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Moving From Misattunement to Coregulation

By Beth Newton, LCSW, LCAS
PACT Level II, PACT Ambassador
Durham, NC
https://newtoncounseling.com/

Every week I sit in my office watching couples struggle with coregulation. Coregulation is defined as warm and responsive interactions that provide support and that help someone understand, express, and modulate his or her feelings, thoughts, and behaviors (Gillespie, 2015). Through coregulation, children learn how to manage their attention and emotions in order to complete tasks, control impulses, and solve problems (McClelland & Tominey, 2014). This requires them to attune to subtle cues of distress, curiosity, bids for attention, fear, and joy. The concept of coregulation can also be applied to adult relationships.  

As a therapist, I often work with couples in which one or both partners experienced parental misattunments, neglect, or abuse. The fear and insecurity they experienced as children led to poor self-regulation (internal) and coregulation (with another) skills, resulting in stress and lack of attunement in their current relationship. Moreover, if adults experienced chronic childhood stress, their hypothalamic pituitary adrenal (HPA) axis habituated and sustains activity. This “on switch” can lead to underdevelopment of the prefrontal cortex, which moderates social behavior, complex thinking, and decision making (Kumar et al., 2014).  

As a PACT therapist, I know that when an individual is not skilled at coregulation—and by extension, self-regulation—he or she will often report that a partner is not safe. Moreover, when the HPA axis is in overdrive, the individual cannot attune to self or a partner. When a partner has experienced dysregulated parents, he or she lacks the capacity to pivot toward a choice that balances the relationship. In the PACT model, we evaluate each partner’s regulatory capacities, and then help the couple deal with compromised skills and capacities.  

I work with a couple named Bill and Diego. They have been married for 5 years and have seen at least three couple therapists in that time. Bill’s mother had depression and a personality disorder. His job was to soothe her and ignore his own needs. He reported she did not do anything for him that “wasn’t really about her.” Diego learned at an early age that his homosexuality did not fit into his strict religious household. He reported a great deal of pressure to be good and nice, with no room for self-expression. Both partners developed the belief they would be punished for expressing their own needs and desires.  

These men are locked in a cycle of fear that their needs will not be met by their partner. When one begins to talk about a need, the other interrupts with his own need. In our early sessions, they exhibited disorganized behaviors, such as over-control and mild collapse, resistance to receiving or giving compassion or repair, attacking bids for connection and repair, and numerous withdraws from each other and me. This only turned around after I recognized my out of countertransference and stepped in to become the master regulator for Bill and Diego.  

To challenge their acting out, I began setting limits for the session. I helped them see that they were rejecting me in the same way that they rejected each other. We agreed that the following behaviors would help them gain control: 

  • Cooperate with therapy and their PACT therapist 
  • Agree to take breaks and practice slowed breathing while on break 
  • Return from break and determine readiness to receive repairs or help 
  • Agree to accept regulation by the therapist in the form of (a) stopping attacking behavior, (b) coaching for repairs, (c) guidance on emotional expression, (d) encouragement, (e) accountability, (f) repetition of skills  

The structure I created each week helped me offer warmth and sincerity when things were really challenging. My ability to act as a regulated parent allowed me to attune to Bill’s and Diego’s underlying fears and to express compassion. They learned how to self-regulate during breaks, accept help, and allow coaching when they did not know what to do. My ability to step in as master regulator moved them toward greater attunement to their own and their partner’s needs.  

I still work with Bill and Diego. When they are on break, I continue to help them with breathing, tracking objects or sounds, and muscle relaxation. They work on coregulation during break by practicing statements such as “I love you. I am taking a break so I can come back to us. I promise I’ll be back in 10 minutes.” I use my ability to ground them through structure, compassion, and good-natured challenge, so they can develop coregulation and secure functioning.  

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References 

Gillespie, L. (2015). It takes two: The role of co-regulation in building self-regulation skills. YC Young Children, 70(3), 94–96.  

Kumar, S., Hultman, R., Hughes, D., Michel, N., Katz, B. M., & Dzirasa, K. (2014). Prefrontal cortex reactivity underlies trait vulnerability to chronic social defeat stress. Nature Communications5, 4537.  

McClelland, M. M., & Tominey, S. L. (2014). The development of self-regulation and executive function in young children. Washington, DC: Zero to Three.  

Tatkin, S. (2017). How couples change: A psychobiological approach to couple therapy (PACT). In M. Solomon & D. J. Siegel (Eds.), How people change: Relationships and neuroplasticity in psychotherapy (pp. 221–246). New York, NY: W. W. Norton. 

 

 

 

 

Secure Enough to Be Spontaneous

by Hans Jorg Stahlschmidt, Ph.D., PACT faculty, Berkeley CA,
Website: www.stahlschmidt-therapy.com
Email: hans@thepactinstitute.com

Burnout is common among psychotherapists. Countless articles and books deal with reasons for and prevention of burnout. However, some instances of burnout are nearly impossible to prevent, given dysfunctional institutional settings, demanding and taxing work hours, and a difficult and acting out clientele. Many commentators have opined that psychotherapists may lack sufficient self-care to counter the ongoing stress of dealing with the psychological pain and trauma of their patients, especially in the context of isolation characteristic of this profession.

For me, becoming a PACT therapist has proven to be the best burnout prevention. This approach requires a strong therapeutic frame and a complex set of skills that is rooted in a defined conceptual foundation. It also allows a freedom I have not experienced in other therapeutic approaches. This is the freedom to make use of one’s self and to allow spontaneity in the therapy room. This, in turn, makes work not only more fun and more exciting, but also more rewarding.

PACT focuses on the expressions and signals of the autonomic nervous system. PACT therapy is a bottom-up, show-me process. As therapists, we have to know about our own facial expressions, gestures, and how we come across to others, so we can regulate more intentionally and effectively. To be master regulators who can facilitate a more real, truthful, and authentic relationship between partners, we have to be able to regulate ourselves.

The emphasis in PACT is on “regulating,” which does not mean controlling or being neutral or reserved. I remember being in a psychoanalytic training group 22 years ago and feeling I had to apply a sense of carefulness and guardedness because self-expression that revealed too much about my personhood would contaminate the therapeutic work. That stance required me to exhibit reserve and the control of emotional expression in order to be seen as a neutral figure upon whom the patient could project his or her inner processes. The interaction was limited, and spontaneity rare.

As humans, we can feel and see the difference between a limbic smile and a social smile. Our patients can detect the difference between artificial warmth and authentic warmth, and between simulated empathy and authentic empathy. Because we are in the business of limbic regulation, as therapists we can’t rely on social and artificial signaling in our interactions with couples. We have to be able to bring into play real responses.

Our patients can detect our fear and will not trust us if we pretend. If we are overly guarded, we will not be effective in our attempts to move a couple toward secure functioning. We need both a sense of our own security and a sense of freedom to be able to let feelings, thoughts, impulses, and desires arise and guide our interactions so they do not create a “minefield” and resemble the more careful and guarded stance of previous approaches.

My freedom starts when I greet a couple in the waiting room. I am really happy to see them. I look forward to being with them. I can’t help but smile. I think it is a limbic smile. It is part of “falling in love” with the couples with whom I work. Ten years ago, I did not always fall in love with the couples with whom I worked. But now I do.

An essential challenge to becoming a PACT therapist is to move oneself toward secure functioning. With a stance of secure functioning, the internal regulatory and emotional field of the therapist is not experienced as a minefield that necessitates stepping carefully and gingerly. Rather, the internal vicissitudes can be trusted, and the freedom to risk spontaneous expression can be modeled for the couple.

According to PACT, a therapist is more like a host who can make the couple feel at ease than like an intimidating expert. PACT therapists develop the capacity to relax and then move in. They find a rhythm in their work that includes spontaneity and the ability to trust their own sources of inspiration. In the words of Stan Tatkin, we move from inspiration rather than pressure.

Copyright Hans Stahlschmidt

The Deal Breaker

by Stan Tatkin, PsyD, MFT,
stantatkin.com

A deal breaker is an issue that looks like it cannot be solved. Many couples face issues related to religion or sexuality or money or children. They might feel—and you might think—such deal breakers must lead to the end of the relationship.

For instance, one partner says, “I must have children or my life won’t be worth living.”

The other says with equal strength, “I’m not the parent type. I don’t even like children and I will never have one.”

After a long pause, the first says, “Okay. We should buy a house together.”

Or perhaps one partner says, “I want my children raised as Muslims. That’s nonnegotiable.”

The other says, “I want my children raised Catholic. That’s how it’s going to be.”

One of them follows this deal breaker with, “Have you decided whether you want go to Hawaii this year for Christmas?”

Notice this tendency to kick the can down the road. Why do so many couples avoid deal-breaker issues or simply defer them? The answer may seem obvious. When partners are at the precipice of the cliff that represents the end of their relationship, they flinch. Nobody wants to break up. Relationships are sticky like that. “Say it ain’t so!” And so it isn’t.

Islands, and waves, and even anchors may opt to bend reality and defer loss. However, couples with deal breakers in their basement inevitably seek therapy to circumnavigate the proverbial elephant in the room that just won’t go away. The therapist can’t help but feel their pain, feel the sense of impending doom that has been buried so partners can enjoy another month, another year, or a decade without having to face reality.

But is every deal breaker an actual deal breaker? From the PACT point of view, often it is not.

Because couples indulge in kick-the-can-down-the-road avoidance, they have no reason to believe denial isn’t the best course of action. However, a PACT therapist can help the couple arrive at a creative solution that is win-win—a solution that leaves no residue and has no victim and no perpetrator. For this to happen, partners need to be held with their feet at the edge of the cliff.

“Necessity is the mother of invention.” So, supposedly, said Plato. In this case, necessity places the couple between a rock and a hard place and holds them there. Perhaps the rock is what they absolutely insist upon, and the hard place represents the consequences for ensuring they get what they want. For a couple not dealing with a deal breaker, the consequence is most certainly loss.

I think it is very difficult for the average couple to do this on their own. I suspect anchors would be more readily able to make sacrifices needed to assuage abandonment fears. Although making choices that could end a relationship has never been nor will ever be easy, a PACT therapist can help partners see their way through what looks like a foregone conclusion. When I hold a couple in a deal-breaker tension, I bite my nails along with the couple as we face the potential end of their relationship. My only solace is my faith in the human capacity to create solutions where none seem possible.

It is only under conditions in which partners must choose between this or that and accept their losses that win-win accords can be forged. The PACT therapist must be the villain in this scenario. Forcing partners who have been avoiding their deal-breaker issue to resolve it once and for all is a radical move. However, I believe it is the PACT therapist’s duty to guide couples toward a real future and not conspire in the very human tendency to bend reality in the face of loss.

Copyright © 2003-2014 Stan Tatkin, Psy.D. – all rights reserved

The Ten Commandments for a Secure-Functioning Relationship

by Stan Tatkin, PsyD, MFT,
stantatkin.com

  1. Thou shalt protect the safety and security of thy relationship at all costs.
  2. Thou shalt base thy relationship on true mutuality, remembering that all decisions and actions must be good for thee AND for thine partner.
  3. Thou shalt not threaten the existence of the relationship, for so doing would benefit no one.
  4. Thou shalt appoint thy partner as go-to person for all matters, making certain thy partner is first to know—not second, third, or fourth—in all matters of importance.
  5. Thou shalt provide a tether to thy partner all the days and nights of thy life, and never fail to greet thy partner with good cheer.
  6. Thou shalt protect thy partner in public and in private from harmful elements, including thyself.
  7. Thou shall put thy partner to bed each night and awaken with thy partner each morning.
  8. Thou shalt correct all errors, including injustices and injuries, at once or as soon as possible, and not make dispute of who was the original perpetrator.
  9. Thou shalt gaze lovingly upon thy partner daily and make frequent and meaningful gestures of appreciation, admiration, and gratitude.
  10. Thou shalt learn thy partner well and master the ways of seduction, influence, and persuasion, without the use of fear or threat.

Tatkin, S. (2011). Ten Commandments for a Secure-Functioning Relationship. In J. K. Zeig & T. Kulbatski (Eds.), For Couples: Ten Commandments for Every Aspect of Your Relationship Journey. Phoenix: Zeig, Tucker & Theisen, Inc. Publishers.

© 2003-2013 Stan Tatkin, Psy.D. — all rights reserved

Partnering Up: Falling From Space (or Grace)

by Stan Tatkin, PsyD, MFT,
stantatkin.com

Stages of Courtship

click for larger view

I realize this is a rather lax stage theory of courtship, so forgive me in advance for using a rocket analogy to describe how relationships get off the ground. But understand, I’ve had rockets on my mind for several years while thinking about success and failure in courtship.

Helen Fisher, a brilliant biological anthropologist, expert in the neurobiology of courtship and romantic love, and all-around lovely person, has written extensively on courtship. Please read her articles and books for more on this subject. Others have written on this topic. Harville Hendrix (another wonderful person) comes to mind for his early writings on Imago and stages of coupling. And of course John Gottman, another friend and great guy, has talked about the deleterious effects of testosterone on new lovers’ judgment. So, without further delay, I give you my rocket analogy of courtship.

During the first stage (booster) of partnering, we’re on drugs: dopamine, noradrenaline, oxytocin, vasopressin, and testosterone (to name a few). Nature (biology) does much of our work for us. The phenomenon of novelty (the brain loves strangerness); the process positive projection (“I love who I think you are, and I love who you think I am”); and those endogenous love drugs (“You look, sound, smell perfect to me”) make us want to be together despite our natural inclination to be insecure, shy, judgmental, or contact averse. For many yet-to-be couples, the booster stage marks the end of that particular ride. For others, it’s on to the second stage.

Sadly, the sense of novelty doesn’t last, and nature soon pulls out, ending the booster stage of courtship and leaving us alone with our inherent attachment expectations, which can include fear of being smothered or fear of being abandoned or both. Positive projections give way to negative ones and to a more reality-based knowledge of each other. Good times.

Our first big fight may happen in the second or in the third stage of courtship, but it will happen, and many will not make it beyond this point and will fall back to Earth. We may worry that we’re with the wrong person, and we may be, depending upon the attachment values revealed during and following that fight. We may discover that we cannot effectively regulate each other during distress. Often, the first big fight is the same fight we’ll have in the ensuing years ahead. Poorly done now, and poorly done 5, 10, 15 years from now. Relationship failure at this point can sting more than at other stages because enough fantasy and lack of authentic knowledge still exist between partners, causing them to idealize the relationship beyond what is real.

But it’s only when the relationship becomes more permanent, at least in our minds, that our early attachment expectations (especially those that are unpleasant) really begin to surface. This is the third stage of courtship, and in the case of insecure partners, it sometimes continues into marriage, though it should not. By now, strangerness is fully replaced by familial-arity. That is, we think we know each other, even though we probably don’t. We know what we recognize, what is familiar to us, and much of that knowledge is derived from remembered experience prior to the start of the relationship. In other words, we become deep family.

Relationship failure at this stage generally results in a slowish return to Earth because we’re already too far out of Earth’s atmosphere and gravity exerts less of a force. We may circle reality for a while, orbiting somewhere between anomie and full recovery with readiness to begin again. Insecures may rue the day they ever allowed themselves to get this far and may even consider giving up love relationships altogether. I recommend they remember the words from Alfred Lord Tennyson’s poem In Memoriam:27, 1850, “‘Tis better to have loved and lost than never to have loved at all.”

The real test of the third stage of courtship—and what I’m calling “on the way to mature love”—is our ability to form a secure-functioning relationship. Under secure-functioning conditions, we have resources to spend on other things, such as our career, our extended family, our children, our personal development, and ourselves. Insecure conditions, on the other hand, draw resources from us. We become preoccupied by our relationship status. Partners who are insecure use most of their internal resources to handle their moment-by-moment feelings of being untethered, unloved, and unwanted.

We could say that no one looks very good when they feel insecure in their relationship. When we feel insecure, we don’t perform well. The worst of us comes out. Our negative attributes become amplified and obscure our positive ones. If we are insecure and what PACT therapists call wave-ish (ambivalent, angry, resistant), we may threaten security by over-focusing on our partner’s signs of distancing, insensitivity, and avoidance and by over-focusing on our fears of abandonment. If we are insecure and island-ish (avoidant, dismissive), we may threaten security by over-focusing on our partner’s physical, psychological, or intellectual flaws and by over-focusing on our fear of being smothered, intruded upon, or co-opted.

Whether we are waves or islands, we are likely to create insecurity in the third stage (and beyond) by having only one foot in the relationship, while holding out for something or someone better. In doing so, our partner falls from grace, and so do we.

If you want to avoid this, I suggest you keep the rocket analogy in mind. To soar into space, the first two stages have to fall away completely. Launching is just the beginning. The third stage must inaugurate a process of principled relating, with each partner behaving in a secure-functioning manner. Partners must form a couple bubble—an agreement to provide mutual assurances and reassurances of absolute safety and security—and protect it at all costs. This, and other secure-functioning principles, are what you will need throughout your long journey ahead. Safe (and secure) travels!

* For more information about secure functioning, take a look at Wired for Love and listen to Your Brain on Love.

© 2003-2013 – Stan Tatkin, PsyD – all rights reserved

Security Questions Require Security Answers

by Stan Tatkin, PsyD, MFT,
stantatkin.com

Many of you who know my work or take my training have heard me talk about the difference between security questions/security answers and reality questions/reality answers. However, I do not think I have written about this specifically so here we go….

Many people become confused when considering how to respond to matters of relationship insecurity, especially during periods emotionally dominated by fear, ambivalence, or doubt. Bids for affirmation or reassurance can therefore be met with either a secure (reassuring) response or a reality (dice roll) response. For some, the “reality” principle seems a more “secure” option. That may in fact hold some subjective truth, particularly for those who themselves feel fearful, ambivalent, or doubtful (“I can’t reassure you because I, too, feel insecure about us”). And I suppose there are good arguments against providing a secure response when a reality response would be the safer choice (“Our relationship is in danger and so let’s go to therapy”). However, for those who are generally on the fence about this, I’d like you to consider the cost of making a big mistake when that is not your intention.

Let me start by giving examples:

REALITY QUESTION: “What time is dinner?”
REALITY ANSWER: “Around 6pm, give or take 10 minutes.”

SECURITY QUESTION: “Daddy, am I going to die?”
SECURITY ANSWER: “No honey, not for a very, very long time.”

    REALITY ANSWER: “Well sweetheart, I can’t lie to you. There’s a nasty virus going around and it’s killing lots of little children your age. But let’s not think about that right now.”

SECURITY QUESTION: “Will you love me forever and ever?”
SECURITY ANSWER: “Yes. Forever and ever.”

    REALITY ANSWER: “Hmm, that’s a very long time. I don’t know if I can answer that truthfully. I can love you for right now. Let’s take that up again in a year.”

There is a time and place for reality answers and I’m not going to say that it is always appropriate to answer security questions with security answers. However, I will say that in primary attachment relationships, security concerns must be addressed swiftly, simply, and unequivocally if the relationship is to remain safe and secure. Replies that are complicated, contradictory, qualified, evasive, or lacking confidence or seriousness will be read as threatening by the receiving partner. A vote of non-confidence is also read immediately with non-verbal displays such as delayed responsiveness (milliseconds), deflected gaze, vocal changes, and facial controls.

So then, how to avoid shaking your partner’s (and your own) fragile sense of security? The answer is to be prepared! Consider ahead of time the cost/benefit of providing secure responses to insecure bids for reassurance. You will then be prepared to respond with more congruence. If you are among those who believe the best response is the one that is most truthful (realistic), then accept the cost that comes with that stance for there will be a cost in the currency of safety and security. If that is not your concern then go for it. If however you wish to create and maintain a secure relational ecosystem for yourself and your partner, you may want to go with the secure response.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

Sit, Down, Stay!

by Stan Tatkin, PsyD, MFT,
stantatkin.com

This addendum to my previous post, Train Your Partner, is intended to clarify another important concept in relationship management. So many of us struggle with how to “parent” or “train” our partner when we feel rejected, dismissed, ignored, or flat out resisted by him or her. We often get angry and attack or withdraw and give up. While both reactions are reasonable they will likely be received as threatening (yes, I know…you were threatened first). Also threatening are complaints, especially in the form of questions:

“Why do you always do this to me?”
“Why can’t you just do what I want for once?”
“What is wrong with you?”
“Why do you always take his/her side?”

…and so on. The problem with questions, particularly of these kind, is they require resources in your partner’s brain and it is likely that your partner’s brain is either mostly offline (the *autoregulatory state of the island/avoidant) or under-resourced (the *external regulatory state of the wave/angry resistant) and if that weren’t enough, he or she is wired to resist and dismiss and anticipates your intrusion. It can mobilize certain folks and contain others.

Hence, the only sensible workaround are commands such as “sit, down, stay.” *Anchors, islands, and waves respond very well to commands so long as the command is short, easy to process, and made with a friendly but firm tone. We want friendly to quickly disarm primitive alarm systems that are sweeping you for threat. We want firm to enable the fast brain (the primitives) to respond without consulting the “higher-ups.” In other words, proper use of commands should avoid threat while acting quickly to bypass defenses that arise out of increasing arousal. Commands work well when used skillfully because we hear them and we act before thinking and with less arousal expenditure. It should be fast, confident, and friendly.

“Come here.”
“Sit down.”
“Look at me.”
“Repeat what I said.” (for the attention-challenged)
“Let’s go.”
“We’re leaving.”
“We’re walking.”
“We’re staying.”
“Stop.”
“Go.”
“Kiss me.”

WARNING: It is very important that you DO NOT yell commands from outside the same room as your partner. The auditory cortex is very close to the amygdala and can cause a startle response from your shrill or booming voice. Add your partner’s first name to your call to attention and… well start running.

I’ve written about the importance of attraction in love relationships and the danger of using fear, guilt, or threat as a relationship management tool (I will probably write more about this in my next post). The proper use of commands can be attractive. However, don’t expect your partner to smile and be pleased by your commands. The purpose is not to please your partner but to get your partner to do what you want/need without becoming threatening.

*For those of you who are unfamiliar with some of my terms mentioned above, you can find them fully explained in both Wired for Love and Love and War in Intimate Relationships.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

Find Your Mentor Couple

by Stan Tatkin, PsyD, MFT,
stantatkin.com

One of my mentors, Marion Solomon, introduced me to the brilliant idea of mentor couples. Also known as marriage mentors and sponsor couples, this concept originated in the church setting but is becoming increasingly popular. Basically, a mentor couple is one you admire and and look to for guidance. I was impressed that Matt and Marion Solomon have at least one mentor couple. Tracey and I proudly claim two mentor couples. One of course is Matt and Marion. Their relationship is the epitome of secure-functioning. They protect each other in private and public; they most definitely maintain a secure couple bubble; they tell each other everything; neither would ever threaten the relationship or be threatening to the other; they take one another’s distress seriously and provide prompt relief to each other; they know each other and most definitely have each other’s owners manual; and they are a lighthouse to other couples. They put relationships first.

Tracey and I have another mentor couple: Jim and Myrtle Pinsky. They are parent-like figures to us, and we aspire to be like them, as we do to Matt and Marion. Jim is 91 (just turned) and Myrtle is short of that figure (by how much I don’t know). They knew both my parents, and like them, belong to a culture of human beings that puts relationships first. Like Matt and Marion, they serve as a beacon of light to others and authentically live by secure-functioning principles. As world travelers, they are like magnets, drawing people from all over to their warmth, kindness, generosity, and modesty. They put relationships first.

I’d like to give mention also to my late cousin, Pat Kaplan, and her surviving husband, Harold, because they, too, exemplified secure-functioning in their long marriage together. Both put relationships first.

The happiest people I know put relationships first. They value their loved ones, their friendships, and their ability to remain loyal and true. Many of us didn’t experience secure-functioning love relationships as we grew up, and many of us never saw our parents take good care of each other. In a great too many families, relationships do not come first.

It starts with the couple. If the state of that union is poor, everyone living beneath the same roof (and beyond) suffers. It always starts with the couple. If we don’t have a good model, we typically look for it somewhere… in literature, film, or those around us. But we may not have thought of looking to a mentor couple. My hope is that this blog post inspires some of you to keep an eye out for at least one mentor couple, and perhaps even endeavor to be one for others.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

A Call to Therapists Who See Adolescents: Do Couples Work!

For a couple of years now I have been proposing to training and seminar audiences that there is a relatively untapped therapeutic need in teen romantic relationships. Many teens are in romantic relationships and yet few therapists I know make use of these pairings as an opportunity to do couple therapy. Of course there are legal, ethical, and payment issues to be considered and managed. However, working with this young couples population can be a potential learning opportunity that has no rival.

I have had the opportunity, though only a few times, to work with teen couples. All parents agreed and paid for the therapy and rules of confidentiality were maintained. I feel now as I write this a similar excitement and hopefulness I felt as I worked with these teens who eagerly devoured any information about love and relationship and because it was live and with love interests present, the work was very powerful. These sessions were literally pre-pre-pre-marital, giving these kids a good jump ahead of their peers and probably even their parents. At least it seemed that way to me.

Teen patients are famously obsessed with peer relationships and those who are, however temporarily “in love,” seem very interested in getting outside help — as a couple — if invited to do so by a therapist.

Those of you who know my approach to couple therapy (PACT) also know that I use video recording for occasional patient playback but also for research. I think this could be a wonderful population to study in their couple configuration and that couple therapists (not simply specialists in adolescent treatment) could do a lot of early prevention work here.

Again, I tend to be biased toward therapists trained in couple therapy to do this kind of work because it is quite different from one-on-one psychotherapy with adolescents as it is with adults. However, biases aside, I think any therapist who specializes in adolescent psychotherapy should consider this option of inviting a patient’s love interest into therapy.

What do you think? I’d like to hear from you.

Copyright 2012 — Stan Tatkin, Psy.D. — all rights reserved