Staging to Influence the Thermostat in Couple Therapy

By Melissa Ferrari

Dip. of C & C, Advanced Dip in Transactional Analysis (Psychotherapy)

Clinical Registrant PACFA

PACT Level 3 Candidate, PACT Ambassador

https://melissaferrari.com.au/

We all know that moment when we see a couple for the first time. Immediately, as a trained PACT therapist, you notice nuances in how the couple interacts. One partner’s shoulders slouch as they walk in. The other has their chest puffed out almost as if they are protecting themselves. In that moment, you know you would bounce right off of them if you dared to approach or get too close.

Tom and Sarah are a couple in their mid-forties with two adult children who had moved away from home in the last year. Before we even all sit down to talk, I think to myself, “These two have been dysregulated for some time, possibly even years.” I notice, as their couple therapist, that I feel a little sad and possibly even a little worried about them. What is going on with this couple? What has happened to cause this level of protection and pain? How have these two people, who seem nice enough, caused each other to feel unsafe or unloved or possibly even threatened? How am I to help them? What do they need to feel safe enough to re-engage again?

I sit and wonder about how long it will take for them to recover from the states they are both in. How will they help each other out? Are her shoulders hunched because she feels withdrawn and unhappy? What other signs do I see that confirm my thoughts?

As they begin to speak, I can see how she seems so small, so deflated, with her shoulders slumped. I observe her partner. He sits stiff-backed in his chair, chest high, shoulders set, staring at her. When she looks back at him, he looks away. To me, it’s like watching a critical father, observing his child – saying everything while saying nothing.

Therapist Self-Regulation

I scan my body as I observe this couple to see where I am holding tension: in my chest, my arms, and across my upper shoulders and back. I think of how I can move a big muscle group to help shift that tension, so I get up out of my seat and turn on my video camera. I explain to my couple that the camera is part of what I use as a PACT therapist who likes to have all the tools she needs on hand to help them. They nod that this is fine, as they were already aware that video playback would be part of the treatment. I get back in my chair and settle, realizing my tension has shifted and that moving the big muscle groups made a difference. I remain in my seat with legs uncrossed. I sit between them both, all three of us on my brand new rolling chairs. I think to myself, “Finally, this third round of chairs fits the bill regarding comfort, mobility, and movement.” I feel settled. The tension has left my body.       

Co-Regulation and Engagement

As I focus on the couple, I ask them, “So, how can I help?”

Sarah: “He is always angry with me.”

Tom: “She is so boring and doesn’t talk to me.”

Sarah: “No, why would I?”

Me: “Wow, you two are very angry with each other.” I pause to give them time to reflect on my observation. After a short silence, I say, “Why don’t you two turn your chairs and face each other? I have these chairs for a reason, so we can do this. Tell him why you are so angry with him.”

Sarah: “There is no point. He doesn’t listen anyway!”

Tom: “Who says I don’t listen to you? You talk so softly that half the time I can’t hear you.”

Me (to Sarah): “Raise your voice a little and tell him why you don’t tell him why you are so angry. Go on, tell him.”

Sarah (with her voice raised as I look at her confidently with support and encourage her to face Tom): “I am angry with you because you don’t talk to me! You don’t look at me like you love me anymore! You just ignore me and tell me I don’t talk loud enough for you to be bothered listening to me.”

I glance at Tom and then look back at Sarah and tell her to stop and wait. I then look at Tom again with a smile to encourage him to look at her and respond to what his partner has said to him. 

Tom (to me): “I have never heard her say that she even notices how I look at her.”

Me (stopping him): “Tell her, not me.”

Tom (looking at Sarah): “I have never heard you say that you even notice how I look at you. Of course I love you, but I just think you aren’t interested in how I feel because you speak so softly and seem so unhappy.”

Sarah (in a loud voice, crying): “I love you, goddamnit. I have loved you forever.”

Tom (with a twinkle in his eye): “Well, why did you not say so earlier? I love you, too.”

Sarah (still crying): “You have not told me that in years!”

Breaking Patterns

What I have used above is an intervention to enable the couple to show me what they do. I asked Sarah to lift her voice, even yell at him to see what she does. She did exactly what I anticipated. As soon as she felt safe enough, she used all her might to tell him. In turn, he – who seemed so very closed off psychologically – “saw” her. Once she felt seen, she responded kindly.

As a PACT therapist, I want to see what happens – and I am prepared for whatever happens. I am not afraid. I am confident in my interventions because in my mind I am “experimenting,” as I had reminded Tom and Sarah at the beginning of our session.

I have also had the fortunate experience as a PACT therapist to listen to Dr. Stan Tatkin explain that getting couples to stage a disagreement in the therapy room helps the PACT therapist get as much information and data as possible. Doing an intervention, like the one between Tom and Sarah, forces the couple to see each other fresh and in real time. When they are not engaged in automatic content – work, kids, the relationship – they are forced to improvise. As a result, a new experience can emerge.

Engaging a couple, having them go face-to-face in real time helps them create a new experience, which has a good chance of creating new excitement in their relationship as it breaks that old pattern of negative memories. My job is to sit and wait over the course of therapy to see how staging can help them create new memories that have some novelty, engagement, and excitement.

The joy I feel when I see a couple re-engage brings me the kind of fulfilment that in my final days will confirm for me that my life was worthwhile and that I made a difference.