CC23 Keynote 06 - A Psychobiological Approach to Couple Therapy - Stan Tatkin, PsyD, MFT

A psychobiological approach to couple therapy (PACT) is, at is core, a social-justice, purpose-centered approach to primary attachment relationships (two or more). That is to say, PACT therapists expect their partnership clients to become secure functioning. A secure-functioning system is one that is a two (or more) psychological system grounded in fairness, justice, mutual sensitivity, collaboration, and cooperation. In other words, secure functioning relationship is a team sport. For many, secure functioning is a high bar to achieve. It requires a degree of social-emotional development, moral reasoning, individuation, differentiation, self-activation, and of course interest in, and a willingness to pursue it as a goal.

PACT, underneath the hood, is a polytheoretical approach that combines, among other things, attachment, arousal regulation, and developmental neuroscience. Aside from the top-down therapeutic stance of secure functioning, PACT is a bottom-up approach that focuses on implicit, somatic “tells” in each partner’s face, body, voice, movements, and linguistic choices, particularly when partners are under stress. This process orientation helps the clinician obtain more information quickly and strategically than content oriented or procedure-based approaches.

Learning Objectives:

1. To be able to list at least five characteristics of a secure-functioning relationship.
2. To be able to describe a two-person psychological system and how it operates.
3. To be able to describe and define co-regulation, autoregulation, external regulation, and self-regulation.

Outline:

Introduction to PACT and Foundational Concepts

• Developed from studies in autonomic nervous system and arousal regulation.

• Emphasizes interactive regulation: eye-to-eye, face-to-face, and skin-to-skin contact starting in infancy.

• Mutual regulation is prioritized over self-regulation in couples therapy.

Interactive Regulation and Clinical Role

• Interactive regulation is messy but essential, especially early in development.

• Clinicians must often observe, not direct—letting couple dynamics unfold naturally.

• PACT integrates infant/adult attachment theory, body-based therapies, and neuroscience.

Polytheoretical Framework and Methods

• Draws from attachment science, somatic tracking, Gestalt, psychodrama, and trance work.

• Focus on micro expressions, body cues, and implicit material.

• Applies social justice principles and diverse therapeutic modalities.

Assessment and Investigative Strategy

• Avoid assumptions; instead, test and retest ideas through real-time observation.

• Use staging and containers to provoke and assess couple dynamics.

• Interpret only after collecting clear behavioral evidence.

Strategic Long-Term Focus

• Therapy guided by the couple’s long-term goals and shared vision.

• Use of forensic-style interviews to reveal interaction patterns.

• Prioritize experience creation over cognitive explanation.

Secure Functioning in Relationships

• Couples must share purpose, vision, and principles (e.g., transparency, mutual protection).

• Address influence of “thirds” (outside individuals/forces) on the relationship.

• Fast repair and shared governance are hallmarks of secure functioning.

Managing Difficult Dynamics

• Techniques include cross-interpretation to bypass defenses in avoidant/narcissistic partners.

• Maintain therapeutic pressure to shift toward secure functioning.

• Therapist works for both partners and the relationship as a whole.

Bottom-Up Techniques and Containers

• Use movement, surprise questions, and psychodrama to engage implicit systems.

• Containers organize sessions and stress-test the couple’s functioning.

• Observe partners “in the wild” during stress to assess true dynamics.

Health and Allostatic Load

• High allostatic load (chronic stress) harms health and relationships.

• Secure functioning lowers stress and benefits partners’ and children’s well-being.

• Clinicians should also live PACT principles in their own lives.

Conclusion and Continued Learning

• Secure functioning reduces conflict and improves quality of life.