In this episode, Dr. Christine McKee discusses her approach to working with couples in therapy, focusing on somatic and relational health. She emphasizes the importance of regulation and attachment in relationships, and how these factors impact the ability to be present and connected. Dr. McKee explains her step-by-step process, starting with self-regulation and then moving to co-regulation, where couples practice techniques such as eye contact, light touch, and non-distracted space. She also highlights the significance of tempo and pacing in therapy, ensuring that the slowest person's needs are met. The goal is to create a safe and regulated environment where vulnerable conversations can take place.

Takeaways

• Regulation and attachment are key factors in healthy relationships.
• Self-regulation is the first step in therapy, followed by co-regulation.
• The pace and tempo of therapy are important, and the slowest person sets the pace.
• Therapy involves practicing techniques such as eye contact, light touch, and non-distracted space.
• The goal is to create a safe and regulated environment for vulnerable conversations.
• The Importance of Tempo and Pacing in Therapy
• Creating a Safe and Regulated Environment for Couples

Chapters

00:00 Introduction and Background

01:03 The Role of Regulation and Attachment

08:43 The Importance of Tempo and Pacing in Therapy

14:04 Practicing Techniques for Connection and Vulnerability

Keywords: couples therapy, somatic health, relational health, regulation, attachment, self-regulation, co-regulation, tempo, pacing

This is unedited.

Peta Stapleton (00:00.942)

Welcome back everybody to another episode. And I'm thrilled today to actually have a long -term colleague and friend. We go way back. Don't know that we'll get into that, but I'm thrilled to have with me in the studio here, Dr. Christine McKee, who I think it was at a different university a long, long time ago that we crossed paths and have sort of stayed connected since. Christine is an Aussie and an Aussie at heart now calls Canada home. Christine, welcome to the podcast.

Chris (00:10.281)
Ha ha.

Chris (00:22.601)
Yes.

Chris (00:30.793)
Thank you, Peter. I'm super excited to be here. And we do go a long way back. I think it's like 20 years, which is extremely exciting. And we've done a lot across the years. And here we are again.

Peta Stapleton (00:35.566)
Whale.

Peta Stapleton (00:39.47)
We have, I think it was even pre -transition on my behalf that, yeah, we connected when you were a wee student back in the day and I was a wee lecturer, I'm pretty green myself. Yeah, so, and Christine, of course, has come right through to the PhD level and she's a psychologist by trade, but full details below and we'll get into that later. But our conversation today is,

Chris (00:48.649)
I was. I'm.

Chris (00:58.921)
Yeah. Great. Thanks.

Peta Stapleton (01:03.982)
is going to go down and obviously we're in the fourth wave here and that's what we talk about and we love sort of exploring different strategies and techniques that might be supporting client patient health. Particularly at a somatic level, your expertise is in what we would call relational health but very much about relationships and really where I want to go today is a conversation about how you work with couples in therapy. So,

Chris (01:13.865)
Right. Yeah.

Chris (01:24.233)
Mm -hmm.

Peta Stapleton (01:33.23)
you know, whether that is an intimate relationship or a different style of, you know, a couple pair. But if we were to just start with the whole concept of, you know, how it is that if we were to kind of overlay, you know, the fourth wave, the autonomic nervous system, somatic body base, what brought you into that type of field when you might've been working in, you know, psychology back in the beginning and even seeing couples?

Chris (02:04.393)
Great question. I think what really took me where was I was realizing that standard talk therapy just wasn't landing the plane with so many clients that what they'd be presenting with would come up over and over again. There'd be some level of solution, but it didn't metabolize almost inside to a point that integration could happen where the past could be left in the past and seeing through the lens of current time awareness.

in every moment that comes up inside a relationship. So for me then I started to look into, well, there has to be more what's going on inside. And I started to do a lot of training in the somatic world around regulation to self and to other. And what are the things that actually get in the way of being able to show up in a present way? And what are the things we need to do in the therapeutic environment to be sure that both parties are

engaged, grounded, regulated as the working the material of what's not working in the relationship. So that's really what got me there. And that led to several years of training over in the US.

Peta Stapleton (03:17.006)
Yeah and the importance then of something like the autonomic nervous system in you know both parties that are present in front of you in that relationship in order to have and I'm guessing because I'm in no shape or form any kind of marriage therapist made that decision back in the other time there just could not even get my head around working with one person let alone two so deep inspiration for you and

Chris (03:35.401)
Hahaha!

Chris (03:42.153)
You'd be fabulous at it.

Peta Stapleton (03:45.998)
all the colleagues behind that do marriage couple therapy, because I just do a runaway. But I can imagine, you know, the importance of that level of autonomic regulation individually, but within the couple relationship in order to get some level of connection, because I'm guessing that's why they're coming in, because something's disrupted, something's gone wrong in, yeah. I mean, how important is it, you know, do they know that when they come in, or are they just bouncing off each other?

Chris (03:47.913)
Yeah.

Chris (04:17.001)
So I'm going to say some people have some level of awareness around it. However, the bouncing off each other, because we learn relationship in a particular biosphere. And that is what we carry through with us if we're not conscious about what we're doing at any moment. And actually, if we grow up in an environment where regulated nervous system is not the norm, we don't know any difference. So we actually don't know that that impacts how we're able to be present.

So I would say there's a large proportion of people who through no negativity, just simply are not aware that if you're not grounded, you are at the mercy of your history. And if the history is, yeah, you're at the mercy of it because if you're not coming from a place of a secure attachment and when I talk in the nervous system world, if you like, for me, attachment theory is regulation theory.

Peta Stapleton (04:59.79)
I love that.

Chris (05:15.529)
To be securely attached, we need to be regulated in the nervous system. And for safety,

needs to come from secure attached modeling somewhere, whether it's in our early years or as an adult, we learn how to do it. It doesn't actually matter, but the, the reality is we only feel safety when our nervous system is grounded. And no, the majority of us do not come from that world consistently. And that's no disrespect to any of our upbringings. It is just part of society. I feel at these day and age, we're all busy. We're all multitasking.

Peta Stapleton (05:39.886)
Yeah, so.

Chris (05:53.257)
We're all not attentive all of the time and we don't need a big T trauma to not be attached in our relationships.

Peta Stapleton (06:03.182)
Yeah, I really like that because it could almost be a reflection of current day as well as history because there's so many demands on people's time but that then is a demand on your nervous system. So, you know, that taxing kind of. So is that the first step when you might in your model approach, you know, working with a couple? Is that the first step that it is all about regulation slash attachment?

Chris (06:22.665)
Mm.

Chris (06:30.825)
Yes. So I don't always start with the attachment language, if you like. I think there's a, there's a lot of buzzwordiness around that now. And sometimes I don't, I prefer to not bring that in, straight up the front, but certainly I'll sit with a couple and talk to them about, you know, talk to me through what your definition of connection is. How do you do it? How do you know you're in connection versus when you're not? And then I will fold in. So what happens inside, you know,

Do you know if you're regulated? Are you here? Are you not? Do you disappear? Do you dissociate? Do you check out? Do you avoid? Do you blame? And people can catch hold of those words and go, yeah, this is how we roll. And they'll go, great, now let's talk about what your nervous system is doing in that. And then that's where we start. And then I'll usually start with myself. Am I grounded and present? Am I role modeling the capacity to create a safe environment? Am I distracted? Am I...

hypervigilant in my own way at the start of a session. So I need to do the grounding first because that's going to influence the energetic field around me. And then I will say to clients, can we live coach this? Can I highlight for you when I feel that one of your nervous systems might be. We're going to out to some extent or dropping out and depending, and let's start to talk about what self -regulation looks like. So we always start with me. Am I regulated? Am I setting the scene?

then self -regulation for the individuals sitting in front of me. And there's a whole bunch of techniques with that. Then once there's demonstrated enough across time that regulation is possible, then we move to what we would call co -regulation through a series of activities that really date back to how we connect at birth. And then we look at what do you do when one party's not able to stay regulated in a particular moment? How can the team?

work together then to come back into regulation to then work the material. My experience is there is absolutely no point working on the dark, challenging aspects of a relationship if both parties are not available in the nervous system to work the material.

Peta Stapleton (08:43.214)
And it sounds like that at some level structured approach, self -regulation, us as a therapist, individuals first to get that, it's almost like I think of Maslow's hierarchy, that bottom rung really tightly firm connected to them be able to close. And you think about where he put love and belonging in that hierarchy, it certainly wasn't at the bottom. So how long...

Chris (08:58.505)
Yes. Yes.

Peta Stapleton (09:08.942)
might it take, I'm guessing it's not a one -session wonder, for self -regulation in the individuals, you know, to get before you actually take that next step of co -regulation.

Chris (09:21.321)
So I did them simultaneously to some extent. So we'll do a lot of education first around the three tiers of the nervous system. Start to really work into that social engagement portion of the nervous system because that's new to most people. Like they really don't understand that concept. They understand sympathetic nervous system dysregulation very well and parasympathetic nervous system dropout regulation or dysregulation quite well.

But to think about coming into connection in a different way as a part of the nervous system is kind of astonishing to some people. So I will talk about that first, discuss window of tolerance, knowing when you're in it, when you're out of it, what's your preference, how do you know, and start to really teach tracking, track what's going on inside your system. How do you know? So we live model all of that. And then I will live coach that. So I will say, I will give a short description.

I'll do the first round, get everyone else to do the round. And as soon as I see they can do it, that's a lifelong experience then anyway. So once I know they can, then we're ready to move on with lots of tasking in between session, practice, practice, practice, find the tools for grounding in self that work for you. Practice, practice, practice, come back and show me that you can do it.

and then we'll use those skills as we do co -regulation. So it can honestly, it can be done in a session. It's what they do outside of session. But I won't progress until I've physically seen them do it.

Peta Stapleton (10:47.31)
Yeah, okay. Yep.

Peta Stapleton (10:52.494)
So, so many gems in there. I just want to unpack a couple of them. One, you're referencing polyvagal theory, aren't you? And Stephen Porgers' third arm of, so just in case anyone's listening in going, what's my third arm? So social engagement being the third arm of the nervous system. And ultimately totally makes sense when you're working with couples. So when you say you'll live coach it, is it that you're presenting a topic to talk about and it might kind of...

Chris (11:01.797)
yeah. Yeah.

Peta Stapleton (11:19.342)
create some response and but you're showing them how to like, what does that look like if you're showing them and demonstrating it yourself and giving them the opportunity and checking that they can do it? What do you mean?

Chris (11:31.081)
Great, yeah, no, they're really good. So there's a range of exercises or tools if you like for self -regulation. And they can be as simple as give me three things in your immediate environment that are white. Or what are three sounds that you hear right now in this moment? Or identify three things that have a soft, fluffy texture in your immediate environment. So that could be one thing. Or it could be...

Peta Stapleton (11:44.878)
okay.

Chris (12:00.361)
Let's just do some body compression, which is simply putting force on a safe part of your body that you feel good about to re -embodied you, to bring you back into the now. So it could be something simple like that. It could be a deep breathing exercise. If someone's more triggered in their sympathetic nervous system, they usually only breathe to here. Well, you're not going to integrate too much if you can't breathe through your whole body. So there's.

I don't even know how many, but a bunch, a bunch of those kinds of tools. And I'll usually give 10 or so in a session, I'll live coach each, I'll do around and I go, okay, guys, you do it now. And then pick your top three or four of those activities that resonate for you that you go, you know what this I can do. And they're, they're the ones that's what I mean by the live coaching. where I want to see that they can be, have an interest in something that's going to be regulating.

Peta Stapleton (12:53.006)
Yeah.

Chris (12:59.785)
Because regulation for many is terrifying. To be out of survival mode is a bigger threat.

Peta Stapleton (13:08.814)
I can imagine it could be quite a fearful state for a lot of people.

Chris (13:13.449)
being regulated. I have a wonderful teacher and a cheat. She's so amazing. Her terminology for it. And I just love it so much is for people who haven't learned regulation or secure attachment, hummingbird sips of safety. How much does a hummingbird sip on like a droplet? Let that go in. Can you hold it? If you can, then you can have another sip. But if it terrifies you, then we're not going to, we're just going to pull back a little bit and go even slower.

Peta Stapleton (13:43.822)
Yeah, well, that's really good.

Chris (13:44.425)
So yeah, so they're the kinds of tools that I live coach first, just because what I'll then do is I'll say, guys, can I have your permission that whenever I see either one of you become dysregulated, I call it out. And then we're going to do another one of those tools in that moment. So that's how the live coaching tends to unfold.

Peta Stapleton (14:04.398)
Yeah, right. Yeah, that's really good. So let's say we have the perfect client couple here and they go home and they do all their homework and practice and it's great and they come back and then you get to this place of we're laughing because it might not happen as easily as that. Look, we get there.

Chris (14:13.865)
How wonderful.

Chris (14:23.625)
Yeah, exactly. The messy imperfection that is.

Peta Stapleton (14:30.766)
That's it. And then you get to this phase of, OK, well, let's now demonstrate co -regulation. What do you mean by that? What is co -regulation?

Chris (14:41.129)
Yeah. So co -regulation is the capacity to sit with each other. I call them the foundations for connection for co -regulation where we simulate the birth experience, the immediate moments post -birth experience where bonding and attachment starts to unfold through four things immediately. And it's light touch if it feels safe in adults, eye contact, non -distracted space.

and close proximity, which is where in an intimate space together. It doesn't mean sexual, obviously, but it's intimate space. So can I hold eye contact with light touch, with no distraction in close proximity with my intimate partner? And honestly, it's terrifying to many.

Peta Stapleton (15:30.67)
Yes, yeah, I can imagine.

Chris (15:32.713)
And just even hold, and when I say brief, we're talking 10, 15 second intervals where you're not doing anything else, but facing each other, holding beautiful eye contact with light touch and connection. So that's the first step. Now, when people can do that and breathe at the same time and hang out in that, oxytocin starts to release the love hormone, the bonding hormone.

And when that starts to unfold, then the resonant field, which is the whole of being taking in what's going on in the heart resonance, taking on what's going on in that overarching biosphere, if you like, of what's happening, both parties will then slow down. You'll feel it's palpable. You can actually feel the energy field widen and deepen. And then to help people stay in it when it's a new thing to do to be able to be in that.

level of intimacy together, we add silent appreciation of other. So while I'm looking at you and holding your hand or touching you rather pinky or whatever, I'm going to project onto you only the fabulous things I think about you. Quietly, silently, and the energy exchange becomes even more palpable. Most people cry.

Peta Stapleton (16:46.734)
and silently.

what

Peta Stapleton (16:53.518)
I was about to say, are there tears in this moment?

Chris (16:55.049)
Lots of them, lots of them. And then we do another round of it where then we still hold the space, but now we one for one share an item back and forward, back and forward. Now we started to build in deep connection with the remembrance of appreciation that we actually have of our partner. Now you're in a space that you can talk about the hard stuff because what we tend to find is when people hold eye contact, touch, close proximity, no distraction with appreciation.

and oxytocin is flying, it's almost impossible to fight.

Chris (17:31.657)
And that's then two people who have genuine care on the dichotomy of love for each other, able to hold space for each other. Now you're at the starting point of being able to have really vulnerable conversations. So that's what that is.

Peta Stapleton (17:46.414)
And I'm imagining that by the time you get to this point with whatever brought them into therapy in the first place, the conversation is probably going to be actually different to even if it's about, I don't know, a bad habit that they don't like in their partner. It feels like to me that would be a different conversation by this point anyway.

Chris (18:02.537)
Okay.

Chris (18:08.457)
It can be, it's amazing what's really, what happens really quickly though is when you start to bring the verbal dialogue in, how quickly the default behavior goes back to what it was, which is wonderful. We want that because then we want to be able to call the pause and go, okay, come back into connection with one another. And now, and now, now usually when you're doing this, so you're adding a different type of communication skill as well. that involves a lot of.

I call them inquiry questions, but a lot of questioning to ensure understanding before even going into solution mode. And it's not the starting point often if people are in cycles of things that aren't working for them inside the relationship. So there is a communication verbal skills set that will start to come in as a combination on this.

Peta Stapleton (18:57.262)
Yeah, okay. I'm anticipating that sometimes in that couple relationship, the need for individual sessions could be important. Is that more common than uncommon?

Chris (19:13.961)
I'm going to say it depends. So the invitation can certainly be there that as a combination for the purpose of the goal of the couple sessions that we might do one or two sessions individually. So long as both give permission, both are actively knowing that it's happening and that it's for the purpose of the couples counseling as opposed to individual counseling. So certainly we can do that to work on any.

trigger pieces that actually don't have anything to do with the partner. So yes, some couples though choose to want to be witness to that, to be the support to that, which is more regulating. So I think it depends on the couple and it depends on.

the level of vulnerability they've probably been able to demonstrate together in the past. It's a very vulnerable thing to do, so I think you've got to get that level of ability to sit in vulnerability quite well -versed.

Peta Stapleton (20:08.27)
Yeah, okay.

Peta Stapleton (20:17.55)
Yeah, yeah. Which lends itself to my next question which I know I've asked you before. It would appear as though pace or I think you might call it tempo of the whole situation is really important. And what if you've got...

Chris (20:34.537)
critical.

Peta Stapleton (20:35.502)
the two individuals are at completely different levels, perhaps of awareness, insight, ability to do their self -regulation. What happens there if you've got some radically different differences between their development therapy, I guess.

Chris (20:52.905)
Yeah. So tempo is, I would say the largest important factor. And we move at the pace of the most dysregulated person. And the reason that we do that is if we push too fast and somebody is not regulated, they will not be able to metabolize and digest the new. It's not possible because the dumb Vegas is on board at that point in time.

and the capacity to stay in the social engagement system, drastically falls off. So what it looks like is we call a pause. We name what we're seeing. We find out what's going on. We do a self -regulation tool. We come back into connection together and then we snacky size chunk on the material. So, part of it is a lot of titration work. So we're going to take a small chunk of the difficult piece.

we're going to find out how that plays out in the nervous system for the person. So there's a lot of technique that sits around getting very detailed in the physiological response. And that can show up internally or in the gestures and the movement and the posture and whatnot. And then we allow a little bit of space for the old that might not be as healthy, but for it to be there because that's actually how the person functions in that moment.

And then we will titrate back and swing back into another little chunk, another little bite. But it might mean that a conversation happens a sentence at a time, but we have it so that in the nervous system, it can feel grounded and regulated through that whole sentence. And then we might take a breather. Okay, great. How does that feel? What's different? What actually feels like it's a movement away from what wasn't working.

So we have to go at the pace of the slowest person, otherwise their nervous system will blow out and they won't be integrating. And when they go home to practice, even the memory of what was spoken about will be distorted to some extent.

Peta Stapleton (23:01.334)
Why would that be? What's the impact here on distress, trauma, memory?

Chris (23:09.321)
Yeah, so when, if we try and do something new on an old behavior, but in the physiology of the old, the old will play back out again. So we need in those types of sessions in the tempo to, for a person to be able to track how the new feels different.

So you might have the same argument, but the way you get to the resolution is different. Well, what's the physiology tell you about that? And the person to clearly be able to define the difference between the two. But if we only get a short way into that and then the person dysregulates and they go back into the old story, the old history, there's a very good chance that they're not at current age anymore and we're not actually dealing with the adult.

Peta Stapleton (23:56.846)
Yeah, okay. Yeah, yep, totally.

Chris (23:58.441)
And then there's, let's not even bother dealing with the part. We want to have compassion for the younger part, but the part can't be driving the bus that day. The part has to be the passenger that we lovingly bring on with current age resourcing and current age wisdom and skills. But as soon as an adult becomes dysregulated, it's likely, not guaranteed, but it's likely they're in a younger version of themselves.

and there's no point trying to resolve current age issue at a younger mindset.

Peta Stapleton (24:29.974)
Yeah, yeah, yeah, totally makes sense. And I know anyone listening in may well have understanding of different modalities that can deal with those kind of aspects of ourselves. And we've all got them, you know, everybody's got them.

Chris (24:31.113)
Yep. Yep.

Chris (24:43.177)
Yeah, absolutely. And, you know, we want to be able to normalize that too, so much in the sessions. And, you know, I think that's part of what makes it brilliant is we're all still learning as we go. And we're all still regulating in every moment and, you know, being vulnerable enough to be able to say, Hey, this is a work in progress constantly no matter how many skills you got.

Peta Stapleton (25:04.174)
Yeah, yeah, totally. Chris, this has just been gold and certainly somebody who doesn't work with couples just imagining this kind of playing out and thinking compared to where we were trained a very long time ago in some, you know, more traditional sort of therapy situations. We may well have even watched, you know, videos of, you know, therapy sessions. Virginia Satir comes to mind from my training day compared to

Chris (25:11.337)
Hahaha!

Chris (25:20.905)
Yeah.

Chris (25:30.473)
Yeah. Yeah.

Peta Stapleton (25:33.262)
this model that you're really painting the picture of and what this would look like. To me it feels like it would be a very gentle kind of paste and very role modeling. So you kind of role modeling but very practical at the same time. Like I like that there's something that they're doing because that's just me. They're doing something but feeling an outcome when they walk out of that session.

Chris (25:36.681)
Yeah.

Chris (25:49.033)
Yeah. Yeah.

Chris (26:00.745)
Yeah, definitely. It's only actually in being able to track the physiological shift between, I call it that, not that. And so in the training through the, the chitties that I had, it's, it's the, that could be the new behavior that you're seeking and the not that is all the history or the old way of responding. But if a person is not able to discern the physiological difference between the two, it's very difficult to know when progress has been made.

so there's a lot of, a lot of energy goes into, well, when you resolve the issue in X way, how do you know? And then we'll go into the physiology and use a lot of parameters of description. Like if somebody just says, I don't know, I just, I just know, you go, no, that's going to slow the session right down because actually we're going to get really, might use in that now to the best that someone's able to physiological level all through the senses. So through the five main senses.

Peta Stapleton (26:30.926)
Yeah, yep.

Peta Stapleton (26:53.71)
and other physical.

Chris (26:59.817)
you want and it could be that someone feels it in the palm of their hand, let's say. Well, then we're going to go into a deep description about, is it more to the right, to the left, to the top, to the bottom? Does it have a color? Does it have a temperature? Does it move? Does it expand? You know, all sorts of different categories, just so a person can get intimate with what their physiology is doing.

Peta Stapleton (27:22.286)
And it's almost like teaching the mind that the body can be safe.

Chris (27:28.393)
Definitely. And that in the presence of someone who they care about, it can be safe. Yeah. Yeah.

Peta Stapleton (27:34.094)
Yeah, taking it that extra level. Wow, this is profound and incredibly invaluable work that you're doing. Now I know people listening in might be like, I need more. And I know that you have a resource that we're going to make available and the URL will be below here in the show notes. A tool, a tool sheet, a tool sheet, what would you call it?

Chris (27:40.009)
Right. Wait.

Chris (27:50.217)
Yeah, sure.

Chris (27:56.969)
Yeah, let's call it a practitioner tool sheet if you like. And in that, you know, there'll be tips for how to regulate yourself before you go in so that you know your role modeling in the way that is going to be effective. And then ways to support clients to self -regulate, ways to support a client to co -regulate, and then what to do if a client becomes resistant on this because that's common.

becoming regulated actually creates, no, no, no, back up, back up. And so what to do in those situations so you can really support a client to stay with you in the session and come back into that space of regulation.

Peta Stapleton (28:37.806)
Fantastic. That's exactly what I know people are going to want to come and download at the end of listening to this conversation. So that URL is below. Absolutely check out dr. christinemckay .com anyway. You have an abundance of resources as well as support for people in this field that might be working through it. It's just been a joy to connect with you. You're on the other side of the world to me now. We don't have as much of a play to come. That was so fabulous. Thanks everyone and we'll see you again soon.

Chris (28:53.993)
Yep. Sure.

Thank you. Yay. That was wonderful.

Christine discusses a guide she created just for our listeners - An Orienting to Now Tools Guide

What you get inside the Guide:

•  6 x quick tips to self-regulate prior to and during a session, as a practitioner
•  5 x practical Orienting to Now tools to share with client 

Free download is available here https://www.drchristinemckee.com/Orienting_to_Now_Tools_Guide