Compassion is not just a moral imperative—it is a neurobiological necessity for healing and well-being. Unlike coercion, which activates the body’s defensive systems and reinforces disconnection, compassion engages the social engagement system, governed by the ventral vagal complex —a critical component of the autonomic nervous system responsible for feelings of safety and connection (Porges, 2011). In this regulated state, individuals are better able to access the prefrontal cortex, allowing for reflection, emotional regulation, and the processing of traumatic memories (Siegel, 2012).
Moreover, relational compassion promotes co-regulation, where the calm and attuned presence of a therapist helps stabilise the client’s nervous system, fostering trust and psychological integration (Fisher, 2017). Clinical studies underscore that compassionate, client-centered approaches significantly improve outcomes in trauma therapy and mental health care (Norcross & Wampold, 2011). In short, compassion creates the neurophysiological and relational conditions that make healing not only possible but also sustainable. The human story is etched with moments of profound suffering. Whether it stems from the jagged edges of trauma, the quiet devastation of loss, the relentless grip of illness, or the heavy burden of systemic injustice, suffering is a fundamental, often isolating, part of the human condition. When individuals find the courage to seek help in these moments, they stand at their most unprotected, their nervous systems potentially wired for high alert or frozen in shutdown. The critical question is not if we respond, but how. Our choice – to meet vulnerability with compassion or with control – does not just shape the immediate interaction; it dictates the very possibility of healing itself.
For too long, the default setting in approaches designed to help those in distress, particularly within mental health and addiction services, has leaned heavily towards methods rooted in control, compliance, and even subtle forms of coercion. Picture rigid protocols that steamroll individual needs, or power dynamics that silently strip away a person’s voice and agency. The unspoken assumption often seems to be that the suffering individual is a problem to be managed, a broken piece to be fixed by outside authority.
The prevailing approach to individuals in distress often focuses on management and control. However, this perspective overlooks a crucial element: the potential for such methods to exacerbate suffering inadvertently. This raises a fundamental question: Is the act of controlling someone in distress inherently counterproductive to healing? I propose a change in basic assumptions: instead of focusing on management, the priority should be fostering empathy, ensuring safety, and rebuilding trust with meticulous care. The belief that distressed individuals require management is based on assumptions about human behavior and healing that are not universally accepted.
Although control might seem to create order and predictability, it can have a profoundly negative effect on an individual’s nervous system. Different forms of coercion can provoke or exacerbate the nervous system dysregulation that often accompanies distress, especially following trauma. When compassion is supplanted by coercion, existing wounds, which are frequently unseen but deeply embedded in the nervous system, remain unhealed; instead, they worsen. This physiological reaction weakens an individual’s ability to connect, which is essential for authentic engagement and healing. The very biological processes vital for recovery get compromised.
For example, Bessel Van der Kolk highlights the storage of trauma in the body and nervous system, explaining that re-traumatisation can happen when people are not provided with responsive and compassionate care. Coercive methods perpetuate defensive responses and hinder the neurobiological pathways essential for healing and recovery: “Traumatised people chronically feel unsafe inside their bodies…they learn to ignore what they feel and instead do what they are told. This interferes with healing.” (Van der Kolk, 2015, p. 97).
Stephen Porges explains that safety is essential for activating the ventral vagal system, which is crucial for social connection and healing. Coercion disrupts neuroception and pushes individuals into defensive states that interfere with integration and recovery: “When the environment is perceived as unsafe, the nervous system shifts away from social engagement toward defensive strategies… which inhibit healing and relational trust.” (Porges, 2011, p. 13).
In her book, Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists, Janina Fisher outlines how shame, coercion, and lack of relational attunement exacerbate trauma symptoms and increase dissociation. Trauma healing requires safety, validation, and compassionate witnessing: “Trauma is exacerbated by responses that dismiss or override the survivor’s inner experience. Coercion reactivates the very helplessness that trauma imprinted” (Fisher, 2021, p. 49) A response that carries serious consequences for the therapeutic process.
When coercive dynamics mirror the original conditions of trauma—characterised by powerlessness, voicelessness, and lack of control—they do more than trigger defensive adaptations such as dissociation, emotional numbing, or internal fragmentation; they fundamentally impair the therapeutic process by reactivating unresolved survival strategies that therapy is designed to resolve. These defence mechanisms are not inherently maladaptive—they are protective responses encoded in the nervous system to manage overwhelming experiences (van der Kolk, 2015). However, when reactivated in therapy due to perceived coercion, they block access to higher-order brain functions needed for self-reflection, emotional regulation, and relational trust (Siegel, 2012). Clients may become compliant but disengaged, or appear cooperative while inwardly dissociating, which can result in false indicators of progress. Over time, this leads to stalled treatment, increased drop-out rates, or even retraumatisation.
As Janina Fisher (2017) notes, healing occurs when clients feel safe enough to approach, rather than avoid, their internal experiences. Coercion undermines this capacity by reinforcing the very neural and relational patterns therapy must rewire, thereby obstructing the potential for meaningful change. This reactivation can stall or even reverse therapeutic progress by pulling the client out of a state of relational safety and into a state of self-protection. In such a state, the prefrontal cortex—the seat of reflective thinking and emotional regulation—is less accessible (van der Kolk, 2015), and the client becomes less able to process new experiences, engage in therapeutic dialogue, or integrate difficult emotions. Rather than fostering repair, coercion entrenches survival-based patterns and erodes the very relational trust that healing depends upon. Understanding this requires a fundamental re-evaluation of how professionals interact with individuals in distress. The question then becomes: how do we create environments that prioritize safety and foster genuine, relational engagement conducive to healing?
Emerging research, particularly within the framework of Polyvagal Theory, provides valuable insights. By understanding the intricate workings of the nervous system, we can develop more nuanced and practical approaches that prioritise the individual’s inherent capacity for self-regulation and healing. This relational approach acknowledges that true healing necessitates not control, but the cultivation of trust, empathy, and a safe space for the individual to process and overcome their distress. Only then can genuine connection and recovery thrive.
The Chilling Hand of Coercion: What Happens When Compassion is Replaced? At its core, compassion is a simple yet powerful act of acknowledging another’s suffering and genuinely wanting to help alleviate it. It’s interwoven with empathy, warmth, and a fundamental respect for the inherent dignity and autonomy of the person before you. Coercion, in stark contrast, compels someone to act through force, pressure, or threats. In the context of helping professions, this isn’t always overt physical restraint. It can insidiously manifest as imposing rigid rules or predetermined treatment plans without genuine input. Hinting at negative consequences for non-compliance (like being discharged or reported). Using guilt or shame to manipulate behaviour or choices. Dismissing or invalidating feelings or experiences that don’t fit the ‘expected’ narrative.
Creating pronounced power imbalances where the professional’s authority consistently trumps the client’s internal experience or preferences. Demanding compliance or trust before demonstrating that one is trustworthy. When these coercive dynamics seep into a helping relationship, they not only create emotional distance but also actively activate the nervous system’s ancient defense mechanisms – the very mechanisms that are often already in overdrive or shut down in individuals who are suffering, especially those bearing the heavy legacy of trauma. Picture someone whose experiences have, often harshly, taught them that authority figures can be unpredictable or threatening, that their voice lacks power, and that their own needs come last. When this individual, during a moment of profound vulnerability, reaches out for assistance and encounters even minor forms of coercion—like being told what they ‘must’ do, feeling pressured to divulge information before they’re ready, or having their legitimate emotions dismissed—their internal alarm system doesn’t take a moment to assess the situation. It blares, “Danger!” This reaction isn’t a conscious decision; rather, it’s a deeply ingrained, protective instinct activating. What happens to a person’s fundamental ability to connect with the helper and with the world around them when coercion replaces compassion?
The effects are devastating. Erosion of Trust — Trust is not merely a desirable quality in therapeutic relationships; it is a foundational mechanism of healing. Research consistently identifies the therapeutic alliance, rooted in mutual trust and safety, as one of the strongest predictors of positive treatment outcomes (Horvath et al., 2011). When trust is compromised, the client’s sense of relational safety is replaced by guardedness, resistance, or withdrawal.
Judith Herman (2015) emphasises that recovery from trauma “can only take place within the context of relationships; it cannot occur in isolation,” and that coercive or authoritarian interventions replicate the original dynamics of powerlessness that caused the trauma, thereby impeding healing. Without trust, the client cannot risk vulnerability or access the neural pathways required for co-regulation, reflection, and integration—key components of therapeutic progress. Coercion not only damages trust: it shatters it. It confirms the client’s deepest fears—that others are not safe and trustworthy, that relationships revolve around power and control rather than mutual respect.
Without trust, a genuine connection becomes biologically inhibited because the nervous system remains in a state of defence, governed by the sympathetic or dorsal vagal branches of the autonomic nervous system. From a Polyvagal perspective (Porges, 2011), trust is not merely an emotional or cognitive state—it is a neurophysiological condition that arises when the ventral vagal system is activated. This system supports social engagement by enabling facial expressivity, prosody, eye contact, and the ability to interpret relational cues—prerequisites for mutual connection.
In contrast, when trust is absent and the environment is perceived as unsafe, neuroception detects threat, shifting the system into fight, flight, or freeze. These defensive states suppress the prefrontal cortex (Arnsten, 2009), impairing reflective thinking, emotional regulation, and the capacity to co-regulate with others. As a result, relational repair, therapeutic alliance, and collaborative healing efforts become inaccessible at the neurobiological level. Research consistently shows that a strong therapeutic alliance—grounded in perceived safety and trust—is one of the most robust predictors of positive outcomes in psychotherapy (Horvath et al., 2011). Activation of Threat Responses: According to Polyvagal Theory, coercion forcibly pushes the nervous system into defensive states: the sympathetic ‘fight/flight’ response or the dorsal vagal ‘freeze/collapse’ state. Fight: The individual may become openly resistant, defiant, irritable, pushing back against the felt threat to their autonomy. Flight: They might withdraw, become evasive, miss appointments, or disappear from care, physically or emotionally escaping the unsafe environment. Freeze/Collapse: They may appear compliant on the surface, saying the right things, but internally, they dissociate, shut down, or passively resist. This is tragically often misinterpreted as cooperation, when in fact, it is a state of surrender, a biological collapse that is fundamentally incompatible with active engagement or healing. – Diminished Sense of Agency and Self-Worth: Coercion, by its nature, conveys to individuals that their perceptions, needs, and choices are either invalid or insufficient—a message that strikes at the core of self-agency.
In therapeutic contexts, this undermines the client’s capacity to engage authentically in the healing process. When a person feels that their inner experience is disregarded or overridden by external authority, it not only reinforces internalised beliefs of inadequacy or powerlessness (prevalent in trauma survivors) but also fosters emotional disengagement and guardedness. This weakens the therapeutic alliance, which research identifies as a primary driver of successful outcomes (Horvath et al., 2011). The client may adopt a compliant posture out of fear or learned helplessness, yet such surface-level cooperation masks an internal shutdown that inhibits exploration, emotional processing, and integration (Fisher, 2017).
Furthermore, autonomy is a core psychological need, as outlined by Deci and Ryan’s Self-Determination Theory (2000), and when it is denied, intrinsic motivation for change diminishes. The result is a relational impasse: instead of building trust, safety, and mutuality, the therapeutic relationship becomes another site of imposed control, replicating the very dynamics many clients seek to heal from. In therapeutic contexts, this dynamic can be particularly damaging, as it reinforces internalised beliefs of inadequacy or powerlessness, pervasive among trauma survivors.
When professionals impose treatment plans without collaboration, override expressed boundaries, or condition support on compliance, clients may internalize the message that they are incapable of navigating their healing. This fosters what Deci and Ryan (2000) identify in Self-Determination Theory as “external locus of causality”, where individuals attribute outcomes to forces beyond their control, diminishing motivation and self-efficacy. Diminished Sense of Agency and Self-Worth: Coercion, by its nature, conveys to individuals that their perceptions, needs, and choices are either invalid or insufficient—a message that strikes at the core of self-agency. In therapeutic contexts, this undermines the client’s capacity to engage authentically in the healing process.
When a person feels that their inner experience is disregarded or overridden by external authority, it not only reinforces internalized beliefs of inadequacy or powerlessness (prevalent in trauma survivors) but also fosters emotional disengagement and guardedness. This weakens the therapeutic alliance, which research identifies as a primary driver of successful outcomes (Horvath et al., 2011). The client may adopt a compliant posture out of fear or learned helplessness, yet such surface-level cooperation masks an internal shutdown that inhibits exploration, emotional processing, and integration (Fisher, 2017). Furthermore, autonomy is a core psychological need, as outlined by Deci and Ryan’s Self-Determination Theory (2000), and when it is denied, intrinsic motivation for change diminishes. The result is a relational impasse: instead of building trust, safety, and mutuality, the therapeutic relationship becomes another site of imposed control, replicating the very dynamics many clients seek to heal from. In therapeutic contexts, this dynamic can be particularly damaging, as it reinforces internalised beliefs of inadequacy or powerlessness, pervasive among trauma survivors.
When professionals impose treatment plans without collaboration, override expressed boundaries, or condition support on compliance, clients may internalise the message that they are incapable of navigating their healing. This fosters what Deci and Ryan (2000) identify in Self-Determination Theory as “external locus of causality”, where individuals attribute outcomes to forces beyond their control, diminishing motivation and self-efficacy. – Studies affirm this effect: research by Priebe et al. (2013) found that perceived coercion in psychiatric care is strongly associated with reduced therapeutic alliance, poorer treatment adherence, and increased feelings of helplessness and demoralisation.
Similarly, Fisher (2021) emphasises that trauma recovery hinges on restoring a sense of agency and that even subtle coercion can reactivate traumatic powerlessness, leading to shutdown or dissociation rather than engagement. These dynamics are not abstract; they play out in the micro-moments of therapy: when a client is pressured to disclose before they’re ready, when their refusal is pathologised, or when their autonomy is minimised in the name of clinical efficiency. Studies affirm this effect: research by Priebe and colleagues (Priebe et al., 2013) found that perceived coercion in psychiatric care is strongly associated with reduced therapeutic alliance, poorer treatment adherence, and increased feelings of helplessness and demoralisation.
Restoring agency, therefore, is not ancillary—it is central to the healing process. Therapeutic environments that prioritise collaborative decision-making, consent-based practices, and attunement to client pace support the re-establishment of self-worth and the belief that one is capable of making meaningful choices. Internal Fragmentation: When external control clashes with a person’s internal needs or feelings, it creates a painful internal split. One part may desperately want help, while another is terrified and resistant.
Coercion disrupts psychological integration by reinforcing internal divisions between conflicting parts of the self, such as the part seeking help and the part fearful of vulnerability, rather than fostering dialogue or coherence between them. This internal fragmentation hinders healing by preventing the development of self-compassion, emotional coherence, and narrative integration, all of which are essential for trauma resolution. When one part of the self is pressured to comply while another feels threatened or invalidated, the individual may experience increased internal conflict, self-alienation, or dissociation. As Janina Fisher (2017) notes, healing requires not the silencing of any part, but the establishment of communication and trust between them. Coercion, however, sends the message that some inner experiences are unacceptable, thereby encouraging further suppression rather than curiosity and integration. Over time, this exacerbates symptoms such as anxiety, avoidance, and internalised shame—obstacles that derail therapeutic progress. Instead of fostering a unified self-capable of reflective processing, coercive dynamics often entrench protective mechanisms that keep the trauma unprocessed and the person disconnected from their core self. This phenomenon is well-documented in trauma-informed and parts-based approaches.
According to Janina Fisher (2017), trauma often results in a fragmented internal system where different parts of the self-hold opposing roles—some oriented toward survival through avoidance or aggression, others longing for connection or healing. When coercion is introduced, protective parts may become hyperactivated, interpreting external pressure as a repeat of earlier violations, thereby escalating internal conflict and suppressing vulnerable, help-seeking parts. Richard Schwartz, the developer of Internal Family Systems (IFS), also emphasizes that forced interventions can cause exiled parts (those carrying pain and vulnerability) to retreat further. At the same time, protectors take over to manage perceived threats, making inner harmony and cooperation more difficult (Schwartz, 2021).
In therapeutic settings, this disintegration is not merely theoretical. Clinical observations and qualitative studies (e.g., Maylea, 2021) highlight that clients who experience coercion in care settings often report feeling fragmented, silenced, or in conflict with themselves, undermining the integrative processes necessary for healing. Therefore, interventions that bypass consent or agency not only fail to resolve inner conflict but often entrench it. When an individual feels pressured or overpowered, protective parts often become hyperactivated, increasing resistance, shame, or dissociation.
This defensive response impairs the person’s ability to access reflective functioning or engage in inner reconciliation, thereby widening the internal divide and entrenching fragmentation rather than promoting healing. Reduced Capacity for Connection (Ventral Vagal Shutdown): This is perhaps the most critical point. The very state of being under threat, whether fighting, fleeing, or freezing and collapsing, actively shuts down the neural pathways associated with social engagement and connection – the Ventral Vagal state. Humans are fundamentally wired for connection, as this is our primary pathway to safety and regulation.
Coercion activates the body’s defence systems—most notably the sympathetic and dorsal vagal branches of the autonomic nervous system—triggering states of hyperarousal or shutdown that inhibit the social engagement system, which is governed by the ventral vagal complex. This neurophysiological shift impairs facial expressivity, vocal tone modulation, and the ability to interpret social cues, thereby creating a biological barrier to connection at the precise moment it is most needed for regulation and healing. They become less able to read social cues, less interested in engaging; their focus is narrowed desperately on mere survival. The world shrinks from a place of potential connection and growth into a landscape of possible threats. In essence, substituting compassion with coercion forces an individual into a perpetual state of defense. Their energy and internal resources become entirely consumed by managing the perceived danger from the very person meant to help them. There is no biological bandwidth left for the vulnerability, exploration, and collaborative effort essential for genuine healing. They cannot connect with a world, or a person, that their nervous system registers as dangerous or controlling.
The Neurophysiological Foundation for Cooperation and Healing. If coercion triggers defense and isolation, what enables genuine engagement and healing? Cooperation in therapeutic or helping relationships is not just an intellectual agreement to follow advice; it is, crucially, a neurophysiological state. For a person to truly engage, explore difficult emotions, collaborate on goals, or integrate new perspectives, their nervous system must be in a state that biologically supports these complex functions.
What are these necessary prerequisites? A Sufficient Sense of Safety: This is non-negotiable. At a level far below conscious thought (what Polyvagal Theory refers to as neuroception), the nervous system must register that the environment and the people in it are safe enough to relax its guard. When safety is perceived, biological resources are freed up from survival efforts and redirected toward growth, repair, and connection—a shift with profound implications for therapeutic practice. In real-world settings, this means that therapists must first focus on co-creating an environment where the client’s nervous system can downregulate from states of hyper- or hypoarousal.
This involves using a calm tone of voice, maintaining regulated body language, making attuned eye contact, and exhibiting predictable relational rhythms—all of which signal safety to the client’s neuroception (Porges, 2011). When such safety is established, the ventral vagal system becomes dominant, enabling the client to access higher-order functions, such as emotional regulation, narrative integration, and perspective-taking—capacities essential for therapy to be adequate. Without this foundational state, therapeutic interventions such as cognitive restructuring, trauma processing, or parts work are unlikely to succeed because the client’s system remains stuck in survival mode, oriented toward defense rather than openness. Thus, the therapist’s ability to help regulate the client’s physiological state is not peripheral and is central to achieving meaningful clinical outcomes.
Accessing the Ventral Vagal State: This biological state is characterised by calmness, social engagement, and a sense of safe connection. In this state, the prefrontal cortex – the brain region responsible for planning, rational thought, and decision-making – operates at full capacity. Emotional regulation is achievable, and the ability to empathise and connect with others is activated. Genuine cooperation emerges only when the nervous system is in a regulated, ventral vagal state, characterised by feelings of safety and a sense of connection.
As Porges (2011) explains through Polyvagal Theory, this state enables access to higher cognitive functions necessary for relational engagement and collaboration. In contrast, coercive environments activate threat responses that disrupt this state and erode trust, a dynamic well-documented in trauma literature. For example, Herman (2015) highlights that coercive interventions reinforce powerlessness and fear, making mutual cooperation neurologically and psychologically unattainable. Similarly, research by van der Kolk (2014) demonstrates that traumatized individuals cannot engage meaningfully until they feel safe enough for the prefrontal cortex to regain regulatory function.
Regulated Arousal: The nervous system needs to be in a state of flow, neither stuck in hyperarousal (sympathetic overdrive) nor collapsed into hypoarousal (dorsal shutdown). A regulated state allows for flexible presence, responsiveness, and the energy needed for emotional processing and change.
Capacity for Co-regulation: Humans are wired to regulate each other’s nervous systems, particularly within safe and trusting relationships. For effective practical cooperation, the client must be able to receive and benefit from the professional’s regulated, calm presence. This is only possible when the professional’s nervous system acts as a “safe harbour,” inviting the client’s system towards a state of calm and connection.
Openness to Connection: True collaboration involves being able to be vulnerable, share internal experiences, and accept support. This fundamentally relies on the availability of the neural pathways for social connection that characterise the Ventral Vagal state. Consider the nervous system’s need to transition from “emergency mode” (sympathetic fight/flight or dorsal collapse) to “operating mode” (ventral vagal) for performing complex tasks such as introspection, emotional processing, and collaborative problem-solving. Coercion keeps the system entrenched in emergency mode, whereas compassion, offered within a skilled and secure professional relationship, facilitates a smooth shift to operating mode.
Understanding Trauma: Not the Event, But the Imprint. To utterly understand why compassion is paramount, we must define trauma accurately, especially in the context of healing. Trauma, in this sense, is not merely the distressing event itself. Instead, it refers to the enduring imprint – the residue, the unresolved physiological and emotional charge – that remains trapped in the nervous system and body when a person is overwhelmed by an experience and the system cannot fully process or move through it at the time. This unprocessed imprint keeps the nervous system on high alert or in a chronic state of shutdown, constantly reacting as if the past danger is still present. For individuals carrying this imprint, coercion isn’t just unhelpful; it’s deeply re-traumatising, confirming the world is unsafe and their autonomy is under threat.
A Path Forward: Embracing Compassion for True Healing Suffering is a raw, vulnerable state that calls not for control, but for connection. Control, in the context of helping, functions as a biological toxin, triggering ancient defence systems, eroding trust, dismantling agency, and shutting down the very capacity for connection that is essential for healing. Compassion, when grounded in an understanding of the nervous system’s needs, sets the stage for healing by fostering a sense of safety, enabling connection, and creating the biological conditions necessary for genuine engagement and growth. This approach helps the suffering individual’s nervous system gradually transition from emergency mode to a more stable operating mode. The path to effectively supporting individuals in psychological or emotional distress lies not in regulatory control or enforced compliance but in cultivating empathy, honoring personal autonomy, and prioritizing relational environments grounded in safety, trust, and human connection. Individuals can only begin to heal when they genuinely feel seen, safe, and supported, allowing their nervous systems to relax enough to consider the possibilities of healing, reclaim their agency, and restore their ability to connect. Connection is the essential human need that ultimately leads us back to wholeness. Healing is not about control; it involves offering compassion that enables the body’s and spirit’s innate wisdom to regain connection and well-being.
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