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Working Bottom Up in PACT

by Karen Berry, PhD, PACT faculty, New York, NY

Bottom-up interventions are the bread and butter of PACT. These interventions can be simple to execute, yet powerful in their effect. For example, the therapist can ask partners to face one another, with the therapeutic intention of using eye gazing to reduce their allostatic load. Compared with habitual long, slow, top-down conversations, bottom-up interventions more readily empower the couple to use their neurological systems to affect change in the relationship.

All clinicians have seen how a couple can become reactive and operated out of conditioned responses from childhood. Their brains can register threat in nano seconds. The autonomic nervous system (ANS) moves at lightning speed in response to facial gestures, dangerous words and phrases, jerky gestures, tone and prosody, as well as general body language. PACT therapists watch moment-to-moment shifts of the ANS, implicit expressions in the face, voice, eyes, and body posture and body language to assess what is happening between partners’ two nervous systems. Content takes a backseat to process.

Sam and Margaret have been married for almost 10 years, and their marriage has been sexless for the last 5 years. Margaret is troubled by their lack of sex and wants closeness in their relationship again. Sam bows his head and shamefully admits he has had no interest. Using an enactment of the couple reuniting after a day apart allows me as a PACT therapist to take a closer look at what’s actually going on for them.

Sam is in the den with the boys, and Margaret comes in to say a momentary hello, but then launches into questioning him about the whys and hows of his day with the children. As she is standing over him, he is sinking into the couch, disinterested. His guard is clearly up.

I have them reenact this event several times. I ask Margaret to give a sincerely warm hello to her man, who has been at home caring for the kids all day. I begin to notice subtle shifts in both their bodies, which reflects their increased friendliness. Then I ask her to sit alongside Sam after the warm hello and make eye contact while she checks in with him about the day. As they do this, I observe more shifts in both their nervous systems. They are more relaxed and they begin to move closer to each other.

Lastly I ask Margaret to sit on the floor while inquiring about the boys. The result is amazing. Sam shifts dramatically. She looks at me and says, “Do you see what I see?” I nod. Sam’s face is soft and engaged, and he’s leaning in warmly toward her. As they continue talking, the warmth becomes sensual and exciting for both of them. This couple have begun to lay the groundwork for increased friendliness and possibilities for play between them.

As PACT therapists, we regard sex as an aspect of play. If partners are unable to play together, it is highly unlikely they will engage sexually. And when the partner who wants sex operates in ways that are perceived as threatening, with little or no self-awareness, her or she is unlikely to attract the other to genuinely say yes to sex.

The use of bottom-up interventions makes PACT a “show me therapy,” rather than a “tell me therapy.” PACT therapists work in real time with couples in the office, reenacting psychobiological scenarios that can make palpable and possible differences at home.

Copyright Karen Berry

The Deal Breaker

by Stan Tatkin, PsyD, MFT,

A deal breaker is an issue that looks like it cannot be solved. Many couples face issues related to religion or sexuality or money or children. They might feel—and you might think—such deal breakers must lead to the end of the relationship.

For instance, one partner says, “I must have children or my life won’t be worth living.”

The other says with equal strength, “I’m not the parent type. I don’t even like children and I will never have one.”

After a long pause, the first says, “Okay. We should buy a house together.”

Or perhaps one partner says, “I want my children raised as Muslims. That’s nonnegotiable.”

The other says, “I want my children raised Catholic. That’s how it’s going to be.”

One of them follows this deal breaker with, “Have you decided whether you want go to Hawaii this year for Christmas?”

Notice this tendency to kick the can down the road. Why do so many couples avoid deal-breaker issues or simply defer them? The answer may seem obvious. When partners are at the precipice of the cliff that represents the end of their relationship, they flinch. Nobody wants to break up. Relationships are sticky like that. “Say it ain’t so!” And so it isn’t.

Islands, and waves, and even anchors may opt to bend reality and defer loss. However, couples with deal breakers in their basement inevitably seek therapy to circumnavigate the proverbial elephant in the room that just won’t go away. The therapist can’t help but feel their pain, feel the sense of impending doom that has been buried so partners can enjoy another month, another year, or a decade without having to face reality.

But is every deal breaker an actual deal breaker? From the PACT point of view, often it is not.

Because couples indulge in kick-the-can-down-the-road avoidance, they have no reason to believe denial isn’t the best course of action. However, a PACT therapist can help the couple arrive at a creative solution that is win-win—a solution that leaves no residue and has no victim and no perpetrator. For this to happen, partners need to be held with their feet at the edge of the cliff.

“Necessity is the mother of invention.” So, supposedly, said Plato. In this case, necessity places the couple between a rock and a hard place and holds them there. Perhaps the rock is what they absolutely insist upon, and the hard place represents the consequences for ensuring they get what they want. For a couple not dealing with a deal breaker, the consequence is most certainly loss.

I think it is very difficult for the average couple to do this on their own. I suspect anchors would be more readily able to make sacrifices needed to assuage abandonment fears. Although making choices that could end a relationship has never been nor will ever be easy, a PACT therapist can help partners see their way through what looks like a foregone conclusion. When I hold a couple in a deal-breaker tension, I bite my nails along with the couple as we face the potential end of their relationship. My only solace is my faith in the human capacity to create solutions where none seem possible.

It is only under conditions in which partners must choose between this or that and accept their losses that win-win accords can be forged. The PACT therapist must be the villain in this scenario. Forcing partners who have been avoiding their deal-breaker issue to resolve it once and for all is a radical move. However, I believe it is the PACT therapist’s duty to guide couples toward a real future and not conspire in the very human tendency to bend reality in the face of loss.

Copyright © 2003-2014 Stan Tatkin, Psy.D. – all rights reserved

The Ten Commandments for a Secure-Functioning Relationship

by Stan Tatkin, PsyD, MFT,

  1. Thou shalt protect the safety and security of thy relationship at all costs.
  2. Thou shalt base thy relationship on true mutuality, remembering that all decisions and actions must be good for thee AND for thine partner.
  3. Thou shalt not threaten the existence of the relationship, for so doing would benefit no one.
  4. Thou shalt appoint thy partner as go-to person for all matters, making certain thy partner is first to know—not second, third, or fourth—in all matters of importance.
  5. Thou shalt provide a tether to thy partner all the days and nights of thy life, and never fail to greet thy partner with good cheer.
  6. Thou shalt protect thy partner in public and in private from harmful elements, including thyself.
  7. Thou shall put thy partner to bed each night and awaken with thy partner each morning.
  8. Thou shalt correct all errors, including injustices and injuries, at once or as soon as possible, and not make dispute of who was the original perpetrator.
  9. Thou shalt gaze lovingly upon thy partner daily and make frequent and meaningful gestures of appreciation, admiration, and gratitude.
  10. Thou shalt learn thy partner well and master the ways of seduction, influence, and persuasion, without the use of fear or threat.

Tatkin, S. (2011). Ten Commandments for a Secure-Functioning Relationship. In J. K. Zeig & T. Kulbatski (Eds.), For Couples: Ten Commandments for Every Aspect of Your Relationship Journey. Phoenix: Zeig, Tucker & Theisen, Inc. Publishers.

© 2003-2013 Stan Tatkin, Psy.D. — all rights reserved

No Pain No Gain

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?

1. Pain
2. Focused, coherent therapeutic stance
3. Pressure

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

Security Questions Require Security Answers

by Stan Tatkin, PsyD, MFT,

Many of you who know my work or take my training have heard me talk about the difference between security questions/security answers and reality questions/reality answers. However, I do not think I have written about this specifically so here we go….

Many people become confused when considering how to respond to matters of relationship insecurity, especially during periods emotionally dominated by fear, ambivalence, or doubt. Bids for affirmation or reassurance can therefore be met with either a secure (reassuring) response or a reality (dice roll) response. For some, the “reality” principle seems a more “secure” option. That may in fact hold some subjective truth, particularly for those who themselves feel fearful, ambivalent, or doubtful (“I can’t reassure you because I, too, feel insecure about us”). And I suppose there are good arguments against providing a secure response when a reality response would be the safer choice (“Our relationship is in danger and so let’s go to therapy”). However, for those who are generally on the fence about this, I’d like you to consider the cost of making a big mistake when that is not your intention.

Let me start by giving examples:

REALITY QUESTION: “What time is dinner?”
REALITY ANSWER: “Around 6pm, give or take 10 minutes.”

SECURITY QUESTION: “Daddy, am I going to die?”
SECURITY ANSWER: “No honey, not for a very, very long time.”

    REALITY ANSWER: “Well sweetheart, I can’t lie to you. There’s a nasty virus going around and it’s killing lots of little children your age. But let’s not think about that right now.”

SECURITY QUESTION: “Will you love me forever and ever?”
SECURITY ANSWER: “Yes. Forever and ever.”

    REALITY ANSWER: “Hmm, that’s a very long time. I don’t know if I can answer that truthfully. I can love you for right now. Let’s take that up again in a year.”

There is a time and place for reality answers and I’m not going to say that it is always appropriate to answer security questions with security answers. However, I will say that in primary attachment relationships, security concerns must be addressed swiftly, simply, and unequivocally if the relationship is to remain safe and secure. Replies that are complicated, contradictory, qualified, evasive, or lacking confidence or seriousness will be read as threatening by the receiving partner. A vote of non-confidence is also read immediately with non-verbal displays such as delayed responsiveness (milliseconds), deflected gaze, vocal changes, and facial controls.

So then, how to avoid shaking your partner’s (and your own) fragile sense of security? The answer is to be prepared! Consider ahead of time the cost/benefit of providing secure responses to insecure bids for reassurance. You will then be prepared to respond with more congruence. If you are among those who believe the best response is the one that is most truthful (realistic), then accept the cost that comes with that stance for there will be a cost in the currency of safety and security. If that is not your concern then go for it. If however you wish to create and maintain a secure relational ecosystem for yourself and your partner, you may want to go with the secure response.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

A Call to Therapists Who See Adolescents: Do Couples Work!

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