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by Stan Tatkin, PsyD, MFT,
Therapy is only useful for changing people who are experiencing sufficient distress. This is not to say that education, consultation, or brief counseling will have no effect. People often benefit from couple counseling for premarital or other short-term work. However, as a matter of therapeutic stance, the PACT therapist assumes the presence of a sufficient level of distress that can only be relieved by pressuring couples to go down the tube of secure functioning. The PACT therapist thus takes a stand for secure-functioning principles. For insecure partners, this requires a big leap of faith.
That leap of faith can be viewed as a metaphor for neuronal action potential (AP) and long-term potentiation (LTP). AP is basically a charge that is sufficient to fire a neuron. LTP is a cellular mechanism related to learning and memory. LTP involves the building up of synaptic strength between neurons, whereby several weak synapses repeatedly fire simultaneously to create a new (or reinforce an old) neuropathway. In therapy, LTP can be associated with the aha experience of “getting it.”
Insecure partners do not have any experience in their historical record that can serve as proof that a secure-functioning model would be good for them. Insecures may be attracted to the menu of secure-functioning principles, but should not be expected to know what the food tastes like or if they would like it. Remember that insecure models are fundamentally unjust, unfair, and insensitive and that relationships do not come first. Therefore, insecure partners have no reason to believe in the therapist’s belief in secure functioning. In a manner of speaking, insecure individuals, like connecting neurons, must cross a synaptic cleft of unknowing in order to forge a new neuropathway that represents new knowledge. In systems theory, this is first-order change. In Piagetian terms, this is accommodation.
So what builds LTP in the insecure partner or couple?
2. Focused, coherent therapeutic stance
Without pain, the therapist’s tools are useless. No pain, no gain. Pain is a huge motivator because it opens the mind to influence. If partners are not in distress, the therapist is without leverage to convert their pain into increased complexity and neuronal growth. This alchemical process of using distress to convert lower social-emotional complexity into higher social-emotional complexity is an essential aspect of LTP, and of the neuroplasticity needed for change to occur.
The PACT therapist must locate each partner’s pain and amplify it. If one partner is without distress, both the therapist and the other partner are rendered helpless. Therefore, the therapist must locate the pain of the non-distressed partner, amplify it, and then leverage it for change. Finding and leveraging the pain creates interest, which creates AP in the brain.
Focused, coherent therapeutic stance
The PACT therapist maintains a clear, focused, and coherent narrative (therapeutic stance) that is secure functioning. The therapist maintains a clear image and set of goals that point toward secure functioning and away from insecure models of relating. This clarity is expressed through repetition of the therapeutic narrative, which creates interest and in turn creates AP in the brain. Repetition greatly contributes to LTP. Therapy, in essence, involves repetition, both in the patient’s psychobiological response to inter- and intra-relational stress and in the therapist’s focused, coherent therapeutic stance, which points the way forward on a path toward relief.
The PACT therapist applies continuous pressure on partners to perform in a secure-functioning manner. This pressure is like pushing partners down a tube that both focuses and limits behavior and attitude. The combination of pressure, focus, and limitation also forces feelings and emotions to arise. For instance, when the therapist expects partners to demonstrate developmental complexity, they will expose their limitations, along with the pain (e.g., fears of abandonment and engulfment) that underlies their developmental delays. Pressure, support, and expectation promote interest, which creates AP in the brain and contributes to LTP.
The PACT therapist creates neuroplasticity through LTP and AP in the insecure couple (or partner) by locating, amplifying, and leveraging pain and distress toward a secure-functioning model of relating, and maintains persistent pressure on the couple (or partner) to move in this direction. In this way, the therapist pushes insecure partners through the synaptic cleft of unknowing to create a previously unexperienced knowing of secure function. The influence the PACT therapist can exert on partners may result in both neuroplastic and epigenetic first-order changes.
© 2003-2013 – Stan Tatkin – all rights reserved
For a couple of years now I have been proposing to training and seminar audiences that there is a relatively untapped therapeutic need in teen romantic relationships. Many teens are in romantic relationships and yet few therapists I know make use of these pairings as an opportunity to do couple therapy. Of course there are legal, ethical, and payment issues to be considered and managed. However, working with this young couples population can be a potential learning opportunity that has no rival.
I have had the opportunity, though only a few times, to work with teen couples. All parents agreed and paid for the therapy and rules of confidentiality were maintained. I feel now as I write this a similar excitement and hopefulness I felt as I worked with these teens who eagerly devoured any information about love and relationship and because it was live and with love interests present, the work was very powerful. These sessions were literally pre-pre-pre-marital, giving these kids a good jump ahead of their peers and probably even their parents. At least it seemed that way to me.
Teen patients are famously obsessed with peer relationships and those who are, however temporarily “in love,” seem very interested in getting outside help — as a couple — if invited to do so by a therapist.
Those of you who know my approach to couple therapy (PACT) also know that I use video recording for occasional patient playback but also for research. I think this could be a wonderful population to study in their couple configuration and that couple therapists (not simply specialists in adolescent treatment) could do a lot of early prevention work here.
Again, I tend to be biased toward therapists trained in couple therapy to do this kind of work because it is quite different from one-on-one psychotherapy with adolescents as it is with adults. However, biases aside, I think any therapist who specializes in adolescent psychotherapy should consider this option of inviting a patient’s love interest into therapy.
What do you think? I’d like to hear from you.
Copyright 2012 — Stan Tatkin, Psy.D. — all rights reserved