Psychodrama in Couple Therapy

Guest blog by Stefan Neszpor, FRCPC, director of the Adelaide Couples Clinic and PACT Level II practitioner, Adelaide, Australia

Most couples have a story about what is taking place in their relationship. However, the story often doesn’t match the reality of how they experience one another. I was reminded of this recently when I met a couple in their mid 30s, with two small children. With respect to PACT attachment styles of relating, he was an island and she was a wave. In simple terms, that meant he tended to distance himself, while she was more the clinging type.

They came to therapy because she had become infatuated with a man living next door who seemed more approachable to her. Indirectly, it seemed she was trying to signal to her partner that she wanted him to be more attentive.

In the initial therapy sessions, they were able to identify one of her early patterns whereby she had a deep desire for affection. This showed itself as anxiety. Her way out was to gain attention as a form of approval for her sense of self.

Several sessions later, I asked them to do a simple exercise called the lovers’ pose as a way enabling themselves to have greater access to one another. They liked it and I could see that it was helpful, so I asked them to experiment with aspects of their experience at home.

When I saw them at the next session, I asked them how it went. The husband reported that they had been “too busy” to do the exercise on their own.

Ordinarily if I were using a psychodynamic therapeutic frame, I would have gotten caught up in asking them to define busy. I would have tried to understand the various dimensions of “busy” to find out how that undercut their attempts at connection. However, I decided instead to use my PACT skills of psychodrama. I asked them to “show me what busy looked like.”

The first step was setting the scene. They proceeded to set up the therapy office as though she were in the kitchen preparing some food, and he had just arrived home from a busy day’s work. He gave her the shortest of greetings and started to play with one of the children. He virtually ignored his partner.

All this was videotaped, so they were able to review it afterwards. I began by asking how satisfying it was to have this distance between one another, and whether this was actually meeting their needs.

As they reviewed the video, they saw their overall lack of contact, lack of eye contact, and distancing behaviours. They recognized the impact on their relationship and were able to articulate a different story about what they had called “busyness.” It was a story of sadness, of fear and apprehension about making contact. He expressed the overwhelming shame he felt at his inability to know how to initiate contact with her in an affectionate way.

I asked them if they could think of any particular things they could add to their interaction to make it more pleasant. Both of them found this difficult to identify. So I coached them in how to make greater eye contact and use physical contact as a way of signalling to one another what actions felt safe. I modelled the behaviours and encouraged them to give it a try—much as a director might do with actors in a play.

I then gave them the option of re-enacting “busyness in a way that their needs could be expressed. With the support of my coaching, they were able to do this. They found it to be much more enjoyable and engaging. They seemed empowered to go further with their ability to seek each other out. The psychodrama had made it safe for them to make the contact for which they both seemed to yearn.

I set new homework assignment for further exploration, which they were able to do. The end result of this process was that they were able to dissipate some of their fear and avoidance behaviours, and begin to make true, meaningful contact with one another.

Beyond the Ick Factor: Deeper Healing for Issues of Sexuality

Guest blog by Karen Berry, Ph.D., PACT faculty, Warwick, NY

Often when couples come to therapy seeking assistance with issues related to sexuality, the problem is not what it appears to be. They describe issues such as sexual dysfunction, discrepant desires, pain during intercourse, inability to maintain an erection, and/or profound loss of interest. But often what we might call the “ick factor” is what is actually driving their presenting problems. Thus it is essential to look more deeply in order to get to the real difficulty. When the real problem is successfully addressed, treatment is much more effective and true healing becomes possible.

For example, when one partner discloses difficulty tolerating the other’s body odor, taste, and/or touch, the tension in the therapy room grows palpably. Until I studied PACT and began to think in terms of psychobiology, this was a moment I dreaded as a psychologist and a sex therapist. This was painful and overwhelming to the couple and to me due to the meaning inferred: “I find you disgusting.” We would do our best to bumble through the conundrum, but rarely did the couple or I feel peaceful in the presence of this reality.

Everything in my office began to change when I read Love and War in Intimate Relationships (2011) by Marion Solomon and Stan Tatkin. I began to understand the psychobiological reasons some people are repulsed by their partner’s taste, smell, or touch. Some individuals who lacked skin-to-skin contact in early childhood possess an acute ick response to all near-sense experiences (i.e., touch, taste, smell, and near vision). The extreme ick response is most likely only a consequence of a nervous system developing and adapting to ensure survival. Now I see that it is simply another obstacle that, if understood and normalized, can be managed collaboratively within a secure-functioning relationship.

Every couple is unique. They consist of two human bodies—with two nervous systems and different family histories—and had little or nothing to do with each other until they became a “we.” The key to collaborating is deciphering what the words and behaviors mean to a particular dyad. A couple who present as scared to talk openly with each other about the difficulty pose a different problem than a couple filled with of blatant anger and hostility toward the ick factor.

Let’s look at Donna and Marcy, who are in their late thirties, successful, professional, married, and with two children. Their marriage is in trouble. The tone between them is cold and separate. Touch is nearly nonexistent, never mind sex. Marcy is angry about this. Donna doesn’t mind, and justifies her unwillingness to engage by stating, “I show you my love in other ways.”  Neither partner wants a divorce, but Marcy is furious and threatening.

Reunions, for this couple, are challenging, no matter what time of day. But late nights when Donna returns home from work are particularly difficult and set the tone for the next day. We enact this repetitive event in the office. Marcy pretends she’s asleep so she won’t have to deal with the rejection of Donna’s complaint about her breath. Donna agrees she finds night breath repulsive, but she’s angry and hurt about returning from work with no welcome. Both are suffering, alone, and angry. We work together to make adjustments and build ways to reunite that feel good and doable to both.

As we continue our work, it becomes clear that the issue of Donna finding Marcy’s breath offensive permeates their connection. It has far reaching implications. Focusing on ways to amplify their positive states together, I ask Donna to sit on Marcy’s lap. I watch carefully as they orchestrate this task. At first, they laugh, having fun. As they proceed, they appear awkward with each other. Clearly, this is not something they do. Eventually I ask Marcy, “Does she look comfortable?” In unison, they speak again about Donna’s aversion to Marcy’s breath. Donna’s aversion is so extreme that she also hounds her children about their breath. It is clear that she is awkward about closeness—not only with her partner, but also with her own kids.

I get curious. What else is going on here? As they sit face to face, touching, I ask Donna how far back this goes: “What’s your earliest memory of being so anxious about breath—yours or others?” At first, she has no association. Then, she remembers being at school with her mom in the auditorium. A classmate seated nearby said to Donna, “Your breath stinks.” Donna’s mom provided no comfort for her humiliation. The issue became traumatic because no adult helped her metabolize this painful event. Therefore, the unremembered, unresolved trauma emerges in other situations. Finally, Donna has a family member, Marcy, who is able to provide healing. Now that she understands, Marcy has compassion for Donna. She truly comprehends that this is not about herself. She no longer feels threatened. Together, they can collaborate on managing the obstacle of Donna’s acute ick response.

This collaboration allows them to heal Donna’s trauma. She can now receive comfort from a loved one for the first time in her life. This healing also allows Donna to become less awkward with physical touch with her loved ones. The future is much more hopeful for this couple and their family.

Copyright Karen Berry

Therapist Self-Regulation, or Flying into a Hurricane

Guest blog by Hans Jorg Stahlschmidt, Ph.D., PACT faculty, Berkeley, CA

Some couple therapists have referred to their work as flying a helicopter into a hurricane. Perhaps the metaphor is inflated, but couple therapy is certainly an enterprise that can create acute anxiety. Like a pilot, a therapist needs the skills and training that make it possible to stay calm and alert when the going feels treacherous and unexpected turbulence appears seemingly out of nowhere. Interestingly, some Air Force pilots, called “hurricane hunters,” are specially trained to fly into the eye of the hurricane to collect weather data. Maybe that is like what we are trained to do in PACT: instead of fearing and avoiding conflict, we are trained to fly into it with our capacities to collect data and navigate skillfully intact.

Besides this hurricane-related skill set, a couple therapist needs the ability to hang out in uncertainties, to act not out of anxiety but out of creative insight that is the expression of an integration of limbic system and frontal cortex. In other words, the therapist relies on a solid self-regulatory capability

The therapist’s task is to be fully present when focusing on the couple, capable of what Bion (1962) speaks of a therapist metabolizing the error-filled process of the couple, similar to a mother’s ability for maternal reverie. The capacity to be a master regulator is, in essence, the ability to tolerate and manage anxiety in such a way that one can become an agent of change. The process requires a transparent self that has the ability to relinquish defensive strategies and tolerate anxiety.

As passengers look to the pilot hoping to find confidence in his or her expression, a reassurance they are in good hands as they lean back and buckle their seatbelts, so a couple in the varying states of activation and vulnerability that bring them to therapy need to feel the therapist’s confident and caring presence. From the couple’s perspective, a dysregulated therapist is potentially impaired in all important functions.

Dysregulated therapists are perceived as misattuned because their ability for attunement is hindered by the activation of alarm or threat. They are experienced as relatively unempathetic because of interference from relational processing areas around the orbital frontal cortex. For instance, if the therapist is experiencing an inordinate amount of threat, his or her understanding and conceptual assessment of the couple’s situation may be inadequate and even tilted because the prefrontal cortex, as an executive and regulating center, does not have the necessary resources to inhibit impulses, down-regulate high arousal, and think in an integrated fashion.

The ability to challenge a couple’s maladaptive patterns and their respective defensive systems cannot be effective and on target when the therapist is preoccupied with his or her own emotional reaction in a way that clouds the task at hand and hinders the necessary therapeutic interventions. The dysregulated therapist ceases to function as the master regulator in the room. The couple may experience the therapist as “nice” but weak, as absent and detached, as avoidant and distancing, or perhaps as needy or even threatening. Such a therapist is “dangerous” in the sense that the partners may feel ensnared in regressive dynamics, pushed into parentified roles, or hopeless about the therapeutic process and the prospect of their relationship in general.

I have painted a relatively stark and dark picture of a highly anxious or fearful therapist and his or her impact on therapy. Of course, we all are vulnerable to periods of dysregulation. The point is that the development of a durable and solid capacity to work through and manage our own anxieties as therapists is crucial for the therapeutic process.

To help a couple we, as therapists, have to be able to step in to regulate the emotionality, tension, anger, or upset in the room in a way that is not distancing or reactive, not judgmental or self-referential, but rather that is real, empathic, and focused on the conflict at hand. This regulation has to be bottom up not only for the couple but also for the therapist. This regulatory process has to be anchored in the body and has to include emotional processing that can lead to integration and solidity.

The most important aspect of self-regulation for PACT therapists is being anchored within a comprehensive and effective therapeutic model. This model gives us the frame as well as the modalities to process and transform anxiety into “play,” worries into curiosity, and negative expectations and shame into a frank acknowledgment of imperfection or sharing one’s own humanity in a therapeutically effective fashion. The model in and of itself is regulatory for the therapist. It prepares him or her for the worst and the best, for being in minefields, in fog, or in the middle of a hurricane. The PACT therapist is ready for both the high- and the low-functioning couple.

The PACT principles and operating methods are like a psychological GPS system that helps orient therapists in our work. This GPS also helps couples to re-map their minds and relational brains and to get better at finding their partners. It helps them to give up old dysfunctional habits and to develop more relational new ones. Although at the outset of therapy, we don’t know how the travel will unfold and who partners really are, we do know that our GPS works under almost any condition. This certainty and the continuous recalibration to the basic frame and principles of PACT are probably the most valuable tools a therapist has for self-management of anxiety.


Bion, W. R. (1962). Learning from experience. London, UK: Heinemann Medical Books.

Copyright Hans Jorg Stahlschmidt Ph.D.

Fighting About Hot Topics: “Do What I Want!”

Guest blog by Annette Kreuz Smolinski
Licensed clinical psychologist (Spain), Dipl. Psych. ( Germany),
Trainer and supervisor in couple and family therapy, PACT Level II practitioner

The annoying truth is that all couples fight. Conflicts are an absolutely normal phenomenon in human systems, and couples are not an exception to this rule. It is unrealistic to think you could avoid having arguments from time to time.

When you face issues such as the education of your child, the sharing of household chores, finances, sexual relations, and your relationships with relatives, some of your partner’s opinions and preferences will inevitably differ from your own. He or she will not just do what you want. However, when it comes to hot topics, you need compromise and acceptance.

The good news is that conflict avoidance is more dangerous to your relationship than is properly handled conflict, or “fighting fair.” The bad news is that if you fight “dirty,” you will ruin your relationship, even if you come up with an agreement that seems to work.

Spain, where I live and work, is a Southern European country with a strong religious tradition. In this environment, couples typically do not go into therapy unless they are extremely distressed. As the literature shows, these kinds of couples are the least likely to achieve successful outcomes from therapy (Snyder, 2006).

When I start therapy with a couple, I don’t know if they are heading for separation or will be able to stay together. However, since I have begun to incorporate PACT techniques, the percentage of couples who stay together has clearly increased.

In my opinion, working on how couples fight is extremely important. I usually include a special session about fighting fairly during the second or third meeting. The rational I give is that partners must learn how to create win-win outcomes for one another. This skill is a must for both partners regardless if they stay together or not. To help with this, the PACT therapist focuses on principles of true mutuality, fairness, justice, and sensitivity, with the emphasis on both partners working toward mutual relief as quickly as possible. Partners are expected to pay close attention to each other’s facial, vocal, and bodily cues for purposes of regulating each other’s emotional state while in conflict. The idea is that as soon as partners are perceived as unfriendly, a biological threat system takes over and prevents either from getting what he or she wants. The required moment-by-moment attention to external social emotional cues helps to keep partners from becoming dysregulated or threatened.

Consider Jorge and Isabel. He is 61, she is 52, and they have been married for 38 years. They have two grown children, both of whom are independent and thriving. A month ago, the psychiatrist who was treating them in individual therapy suggested they separate. She considered Jorge to be pathologically jealous due to his obsessive compulsive disorder. At that time, she referred the couple to me, so they could determine their future.

Jorge had moved out before they came to see me. In our first session, he said, “I only lose my temper with Isabel.” It turned out that at home he is a champion of conflict avoidance. He withdraws until he can’t any more, and then he attacks. Isabel presented her own version of the couple’s estrangement. Both think the other overpowers them.

In the fourth session, an old sensitive issue arises: Jorge has always yearned for a dog. When the kids were small, he talked Isabel into buying one, but the lack of support by him and the children left the dog’s care to the overwhelmed working mother. Isabel banned the dog from the house with “it’s me or the dog.” Jorge now wants a dog if they come together again.

To address this issue, I gave them instructions for the 5-minute argument. The couple must sit face to face, with eye contact, and start to talk about the topic. They must finish within 5 minutes, with both partners feeling okay. This is videotaped and “fed back” to the couple immediately.

For Jorge and Isabel, the turning point came in the third round of 5 minutes when Jorge stated calmly, clearly, and sorrowfully, “Look, the dog is exactly the same issue as our bedroom: I feel you don’t take me into account. I am not in your mind when you make decisions.”

Noticing him tearing up, Isabel reacts softly: “I am so sorry about the bedroom. I promise that won’t happen again. But when you try to impose a dog on me, I feel obliged and I rebel. Instead, I want you to seduce me. That is the only way I will do what you want, because I will want it too.”

Jorge responds: “Will you go on a date with me to visiting an animal shelter, so I can show you the kind of dog I like now? I promise we won’t get any dog until you are totally seduced by the idea!” He smiles, and both laugh.

As a therapist, it is rewarding to see couples start to fight fair, think of conflict resolution as creating a win-win situation and immediately repair wounds produced in the heat of an argument.


Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–44.

The Red and Blue of Marriage

by Stan Tatkin, PsyD, MFT,

A study by Harvard University researchers that looked at data for more than five million families, and that was recently featured in The New York Times, found that where you live in the United States greatly influences your chances of getting married. The study parsed the data according to political affiliation (blue versus red counties and states), as well as population density (big town versus small town). In a nutshell, if you were brought up in or even have moved to a liberal-thinking, densely populated, metropolitan area, such as New York City or Washington DC, you are less likely to marry than if you lived in a small town, in the deep South, or generally anywhere in a red state.

We also know from Pew Research Center findings that 80% of Conservatives think society benefits when people consider marriage their priority, while 77% of Liberals think other priorities are more beneficial. We only have to think of same-sex marriage, abortion, the Confederate flag, immigration, and countless other issues to realize how deeply divided our society is. Marriage, it seems, is one more issue that divides us. This debate was the subject of Cahn and Carbone’s Red Families v. Blue Families (2010), and proponents from each side of the debate continue to seek data that will advantage their views.

It may be that marriage in its current form is undergoing a change. Or perhaps, as some like to predict, it is being phased out entirely. For instance, many Millennials claim they are not interested in committed, long-term love relationships. They are more comfortable with groupings of individuals and less drawn to pair bonding. One thing we can say for certain, however, is that even if the forms are changing, relationships themselves are not being phased out. Families aren’t being phased out. Falling in love is not an archaic experience. Just walk down the street and look around. Just turn on the TV. Just scan the Internet. People are pairing up in some form or another.

I think we should also admit that we don’t have a crystal ball. It is premature to draw conclusions about the long-term future of marriage. The participants in the Harvard study are only old enough to yield data up to the age of 30. We don’t know if they will move away from their current Liberal perspective and adopt more Conservative views by the time they reach 40. Many in previous generations have done so.

From a PACT perspective, we can consider whether researchers would find different results if they focused on our definition of secure-functioning relationships between two people rather than on more conventional definitions, such as whether families are “intact” or “stable.” While being intact and stable are certainly correlates of secure functioning, they do not necessarily include all the beliefs and behaviors that make a marriage secure. Ultimately, I believe that people pair bond for the purpose of obtaining a safe and secure union. That may look one way in blue states and another way in red states, but our job as therapists is to look beyond the politics and concentrate on improving the lives of those who come to us for help.


Leonhardt, D. (2015, July 1). Intact families, continued: The red-county advantage. The New York Times. Retrieved from

Leonhardt, D., & Quealy, K. (2015, May 15). How your hometown affects your chances of marriage. The New York Times. Retrieved from

Pew Research Center. (2014, June 26). Compare political typology groups. Retrieved from

Cahn, N., & Carbone, J. (2010). Red families v. blue families: Legal polarization and the creation of culture. New York, NY: Oxford University Press.

Working Through Betrayal – Regret to Redemption

Guest blog by Eva Van Prooyen, M.F.T., PACT faculty, Los Angeles CA

When a betrayal has been discovered in their relationship, couples come to therapy feeling lost, disoriented, confused, and angry. They may even wonder if there is hope. Infidelity strips away happiness and threatens emotional security. It can come in a variety of ways, including contempt, neglect, indifference, violence, lying, and affairs. Information is discovered that forces the deceived partner to reevaluate history. Partners are left asking: Who am I? Who were we? Who are we?

Couples can come through painful infidelity, but only if the perpetrator shows regret, if there is transparency, and if both partners want to get back into the relationship. Under these conditions, a skilled PACT therapist can set up an architecture to work through betrayals.

The first phase is to address the fact that the victim has experienced a trauma that can never be undone, and that it has to run its course.

The perpetrator at this point has no power to negotiate. Although this is a temporary role, the perpetrator must simply sit there and take the rage and inquiry of the deceived. The perpetrator has to deal with feelings of shame, guilt, and regret and has to express a commitment and desire to want to get back into the relationship.

PACT therapists understand that no one would blame either partner for wanting to get out. At the same time, the therapist is there to offer support if both partners want to stay. Often, the perpetrator turns out to be both the cause and the cure. There is no sweeter repair than one genuinely originated by the most important person in your life.

The next phase is aimed at resolution, and must come in the form of real-time, stable, consistent support for the deceived. Transparency is paramount, and couples soon realize this is what their relationship needed from the beginning. The deceiver has no right to hide anything or withhold information.

The final phase is for the deceived to let the perpetrator out of the doghouse, honoring the new and improved version of their relationship.

Joe and Susan, a couple married for 6 years, both 38-years-old, with a 5-year-old son, came to couple therapy a year after a set of sexual encounters was discovered. Joe, a financial executive, had worked overtime for the past few years because he was eager to create financial security for the next few generations of his family, after himself being raised in poverty. Susan, a stay-at-home mom, had been disgruntled with Joe’s fatigue and over-focus on work. Feeling neglected, she became involved with a man she’d met online. Joe came home one day to surprise his wife with flowers and lunch and caught the two of them in the act, on his desk, in his home office.

After that, Joe was unable to focus at work. His sleep was disturbed, and he cycled between numbness and rage. Claiming it was her only affair, Susan was immediately remorseful. But she felt lost about to how to “build a bridge back” to her husband. Neither wanted to end their relationship. They tried unsuccessfully to piece themselves back together over the course of a year, but Joe was disturbed by the images that replayed in his mind, and he didn’t fully believe Susan. She tried to be forthcoming with information, but that often resulted in finger pointing and defensiveness when she found herself on the receiving end of Joe’s anger and interrogations.

My first task when I saw Joe and Susan was to address the fact that a trauma had occurred that had to run its course. This healing process was interrupted for Joe by Susan’s inability to tolerate her own shame and her anger at being neglected. She needed support bearing her (hopefully temporary) role of having zero bargaining power and enduring Joe’s rage and inquiry.

The next task was aimed at resolution. This had to come in the form of Susan giving support to Joe. She had to accept that she had no right to hide anything because any holding back would be re-traumatizing for Joe.

Finally, Joe had to let Susan out of the doghouse, honor the renewed version of their relationship, and let genuine repair take hold. He had to allow her a turn at being angry, and set more time aside for simply being together with his wife and son. Both needed to explore how they were culpable. They had to deepen their understanding of one another and learn how to care for the person they chose to marry. It was time for genuine repair take hold. They were even able to reveal shared intimate fantasies to one another, which led them to Joe’s home office for a late-night rendezvous (after a ceremonial burning of the desk).

Through their couple therapy, Joe realized the impact of his neglect on his family and how his over-focus on earning money had hurt everyone. Susan was able to claim her passive-aggressive acting out, and came to deeply understand the intention behind Joe’s need to work. She became the protector of that part of him, and made it easier for them to spend time together.

On the other side of working through betrayal with a PACT therapist, a relationship will not look like it did before. Couples can come up with inspiring, creative workarounds that ultimately strengthen their relationship. Having seen many couples come through difficult times, I have great trust in people’s ability to create amazing solutions that align their hearts, minds, and intentions toward secure functioning.

Applying the Three PACT Domains

Guest blog by Mary Ackerman, MIC, BASS (Cllg); CARE Counselling Hong Kong, PACT Level II practitioner

Philippe and Grace, who have been married for twelve years, are clients in my clinical practice in Hong Kong. He is French Swiss and works in finance, and she is Korean American and works as an auctioneer. They have three daughters. They sought therapy after Grace found out that Philippe had been paying for prostitutes on his overseas travel. He admitted to fathering a child in the Philippines.

When I asked why they had come to therapy, both said, “To save our marriage.”

As I worked with them, I found it helpful to observe the influence of the three domains of PACT: attachment theory, arousal regulation, and neuroscience. An overwhelming sense of anger and fear ran through each session, and these domains helped me understand this challenging couple so I could develop an effective treatment approach.

First, their attachment styles were key. Philippe is a wave. He causes disturbance in the marriage because he wants to connect, yet fears connecting. Grace is also a wave. As such, she has not been able to provide any sense of steadiness or security in the relationship. Despite parenting three children, neither partner feels the two of them really belong together. Each is preoccupied with fear, anger, and ambivalence about being close.

Next were their arousal regulation styles. As waves, both Philippe and Grace carry with them fears about being abandoned by a partner. Each travels a lot and finds the separation disruptive to their connection with each other and with their children. In addition, each feels discomfort when alone. Philippe soothes himself by seeing prostitutes and having a second family overseas. Grace tends to look toward food and alcohol for comfort, especially when Philippe is out of town.

With respect to neuroscience, both Philippe and Grace have primitives that are permanently in a state of readiness for danger, quick to jump at the slightest sign of threat. This leads to very frequent and heated arguments. Philippe’s ambassadors tend to come online before Grace’s do. Even so, he finds it nearly impossible to assuage Grace’s fears because she withdraws and does not respond to his overtures.

In sum, these partners are mired in a place where they do not serve as each other’s go-to people, where thirds are allowed to take precedence, and where they lack rituals to reengage after being apart. It takes time for them to come back together again, and they are often unable to reconnect before one or both are overseas for yet another trip. The result? No resolution, no learning to reconnect.

Although working with these clients could be a long process, especially given their travel demands, I believe they are sincere in wanting to save their marriage. I decided to focus my initial strategy on PACT’s tenth guiding principle, as defined in Wired for Love: partners can minimize each other’s stress and optimize each other’s health. As waves, Philippe and Grace will benefit from learning to regulate each other’s arousal and lower their threat levels. Within this overall goal, I began by introducing several simple yet oh-so-effective interventions. I suggested experimenting with launching and landing rituals to help them reconnect after their travels. I also suggested they text and Skype regularly during their travels so they can stay connected. These and other related strategies quickly helped Philippe and Grace begin to build a secure base.

Copyright Mary Ackerman

Our Automatic Brain: Everything New Will Soon Be Old

by Stan Tatkin, PsyD, MFT,

Our brains are remarkable organs. They take in and use massive amounts of information from inside and outside our bodies and allow us to go through about 90% of our day automatically. We can get from point A to point B while checking our emails, talking to others in the subway, drinking coffee, or doing any number of tasks simultaneously. Our brains are on automation, running our lives, making decisions, and doing what needs to be done, with little thought required. Our automatic brains are cheap to run and extremely fast and efficient. That’s a very good thing when you consider how much that ability would cost if we had to use the very expensive novelty-oriented parts of our brain. If we couldn’t rely on automation, we’d never be able to accomplish much of anything.

The automatic brain is made up of old memories, some of which are explicit, but most of which are implicit, or outside our awareness. This is called procedural memory. We know it because everything we have learned—riding a bicycle, driving a car, dancing a routine—has become something our body knows.

Imagine you and I are on our first date. We are both excited by this new creature before us (assuming we are interested in each other, of course). Our aliveness is apparent, and our attention is focused intensely on each other’s face, body, smell, touch, and maybe even taste. You and I want to know everything about the other. We are fully present, and wonderful neurochemicals are coursing through our blood, brain, and body, much like cocaine. That is nature’s love potion working on us. Delicious, isn’t it? Would you like to have a bit more?

But I have good and bad news for you. First the bad first. The beautiful, fascinating, mysterious new thing that you are will be automated by my brain very soon. And your brain will automate me soon, too. When that happens, we will become familiar, and our novelty-seeking brains will no longer pay each other so much attention. Instead, we will draw from our vast reservoir of memories and experiences to do our daily business.

What is potentially bad news about this is that we think we know each other, but we don’t really. So we will make mistakes. We’ll operate from memory, which does not require presence, attention, error correction, and the other fancy things our brain does when faced with newness. For example, my brain will automatically see you as if you were my ex-wife or my mother or my father, and base its reactions on those memories.

Oh! I almost forgot: the good news. Due to the automatic brain, our relationship will seem easier, more comfortable, and more familiar. Probably the best news is that automation does not have to become a problem. This is because the antidote to automation is presence and attention to detail. By that I mean that you become habituated to attending to the details of your partner’s face, voice, body, movements, and words and phrases. When you are together, stay present in your body and don’t wander off into your own thoughts, your cell phone, and or other potential partners across the room. Keep your eyes on the ball—and that ball is your partner. Pay attention as if you’ve never seen or heard him or her before.

Paying close attention engages your brain’s novelty-loving parts. You’re telling it, “Hey, this person is unpredictable, surprising, beautifully complex, and the one on whom I am placing all my bets.” Much like a sign I once saw in Las Vegas: “You have to be here to win!”

King and Queen: Protecting the Couple Relationship

Guest blog by Rachel Holland, DClinPsych, PACT faculty, Buckinghamshire, UK

One of the characteristics of secure functioning a PACT therapist communicates is that romantic couples are the King and Queen of their domain who protect their relationship and each other in public and in private.

I had been working with Peter and Jane for four sessions. They came to therapy for help with intimacy, and our initial work focussed on therapeutic alliance and social contracting. Both were outsourcing their arousal regulation away from the relationship to substances.

From the Partner Attachment Inventory (PAI), I knew both Peter and Jane experienced emotional neglect in childhood and had parents and caregivers who were either unavailable and didn’t protect them sufficiently or behaved in ways that were frightening. More importantly, the couple now had this information about each other and a better understanding about how each operated. They were beginning to understand how they had internalized an insecure model of one-person psychology and auto-regulation that kept them safe up to a point as children. As adults in a romantic partnership, the strategy of tolerating distress alone was leaving their couple bubble open and vulnerable.

It was coming up to Christmas time, and they were talking about their plans, including their families coming to dinner at their house on New Year’s Day. Jane’s stepfather is sarcastic and insulting toward her mother and also Jane. He likes to irritate Peter, and has a pattern of dividing and conquering those within whom he interacts. Jane’s mother is passive in the face of her husband’s unpleasant and unkind behavior.

The dinner sounds torturous. Could they avoid it? Absolutely; however, this family scenario would quickly be replaced by an inconsiderate boss, an awkward co-worker, or other threats to their relationship that would need to be skilfully handled together.

“So,” I ask them, “how are you going to take care of each other during the visit?” In asking this, I send the explicit message that secure couples manage together and protect each other from threats.

PACT is a “show me” therapy. So I invite Peter and Jane to stage the dinner. First, they walk through how family dinners typically run, and how the stepfather divides and conquers. Their arousal levels move quickly outside the window of tolerance, and they auto-regulate to cope with the all-too-familiar activation and threat. It becomes clear that it can take days for the couple to recover separately from an event like this.

The role of the PACT therapist is to push couples down the tube of secure functioning, toward each other and into the couple bubble for protection. Therefore, I use the language and frame of King and Queen to communicate that Peter and Jane are and should be at the top of the hierarchy together, and not somewhere at the bottom, getting run over by the stepfather’s derogations. I invite them to stage in real time being the King and Queen (in this case, host and hostess) in the protection of each other with their challenging guests. I offer the psycho-education that they are in the role of protector of each other, as the public stewards of their relationship. The process is to take a second pass through the scene, during which they can practice secure functioning.

We try out seating arrangements in which they are in each other’s line of vision, rather than side by side. This way, they can more readily pay attention to each other’s arousal states and help each other regulate with eye gaze or signal for help. Being side by side would leave them more prone to perceiving each other as predatory.

They think up the ruse of tasting or stirring the gravy as a means to allow them to escape to the kitchen together and check in with each other. I suggest eye gazing, making faces at each other, eye rolling at the stepfather, and embracing as means for arousal regulation through interaction and levity so they can respond as a couple to the activation they feel from the challenging personality styles in the family.

Jane has learned about Peter’s attachment and arousal styles, she knows he will need a break from being with people, just to breathe out. She says that when she notices his arousal level shifting, she will suggest that he take the dog for a walk while she continues to host the guests. He can reciprocate for her later.

After dinner, they plan to sit their guests in front of the television with a box of chocolates while they clean up in the kitchen, which will give them more time together as a couple to decompress, connect, and protect. They will also be proactive in returning to the living room with their guests’ coats in hand, and reminding them that traffic is building and perhaps it is time for them to head home.

PACT takes the therapeutic stance that one does not have to have a secure model growing up to have a secure, protected, loving, and nurturing relationship as an adult. The PACT therapist expects couples to move toward secure functioning. We expect partners to know each other well, manage each other well, and protect their couple bubble. A King and Queen who protect their relationship are a couple who rule their world.

Copyright Rachel Holland

Couples in Distress: Working With Bottom-up Interventions

Guest blog by Inga Gentile, MFT, PACT faculty, Bardu, Norway
“Nothing is more revealing than movement.” — Martha Graham

Despite our conscious narratives, which are formed in the brain’s left hemisphere, much of what we do is driven by fast-acting processes and affect-regulating capacities encoded in the right hemisphere as part of procedural memory. Our early repeated relationship experiences not only create a psychological blueprint for how we view ourselves and others, but also determine how we will operate in future relationships. They also influence the development of brain structures responsible for affect regulation later in life. These memories (when manifest in psychobiological reflexive behaviors\micromovements in the body and face) can either refute or support our conscious narratives. They also influence how we move toward and away from people and how we get people to move toward and away from us, particularly in times of threat. This is one way that the past can be seen as taking place in the present.

Accessing these processes and capacities in real time can provide clues about the subpsychological issues related to attachment organization and arousal regulation that underlie high and chronic levels of distress in couples. Armed with this information, a PACT therapist does not rely on verbal report alone while assessing what is really going on when a couple present in therapy. This is where bottom-up interventions are particularly potent because they are designed to access processes encoded in procedural memory. The PACT therapeutic stance is focused on moving couples toward secure functioning and uses both top-down as well as bottom-up interventions to do so. In attachment terms, secure functioning is characterized by qualities such as attentiveness, true mutuality, attunement, and sensitivity. These qualities are considered optimal for psychological and neurological development, as well as for social-emotional functioning.

In PACT, using bottom-up interventions (e.g., asking questions to elicit psychobiological responses; staging specific interactional events; and tracking moment-to-moment shifts in internal states, as registered on the face and in the body, and bringing them into awareness) can lead to powerful revelations about what is really going on with a couple in chronic distress. Subsequently, this positions the couple to move in the direction of repair and development, and toward safety and security.

Sarah and Erik are in their mid 30s and have been together for 8 years. They present complaining of exhaustion, miscommunication, and frequent arguments that leave them feeling little other than frustrated. In session, they appear to exhibit frequent moments of misattunement, and attentiveness and mutual sensitivity are lacking in their interactions. This is reinforced by their respective attachment histories, which appear to be characterized by insecure parenting.

In session, as Sarah begins to express feelings of hopelessness about things ever getting better, I notice her voice volume begin to increase, her speech become pressured, and her tone become sharp. As I cross track between Sarah and Erik, I notice that Erik several times breathes in as if to speak but does not. As Sarah continues to speak, Erik grows increasingly silent and still. His face is flushed, and his breathing shallow.

I use a bottom-up intervention to ask Sarah to notice what is happening to Erik. “He’s doing what he always does. Just sitting there.” she says.

To validate how she might experience him in this moment, I then wonder out loud if she’s aware of how she sounds and how that might affect Erik. As we examine together the moment-to-moment shifts in this real-time interaction, Sarah recognizes that her harsh tone and voice volume, more than her words themselves, trigger on a psychobiological level Erik’s early experiences with intrusive caregivers, leading him to grow more silent and still, as he did when he was a child. Erik sees that his self-protective and reflexive behaviors trigger Sarah’s childhood experience of inconsistent caregiver availability and neglect, and as such, only serve to escalate her distress.

Further moment-to-moment tracking in session reveals that Sarah is negativistic when Erik attempts to reach out to her in real time with the comfort she reportedly longs for. In the wake of this awareness, Sarah’s face turns flat, her eyes dart, and her body freezes. I point this out and ask each of them to notice what is happening.

Sarah is able to report that she sees her partner reaching out, but that she can’t go to him. Erik becomes aware that he feels conflicted—both wanting to reach out but not being certain how to, or only doing so in small ways, and fearing rejection. This new information reframes the couple’s difficulties as issues related to giving and receiving comfort—issues that are rooted in early experience and are now being expressed on a psychobiological level.

At one point, I roll my chair closer to Sarah to provide support through proximity, while directing a cross comment to Erik: “Remember when Sarah told the story about falling down the stairs and hurting herself, and no one came for a long time… and when they did come, they didn’t really help her ? I wonder if that happened to her more than once, and if that is part of what is happening to her when she hurts in some way and needs you to help? Maybe she can’t receive it now, just as she didn’t receive it then.”

Erik nods. From the way he leans forward and the gentle look he gives Sarah, I sense that this cross comment both brings him out of his shell and also helps him feel closer to Sarah, while allowing Sarah, the space to explore her feelings.

As I help Erik and Sarah explore what is happening within and between them, she is able to have a somatoaffective experience that links some of her present difficulties in her relationship to her experiences of neglect and abandonment in childhood. She is able to get in touch with her grief as it felt in her body when she was a child, as well as give words to it now. This is something she was denied at critical junctures in her childhood. In turn, her husband, who so often felt frozen and unable to respond to her complaints, begins to feel he can have a meaningful impact on his partner.

It is interesting to note that Sarah’s prosody toward her husband changes in subsequent sessions, as her voice takes on a softer, more modulated tone. And Erik, although still less talkative than Sarah, is now willing to risk sharing more with her. Individually and together, they are positioned to move toward greater collective safety and security in their relationship, which in turn can foster mutual resilience, growth, and development.


Copyright Inga Gentile

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