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.