By Rachel Holland, DClinPsych,
PACT core faculty
Dan and Jane have been married for thirty years and have three sons. They came into therapy following a challenging time in their lives after they faced a number of health, family, and work problems in quick succession. Jane had also suffered a recent traumatic event and was struggling with posttraumatic hyperarousal. She was sensitive to noise and crowds and felt that nowhere was safe anymore. Both Dan and Jane were distressed and looked exhausted in response to these events. Their relationship had become adversarial and verbally aggressive, and they felt like they were “on eggshells” with each other. Both were seeing individual therapists for support, as well as seeking couple therapy.
My initial ideas about this couple included issues related to allostatic load (i.e., the cumulative burden on the nervous system from multiple chronic stressors; McEwen & Seeman,...
Most people would agree that relationships, especially love relationships, are incredibly complex. Most honest psychotherapists would add that couple therapy itself can be extremely complicated, and that it isn’t always clear how best to intervene with a couple who are distrustful, disconnected, and in the midst of pain. With so many moving parts, what should the effective PACT therapist focus on? The answer is affect, and helping the couple attend to each other’s affect by tolerating it and responding appropriately. Affect regulation theory offers a succinct lens through which to view how skilled PACT therapists can be most effective in helping a couple move toward a secure-functioning relationship.
What is affect?
According to psychologist Daniel Hill, affect is “the somatic representation of the state of the...
I love being a couple therapist, and after 18 years, I am pretty confident I know what I’m doing—mostly. What I love about the work is the sense of honor I feel when a couple engage me in their process and I can help them create a better relationship. Each and every time I embark on that journey, I commit to it fully and I give it my all. It is such a privilege.
As you can imagine, I’ve learned many skills and worked with a range of modalities. Some of these have stayed with me, but many have been left behind. Not only is it my professional responsibility to stay on top of what’s new in clinical practice and what the clinical evidence tells us about what works and what doesn’t, but for me it’s also important to keep...
by Eda Arduman, Ma., clinical psychologist couple therapist
Level 2 PACT therapist
Istanbul Bilgi University clinical supervisor instructor
Clinical Psychology MFT Master Program
It has been said that intimate relationships are not for the faint hearted, yet research shows us time and time again that the pleasure and reliability of relationships provide us with the resiliency to overcome the challenges life often presents. Some of the hurdles life throws are external (e.g., an economic crisis or severe illness of a loved one or divorce of parents) and others are internal (e.g., states of ambivalence, self-sabotage, and depression). Sometimes an external event spurs an internal reaction that interrupts movement; the braking mechanism acts as a counterforce to expansion and results in contraction.
The PACT therapist works with couples in severe conflict who are responding at a pace at which their minds cannot keep up with their words. The couple are trying to say things to each other,...
by Allison Howe, LMHC
PACT Level II practitioner
Saratoga Springs, NY
Email: [email protected]
Do you and your partner have any mentor couples in your lives? A number of couples in my practice report that they don’t have a mentor couple in their social or support network. Yet mentor couples are important because they model the principles of secure functioning. They protect each other in our presence, and we can see and learn from the fair and sensitive ways in which they interact.
Years ago, my husband and I met such a couple, Rhonda and Pat, and they advised us to not become “married singles.” We didn’t fully know what they meant, although now we do. Married singles are partners who are married but spend little time together. They operate mainly as a one-person system. PACT therapists believe couples can design their marriage in any way they see fit. If the design works for both individuals, the marriage can flourish. My husband and I saw that spending...
by Elaine G. Tuccio, LCSW, PACT faculty, Austin, TX
Email: [email protected]
Challenging couples are difficult to work with if all the therapist knows to do is referee the flow of conversation and inappropriate behaviors. PACT-trained therapists, on the other hand, have numerous therapeutic tools that can be used to move these couples toward secure functioning.
For example, the PACT therapist sees acting out in session as an opportunity for staging an intervention toward secure functioning. Our training teaches us that it is usually best to sit back and observe, as if tracking the plot in a suspenseful detective novel. Underneath the precarious nature of challenging partners’ harmful defensive behaviors a relationship is waiting to be saved. Despite appearances, couples bring lots of resources, such as healthy drives and capacities that may be hidden under years of erroneous narratives about themselves, their significant other, and the world at large. The PACT...
Loving in a way that supports, energizes, and grows a long-term relationship means loving your partner the way he or she needs to be loved. Many well-intended people unconsciously get caught instead in the destructive loop of offering their partner the kind of support, care, attention, and love they themselves thrive on, only to be left feeling unseen, unsuccessful, misunderstood, and lonely, which often leads to defensiveness and fighting.
Aligned with a related PACT therapeutic goal—knowing who your partner is and how he or she operates—comes this question: Are you using that information to help your partner do a good job for you?
Successful couples arm themselves with detailed owner’s manuals that explain how each partner maneuvers through and makes sense of his or her world. Partners then put that unique and distinctive...
by Inga Gentile, LMFT (California), licensed psychologist (Norway)
PACT core faculty, Tromsø, Norway
A couple’s relationship is especially vulnerable to crisis during key transition points in life, such as the birth of a baby, the formation of a first romantic relationship, adolescence, a chronic illness, and the frailty and illnesses of aging (Staton & Ooms, 2012). From a psychobiological perspective, relationships operating under insecure models of functioning are even more vulnerable to distress at these junctures. This is because insecure models, as one-person psychological systems, tend to promote behaviors and attitudes that are not pro-relationship, and therefore partners can perceive each other as insensitive and unfair. During highly vulnerable periods, partners need one another more than at other times, yet insecure partners are not able to be there for each other. Often partners come to therapy at these times either as...
by Stefan Neszpor, FRCPC, director of the Adelaide Couples Clinic and PACT Level II practitioner, Adelaide, Australia
Email: [email protected]
Most couples have a story about what is taking place in their relationship. However, the story often doesn’t match the reality of how they experience one another. I was reminded of this recently when I met a couple in their mid 30s, with two small children. With respect to PACT attachment styles of relating, he was an island and she was a wave. In simple terms, that meant he tended to distance himself, while she was more the clinging type.
They came to therapy because she had become infatuated with a man living next door who seemed more approachable to her. Indirectly, it seemed she was trying to signal to her partner that she wanted him to be more attentive.
In the initial therapy sessions, they were able to identify one of her early patterns whereby she had a deep desire for affection. This showed itself as anxiety. Her way out...
Often when couples come to therapy seeking assistance with issues related to sexuality, the problem is not what it appears to be. They describe issues such as sexual dysfunction, discrepant desires, pain during intercourse, inability to maintain an erection, and/or profound loss of interest. But often what we might call the “ick factor” is what is actually driving their presenting problems. Thus it is essential to look more deeply in order to get to the real difficulty. When the real problem is successfully addressed, treatment is much more effective and true healing becomes possible.
For example, when one partner discloses difficulty tolerating the other’s body odor, taste, and/or touch, the tension in the therapy room grows palpably. Until I studied PACT and began to think in terms of psychobiology, this was a moment I dreaded as a...