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Working with Families – PACT Style

By Stan Tatkin, PsyD, MFT
PACT Co-Founder
http://thepactinstitute.com

Two main issues face the PACT family therapy process: Structure and Attendance.

Structure

A challenge within typical family therapy is the structure that holds some family members to their particular family roles. While viewing members within the system frame is valuable, especially when it comes to various roles different members play, it can also restrict the flow of information as some members expand and express while others contract and remain in the background. 

Using the PACT method to do family therapy may be more effective and convenient for both therapist and family. By dividing family members into pairs, the therapist can do “couple therapy” with various dyadic combinations, thereby freeing members from default role constraints and constrictions encountered when faced with the entire family system.

As long as invited members are of an appropriate age and maturity to participate in a couple-oriented approach, this structure:

  • allows pairings to speak more freely about thoughts and feelings.
  • breaks up alliances or substructures that exacerbate family conflict.
  • increases intimacy between family members.
  • opens more time and space for good work to be done.

Consider holding one or two sessions for at least two to three hours each per configuration to accomplish focused goals. The longer session serves a goal-driven purpose and can lead to satisfactory results for all involved.

Attendance

Family therapy is typically organized by getting most or all family members in for at least one meeting, if not several subsequent sessions. The challenge facing therapists who use this format is legendary: how to get the same people to show up each time. Dyads solve the attendance problem as only two family members meet with the therapist at any given time – father and son, mother and daughter, sister and brother. Again, the only requirement is that children be mature enough to do “couple therapy” with an adult parent.

Frame

The dyad sit on moveable chairs and will spend a majority of session time face to face and eye to eye. However, the first-seating orientation is likely a V-formation with both individuals facing the therapist. This initial PACT session interview structure allows for a back-and-forth interaction between individual and therapist with cross-tracking, cross-questioning, and cross-interpreting. Specifying seating positions allows the therapist to get the lay of the land, so to speak, before putting the couple into the face-to-face position.

When the therapist obtains enough information to move into face-to-face positioning, individuals will then sit closely across from one another. The therapist will begin additional cross-questioning to test and retest early hunches, earlier flagged behaviors, responses, and interactions for further examination.

During this configuration, the therapist may choose to draw partners into an informal trance, the purpose of which is to slow partners down, focus their attention. Cultivating attention and presence ensures that partners keep eyes on each other while the therapist has them sit in silence for about ten minutes. This focusing exercise helps partners build vagal tone, an alert but relaxed state. Focusing and grounding partners in this way also builds a safe container, allowing more emotional “headroom” to tolerate difficult topics and painful admonitions.

Following the initial focusing phase, the therapist can move to difficult questions, bring up historical injuries for clarification and reconciliation, and help partners confront matters of deception, withholding of information, wrongdoing, and other unresolved issues in a safe container. Emphasis should be on truthfulness, clarity, and repair.

Example

Mother and daughter come in after years of estrangement. The session length is four hours, sufficient time to reach the stated purpose for the session. Without unforeseen complications, and if done properly, they should not need a second session.

Mother has not been forthcoming about husband’s disappearance from their family home a decade ago. After 10-15 minutes of focusing the partners on each other’s eyes and tracking the moment-to-moment changes on each other’s faces, I ask my first question.

Therapist [to Mother]: As you look into your daughter’s eyes, tell her the truth about you and her father.

Daughter: (starts to cry)

Mother: (reaches out for Daughter’s hands) You were away at college. Your father was having an affair, or so I believed, and I kicked him out of the house. It turned out I was wrong this time, but only for this one instance. He cheated on me several times during our marriage. I couldn’t trust him.

Daughter: Why did you lie to me? Why didn’t you tell me the truth? You told me he left us for another family. He died a month later, and I never had a chance to speak with him again. How could you continue the lie even after his death? I thought he abandoned us. You turned me against him.

Mother: I know. (lowers her head)

Therapist [to both]: Just hold for a moment. Go back to staying in each other’s eyes. [Moments pass, then to Mother] Tell her why you lied to her and continued to lie.

Mother: I hated him, what he was doing to me and our marriage. I was terrified to tell you the truth.

Therapist: “Terrified.” Why terrified?

Mother: One or two of the affairs were with underage girls. (starts sobbing) Daughter: (face goes white, starts to say something)

Therapist [to Daughter]: Hold for just a moment. Just stay with your mother.

Several minutes go by before the mother recovers enough to speak.

Mother: I felt so ashamed. You knew one of the girls. I couldn’t tell you that your father was a sexual predator. I couldn’t. I know I hurt you. I lied to you and made you think that your father just abandoned you. I was confused. I was afraid maybe that he… maybe he…

Therapist: …molested your daughter?

Mother: Yes.

Daughter: (with a soft voice) He did. Twice when I was about 12. I never told you. I never thought you would believe me.

Later in this session and in this face-to-face configuration, the therapist might install secure-functioning principles in order to midwife a reparative trajectory or pathway for moving the dyad forward into the future. Moving the couple into the future is also a device to fulfill their agreed upon therapeutic goals.

Therapist [to Mother]: Now as you realize the consequences of withholding the truth from each other, do you believe you both made the right decisions?

Mother: No. The secrets I kept led you away from me. You lost your father and then you lost me. I was wrong to keep this from you. And, I am so very sorry that I didn’t check with you earlier when I found out what your father was doing with underage children. That was horrible. I should have protected you. I should have made it okay for you to come to me.

Daughter: I blamed you for Dad leaving us. All that time I thought it was you. I didn’t tell you about what Dad did to me. I never thought I would. I wanted to think he was my only ally.

Therapist: Neither of you have been honest or forthcoming with the other. You both have been feeling alone, isolated, bound by secrecy and shame. Isn’t it about time for that to end? Your husband, your father, is no longer here. It’s just the two of you now. What will be the future of this relationship? What should the future be? What do you want it to be?

With partners still face to face in close proximity, the therapist can, and should, facilitate a process whereby both partners can forge a new relationship based on what they learn and want going forward. In this particular form of family therapy – though this example might seem complex for one session – the therapist acts as a consultant and facilitator with an agreed upon purpose and goal.

Overview

Each family dyadic combination requires a unique clarification of purpose, procedure, and goal for the session. Many variables exist. Suffice to say, each dyad has distinctive issues and concerns relating to history, age, and family role.

Dyadic sessions require a minimum of two to three hours. In general, I book three to four hours to get the job done. It’s not that future sessions are off the table. Rather, when using this modality, the therapist should be highly focused and time efficient so the “couple” finds clarity and relief as quickly as possible. If appropriate, the couple therapist should encourage ongoing individual therapy for both people.

As in all PACT therapy, the therapist is tasked with getting accurate detailed information from both individuals. Among methods for obtaining truthful information:

  • disciplined testing and retesting of hunches
  • corroboration
  • finely-tuned monitoring of somatic reactions
  • monitoring of collaborative and coherent speech

Only with accurate, detailed data that arises from each individual’s narratives, implicit and explicit behaviors, and partner reactions, can the therapist adequately formulate interventions and a treatment pathway for the dyad. Leading the session by following each partner step by step – remaining present to the interpersonal field and alert to the actual interactive sequence – helps mitigate therapist overreach, false assumptions, misappraisals, and personal bias.

Next time you are tasked with seeing a family or family members, consider forming various dyadic combinations instead of working with the family in its entirety. I think you will find this PACT approach more rewarding, more enlightening, and more effective.

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How Secure-Functioning Principles Help Parents Who Are Divorcing

By Edna Avraham, LMFT
PACT Ambassador, Level III Therapist
ednaavraham.com

The Psychobiological Approach to Couple Therapy (PACT) focuses on helping and coaching couples to “secure” each other in order to reduce threat, thrive, and grow closer. While they are designed for couples who want to deepen their connection, PACT principles can also apply to uncoupling or divorcing parents.

Some of the secure-functioning principles are:

  • Thinking in terms of WE, the two people in the couple
  • Making the relationship a priority over other relationships in your life
  • Being sensitive and considerate of each other’s known vulnerabilities, and being able to predict how the other member of the couple may perceive your actions
  • Being transparent and turning to each other for support and comfort.

Following these principles creates a secure foundation for each member of the couple to feel cared for, prioritized, loved, and considered.

Divorcing couples are often in a constant state of threat: flooded with fears, uncertainty, anger, sadness, and guilt. Whether the leaver or the left, each partner is experiencing a huge loss of the family they know and expected to keep. Now they are facing an uncertain future relationally and financially. For divorcing couples with children, applying certain secure-functioning guidelines can help create a sense of safety and security for the children.

Tina and Tom were married 13 years and together 15 years. They have two children ages 12 and 8. Tom is a businessman who traveled 70 percent of the time, while Tina is a full-time mother. Tom announced his decision to divorce and move in with his new love, whom he met at work.

Tina was devastated, shocked, and angry. The most difficult issue for her was Tom’s decision to significantly reduce his travel time so he can share custody with the kids fifty-fifty. Tina felt that Tom had not been emotionally available to the children, that she was the go-to parent all these years, and that she had earned her right to be the parent with whom the kids remain most of the time.

Tom had his own version of justifying his demands. He had traveled to provide for the family and sacrificed time with his children, and now he did not want to lose more time with them. He blamed her for not being there for him when he was home and not understanding how hard he worked.

She blamed him for “living his single lifestyle while traveling” and focusing on his needs first when home. Clearly, they had not achieved secure functioning during their marriage. Could they make it happen in the divorce?

As they ceased to be a couple, Tina and Tom began transforming their relationship into a partnership of co-parenting. Within that framework, it was clear that collaboration, mutual care, and respect for the other in each of their roles as parents would create a secure co-parenting relationship as well as secure relationships with their children. The challenges of developing this capacity, however, were significant.

The major challenge of divorce is, of course, the end of coupling and the building of a new life without a partner. Doing that in the face of rejection, emotional injury, anxiety, uncertainty, guilt, shame, and increased stress should not be underestimated. Part of the work in a collaborative divorce is to have deep empathy for the pain of the loss of the marriage.

The PACT therapist understands that the feelings of anger, blame, attack, shame, and general sense of threat and insecurity need to be handled with care. For the majority of people, divorce is a traumatic experience. The therapist must balance the internal dynamics of each partner and at the same time weave in secure-functioning principles that will be most useful for each parent and for the entire family.

Divorce is an earth-shattering experience for families. The uncoupling process has a different speed for the two partners. Usually the person who initiates the divorce is more ready to move on because they have been thinking, contemplating and planning it for a while. The person who is being left tends to take longer to adjust and accept the new reality and deal with the loss.

As their therapist/coach, I first needed to support each of them with empathy for their subjective experience. In order to help them understand and empathize with each other’s intentions and investments in the family, we used communication tools that, with practice in the office, enabled them to acknowledge the hurt and disappointment they each felt. They also benefited from additional individual support. They each had their own therapists and, over time, were able to separate their own emotional war with each other from their children’s needs and suffering.

In our joint sessions, we spoke about what they want their children to remember about their divorce. I asked them to:

  • think about what is most important for each child to suffer the least damage.
  • redefine their future relationship as parenting partners.
  • discuss their vision of what their relationship will become now that they are uncoupled.

We identified their common link: the attachment and precious relationship they each had with their children. This created leverage and an incentive they could both focus on. We discussed what each honors about the other as a parent, and how they want their relationship to be with each other in the future as well as with their children. Which of the secure-functioning principles could apply to them as parents outside of the couple relationship?

They agreed to:

  • make each other a priority as the other parent. That even when they are with other partners, they will always be present as parents for their children, making decisions together and being each other’s go-to person regarding the children’s concerns.
  • respect each other’s role as a parent and never disparage each other in front of their children, family, or community.
  • think as “WE, the parents,” and be sensitive to ensure each other’s secure place with the children and each other.
  • remember each other’s vulnerabilities and protect each other from feeling excluded or isolated as parents.

The therapist must carefully weave in secure-functioning principles, paying attention to the client’s emotional readiness to make the shift into a secure co-parenting relationship. They are no longer a couple, but they can still be great parents to their treasured children – and perhaps even good friends. Throughout this difficult journey, these principles benefit all members of the family.

Do You Have Your Partner’s “Owner Manual”?

By Lisa Rabinowitz, LCPC
PACT Level II Therapist
https://baltimorecounselor.com/ 

In your romantic relationship, paying attention to your partner’s responses and attitudes is especially prudent. Observing impressions and reactions can help you become more in tune with a partner’s likes and dislikes. I refer to this practice as “obtaining your partner’s ‘owner manual.’”

For example, if I say the word rollercoaster, most people have a strong response, whether positive or negative. If I then plan a trip to an amusement park with my partner – and I love amusement parks – that’s great for me, but did I think about my partner and his reaction?

What if my partner hates amusement parks? The above example could be a win-lose situation if one of us likes rollercoasters and one of us does not. Pro-relationship couples promote win-win situations. Therefore, I need to know more detailed information about my partner to increase my chances of win-win opportunities with him.

Inevitably, your lives get busy. Time marches on. However, if you want your partner to feel important and loved, you must continue to update your knowledge and understanding of this person on a monthly, weekly, and daily basis. You need to be observant, like Sherlock Holmes. What makes her smile? What makes her feel sad? What triggers and irritates him? What brings him joy and happiness?

I’m not suggesting that you stalk your partner and start looking in his phone or following her when she leaves the house, but do you know what matters most to this person? In case you’re asking yourself, “Why does all this detail matter?” it does matter. When you know and understand your partner, then you can predict what may be perceived as threatening, which then creates insecurities.

In addition, you can learn the fastest ways to soothe and comfort your partner whenever he or she becomes hurt, which inevitably happens. I suggest when you notice X about your partner, you should be cautious and check in with a question, such as, “I think I noticed your face change to a sad expression. Did that just upset you?” Nonverbal cues, such as a change in facial expression, can help you better understand your partner and add new information to your partner’s “owner manual.” Here are a few scenarios to help illustrate why gathering this type of information about your partner is important.

Angie and Steve have been dating for a little over a year. Last week Steve stopped to buy her a hydrangea plant. Angie felt letdown as she wondered, “Why is he giving me blue hydrangeas when he knows I love yellow roses?” You might say, “It’s just flowers, so what? Why does that matter?” The reason it matters is because Angie wants to know she matters, just as your partner wants to know you are paying attention and noticing her likes and dislikes, interests, triggers, sensitivities, and what makes her tick.

Another example of paying attention to details happened to me last month. My husband said he really liked the chicken dish I made. How did I respond? I proceeded to make the same chicken dish every weekend that month! He had to politely let me know that, while it was delicious, he likes variety and asked if I could make a different chicken dish.

After our conversation, I realized that I should have known my husband likes variety. Even though I have eaten oatmeal for breakfast every day for the past 10 years (OK, a little exaggeration), he has a different type of breakfast almost every day. And, he regularly comments on my singular breakfast choice. How did I miss that?

Of course, you need to realize that you and your partner will make mistakes and overlook things that seem inconsequential. I share this example of paying attention to what my spouse said because as a committed partner, I want my husband to know I care about him, just as he shows me that he cares about me. Each of us can practice paying attention on a daily basis so we become more attuned to what matters to our spouses and more connected as couples.

In one of my sessions, Elizabeth and Rafael were discussing a conversation they had about going out of town so they could spend time together. Their lives were exceptionally busy, and Elizabeth kept saying, “Yes, we should go out of town, but now is not a good time.” Rafael was trying to reach out to his wife, but Elizabeth was not understanding his needs. In our conversation, I brought up information he had shared in a previous session. As a child, his parents were unavailable to him and would constantly cancel plans. As a result, he was sensitive to Elizabeth’s lack of commitment to spending time together.

Whether dating or married, every couple gets busy and caught up in their own lives. At times, one partner may even feel stuck doing all the listening without the equal opportunity of being heard. However, couples who understand and listen to each other’s needs and counter with solutions stay connected.

Elizabeth shared her concerns about the relationship, too. In the end, the couple worked out that, when Rafael asks her to spend time with him, Elizabeth could say, “I’d love to spend the weekend with you. Would X date work for you?” By giving her husband a specific date, he felt that she was making him and the relationship a priority, healing old hurts and pain from his childhood. The couple made a date – just the two of them – for 3 months from our appointment. We discussed how to be understanding of individual schedules and, on balance, the need to make time for each other.

  • Slow down and focus on your partner’s feelings and reactions to situations.
  • Take note: if you are talking about X and your partner turns away or looks down, check to see if he is upset or if something is bothering him.
  • Create win-win situations by thinking about your partner.

As partners, it’s essential for us to have our partner’s owner manual. When we don’t, we risk being seen as threatening or not loving our spouse. Frequently, partners end relationships because one partner didn’t know what really mattered to the other. If you begin to hear statements such as, “You just don’t know me,” “You don’t get me,” “You don’t seem to really care about me,” take action. Find a reputable PACT therapist in your area to help you “know each other,” reduce insecurities and increase your connection. When you take the time to obtain your partner’s owner manual, you begin communicating “I want to understand you,” which will improve the likelihood of a secure relationship.

References

Tatkin, Stan. (2016). Wired for dating: How understanding neurobiology and attachment style   

can help you find your ideal mate (p. 31). Oakland, CA: New Harbinger Publications, Inc.

Tatkin, Stan. (2018). We do: Saying yes to a relationship of depth, true connection, and enduring

love. Boulder, CO: Sounds True.

Looking for the Baby

By Lisa Rabinowitz
LCPC, PACT Level 2 
https://www.baltimorecounselor.com

We have all been in situations in which we feel misunderstood by our partner. We might be left scratching our head, wondering why our partner just doesn’t get us. PACT therapists recognize that such misunderstandings or misattunements to nonverbal and verbal cues are similar to what can happen with babies and their primary caretaker(s). We know from attachment theory that if the caretaker is unresponsive, punitive, anxious, or inconsistent, then the baby may fear abandonment or withdraw or overreact, developing an insecure attachment. On the other hand, if the caretaker responds in a consistent and reliable manner, then the baby will develop secure attachment, believing the caretaker will be there for him or her in the future. As adults, this kind of signal-response system affects our romantic relationships, whereby we repeat the patterns of our childhood—either with inconsistent and unreliable responding partners or with partners who are reliable, loving, and responsive.   

Each of us has a “baby” inside us, and PACT therapists often encourage partners to look for the baby in each other as a way to achieve greater connection and intimacy. As adults, we have an opportunity to respond to that baby in our partner, who wants to be held, cared for, connected to, talked with, cuddled, reassured, encouraged, or comforted. We can also miss each other’s cues and fail to interpret the signals made by the baby. When we miss the baby, an argument may ensue, causing the baby to lock him or herself behind a protective wall, feel scared to come out, scream, rant, or leave the scene of the fight. If we miss seeing the baby, then we can repeat the cycles from childhood. We may be scared to get too close to our partner out of fear that he or she will not take care of the baby inside us, just as our parents failed to do. In our romantic relationship, we can finally get it right and care for and be cared for by our partner, but only if we hear and see the baby in each other.  

Sometimes when couples are upset and feeling hurt, their comments become more and more negative and attacking. This can result from reading each other’s faces as negative instead of neutral. For example, if you blankly stare at your partner or pause after your partner asks you a question, your partner’s brain may interpret your face as negative and fill in the pause with all sorts of negative statements. That doesn’t mean you always have to smile (fake smiles are also taken as negative) and make small talk while you try to think how to answer the question, but you need to be aware of how your partner is interpreting your face and your pauses, along with your tone of voice and body posturing.  

When we interpret a cue as a threat, we can respond in a fight, flight, or freeze manner: (a) we attack, criticize, or dismiss our partner; (b) we leave the room, or (c) we don’t respond. As the conflict escalates, we act as if our partner is an enemy, seeing any action or statement in a negative light. 

Consider the example of Lila and Roberto, who are in the kitchen, preparing for dinner. 

Lila: (reaches out for connection) Hey, do you want to spend time together tonight?  

Roberto: (looks away) We’ll see. 

Lila: (interprets his look as withdrawal) What? You never want to spend time with me! You always want to play on your phone.  

Roberto: (misses her need for closeness) It’s not that I don’t want to spend time with you, but (pauses) I’m tired from work.  

Lila: (doesn’t know how to create connection, so continues the argument) You always are tired. When are you ever going to make time for me?  

In this exchange, Roberto lost an opportunity for connection when he missed the baby in Lila as she reached out. She responded with a fight response, and he continued to overlook the baby. In the following replay, we see how this can be corrected:  

Lila: (walks over to Roberto, waits for him to turn and look at her) Hi, honey. Is this a good time to ask you a question?  

Roberto: (sees the baby in her) Sure. What did you want to ask?  

Lila: (cues that she wants connection) I was wondering if we could spend 15 minutes together after the dishes?  

Roberto: (continues to see the baby, offers connection and responsiveness) I was hoping to watch my favorite show for 30 minutes after the dishes, so can we spend time together right after that?  

Lila: I’d really appreciate that. Thanks. 

The next time things start to get heated between you and your partner, take that as an opportunity to stop, listen, and care for each other. By taking care of the baby within you, you can repair hurts from childhood and strengthen the bonds of your romantic relationship. Here are three tips: 

  1. Stop, listen and look: stop talking, listen to your partner, and look for nonverbal cues from your partner that reveal his or her baby. 
  1. Ask yourself: “What are the nonverbal cues telling me?” “What does the baby need?” “What does my partner need right now?”  
  1. If the argument has started already and you are miscommunicating, replay: ask your partner if you can restart the conversation and take care of the baby inside of him or her. 

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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. 

 

 

 

 

All People Are Difficult, But You Shouldn’t Be Too Difficult

by Stan Tatkin, PsyD, MFT

As a couple therapist, I know how difficult people can be. Actually, as a person on this planet and a romantic partner to my wife, Tracey, I count myself as one of those difficult people. Indeed, in no way do I put myself above any of the other annoying people out there. Yet here I am, writing about how to be less of a pain in the ass. Well, while I know I can be difficult, I know how not to be too difficult. And the line between them is actually clearer than you might think. Here’s how not to cross it.

When I work with couples, our goal is for them to become secure functioning. Secure functioning partners are least difficult with and toward each other. That’s because they understand their purpose: To ensure each other’s absolute, unequivocal sense of safety and security. Partners are equal stakeholders in this endeavor, therefore, they agree to make life easier for each other, not harder. That’s one of the main principles of secure functioning relationships.

Oh, wait, you think you’re not difficult? Let me tell you, you are. Here’s why:

  1. Your brain. Though a very impressive organ, your brain is prone to lots of errors, especially in social situations. For example,
    • Your brain all too often conflates social cues (faces, voices, movements, postures, words, and phrases) with real danger.
    • Your brain is mostly automatic, memory-based, and therefore confuses current events with previous experience via a lightning fast memory and recognition system.
    • Your brain constantly replaces missing evidence with made up “facts.”
    • Your brain imagines things that are not there.
  2. Your biology. Your development plays a considerable role in how difficult you are. Your biology affects your ability to:
    • Manage your impulses.
    • Tolerate frustration.
    • Shift your attention at will.
    • Manage your state of arousal.
    • Socially-emotionally act and react appropriately under stress.
    • Make decisions.
    • Override what feels good for what does good.
    • Remain self-aware in real time.
  3. Nature. You are genetically predisposed as a homo sapien to be aggressive, self-interested, and prone to dislike people who are “too familiar to ignore, but too different to tolerate.”1
  4. Nurture. Your experiences and memories shape who you become.   If you experienced any trauma, especially in early childhood that remains unresolved, you are likely to be hyper-reactive to threat cues, both internally and externally.

This is not an exhaustive list. The ways to be difficult are limitless. However, that you and I are difficult is not a problem. It’s when we cross the line and become too difficult, that is the problem. How does focusing on secure functioning help?

Secure functioning partners co-create their own kind of social contract which protects them from each other. These are “golden rules” in that they are, if agreed upon, undisputable and therefore help partners rein in difficult behavior.

One golden rule could (and should) be, “We protect each other in public.” Keri and Dave, for example, agreed to this principle. They both decided that it served both a personal and mutual good. In the example below, they are out to dinner with another couple. Dave is an actor and he received news that he won a co-starring role in a major motion picture. He told Keri that he signed a non-disclosure agreement and to keep it to herself.

Keri: [to the other couple] The other night Dave got news that he’s doing the next (fill in the blank).

Dave: [turns his head away in anger]

Keri: What? [raising her shoulders and hands in a disdainful, questioning manner]

Dave: [quietly in her ear] Remember what I told you earlier. Don’t talk about this.

Keri: [out loud] Oh come on. It’s great news. I’m proud of you.

At this point, Keri has stepped over the line and has become too difficult. That she reflexively said something that he explicitly told her not to say breaks an agreed upon principle. However, that she continued to violate the principle when reminded by Dave – that is what defines being too difficult. It also shifts Dave’s experience of Keri from annoying to threatening.

Here’s how it should have gone:

Keri: [to the other couple] The other night Dave got news that he’s doing the next (fill in the blank).

Dave: [turns his head away in anger]

Keri: [covering her mouth in horror, turns to Dave] I’m so sorry. I forgot. I’m so sorry, really I am. [to the other couple] I just betrayed Dave by telling you that. [back to Dave] I am so very sorry I did that.

Dave: [to couple] I’m under an NDA so no one is supposed to know this. Keri’s very excited for me about this. Please, keep this to yourselves.

Keri: [whispers in Dave’s ear] I’m so sorry.

Now that is an example of repair and recognition of being difficult.

Other examples of being too difficult include:

  • Persistently not releasing your partner after a satisfactory repair.
  • Not being willing to bargain with your partner.
  • When bargaining, not providing alternatives following the word “no.”
  • Being unwilling to admit your wrongs and make amends.
  • Being unwilling to see your partner’s point of view.
  • Not being curious.
  • Persistently stubborn.
  • Persistently inflexible.
  • Persistently conflict avoidant.
  • Continually failing to check with your partner when discussing them in public.
  • Continually disregarding your partner when together in public.
  • Persistently (and unapologetically) failing to keep your word.
  • Persistently talking too much.
  • Persistently talking too little.

Again, this is by no means a definitive list. But notice the wording in here. It’s not about reflexively doing something that makes you difficult for your partner. It’s about the refusal to stop when cued that makes you too difficult. It’s also about the refusal to repair the hurt and makes things right.

We are all fundamentally automatic creatures – all day, every day. Our brain cannot possibly remember the countless changes in behavior our partners require under various circumstances. That’s why telling your partner to never again embarrass you in public, while understandable, can never work. Your partner will do something again, and likely without any malicious intent. It will be far more effective to remind your partner just before entering a public situation. “When we go in, please don’t make any jokes at my cost, okay?” If your partner is not too difficult, they will comply. If they don’t, well, now you have a problem. If they slip (which should not happen), and remain unapologetic, it’s likely time to move on.  

Because we are all mostly automatic, we shouldn’t be faulted for many of the knee-jerk behaviors we do without thought and, at times, without intention. We are, however, responsible for what we do after we do something stupid, thoughtless, or insensitive. We are all difficult in one way or another. The challenge for secure functioning couples is in not crossing the line to becoming too difficult.

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NOTES:

  1. Harari, Yuval Noah. Sapiens: A Brief History of Humankind (p. 18). HarperCollins. Kindle Edition.

Pause, Allow, Soften, Breathe, Appreciate: PACT Therapist Self-Care

Uri Talmor, M.A., L.P.C.
PACT Level II
Boulder Colorado
http://www.consciousheartintegration.com/

A couple come into my office, already in argument mode. They emanate Neanderthal-reptilian contempt, talking over each other, and perceiving most of what comes out of the other’s mouth as an attack.

Immediately, some snarky down-the-middle possible responses fill my mind: “You two are really good at hurting each other.” Or “You’re both really good at making the other person wrong.”

I take a deep breath, soften a little on the inside. It hurts to watch them; there is so much pain. I wonder, “Is this what their children feel? Is this what I felt growing up?”

She’s crying now, but he’s continuing to talk. Why hasn’t he slowed down? Where’s his sensitivity to her pain? He’s missing her. Doesn’t he see she’s gone?

With some couples, these types of mis-attuned moments are chronic. They seem to be trapped in altered states of angst, unable to fully see the human they’re partnered with. Usually I take for granted that these people care about each other, based on where I’ve seen them go in previous sessions, but there are periods when the care has been sucked clear out of the room.

In such moments, I turn to the tools I’ve learned from PACT that can help me shift these mis-attunement ruts. In particular, I juxtapose these couple therapy moments with a memory of volunteering for a Level II demo with Stan. It was a short demo but made a powerful imprint on me.

There I was, sitting in front of a male colleague (for context, I’m heterosexual) and Stan was watching us. We made eye contact, role playing a couple I had asked a question about. Stan threw out a couple of comments, and in a matter of what seemed like seconds, I felt like I had entered a relationship wind tunnel. The rest of the room fell away, and I felt focused on, aware of, and connected to this colleague in a way I rarely experience with anyone. My whole being was attuned to him, to what was happening between us. It was easy; graceful; and as cliché as it may sound, a flow state.

I was stunned at how quickly Stan got us there, using cross-questions and cross-comments. His timing was perfect; his own tone of voice and regulation seemed at ease and relaxed. We could both rest in his care, as he gently prompted us to be in each other’s. The two of us shifted quickly into a state of secure functioning because we could feed off how solidly Stan was with us.

As PACT therapists, our own self-care is so important. One of the most valuable things I can bring to couples is my own ability for co-regulation. To this end, I’d like to share some tips that work for me.

  • Early bedtime. I’m a different creature on days when I’ve fallen into auto-regulating to YouTube until the wee hours. I’ve asked my partner to help hold me accountable, to drag me to bed if she has to. What self-care practice would most improve your ability to self-regulate?
  • Consistent peer consultation. I’m lucky to live in an area where PACT has taken off, so I have a handful of colleagues with whom I can get together and share cases. Every time we touch base, I feel recharged and rejuvenated. You can also do this with colleagues long distance.
  • The PACT serenity prayer. I find it to be such a simple and powerful reminder.
  • The breath. I pause and self-regulate throughout the session with my breath. Usually it doesn’t take long, especially when combined with mindful acceptance. I’ve observed Stan do this simply by getting up and grabbing his smoothie from somewhere else in the room. With some couples, that’s all it takes; with others, I need more frequent internal support so I can stay with them. Pause, allow, soften, breathe, appreciate.
  • Work on my own issues. I can’t imagine a day when I won’t be in my own therapy or doing some form of personal growth work. Most of us were born into internships; doing our work is a necessity. If you haven’t done your own PACT therapy, I recommend putting that high on your priority list.

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One Way Memory Impacts Your Relationship (and it might not be the way you think) 

Inga Gentile, MFT
PACT faculty
Oslo, Norway
www.ingagentile.com

“Why does she always seem to get clingy right when I have to go out of town for work?”

“Why does he lock himself in his office after work and watch Netflix while I’m alone in the living room?”

Many couples experience confusion and frustration related to often repeated scenarios like these. But it’s not a sign that your partner doesn’t love you. Or that you’re not the right fit.

There’s actually a psychobiological reason these scenarios play out among couples everywhere. It’s called implicit memory. Implicit memory begins at birth and is unconscious and nonverbal. It precedes declarative memory, which refers to the conscious recollection of facts and events. Implicit memory, on the other hand, because it involves older, more primitive parts of your brain, operates rapidly and largely outside of your awareness.

How does implicit memory play out in your relationships? One way is through your attachment style. Your attachment style is based on your experiences early on in life, and the type of care you received from your parents or first caregivers. Those experiences – especially in the first two years of life as the brain structures needed to support declarative memory develop – become stored as implicit memory and drive much of the way you act and interact with those closest to you. These implicit memories can be activated by everyday events, like separations and reunions, and because there isn’t an awareness that you are remembering something as there is with declarative memory, it can be mystifying.

Seen in this light, a partner who clings at the moment her loved one is leaving isn’t intentionally trying to make her partner’s life difficult; she may have early experiences of separation that induce distress and in turn activate her attachment system to seek proximity and comfort.

If your partner is sensitive in this way, move towards them, physically or verbally. Embrace them, look them in the eyes and say something like, “I know you get anxious when I go away.  I want you to know I’ll never leave you.” If you’re the one in distress, be aware of your response and take responsibility. Ask your partner for what you need: “It’s hard for me when you leave. Can you please hug me tight and tell me that I’m the only person for you ever?”

The partner who locks himself in his office isn’t necessarily trying to punish his partner by being withholding but may have difficulties with transitions from one state (work) to another (home) and may lean towards “alone time” as a way to reset—again, a possible adaptation to early relational experiences.

One sensitive way to respond: Say in a friendly tone, “I know you need some time alone. Netflix together in the living room in 10 minutes, baby!” Conversely, the partner could take responsibility for his hardwired tendency by understanding that, although it might feel unfamiliar, learning to “reset” in the presence of his partner can actually be soothing, on a nervous system level.

Appreciating that memory exists in many forms—both conscious and unconscious—can help you create mutually satisfying and safe relationships: Understand what drives your own reactions. Learn what drives those of your partner. Take responsibility for your own automatic reactions. And be sensitive to those of your partner.

Learn and practice new ways of meeting and caring for one another’s implicit memories in the present and watch what happens in the future.

Back to School with the 3Rs

Allison Howe, LMHC 
PACT Level II 
Saratoga Springs, NY 
http://www.facebook.com/AllisonHoweLMHC

As PACT-trained therapists, it is perplexing when we find ourselves working with a couple who are not moving into secure functioning. There are a number of factors to consider: Is there a deal breaker that hasn’t been addressed? Are both partners truly committed? Are resources outside the therapy office allocated to restructuring the relationship? 

As we work to move couples from a one-person psychological system into a two-person system, we are facilitating the development of skills. Learning to have relaxed and mutually satisfying conversations requires skill. However, when partners demonstrate curiosity and interest in their partner, they are taking an essential step forward. Their time and attention are a precious resource and are too often in short supply.  

The changes we are endorsing require clear messaging, repetition, and lots of support. The job of a PACT therapist is to help couples gain clarity and understand that creating new neural pathways in the brain requires practice. This is the reality. The reflexive systems are deeply rooted, and it is unrealistic to believe we can create a new system without time, attention, and practice. 

In the same way a coach gives his or her athlete a training plan, I encourage couples to practice outside the therapy session. Recently, I worked with a couple who are making forward strides. However, I observed a missed opportunity at our last meeting. More specifically, there wasn’t a clear structure in place for them to reflect and review the changes that were indeed taking place. The following dialogue took place: 

Carmen: “Did you notice how I handled things differently this week? “ 

Liam: “I’m not sure what you are referring to. Are you talking about the conversation on our porch with my friend Tim? “ 

Carmen: “Yes. That is what I’m talking about. “ 

Liam: “Well, I know I handled things differently!” 

This couple was consciously considering the way they do business with each other, but I observed that as time elapsed, their memory of the event became a bit unclear in terms of detail and sequence. While positive steps in a secure direction were being taken, not sharing these experiences was a lost opportunity. So I had them do the following exercise, which is designed to gather evidence of progress. 

Exercise: REVEAL, RECOGNIZE, REINFORCE 

Instructions for therapist: Have couple sit face to face. Encourage both partners to keep their messages friendly and succinct.  

Step 1: REVEAL: 

Partner A: Take a moment to reflect on your recent interactions or experiences with your partner. Identify a behavior aligned with your secure-functioning goals. Examples include but are not limited to distress relief, quick repair, contact maintenance, or management of thirds. Reveal the behavior to your partner.  

Step 2: RECOGNIZE: 

Partner B responds to Partner A by acknowledging this positive step.  

Step 3: REINFORCE: 

Discuss together how this change is positive for the relationship. This is a moment to feel good together. Switch and repeat the steps with Partner B moving to Step #1.  

When Carmen and Liam used this exercise in our session, the following dialogue occurred. 

Carmen: “Remember when Tim was visiting? Well, I did what I usually do. I became sarcastic and made a joke at your expense. Tim noticed. I’m sure you did. But that’s not the change!” 

Liam: “What did you do differently?” 

Carmen: [REVEAL] “I came up to you before bed, looked into your eyes, and said I was sorry for it. It’s not okay for me to do that anymore.” 

Liam: [RECOGNIZE] “I do remember you coming up to me and apologizing. I appreciated it. Thank you, and it matters to me that you are paying attention.” 

Carmen: [REINFORCE] “I want to repair things quickly the way I did that night. That’s so much better for us. I also want to quit being snarky with you. I know these changes are good for us.” 

Liam: “I agree. This feels so much better than the old ways. Now can I tell you my change? [REVEAL] I was bothered by your joke, especially in front of Tim. I made a conscious decision in that moment that I wanted to change how I handled it. You know, I withdraw from you when this kind of thing happens. I decided that has to stop. I decided I was going to let this go and not punish you with my silence. If I was feeling upset the next morning, I promised myself to talk to you about it.”  

Carmen: [RECOGNIZE] [smiles] “Thank you. I have suffered a lot when you pull away from me. I know that is a big change for you.” 

Liam: [REINFORCE] “A big change. And a good one.”  

Carmen: [REINFORCE] “This feels like a big deal. We are on a better path.” 

What does this exercise accomplish? Having the couple face one another while mutually amplifying the positive enables coregulation. Learning to uphold Grice’s maxims for the quality, quantity, relevance, and manner of the message fosters secure functioning. Additionally, focusing couples on true behavioral changes makes the implicit fully explicit. This exercise encourages increased interdependence, with a focus on both self and other. Finally, with the focus on positive change, the exercise can bring much needed vitality to a couple as they make sustainable change.  

Using Quality Moments to Soothe or Bypass Core Vulnerabilites

Inga Gentile, MFT
PACT faculty
Oslo, Norway
www.ingagentile.com

Many couples tell me they simply don’t have the time they need to set aside to address issues in their relationship daily. They are too tired at night, mornings are too hectic, and their days are a blur. However, there are things they can do and ways they can be toward one another to help create greater safety and security in their relationship.

One way to increase secure functioning in your relationship is to be aware of the core vulnerabilities that underlie chronic distress for you and your partner. Stan Tatkin (2012) talked about the three or four core vulnerabilities most people have, usually rooted in childhood experiences. Secure-functioning couples realize it is their job to be aware of such vulnerabilities and to tend to injuries when needed. They don’t spend a lot of time complaining that an injury shouldn’t be there or shouldn’t ache so much; rather, they make a point of creating quality moments during which they can say and do things that have a positive impact on each other’s self-esteem and sense of security.

This is important when you find yourselves in a distressed situation as well as when you are in either a non-distressed situation or a situation that is building toward a point of distress. In each case, you can make an effort to circumvent or diffuse reactions linked to your core vulnerabilities. Do this by knowing what makes each of you feel bad as well as what makes you feel good. Use this information often in large and small ways.

Paul and Anna are a couple in their thirties with no children. One of Paul’s core vulnerabilities is a fear of being blamed. Another vulnerability is feeling he can’t get it right with those he loves. When he senses that Anna might blame him, he freezes or withdraws. Fear of abandonment and fear of being a burden are two of Anna’s core vulnerabilities. She experiences Paul’s freezing and withdrawal as abandonment of her. Experiencing his withdrawal as abandonment confirms her belief that she is a burden to him, and she often responds by amping up her criticism of him.

After they worked in therapy to uncover their core vulnerabilities and reshape their narrative around who they are and why they behave as they do, Paul and Anna began to practice in real time saying and doing things to shift the other’s state, and then paying attention to what happens. In session, we worked on their physical impulses to move toward or away from one another in moments of distress. Here is one example of how that played out at home.

When Paul comes home from work, Anna is in the kitchen washing dishes. As soon as he walks in, she begins to complain to him about her day. He picks up a yogurt and starts to eat it. She says, “I can’t believe you can just stand there and eat when I told you I haven’t eaten all day.”

Instead of feeling blamed and withdrawing, Paul makes the decision to move toward Anna in a friendly (and unexpected) way. As she is speaking, he offers a spoonful of his yogurt, holding it up to her mouth for her to eat. She tastes the yogurt and begins to laugh.

In this quality moment, Paul shifts Anna’s state and assuages her core vulnerability of being a burden. He is able to listen closely to her words, feel her distress, and understand that she is hungry. Because he isn’t feeling attacked, his impulse is to nurture her. This is mutually rewarding because Anna expects to be abandoned, especially when she is fussy, and instead feels soothed. Additionally, she is touched by his ability to get it right with her in a way that perhaps no one else could.

This couple demonstrated an ability to soothe and to give each other what they most need in the present, thus bypassing their core vulnerabilities. When it comes to such quality moments, frequency and precision (and not necessarily duration) go a long way toward creating a greater sense of safety and security.

Reference

Tatkin, S. (2012). Wired for love: How understanding your partner’s brain can help you defuse conflicts and spark intimacy. Oakland, CA: New Harbinger.