PACT Therapy with Disorganized Couples
Nov 11, 2021
PACT Level 2 Therapist
Insecurely attached partners, those who operate from a one-person psychological system, tend to place “pro-self values over relationship and defend against interdependency and mutuality,” as Stan Tatkin writes in the October 2020 issue of Science of Psychotherapy.
In other words, when feeling backed against the wall, these partners will instinctively move to protect the self at the expense of their relationship, not realizing their well-being is linked. In these scenarios, both partners lose.
With an organized insecure couple, the capacity to create a therapeutic alliance with the couple therapist exists when all parties understand their roles and the purpose of the work. The therapist may notice they feel part of a team. Disorganized partners have not achieved this developmental milestone and instead operate at a much lower level. They may come to therapy seeking to work on or change their partner instead of working on the system the two have created and maintained.
Disorganized partners will need the help of the PACT therapist to learn how to construct a safe relationship system, first by learning to trust the therapist.
Case Example: Nicki and Carlos
Nicki and Carlos have been living together as a couple on and off for three years when I first meet them. I learn in our first session that Nicki is the youngest of three siblings. She has a history of early childhood neglect and abuse yet remains enmeshed with her family of origin, which Carlos cites as a major issue in their relationship.
I cross-comment to Nicki that it can be hard to differentiate from our family system for a variety of reasons and that many people struggle with this well into adulthood. My intention is to both create a sense of feeling felt in Nicki while also beginning to build curiosity and compassion in Carlos for his partner. Carlos grew up as the only child of a single parent. He has limited insight into his family dynamics or how they affect him today.
Observing the Assumptions and Ruptures
My first clue that I may be dealing with disorganization is that I find these partners difficult to corral in session. They run amuck without allowing me to intervene or slow them down. While they are both warm and pleasant individuals, smiling and nodding often in the beginning of session, I must remind myself not to mistake the friendly rapport for a therapeutic alliance.
Both partners’ narratives are full of assumptions. They neglect to bridge their trains of thought. They are showing me that no one ever cared for them in ways that instilled the basic principles of safety and security. Disorganized partners have experienced their primary caregivers as threatening and unreliable: the hand that feeds you can turn on you at any time. They will need support to learn how to take care of each other and not turn on each other, even when they are angry and upset.
In the second session, I try to slow an exchange around a recent fight at home. Nicki suddenly turns her rolling chair around to face me as she takes her phone out saying, “Dr. Moates, I am glad you brought this up because I actually recorded him during the fight. I think you should see this so you can understand what I’ve been trying to tell you about how he treats me.” She gestures toward Carlos, who sits motionless.
I pause then let her know kindly but firmly that I don’t have partners show videos or text threads to me. I need to see interactions in the room in order to help them. It is clear to me that they lapse quickly into seeing each other as threats, and I must take great pains to be a safe person to each of them, scaffolding them toward security first in their relationship with me.
Going Down the Middle
I let them both know, down the middle, that whatever information I need to gain about their relationship will undoubtedly be communicated during sessions. I let them both know that I can sense that they are worried that I might not understand how badly they feel hurt by each other. I reassure them that I can already see that they have wounds that we need to heal. I let them know that we will work diligently to create a sense of safety with each other, but that videos or text threads or emails are not necessary for me to understand how to help them.
I make friendly eye contact with each of them and keep my face relaxed and warm as I convey this, scanning to see if either seems to feel shamed or targeted. Disorganized partners are quick to feel attacked and see the therapist as a threat, so I am careful to keep my tone, face, and gestures soft and welcoming.
Staying Regulated
Near the end of the second hour, their arousal spikes again. Nicki bursts out in loud wails in response to Carlos rolling his chair backward and throwing his arms up. Nicki stands, screaming she “can’t take anymore.” Because I won’t take her side that Carlos is the bad guy, she feels like she is going crazy. She screams and runs out of my office, slamming the door so violently my wall hangings shake and almost fall.
Carlos sits frozen. After I take a few breaths to bring my own nervous system back online, I escort him out to the waiting room and help him formulate a plan to call for a ride since Nicki has left the office with their car.
When working with disorganization, the session can devolve quickly. The PACT therapist needs to know how to stay regulated, even when the partners are not. By modeling how to stay calm in eruptions, I am starting to signal to Carlos that even when it looks like things are falling apart, you can stay regulated and work toward repair. This lesson will need to be repeated with Nicki in the room in the future. They will likely go through multiple rounds of rupture and repair with me helping them experience feeling safe in each other’s presence.
Returning Back to Basics
Nicki and Carlos return for a follow-up session, but this time I plan for only an hour and am more directive. We need to reestablish basic boundaries of safety before therapy can proceed. I gently point out that raising their voices — screaming and slamming my doors — will prevent us from being able to work together because that behavior is dysregulating and threatening to each one of us.
I explain that while it may feel very important to pursue a specific thought or agenda, I need them to allow me to interrupt them. Finally, I tell them we need to meet more frequently for shorter sessions because apparent to me is that it’s hard for them to stay regulated for more than an hour.
I do this as a down-the-middle comment so that neither partner feels targeted — they can feel sewn together in that they both have a similar struggle. It is important not to overstress a disorganized couple system with extended appointments. Prolonged meetings often lead a couple to unravel without giving us, as therapists, sufficient time to put them back together. A schedule of one hour twice a week can help provide the containment and consistency necessary for disorganized couples to establish the safety they so desperately crave but are often unable to create outside the therapy room.
