PACT Level 1 Therapist
There is an elephant in the room. It is big, it is smelly, it is old, and it doesn’t seem to want to go away. Money won’t move it. Ignoring it doesn’t change it. Some choose to dress it with niceties to make it appear more tolerable, but its harm still remains.
This elephant takes many shapes, making it hard for some to recognize when it’s right in your way. It can be subtle, overt, passive, abrupt, implicit, covert, and even micro. Until we are able to address the elephant in all its forms directly by name, it will continue to fester and transform, creating havoc in all spaces, even in those as esteemed as the therapy space.
Its name is racism, and some would say it is as old as humanity. It is the foundational economic structure for the United States and many other parts of the world. Although structures such as American slavery and Jim Crow laws are no longer in existence, the residual impact and trauma of...
PACT Level 3 Candidate
Sexual trauma knows no discrimination. It can happen to anyone, at any age, and occurs across gender, race, religious affiliation, and socioeconomic status. The statistics vary from study to study, but of reported cases, most studies concur that one out of three women and one out of six men will experience some form of sexual abuse prior to the age of 18. More obvious examples of sexual trauma might include molestation, rape, and sexual harassment at work. However, some of the more covert examples include early exposure to sexually graphic content, sexual betrayal, sexual shaming as a child or adult, and repeated sexual objectification.
For most couples, sex is an integral and enjoyable experience. Sex can be a chance to have fun, destress, and reconnect. Survivors of sexual trauma may have a bifurcated relationship to sex. At times they may feel liberated with pleasure, connection, and embodiment....
PACT Level 3 Candidate, PACT Ambassador
For a sexual trauma survivor, the idea or act of being sexual with their partner can be ripe with hopes, pleasure, fears, frustrations, and shame. For the partner of a sexual trauma survivor, sex can be just as daunting; fear over what to say, what to do or not do when their partner feels triggered. Couples can become paralyzed or at war over difficulties in communicating their needs around sex. This is where a PACT therapist can be of invaluable assistance.
Consider Marco and Elana*. Elana endured sexual abuse at the hands of a family member when she was approximately six. The secondary trauma of invalidation and alienation following her eventual outcry left her hesitant to discuss the experience as an adult with any partners, even her long-time partner, Marco. She was in therapy for a long time and, for the most part, experienced few flashbacks or intrusive thoughts about the abuse as an...
By Jeff Cohen, MFT
PACT Level III Therapist, PACT Ambassador
When Gayle and Paul came to see me, it was clear that Gayle felt Paul was the problem. Paul was taciturn to an unusual degree and could be quick to anger. For her part, Gayle presented as highly verbal, competent, and overtly friendly; adept at managing the tasks of their family and her career.
Though I didn’t know of Paul’s trauma when we first met — he lived in terror of upsetting a threatening stepmother and a physically punishing older brother — his manner and speech suggested that he moved through the world in a very protected stance.
It might have been easy to view Paul as the one who needed help. He was extremely literal, arguing about the minutia of his upset with Gayle, and for a long time was unable to understand the concept of providing relief first in an argument. From a PACT perspective, when a willing partner is able to help settle the distressed...
By Stan Tatkin, PsyD, MFT
Two main issues face the PACT family therapy process: Structure and Attendance.
A challenge within typical family therapy is the structure that holds some family members to their particular family roles. While viewing members within the system frame is valuable, especially when it comes to various roles different members play, it can also restrict the flow of information as some members expand and express while others contract and remain in the background.
Using the PACT method to do family therapy may be more effective and convenient for both therapist and family. By dividing family members into pairs, the therapist can do “couple therapy” with various dyadic combinations, thereby freeing members from default role constraints and constrictions encountered when faced with the entire family system.
As long as invited members are of an appropriate age and maturity to participate...
Amanda Woolveridge, M.App.sci.
PACT Level II
John yanked open the curtains at 10:30 am. Light flooded the bedroom as he placed their one-year-old baby on Susanne, who looked bleary eyed and confused as she struggled to wake up. “He’s been asking for you,” John said, before he disappeared downstairs. In his role as house husband, he had decided that Susanne, who had reluctantly returned to full time work after 9 months at home, had slept in long enough for a weekend.
The day was not off to a good start for Susanne. She felt shocked into wakefulness, jarred by the sudden noise and light, confused by the instant demands of her little son, and completely abandoned by John. Because of her complex developmental childhood trauma history, all the alarm bells in her amygdala jangled simultaneously. The stage was set for her to have what John calls “one of her episodes.” She came thundering down the stairs to let...
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,...