Home » Prevention
Category Archives: Prevention
By Beth Newton, LCSW, LCAS
PACT Level II, PACT Ambassador
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.
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 Communications, 5, 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.
by Stan Tatkin, PsyD, MFT,
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
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