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September 2020
Photo by Eenne Boulanger on Unsplash
PACT
Psychobiological Approach to Couples Therapy
Part 1
by Stan Tatkin
Despite tons of
research, it should
be obvious to most
adult minds that basic
human nature can be
problematic.
FEATURE
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The Science of Psychotherapy
This article discusses the prevalence of one-person psychological
thinking in the insecurely attached population that comes to cou-
ple therapy. I also discuss matters around poor therapeutic al-
liance with insecures: those suering from personality disorders
and unresolved trauma histories. I tie this into brain areas that are known
to strengthen executive areas and known to be more cognitive and most
related to doing the right thing, which is to say, delay gratication for
something better. I also discuss how the dopaminergic and GABAergic re-
ward circuit inuence other executive brain structures and how these ex-
ecutive structures may contribute to acting-out behaviors that drive part-
ners to do what feels better at the cost of getting better.
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September 2020
INTRODUCTION
For years, all forms of psychotherapy have
avoided the matter of social justice as part of
social emotional development. Lawrence Kohl-
berg’s moral developmental stages, based on
Piaget’s cognitive scale, attempted to parse an
individual’s moral development by giving them
moral stress tests to determine their upper level
of moral reasoning (Kohlberg, 1971). Kohlberg,
along with Carol Gilligan and their students at
Harvard, famously analyzed public gures ac-
cording to their moral level of reasoning based
on their past and current public record. Of par-
ticular interest were leaders and inuencers in
elds of medicine, education, law, government,
and law enforcement. Matters involving right
to life, right to die, racial proling, individu-
al rights, and so on, would be examined and
scored based on an authority’s ability ethical
and moral reasoning and behavior.
Kohlberg based his thinking on the phil-
osophical ethics of Immanuel Kant and John
Rawls (Kohlberg, 1974). Rawls, who wrote ex-
tensively on social contract theory and justice as
fairness, paved the way for modern social, po-
litical, and even relational ethics, to which this
paper addresses (Rawls, 1958, 1999). Equally, if
not more inuential, was the seminal work of
Ivan Boszormenyi-Nagy (1996; 1973), a Hun-
garian-American psychiatrist and one of the
founders of the eld of family therapy. Bo-
szormenyi-Nagy integrated relational ethics
into family systems theory and his contextual
therapy approach (Boszormenyi-Nagy, 1996).
He endeavored to show that invisible loyalties
in families often led to childhood experiences
of injustices. Like revolving ledgers of unfair-
ness, these children would later seek payback
Photo by freestocks on Unsplash
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The Science of Psychotherapy
in future relationships. In other words, family
injustices become society’s burden.
I look at a remedy for what may be missing
in couple therapy: social justice. Couple thera-
py approaches, to date, do not expect partners
to co-create an overarching container, purpose,
shared meaning or vision, nor co-create guard-
rails that ensure partners remain fair, just, and
sensitive in their dealings with one another.
Overarching ideas, big ideas that address ques-
tions, such as why we are together, what or
who we serve, what our purpose is as a couple,
are, I believe, central to the successful treat-
ment within couple therapy.
Along with a big idea that drives shared pur-
pose, vision, and meaning, comes the notion of
shared principles of governance based on real-
ities of life, stresses, and the human condition
as we mostly do the wrong thing when it suits
us.
Though this approach is distinctly aimed
at implicit, somatic systems within and be-
tween partners, the couple’s “big idea” – be it
a shared purpose, shared mythology, or shared
meaning – forms the explicit container within
which both therapist and couple can create and
maintain a therapeutic alliance and meet the
therapeutic expectation and goal.
This article focuses on a particular way of
working with couples. Starting with the ther-
apeutic expectation, or “big idea,” as described
here and throughout this article, therapists
drive a top-down narrative, implicitly and ex-
plicitly, whereby partners are expected to a)
be in reality, consider the future, co-create a
container that is their relationship, b) have
a shared purpose and meaning, and c) create
guardrails that guarantee fairness, justice, sen-
sitivity, collaboration, and cooperation among
two individuals who share power. This, as will
be discussed later, is the therapeutic expecta-
tion or goal that the couple is required to meet.
Under this pressure or expectation, the ther-
apist is able to view in stark relief the develop-
mental barriers against self-activation, reliance
on a reality ego, ability to orient to a two-per-
son psychological system, and other factors,
including developmental neurobiological de-
cits. With this therapeutic stance or goal, the
therapist is able to maintain continuous pres-
sure and stress on the couple system to perform
in an individuated, complex, fully mutual, and
adaptive manner.
Built into this expectation is that partners
are truthful, forthright, transparent, fully pres-
ent, and interactive. They must be focused on
the task of therapy, which is to work on their
relationship and not on each other. Therapists
view this therapeutic goal, which will be de-
scribed later as secure functioning, and convey it
to the couple as the only system that can ensure
a long-lasting relationship without the accu-
mulation of threat and resentment.
Before proceeding, it might make things
easier to name the approach to which I’ll be re-
ferring throughout this article. At the risk of
promoting a brand, which I am not, this ap-
proach was originally termed A Psychobiolog-
ical Approach to Couple Therapy and has since
abbreviated to PACT. I will henceforth use PACT
to denote this approach for simplicity sake.
Having said that, PACT by no means represents
a cloistered set of gurus, clinicians, or dogma.
The name refers to an ever-developing eld
of study and practice that is, to a large extent,
open-source and intended to contribute to an
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September 2020
Photo by Fred Moon on Unsplash
already expanding eld of knowledge in the
psychotherapy community.
PREDICTORS OF RELATIONSHIP
DISSOLUTION
From this particularly psychobiological van-
tagepoint, adult romantic attachment relation-
ships fail over time for a variety of predictable
reasons. On a nervous system level, partners
who function poorly as a regulatory team – in
their management of exciting, quiet and, most
importantly, distress states – will run aground.
Partners who are not good at co-regulation
eventually fail due to mismanagement of state
changes, particularly those involving distress
and threat perception.
Along similar lines are tendencies for all at-
tachment systems to accrue various amplitudes
of threat memories through historical mem-
ory around dependency relationships in early
childhood and later life (Tatkin, 2018). Current
attachment relationships are equally likely to
reanimate old memories of attachment inju-
ry. Another predictor of relationship failure is
active insecure attachment organization in and
among adult partners who remain burdened by
dependency fears stemming from unrepaired
attachment relationships. These individuals,
similar to all those with developmental de-
lays (poor individuation, dierentiation, object
constancy), replicate the very same unfairness,
injustice, and insensitivity in their current at-
tachment relationships. We call these orien-
tations one-person psychological systems. They
place pro-self values over relationship and de-
fend against interdependency and mutuality.
These insecurely attached partners are pre-
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dicted to disrupt the couple system’s safety and
security through repeated interactions that are
non-collaborative and non-cooperative, cre-
ating resentment and interpersonal threat. A
variety of individual factors aect each part-
ner, such as developmental, intellectual, and
social-emotional capacity, brain hierarchical
error-correction, neuroendocrine regulato-
ry function, life experience. Depending upon
these and other important factors, such as
physical health and trauma history, insecure
partners can inadvertently destroy their rela-
tionship through burgeoning threat cascading
toward massive mutual dysregulation, a bio-
logical condition that is extremely dicult to
undo. This matter of threat perception – part of
the human primate’s nature state – is so ubiq-
uitous and inescapable that all people must be
alert and conscientious.
Threat here should not be confused with out-
ward threats of physical harm. I refer rather to
small “t” threats, such as the kind we experi-
ence on a daily basis by way of our perceptions
and interpretations of negatively valenced be-
haviors by others – through facial expressions,
gestures, postures, movements, vocal sounds or
utterances, and certain words or phrases. Small
“t” threat is always present in the environment
depending upon the receiver’s state of mind,
memory, social context, and a multitude of
other variables. Threat perception is phenom-
enological and intersubjective and cannot be
judged as objective reality, particularly among
partners in a couple. Several other predictors of
relationship failure, most threat-related, per-
tain to partner betrayal of trust, a subject too
vast for this article.
Through the lens of this model, fundamen-
tal interpersonal problems involving relation-
ship insecurity and unsafety are, almost entire-
ly, in partner explicit and implicit interaction.
Through detailed examination of a couple’s
interactions during moments of stress, dis-
tress, and non-distress, interactive errors can
be small or large, yet they are repeated in all
scenarios involving similar state changes with-
in and between partners. These errors result
in misattuned moments that sustain without
error-correction or repair. They contribute
to threat perception, defensive behaviors, in-
creased error rates of appraisal, and increased
psychobiological threat. Unrepaired perceived
misunderstandings, injuries, or injustices, if
intense and sustained and without quick re-
lief, lead to event-related long-term memory
formation in both partners and are predicted to
repeat in future encounters. Threat memories
repeat during other interactions, even those
unrelated to the original event.
To eectively track these interactions, a
trained, relaxed, and alert therapist pays con-
tinuous attention to each partner’s immediate
moment-by-moment somatic reactions to each
other and to the therapist. Partner microex-
pressions, micromovements, and somatic shifts
are the primary objects of therapist observation
during partner interaction. Additionally, the
therapist carefully observes and analyzes lin-
guistic “tells” that support somatic markers.
These tells alert the therapist by way of their
own countertransferential somatic reactions to
irregularities in partner narrative coherence,
collaboration, and verbal/non-verbal signs of
deception. The psychobiologically-oriented
couple therapist looks for partners in the spac-
es between words, phrases, and movements.
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September 2020
They strive to catch partners in the act of being
themselves. The typical conict content areas
– money, time, messiness, sex, kids – become
background to implicit material gained through
nonverbal means of data gathering. We consider
partner narrative, partner self-report, partner
declarations of intention, motivation, theories
of causation, and explanations for relationship
discontent to be the least reliable part of data
collection. Therapist, as audience member, ob-
serves partner interaction for lengthy periods
to study linguistic and somatic micro-behav-
iors played out and uninterrupted as if watch-
ing a play or observing animals interacting.
The approach discussed in this article is a
psychobiological, nonlinear, poly-theoretic lens
through which to view human social-emotion-
al development and function, beginning from
pre- and post-natal epochs and continuing
throughout the lifespan. The model is based on
social-emotional capacity, as shaped by neu-
robiological, environmental, and genetic inu-
ences. Before getting into this psychobiological
approach to couple therapy, let’s rst discuss
challenges the couple therapist must face when
working in a developmental capacity model of
therapy.
THE HUMAN CONDITION AND
BRAIN ERROR POTENTIALS
To ground both partners’ expectations, the
couple therapist must come to understand cer-
tain realities of how various brain functions can
be advantageous to certain life circumstances
and disastrous to others. Equally important is
knowledge and acceptance of the human con-
dition, in all its magnicent and disappointing
aspects. Both therapist and couple must under-
stand the features and the bugs, so to speak.
Partners who do not understand this will con-
tinue to attack each other for no reason and fail
to understand the brain’s error potentials that
aect all human beings on the planet. First,
consider the notion that human interaction is
one of the most complex and challenging things
we’ll ever do. No individual is easy, particularly
in primary attachment relationships. All people
are perfectly imperfect, disappointing in some
manner, and frustrating. With that in mind,
let’s look at where couples go from there.
Photo by Alex Iby on Unsplash
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THE SCRAPPY HUMAN PRIMATE
Despite tons of research, it should be obvious
to most adult minds that basic human nature
can be problematic. I am not talking about an
individual’s personality structure, attachment
organization, or pathology. Just the species
itself – Homo sapiens. As a species, through-
out our entire history, we are, by nature, ag-
gressive, warlike, selsh and self-centered,
moody, ckle, opportunistic, easily inuenced
by others, always comparing and contrasting,
always aware of what is missing, and racist and
xenophobic – and all of it wired in (Fletcher,
Simpson, Campbell, & Overall, 2015; Harari,
2014; Sapolsky, 2017). Like it or not, this seems
to be our heritage, and very little has changed
since our beginnings. We may judge our nature
to be good or bad, but nature doesn’t. Nature is
indierent and amoral. The human primate is
a messy animal, tilted more toward war than
love, particularly when threatened.
THE BRAIN’S ERROR POTENTIALS
Human verbal communication is highly er-
ror prone. When it comes to commands,
such as “stop,” “go,” “wait,” “sit,” “eat,”
“run,” human verbal communication
should run smoothly. However, beyond the
one-or two-word commands from which
our language evolved, there can and will be
trouble. For one thing, a phenomenology
particular to an individual’s word choice,
meaning, and context opens the possibil-
ity of misunderstanding. Add the brain’s
tendency to take shortcuts, and we’re o
to the races. Consider still the implicit or
nonverbal conveyances through the face,
voice, movements, gestures, posture and,
for good measure, each individual’s cur-
rent mental/emotional state all aect ap-
praisal of words and phrases.
Memory is unreliable. Partners com-
monly argue over memory – and both are
likely incorrect. To begin with, our record-
ing of experience into memory is depen-
dent on a multitude of internal and exter-
nal factors (Garrett, Grady, & Hasher, 2010;
Nadel, Payne, & Jacobs, 2002; Sapolsky,
2018). Recorded experience, along with
memory formation, includes the brain’s
tendency to ll in blanks, confabu-
late, conate data, decontextualize sub-
ject matter, and embellish with emotion.
With each recall of events, memory again
changes according to state of mind, body,
and current experience. With couples in
distress, matters worsen with the presence
of glucocorticoids and their eect on hip-
pocampal, amygdala, anterior cingulate,
and prefrontal cortex function. In these
instances, partners are unable to proper-
ly sequence and contextualize events. Why
might partners choose their memories as
the hill on which to ght to the death? One
explanation may be the strong relationship
between one’s memory and one’s sense of
self (Lin, 2018).
Memory and state are interlinked –
meaning, current state inuences mem-
ory; memory inuences current state of
mind and body; and state of mind then
alters sensory perception like a funhouse
mirror. What one sees, hears, smells,
tastes, and touches, is greatly modied by
state of mind. This nal line of reasoning
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is exceedingly relevant in matters of dis-
tress and threat perception.
AUTOMATIC BRAIN
Procedural memory is known to be “cheap”
because subcortical systems require less oxy-
gen and glucose to operate than do higher cor-
tical areas. Procedural memory is considered
extremely fast and associated with recognition
systems that respond subcortically to manage
instant functions, such as those that would
be lifesaving. Because partners automate each
other in and around the latter phases of court-
ship, novelty-seeking functions of the brain
turn elsewhere as the relationship begins to
rely more heavily on memory and recognition
and not on presence and attention.
Everything new is bound to become old in
relative short order. Automation leads to the
cessation of presence and attention between
partners and a signicant increase in partners
error rates in communication, perception, and
attribution. It begins to elevate memories of
dependency injuries in the attachment experi-
ences of childhood. The brain’s ability to im-
mediately parse past from present, this person
to that person, is compromised by the expedi-
ency of the right hemisphere and subcortical
regions of the brain. When under threat or per-
ceived threat, partners are more likely to shoot
rst and ask questions later.
Nonetheless, though the human primate is
saddled with an automatic brain that is mem-
ory-based, reexive, blessed and cursed with
lightning-fast recognition systems that keep
us alive, we are not necessarily able to keep our
relationships intact with the same autonomy.
NEGATIVITY BIAS
The human brain’s emotional negativity bias
is well known and aects human interaction of
all kinds (Braund, Palmer, Tillman, Hanna, &
Gordon, 2019; Ito, Larsen, Smith, & Cacioppo,
1998; Jing-Schmidt, 2007; Kiley Hamlin, Wynn,
& Bloom, 2010; Lilienfeld & Latzman, 2014; Ro-
zin & Royzman, 2001; Vaish, Grossmann, &
Woodward, 2008). A hardwired human neg-
ativity bias makes good sense if one accepts
the idea that survival of the organism, not to
mention the species, depends on excellent
threat detection and danger avoidance. In the
absence of positive information, we are more
likely to make negative attributions. A good ex-
ample of this is the tendency to misinterpret a
shy stranger’s behavior for that of unfriendli-
ness, arrogance, or disdain. Partners who are
conict-avoidant, under-expressive, and un-
der-communicative encounter their partner’s
negativity bias along with the brain’s penchant
for lling in blanks. We remember negative ex-
periences more readily than positive ones, os-
tensibly because we must remember what or
whom we should not revisit. Undoubtably, the
brain’s negativity bias plays a considerable role
in accrued psychobiological threat experienc-
es that lead to degradation of a couple’s safety
and security system (Coyle, 2018; Norris, Leaf,
& Fenn, 2019).
EXECUTIVE SYSTEMS
Interestingly, psychologist and neuro-
science researcher and author, Lou Cozolino,
considers the amygdala, along with the default
mode network and posterior parietal regions, as
one of brain’s three executive systems (Cozoli-
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no, 2017).
The psychobiologically-oriented couple
therapist is keenly aware of the amygdala’s
role in threat detection and its seminal role in
the survival of the organism specically and of
the species in general. PACT focuses on the role
threat plays in day-to-day life and in many dai-
ly interactions with one’s primary attachment
partner. As Cozolino (2002) puts it, “Therapists
really want to be amygdala whisperers…” (p.
18), and the couple therapist wants each part-
ner to quickly become experts in the critical ar-
eas of conict management, distress relief, and
their own couple safety and security system.
In fact, one of the best predictors of relation-
ship failure is partner incompetence at rapidly
shifting the other’s threat state to one of safety.
The amygdala holds considerable sway over
the entire brain. Unlike other brain structures,
it can take shortcuts necessary for survival. Like
all brain features, each have features, and each
have bugs. For instance, amygdala shortcuts
are extremely important for acting at light-
ning speeds to save one’s life. That’s a feature.
However, this very same feature is a bug when
it comes to shooting rst and asking questions
later, literally. It’s the classic tragedy of a po-
lice ocer shooting someone of color because
they mistook a wallet for a gun. I add ‘of col-
or’ because the amygdala, as well as other brain
structures, are heavily biased in terms of who is
like me and who is not like me - the other. The
human primate, by nature, is xenophobic and
racist. This is not a value judgment. Fortunate-
ly, society has value judgments about racism
and xenophobia. Nature does not. The human
primate is famously biased against those per-
ceived as others. The other is understood to be
like that kindred fan of the same baseball team,
and both others and familiars, those we know
personally, can change on a dime depending
upon environmental context. This bias is en-
hanced not only by the pre-wiring of the brain
but also of environment, especially that of early
family environment and social attitudes.
Contextually, the current environment is an
important determinant as well. This required
nature of ours is also augmented by hormones,
such as oxytocin. Oxytocin may lead me to be
extremely helpful, compassionate, and seless
with a familiar in distress, but if I’m the least
bit threatened by someone, I will also be less
compassionate, forgiving, gracious, and em-
pathic. This is due to the presence of gluco-
corticoids coursing through my brain. Even the
smallest presence of glucocorticoids is known
to alter the functions of the hippocampus, an-
terior cingulate cortex (ACC), and the prefrontal
cortex (PFC).
Amygdala function goes unchecked at all
times and can be amplied in memory without
PFC and ACC error correction and fear extinc-
tion. So many variables, in fact, go into doing
the wrong thing when the wrong thing feels
good or feels safer. Parsing the exact cause of
any behavior in any one moment is dicult,
given the conuence of environmental stress-
ors, early developmental and environmen-
tal adaptations, genetics, current mental and
physical states, empty versus full stomachs,
sleep hygiene… The list of disruptors is long.
As primatologist and neuroscientist Robert
Sapolsky brilliantly states in Behave: The biology
of humans at our best and worst (2017), any act
of aggression or defensive behavior is deter-
mined by what happened a minute before, days,
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September 2020
weeks, months, and years before, even going
back to the beginning of one’s life.
The executive function I speak of here is the
integration and ongoing tension between the
emotionally based executive, the ventromedial
prefrontal cortex (vmPFC), and the more cog-
nitively based executive, dorsolateral prefrontal
cortex (dlPFC). At the risk of oversimplication,
these areas along with the anterior cingulate,
posterior cingulate, temporal parietal junction,
temporal pole, interior insula, and hippocampal
components are essential for error-correction
and the capacity to repair misunderstandings
and injuries. These areas are vital for co-regu-
lation of distress and threat reduction.
This also brings to the forefront the matter
of purpose over feeling. The notion of purpose
can generally be ascribed to the dlPFC among
other structures. The matter of feeling can be
ascribed to the vmPFC and the orbital frontal
cortex as well as other limbic structures. While
both are essential for navigating the complexity
of human relationships, doing the right thing
when it’s the hardest thing to do requires a
predominance of certain structures over others.
Doing the right thing is not reexive and
may not be the rst thing a person does practi-
cally when under stress. But we can expect it to
be the second thing. Therefore, the only thing
that might elevate us above the natural, the
basest of our humanness, is to put our attention
on purpose-centered principles that can help
navigate us and hold us to prosocial behaviors.
Pro-self is our nature state. It is what we will
always go to when we are under threat – and
threat is a daily experience, ranging from the
most subliminal experience to the most gross
and horric.
Photo by Claudia Wol on Unsplash
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By placing the couple in a container from the
onset of couple therapy, or shortly thereafter,
the PACT therapist points them to shared pur-
pose, shared vision, or if you prefer, shared my-
thology, which includes meaning and elevates
them to something greater than the individuals
who comprise the system. In PACT, therapists
set the stage for complexity, object constancy,
impulse control, frustration tolerance, and the
capacity to create a secure-functioning envi-
ronment that can, nally, create the resourced
milieu essential for the couple’s development
to continue.
THE BIG IDEA
I would argue that couple therapy is not
suited for nondirective forms of therapeutic ap-
proaches. The therapist only has a short time to
work with the couple before they break up or,
worse, harm one another. Therefore, the thera-
pist can expect certain behaviors, but those be-
haviors must make sense and be coherent with-
in a larger frame. In other words, the therapist
should have an architecture in mind that gives
meaning, purpose, and vision to the couple to
build guardrails that keep behavior construc-
tively based on a big idea that the couple buys
into. This is the shared mythology the therapist
must create.
That is the overarching container of this
approach – partner’s shared purpose as a
couple, and the shared meaning and vision
they co-create. Containers are necessary
for therapists to study a process, orga-
nize a complex set of variables, and focus
on completing a task. Containers provide
a concentrated eld free of distracting el-
ements and restrict outside contaminants
and internal leakages that would negative-
ly aect understanding and outcome.
PURPOSE, MISSION, VISION
Based on attachment and social justice the-
ory, secure functioning is a social justice system
whereby partners adhere to principles of fair-
ness, justice, and sensitivity along with col-
laboration and cooperation (Solomon & Tatkin,
2010; Tatkin, 2012). It informs how partners
are going to protect themselves from each oth-
er. Secure-functioning partners view them-
selves as fully individuated, dierentiated,
autonomous individuals who accept each oth-
er’s imperfections and think in terms of “good
enough” and not “perfect.” They are joined by
purpose rst, feeling second.
They accept each other as burdens. They ac-
cept each other’s past and accept responsibility
for each partners past as it appears in the pres-
ent moment. They view each other as in each
other’s care and not their own by focusing on
the other, nding the infant in the other, and
being experts on the other.
We might think of the secure-functioning
couple as each other’s whispers. They’re good
at one another, fearless, competent, and use
attraction, persuasion, inuence, seduction,
bargaining, and negotiation instead of fear,
threat, or guilt. They operate as a two-person
psychological system, sharing power, commit-
ting to full transparency, and other principles
of governance that ensure safety even during
times of stress and distress. We believe that
secure-functioning couples are able to handle
high levels of loadbearing as dierentiated from
insecure functioning couples. Because they are
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September 2020
purpose driven, they hold principles and ideas
of behavior that are independent of feeling and
uctuating states.
THERAPEUTIC EXPECTATION
Secure functioning, the therapeutic goal,
is inconsistent with deceptive behavior, sub-
stance and behavioral addiction, all forms of
abusiveness, codependency, acting out, cheat-
ing, and other behaviors commonly thought of
as destructive to relationship. As a result, the
couple therapist is relieved of taking a moral
stance since secure functioning does not have
to do with these behaviors but rather has to do
with if and how these behaviors interfere with
fairness and sensitivity in the couple system as
expressed solely through partner complaints.
The goal of secure functioning is to reduce
acute and chronic interpersonal stress result-
ing in allostatic load1 and the accumulation of
psychobiological threat. The couple system is
viewed as an interdependent entity of auton-
omous individuals who must forge appropriate
and reliable social contracts that rely on prin-
ciples and purpose rather than self-determined
(non-mutual) relationship values. The couple
is also viewed as a fully capable, fully dier-
entiated set of autonomous individuals who are
expected to do the right thing (as agreed upon)
in service of both personal and mutual good.
Secure functioning requires the couple to
fully be in reality and employing a reality ego
rather than a pleasure-seeking or pain-avoid-
ing ego to defend against perceived or antic-
ipated losses. To achieve this, the couple un-
derstands that they must view the relationship
as a two-person psychological system, whereby
1 Allostatic load is the accumulated wear and
tear on four major systems due to chronic
stress. Those systems are cardiovascular, auto-
immune, inammation, and metabolic.
each partner is in the other’s care as mutual
stakeholders and stewards of their safety and
security system.
These couples understand that their union,
if based on a shared vision, purpose, and shared
principles of mutual governance, are bound by
agreements that serve both interests and pro-
tect partners from each other’s tendencies to
feel good at the cost of being good in the rela-
tionship. This approach is purpose- and char-
acter-driven, requiring partners to accept the
realities of human relationships, including the
ideas that partners can only be good enough and
never perfect and that all people are dicult
and disappointing. Secure functioning requires
partners, if they buy into this idea, to think on
a higher level, which provides a container, as
mentioned, for the therapist to understand all
the obstacles that will emerge under this pres-
sure to be secure functioning. In a nutshell,
that is the entire big container, or big idea, of
this treatment.
A PSYCHOBIOLOGICAL
APPROACH
Under the hood, it’s quite another story. In
a psychobiological approach, we observe part-
ners as infants on a developmental trajectory,
whether we are looking at personality theory or
attachment science. The same is true wheth-
er looking at relational trauma or PTSD. Either
way, with the therapeutic narrative or goal, the
therapist continues to insist and expect that the
couple behave in a secure-functioning manner.
This method should be distinctly recognizable
by those familiar with American object rela-
tions and ego psychology.
The approach discussed in this article is a
psychobiological, nonlinear, poly-theoretic lens
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The Science of Psychotherapy
through which to view human social-emotion-
al development and function, beginning from
pre- and post-natal epochs and continuing
throughout the lifespan. The model is based on
social-emotional capacity, as shaped by neu-
robiological, environmental, and genetic inu-
ences. Before getting into this psychobiological
approach to couple therapy, let’s rst discuss
challenges the couple therapist must face when
working in a developmental capacity model of
therapy. The approached developed over many
years of study with my mentor, Allan Schore
(Schore, 1994), and was greatly inuenced by
his work. PACT is also inuenced by a great
many thought leaders, science writers, and
clinical researchers such as James Masterson,
Jaak Panksepp, Stephen Porges, Carl Whittak-
er, Salvador Minuchin, Peter Levine, Dan Sie-
gel, Lou Cozolino, Beatrice Beebe, Mary Main,
Jerey Zeig, Ivan Boszormenyi-Nagy, Donald
Winnicott, Otto Kernberg, Ed Tronick, Mari-
on Solomon, John Gottman, Pat Ogden, Paul
Ekman, Helen Fisher, and a great many oth-
ers. PACT, in fact, combines various methods
as part of its larger ethic and therapeutic goal
of secure functioning. We use infant and adult
attachment models, personality theory, arousal
regulation theory, strategic and structural fam-
ily systems, psychodrama, somatic body track-
ing, Ericksonian limited trance, developmental
neuroscience, social justice theory, psychoana-
lytic models such as American object relations,
and ego psychology, Paul Ekman’s facial action
coding system, and other methods to help move
couples toward secure functioning.
This particular approach emphasizes adap-
tation and reality over maladaptive, self-harm-
ing defensive behaviors, such as a partner’s
Photo by Priscilla Du Preez on Unsplash
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September 2020
reasons for underperforming. This pressure
is necessary to compete with the limited time
available for the couple therapist to triage a
couple crisis and ensure a better treatment out-
come. It also pushes people faster and further
in their personal development as the therapist
expects secure functioning, which may possibly
be out of their reach at the start of therapy.
The therapist’s expectation is the driv-
ing force for moving the couple toward secure
functioning, which at the same time, creates
enough stress and distress to maintain interest
in the treatment itself. A careful titration of ap-
plied therapeutic stress is essential for progress
to occur and positive results to be experienced
as quickly as possible. More about this thera-
peutic approach will be explained shortly.
Psychobiology is a developmental model
based on infant brain development, attach-
ment science, arousal regulation theory, and
neurobiological capacity, particularly in the
social-emotional realm. In couple therapy, the
focus is on social-emotional capacity from a
developmental point of view. We view criti-
cal periods in early attachment as postnatal to
24 months, while arousal regulation systems
and right- brain social emotional development
as having critical periods from prenatal to 18
months and more (Chiron et al., 1997; Cozoli-
no, 2013; Mahler, 1979; Masterson, 1981; Ramey
& Ramey, 1999; Schore, 1994, 2002, 2015). We
also carefully track known brain developmental
changes or “upgrades” throughout the lifespan
(Champagne & Curley, 2005; Fuhrmann, Knoll,
& Blakemore, 2015).
Photo by Victoria Roman on Unsplash
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The Science of Psychotherapy
Various decits in social-emotional func-
tioning may be deemed as hardware, software,
or both when a decit appears in the adult ro-
mantic attachment system as a threat to the
couple’s safety and security. Implicit systems
and the tracking of somatic markers as ex-
pressed in the face, skin color, striated muscle
tensing and loosening, pupil size and move-
ment, gestures, body posture, and vocal pros-
ody, volume, and tempo. The couple therapist
is trained to pick up moment-by-moment
micro-expressions and micro-movements in
partners while at the same time remaining
available to sense the couple as a receptive au-
dience member. This receptive stance is critical
to the intersubjective experiencing and obser-
vation of the couple.
The therapist employs tools and techniques
to maintain a continuous visual attention to
details in each partners physicality while at the
same time practicing continuous muscular re-
laxation to maintain an alert yet relaxed state of
mind. Dan Siegel’s window of tolerance (Ogden,
Minton, & Pain, 2006; Siegel, 1999) provides a
successful schematic metaphor for remaining
in optimal arousal. That is, the therapist re-
mains fully resourced and has adequate oxygen
and glucose to run high cortical, error-correct-
ing, and regulating brain structures. Stephen
Porges refers to the state as the social engage-
ment system whereby the therapist conscious-
ly engages the out breath, vocal prosody, eye
contact, and communication eorts as a means
to maintain an internal state of safety (Porges,
2011).
***
Editor’s Note: Part 2, that will appear in the Oc-
tober issue, addresses the practical application of
PACT. Stan Tatkin shares with us a selection of exer-
cise and activities that bring the theoretical frame-
work, established in Part 1, to life.
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