CC19 Workshop 08 - Introduction to a Psychobiological Approach to Couple Therapy – Part 1 - Stan Tatkin, PsyD, LMFT

Description:

PACT is a non-linear, poly-theoretical approach that fuse theories of attachment, developmental neuroscience, and arousal regulation. PACT is quickly gaining a reputation for effectively treating couples typically thought of as challenging.

This two-part workshop will introduce attendees to this psychobiological model, the forensic-like techniques employed to obtain information rapidly, the skills required to quickly read and assess microexpressions and micromovements and other somatic signalling, the use of creative and sometimes outrageous interventions, how to regulate difficult partners and couples as well as oneself, how to identify and work with various presentations of insecure attachment, how to differentiate psychological defenses from neurological deficits, how to recognize and deal with partner acting out, how to get partners into a light trance, how to determine attachment organization through interview and finding somatic markers, how to work strategically and improvisationally, and how to guide partners toward secure functioning. This approach is highly effective, not for the faint of heart, yet exceeding fun! Clinical video and live demonstrations included.

Educational Objectives:

1. List at least five interventions for getting information from partners.
2. Describe and define secure functioning in relationships.
3. Apply at least two different techniques for managing acting out behaviors.

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

Outline:

Workshop and Key Concepts

• Emphasis on understanding the core issue before intervening.

• Therapist must remain rigorous, suspicious, and precise in diagnosis.

The Importance of Accurate Diagnosis

• Mistaken assumptions are common—cross-check everything.

• The brain fills in gaps and can mislead; test and retest conclusions.

Challenges in Couples Therapy

• Partners bring pro-self narratives instead of pro-relationship ones.

• Self-reports are unreliable; historical and developmental context is key.

• Dysregulation may have hidden origins.

Narratives and Brain Function

• People fabricate or distort memories without realizing it.

• The brain’s visual systems and memory distort perception.

• Rigorous testing helps counteract these tendencies.

The Capacity Model

• Focuses on individuals’ social-emotional development.

• Everyone has deficits; therapy should uncover and address them.

• The relationship—not the individual—is the primary patient.

Secure Functioning in Relationships

• Secure functioning = fairness, justice, sensitivity, mutual care.

• Partners must govern and care for one another.

• Therapists should prioritize strategy and evidence over interpretation.

Arousal Regulation and Brain Systems

• Four strategies: auto, external, interactive, and self-regulation.

• Right brain manages sleep, temperature, and autonomic regulation.

• Triune brain model: reptilian, paleomammalian, neomammalian systems.

Attachment in Relationships

• Attachment is a signaling system requiring attuned responses.

• Early experiences shape attachment and arousal patterns.

• Avoidant = distancing; anxious = clinging.

Impact of Early Experiences

• “Islands” (avoidant) and “waves” (anxious) are adaptive patterns.

• Both suffer from relational trauma and need collaboration for healing.

Therapist’s Role

• Focus on the relationship system, not just individuals.

• Therapist’s regulation affects the couple.

• Strategic, well-regulated therapists foster deeper change.

Avoidant and Anxious Styles

• Avoidants struggle with self-expression and fear intimacy.

• Anxious partners fear abandonment and over-pursue connection.

• Both need help developing assertiveness and healthy entitlement.

Island/Wave Challenges

• Islands feel relief at separation, then dissociate.

• Waves experience panic at separation but are better at handling it.

• Therapy should help avoid extremes and promote connection.

Therapeutic Techniques

• Use rolling chairs and somatic cues to promote regulation.

• Therapist must remain grounded despite client intensity.

• Match interventions to clients’ energy and style.

Allostatic Load and Physical Health

• Chronic stress = wear and tear on the body.

• Secure contact (e.g., belly-to-belly) reduces physiological stress.

• Allostatic load impacts aging and illness.

Secure Functioning and Interdependence

• Regardless of style, couples need mutual protection and loyalty.

• Use models from military/police for high-stakes interdependence.

• Secure functioning is a broader societal model, not just clinical.

Challenges in Therapy

• Highly dysregulated couples may need meds and strong structure.

• Pain can be leveraged for growth—if it’s contained and directed.

• Therapist must manage countertransference and stay objective.

Memory, Perception, and Conflict

• Memory is state-dependent and unreliable.

• Cross-check facts to reduce conflict based on misremembering.

• Help couples perceive alignment, not opposition.

Secure Functioning in Opposing Styles

• Video example: anxious + avoidant couple functioning well.

• Help partners understand each other’s stress lenses.

• Find the “baby” in each other—shared vulnerability.

The Marshmallow Test

• Predicts emotional regulation and impulse control.

• Therapy helps build frustration tolerance and delay gratification.

• Regulating sympathetic/parasympathetic systems supports change.

Cross-Checking in Practice

• Ask if the partner’s version feels true to the other.

• Adjust interpretations when needed.

• Reduce threat to improve recall and connection.