Michele McCormick, Ph.D.
PACT Level III candidate
Newport Beach, CA
The body tells the story. In contrast with traditional psychoanalysts, PACT-trained therapists need not take an extensive life history in the first session to discern how a client’s past affects how he or she relates to his or her partner. Sure, early histories eventually emerge during the highly interactive Partner Attachment Interview. However, for a PACT therapist, the way a couple interact in the realm of the body becomes a powerful early assessment of where they are with each other. Are they securely attached? Are they safely in one another’s care?
Alex came to therapy to fight for his 6-year relationship. He described feeling neglected by Cindy. They had not had sex in more than a year, and he longed for intimacy. He believed Cindy did not love him and he demanded she agree to marry him within the next 30 days to prove her devotion. Cindy’s belief was that she did love him, but felt his temper drove her to keep her distance.
Making use of the body through PACT’s Toward and Away intervention, this couple’s comfort with physical proximity told a very different story than presented in their initial verbal narrative: Alex stood silently still in one corner of the office while I directed Cindy to, “Walk toward him and stop where you think you should.” She stopped four feet from him.
When I asked her to gradually step closer, Alex became increasingly agitated. When Cindy was within a foot, he suddenly turned his body away from her, his discomfort palpable. Alex broke the silence: “Can we stop? This is just too weird for me.” While his avoidance of closer contact might indicate past trauma, in that moment, it showed the couple that Alex may not have been as ready for the intimacy and commitment as his demands indicated.
Because PACT’s approach incorporates the importance of neurobiology and arousal regulation between partners, couples actively and efficiently learn right there in the office what blocks them and what heals them. PACT is so much more than a “he said, she said” talking cure with the therapist playing the role of judge and determining who’s right and who’s wrong. Instead, a couple’s metaphorical and very real relational dance is revealed through posture, proximity, facial expression, pupil dilation or constriction, the capacity to sustain eye contact, hand gestures, a dip of the chin, and facial micro movements. As a couple sit in rolling chairs facing one another, arousal regulation takes center stage. While I remain interested in what they are saying, I am even more enthralled with how they are moving. I have come to respect the phrase “The body never lies”.
When Marie and Steven initiated therapy, they were on their seventh couple therapist. Married for 18 years, they claimed they were living parallel lives in a sexless marriage. Steven was an accomplished engineer and bronze sculptor, and lived very much in his head. He showed up for therapy highly motivated. Marie came in kicking and screaming. She was all about wanting to feel it. His motto was “You’ve got to work at it, and here’s my three-step plan.” Her mantra was “If I’m not feeling it, I just can’t do it.”
Not yet trained as a PACT therapist, I initially used a traditional seating arrangement with this couple. Each week, they came in and sat down at either end of the couch, as far apart as possible. Steven rarely reached out to or moved toward Marie. While his body was often turned toward her, his gaze stayed fixed on me despite my attempts to redirect him toward her. Her body typically turned slightly away from him.
Invoking the language of a Shakespearian tragi-drama, I thought Steven “did-est proclaimeth too much”. The relentlessness of his expressed love for Marie in no way matched his physical proximity seeking. His body and his mind told very different stories. While Marie was clear about her entrenched ambivalence, Steven appeared to be equally ambivalent about actualizing intimacy. If I had focused exclusively on words I would have missed the centrality of his ambivalence, which ultimately informed my interventions.
With PACT’s strategic use of rolling chairs, I was able to orchestrate more face-to-face contact for this couple. Even then, they initially began each session rolled back and away from one another. I then introduced them to simple eye-gazing—both in session and at home—which was the shift they needed to once again find their couple bubble.
As a therapist informed by PACT’s integrative theoretical model, I continue to analyze my clients’ narrative content. These brief case examples, however, also illustrate the importance of reading the body. My understanding of how neurobiology informs PACT’s dynamic interventions has radically increased my ability to move couples in the direction of secure attachment and deeper intimacy. The body knows how to love!
Carolyn Sharp, LICSW
Pact Level III candidate
We all know the scene: a couple begin discussing a current challenge for them and are quickly down the rabbit hole of past injuries. “Why do you keep bringing that up?”
Jenny and Michelle have had a tumultuous relationship. They met right after college, fell in love quickly, and married after a year. They soon moved internationally for Jenny’s work, which was possible because Michelle had told Jenny her own work was mobile. However, Jenny soon discovered that Michelle had hidden things from her during their courtship, and lied about her work and financial history. These breaches led to a crisis and eventually divorce.
When Jenny and Michelle came to therapy, they had reconciled and were in a hurry to return to their earlier romantic feelings. However, in session, their discussion inevitably returns to the original injury. When they look to me in frustration, I ask if the original wound was ever repaired, and the room falls quiet. “Well, what am I supposed to do?” Michelle asks. “It was ten years ago!” Jenny says.
We know from our studies in PACT that injuries must be tended to quickly so they do not enter into procedural memory. Strong eye contact, physical touch, and the right words can soothe many hurts and create connection. Error correction is one of the strongest means of building connection: we demonstrate our willingness to be vulnerable to our partner, we show our partner that he or she is more important to us than being right, and we put the health of the relationship above all else.
However, we often form relationships without having learned what it means to adequately repair injury. As a result, many couples carry built-up hurts, both big (affairs and large betrayals) and small (repeated slights). It is common for couples to have unattended injuries in a relationship, without any idea how to mend them successfully. Couples often avoid dealing directly with these wounds because of shame and regret for their mistakes or fear of old pain resurfacing. When triggered, old hurts—both within the couple and from their early life—pop back up, and couples often retreat into exasperation and hopelessness. The PACT therapist’s job is to confront the injuries the couple want to avoid; only by leveraging the pain can true repair occur.
Reenacting hurtful conversations in extremely slow motion helps couples see how these injuries have become stored in the automatic brain. Viewing injuries as stored, and responses to them as automatic, begins to reduce shame and defensiveness, opening the door to curiosity and compassion. Continued practice with declarations, using face-to-face attention and careful recognition of changes in each partner, promotes inquiry into whatever is driving the reaction. Learning to lead with relief facilitates a sense of safety and trust.
As Jenny and Michelle return over and over to the incidences of dishonesty, secrecy, and attack that marred their early relationship, gradual change occurs. Michelle is slowly getting better at dropping the explanations when she sees the hurt that comes out as flashes of anger and accusation. She says, “I’m so sorry for all the secrets I kept from you, Jenny. I know it hurt you. I am sorry. I love you.” And Jenny is learning to drop the escalations and insults she used to get Michelle’s attention and instead to take in her apologies without shame. She says, “Thank you. I know you didn’t mean it. I’m sorry for not making more space for you to tell me in your own way. I’m sorry for being judgmental about your ways of doing things. I love you.”
With practice, protecting the self from feelings of inadequacy and shame becomes secondary to providing whatever a partner needs to feel safe in the relationship. In return, receiving such care allows the injured one to drop the attack: he or she no longer needs to shame his or her partner again for the old injury. Both partners can receive care and provide soothing in return. Over time, this mutuality of care leads to healing the ghosts of injuries past, and to a much stronger connection in the present.
by Beth O’Brien, PhD, licensed psychologist
PACT Level III candidate
“Fast acting, long lasting.” Those are the words one couple used to describe their experience of PACT in session with me. As a PACT Level III candidate, I find that once each partner learns to really understand the other and how the other works, their relationship runs more smoothly.
Couples often begin their first counseling session pointing their finger at the other partner. They blame, explain, and defend. I understand that they are angry and hurt, and it took a while for them to come to counseling. As our sessions continue, the partners experience the benefit of safe and secure functioning, and this becomes the primary goal for their relationship and how they want to be with one another. Through PACT interventions, they begin to collaborate more. “I” becomes “we.” They look out for one another more. What the other person says and needs matters more.
Wouldn’t anyone want that level of mutual care in his or her relationship? When I saw that Drs. Stan Tatkin and Tracey Boldemann-Tatkin were leading a Wired for Love Retreat at the beautiful Shambhala Center in Colorado, my husband and I decided we were in. I was eager to take off my therapist hat for the retreat weekend and be on the receiving end of PACT teachings and principles.
I did have some reservations, though. How many other couples would be attending? Would we have to air our dirty laundry in front of people we didn’t know? Would privacy and confidentiality be respected?
My concerns disappeared after our initial group session. Twenty-five couples attended, which allowed for an intimate setting. Most of the exercises were done with our partner, not as small group exercises. Confidentiality was paramount. Stan and Tracey, along with trainers Jeff Pincus and Rachel Cahn, were warm and welcoming. At one point, Stan revealed a difference of opinion he and Tracey were having, and that proved to be a role model for opening up and acknowledging that even couples who deeply love each other can struggle. Stan and Tracey then shared with us how they resolved their difference, which was very impactful to the group.
Topics for the retreat included How to Form a Couple Bubble, Becoming an Expert on One Another, Fighting Well, and How Your Partnership Can Heal. One of my favorite topics was How to Rekindle Love Through Eye Contact. In this exercise, we quietly gazed into our partner’s eyes. With our busy schedule, my husband and I often communicate across one room to another, or speak while tending to other duties. So looking into each other’s eyes felt like a treat. We laughed, we teared up, and we were reminded that the wonderful person sitting before us was the person we chose to be with all those years ago.
My husband said he liked getting to know the other couples. He found it touching to hear their stories about how they met and how their relationship developed. On the last day of the retreat, a few couples worked directly with Stan in front of the group on their particular issue. By this time, trust had built within the group, and it seemed perfectly natural to listen, be supportive, and root for resolution. To some extent, the concerns shared in this exercise were similar to those all of us had dealt with or were dealing with at present. The work these couples did with Stan validated our own journeys and gave us concrete tools to move forward in healing and growing as a couple.
My husband and I look back at the Wired for Love Retreat with fondness and great appreciation. We have become closer because of it. And yes, we gaze into each other’s eyes more often. Since the retreat, I’ve put my therapist hat back on, but I believe that I am able to bring a new depth and richness to my work after having experienced the rewards of PACT with my own partner.
by John Grey, PhD
PACT core faculty
Like many couples who arrive for their first session, Robert and Susan initially sat down facing me rather than each other. Both in their mid fifties, they had been married for seventeen years and had two children they loved very much. As Susan started describing what brought them to my office, I saw Robert’s facial expression occasionally change. But Susan did not see this. As she complained about not feeling very important to him, she didn’t notice Robert’s momentary grimaces. If she had seen these, she might have realized that she had a big impact on him.
A basic principle of secure functioning is that couples are in each other’s care. Part of the PACT method is to help partners accurately recognize their moment-to-moment impact on each other, and to help each use his or her power to better care for the other and thereby increase shared satisfaction.
One step in this approach is to turn partners to face one another, and to recognize what is actually occurring in each other. As Susan went on to complain, “The only thing meaningful to him is work,” I asked her what Robert’s facial response was. This time she saw his slight grimace. I asked her what she thought it indicated. “He’s thinking I’m too needy.”
I asked Robert if she was accurate. It turns out she wasn’t. He was actually thinking he was “a failure as a mate in Susan’s eyes.” What’s more, he reported feeling pain in his heart about this.
Clearly, Susan had a huge impact on Robert. Hearing him say what was really going on inside was surprising to her. She hadn’t believed he felt very much about her at all. She seemed shocked to hear that what he thought she felt about him mattered a great deal to him.
How could Susan have missed this for so long, and instead have built up a false belief that Robert did not consider her to be all that important? Partly, this was due to not accurately seeing her impact. Of course, this went both ways. For years, Robert also missed seeing his impact on her.
As unresolved upsets build over time, couples often end up believing inaccurate, negative theories about each other. A decrease in eye contact facilitates such a buildup of misconceptions. Instead of seeing our partner, we see the cartoon our brain makes up about him or her. It seems a cruel irony that just as couples need to better see and understand one another, they so often end up looking toward each other less.
This was true for Robert and Susan. Instead of seeing and understanding one another, they made far less eye contact than they had earlier in their relationship. Now they missed seeing important visual cues about the ongoing impact they each had on one another. Instead, they “saw” each other mostly through the lenses of their negative mental theories, such as “I don’t really matter” or “I’m a failure.”
Contrast this with the time when they were first together. Then, Robert and Susan often gazed at each other. They also frequently touched and held each other. Touch and eye contact are powerful biological forces that promote feelings of security and emotional connection. But by this point in their relationship, this couple’s strong forms of interactive caring had dropped away.
Restoring such vital channels of connection can help you and your partner better see, understand, and care for each other. It is especially important to remember this when you get upset with your partner. Beware of your tendency to drop eye contact and touch, and to over-rely on mental interpretations. Just because you think something is true doesn’t make it true.
Curiosity can be a powerful antidote to mental misconceptions. Don’t be afraid to explore what is really happening inside your partner. It pays to look into his or her eyes and wonder more about the complex, marvelous person with whom you chose to spend your life. Seeing and understanding your impact helps you to better care for one another and to make your relationship a truly loving place to share.
By Ellen Boeder, MA, LPC
PACT Level II practitioner
When I witness a couple move from fear and blame into trust and genuine care, I am inspired to feel hope for humanity. Protecting our loved ones and providing real relief to each other are qualities our entire world needs right now. And this starts in romantic partnerships. The primary relationships within our own homes are powerful resources that can provide needed comfort and safety in a difficult, uncertain, and challenging world.
A couple who willingly embark on improving the security in their relationship will learn how much is possible when they have truly cultivated a secure-functioning relationship. They work in the present moment to discover who each of them is as an individual; practice new ways of being in relationship that may feel vulnerable but that strengthen their connection; and challenge themselves to do the work of creating a mutual, safe, and just two-person system. They will not want to revert to anything less than this once they have experienced how impactful and necessary a secure intimate relationship is.
But what about couples who struggle to get on board with the work of building a secure-functioning relationship? I may know how important security is for the long-term health of the individuals and the relationship, but my clients often don’t. They come in for help, but are ambivalent about therapy, as well as about their relationship. Instead of participating collaboratively in therapy, they may repeatedly act out their ambivalence, despair, frustration, anger, and other unconscious feelings and agendas. The try to make therapy, or the therapist, the problem. Our sessions can feel like one step forward, two steps back.
I find I have to work hard to stay oriented and clear in my stance with these couples. The challenge in these sessions for me is countertransference. The definition of countertransference has evolved over decades, but can be thought of as the therapist’s experience of thoughts, emotions, and body sensations in relationship to the client. We all work with this material within ourselves as therapists—because we are human, after all—and our own experience must be identified, observed, and sorted through. The awareness and skillful use of countertransference can be a pivotal factor in helping these couples.
PACT supplies a framework to address acting out, and to use countertransference, so that a couple can get back to the task of therapy. The antidote to acting out is already in our hands: Stan Tatkin speaks about “pushing couples down the tube of secure functioning.” By pressuring the couple to assert themselves, to take a stand, to use each other fully, to make the relationship their highest priority, to create agreements, and to act in ways that cultivate and demonstrate mutuality, a PACT therapist directs the couple back to the work of creating a safe and secure foundation for their relationship.
Sometimes I need to consult with my PACT peers and supervisors as I wade through the uncomfortable feelings of countertransference I know will eventually lead me to the clarity I need to intervene. Ultimately, I have to give back to the couple the discomfort they don’t want to feel, that they disown to temporarily feel better without really getting better. As I support them to become aware of and cope with the feelings that have been unregulated and unconscious, they have a chance to move forward.
To grow in security, a couple must also grow in complexity. They have to expand their awareness of themselves and each other, and learn to be a two-person system. They need to face the learned behaviors and beliefs about relationship that they are acting out and that sabotage their long-term security. Focusing on the subtleties of adult attachment and secure functioning, as well as skillful use of countertransference, can help even the most “difficult” couples learn to function in the here and now in a fair, friendly, and mutual way. Not only do primary relationships benefit greatly from this work, but our entire world benefits from having mature adults who can respond well to each other.
By Lindsey Walker, LMFT
PACT Level II practitioner
You’re lying in bed, curled to one side, your blankets pulled up tight and cozy. It’s cool and quiet, and the night has long fallen around you. “Ah, sweet slumber,” you think, “just moments away.” But wait, what’s this? Your mind is racing as if you’ve just had your morning cup, and your heart is fluttering to match. You’re far from slowing down, yet a little voice inside keeps trying to convince you it is time for bed and you’ll be drifting off to sleep in no time.
If only you and your partner hadn’t just had that fight.
Mere inches away, the love of your life is also pretending to sleep. What a fantastic game of charades you find yourselves in—each keeping up your act while guessing if the other is actually sleeping or is just lying there and waiting. You both want the other to reach out, say something, do something, acknowledge the other’s existence. But pride gets the better of you, and neither one of you moves.
Tick. Tock. The minutes are eating away at your much-needed rest. Thankfully, long before the morning light, it dawns on you that the best way to get your precious Zs is to show your partner some sign that you are still in it together—to offer relief.
You realize you have a choice. You don’t have to listen to the voice that says, “Okay, I’ll lie here until I pass out, and we can deal in the morning. And, boy, will I have won this if I can fall asleep, having gotten in those smart remarks.”
Instead, you can tell yourself, “Reach out. Touch her. It will be okay. Really. Let her know that you love her and care for her. You can make her feel better…”
Only the second option is pro-relationship. It allows for quick repair in a way that is beneficial to both of you. Many couples do not realize that winning an argument often looks different from what they imagine. It’s not about one person ending up the champ and the other knocked out, bloodied, down for the count on the floor of the ring. To really win in a relationship, both partners need to win. And on occasion, both need to lose.
Many couples who come in for therapy find this kind of pro-relationship stance tricky to envision. They are used to a winner-loser model of arguing, which is usually rooted in some kind of unfairness they experienced growing up. PACT offers tools to help them realize they do have a choice in their relationship.
Specifically—and paradoxically—devotion to your partner’s well-being is more supportive and more protective, and offers more opportunities for growth for you, than does putting yourself first. If you and your partner have conflicts that leave you with sleepless nights, a PACT therapist may guide you through a reenactment of the night’s events. This will slow down what happened so you can gain valuable insight not only about your partner, but also about your own thoughts and feelings. You will have the opportunity to move away from your wired-in, habitual reactions that are focused on self-preservation and to move toward greater mutuality.
A PACT therapist is also adept at guiding you through the powerful arena of touch so you can discover each other’s sensitivities and strengthen your ability to feel and understand what is soothing for the other. This enables each partner to truly become an expert at helping the other be calm in an anxious moment. By choosing a simple, friendly touch, you both begin to melt. Your bodies respond to the connection—slowing, calming, comforting, and bringing you back to a place where you can really talk, listen, and be open to one another.
If you are able to use simple touch after that late-night argument, and just hold one another to make amends, you have at your disposal a powerful means of quick repair. Then, soon after, you will both drift off to a restful night’s sleep.
By Michelle Rae, M.S.W., RSW
PACT Level II practitioner
Can you imagine living in a world where every person—adult and child alike—started and ended his or her day feeling loved and connected to another? In a culture that values independence, autonomy, and self-reliance, and that views vulnerability and interdependence as weaknesses, knowing how to operate as a two-person system (one that promotes taking care of me and you at the same time) can feel like an incredibly foreign idea. Yet, research tells us that children who are securely attached have the confidence to explore their world. They know that their caregivers have their backs and will be there to catch them should they stumble or fall, no matter what. The same is true in adult romantic relationships. The need for secure attachment is not something we outgrow.
Part of what drew me to PACT was a desire to improve my own marriage. The more I studied PACT, the more I became aware that I was in an insecure-functioning relationship. And as a result, sadly, it ended. At the same time, I was drawn to work with couples in my practice so I could help them make the most of their “we” system. I might not have had that fully yet in my own life, but I understood its significance.
“We have each other’s backs,” “Fairness, justice, and sensitivity” and other PACT maxims resonate strongly for me. Although seemingly straightforward, these concepts can be difficult to put into practice. We naturally feel bad when the person we love most in this world and who loves us just as deeply can’t figure out how to work collaboratively and cooperatively when conflict arises. This kind of problem is often what leads partners into my office. It rarely has to do with the specifics of what they are fighting about, and has everything to do with not knowing how to work with and manage one another.
We enter adulthood with a blueprint for relationships that is informed primarily by our experiences growing up within our family of origin. For better or worse, we import our knowledge about intimate relationships from what we knew in that family. In most cases, our caretakers were figuring things out as they went, doing the best they could as they tried to parent us. Thus, most of us carry scars and relational wounds that show up in our intimate relationships, often without warning or awareness of where these came from.
Couples who are attuned to one another learn to anticipate where their vulnerabilities and landmines lie. When these relationship time bombs are detonated, secure-functioning couples work quickly to soothe and relieve each other of distress.
Perhaps, aside from a newborn baby, there is nothing more beautiful to watch than a couple in connection with one another. The way they gaze at each other lovingly, the attunement and synchronization of their movements, and how they anticipate the other make for a beautiful dance of intimacy. These two people exist in a private world, with its own rules, culture, and principles to guide them. When done mindfully, in a secure-functioning manner, the results are life changing—not only for the two in the couple system, but for all those who come into contact with them.
Often, however, when couples come into my office, they are the opposite of beautiful to watch. They are lost in their anger and hurt, and unwilling or unable to acknowledge, let alone attend to, their partner’s hurts, as well. However, I find it something of beauty to watch as couples get on board with and commit to being in a truly two-person system. It is so satisfying to see the transformative power of PACT as they adjust the lenses through which they view each other. I feel fortunate that couples allow me the privilege of being with them at their most fragile, and of using the principles of PACT to guide them toward a much more fulfilling relationship that embodies what it means to be secure functioning.
By Rick Hupp, LMFT
PACT Level II practitioner
West Hills, CA
When I was a boy, I had a loyal and loving friendship with our family dog, a Labrador retriever mix named Domingo. He was our docile family mascot, and he had a wonderful ability to influence us in a playful manner, whether it was to get us to throw a ball for him, sneak him a snack under the dinner table, or give him a thorough scratching behind the ears. He was mostly by my side, even when sleeping, as my parents had made a special padded nook for him next to my bed.
One morning I awoke to the sounds of him growling. As I looked over to see what the matter was, I realized he was fast asleep but having a bad dream. Whatever was threatening to him in that dream was causing him to respond with an aggressive, defensive stance—rare for his generally happy-go-lucky demeanor. Thinking I was going to offer comfort by waking him from his doggie nightmare, I leaned out to gently pet him. Much to my surprise, as soon I made contact, he lurched around and tried to bite me! I shrieked and pulled back. He pulled back, as well. We were both confused and embarrassed, and sat there looking at each other for a bit. We were startled at first, but then quickly recognized each other as friends. I reached out to pet him again, and this time my gesture was received with his familiar bashful grin as he leaned in as if to say, “I’m sorry I didn’t recognize you at first. Can we be friends again?”
I share this story because it demonstrates some of the maxims and principles that PACT clarifies for couples. For one, a PACT therapist encourages couples to get what they want from each other using attraction and playfulness, rather than intimidation and threat. Domingo’s attempt to bite me had me in retreat, but his bashful grin brought me closer.
Regarding conflict, when clients learn how their “bite fits their partner’s wound”—another PACT maxim—a PACT therapist can prepare them for how they will inevitably activate each other’s past unrepaired pain in the present. We help them recognize the subconscious “family-iar” template installed by insensitive relationships in the past and understand how their current relationship can be an opportunity to heal by proxy. We help them wake up more quickly from their dream-like projections on the present.
I wanted to “lead with relief” (a PACT principle) when I reached out to wake my pal, yet it was startling for him, and didn’t fit what he needed in the moment. Fortunately, in my case, there was no bite, just my doggy’s initial reflexive attempt to defend from a semi-conscious state—much like what happens with couples in therapy! Like being in a bad dream, many couples interact automatically and reflexively from their protective mammalian directive of “thou shall not be killed,” (another PACT maxim) amplified long ago from unjust relationships.
PACT encourages partners to use in vivo activation and repair to replace old experiential memories with new safe experiences to help a cooperative mate appear as a friend instead of a misidentified foe. PACT gives couples the confidence to normalize their automatic survival-based adaptive behaviors, and helps them replace blame with an incentive to develop competent secure-attachment strategies. Just as with my doggie, there is benefit for both in becoming competent at taking care of another. Said another way, “We know our primitive brains are going to get us into trouble, let’s accept that and practice reducing how we threaten each other, and repair more quickly… because it’s good for both of us!” These important PACT maxims and principles help couples put their shame and anger down in favor of picking up compassion and curiosity for their partner’s needs, and creating mutuality and fairness.
It was difficult for me to understand at the time why my loving companion Domingo wanted to bite me when I was only trying to offer comfort. Happily, we made quick work of the repair and returned to the secure joy we both wanted. Years later, I can say that seems like a reasonable goal to have in any relationship!
By Rachel Holland, DClinPsych,
PACT core faculty
Dan and Jane have been married for thirty years and have three sons. They came into therapy following a challenging time in their lives after they faced a number of health, family, and work problems in quick succession. Jane had also suffered a recent traumatic event and was struggling with posttraumatic hyperarousal. She was sensitive to noise and crowds and felt that nowhere was safe anymore. Both Dan and Jane were distressed and looked exhausted in response to these events. Their relationship had become adversarial and verbally aggressive, and they felt like they were “on eggshells” with each other. Both were seeing individual therapists for support, as well as seeking couple therapy.
My initial ideas about this couple included issues related to allostatic load (i.e., the cumulative burden on the nervous system from multiple chronic stressors; McEwen & Seeman, 1999), unresolved trauma, and dissociation in response to multiple traumatic events that were out of their control. I also had a sense they had the potential to be resilient and collaborative.
I took Dan and Jane through the Partner Attachment Inventory (PAI), an intervention tool PACT therapists use to foster engagement. They listened to each other’s attachment narratives and caregiver responses to their bids for care. While they both had experiences of being well fed and having clean clothes, an education, and health care, their descriptions of being loved by parents were patchy. Dan, in particular, was often left to attend to his emotional needs alone.
The couple were also able to hear each other report a number of traumatic events dating back to childhood and young adulthood, in addition to the recent events. They were surprised during this process because they had not been aware of some of the events that the other faced.
The PACT therapist leads with relief. This means that the couple, particularly after the first session, should leave with some contextual understanding and a shift in arousal that gives them a sense of hope. PACT is a bottom-up method, but also includes top-down interventions, such as interpretation and psychoeducation.
In this case, I offered Dan and Jane the explanation that following a traumatic event, the amygdala, the smoke detector of our brain, is hypersensitive to threat and will respond to neutral signals, let alone threatening ones. Essentially, a partner in a state of fear and dysregulation presents as psychobiologically frightening to his or her partner. Partners start to “walk on eggshells,” which paradoxically makes them look more predatory to their partner’s frightened and overwhelmed nervous system. As a result, the relationship becomes a place in which no one feels safe, confirming the partners’ earlier experiences that relationships are not to be trusted.
My initial goal in working with Dan and Jane was to establish safety though arousal regulation by working toward relaxed quiet-love states so they could begin think in a contingent manner (Siegel, 1999). Rather than having Dan and Jane tell me about their problems, I invited them to show me their struggles in real time.
They reenacted a scene in which Jane was sitting, staring into space. Dan noticed and came over to her to attempt to wake her up. He started talking at her about plans for their garden in an attempt to engage her. Jane exploded at him, gesticulating and shouting. He looked distressed and retreated back into the house. Jane said that what she really wanted was for him to come closer and hold her.
I interpreted Jane for Dan, and explained that people can dissociate, or space out, in response to overwhelming emotions. A partner can look apparently normal, but be in a state of deep distress (Nijenhuis, Van der Hart, & Steele, 2004). Dan was concerned about Jane, but his attempt to pop her out of a dissociated state backfired. His retreat made sense, given his attachment style and his current distress.
I gave Dan and Jane a chance to reenact this experience again, encouraging them to slow down, and inviting Dan to approach Jane gently. He did this by reaching for her hand, holding it for some time, and then with a quiet prompt from me, saying her name softly. She warmed to him and slowly lifted her gaze to his. As their arousal level fell, they continued to hold hands. I watched, waited, and then invited them to find each other’s eyes if they could. They gazed into each other’s eyes and were able to hold the pose. I used corralling comments, such as “You’re in each other’s care” and “You’re safe together,” to help them move further into a quiet, relaxed, and loving state.
For couples affected by trauma, a romantic relationship has the potential to further kindle trauma and retraumatize. Instead, the PACT therapist can support the traumatized couple by working with arousal regulation and attachment style to guide them to find safety and security in their relationship. The romantic relationship thus becomes the couple’s posttrauma secure base.
McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences, 896, 30–47.
Nijenhuis, E. R. S., Van der Hart, O., & Steele, K. (2004). Trauma-related structural dissociation of the personality. Retrieved from http://www.trauma-pages.com/a/nijenhuis-2004.php
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York, NY: Guilford Press
by Jeff Pincus, LCSW, and Rachel Cahn, LPC
PACT faculty members
Emails: email@example.com, firstname.lastname@example.org
Most people would agree that relationships, especially love relationships, are incredibly complex. Most honest psychotherapists would add that couple therapy itself can be extremely complicated, and that it isn’t always clear how best to intervene with a couple who are distrustful, disconnected, and in the midst of pain. With so many moving parts, what should the effective PACT therapist focus on? The answer is affect, and helping the couple attend to each other’s affect by tolerating it and responding appropriately. Affect regulation theory offers a succinct lens through which to view how skilled PACT therapists can be most effective in helping a couple move toward a secure-functioning relationship.
What is affect?
According to psychologist Daniel Hill, affect is “the somatic representation of the state of the organism.” Affect is the way it feels to be the person we are, in the present moment. It is our subjective experience of existence, reflected through our biology. It is the experience of emotion in the body.
Skilled PACT therapists can quickly discern a partner’s affect by tracking facial expressions (including micro-expressions), tone of voice, and body movements. Based on what is revealed, the PACT therapist facilitates appropriate experience that allows the affect to come into clearer focus for both partners.
Secure-functioning couples are able to tolerate a range of affect and are curious about what they might learn about themselves and each other by paying attention to it. This includes being with and understanding higher-arousal states, such as excitement, anger, and fear, as well as lower-arousal states, such as sadness, disappointment, and shame. They also note what brings about pleasant and unpleasant affective states, so that over time, they better understand the causes and conditions of various affects. They are especially good at responding skillfully to help one another mitigate and metabolize difficult or painful states, as well as enhance and amplify positive states together.
Most couples come to therapy because they lack the skill to effectively work with affect, and rely instead on immature strategies that are self defeating or used at the expense of one partner. By not understanding how to respond in the moment when affect is on line, they end up harming the relationship. As therapists, our job is to help them move forward by developing a greater capacity to know and be known by their partners in sensitive mutuality.
Jack and Joni came to therapy after Jack had an affair. Neither had developed much capacity to recognize or respond to the other’s or his or her own affect, and that landed them in deep trouble. Jack had poor affect tolerance for any negative emotion, whether he or Joni was experiencing it. Jack and Joni’s oldest daughter had a difficult adolescence and became frighteningly involved with drugs. Jack distracted himself from the pain of feeling like a failure as a father, and avoided showing Joni his pain. Joni missed the signs that Jack was hiding how he really felt, and accepted his superficial interactions at face value. Jack’s strategy of distraction led him into a dalliance, which he then compartmentalized so as not to be overwhelmed by the guilt that could have course-corrected his behavior. Joni sensed that something was off, but grew to live with her uneasy feeling by ignoring it. It came as a shock to both of them when his affair was found out.
In the office, even though Jack doesn’t show his cards easily, a moment arises when his eyes look moist. I* ask Joni, “What do you see in his eyes?” She focuses on his face and says, “Sadness,” with surprising tenderness, since Joni has primarily expressed her righteous anger up until this point. I direct them to stay in each other’s eyes, countering their instinct to turn away from this quieter affect. He begins to weep, saying, “I am so sorry for what I did to you. I was so confused and I didn’t know what to do. I couldn’t tell you. I’m so ashamed… I don’t want to lose you.” She rolls her chair close to his and they melt into each other, feeling the grief and loss together.
In couple therapy, Jack will need to continue repairing the damage done by demonstrating sincere regret for how his actions have harmed Joni and their marriage. Yet to move into secure functioning for the long term, they will need to be better at attending to each other’s affective states, such as by seeing when one is sad, being interested and present, and responding with a love that is palpable to the other. They could have shared the burden of difficulty with their daughter and shored each other up by dealing directly with each other’s genuine feelings.
Couples can be dangerously inattentive toward their own and/or their partner’s affect—so much so that they miss what is actually happening in the moment and over time. Doing so, partners squander the opportunity to learn more about the person they chose. Tolerating affect and responding appropriately empowers couples by deepening their understanding of one another, while amplifying the love and goodness that lives between them.
* Although the blog is co-authored, the case is presented in a singular therapist’s voice.
Hill, D. (2015). Affect regulation theory: A clinical model. New York, NY: W. W. Norton.