PACT Level 3 Therapist
“I’m still not comfortable,” says Sam, jiggling his foot.
Sam and Sandra came to couples therapy because they can’t communicate. I start them in each session with a typical Psychobiologic Approach to Couples Therapy (PACT)  mutual eye-gazing exercise . They have just settled into their rolling chairs. I ask that they sit comfortably with their knees touching.
I tell couples to breathe deeply, focus attention on the other's face, and notice every detail. Try not to talk or touch. Sam lasts about 15 seconds and then says, “I don’t like this staring thing.”
I sit on my rolling chair between them, a few feet away. My standard poodle, Hobbes, sits statue-still next to my chair. He looks up into my eyes. I look into his.
Sandra catches our exchange. She returns her gaze to Sam’s. Her eyes well up with tears.
Sam’s eyebrows rise with a question, then collapse into a knitted frown. “Now what did I say wrong? We just started the session....”
"No," Sandra puts up her hand. “Don’t go there. I want to try to say what I’m feeling.”
She pauses. Sam and I halt at her hand. We wait.
“I notice how you (she looks at me) and Hobbes look at each other. His big, brown, saucer eyes love you up. And your eyes smile at him. I so long for you" — she leans toward Sam — “to look at me with all that love.”
“Wait.” Sam leans back slightly. “You’re comparing me to a dog?!"
“No,” Sandra insists. “It’s that look of love that just melts me. I long for it.” Sandra reaches for Sam’s hand. “Look, you’re getting better at staying in eye contact with me. I’m even reading your body language better. Like when you lean back the way you just did — it’s how you try to protect that vulnerable side of you. You’re not rejecting me like I first thought. It’s the opposite. You actually want a hug. To be cuddled. Or stroked. But are afraid to say so.” Sandra looks down at her hands. She twirls her wedding ring.
I sit motionlessly. PACT technique offers a safe space to respond to micro-movements and feelings. Sandra has learned more quickly than Sam how to articulate her feelings in their shared emotional space.
Sam remains silent. He looks like he’s thinking out the window. His face has fallen.
I decide to intervene. We’ve seen this pattern before: Sandra leans in; Sam leans back. Sam is so intellectually focused. So I attempt to offer information he’ll understand apart from his feelings: “It looks to me like two different things are happening here. First, the way Hobbes looks at me, with that unconditional love, is pretty typical with dogs and their owners when they love each other. What Sandra is yearning for, I think, is that delicious ‘feel-good’ experience. What you see in that lovely moment between Hobbes and me is actually backed by science.
“That moment can happen between dogs and their owners, between babies and their mothers, and between romantic adult couples. Our pupils unconsciously respond to our emotions. When your partner’s pupils dilate, your emotion center, your amygdala, is registering a sign of welcome, of interest, of excitement. He’s signaling he’s a safe person. And oxytocin is released. This is the ‘feel-good’ neuropeptide or hormone. It’s a positive indicator of attachment. Neuroscientists have used fMRI techniques to show that oxytocin activates dopamine-rich areas of the brain , like the substantia nigra, globus pallidus, and thalamus.”
They are both listening intently, so I continue. “In turn, dopamine is the primary neurotransmitter of the feel-good circuit in the brain. It’s associated with reward, motivation, and wanting. You feel good while gazing at your partner. So you continue the same approach behavior. This feels good, so it reinforces the continued positive loop. You can see how mutual gaze is the entry point into that feel-good circuit loop.”
“Infant researchers  since the 1970s showed us how babies gaze intensely at their mothers [or fathers]. Babies begin to find out who they are as they see themselves reflected in their parents’ eyes.” I pause.
“And several studies  have shown that gazing between dogs and their owners increases urinary oxytocin concentrations in both the owners and their dogs. But not in the control group of wolves. That’s what you’re seeing when Hobbes and I look at each other.
“So this feel-good oxytocin loop helps all these pairs bond better—mommies and babies, dogs and their owners, and adult partners.”
“Wow.” Sam looks carefully at Sandra. “I’m happy to see that Sandy loves it. I might get that oxy — what you said — good feeling sometimes. But… well, I still squirm.”
“That’s the second thought I mentioned.” I pause to figure out how to say this. “Remember when we talked about how babies develop different attachment styles  depending upon how comfortable a parent herself is bonding intimately and consistently with her baby? I suggested that your discomfort reflects how you protected yourself — starting when you were a baby — from your mom’s inconsistencies— holding you close and then pushing you away.”
“You mean how she’d get intrusive, demanding, then critical when I didn’t give her exactly what she wanted...?” Sam’s voice trailed off.
“…and she still does that,” Sandra interjected. “When she gets critical, then angry, she stops talking to you for days. She runs hot and cold....”
“Yeah,” Sam nods. “I can say with my head that I do want closeness. I mean with you. But I can’t feel it.” Sam peers into Sandra’s eyes. Then looks down. He says quietly, “I just don’t know how to get there.”
Sandra takes Sam’s hand. “I’m beginning to understand that.” She sighs too.
I let the silence linger, hoping it can be a moment of bonding, even if they both feel frustrated.
Then I say, “This is the work of therapy. And this mutual eye-gazing exercise helps us zero in on when and how you can have that deeper emotional experience. Right now, it may feel confusing — that mixture of longing to be close, but your unconscious reaction to protect yourself from being hurt and pushed away. That’s likely when you lean back, which Sandra noticed.”
“Maybe we can try the eye gazing in little bits, so you can get used to it?” Sandra offers. “I mean, without feeling too squirmy?”
I turn to Sandra. “I see you’re trying to problem-solve. To find something that works for you both. As a team. Willing to give it a try?” They nod.
Originally published in Psychology Today on March 2, 2022. Reprinted with permission from the author.