Introduction and Workshop Overview
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Stan Tatkin introduced with credentials in clinical psychology, family medicine, and multiple publications.
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Focus: Managing acting out in couples therapy—a common therapist challenge.
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Q&A encouraged via chat feature; gallery view used to engage participants.
Therapeutic Alliance
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Alliance is based on cooperation, not liking; essential for effective couple work.
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Therapist must have permission and mutual agreement to guide the couple.
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Acting out must be addressed immediately to preserve the therapeutic alliance.
Types of Acting Out
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Includes attacking the therapist, undermining therapy, or mismanaging “thirds” (external influences).
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Mismanaging thirds leads to triangulation, jealousy, and resentment.
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Therapist must redirect and confront to refocus on the relationship.
Communication and Self-Activation
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Paul Grice’s communication maxims (quality, quantity, relevance, manner) are key.
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Self-activation: developing the ability to make independent decisions and delay gratification.
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Acting out often stems from avoiding pain, developing a false self, or primitive defenses.
Understanding Acting Out
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Acting out = self-harm; blocks relationship growth.
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Therapist’s role: confront the system (not individual) to expose underlying issues.
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Use supportive confrontation and strategic intervention to foster collaboration.
Neurobiology and Stress
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Prefrontal cortex (executive function) weakens under stress, reducing regulation and empathy.
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Chronic stress leads to inflammation and threat sensitivity.
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Therapists must help couples manage stress to maintain effective functioning.
Neurodivergence and Social-Emotional Deficits
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Must investigate underlying deficits that may be mistaken for intentional behavior.
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Critical periods for development (first 18 months) shape social-emotional regulation.
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Accurate assessment is essential for effective intervention.
Managing Acting Out
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Therapist acts as external prefrontal cortex until couple can self-regulate.
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Avoid splitting or taking sides; confront system dynamics instead.
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Countertransference must be managed to avoid reactivity.
Therapeutic Techniques
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Use “supportive confrontation” with disruptive partners.
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Divide clients by attachment style: distancing vs. clinging.
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Use tailored strategies for different attachment presentations.
Narcissistic Defenses and Crossing Techniques
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Address narcissistic vulnerability gently—"pain self-defense" as a diagnostic lens.
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Crossing: validate one partner’s feelings while managing the other’s disruptive behavior.
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Protect the bond while challenging destructive actions.
Role-Playing and Case Examples
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Demonstrations used to model interventions (e.g., inequity in work distribution).
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Importance of agreement on principles like fairness and effort-sharing in relationships.
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Role-plays show how to reframe conflict and redirect communication.
Working with Non-Cooperative Couples
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Explore differing relationship expectations (e.g., complaint vs. problem-solving).
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Focus on co-creating shared principles to prevent relational breakdown.
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Some couples may not be willing to change—therapist must assess willingness.
Attachment, Agency, and Survival Unit Thinking
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Treat both partners as adults with agency and capacity for better decisions.
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Relationship must function as a survival unit; lack of cooperation endangers emotional and physical well-being.
Fees and Therapist Sustainability
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Set fees according to the difficulty of the most challenging couple you’d accept.
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Avoid resentment; set clear expectations and protect therapist well-being.
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Address burnout risks and highlight the intensity of the work.
Closing Remarks
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Encouragement to use discussed tools and enjoy the therapeutic process.
