A Psychobiological Approach to Couple Therapy and Sensorimotor Psychotherapy: A Clinician’s Way to Blend the Two Modalities

By Dahlia Greenbaum, MA, LMFT
PACT Level 3 Clinician

A Psychobiological Approach to Couple Therapy® (PACT) and Sensorimotor Psychotherapy (SP) are two therapeutic modalities that provide robust ways to treat clients with a variety of presenting symptoms and problems, using an integrated approach of both bottom-up and top-down approaches. 

PACT is a model developed by Stan Tatkin, PsyD, MFT, that fuses attachment theory, developmental neuroscience, and arousal regulation (The Pact Institute, 2024). PACT is based upon the belief that most couples, regardless of trauma history or psychiatric diagnoses, can create and sustain a secure-functioning primary relationship if they are willing to engage in PACT couple therapy. 

SP is a holistic modality founded by Pat Ogden, PhD, that includes somatic, emotional, and cognitive processing and integration (Sensorimotor Psychotherapy, 2024). SP practitioners believe in every client’s innate ability to heal. Practitioners conceptualize trauma, developmental and relational injury, and (when the two are combined) developmental trauma as the root causes of one’s symptomology.

 SP practitioners work with child states and trauma parts that, when triggered, will hijack one’s nervous system (an understanding of polyvagal theory and structural dissociation as well as active somatic ways to release trauma from one’s body) and help the client feel more embodied, integrated, and regulated. 

As both a PACT and SP trained therapist, I have found that integrating SP principles and interventions within a PACT framework can deepen and enhance PACT couple therapy work. This integration can create more scaffolding for clients who have difficulty tolerating some traditional PACT interventions and can provide a host of additional moves for the PACT therapist who finds themself gridlocked with a challenging couple. 

Working with Parts of the Self

Acting out as a couple is one of the most common difficulties couple therapists face when implementing PACT work. Incorporating parts work — as an alternate intervention to supportive confrontation for acting out — can aid in creating a slower-paced, gentler, and often more palatable therapeutic experience for some clients. 

In SP, working with child parts is integral to the model. These parts are divided into 

1) trauma parts based on the framework of structural dissociation classified by Stephen Porges, PhD as cry for help, fight, flight, freeze, and collapse 

2) vulnerable child states frozen at a particular developmental age 

3) developmental strategy parts of the self that are viewed as having been adaptive in some ways at the time of creation but often no longer serve the client in their present-day life 

These strategy parts, which other models might call defenses, are protective in nature, and were the best the child could create given the environmental and developmental limitations they may have faced growing up within their family of origin as well as the broader cultural context a person with marginalized identities might have experienced. 

In SP, trauma parts are worked with by completing the somatic, primitive response to life threat that was unable to be completed. Childhood states and strategies are also acknowledged, understood, and soothed, rather than rejected or fought. This distinction of soothing rather than confronting these strategies or defenses creates openings for integration between the two models. 

Identifying Child Parts

There are several ways child parts are identified, soothed, and worked with when they come online and begin to drive acting-out behavior. One SP method is for the hijacked client to develop a dual awareness of their present-day adult self while simultaneously staying mindful of one’s particular child state (Ogden & Fisher, 2015). 

One of the ways I use this conceptualization in harmony with PACT is by helping the couple identify the child parts who may be acting out in a dysfunctional attempt to get their needs met by their partner. That way, we get to know how those parts operate within the couple system. 

This understanding alone aids tremendously with acting out in couples, as it creates access to a more neutral observer part of the self who can reframe the difficult experience with a partner to a more palatable one. 

Sometimes we even name these child parts —  “Little Pete,” for example — which helps clients begin to move away from identifying with that little one inside themselves. Instead, it guides them toward identifying with a wiser adult self. Once we have discovered and named these younger parts, I am able to teach the partners how to handle and contain them. 

Establishing the Adult Self

For the individual within a couple unit, we work on reorienting them structurally around what they can do with their little one’s unmet needs and desires when they begin to arise. As the therapist, the first step is helping them find their present-day adult self. 

For some clients with a complex trauma history, this alone may be a struggle. Some child parts become so prominent throughout a person’s lifespan, one begins to merge with these parts. The client begins to identify with that child part of themselves rather than their present-day self. 

If this is the case, the therapist can help both partners get in touch with their adult selves by guiding them to remember a time when they felt a sense of peace or joy, and then helping them embody the physical sensations, thoughts, feelings, posture, and even gait of this adult self. Some clients may relate to this state as their divine or higher self rather than their adult self. 

Finding language that resonates with the clients’ sensibilities is an important part of this resourcing process. 

If clients continue to struggle with finding their adult self, collaborating with an individual therapist to work on this with the client can be tremendously helpful. Once the adult self is established, the therapist can help the client identify the child state that is currently acting out. 

This process provides an opportunity for intrapersonal regulation that the adult self can provide for one’s internal little one, a child part that was fragmented and developmentally stunted at a particular age. You can work with them to hold their little one’s hand, so to speak, and go to their partner to advocate for their little one’s needs, rather than the little one directly speaking to their partner with the limited communication skillset of that part’s developmental age. 

This conceptual shift helps the couple reorient to their couple bubble being governed by their adult selves, with each of their child parts in their own care rather than the child parts being in the direct care of their partner. In these moments, I have invited partners to hug a pillow or a stuffed animal as they do this so they can have a tangible representation of their child part, which helps with embodiment and integration of this paradigm shift. 

This structural distinction alone can be transformative for couples, and often helps clients self-activate to move toward their partner in critical moments more successfully. 

Soothing a Partner’s Child Parts

For the couple, once we have identified their younger parts, a practitioner can work on what the partners can do to handle or soothe their partner when, for example, Little Pete shows up. In this instance, the therapist would tightly hold the couple in the container of teaching them how to recognize when their partner’s child part surfaces, and then how to assist their partner’s adult self in soothing the little one as the child part gets louder. 

For example, the therapist might cross question and interpret, asking the partner a multitude of different questions. 

• How can you recognize when Little Pete is talking as opposed to Peter? Notice how his voice gets higher, and his mouth starts to look pouty. 
• What do you do with Little Pete when he is showing up? 
• What triggers Little Pete to hijack Peter? 
• What did Little Pete never get from his parents that he is desperately trying to get from you?” 

In these delicate moments, the therapist can also use information gathered from the PAI about the family of origin to blend with working with that child state’s missing experience or limiting beliefs in real time. 

There are unlimited cross questions and interpretations to use within this container, and the therapist has ample room to be creative with touch and experiments that aid them in accomplishing this piece of learning, which often creates a tender, powerful, and memorable experience for the couple.

Creating and Integrating Somatic Experiments

In addition to incorporating parts work into PACT, SP and PACT blend beautifully when the couple therapist uses SP knowledge to create somatic experiments for couples to do together in session with the therapist’s support and guidance. 

PACT has many reliable somatic exercises that are named and taught to PACT trained therapists, such as “Toward and Away,” “Lover’s Pose,” or the “Welcome Home Greeting” to name a few. In addition to these, boundless possibilities for the use of experiments with couples can be integrated based on what is needed in each session. 

Somatic experiments can be particularly helpful when the therapist senses that the couple is stuck in a loop that struggles to shift despite other interventions. One way this can manifest is by hypothesizing what movement or action the client’s body wants to complete when a client gets activated. 

The therapist can look for clues from the body by tracking unusual fidgets or micromovements often held in the jaw, hands, and feet. When identified, the therapist can take a moment to directly work with the client who is getting activated, asking them what they notice happening, for example, in their hands.

Tracking a Client for Clues - Examples

If angry, the client might say something like, “I’m so mad, I feel like I want to punch him.”  This type of response gives the therapist an opportunity to understand that the client’s body might be going into a primitive fight response that is stuck in their nervous system, thereby causing the frustrating loop in the relationship. If their partner can stay regulated, the therapist can help them complete this fight response in session with their partner rather than them acting it out subconsciously in the relationship. 

In this scenario, the rageful person would be instructed to push against the hands of their partner, with the regulated partner offering their hands some resistance. As this is happening, the therapist instructs the regulated partner to offer declarations such as, “You have every reason to be mad at me, and I’m so sorry” or “You can push me away as much as you want, but I’m not going anywhere,” tailoring the declarations to be attuned to the specific scenario and needs of the rageful partner. 

This experiment offers both a potential completion of the fight response along with repair within the relationship. 

There are also variations of the above scenario, where perhaps instead of a rageful partner, you have a timid, dissociated, or collapsed partner, afraid to voice their needs or take up space in the relationship. If this is the case, the therapist might set up a similar experiment where the collapsed partner pushes against their partner’s hands. 

This time, instead of the task being to complete the fight response, it shifts to supporting the partner in feeling empowered and helping their nervous system come out of a dissociative state or a collapse. 

Another way these somatic exercises can manifest is in more tender moments of attunement. While the couple is in a trance in each other’s eyes, the PACT therapist is cross-questioning and commenting artfully to explore their ability to melt into the safety and security of the relationship. 

The therapist might discover that they each have some protective fear holding them back from truly trusting each other. The therapist would then explore with them where these fears are held in their bodies, with them reporting perhaps a pit in one of their stomachs and a tightening in the other’s chest. 

While they are held in each other’s eyes, the therapist would invite them to put a hand on their own fearful body parts (in this example, the stomach and chest), and then to put their other hand over their partner’s hand, calling back to the parts work described earlier and the structural importance of the partner assisting the adult self to contain and soothe their own child parts. 

As they do this, still in each other’s eyes, the therapist might ask the couple what messages the hands are communicating to their younger, more fearful parts of the self. They might  also ask if those younger parts are able to take in those messages of comfort or care. Usually they will report nurturing messages such as, “You’re safe. I’m right here with you” or “You are lovable just the way you are.” 

Often clients will become quite emotional, as they notice their body beginning to soften and connect to their partner in a deeply soulful way.  

Encouraging Mindfulness

Another impactful way to use experiments with couples is working somatically with how much space each of them take up in the relationship by asking them to notice energetically where they end and the other begins, in a manner of speaking. 

This intervention is particularly useful when the therapist is working with one or more codependent partners who are struggling with differentiation. It can also be useful for boundary work when one or more partners struggle to assert themselves or take up space in the relationship. 

The therapist helps them attune to this dynamic by inviting them to move their chairs closer or farther away from each other so they can really feel where their individual energetic bubble bumps up against their partner’s bubble. 

The therapist can present the idea of energetic bubbles as a throwback to how a teacher might discuss personal space to a kindergartener. Once they map out their bubbles, the therapist might ask them to notice what happens to their bubble, or sense of self, as they move closer or farther away from their partner. 

• Do they disappear and get overtaken by their partner’s bubble? 
• Is there enough space for both bubbles in the room? 
• What do they notice in their bodies as this unfolds? 

Depending on what is needed for the clients, the therapist can apply this experience to a traumatized partner or couple struggling with physical closeness. With this type of couple, the therapist could use a similar setup as the previous application and then deepen the exercise by offering the couple string to help them tangibly lay out their energetic bubbles as they experience them on the floor. Now, the therapist is set up for a plethora of explorations that can be played out similarly to psychodrama. 

Approaching a Traumatized Partner

For example, the therapist could work with how to approach a partner who has a trauma history and startles easily when approached. They could invite the traumatized partner to stand in their bubble and instruct the other partner to step over the string and into the bubble with them. 

With questions directed to the traumatized partner, the therapist might ask, “How does it feel when your partner steps right into your bubble without permission? Are they welcome in there with you? Why or why not? What does your body want to do when they step into your bubble? How does this feel for the little ones inside you?” 

A slight variation on this might be that perhaps the partner only experiences a startle response when their partner is angry and approaches them in that activated state. The therapist could then isolate that triggering state and instruct the partner to behave angrily while stepping into their partner’s bubble, the way one might work with a psychodrama intervention. These are just a few of the many possible ways to work with this setup to further incorporate somatic experiments into PACT. 

Responding to Touch

Although there are unlimited ways to create and integrate somatic experiments into PACT couple therapy work, here is a final idea of how to apply this when working on touch and physical intimacy with a couple who may be struggling in this arena, whether it be from trauma or from chronic disconnection and lack of intimacy. In either case, the therapist can invite one partner to touch the other’s arm or shoulder slowly and then ask them to leave their hand placed on their partner’s body. One could also invite them to embrace in a hug and to hold the hug. 

The therapist would encourage mindfulness, asking them both to notice what happens in their bodies as they touch. 

• Does your body like the touch? Does it resist it? 
• What happens when you hold it there? 
• Does the touch then become easier to accept? 
• Do you feel foggy or numb (a way to assess possible dissociation)? 

If one of the partners has a visceral response from the touch of either dissociation, a flight response, or any other vehement emotion, then not only is this an excellent assessment tool, but the therapist can help them navigate this in session. 

The therapist can then offer psychoeducation about nervous system flooding to help them understand their physiological responses. They can also use SP interventions to help the couple move out of that activated state and back into their windows of tolerance. 

Some somatic ways to regulate the couple when one or both are flooded?

1. The therapist can assist one partner in completing the flight response that is alive in their body by helping them mindfully move their feet up and down as if running away, simulating their ability to leave the interaction in their feet. 
2. Or, the therapist can help them learn how to come back into their body when feeling dissociated by pushing against the wall, looking into their partner’s eyes if that provides a resource, or by tuning into their senses and naming objects they can see, hear, and touch. 

Standing in the Expectation of Secure Functioning

Once the therapist has assisted the partner(s) in regulating again, they can continue to work with the aforementioned setup by finding the couple’s touch growth edge, where the traumatized partner is slightly activated but is not yet flooded. The therapist is slowly and carefully scaffolding the experience to help them increase their capacity to accept touch from their partner. When working with trauma in this delicate way, profound patience and compassion are held and modeled by the therapist.

PACT is a dynamic, complex, and robust approach that requires sophisticated skill, attunement, bravery, and creativity to implement it effectively with couples. The model calls upon the PACT therapist to have a broad range of tones and interventions while standing firmly in the expectation of secure functioning from the couple. 

Being a PACT therapy client is difficult work and can be overwhelming and triggering for some couples, thereby potentially thwarting progress. For the traumatized or more sensitive couple, working with parts of the self and incorporating slower-paced somatic experiments based in SP concepts provides opportunities for a titrated PACT experience that does not flood one’s nervous system. Instead, it provides tighter scaffolding and containment for clients who require more hand-holding from the therapist. 

References

Ogden, P., & Fisher, J. (2015). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment. In Norton Series on Interpersonal Neurobiology (p. 479). W. W. Norton & Company.

Tatkin, S. (2012). Wired for love: How understanding your partner's brain can help you         defuse conflicts and spark intimacy. New Harbinger.

Tatkin, S. (2004). A developmental psychobiological approach to therapy. Psychologist-Psychoanalyst: Division 39 of the American Psychological Association, 23(No. 4), 20-22.

Tatkin, S. (2009). A psychobiological approach to couple therapy: Integrating attachment and personality theory as interchangeable structural components. Psychologist-Psychoanalyst: Division 39 of the American Psychological Association, 29(3), 7-15

Tatkin, S. (2021). PACT Training Manual. www.ThePactInstitute.org.  

"The PACT Institute". www.thepactinstitute.com. Retrieved 2024

“Sensorimotor Psychotherapy”. www.sensorimotorpsychotherapy.org. Retrieved 2024