BT18 Great Conversation 09 - Treating Trauma in Couples - Janina Fisher, PhD and Stan Tatkin, PSYD, MFT

Description:

Trauma in couples includes infidelity, medical illness, and financial issues. Assessment and treatment will be covered.

Educational Objectives:

1. Describe the components of how trauma effects couples.
2. Given a couple in trauma, indicated treatment plan.  

*Sessions may be edited for content and to preserve confidentiality*

Outline

Determining Trauma in Couples

• Different backgrounds and approaches contribute to how trauma is identified in couples.
• Nervous system dysregulation is a key indicator of trauma.
• A partner’s lack of attunement to the other’s trauma responses can be significant.
• Small "t" threats can escalate into larger relational issues over time.

Impact of Negativity Bias and Memory

• Negativity bias affects behavior and relationship dynamics.
• The brain encodes negative memories more quickly and vividly than positive ones.
• Quick repair of negative interactions is crucial to prevent long-term impact.
• Memory is shaped by intensity and duration—unresolved conflict can create lasting damage.

The Role of Eye Contact and Body Language

• Eye contact and body language play a significant role in therapy.
• Eye contact can activate the amygdala—sometimes calming, sometimes triggering.
• Maintaining eye contact supports present-moment awareness.
• Being attuned to non-verbal cues enhances communication and connection.

Handling Trauma in Couples Therapy

• Couples benefit from becoming more aware of their moment-to-moment impact on each other.
• Therapists must maintain regulation and flexibility to support both partners.
• Differing levels of trauma awareness can create challenges that need careful navigation.

Identifying and Addressing Disorganized Attachment

• Signs include inconsistent behavior, seductive or avoidant actions, and conflicting timelines.
• Alternating between pursuit and withdrawal may indicate trauma-based attachment patterns.
• Understanding a couple's relational history is essential.
• Therapist self-regulation is key to managing complex attachment dynamics.

Dealing with Acting Out and Self-Harm

• It's important to differentiate between acting out and genuine trauma responses.
• Therapy should not inadvertently reinforce destructive behaviors.
• Avoidance can be a survival strategy and should be understood, not judged.
• Addressing non-collaborative behavior is crucial for healing and safety.

Managing Different Paces of Recovery

• Partners may move through trauma recovery at different speeds.
• Therapists should explore underlying issues and promote collaborative behavior.
• Building new, positive shared experiences helps shift the emotional dynamic.
• External factors (e.g., substance use) should be addressed if they create division.

The Role of Individual Therapy

• Individual therapy can support recovery, especially when partners progress at different rates.
• Exploring the couple’s shared history helps contextualize current struggles.
• Focus remains on how individual behavior impacts the relationship.
• Creating new, positive memories together fosters healing.

Addressing Alcohol as a Third Party

• Substance use (like alcohol) can function as a disruptive “third party” in the relationship.
• It’s important to address how these behaviors affect the couple dynamic.
• Creating healthier coping mechanisms and shared positive experiences supports recovery.

The Importance of Secure Functioning

• Secure functioning requires collaboration, cooperation, and shared responsibility.
• The couple must prioritize the relationship regardless of past trauma.
• Building new, positive memories together is essential.
• Third-party disruptions (e.g., substances, external stressors) must be confronted directly.