What is PACT?

Understanding the Foundations of PACT Therapy

PACT stands for Psychobiological Approach to Couples Therapy.

PACT therapy prioritizes connection and attunement over verbal communication. It invites couples to find a felt connection using non-verbals such as eye contact, body positioning, sensitivity to each other’s cues and direct bids for care and attention.  

PACT therapy emerged from Stan Tatkin’s career working with groups and individuals dealing with issues caused by personality disorders, addictions and trauma. When his own marriage went into crisis he began to work towards early prevention with mother-infant dyads. The failure of his marriage plagued him and he began to transfer his thinking about infant attachment, arousal regulation, and developmental neuroscience to adult couples in an attempt to understand his own loss.  

The PACT approach pays close attention to the brain, mind and body. It is based on the premise that the implicit, primitive and nonverbal parts of the brain are responsible for most behavior in adult primary attachment relationships.  

For therapy nerds, Stan’s work also incorporates structural and strategic family therapies gestalt, psychodrama, body psychotherapies, mindfulness, Morita and Naikan therapies and object relations. Although this combination of approaches sounds a bit scattershot, Tatkin’s genius lies in his ability combine elements of different approaches into a coherent and applicable framework.  

Stan’s simple epiphany that the couple is ‘in each other’s care’ forms the basis of PACT. He shifted his emphasis away from self-regulation and towards interactive co-regulation and precipitated a creative process that began in 2003 and continues to evolve.

The Goals of PACT

• Maintain a healthy and embodied connection 

• Learn how to help each other feel secure and safe

• Minimize each other’s stress and protect each other’s health

• Learn how to fight well

• Learn to tolerate and navigate each other’s emotional highs and lows

What to Expect in a PACT Session?

• The therapist will pay close attention to shifts in your face, body and voice and ask you to pay closer attention to these in your partner. 

• The therapist will invite you to re-enact experiences that trouble your relationship in order to work through them in real time.  

• The therapist will invite you to explore aspects of your past that may have laid the groundwork for unconscious and habitual patterns you bring into relationships.

My Approach to PACT

Although PACT provides an effective framework it will always be implemented in combination with the therapist’s distinct style and background. For example, I often use the sand tray for re-enactments and family of origin work. And I make modifications for clients that do not tolerate eye contact and/or feel resistant to directive interventions.  

PACT work requires physical as well as emotional availability from both partners. It is more demanding on the nervous system than individual work where the therapist can focus exclusively on keeping one client safe and cared for. For couple’s dealing with a history of trauma it is recommended that you maintain a relationship with an individual therapist alongside the couple’s work.  

My therapeutic style my not be a good fit if one partner is leaning out of the relationship and wants to use couple’s work to explore their reasons for leaving. If our sessions are leading toward the possibility of a separation, I may offer a referral to a therapist that specializes in this type of work.  

I like to give a heads up that you may be tired, dysregulated and emotionally tender after a couple’s session. If possible, it is a good idea to schedule some stress-free time together after couples to rest, look after each other and integrate the work you have done.

Further Exploration of PACT

Explore PACT even further with this video by Stan Tatkin.

CRISTINA WAIT
Psychotherapy Services

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What is EMDR?

Understanding EMDR

EMDR stands for Eye Movement Desensitization Reprocessing.

The central goal of EMDR is to stimulate the brain’s innate capacity to to self-heal.

It is widely known as an effective and research-backed treatment for PTSD and a growing list of other applications.  The underlying mechanism of EMDR is somewhat shrouded in mystery and can be difficult to describe.  Like so much of psychotherapy, effective implementation is part science and part art.

EMDR is based on the premise that much of our unwanted psychological disturbance is caused by dysfunctionally stored information.  Given the right circumstances, we are naturally equipped to cope with and recover from intense levels of difficulty and challenge.  Our built-in ability to cope is called the Adaptive Information Processing system (AIP).  EMDR therapy recovers dysfunctionally stored memories and connects them to the AIP.  For those that appreciate a more tangible explanation - the AIP requires a successful transfer of information from the lower threat detection centers of the brain up to the prefrontal cortex (PFC).

When the stresses and challenges of a situation overwhelm the nervous system, it loses the ability to connect to the PFC and gets stuck in its original state of disturbance.  Disturbing experiences along with their nightmarish qualities, become embedded in the deeper base areas of the brain. 

These embedded memory components can present in a variety of ways that may include:

• Flashbacks

• Nightmares

• Panic attacks

• Eating disorders

• Chronic pain

• Autoimmune disorders

• Unexpected and overwhelming emotions

• Social isolation

EMDR does not focus on the severity of the events but turns its attention to the ways in which your nervous system has stored the impact.  Dysfunctionally stored information can include:

• Physical sensations

• Direct sensory inputs

• Strong emotions

• Distorted beliefs

Unlike some forms of traditional talk therapy, EMDR asks for the full participation of your physical body alongside emotions and thoughts.  Processing a memory with EMDR does not require an inventory of all the details of the trauma.  Forming a connection with a sensation, muscle memory, emotion and embedded thought is often enough to re-capture the memory and start the healing process.

Connecting with body sensations and emotions opens the door to internal discrepancies where you know one thing yet feel another.  This can include times when:

• You feel afraid, yet know you are safe

• You feel strong emotions for no apparent reason

• You know what to do but can’t follow through

Experiencing a disconnect between what you know and how you feel is often the working edge of therapy.  An effective EMDR intervention can help you reconcile this internal conflict and move towards re-alignment and understanding.

EMDR Therapy Process

For reasons that we do not fully understand, bi-lateral stimulation (known as BLS movements) creates space for the brain to re-process intolerable feelings, sensations and thoughts.  In EMDR the most commonly used BLS is a horizontal right-to-left motion of the eyes.  Therapists can also use tapping, buzzers or auditory devices to create the same effect.  This explains why you can sometimes find resolution to a problem or dilemma during a walk or swim – both activities are distinctly bi-lateral.  It also explains the growing use of headphones and binaural beats for helping with focus and meditation.  We also know that during REM sleep the eyes spontaneously move back and forth while dreaming.

The actual implementation of EMDR varies from client to client based on presenting issues.  But the basic order of events is to

1. Identify and target the memories linked to your disturbance

2. Re-encounter the memory in a safe manner

3. Use BLS to re-process the memory

4. Connect with your innate intelligence and resilience

5. Place the memory in its proper context and move forward with your life

Following EMDR, the memory may still register as sad or upsetting but the debilitating side effects are lessened.  You recover the ability to remember without re-experiencing.  Clients often report a renewed ability to feel smart, aware and skillful alongside their strong emotions.

Practical Aspects and Benefits of EMDR

EMDR can be useful under a broad range of circumstances ranging from single events to ongoing persistent stress.  It combines well with all the other therapeutic modalities.  And can be an adjunct to talk therapy when a specific issue seems stuck and intractable.

For some clients the contained structure of EMDR reduces the pressure to figure out what they want to talk about in therapy. EMDR includes goals and metrics for improvement that provide a sense of closure and completion when a target is fully processed.  This can be reassuring for clients that want to feel a sense of tangible forward momentum in therapy.

I am consistently stunned and inspired by the deep insight, courage and intelligence people show while processing via EMDR.  It is an approach that positions clients to leverage their own inner resources and strengths rather than relying on the therapist for insight.

EMDR in Practice

EMDR can be done via telehealth or in-person.  Session lengths can vary between one hour and 3 hours for an intensive.  I personally prefer to see people in person so I can monitor their body language and provide a felt connection if they encounter a strong reaction.

I appreciate the humanistic aspects of EMDR.  Rather than viewing people as problems and attaching diagnostic labels, it treats mental health symptoms as glitches in memory produced by earlier experiences.

Like all psychotherapy, EMDR is collaborative and relies on a good connection between client and therapist.  For a client, there is no such thing as doing EMDR ‘wrong.’ The burden of proof is always on the therapist and the modality.

If you are interested in trying EMDR bear in mind that it is a non-linear multi-step process.  And, depending on your circumstances, it may take some time to get results.  As always, the gold standard for any form of therapy is whether it works for you and alleviates your symptoms safely and within a reasonable time frame.

Further Exploration of EMDR

Explore EMDR even further with these two videos, providing a visual understanding of its techniques and effects.

CRISTINA WAIT
Psychotherapy Services

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What is Therapy?

Therapy often traverses the baffling territory between what we ‘know’ about ourselves versus how we ‘feel’ and experience ourselves (and others). When we experience abuse, neglect, mis-attunement, racism, neurodivergence, codependency and traumatic events, we often form deep brain stem defenses designed to ensure our basic survival and protection. These defenses can become rigid and embedded, leaving us disconnected from ourselves and vulnerable to depression, isolation, anxiety and despair. A therapist can help you reconsider outdated reactionary patterns and initiate a renewed sense of choice, authorship and personal freedom.

We regularly update operating systems on our technological devices, but often drag defensive operational systems formed during childhood and difficult adult experiences across our lifespan.

Newcomers to the idea of therapy often assume that trauma refers to a single catastrophic event. In reality, trauma is often experienced as a glitch in the way our brain stores memories.

Traumatic memory is often blurry, adhesive and imprinted with fear. It can leave us stuck in a continuous bodily experience of hypervigilant overreaction and/or paralysis and collapse (or both). Re-visiting difficult experiences in therapy provides the chance to reconsider them in the clear light of your intelligence, strength and awareness.

Therapeutic theories describe this process in different types of language – re-claiming your true self, re-moving unconscious barriers, re-engaging the prefrontal cortex, re-authoring and revising your life, moving away from reaction and towards choice. Regardless of the language, the central message is the same - your problems don’t necessarily go away, but you can establish a strong connection to your inner resources and navigate problems with skill, choice and insight. The work is non-linear and often slower than we would like, but therapy should be accompanied by a sense of expansion, coherence and forward momentum.

Ongoing discoveries in neuroscience research confirm what therapists have always known - that a large percentage of healing and change in the therapy room occurs in the creative, relational and nonlinear right hemisphere of the brain. Although therapy is challenging work, it should also feel warm, playful and enlivening.

CRISTINA WAIT
Psychotherapy Services

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