No Pain No Gain

by Stan Tatkin, PsyD, MFT,

Therapy is only useful for changing people who are experiencing sufficient distress. This is not to say that education, consultation, or brief counseling will have no effect. People often benefit from couple counseling for premarital or other short-term work. However, as a matter of therapeutic stance, the PACT therapist assumes the presence of a sufficient level of distress that can only be relieved by pressuring couples to go down the tube of secure functioning. The PACT therapist thus takes a stand for secure-functioning principles. For insecure partners, this requires a big leap of faith.

That leap of faith can be viewed as a metaphor for neuronal action potential (AP) and long-term potentiation (LTP). AP is basically a charge that is sufficient to fire a neuron. LTP is a cellular mechanism related to learning and memory. LTP involves the building up of synaptic strength between neurons, whereby several weak synapses repeatedly fire...

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Waiting for Inspiration

by Stan Tatkin, PsyD, MFT,

Inspiration should be the guiding incentive for doing interventions, not pressure. Many therapists, including experienced ones, act on pressure rather than from a creative place. Pressure can come in various forms: pressure from the patient, pressure from time, pressure from one’s own need to perform, pressure from a supervisor, etc. Pressure to act may lead the therapist to make mistakes: ill-timed or ill-placed interventions, incorrect assumptions, misattuned moments, or countertransference acting-out.

In contrast, inspiration comes as an “aha’ moment when the therapist has waited a sufficient amount of time to allow for percolation of his or her ideas, impulses, fantasies, etc. Inspiration comes as a result of a convergence of implicit and explicit experience, of both fast and slow thinking (Daniel Kahneman), and of a relaxed body.

Unfortunately for new therapists inspiration usually must take a backseat to pressure as...

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