Why Nervous System Regulation Matters in Trauma and Psychotherapy
In trauma therapy, healing doesn’t start with revisiting the past — it starts with safety in the present. Nervous system regulation is not a superficial goal; it’s the ground that allows the psyche to explore, integrate, and transform. Without it, even the most profound insights cannot take root.
When someone begins therapy, it’s natural to want to go straight to the emotional wounds: the past, the traumas, the patterns. The hope is that once we uncover them, liberation will follow. Yet, in my work with people who carry deep nervous system impacts from chronic stress, developmental trauma, PTSD, or complex PTSD, I have seen again and again how pushing too early into deep material — before sufficient regulation, containment, and resourcing — can backfire. In some cases, it reinforces the trauma rather than heals it.
In some cases, people come to therapy highly activated, depleted, or struggling with symptoms of dysautonomia, anxiety, or post-traumatic stress. Their nervous system may be operating close to its limits — oscillating between hyperarousal and shutdown. In such cases, the therapeutic focus often begins with containment and co-regulation: finding safety, slowing down, restoring energy.
In others, the system is more stable, and the work naturally leans toward exploration of deeper psychodynamic or existential layers.
The truth is, there is no single entry point into therapy that fits everyone.
The rhythm and depth of the process depend on the person’s capacity to stay connected to themselves while engaging with challenging material.
When we talk about nervous system regulation, it’s easy to imagine a universal process — something everyone should do before going deeper into therapy.
But regulation is not a technique we simply “apply.” It’s an evolving capacity that depends on many individual factors: our current mental state, physical health, trauma history, support network, and what we want from therapy at this particular moment in our lives.
Our nervous system is the relational ground on which mind, emotion, and memory rest. It constantly scans for safety or threat. When that system is dysregulated, it is as if the ground beneath our feet is shaking — no amount of insight, narrative, or cognitive reframing can reliably take root.
To clarify — when I speak about regulation, I don’t refer to “symptom management” or a surface-level calming of emotions. Regulation is not about invalidating the client’s autonomy or minimizing their ability to take care of themselves.
It’s about supporting the body’s capacity to hold emotional truth without fragmentation.
It’s about creating enough internal stability so that exploration — whether of childhood trauma, unconscious dynamics, or relational patterns — can happen safely and with integration.
In this sense, regulation is relational, not mechanical. It unfolds through presence, through connection, through the therapeutic relationship itself.
Sometimes, it looks like breathing and grounding; other times, it looks like staying with an emotion, or naming a defense with curiosity instead of judgment.
It’s not separate from psychotherapy — it’s part of how psychotherapy becomes embodied.
The Tension Between “Regulation” and “Depth”
In trauma-informed and somatic approaches, we often hear that we must “regulate before we process.”
In classical psychodynamic or psychoanalytic traditions, on the other hand, there is sometimes skepticism toward the focus on regulation — the concern that it might reduce psychotherapy to symptom relief, avoiding the unconscious or the transformative potential of conflict.
Both perspectives hold truth.
Regulation alone is not psychotherapy. It doesn’t replace the exploration of unconscious meaning, relational dynamics, or early experiences.
But without sufficient regulation, deep work can become retraumatizing or destabilizing, especially for clients whose nervous systems have been overwhelmed for long periods.
In my experience, the integration of both perspectives — the depth of psychodynamic work and the embodied safety of somatic awareness — allows therapy to move at a pace the person’s system can truly sustain.
This is especially true in trauma-informed frameworks such as NARM (NeuroAffective Relational Model). Although NARM is not primarily a “regulation therapy,” it acknowledges that dysregulation is part of developmental trauma — and that self-regulation emerges naturally when connection and curiosity replace shame and self-rejection.
In practice, many clients need more explicit somatic support before they can access this curiosity. That’s not a contradiction to NARM’s philosophy — it’s an adaptation to the person’s current capacity.
Individual Differences: What Shapes the Process
Regulation and depth depend on a complex set of variables, including:
- Current state and symptoms — hyperarousal, fatigue, dissociation, anxiety, depression, etc.
- Psychiatric or medical conditions, medication, and energy levels.
- Resources and resilience factors — what gives the person strength, meaning, and grounding.
- Support system — whether the person is held by relationships or feels isolated.
- Stage of life and therapeutic goals — whether they seek deep self-discovery or emotional stabilization.
- Capacity for self-regulation — the ability to soothe oneself, pause, or reflect when activated.
A trauma-informed process doesn’t impose one “right way” of healing. It listens to these variables and adjusts the depth and pace accordingly.
Sometimes therapy focuses more on resourcing and stabilization; other times on insight, emotion, and symbolic meaning.
Regulation as a Pathway to Depth, Not a Detour
From this perspective, nervous system regulation is not a preliminary phase we complete before the “real therapy.”
It is an ongoing dialogue between body and psyche — a foundation that allows meaning, memory, and emotion to surface safely.
When clients experience enough containment to stay connected to themselves during activation, they can engage with unconscious material more deeply and creatively.
Therapy, then, becomes not only a space of emotional catharsis or cognitive understanding, but a place where new patterns of regulation, relationship, and self-awareness are practiced in real time.
The goal is not simply to feel calm, but to expand the capacity to feel fully — to stay present, embodied, and connected even when what arises is painful.
In the End
Healing is not a linear progression from regulation to exploration to insight.
It’s a spiral — moving back and forth between safety and discovery, between body and psyche, between past and present.
The art of therapy lies in recognizing what is needed now — and meeting that need with attunement rather than agenda.
In my opinion real psychotherapy, and life, in general, is not about staying regulated all the time. It’s about developing the capacity to move through dysregulation consciously, to recognize our defenses and impulses, and to relate to them with curiosity instead of fear.
That’s where both somatic and psychodynamic perspectives meet: in restoring the natural rhythm of connection, protection, and growth.
References:
Schore, A. N. (2003), Affect Dysregulation and Disorders of the Self.
Van der Kolk, B. A. (2014), The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
Siegel, D. J. (2012), The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (2nd ed.).
Levine, P. A. (2010), In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.
Ogden, P., Minton, K., & Pain, C. (2006), Trauma and the Body: A Sensorimotor Approach to Psychotherapy.
Porges, S. W. (2011), The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.
Heller, L., & LaPierre, A. (2012), Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship.
Schwartz, A. N. (2020), The Complex PTSD Workbook: A Mind–Body Approach to Regaining Emotional Control and Becoming Whole.
Kain, K. L., & Terrell, S. J. (2018), Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma — An Integrative Somatic Approach.