Making an Im – PACT: An Interview with Stan Tatkin
Stan Tatkin, Psy.D., MFT, holds a degree in clinical psychology. He is a clinician, researcher, teacher, and developer of A Psychobiological Approach To Couples Therapy® (PACT) which has training programs both nationally and internationally. In addition to his private practice, he teaches and supervises first through third-year family medicine residents at Kaiser Permanente, Woodland Hills, through which he is an assistant clinical professor at the UCLA David Geffen School of Medicine, Department of Family Medicine.
Stan Tatkin will be presenting a number of sessions at our Brief Therapy Conference this year, including Dealing With Projective Identification in Couple Therapy: The PACT Approach, Treating Trauma in Couples and Working with Different Attachment Organizations.
Ellyn Bader: Stan, I’m happy to be interviewing you. You’ve been such a good friend and a valued presenter at the Couples Conferences. You’ve also made an important contribution with the PACT model and have had impact in the world of couples’ therapy. Due to your understanding of attachment and neuroscience, your presentations are always well received. You have often said that there’s nothing more difficult than a relationship with another person. Since readers may not be familiar with your work, could you please explain this?
Stan Tatkin: The interaction that goes on between two people — especially those in a romantic relationship — is highly complex, and moves at lightning speed. Therefore, we can plan how we want to be with someone, but when we “go live” (actually in the interaction) all bets are off. In the moment, we are victims of our automatic brains. We’re always hobbled by fundamental problems involving memory, perception, and communication. Things get crazy when we interact because we don’t understand that real time is too fast and we’re forced into a position to act reflexively and automatically according to memory. And while automation is good for day-to-day operations, it gets us into trouble when we’re in distress and dealing with each other.
Another person is always much harder to deal with than just dealing with our things, tasks, pets, or other nonhuman objects.
EB: Or our work.
ST: Yes, even our work. Between work and love, love is by far more complex. I often say that pets are easy; partners are hard. In a way, kids are hard, but partners are still harder. In our relationship with our primary attachment – and I consider romantic relationships as a primary attachment situation — we become dependent on one another and therefore become deep family. The relationship is mostly governed by procedural memory, and that memory includes everyone and everything of emotional importance in our life.
EB: Could you please explain the PACT model? And, what does PACT stand for?
ST: PACT stands for A Psychobiological Approach to Couples Therapy. Psychobiology simply means brain and body. We study the brain, including its development and social emotional function. PACT is a capacity model not a conflict model. We pay attention to what people can and cannot do well in the social emotional arena. We pay special attention to nervous system, or arousal, regulation. We have to have a good working knowledge of the neuro-endocrine system, the autonomic nervous system, cranial nerves, and various memory systems. Also, if we’re working psychobiologically as part of the PACT model, we must know about medicines and have some understanding of the medical maladies that affect how a person operates in their interactions with their primary.
PACT is a nonlinear, polytheoretical approach that draws on neuroscience, family systems, psychoanalytic theory, psychodramatic techniques, social justice theory, and attachment theory…and that’s just to name a few. We’re pulling multiple disciplines together in a way that focuses our work as we try to move couples toward something we call “secure functioning.” Secure functioning is like being in a foxhole together. It means that the couple is fully mutual and collaborative, and they operate in a way that is, for the most part, fair, just, and sensitive. In other words, it’s a two-person psychological system. Basically, PACT involves three domains or pillars: developmental neuroscience, attachment (we largely focus on infant attachment), and arousal regulation theory. We particularly pay special attention to moment-by-moment changes and shifts in partners as observed through micro-expressions, micro-movements, and changes in the voice, and body. This is a highly somatic, phenomenological-based approach.
EB: A lot of what you do is experiential. You often have couples moving about in the room so that you can see what’s live – happening in the moment. Could you talk more about this?
ST: This is based on some neurobiological principles, one of which I alluded to earlier — that real time is too fast. In real time, we mostly don’t know what we’re doing or why we are doing it. Therefore, we’re put into a position to make things up. And because of this, we understand that narratives are not accurate and mostly unreliable. So we must look at other means to find people, to understand them, and to know what they want and what they’re up to in therapy. We put couples under pressure and catch partners in the act of being themselves. Narratives may lie, but the body doesn’t.
EB: Can you give an example so that readers can get a picture of what you’re describing?
ST: People come into therapy with all sorts of complaints, for example, money, and say things that sound like they have meaning. But, when we diligently try to find out what they’re talking about and we’re watching them and how they interact with each other, we find that the content areas are rarely the problem. And, if we only listen to narratives and believe what people are telling us, then the therapist is in danger of going down the rabbit hole and misunderstanding what’s in front of them. So we’re big on evidence and proof.
We put a lot of evidence on continually answering the questions: What is this? What are we really seeing? And we assume that patients are not going to tell us, because either they don’t know, or they don’t want the truth to come out. Therefore, it’s our job to become sleuths. With this principle in mind, we can put them under a certain amount of stress, so that we track somatic reactions. That way we can align what they say to what is happening in their bodies – and this gets us closer to the issue at hand. If we aren’t clear about our assessments, then our interventions will not be helpful. In PACT, our exploration is on a granular level. We want to get as close to the truth as possible by employing strategic techniques.
EB: It makes sense to me, because I am familiar with your work. But for those who aren’t, could you please further describe.
ST: A partner comes in and says the problem is that the couple is not communicating properly. The therapist must understand that this could mean anything and everything. It’s the therapist’s job to find out precisely – on a micro level – what the client means. And the only way we can do that is to flesh out what it means to not communicate by not only hearing their report, but by watching them — and even stressing them so that we can see the minute shifts and changes their bodies are demonstrating, which often reveals the real problem. This drilling down is harder than people think because it’s not just going back and forth verbally. That’s insufficient because people often lie, they don’t know what they’re talking about, or they make up things because they are protecting their own interests, which believe it or not, often conflicts with therapeutic goals.
If people didn’t do this, if people didn’t hold information back, or if they knew what they were doing, they wouldn’t need a therapist. It’s our job to find out what they mean. That takes a lot of work by cross checking, corroborating, and being open to being wrong. PACT is proof-centered; we look for evidence. And, we try to bring that evidence into the foreground so that instead of simply reporting it, everyone sees it, hears it, and feels it at the same time. We must create an experience that puts the information out on the table, so that the therapist doesn’t have to interrupt something already obvious. It’s a bit more work for the therapist, but it is important work.
Here’s another example: Someone comes in and says that they don’t know whether they want to remain in their relationship. It’s our job to find out what’s true and what’s not true because people say all sorts of things. As psychobiologists, if we understand that people don’t know, then we need to structure something for them to find out. A therapist can stage scenes, events, or put people under certain stressful situations so that the therapist will be able to understand how the client feels and what they want by observing the client’s body, their voice, and reactions.
EB: Let’s say a couple comes in and one partner says they want to make the relationship better and want to stay together, and the other partner is ambivalent and says they’re not sure if they want to stay together — what might be an experiential stress enactment that you’d do to figure out the situation?
ST: One technique that we use is something called “bending metal,” which borrows strategic methods from Peggy Papp and Jay Haley, where we go with resistance and we push it all the way. For instance, for the person who is ambivalent, we might have them look into their partner’s eyes and give them a declaration such as, “I want to divorce.” In PACT, we pay extremely close attention to somatic reactions in both partners. We may then direct the same partner to make an opposite declaration such as, “Marry me.” Other forms of bending metal would be to push partners directly in one direction, such as breaking up, and look for explicit or implicit pushback.
EB: What will you be emphasizing at the Couples Conference?
ST: This time around, I’m going to focus more on deception, but not simply lying. As I’ve said before, people don’t deceive to be evil. There are, of course, some who lie with malicious intent, but that’s not going to be my primary focus. Instead, I will talk about the average person who behaves in a deceptive manner, perhaps not knowing that they are doing this, or even knowing why. Most people deceive because they are protecting their interests and they may tell themselves that they are also trying to protect their partner’s interests. Others are deceptive because they’re specifically afraid that if they are themselves and say what they truly feel, think, or want, their partner will leave them.
One of our jobs as couple therapist is to get partners to clarify themselves, and make themselves fully visible to one another. For instance, insecure partners commonly fear that their next move is their last, so they hide, withhold information, deflect, or distract by setting meaningless fires elsewhere so as not to clarify who they are and their position. As therapists, we should not be upset or disturbed by deceptive behavior. After all, if partners could be straightforward with one another and deal with reality, they probably wouldn’t need us. So how do we get people to come forward and clarify themselves? That’s what I’m going to teach and demonstrate at the next Couples Conference.
EB: Are you working on any new projects?
ST: I just completed a presentation for TEDx (see below). We are working to set up an outcome study to demonstrate the effectiveness of PACT. I am expecting three more books to come out in 2017.
EB: What do you value about presenting at the Couples Conference?
ST: The Couples Conference represents what is best about the conferences offered by the Erickson Foundation. Both the Couples Conference and Evolution of Psychotherapy remain two of the most important and influential training events where students of psychotherapy can get an in-depth feel of the work produced by some of their favorite clinicians and theoreticians, as well as being exposed to unfamiliar leaders in the field. Audience members can see how presenters interact with one another and how they clarify their ideas in contrast with other presenters. I believe that the Couples Conference exposes both audience members and presenters to the vanguard for cutting-edge research and clinical skills. Having been an audience member myself, I am proud and honored to be one of those in the position to nurture the advancement of our field.