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by Stan Tatkin, PsyD, MFT,
Therapy is only useful for changing people who are experiencing sufficient distress. This is not to say that education, consultation, or brief counseling will have no effect. People often benefit from couple counseling for premarital or other short-term work. However, as a matter of therapeutic stance, the PACT therapist assumes the presence of a sufficient level of distress that can only be relieved by pressuring couples to go down the tube of secure functioning. The PACT therapist thus takes a stand for secure-functioning principles. For insecure partners, this requires a big leap of faith.
That leap of faith can be viewed as a metaphor for neuronal action potential (AP) and long-term potentiation (LTP). AP is basically a charge that is sufficient to fire a neuron. LTP is a cellular mechanism related to learning and memory. LTP involves the building up of synaptic strength between neurons, whereby several weak synapses repeatedly fire simultaneously to create a new (or reinforce an old) neuropathway. In therapy, LTP can be associated with the aha experience of “getting it.”
Insecure partners do not have any experience in their historical record that can serve as proof that a secure-functioning model would be good for them. Insecures may be attracted to the menu of secure-functioning principles, but should not be expected to know what the food tastes like or if they would like it. Remember that insecure models are fundamentally unjust, unfair, and insensitive and that relationships do not come first. Therefore, insecure partners have no reason to believe in the therapist’s belief in secure functioning. In a manner of speaking, insecure individuals, like connecting neurons, must cross a synaptic cleft of unknowing in order to forge a new neuropathway that represents new knowledge. In systems theory, this is first-order change. In Piagetian terms, this is accommodation.
So what builds LTP in the insecure partner or couple?
2. Focused, coherent therapeutic stance
Without pain, the therapist’s tools are useless. No pain, no gain. Pain is a huge motivator because it opens the mind to influence. If partners are not in distress, the therapist is without leverage to convert their pain into increased complexity and neuronal growth. This alchemical process of using distress to convert lower social-emotional complexity into higher social-emotional complexity is an essential aspect of LTP, and of the neuroplasticity needed for change to occur.
The PACT therapist must locate each partner’s pain and amplify it. If one partner is without distress, both the therapist and the other partner are rendered helpless. Therefore, the therapist must locate the pain of the non-distressed partner, amplify it, and then leverage it for change. Finding and leveraging the pain creates interest, which creates AP in the brain.
Focused, coherent therapeutic stance
The PACT therapist maintains a clear, focused, and coherent narrative (therapeutic stance) that is secure functioning. The therapist maintains a clear image and set of goals that point toward secure functioning and away from insecure models of relating. This clarity is expressed through repetition of the therapeutic narrative, which creates interest and in turn creates AP in the brain. Repetition greatly contributes to LTP. Therapy, in essence, involves repetition, both in the patient’s psychobiological response to inter- and intra-relational stress and in the therapist’s focused, coherent therapeutic stance, which points the way forward on a path toward relief.
The PACT therapist applies continuous pressure on partners to perform in a secure-functioning manner. This pressure is like pushing partners down a tube that both focuses and limits behavior and attitude. The combination of pressure, focus, and limitation also forces feelings and emotions to arise. For instance, when the therapist expects partners to demonstrate developmental complexity, they will expose their limitations, along with the pain (e.g., fears of abandonment and engulfment) that underlies their developmental delays. Pressure, support, and expectation promote interest, which creates AP in the brain and contributes to LTP.
The PACT therapist creates neuroplasticity through LTP and AP in the insecure couple (or partner) by locating, amplifying, and leveraging pain and distress toward a secure-functioning model of relating, and maintains persistent pressure on the couple (or partner) to move in this direction. In this way, the therapist pushes insecure partners through the synaptic cleft of unknowing to create a previously unexperienced knowing of secure function. The influence the PACT therapist can exert on partners may result in both neuroplastic and epigenetic first-order changes.
© 2003-2013 – Stan Tatkin – all rights reserved
by Stan Tatkin, PsyD, MFT,
I’m an avid lover of theory, all kinds of theory—psychoanalytic, systems, humanistic-existential, and so on. I think my appreciation of theories grows as I age, as does my appreciation of people, relationships, music, art, and politics. As I grow older and hopefully wiser as a clinician and educator, my appreciation increases for the various approaches to psychotherapy available today, just as the illusion decreases that my particular approach to couple therapy is better than the other ones out there. In the couples arena, I greatly admire the work of Sue Johnson, Ellyn Bader and Peter Pearson, David Schnarch, John and Julie Gottman, Esther Perel, Dan Wile, Harville Hendrix, Marion Solomon, Terry Real, Rob Fisher, and many others. These are not only master therapists, but enormously creative producers of inspiration to couple therapists worldwide.
Having developed an approach myself—in part, a result of having been personally influenced by other approaches—I have come to understand that the success of any approach hinges not only on its utility in providing clarity and organization for the therapist, but also on its ability to inspire personal meaning. In other words, therapeutic approaches are first “sold” (wholesale) to clinicians, who “buy” its organizing principles because it speaks to them, fits their personality and style, and works for them in a deeply personal way. The clinicians then sells (retail) this template for organizing experience to their patients (consumer). Theory and approach are for the therapist directly, and therefore only indirectly benefit the patient.
I think it is fair to say that people who are attracted to PACT are attracted to my particular thinking about the problem of adult romantic relationships. With EFT, students are attracted to Sue Johnson’s epiphanies about relationships. Same with Gottman, Schnarch, Hendrix, Perel, and so on. Interesting, to me at least, is that the people I mention here agree with one another more than they disagree, although it may appear differently at times to others. We’ve all put our finger on something that rings true about relationships, and many of our ideas are similar, give or take some terms and nuances.
John Norcross, a specialist in psychotherapeutic approaches and their effect on behavioral change, has collected compelling evidence that what changes people is not any particular therapeutic approach or theory per se, but rather the relationship that develops between clinician and patient. He argues for integrative approaches that allow therapists to tailor interventions to respond with flexibility to the unique demands of each patient or situation in a manner that best fosters change. The matter of effectiveness in psychotherapy, therefore, may be as elusive as is our understanding of the complexity of the human mind, and more mysterious still, the phenomenological, intersubjective nature of human relationships.
© 2003-2013 – Stan Tatkin, PsyD – all rights reserved