CC07 Workshop 05 - Developmental-Psychobiological Approach To Difficult Couples - Stan Tatkin, PsyD

Description:

This introduction to a developmental-psychobiological approach for working with personality disordered couples will provide attendees with a powerful new method that continues to show good success. This approach focuses on a two-person psychobiological model using attachment, developmental neuroscience and arousal regulation, and moves the clinician from a conflict-content model to a deficit process model focusing on real-time enactments of dysregulation.

Educational Objectives:

1. To describe three interventions for regulating highly avoidant (narcissistic schizoid) partners.
2. To describe three interventions for regulating highly angry and resistant (borderline/narcissistic) partners.

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Developmental-Psychobiological Approach to Difficult Couples

• Couples need time to think and react without pressure; clear session timeframes help.

• Goal: partners become “experts” on each other—like having an owner's manual.

• Focus on identifying and soothing the few specific issues that deeply trigger each partner.

• Reflective functioning (accurately guessing each other’s inner states) builds attachment and safety.

Core Issues in Couples Therapy

• Deep issues often stem from early attachment injuries.

• Fast repair after distress prevents long-term trauma.

• Partners’ nervous systems are interconnected; one’s distress affects the other.

• Successful couples reduce distress quickly; unsuccessful ones escalate and prolong it.

Nervous System Dynamics

• Relationships operate as two-person regulatory systems.

• Interactive regulation: partners soothe each other’s nervous systems.

• State shifts—quick actions that change emotional states—are critical.

• Efficient co-regulation distinguishes resilient couples.

Cultural and Environmental Influences

• Culture influences arousal styles:

  • Low arousal couples = anxiety, somatization.

  • High arousal couples = expressiveness, intensity.

• Primary caregiver shapes nervous system regulation; environment and genetics matter.

• Face-to-face and skin-to-skin contact aid regulation.

Attachment and Autoregulation

• Autoregulation: self-soothing without partner interaction.

• Avoidant partners struggle to shift states without help.

• Dysregulation occurs when neither can regulate the other.

• Overusing time-outs leads to disconnection and poor regulation.

Therapeutic Techniques

• Work with couples together, not individually.

• Use humor and psychoeducation to reduce tension.

• Therapist may take a parental role: stop destructive behavior, set boundaries.

• Physical, in-the-moment actions model effective regulation.

Video Feedback in Therapy

• Video reveals unconscious behaviors and their impact.

• Playback “sobers” clients and promotes insight.

• Priming: subtle cues (tone, glance) can trigger arousal and conflict.

• Therapists use video as a tool for awareness and change.

Eye Contact and Physical Proximity

• Eye contact and closeness regulate distress.

• Distressed couples often avoid courtship or attachment distance.

• Face-to-face interaction supports nervous system regulation.

• Therapist encourages physical presence and gaze.

Right Hemisphere and Regulation

• Right hemisphere governs nonverbal, emotional regulation.

• Brief, physical gestures are more effective than talk.

• Therapists model reparative actions for couples.

• Fast, physical interventions create state shifts and repair.

Mindfulness and Recovery

• Mindfulness improves recovery from arousal states.

• Therapists guide couples through grounding and calming exercises.

• HPA axis (stress system) plays a key role in emotional recovery.

• Goal: faster recovery from conflict and improved emotional regulation.