CC12 Workshop 05 – Exciting Bottom-Up Techniques to Use with Your Couples: Applying PACT® – Stan Tatkin, PsyD

Description:

A psychobiological approach to couple therapy utilizes a bottom-up versus a top-down approach to psychotherapy. This means that the couple’s therapist utilizes very fast, often surprising interventions in order to access implicit systems as revealed in micro expressions and micro-movements in the face and body, respectively. This workshop will introduce several exciting bottom-up techniques to use in couple therapy, including the use of surprise statements, movements, poses, and music.

Educational Objectives:

1. List and describe at least three bottom-up interventions for accessing implicit material.
2. Demonstrate the use of at least one bottom-up intervention.

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

Outline:

Workshop Introduction

• Stan introduces his background and experience with food addiction and couple therapy intensives.

• Describes a three-day intensive with a couple “on death’s door” and the need to “prove death” in therapy.

Core Model: Psycho-Biological Approach

• Focuses on three domains: attachment, arousal regulation, neurobiological deficits.

• Assessment involves scanning faces/bodies, using relaxed but forensic questioning.

• Uses cross-questioning and watching non-speakers to gather truthful information.

Key Techniques

• Emphasizes micro-expressions, micro-movements, and procedural memory.

• Uses bottom-up, body-based assessment and intervention strategies.

• Aims low (limbic system) with language and interventions.

• Tracks autonomic nervous system cues for emotional states.

Relationship Dynamics

• Secure vs. insecure functioning: mutual regulation vs. distress cycles.

• Describes the role of dopamine in mutual excitement and bond maintenance.

• Introduces primary and secondary intersubjectivity and threat system management.

Intervention Methods

• Uses projective identification and state-dependent memory.

• Applies window of tolerance to manage arousal.

• Tracks subtle facial/body shifts for cues about emotional safety.

Case Example

• Couple assessed using walking-toward/away and lover’s pose exercises.

• Exercises surface attachment issues and arousal dysregulation.

• Music used to evoke emotional memory and gauge the relationship’s emotional tone.

Use of Technology

• Video recordings used for assessment and immediate playback.

• Helps couples observe real-time reactions and emotional cues.

Final Takeaways

• Emphasizes nervous system regulation and implicit processes.

• Bottom-up assessment essential for lasting change.

• Encourages using technology and staging environments in therapy.

Challenges in Couples Therapy

• Couples often perceive threat quickly, creating kindling effects.

• Focus is on medical-style regulation, not blame.

• Goal: shift insecure systems into secure functioning through behavioral contracts.

Training & Practical Use

• Two-year training: Year 1 (videos/exercises), Year 2 (case-based).

• Some techniques (e.g., cross-questioning, lover’s pose) usable without full training.

• Postures/poses reveal developmental issues stored in the body.

Attachment Style Exploration

• Avoidant styles addressed in upcoming sessions.

• Couples therapy can help heal old attachment wounds through primary relationship repair.

• Emphasis on proximity, eye contact, and body awareness.

Video Feedback in Practice

• Exercises like walking-toward/away are videotaped and played back immediately.

• Videos aid research, coding, and in-session reflection (though rarely shown later).

Dynamic Attachment Patterns

• Primary childhood attachments shape core personality but can evolve in adult relationships.

• Relationships are dynamic; attachment styles shift through interaction.

• Thorough assessment helps clarify behavioral predictions despite theory confusion.

Handling Intense Emotions

• Revenge-based anger addressed with honest interpretations.

• A blunt interpretation (“You were never really into each other until now”) helped a client accept reality.

• Couple reportedly stayed together post-session.