CC11 Workshop 16 - Nobody Knows What They’re Talking About! Utilizing Bottom-Up Interventions for Reliability and Effectiveness with Couples - Stan Tatkin, PsyD

Description:

This workshop focuses on the use of digital audio and video frame analysis and heart rate monitoring for gathering reliable information concerning attachment and arousal patterns within and between partners. The Psychobiological Approach to Couple Therapy® (PACT) places particular emphasis on implicit body states that drive interaction between partners. Though clinicians are trained to use their senses to pick up micro-movements and micro-expressions through the body, face, and voice, precision equipment such as digital video and biofeedback devices can often provide compelling “proof” of what the clinician sees, hears, and senses when observing partner interactions.

Educational Objectives:

1. Determine if digital video recording is appropriate to their practice and if so, will be able to select and place proper equipment for this purpose in their clinical setting.
2. Define and describe body and facial shifts and changes that reveal internal and interpersonal social-emotional in-formation.
3. Define and differentiate heart rate from heart rate variability and how these measures become relevant for the psychobiologically-oriented couple therapist.

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

Outline:

Office Setup and Participant Engagement

• Emphasizes the importance of mobile chairs in therapy sessions for flexibility.

• Uses humor and interactive questioning to engage participants and gather volunteers.

• Stresses the need for live demonstrations and teaching through real cases and TED Talks.

Attachment and Neurobiological Foundations

• Introduces five domains of the psycho-biological approach, integrating infant and adult attachment.

• Highlights infant brain development as foundational to adult behavior.

• Encourages detailed observation exercises to enhance therapist awareness.

Morita Therapy and Observational Skills

• Introduces Morita therapy: attending to reality and accepting what is.

• Observing clothing, posture, and synchrony reveals connection or distress in couples.

• “Tail wagging” (mirroring behavior) is a marker of relationship health.

Signal Response and Procedural Memory

• Discusses how partners respond to emotional signals (attuned vs misattuned).

• Emphasizes consequences of poor responses and the role of procedural memory in attachment.

• Differentiates between annoying and threatening behaviors.

Distress, Relief, and Co-Regulation

• Brain responds quickly to threats; co-regulation is key to managing distress.

• Therapists should understand fast-acting implicit systems and memory pathways.

• Left hemisphere plays a role in error correction and relief strategies.

Interactive Regulation and Eye Contact

• Eye contact stimulates closeness; visual regulation is essential in therapy.

• Primary attachments (romantic partners) feel more threatening than secondary ones.

• Ventral visual stream enables facial focus; supports emotional bonding.

Mate Selection and Relationship Assumptions

• Assumes couples bonded for a good reason and should be supported as such.

• Biological and nervous system compatibility drives pair bonding.

• Relationship failure often reflects inability, not unwillingness.

Attachment Interviews and Role Reversal

• Attachment interviews uncover partner dynamics.

• Role reversal challenges the “identified patient” to see partner needs.

• Helps address power imbalance and build empathy.

Arousal Regulation and Neural Systems

• Introduces brain systems: primitives (amygdala, hypothalamus) vs ambassadors (regulators).

• Vagus nerve and parasympathetic system are vital for calming.

• “Love and War” metaphor: primitives excel in threat response, ambassadors in prevention.

Voice Modulation and Social Engagement

• Proper tone and volume support emotional regulation.

• Poor modulation disrupts connection; therapists should model effective prosody.

• Social engagement relies on vagal tone and vocal control.

Orbital Frontal Cortex and Morality

• Right OFC regulates emotions, morality, and theory of mind.

• Critical for empathy, mentalization, and affect management.

• Therapy should include more playful, emotionally attuned activities to stimulate this area.

In and Out Dynamics in Couples

• Secure couples move between serious and playful states fluidly.

• Ability to tense/relax and shift focus is key to resilience.

• Mimicking this pattern in therapy aids stress regulation.

Nerf Ball Intervention and Play

• Uses a Nerf ball to encourage play and engagement in shy couples.

• Focus is on movement and connection, not content.

• Encourages physical engagement to shift emotional states.

Neurodevelopment and Social Cues

• Social-emotional development deficits can affect facial and body cue reading.

• Therapy should balance intensity and fun while creating a safe environment.

Case Study: Shy Couple Consultation

• Exercise highlights social cue avoidance and difficulty with eye contact.

• Reveals interpersonal stress and regulation challenges.

Deficit Awareness and Therapist Role

• Therapists help clients identify interaction problems and develop regulation skills.

• Interventions should be diagnostic, regulatory, and transformative.

Surprise Interventions and Creativity

• Uses shocking prompts to trigger emotional insight and therapeutic openings.

• Creativity and spontaneity enhance diagnostic clarity.

Affect in Therapy

• Interventions should create emotional experiences to build procedural memory.

• Affective engagement helps couples shift behavior and awareness.

Case Study: Conflict-Avoidant and Angry Couple

• Illustrates challenges when one partner avoids promises and the other reacts with anger.

• Long-term therapy may stall without effective interventions addressing underlying patterns.

Relationship Management and Therapist Goals

• Emphasizes that couples need tools to “handle” each other skillfully.

• Goal is to foster balance, emotional regulation, and secure functioning.

• Therapists coach couples to alternate between seriousness and play for long-term success.