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Healing Trauma Relationally Through PACT
By Jeff Cohen, MFT
PACT Level III Therapist, PACT Ambassador
When Gayle and Paul came to see me, it was clear that Gayle felt Paul was the problem. Paul was taciturn to an unusual degree and could be quick to anger. For her part, Gayle presented as highly verbal, competent, and overtly friendly; adept at managing the tasks of their family and her career.
Though I didn’t know of Paul’s trauma when we first met — he lived in terror of upsetting a threatening stepmother and a physically punishing older brother — his manner and speech suggested that he moved through the world in a very protected stance.
It might have been easy to view Paul as the one who needed help. He was extremely literal, arguing about the minutia of his upset with Gayle, and for a long time was unable to understand the concept of providing relief first in an argument. From a PACT perspective, when a willing partner is able to help settle the distressed partner, it helps them both feel more settled and available to hear each other.
Looking in Both Directions
As PACT therapists, we look in both directions to assess a couple’s dynamic. Invariably, the couple alerts us to mirroring sensitivities and areas of injury. We see how primary partners are familiar to each other in recognizable and sometimes unconscious ways stemming from their own family histories.
As it turned out, Gayle had lived through her own family trauma. Her father was physically violent toward her mother and self-destructive. As the eldest child, Gayle become highly functional and competent in taking care of others. Indeed, her self worth was linked to that and to a belief that she needed to be perfect to be loved. Though Paul didn’t have a lot of ground to stand on from his angry and defensive stance, he was correct in pointing to a lack of openness and feeling he received from Gayle.
Initially we had to address Paul’s anger. To do so meant understanding the triggers which set him off so quickly. He was terrified of Gayle leaving him, so any comment along the lines of, “I can’t take this anymore,” would elicit that fear. Gayle’s comments were understandable in the context of their conflicts. As a PACT therapist, I also wanted to help her see how her comments threatened their relationship, so we experimented with other ways she could respond in those moments.
Practicing Neurobiological Responses
Gayle learned to set clear limits and be reassuring at the same time: “Stop! I’m scared when you yell. I’m right here. I’m not going anywhere, but I need you to talk more softly.” When this didn’t work, I asked her to simply sit down on the floor, to make herself small, which we experimented with first in the office.
PACT therapists will have couples act out situations to elicit the neurobiology of their actual responses. In this instance, to the surprise of them both, when Gayle sat down, Paul instantly settled down. Her sitting evoked his shame and guilt for how he was treating her.
We also worked with the internal wall which kept Paul safe and protected but also isolated. As he learned to identify when his wall was going up, I validated how well that wall had served him. “Your five-year-old self didn’t have anything else he could do. Thank goodness you found some way to protect yourself.”
Comments along these lines helped Paul feel compassion for what he had experienced. The acknowledgment allowed his softer side to emerge which, in turn, helped Gayle feel empathic toward him. This is the value of working with one person’s trauma in front of their partner.
Healing Trauma, Seeing Tenderness
“Can you look at her now?” I asked in one session when Paul felt his wall going up.
Since he was accustomed to seeing threat, I deliberately slowed the process down so he could take in what was happening. PACT therapists help couples see and read each other more accurately.
“Notice her eyes, what do you see?”
“Warmth, yeah, that’s right. And what does that warmth convey to you?”
“Caring,” he said. “Tenderness.”
“As you continue to look at her,” I instructed, “notice what happens inside of you as you feel her warmth and caring and tenderness.”
“It’s really hard,” he said, “I want to turn away and shut down.”
We had previously identified the shame he carried about being inadequate, how his anger and shame were intertwined, and how his defensiveness was partly a way to keep himself from having to feel that shame.
So now I reminded him, “Of course you want to turn away. It’s what you learned to do, but it also keeps you feeling alone. Young Paul didn’t have another option, but your adult self does. Let’s see if that younger you can watch as the grown-up you tries something different.”
Integrating the Experience
PACT therapists have couples face each other as a means of coregulating each other; doing so also helps keep them in present time, rather than fixating on negative memories. As Paul continued to look at Gayle and speak about his experience, I narrated what was happening, to help him integrate the experience.
“Notice what you’re doing,” I said. “You’re talking about how frightened you are without reacting to the fear by shutting down. You’re tracking your own experience while staying present with her, all at the same time.”
By slowing my pace and speaking gently, I was also eliciting his own mindfulness, which I knew would be settling and help promote new neural pathways to form around this experience of safety and connection.
“As you’re allowing yourself to be vulnerable now,” I asked, “do you think she likes this?”
This was not a hard question to answer. Gayle was doing her best to hold back tears, but I wanted Paul to register the impact he was having.
He nodded. “Yes, I think she’s very happy.”
Gayle reached out to hold his hands. “I feel so close to you when you let me see this part of you.”
“It’s new to me, too,” he joked.
“Yes, it is,” I affirmed before turning to Gayle. “Can you notice a difference in him?”
Changing the Couple Legacy
PACT therapists often ask questions of people about their partners to encourage them to track each other more carefully and to reveal both what they know and what they misread about each other.
In this case Gayle was right on. “He seems much more open.”
“I feel that, too,” Paul replied. “I feel more open and relaxed inside.”
Paul looked visibly different. “Because you’re more connected to yourself,” I said, “you’re able to feel more connected with Gayle. Can you feel how that is true?”
PACT is an experiential-based model of couples therapy, and I kept directing Paul back into his experience so he could verify for himself what I was observing.
“You’re also changing your legacy,” I said, wanting to underscore the importance of what was happening. “It wasn’t safe for you to go to anyone when you were young, but notice how available Gayle is when you allow yourself to be more open and vulnerable. Connection may not have been available to you then, but it is now.”
Seeing Paul take up his work made it safe for Gayle to do so as well. “I want more connection but I’m not sure I’m capable,” she admitted, beginning her own process of healing. Gayle was able to recognize that she also carried shame — remember, people are drawn to what is familiar — though she expressed it differently than Paul did.
As they learned to manage each other more effectively, in part by being more responsive to each other’s sensitivities, Paul also started thinking relationally, which was a paradigm shift for him. “I’m safer to her,” he observed one afternoon, “which allows her to show up more.”
Indeed. Partners do this for each other, and PACT is an approach which can teach them how.
By Susan Orenstein, Ph.D.
PACT Level 2 Therapist, PACT Ambassador
Let me start at the beginning of our love story.
My freshman year at Brown University, a resident counselor introduced me to another student because we both had a love of piano. Growing up, when I played for others, they would politely wait until I finished and offer a general compliment. But when the student to whom I had just been introduced heard me play, instead of general platitudes, he offered constructive feedback. I remember being thrown for a loop but also impressed that he truly listened and was authentic in telling me what he thought. Our basis for trust began right there. A few years later we began dating, and for his senior piano recital, we played a duet, Debussy’s “Petite Suite.” That student is now my husband.
Fast forward 30 years.
As new empty-nesters, my husband and I set off for Vermont to attend Kinhaven’s Adult Piano Workshop. The participants, all there to focus on four-hand repertoire, ranged in age from their 50s to 70s. We were greeted warmly by camp veterans, who had been attending this program for as long as 20 years.
My husband and I were initially intimidated by these musicians, talking in detail about piano scores and concert pianists we had never heard of. We tried to feel like we belonged, knowing we were in it together, and focused on doing our best to learn our duet for the student recital, held at the conclusion of the week.
The camp, located on the northeastern edge of the 400,000-acre Green Mountain National Forest, is rustic. We practiced in weathered cabins with rickety chairs, empty except for a magnificent Steinway piano taking center stage. In anticipating this week, we packed books and cued some movies, thinking we would have lots of leisure time.
We also searched online for things to do in Vermont, planning for some day trips. None of that happened. Instead we were joyfully immersed, practicing, side by side on small benches. The time flew by. Practicing together to get our piece up to par for the final recital took intense concentration, coordination, and teamwork. Here are some lessons we took home from the week’s experience.
1. Stay attuned.
Hear each other. It’s not enough to master your part. You need to listen for your partner. Understand the cues for starting and stopping together, for staying together. Look at each other. Breathe together. If your partner is rushing due to anxiety, connect with them to bring them back to the right tempo. Be in the moment.
As a couples therapist, I recognize that being in sync musically involves interpersonal regulation between two nervous systems. In drawing from PACT, the Psychobiological Approach to Couples Therapy, we pay a great deal of attention to each partner’s non-verbal cues, observing facial expressions, breathing, and posture.
We also watch to see how well couples are able to care for each other — some show an innate ability to comfort each other through humor, a gentle touch, or a soothing voice. Alternately, others become defensive or triggered by the other’s upset and unconsciously make matters worse through displays of subtle aggression or by shutting down.
2. Preparation is, forgive the pun, key.
Defining roles and making space for the other person is key to a healthy relationship. Although my husband and I enjoyed our practice time, we occasionally got frustrated when repeating the same mistakes.
At one point in the piece, I was supposed to place my left hand for one beat and then let go so my husband could play the same note with his right hand. I had gotten into the habit of holding the note too long. By not letting go in time, our fingers would clash. It became our inside joke, and it’s a funny memory (guess you had to be there).
To avoid getting in each other’s way on the keyboard, we needed to coordinate our moves and make sure we didn’t hold on too long. Being in a healthy relationship can often require letting go . . . of hurts, resentment, agendas, and, yes, sometimes keys on a piano.
In PACT, we help couples rehearse sticky situations and slow down the interaction so couples can practice new ways of relating that are more constructive. We help our couples think ahead of what challenges are on the horizon (e.g., a trip to visit the in-laws) and then stage a role-play, in which both partners can practice handling the situation with more ease and collaboration.
3. Let your partner shine.
Four-hand piano music is the most dazzling when the voices are highlighted at different times and in different ways. That makes the music nuanced and beautiful. To make that happen, one of us played the melody while the other played more quietly in a supportive, harmonious role.
As a couples therapist, I have witnessed the value of partners being present and caring during critical times of disappointment and loss. Yet, and the research bears this out (Journal of Personality and Social Psychology, November 2006), more important are partner responses to each other’s strivings and celebrations of success. Supporting your partner’s dreams and celebrating their time in the limelight are both crucial to being a great partner.
4. Coaching was illuminating.
Each day at piano camp, we had a coaching session from a master pianist. Our coaches listened to our piece, pointing out strengths and blind spots. They showed us specific techniques to bring out motifs and subtle sounds we would never have figured out on our own. We were grateful for the outside perspective – professionals who could take in the whole piece and help us integrate our parts.
As a couples therapist, I have a unique view of the couple. I am trained in both intrapersonal and interpersonal dynamics and can often see complex interplays that the couples themselves might not be aware of. That’s what makes my work so fascinating and also challenging. By being in the room with a couple, I can offer broad and specific feedback and point out blind spots that the couple has been too close to see themselves.
As my husband and I traveled home, we reminisced about piano camp. We reviewed the highlights of the week, critiqued the meals and lodging, and talked about who we wanted to stay in touch with in the coming year. We also discussed what pieces we’d like to learn and how to make time to practice before piano camp next summer. We returned feeling refreshed, accomplished and connected, now able to play our new piece – “Peer Gynt,” by the way, if you want to listen online.
By Stan Tatkin, PsyD, MFT
Two main issues face the PACT family therapy process: Structure and Attendance.
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.
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.
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.
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?
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.
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
- 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.
By Debra Campbell, MS, LMFT
PACT Ambassador, Level 3
When a couple comes to our office, they bring a dynamic in the relationship that pains them. Neither partner sees the issue in the same way, and they don’t know how to solve it. Often, they’ve argued about it repeatedly. Talking about it just starts the argument again.
The rate at which the disagreement escalates is an indicator of how many times they’ve argued the same issue. We know they’re not dealing with anything new because the brain deals with novelty much more slowly than something we have habituated. How, as therapists, can we help the couple slow down and experience something new?
In PACT Couples Therapy, we use proximity, micro-expression, and body language to achieve more constructive outcomes that have a lasting effect outside of session. Here’s a familiar scenario:
Last fall, Rebecca and Bob were running late to their therapy session. They had struck a patch of bad weather, both literally and figuratively. These well-educated professionals have been married for about a year. By the time they arrive, Rebecca is in tears. Bob is red in the face.
I can cut the tension between them with a knife as we walk down the hall to my office. They each sit in a rolling chair. Bob crosses his arms and pushes away. Rebecca looks at me, grits her jaw, and fights tears. She declares, “This Kavanaugh trial is going to destroy our marriage!”
The U.S. Senate Judiciary Committee hearing had stirred up some old hurts as well as a historical style of arguing for them. My job is to slow them down so they can experience the argument differently. By doing this, they build new beliefs and gain skills that they can immediately implement outside the office to create safety in the relationship.
Prior to learning PACT, this situation would have been stressful as the therapist. Couples often come to session wanting the therapist to play referee or give solutions. With PACT, the direction is clear – they’re in each other’s care.
I instruct them to face each other, adjust their rolling chairs to eye level, and scoot into each other. They reluctantly agree and slowly move toward each other. Knee to knee, they’re two to three feet away from each other’s face. At this distance, the visual system has the highest acuity for every minute detail and movement on each other’s face.
Suddenly, the couple attunes to the present. Now we are dealing in real time with what is actually happening between them, not historical data or a pre-rehearsed argument. They are able to incorporate new information. When the micro-expression of their partner matches what is being said, a new reality sets in. The couple falls in love in each other’s eyes.
Couples misread each other. Instead, they tend to see what they have experienced in past relationships, generally with their family of origin. This contributes to overall misunderstandings and myths in the relationship. Rebecca and Bob are face to face, eye to eye, as I ask the following questions and check that they accurately read each other’s facial expressions:
Me: What do you seen on her face?
Bob: She is sad, but it is a manipulation. She always gets upset if I disagree with her. [He sighs.]
Me: Is he right?
Rebecca: I’m sad, but it isn’t because he disagrees with me, it’s because I was date raped in college and the trial has been very difficult to watch. Obviously, Kavanaugh is guilty, but he will likely get approved anyway because it is so hard to prove what happened, just like what happened to me in college. [more tears]
Me: What do you see on his face?
Rebecca: He looked angry, but less so now…something else, I can’t place it.
Me: Is she right?
Bob: Yes and no… I was angry before, but now I’m more hurt. I know that happened to her and I feel terrible about it. I would kill that guy if I ran into him. At the same time, I feel scared for all men if the judicial system can find someone guilty without proof. I want to protect her and myself at the same time but it seems impossible…
Me: Do you believe him?
Rebecca: [slowly] Usually not, but right now, yes.
Me: Where do you see it?
Rebecca: In his eyes. I can see he is scared but also that he cares about me. His shoulders are more relaxed, too. His arms aren’t crossed.
Couples often make the mistake of communicating without looking at each other – especially when things start to go sideways. The lack of facial cuing contributes to their misunderstandings.
Me: Do you guys usually have these conversations face to face?
Bob and Rebecca: [Both shake heads, indicating no.]
Rebecca: This argument just went down in the car.
Bob: We talk about this kind of stuff side by side while watching the news . . .
Rebecca: . . . or cleaning the house or cooking in the kitchen. . .
I suspect that they are misreading each other based upon their experiences from their families of origin. I want to expose that by testing their expertise on each other’s history.
Me: Did Bob have manipulative parents?
Rebecca: His father and mother are so manipulative to this day. I can completely understand why that would bother him, if he thought I were manipulating.
Me: Is she right?
Bob: Yes, my parents are manipulative. My relationship with them is strained.
Me: Does Rebecca manipulate you?
Bob: No . . . she really doesn’t. [His face relaxes.] She protects me.
Me: Did her parents protect her growing up?
Bob: Financially, they took care of her. She always had what she needed . . . went to a private school, etc.
Me: What about emotionally?
Bob: Well . . . no, I guess not. Her family doesn’t talk about personal stuff at all. I can understand how she might want that from me. I told you, honey, I would kill the guy who raped you if I could.
Rebecca leaves her chair to sit on Bob’s lap, curls into him, and cries as he holds her and rubs her back. When the crying calms, she resumes her seat. A spark renews in their eyes and a tangible feeling of connection.
Physical touch generally calms the nervous system faster and better than any other method of soothing. When couples can rely on each other for soothing, they become each other’s safe place. Couples that function securely can calm each other down using eye contact, proximity, tone of voice, body language, and physical touch. They act as an emotional resource to each other, a soft landing. Instead of relying on themselves to calm down or someone outside the partnership to soothe them, they rely upon each other. This interactive regulation is generally very healing when they have not received such emotional support in their families of origin.
PACT therapists assess a couple’s ability to accurately read each other’s facial expressions and body language. We do this by going granular. We ask questions about what their partner is feeling, where they see it, and checking with the partner to make sure they got it right. This is often where we expose new data:
- They don’t read each other’s faces accurately.
- They mistakenly apply historical data from their childhood relationships to their current relationship.
- They have never learned that you can tell when someone is telling the truth by their facial expression, tone, body language, and timing.
Instinctually, as therapists, we are trained to reflect whatever we see back to our clients. However, reflecting back that they have clearly had this argument before and that this is not new material does little in and of itself to change the dynamic. By putting them face to face, eye to eye, going slowly, and checking, we force them to address the reality in front of them. This present focus attunes them to live, novel data that creates an immediate shift in their affect and understanding. The truth lies in their facial expression, body language, tone of voice, and timing.
By Lisa Rabinowitz, LCPC
PACT Level II Therapist
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.
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.
By Lindsey Walker, LMFT
PACT Ambassador and Level II Therapist
Couples therapists often struggle with how to sort through the many feelings and complicated relational dynamics that arise in couple therapy sessions. You have two people, both hurt. Each come with a different perspective, combined with years of history and unresolved conflicts, and they are looking to you to figure it all out.
By walking into your office, they invite you into their relationship. As a therapist, you join them through attunement. As a PACT therapist, you combine your attunement with identifying the couple’s observable behavior, which enables you to determine what they have not yet integrated into a secure-functioning relationship.
When you mind your own experience with couples, while simultaneously observing how they interact with each other, they provide you with real-time information about who they are and how they handle their relationship. As you gain this information, you can feed it back to them. This helps them build an understanding of how they are functioning. It also creates opportunities for them to move away from destructive dynamics.
In one session, Rochelle and Brandon sit as far back in their seats as possible, leaning away from one another without trying to be obvious. A line of tension runs through their bodies, which tells me they are not fully relaxed.
I look at one member of the couple and see her folding in on herself, hands tucked under her legs, which are crossed. She bites her lower lip. Her partner’s body twists toward her. However, his neck cranes to look at me whenever discussing his feelings or experience.
I take these observations in and then turn my focus inward to take note of my own senses. Am I feeling something strongly? Seeing any notable pictures in my mind’s eye? How’s my body handling the stress of the situation? What ideas are coming to mind? Is there something I’m moved to say here? How pressing is it? My breath is shallow. I feel tension in the room and also inside of me. Most notably, I feel stuck — if someone asked me to speak, it would seem impossible.
As therapists, through our attunement, we experience the relational wounds that our couples bring to us. This body-to-body exchange of information is communicated so quickly. Couples often miss it, which is why they end up in therapy, stuck in repetitive cycles.
In the example of Rochelle and Brandon, when I look inward, I get information about what it feels like to be with them, which the couple needs for themselves. Closeness is difficult for them. Internally, I interpret their body postures combined with historical information I have gathered about them: they deal with the tension of intimacy by either turning inward (Rochelle), or toward something or someone else (Brandon). Speaking openly about their more vulnerable experiences is not something they know how to do.
From the neck down, Brandon shows me that he wants to be with his partner. From the neck up, however, his eyes plead with me, asking to know whether or not he’s safe to turn all the way toward Rochelle. I feel a great sadness well up in me.
I feel that these two are mourning the loss of closeness in their relationship, and they don’t yet know how to connect over it. When they are not in the therapy room, they resort to old patterns of attack/defend in the face of vulnerability. As a result of not knowing how to express his more vulnerable self safely, Brandon gives his sadness to me, instead of to Rochelle. Though she is facing him, Rochelle does not signal to him (or to me) that she is ready for what he has to offer. She is too preoccupied with managing her own anxiety.
My purpose in their relationship in this moment is to contain the experiences that they are not yet equipped to handle within themselves or their relationship. I recognize this via my own felt experience, what I see in them, and how Brandon is interacting with me. I prepare to help move them toward each other.
Brandon starts to talk to me. I want him to know that what he is saying is valuable, so I focus my attention on him. This kind of affirmation can serve as a bridge for him to contain his own experience within their relationship. Yet, the goal of couple’s work is to help them find affirmation and support within the couple system. Knowing this, I want to turn them back toward one another to see how they handle each other in this vulnerable moment.
Now a therapist can take many directions, all lead to the same essential thing. Here are several possibilities, including the PACT methods of cross-questioning, cross-commenting, or going down the middle:
- To her: “Does he always look away from you when he’s feeling vulnerable?”
- To her: “He’s about to tell me something important, and I don’t want you to miss it. What happens when you ask him to look at you?”
- To him: “There’s something you want to tell her, but you feel more comfortable telling me. Why?”
- To him: “Experiment with turning your head to face her. Look her in the eye, and tell her what you just told me.”
- To both of them: “You want to be close, but it’s hard for you to fully let go.”
- To both of them: “It’s hard to speak about how you feel with one another.”
- To both of them: “You guys are so sad together, but you don’t know how to share it.”
With these interventions, you’ve taken what you discovered about them and used it to highlight how they operate with one another. This helps them:
- Identify a feeling they have so they can begin to integrate it into their couple system.
- Increase awareness of how they react to one another in tense situations.
- Own the idea that there is something they want together (though in some cases, not) and for which they are both responsible.
Couples therapy moves fast. Your couples signal to you all the time about their distresses, their hopes, their worries, the ghosts from the past that they struggle with. Your ability to be pulled into their system, and yet retain the sense of your own experience and observational abilities while in it, is one of the best tools you can use to help them heal their relationship.
By Carolyn Sharp, LICSW
PACT Level III Therapist
After laughing with Marty about the wonderful date they had, Peter adds, “Of course we had to go to the restaurant you wanted.” With that slight emphasis on going to Marty’s restaurant pick, they go from shared laughter to bulging eyes and hostile voices, following each other out of connection and into attack. All it takes is one wrong comment to spin into the dynamic this high-arousal and high-conflict couple came to address. My heart rate increases and my throat tightens as my mind imagines the session going out of control. With my own arousal rising, I’m in danger of losing my capacity to be helpful.
Christina and Sam stare listlessly at the floor during extended pauses after my questions and comments. Their passivity and disconnection are in charge here, and neither partner makes a move toward closeness or engagement. I feel a yawn forming and can hear every sound outside my window, as boredom threatens my effectiveness. This couple will continue to do what they always do if I don’t activate the energy in the room.
In both these cases, the couple’s work together depends on my ability to self-regulate—to calm myself in the former and to self-activate in the latter. With PACT’s embodied approach (whereby the therapist uses the live felt-experiences of a couple to help them learn new ways of being with one another), my job is to help the couple learn to co-regulate each other’s nervous systems so they can find connection and safety. Their ability to do this is central to forming a secure-functioning relationship.
As a PACT therapist, self-regulation allows me to set the tone for the sessions and to create the frame and expectations for partners’ behavior. Additionally, when I am self-regulated, I have the capacity to marshal all my resources to respond helpfully with any interventions needed. I can’t fall outside my own window of tolerance or allow myself to react from emotion. Central to the skill of self-regulation is awareness of the strengths, challenges, and triggers within my own arousal system. The volume and speed of a couple’s speech can be irritating to my system, but tone and emotion are what cause my heart rate to spike. In the other direction, the slowness of their responses can be lulling, but disengagement between partners is the cause of a drop in my attention and attunement. Being aware of these triggers is the key to my ability to notice and take action.
The use of deliberate practice and repetitive skill-building exercises to automate responses to calm or activate myself when stressed has been enormously helpful to my self-regulation (Rousmaniere, 2016). I practice resetting my system when excited or bored so I can do so in session, without pause. Developing the emotional muscle memory to calm or excite myself makes it more likely that I can do the same in times of stress or in overwhelming situations.
Two of the simplest and most reliable means of self-regulation are exhalation and simple grounding (i.e., the ability to return my attention to my body and the room quickly). Using these has proven invaluable, and I often invite couples to practice them with each other when the room goes “high temperature” or “frozen” (the vernacular I share with couples). Lastly, the PACT serenity prayer serves as a powerful grounding in my role and responsibilities as a therapist. Through self-regulation, I am present with the couple before me and I allow them to practice being in each other’s care. The skills of self-regulation were useful in sessions with the two couples I described.
Peter and Marty came to PACT to learn to head off their explosive conflicts, as well as to help each other get through those conflicts safely. Through attunement and better co-regulation they are learning to do this. My self-regulation is integral to their process as I stay present and tuned in, while fully in my own window of tolerance. With a long, slow whistle on my exhale (indicating a nonverbal “wow” to Peter’s comment about the restaurant), I catch their attention. They are immediately connected through their mutual irritation at my interruption, followed quickly by amusement as they realize I just distracted them from their escalating fight. Being tuned into the energy in the room and its impact on me allows me to use a distraction to help regulate this couple and move them back within their window of tolerance and into each other’s care. Following a repair to one another, we talk about the things they have been practicing at home to get out of these scenarios, and then they practice regulating each other.
Christina and Sam came to therapy for help reigniting the passion and connection they lost over time as they focused all their energy on things outside their connection. Helping them requires me to activate the energy in the room, so I stand up and have them join me and take each other’s hands. Sam follows my request and begins to describe Christina’s face. Tears come as Christina feels Sam’s presence. Describing him, in turn, elicits a big smile, the first he has shown today. I watch them squeeze each other’s hands and then move into a hug. I vocalize the shift made when moving to each other. The listlessness I felt when I paid attention to my own response alerted me to the direction I needed to take to help them move toward each other.
Couple therapy can vacillate between high and low energy, between conflict and disengagement. Unregulated, therapists can quickly follow clients down any number of unproductive paths. Remaining grounded and regulated is our most powerful tool in maintaining our focus on facilitating secure-functioning couples.
Rousmaniere, T. (2016). Deliberate practice for early career psychotherapists. Psychotherapy Bulletin, 51(3), 25–29.
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
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:
- 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.
- 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.
- 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
- 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.
- Harari, Yuval Noah. Sapiens: A Brief History of Humankind (p. 18). HarperCollins. Kindle Edition.