by Eda Arduman, Ma., clinical psychologist couple therapist
Level 2 PACT therapist
Istanbul Bilgi University clinical supervisor instructor
Clinical Psychology MFT Master Program
It has been said that intimate relationships are not for the faint hearted, yet research shows us time and time again that the pleasure and reliability of relationships provide us with the resiliency to overcome the challenges life often presents. Some of the hurdles life throws are external (e.g., an economic crisis or severe illness of a loved one or divorce of parents) and others are internal (e.g., states of ambivalence, self-sabotage, and depression). Sometimes an external event spurs an internal reaction that interrupts movement; the braking mechanism acts as a counterforce to expansion and results in contraction.
The PACT therapist works with couples in severe conflict who are responding at a pace at which their minds cannot keep up with their words. The couple are trying to say things to each other, but their brains are simply registering each other’s microexpressions, tone of voice, and gestures. The more they try to talk, the more things spiral out of control. Though humorous in a Woody Allen movie, remaining in a state of high arousal for a prolonged period of time with no resolution can take a heavy toll on both partners.
Ferhat and Şirin came to therapy when their son was a year and a half old. They were stuck in a cycle of discontentment. Until the birth of their son, they shared hobbies and had a satisfying relationship. Now, however, they frequently argued about parenting responsibilities and time spent together or apart. Both have the insecure attachment style PACT refers to as island, and thus they were in the habit of solving problems through individualistic solutions. “Let’s just be happy alone” was their motto.
During our initial session, it came out that Şirin had survived a life-threatening bike accident just before her pregnancy. A car hit and nearly killed her. During the debriefing process, she claimed that what bothered her most was not the accident itself but seeing the bike totaled. She had lost all desire to buy or even ride another bike. She had no idea her loss of interest might be the result of trauma.
Having trained in Eye Movement Desensıtızatıon Reprocessing (EMDR), I decided to apply EMDR in conjunction with my PACT skills. EMDR protocol requires the patient to establish a safe haven in his or her mind. The corresponding PACT protocol entails using the partner as the safe retreat and moving the couple toward secure functioning. I had Sirin sit on Ferhat’s lap because face-to-face interaction was too dysregulating for both of them while in high-arousal states. He was able to hug her back with his body and stroke her arms with open palms in a firm manner.
The exploration went fairly smoothly until we came to the memory of another bike. Sirin’s face became still, and she started trembling and had difficulty following the movement of my hand—all signs of the disorganized-type dysregulatıon. She froze and started to talk about the bike her parents bought her when she was 13, at the same time they told her they were getting divorced. Her face lost affect and her hand began to shake. Even though her body was trembling, her voice and words were dissociated from the rest of her body. She continued to talk about the bike her parents had given her and how she used to ride off to freedom on it.
Noticing the dissociation, her husband moved forward and started to stroke her face. This annoyed her, and she brushed him off. With my support, he began rubbing her arms and knees as she continued to talk about the bike. I urged him to stroke her with wide palms because small finger brushes were ticklish for her. She started to shake and sob. She moved onto her husband’s lap, where he held her firmly as she continued to share how her life changed following her parents’ divorce.
As they jointly calmed down, Sirin and Ferhat were able to move into the fear they had regarding their own relationship. The ruined bike symbolized the loss of an internal as well as external vehicle that took Sirin to freedom. The ruin of the bike, followed by multiple surgeries and months of immobility, and then her pregnancy and all the infant-related responsibilities had resulted in her internally and externally relinquishing her freedom. This resulted in her coming to the unconscious, erroneous conclusion that her husband was the guardian to the jail her traumas had constructed.
Working with PACT allowed Sirin to experience that freedom was possible with her husband. Having built a scaffold of secure functioning, the couple were able to complete the cycle of rupture and repair at a real level, without falling into old habits. They expressed a new felt intimacy and trust, which had been missing in their relationship since the accident.
by Allison Howe, LMHC
PACT Level II practitioner
Saratoga Springs, NY
Do you and your partner have any mentor couples in your lives? A number of couples in my practice report that they don’t have a mentor couple in their social or support network. Yet mentor couples are important because they model the principles of secure functioning. They protect each other in our presence, and we can see and learn from the fair and sensitive ways in which they interact.
Years ago, my husband and I met such a couple, Rhonda and Pat, and they advised us to not become “married singles.” We didn’t fully know what they meant, although now we do. Married singles are partners who are married but spend little time together. They operate mainly as a one-person system. PACT therapists believe couples can design their marriage in any way they see fit. If the design works for both individuals, the marriage can flourish. My husband and I saw that spending time together kept Rhonda and Pat grounded and helped them thrive. For example, they wrote, “2005 held some adventures for us but we never wander far from the most important part of our lives—our family.”
PACT therapists work to help partners clarify who they are as a couple and what they are doing together in life. More specifically, they clarify what they truly value in their life together. Rhonda and Pat both deeply value their professional careers. When they were in their fifties, they began to notice they were spending too much time at work. They told us, “We realize that we need to stop and smell the roses.” This is a common issue in couple therapy; PACT refers to it as management of thirds. The couple have a limited amount of resources with which to care for one another and their relationship. When resources are spent in areas outside the relationship, the relationship can be compromised. Rhonda and Pat addressed this by choosing to make changes that allowed them to spend more time outside work doing things they enjoyed together. This included gardening, traveling, and spending time with family and friends.
Woodworking has been a lifelong hobby for Pat, and he recently completed a conference table for his office. Hobbies bring such satisfaction and meaning to life, yet they can compete for relationship resources in some partnerships. It was clear that Rhonda and Pat were not going to let that happen, as Rhonda shared, “I’m now beginning to turn wood. Took a private lesson and made my first bowl.”
One of the treasures Rhonda and Pat found in marriage is how to create novel experiences together. One year, they shared, “We spent hours on vacation viewing art. It was awe inspiring.” They cruised the Greek isles and said, “We felt like a king and queen.” PACT therapists are trained in the fundamentals of neurobiology and know that after courtship ends, the brain will categorize a partner as familiar and familial. One of the challenges for couples is to keep the flame of vitality burning. Our mentor couple showed us that having shared experiences that are pleasurable is a great way to fuel our partnership.
Recently, they celebrated 39 years of marriage. Rhonda wrote in their most recent greeting card, “We hope to go at least another 39. We are as happy today as we were on day one. In fact, it seems like just yesterday that he was wooing me. Nice thing is that he stills woos me whether it is with flowers or a balloon or having the house work done when arrive home from a business trip. I wooed him with my cooking while we were dating and I’m still cooking his favorite dishes today. Maybe this on-going wooing will result in getting us through the next 39 years.” Wooing is a courtship behavior but can fall off the grid in many marriages. PACT recommends that couples attract one another with friendliness, compassion, interest, and understanding to move relationships, instead of using fear, shame, or guilt.
Our mentor couple are thriving, and they truly epitomize how a secure-functioning relationship can withstand the test of time. Mentor couples can guide and inspire other couples by the unspoken sense of safety and security that exists in their union. A couple striving to form a secure-functioning relationship can be greatly supported by being in the company of a mentor couple.
by Elaine G. Tuccio, LCSW, PACT faculty, Austin, TX
Challenging couples are difficult to work with if all the therapist knows to do is referee the flow of conversation and inappropriate behaviors. PACT-trained therapists, on the other hand, have numerous therapeutic tools that can be used to move these couples toward secure functioning.
For example, the PACT therapist sees acting out in session as an opportunity for staging an intervention toward secure functioning. Our training teaches us that it is usually best to sit back and observe, as if tracking the plot in a suspenseful detective novel. Underneath the precarious nature of challenging partners’ harmful defensive behaviors a relationship is waiting to be saved. Despite appearances, couples bring lots of resources, such as healthy drives and capacities that may be hidden under years of erroneous narratives about themselves, their significant other, and the world at large. The PACT therapist speaks to these resources, not to the defenses.
How might a couple find each other and go toward a coherence that at first may feel threatening? It takes a deft touch to lead the couple in this way; even a seasoned therapist is likely to feel his or her theoretical knowledge and intervention skills are being tested. It is essential for the therapist to stay present and relational when working with challenging couples. The therapist should not have to work harder than the couple. This means making proficient use of self-regulation to engender an impenetrable therapeutic stance. Dr. Stan Tatkin writes, “In all therapeutic approaches, the therapist takes a stance that suggests his or her beliefs about where the therapy should go. This stance must be clear, coherent, and consistent if good therapy is to occur…. The PACT therapist moves partners down the tube of secure functioning.”
A common clinical error therapists make when working with primitive defenses from a partner or couple is becoming drawn into their story and into their use of these defenses in emotional attacks against each other. Forgotten or overlooked are the intentional aspects of these learned defenses for survival, and how they may show up as either running away from or running toward the other. It is important to study the moment-by-moment enactments of these defenses because that can increase understanding about how, why, and when they developed. Doing this requires steady use of PACT intervention skills so the couple can flex their tacit resources and self-correct destructive patterns in real time.
Reactive patterns of negative thoughts, feelings, and beliefs, as well a sensitivity to threat, become structured into family and couple systems and often point to transgenerational trauma. Throughout their lives, these partners have tried without much support to manage the painful symptoms of early traumatized defense systems. Couples do not expect patterns that have existed for decades to be remedied in a few sessions. Yet, in my experience with PACT, a great deal is often accomplished quite quickly.
Highly insecure partners and couples need certain attachment experiences to be able to develop essential relationship capacities for play, calm, trust, security, and touch. PACT gives them a process for moving from insecure functioning to a secure means of connection through increasing their awareness of destructive, dead-end defenses. One challenge these couples face is that they do not have a sense of their own boundaries or those of their partners. They were raised in environments where the map to a relational model of secure functioning was never laid down. They fall off the edges all the time. In these instances, the therapist needs to be ready to use acting out as an opportunity for increasing the partners’ awareness of unhealthy defense systems and for setting up secure-functioning experiences. To do this safely, it is critical that the therapist maintain a strong therapeutic stance that allows him or her to soften, shift, probe, and provide relief from these defenses.
Therapeutically, the means to success in working with challenging couples is to first understand the characteristics of secure-functioning relationships. Next is to develop and maintain a therapeutic stance that takes threats off the table and leads these partners down the path to secure functioning. My own approach includes four psychobiological expectations for the couple: safety, coherence, holding their agreements, and functioning securely. During the session, I see my job as naming, normalizing, and providing practice in each of these. For transformation and integration to occur, these must be repeated in every session, as long as the couple remains in therapy.
In sum, when we challenge couples to be makers of a secure-functioning relational map, they are pressed to navigate each other’s needs and their own primitive defense systems. Their new map charts not only the boundaries of a healthy relationship, but its topography, as well. Partners who function more securely naturally reach for one another. No one gets stranded in his or her own narrative. They feel safe in each other’s care. What the therapist may see as challenging at the start of therapy is actually the vitality partners can use to forge stronger love and commitment in previously uncharted relational territory. They leave therapy with an earned security that provides them a landing they can trust going forward.
Loving in a way that supports, energizes, and grows a long-term relationship means loving your partner the way he or she needs to be loved. Many well-intended people unconsciously get caught instead in the destructive loop of offering their partner the kind of support, care, attention, and love they themselves thrive on, only to be left feeling unseen, unsuccessful, misunderstood, and lonely, which often leads to defensiveness and fighting.
Aligned with a related PACT therapeutic goal—knowing who your partner is and how he or she operates—comes this question: Are you using that information to help your partner do a good job for you?
Successful couples arm themselves with detailed owner’s manuals that explain how each partner maneuvers through and makes sense of his or her world. Partners then put that unique and distinctive information to use on a regular basis by tailoring their love specifically to their partner. This in turn fuels and boosts the partner’s self-esteem.
During a recent couple session, a high-energy and very social wife declared she was “tired of cheerleading” her “lazy” husband, who would not respond to all the “pumping him up” she found herself “continually” doing with respect to his job. The husband, a quiet and productive man, slumped in his chair, his eyes downcast. Although not in the exact job of his dreams, he works full time in an industry he loves, and is able to support his wife and eight-year-old daughter. When the wife said she wished he networked in the same fashion she did in order to move up to the next level of “personal achievement,” he explained that he felt criticized. He admitted to avoiding his wife’s “constant barrage of rah-rah” by “checking out,” which left his wife feeling dismissed, hopeless, and ineffective at motivating the man she loves.
The husband, on the other hand, complained his wife ignored or trivialized his efforts to have his family enjoy one another and the home they have created, and show “grace” for what they already have. “We live really well, but I feel like it’s not enough for her. She usually wants us to go out instead of staying in for family movie night, going on a hike with just the three of us, or using our custom outdoor kitchen,” he said.
“I love our life, but I’m freaked out you don’t care about trying new things and meeting new people. You seem like you’re asleep at the wheel when you check out like that,” she said.
In an attempt to get him motivated, the wife was unintentionally devaluing him, and missed showing appreciation for the resources and contributions he brought to their family. Conversely, his attempts to get his wife to slow down and appreciate their life left her feeling disconnected, bored, and frantic.
Addressing the couple I asked, “So, who between you actually responds to cheerleading and being pumped up?”
After a long silence, the husband looked up and said, “My wife does.”
“And who between you thrives on simple words of appreciation?”
“He does,” she said.
“And you’re both offering those things to the other one, right?” I said, with a knowing smile.
They both chuckled. The husband had no use for cheerleading, and his wife had no use for simple, day-to-day appreciations…or so they thought. In fact, he would have use for the rah-rah if he could give it to his wife. If he did, it would boomerang back to him in the form of a happy, calm partner who feels safe, secure, and able to be more present in the relationship. And vice versa for the wife, if she could give simple words of appreciation to her husband. What you send out to your partner will come right back to you.
When partners don’t understand one another, they amplify what seems negative. Sometimes the behavior or request you find most annoying from your partner is the very thing he or she needs most, but that you resist giving. With the boomerang effect, you can give out what your partner thrives on, and then watch the reward come back to you. This way, you both thrive.
Ultimately, your partner is only as good as you believe him or her to be. So use the information you have gained to help your partner do a good job for you, and trust your partner will do the same, so you can both walk through the world feeling, safe, secure, sexy, and loved.
by Stan Tatkin, PsyD, MFT
Las Vegas used to have slot machines known as one-armed bandits. You only needed to move one arm to let them take all your money. Most slot machines now have buttons or a digital interface, but I remember seeing people in casinos hypnotically putting money in the slot, pulling the lever, listening and watching the cylinders spin, and every now and then getting a (usually small) reward. It’s addictive. Why? Because even though it is a repetitive action, the possibility of being rewarded causes the brain to experience novelty. And our brains love novelty. The fact that the reward is intermittent makes you feel you have to pull that lever one more time. If you do, you might just hit the jackpot.
It occurs to me that some of the new apps for dating or hooking up are similarly addictive. For example, consider Tinder, which is available on all platforms. You can scroll through a plethora of faces and find ones in your local area. Then you swipe to the right if you’re interested or to the left if you are disinterested. It’s all anonymous. And like the one-armed bandit, it’s addictive because it provides your brain with an endless stream of novelty. Am I attracted to her? Is he hot? Will the next one be even hotter? Is she nearby? Maybe we can hook up right now!
That’s another similarity between slot machines and hook-up apps: both answer the need we feel for immediacy. Just as gambling promises instant riches, our date must be instantly available.
I’m not saying that I oppose any form of gambling. If you have some extra cash, enjoy playing a game, and know when to stop, then have at it. Similarly, if you enjoy the process of hooking up, that is your prerogative. But if you are using an app such as Tinder in an attempt to find a serious partnership, that’s another story. I would venture to say your odds of finding what you want are not high.
There are other issues here, as well. The brain may love novelty, but it hates having too many choices. We live in a culture in which we can pick and choose from many different items when we go shopping, and we can usually take things back for a 30-day return. We don’t have to make a commitment. We don’t have to choose one or two things, and stick to those. But Barry Schwartz found that people are not happy with too many choices. We do better with a limited number of choices that allow us to pick one thing and fully commit to it. Whether it’s a car, a pair of shoes, a new dress, a house, a career, or lover—we are more likely to find a happy result if we’re not choosing between multiple items. You may think that if you can keep dating different people, swapping out old partners for new ones, you will eventually be able to hit perfection. But it doesn’t work that way. The search for perfection will always leads to disappointment.
As a couple therapist who stands for secure-functioning relationships, one of my main concerns about the current dating technology is that it is focused first and primarily on people’s characteristics and only secondarily (if at all) on principles of relating. Apps encourage you to look for someone who’s handsome or beautiful, or sexy, or tall or short, or has blonde hair and blue eyes. Instead, I believe you should first consider the kind of relationship you want—or even better, must have—in order to be happy. For example, should the relationship be mutual? Should it be fair? How should my partner and I treat each other? Dating apps that don’t have this kind of focus are doing you a disservice. They are bandits in the sense that they rob you of the likelihood of finding a viable, long-lasting relationship.
Schwartz, B. (2004). The paradox of choice: Why more is less. New York, NY: Ecco Press.
For more about dating, I’d like to invite you to purchase my new book, Wired for Dating, at Amazon.
by Inga Gentile, LMFT (California), licensed psychologist (Norway)
PACT core faculty, Tromsø, Norway
A couple’s relationship is especially vulnerable to crisis during key transition points in life, such as the birth of a baby, the formation of a first romantic relationship, adolescence, a chronic illness, and the frailty and illnesses of aging (Staton & Ooms, 2012). From a psychobiological perspective, relationships operating under insecure models of functioning are even more vulnerable to distress at these junctures. This is because insecure models, as one-person psychological systems, tend to promote behaviors and attitudes that are not pro-relationship, and therefore partners can perceive each other as insensitive and unfair. During highly vulnerable periods, partners need one another more than at other times, yet insecure partners are not able to be there for each other. Often partners come to therapy at these times either as result of the transition itself or as a result of other behaviors triggered by the event.
Conversely, a secure model of functioning is characterized by sensitivity, fairness, and true mutuality. A secure-functioning relationship is by nature a two-person psychological system, and therefore pro-relationship. In a Psychobiological Approach to Couple Therapy (PACT), the focus is on moving couples in the direction of secure functioning. Although the principles of secure functioning provide guidelines for optimal human development and well-being, how secure functioning is demonstrated in a relationship can vary greatly from culture to culture, and even from couple to couple.
As with any new skill or information, to have true meaning for a couple, secure functioning has to carry personal meaning. In my inpatient work with couples at a clinic in Norway, when I see spontaneous moments of connection between partners, I point them out. If possible, I do this in a way that gives the couple a metaphor or symbol of what secure functioning means for them. We make it something they can refer back to again and again throughout therapy and in their relationship going forward.
A couple who were in their late thirties and had been together for five years came to therapy following increasing isolation, loneliness, and fighting after the birth of their first child. Both had grown up in coastal fishing villages in northern Norway, and this common background became a point of reference for them. During one session, while heading into a mutually dysregulating situation, we hit upon a metaphor that illustrated how they were tethered to one another: it was a type of knot used to secure boats in a harbor. In that moment, they touched each other’s hands and both linked their thumbs and index fingers as a symbol of their connectedness. This symbolic linking initiated a bottom-up state shift, and their escalation dissipated. First experienced physically, the gesture then could be translated metaphorically and given meaning psychologically. This became a gesture they could wordlessly return to in moments of difficulty, as well as in play.
Another couple, who were in their early fifties and had been together for twelve years, came to therapy because of awkwardness, isolation, frustration, and loneliness in their relationship after their youngest child (her daughter, his step-daughter) left home. Also, the husband, who had always been the rock in their relationship, had become ill. Although they became acutely aware of their isolation as a result of these stressors, in some ways it had always been there. In therapy, they saw that the isolation and misattunement they had been struggling with mirrored their early experiences in their families of origin.
One day in session, they coined the term “everyday security.” This became a symbolic expression, a mantra they could call on, to remind themselves of their new understanding about who they were—not only what they wanted to be, but also what they believed they could be together. In this way, secure functioning went from being a distant principle to something that applied to them personally. The idea of creating and maintaining a safety and security system and a shared couple identity proved to be powerful for them, and terming it “everyday security” underscored the social contract of “having each other’s backs” at all times. This was something neither had growing up.
I have found that these kinds of personalized symbols and metaphors provide helpful tools for couples moving toward secure functioning. The right symbol can lift partners out of the conceptual realm and into their moment-to-moment experience. The two couples I described were able to use their symbols to help integrate the concept of secure functioning into the fabric of their relationship. When a couple can experience belonging to each other, understand what that looks like for each of them, and also become aware of their automatic defenses against it, they are poised to experience secure functioning not only as something to be practiced under distress, but as a way of engaging with each other at all times.
Staton, J., & Ooms, T. (2012). “Something important is going on here!” Making connections between marriage, relationship quality and health implications for research and healthcare systems, programs and policies. Wingspread Conference Proceedings. Retrieved from http://www.healthymarriageinfo.org/resource-detail/index.aspx?rid=3984
by Stefan Neszpor, FRCPC, director of the Adelaide Couples Clinic and PACT Level II practitioner, Adelaide, Australia
Most couples have a story about what is taking place in their relationship. However, the story often doesn’t match the reality of how they experience one another. I was reminded of this recently when I met a couple in their mid 30s, with two small children. With respect to PACT attachment styles of relating, he was an island and she was a wave. In simple terms, that meant he tended to distance himself, while she was more the clinging type.
They came to therapy because she had become infatuated with a man living next door who seemed more approachable to her. Indirectly, it seemed she was trying to signal to her partner that she wanted him to be more attentive.
In the initial therapy sessions, they were able to identify one of her early patterns whereby she had a deep desire for affection. This showed itself as anxiety. Her way out was to gain attention as a form of approval for her sense of self.
Several sessions later, I asked them to do a simple exercise called the lovers’ pose as a way enabling themselves to have greater access to one another. They liked it and I could see that it was helpful, so I asked them to experiment with aspects of their experience at home.
When I saw them at the next session, I asked them how it went. The husband reported that they had been “too busy” to do the exercise on their own.
Ordinarily if I were using a psychodynamic therapeutic frame, I would have gotten caught up in asking them to define busy. I would have tried to understand the various dimensions of “busy” to find out how that undercut their attempts at connection. However, I decided instead to use my PACT skills of psychodrama. I asked them to “show me what busy looked like.”
The first step was setting the scene. They proceeded to set up the therapy office as though she were in the kitchen preparing some food, and he had just arrived home from a busy day’s work. He gave her the shortest of greetings and started to play with one of the children. He virtually ignored his partner.
All this was videotaped, so they were able to review it afterwards. I began by asking how satisfying it was to have this distance between one another, and whether this was actually meeting their needs.
As they reviewed the video, they saw their overall lack of contact, lack of eye contact, and distancing behaviours. They recognized the impact on their relationship and were able to articulate a different story about what they had called “busyness.” It was a story of sadness, of fear and apprehension about making contact. He expressed the overwhelming shame he felt at his inability to know how to initiate contact with her in an affectionate way.
I asked them if they could think of any particular things they could add to their interaction to make it more pleasant. Both of them found this difficult to identify. So I coached them in how to make greater eye contact and use physical contact as a way of signalling to one another what actions felt safe. I modelled the behaviours and encouraged them to give it a try—much as a director might do with actors in a play.
I then gave them the option of re-enacting “busyness” in a way that their needs could be expressed. With the support of my coaching, they were able to do this. They found it to be much more enjoyable and engaging. They seemed empowered to go further with their ability to seek each other out. The psychodrama had made it safe for them to make the contact for which they both seemed to yearn.
I set new homework assignment for further exploration, which they were able to do. The end result of this process was that they were able to dissipate some of their fear and avoidance behaviours, and begin to make true, meaningful contact with one another.
by Karen Berry, Ph.D.
PACT faculty, Warwick, NY
Often when couples come to therapy seeking assistance with issues related to sexuality, the problem is not what it appears to be. They describe issues such as sexual dysfunction, discrepant desires, pain during intercourse, inability to maintain an erection, and/or profound loss of interest. But often what we might call the “ick factor” is what is actually driving their presenting problems. Thus it is essential to look more deeply in order to get to the real difficulty. When the real problem is successfully addressed, treatment is much more effective and true healing becomes possible.
For example, when one partner discloses difficulty tolerating the other’s body odor, taste, and/or touch, the tension in the therapy room grows palpably. Until I studied PACT and began to think in terms of psychobiology, this was a moment I dreaded as a psychologist and a sex therapist. This was painful and overwhelming to the couple and to me due to the meaning inferred: “I find you disgusting.” We would do our best to bumble through the conundrum, but rarely did the couple or I feel peaceful in the presence of this reality.
Everything in my office began to change when I read Love and War in Intimate Relationships (2011) by Marion Solomon and Stan Tatkin. I began to understand the psychobiological reasons some people are repulsed by their partner’s taste, smell, or touch. Some individuals who lacked skin-to-skin contact in early childhood possess an acute ick response to all near-sense experiences (i.e., touch, taste, smell, and near vision). The extreme ick response is most likely only a consequence of a nervous system developing and adapting to ensure survival. Now I see that it is simply another obstacle that, if understood and normalized, can be managed collaboratively within a secure-functioning relationship.
Every couple is unique. They consist of two human bodies—with two nervous systems and different family histories—and had little or nothing to do with each other until they became a “we.” The key to collaborating is deciphering what the words and behaviors mean to a particular dyad. A couple who present as scared to talk openly with each other about the difficulty pose a different problem than a couple filled with of blatant anger and hostility toward the ick factor.
Let’s look at Donna and Marcy, who are in their late thirties, successful, professional, married, and with two children. Their marriage is in trouble. The tone between them is cold and separate. Touch is nearly nonexistent, never mind sex. Marcy is angry about this. Donna doesn’t mind, and justifies her unwillingness to engage by stating, “I show you my love in other ways.” Neither partner wants a divorce, but Marcy is furious and threatening.
Reunions, for this couple, are challenging, no matter what time of day. But late nights when Donna returns home from work are particularly difficult and set the tone for the next day. We enact this repetitive event in the office. Marcy pretends she’s asleep so she won’t have to deal with the rejection of Donna’s complaint about her breath. Donna agrees she finds night breath repulsive, but she’s angry and hurt about returning from work with no welcome. Both are suffering, alone, and angry. We work together to make adjustments and build ways to reunite that feel good and doable to both.
As we continue our work, it becomes clear that the issue of Donna finding Marcy’s breath offensive permeates their connection. It has far reaching implications. Focusing on ways to amplify their positive states together, I ask Donna to sit on Marcy’s lap. I watch carefully as they orchestrate this task. At first, they laugh, having fun. As they proceed, they appear awkward with each other. Clearly, this is not something they do. Eventually I ask Marcy, “Does she look comfortable?” In unison, they speak again about Donna’s aversion to Marcy’s breath. Donna’s aversion is so extreme that she also hounds her children about their breath. It is clear that she is awkward about closeness—not only with her partner, but also with her own kids.
I get curious. What else is going on here? As they sit face to face, touching, I ask Donna how far back this goes: “What’s your earliest memory of being so anxious about breath—yours or others?” At first, she has no association. Then, she remembers being at school with her mom in the auditorium. A classmate seated nearby said to Donna, “Your breath stinks.” Donna’s mom provided no comfort for her humiliation. The issue became traumatic because no adult helped her metabolize this painful event. Therefore, the unremembered, unresolved trauma emerges in other situations. Finally, Donna has a family member, Marcy, who is able to provide healing. Now that she understands, Marcy has compassion for Donna. She truly comprehends that this is not about herself. She no longer feels threatened. Together, they can collaborate on managing the obstacle of Donna’s acute ick response.
This collaboration allows them to heal Donna’s trauma. She can now receive comfort from a loved one for the first time in her life. This healing also allows Donna to become less awkward with physical touch with her loved ones. The future is much more hopeful for this couple and their family.
Copyright Karen Berry
by Hans Jorg Stahlschmidt, Ph.D., PACT faculty, Berkeley, CA
Some couple therapists have referred to their work as flying a helicopter into a hurricane. Perhaps the metaphor is inflated, but couple therapy is certainly an enterprise that can create acute anxiety. Like a pilot, a therapist needs the skills and training that make it possible to stay calm and alert when the going feels treacherous and unexpected turbulence appears seemingly out of nowhere. Interestingly, some Air Force pilots, called “hurricane hunters,” are specially trained to fly into the eye of the hurricane to collect weather data. Maybe that is like what we are trained to do in PACT: instead of fearing and avoiding conflict, we are trained to fly into it with our capacities to collect data and navigate skillfully intact.
Besides this hurricane-related skill set, a couple therapist needs the ability to hang out in uncertainties, to act not out of anxiety but out of creative insight that is the expression of an integration of limbic system and frontal cortex. In other words, the therapist relies on a solid self-regulatory capability
The therapist’s task is to be fully present when focusing on the couple, capable of what Bion (1962) speaks of a therapist metabolizing the error-filled process of the couple, similar to a mother’s ability for maternal reverie. The capacity to be a master regulator is, in essence, the ability to tolerate and manage anxiety in such a way that one can become an agent of change. The process requires a transparent self that has the ability to relinquish defensive strategies and tolerate anxiety.
As passengers look to the pilot hoping to find confidence in his or her expression, a reassurance they are in good hands as they lean back and buckle their seatbelts, so a couple in the varying states of activation and vulnerability that bring them to therapy need to feel the therapist’s confident and caring presence. From the couple’s perspective, a dysregulated therapist is potentially impaired in all important functions.
Dysregulated therapists are perceived as misattuned because their ability for attunement is hindered by the activation of alarm or threat. They are experienced as relatively unempathetic because of interference from relational processing areas around the orbital frontal cortex. For instance, if the therapist is experiencing an inordinate amount of threat, his or her understanding and conceptual assessment of the couple’s situation may be inadequate and even tilted because the prefrontal cortex, as an executive and regulating center, does not have the necessary resources to inhibit impulses, down-regulate high arousal, and think in an integrated fashion.
The ability to challenge a couple’s maladaptive patterns and their respective defensive systems cannot be effective and on target when the therapist is preoccupied with his or her own emotional reaction in a way that clouds the task at hand and hinders the necessary therapeutic interventions. The dysregulated therapist ceases to function as the master regulator in the room. The couple may experience the therapist as “nice” but weak, as absent and detached, as avoidant and distancing, or perhaps as needy or even threatening. Such a therapist is “dangerous” in the sense that the partners may feel ensnared in regressive dynamics, pushed into parentified roles, or hopeless about the therapeutic process and the prospect of their relationship in general.
I have painted a relatively stark and dark picture of a highly anxious or fearful therapist and his or her impact on therapy. Of course, we all are vulnerable to periods of dysregulation. The point is that the development of a durable and solid capacity to work through and manage our own anxieties as therapists is crucial for the therapeutic process.
To help a couple we, as therapists, have to be able to step in to regulate the emotionality, tension, anger, or upset in the room in a way that is not distancing or reactive, not judgmental or self-referential, but rather that is real, empathic, and focused on the conflict at hand. This regulation has to be bottom up not only for the couple but also for the therapist. This regulatory process has to be anchored in the body and has to include emotional processing that can lead to integration and solidity.
The most important aspect of self-regulation for PACT therapists is being anchored within a comprehensive and effective therapeutic model. This model gives us the frame as well as the modalities to process and transform anxiety into “play,” worries into curiosity, and negative expectations and shame into a frank acknowledgment of imperfection or sharing one’s own humanity in a therapeutically effective fashion. The model in and of itself is regulatory for the therapist. It prepares him or her for the worst and the best, for being in minefields, in fog, or in the middle of a hurricane. The PACT therapist is ready for both the high- and the low-functioning couple.
The PACT principles and operating methods are like a psychological GPS system that helps orient therapists in our work. This GPS also helps couples to re-map their minds and relational brains and to get better at finding their partners. It helps them to give up old dysfunctional habits and to develop more relational new ones. Although at the outset of therapy, we don’t know how the travel will unfold and who partners really are, we do know that our GPS works under almost any condition. This certainty and the continuous recalibration to the basic frame and principles of PACT are probably the most valuable tools a therapist has for self-management of anxiety.
Bion, W. R. (1962). Learning from experience. London, UK: Heinemann Medical Books.
Copyright Hans Jorg Stahlschmidt Ph.D.
by Annette Kreuz Smolinski
Licensed clinical psychologist (Spain), Dipl. Psych. ( Germany),
Trainer and supervisor in couple and family therapy, PACT Level II practitioner
The annoying truth is that all couples fight. Conflicts are an absolutely normal phenomenon in human systems, and couples are not an exception to this rule. It is unrealistic to think you could avoid having arguments from time to time.
When you face issues such as the education of your child, the sharing of household chores, finances, sexual relations, and your relationships with relatives, some of your partner’s opinions and preferences will inevitably differ from your own. He or she will not just do what you want. However, when it comes to hot topics, you need compromise and acceptance.
The good news is that conflict avoidance is more dangerous to your relationship than is properly handled conflict, or “fighting fair.” The bad news is that if you fight “dirty,” you will ruin your relationship, even if you come up with an agreement that seems to work.
Spain, where I live and work, is a Southern European country with a strong religious tradition. In this environment, couples typically do not go into therapy unless they are extremely distressed. As the literature shows, these kinds of couples are the least likely to achieve successful outcomes from therapy (Snyder, 2006).
When I start therapy with a couple, I don’t know if they are heading for separation or will be able to stay together. However, since I have begun to incorporate PACT techniques, the percentage of couples who stay together has clearly increased.
In my opinion, working on how couples fight is extremely important. I usually include a special session about fighting fairly during the second or third meeting. The rational I give is that partners must learn how to create win-win outcomes for one another. This skill is a must for both partners regardless if they stay together or not. To help with this, the PACT therapist focuses on principles of true mutuality, fairness, justice, and sensitivity, with the emphasis on both partners working toward mutual relief as quickly as possible. Partners are expected to pay close attention to each other’s facial, vocal, and bodily cues for purposes of regulating each other’s emotional state while in conflict. The idea is that as soon as partners are perceived as unfriendly, a biological threat system takes over and prevents either from getting what he or she wants. The required moment-by-moment attention to external social emotional cues helps to keep partners from becoming dysregulated or threatened.
Consider Jorge and Isabel. He is 61, she is 52, and they have been married for 38 years. They have two grown children, both of whom are independent and thriving. A month ago, the psychiatrist who was treating them in individual therapy suggested they separate. She considered Jorge to be pathologically jealous due to his obsessive compulsive disorder. At that time, she referred the couple to me, so they could determine their future.
Jorge had moved out before they came to see me. In our first session, he said, “I only lose my temper with Isabel.” It turned out that at home he is a champion of conflict avoidance. He withdraws until he can’t any more, and then he attacks. Isabel presented her own version of the couple’s estrangement. Both think the other overpowers them.
In the fourth session, an old sensitive issue arises: Jorge has always yearned for a dog. When the kids were small, he talked Isabel into buying one, but the lack of support by him and the children left the dog’s care to the overwhelmed working mother. Isabel banned the dog from the house with “it’s me or the dog.” Jorge now wants a dog if they come together again.
To address this issue, I gave them instructions for the 5-minute argument. The couple must sit face to face, with eye contact, and start to talk about the topic. They must finish within 5 minutes, with both partners feeling okay. This is videotaped and “fed back” to the couple immediately.
For Jorge and Isabel, the turning point came in the third round of 5 minutes when Jorge stated calmly, clearly, and sorrowfully, “Look, the dog is exactly the same issue as our bedroom: I feel you don’t take me into account. I am not in your mind when you make decisions.”
Noticing him tearing up, Isabel reacts softly: “I am so sorry about the bedroom. I promise that won’t happen again. But when you try to impose a dog on me, I feel obliged and I rebel. Instead, I want you to seduce me. That is the only way I will do what you want, because I will want it too.”
Jorge responds: “Will you go on a date with me to visiting an animal shelter, so I can show you the kind of dog I like now? I promise we won’t get any dog until you are totally seduced by the idea!” He smiles, and both laugh.
As a therapist, it is rewarding to see couples start to fight fair, think of conflict resolution as creating a win-win situation and immediately repair wounds produced in the heat of an argument.
Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–44.