Growing together with PACT

Building a healthy relationship isn’t easy. Each partner brings a lifetime’s worth of experiences, trauma, and learned behaviors that affect how they attach and relate. The psychobiological approach to couples therapy (PACT) is a couples therapy method that looks past current conflicts and dives into the way your biological systems respond to each other. 

PACT therapy is relatively new, so there’s not much research behind it yet. But, it has the potential to help couples, especially those who’ve tried other forms of couples therapy and haven’t seen the changes they were hoping for. 

What is PACT therapy?

PACT is a newer couples therapy approach designed by Stan Tatkin, Psy.D. It blends biology with attachment theory to help couples understand each other on a deeper level.

Three main areas of research ^[1] come together to form the foundation for PACT therapy. These are:

1. Developmental neuroscience: PACT helps couples to understand how certain life events can shape our brain chemistry and the way we interpret the world around us. For example, people who experienced abuse or neglect in early childhood might feel more reactive to certain triggers within the relationship. 

2. Attachment theory: Attachment theory plays a big role in PACT. This is about the patterns you form in childhood that shape how you connect with others later in life. It explains why some people feel naturally safe and close in relationships while others feel anxious or distant. In particular, having an insecure attachment style can make it hard to develop a safe and healthy bond with your partner.

3. Automatic arousal: There are many neurobiological changes that happen when we’re under stress. PACT therapists are trained to notice and respond to the micro-behaviors in both partners — like slight shifts in facial expressions — that show what each person is feeling. 

Like its name indicates, PACT is a psychobiological approach to couples therapy. This means that it primarily focuses not only on current conflicts but all of the events (in both partners' lives) that have led up to them. 

PACT looks at your relationship through a developmental lens. It considers early attachment experiences, especially from birth through the first two years, as key periods that influence how your brain learns to regulate stress and connect with others. PACT therapists also pay attention to how the brain continues developing throughout your life, since these changes can affect how you respond to relationship stress and closeness.

What happens during PACT sessions

PACT sessions can look and feel different from more traditional couples therapy sessions, so it can help to know what to expect.

First, PACT sessions can last much longer than the traditional 50 minutes — often between three and six hours each. But typically, fewer PACT sessions are required, which means you may be in couples therapy for less time overall.

During a typical PACT session, your therapist may:

• Recreate common situations that lead to conflict in your relationship so you can work them out in real-time

• Help you notice the very subtle shifts in body language and facial expressions that show that your partner is under stress

• Videotape your sessions (with your consent) to provide immediate feedback

Here’s an example of how a typical PACT session might look ^[2]: 

A couple comes to therapy because the wife says she doesn’t feel loved, even though her husband regularly tells her he cares about her. The therapist asks when this usually happens, and they explain that it comes up at night while they’re lying in bed. The therapist has them recreate that moment in the office. When the husband reaches over to touch her arm and says he loves her, the therapist notices the wife tense up.

When asked what she’s feeling, she remembers that her mother, who often drank at night, used to sit on that same side of the bed to say goodnight. Even though she didn’t think about this memory often, her body still reacted to that position. The therapist then has the couple switch sides and repeat the moment while making eye contact. This helps her stay in the present and take in her husband’s words without the old memory getting in the way.

Who PACT may be right for

PACT is based on research and rooted in scientific fact. But we don’t yet have research that helps understand exactly how effective it is.

But according to Dr. Tatkin and other PACT practitioners, this couples therapy method can help with relationship concerns like:

• Insecure attachment patterns

• The pursue/withdraw cycle

• Jealousy

• Conflict and unhealthy fighting patterns

• Infidelity and trust issues

• Feeling disconnected or out of sync emotionally

• Power struggles about closeness, independence, or household roles

• Difficulty recovering after arguments or calming down together

It’s important to understand that PACT is a form of couples therapy. It can’t help with individual mental health concerns like depression or anxiety. But if problems in your relationship are contributing to your mental health, going to couples therapy can help. 

How PACT benefits couples

Unlike more traditional forms of couples therapy, PACT helps couples understand the neurobiological basis behind why each partner behaves the way they do.

PACT therapy may help you and your partner: 

• Better read each other’s nonverbal signals, especially during conflict

• Understand why you and your partner seem to see situations differently

• Understand how your own actions — even involuntary or unconscious ones — might be affecting your partner’s emotional state

• Help each other calm down during conflicts

• Build a secure attachment 

• Help each other feel safe within the relationship

Starting PACT therapy together 

Before you start PACT therapy, make sure you understand what it looks like and what will be expected of you. In particular, know that sessions can be hours long — and to be ready to commit to that time.

There is a certification process to become a PACT therapist. You can find a certified PACT practitioner on the PACT Institute’s therapist directory ^[3].

You might ask potential therapists questions like:

• Are we a good candidate for PACT therapy? Why or why not?

• How long have you been trained in PACT, and what levels of the certification have you completed?

• What should we expect during longer PACT sessions, and how often do you usually recommend them?

• What kinds of concerns or patterns have you found PACT to be most helpful for?

• Do you accept insurance? What about for longer sessions?

Clinician’s take

With PACT, couples begin to understand each other’s nervous systems rather than personalizing each other’s reactions. When they learn to read cues, regulate together, and repair in real time, their conflict softens and safety increases in a way that feels immediate and sustainable.

Ashley Ayala, LMFT

Clinical reviewer