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PACT (Psychobiological Approach to Couples Therapy) – Dr. Stan Tatkin

What is PACT?

PACT is a powerful method for couples therapy that delves deep into the emotional and physiological underpinnings of relationship conflicts. Instead of getting bogged down in endless arguments or debates about who’s right, PACT focuses on what’s happening in your brain and emotions when you experience tension with your partner.


Imagine you're in the middle of an argument with your partner, feeling overwhelmingly angry but unsure why. You struggle to communicate your feelings effectively. PACT helps unravel this confusion by paying close attention to your body and emotions, cutting through the noise to get to the heart of the matter.

How PACT Works

In a PACT session, your therapist will guide you through a process that involves:

  • Slowing Down: When conflicts escalate, PACT helps you slow down and observe what’s happening in real-time. This might involve noticing physical reactions like a frown or crossed arms, which signal deeper emotional responses.

  • Seeing and Being Seen: The therapy encourages you to truly see and understand your partner’s emotions—be it hurt, sadness, or longing. This mutual understanding can alleviate frustration and lead to clearer solutions.

Here are some of the principles that underline the PACT method:

1. Attachment 

We are all looking to feel loved and cared for. We want to be made a priority, to feel secure and special to our partner. The therapist will help you learn how to create a securely attached relationship. In such a relationship couples know how to take care of each other, to address each other’s thoughts and feelings, to respond to their partner’s distress and attempts at closeness, and to have each other’s back.

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2. Regulation

When we get too emotional, we act out of our survival instincts, so we can’t really understand each other and empathize. The therapist will help you manage your feelings so you stay within a range that is manageable and you can actually listen to and understand each other.

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3. Automatic Responses

Since being close to our partner is so crucial for all of us, we usually respond to cues from them with a fast, automatic, knee-jerk reaction–such as changing our tone or subtly becoming more distant. Most of the time we don’t even know we do this, but our partner is still unconsciously affected in a huge way. Learning to recognize your automatic reactions, and what they mean for yourself and your partner is a big step towards a more connected, satisfying relationship.

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Here are some of the principles that underline the PACT method:

  • Your therapist will focus on moment-to-moment shifts in your face, body, and voice, and ask you to pay close attention to these as a couple.

  • Your therapist will create experiences similar to those troubling your relationship and help you work through them in real time during the session.

  • PACT tends to require fewer sessions than do other forms of couple therapy.

  • PACT sessions often exceed the 50-min hour. Longer times allow for the in-depth work of PACT. 

  • Your therapist may videotape sessions to provide immediate feedback to you.

  • Initial sessions are 3 hours and follw up range from 1-2 hours.

PACT and the “couple bubble”

In PACT couples therapy the couple bubble refers to the environment where trust and security is formed in the partnership. This couple bubble acts as a womb or cocoon protecting the couple from outside elements. It is what partners work to cultivate over time. The couple bubble is composed of the couple’s mutual agreements, shared vision of the relationship, and the way they navigate life together.

How to create your own couple bubble:

  • Put your relationship first.

  • Understand your partner’s attachment style and recognize their triggers

  • Maintain shared habits or rituals

  • Be your partner’s support system

  • Maintain eye contact

  • Take breaks for your own self-care

PACT and the body

PACT couples therapy uses a body based approach. The therapist reads the body language of the couple, which can provide meaningful details of the story. The therapist will observe and take notice of changes in voice, posture, facial expression and will help you to recognize these shifts in yourself and in your partner. Paying attention to these more subtle signs and learning what they mean can put you on the path to nonverbal attunement.
 
PACT integrates attachment theory, neuroscience and biology. Here's a brief description of each of these areas and how they are valuable in therapy:

Attachment Theory:

Attachment Theory explains the biological need to bond with others.  Experiences in early relationships create a blueprint that informs the sense of safety and security you bring to adult relationships. Insecurities that have been carried through life can wreak havoc for a couple if these issues are not resolved.  When resolved, safety and security is restored for the couple and the individual.  Understanding our attachment type and what that means in your relationship allows us to understand and respond to each other with more care.  

Neuroscience:

Neuroscience is the study of the human brain.  Understanding how the brain works provides a basis for appreciating how people act and react within relationships.  Some areas of your brain are wired to reduce threat and danger and seek security, while others are geared to establish mutuality and loving connection. Understanding our partner’s brain helps us work with and adapt to each other’s strengths and challenges.  

Arousal Theory (Biology) and Regulation:

This area of study allows us to learn how to help our partners and ourselves keep “the smart part” of our brain online so we can be our best under distress.  Couples can get stuck in the cycles of fighting, withdrawal, and shutdown (fight, flight & freeze).  Seeing responses through this lens reveals that our immediate interactions when upset is simply how we are wired and “not personal or intentional.” The “primitive part” of our brains makes decisions without our conscious permission and we make mistakes and misappraisals- this is usually what we fight about.  

More About Arousal Theory…..

Your nervous system constantly takes in sensory information and responds accordingly. When there is no perceived threat to you feel safe, calm, you can likely breathe easily and your heartbeat is slower. You may have heard the terms "fight or flight'; these are the mobility responses of the nervous system. When the nervous system senses danger and rings the alarm like a smoke detector, can you move into mobility (fight or flight) to stay alive?

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Sometimes fight or flight isn't an option when what we're faced with completely overwhelms us. When this happens, we can go into a free state or a state of mental and/or physical immobility, like a gazelle playing dead when a hungry lion outruns it. This inability to respond or complete our natural, self-protective mobility responses (fight or flight) can result in survival energy getting trapped in our nervous system.

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Imagine your nervous system is like your hand. Notice when your hand is relaxed and open it is able to move easily and complete all kinds of tasks. Now make it tight fist and notice the energy it takes to keep that hand closed and the fingers tight, and how other parts of your body have also likely tensed with your hand such as your stomach. Your hand is not able to do as much in this position, and the tension in your body may be uncomfortable (and familiar).

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Overtime our nervous system can spend so much time and fight, flight or freeze these states become the default setting making it even hard to move into a state of rest and relaxation, even when we want to. Cumulative cycles of unreleased survival energy also build up over time and can affect learning and memory, and cause health concerns such as high blood pressure, heart disease and weight gain.

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So how do you know what state your nervous system is in? Symptoms of a dysregulated nervous system can include:

  • Insomnia

  • Being easily startled

  • Feeling numb emotionally and physically

  • Addiction including substances or behaviors such as gambling & shopping

  • Feeling ‘spacey’ and disconnected

  • Anxiety

  • Depression

  • Post-traumatic stress

  • Occupational stress

  • Relationships issues

  • Inflammation

  • Chronic pain

  • Phobias

  • Headaches

  • Joint and muscle pain / tension not resulting from injury

  • Dizziness or vertigo

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Trauma and chronic stress are one of the biggest causes of nervous system dysregulation. Trauma does not necessarily result from the action, situation or circumstance but how we responded or were able to respond at the time. Trauma can emerge from:

  • Childhood sexual, emotional or physical abuse

  • Ruptures in attachment/attunement with primary caregivers

  • Abandonment

  • Abusive or neglecting relationships

  • Illness (i.e., medical condition, addiction or mental health concerns) in our primary caregiver(s)

  • Directly witnessing the hurt or harm of others

  • Motor vehicle accidents

  • Occupational stress injuries

  • Death of loved one

  • Near death experiences

  • Worksite injuries

  • Fall or near falls

  • War and escape from war torn countries

  • Sexual harassment

  • Surgery

  • Pre and perinatal (before and during birth) issues

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