tell me to breathe — I clearly couldn’t. He breathed, and my body copied him. He got me snacks and water, breaking the adrenaline spike. Within five minutes, a perfect stranger stopped a major panic attack cold.
What These Stories Have in Common
When I look at these three encounters, I am reminded how difficult co-regulation is to execute in real clinical settings. Sometimes it backfires because the wrong note is hit. No one does it perfectly every time.
But the successful encounters share the same vital elements:
- Calm and breathing — The clinician was quiet, still, and breathing slowly and deeply
- Embodiment — Fully present in their own body, not just their head
- Presence over logic — No attempt to reason with a completely dysregulated nervous system. Their presence communicated: “I am here. You are not alone. I see your distress. I will help you sort through this.”
- Physiological tools — Food, water, and aromatherapy to bring the adrenaline spike down
Why This Matters
Co-regulation is not a soft skill. It is the neurological foundation of every meaningful therapeutic relationship — and peer support specialists carry this capacity in ways the clinical system has consistently undervalued and underfunded.
Peers have been in the nervous system state their clients are in. That embodied knowledge makes their co-regulation instinctive. It is not a replacement for clinical training. It is something different — and in this specific domain, something the mental health system desperately needs more of.
Trauma-informed care demands peer inclusion. Not as an add-on. Not as a courtesy. As a clinical necessity.
Between Trust and Trauma exists to make that case — loudly, and with receipts.
