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Healing Couples' Relationships With a New Therapy

The psychobiological approach connects the brain and the heart

By Stan Tatkin

In my early years of practice as a psychotherapist, I worked primarily with individuals diagnosed with personality disorders. I was especially interested in how these disorders might be prevented. These days, there is a fair amount of discussion about prevention of psychological disorders — including some arguably debatable genetic interventions — but back then there was less research. As I began to work more with adult couples, I also found myself interested in how the problems they faced could be stopped before their relationships blew up.

As it turned out, my interest became more than purely professional. Around that time, my first marriage ended in divorce. To be honest, I didn’t see it coming. I was devastated and feeling very vulnerable. My need to understand the failure of my own marriage drove me to delve into the science behind relationships. I wanted to understand what the field of psychology had not taught me and what more could be done to help couples in trouble.

It was too late for my first marriage, but at least I could help others.

The more research I examined, the more convinced I became that we therapists had not fully connected the dots when it came to working with adult romantic relationships.

For one thing, many therapists spent much of the time working one-on-one with partners in a relationship. Working with two people at once was seen as a bit intimidating. And why wouldn’t it be if therapists weren’t confident they had effective techniques for working with a couple together?

Ultimately, I identified three areas of knowledge that, taken together, I believed could revolutionize how we work with couples.

3 Areas of Research

The first of these is the field of neuroscience, the study of the human brain. It tells us a lot about how the brain and nervous system affect our social-emotional functioning. Most importantly, the primitive, implicit and nonverbal parts of the brain — not the more formal, cognitive, speaking parts — run the show in adult relationships.

This, in and of itself, is something I feel has been underestimated by many schools of therapy. For example, a couples therapist may place great emphasis on the words partners use, sometimes to the exclusion of all the subtle gestures and micro expressions going on beneath their verbal exchange.

A second area of research is attachment theory, which explains how we bond with others, starting during our earliest relationships. Attachment research has shown that some people grow up feeling basically secure, while others have a basic sense of insecurity. These initial experiences create a blueprint stored within us that we carry into later life. However, psychologists have only relatively recently acknowledged the extent to which this blueprint plays a role in adult romantic relationships. As I further studied this, and continued to closely observe the couples in my practice, it became clear that people adhere to one of three styles of a relationship, or a combination of them. I gave these the names “anchor,” “island” and “wave.” Couples found them helpful in understanding how and why they responded to each other as they did.

The third area of research is the biology of human arousal. By this, I don’t mean sexual arousal, but rather our moment-to-moment ability to manage our energy, alertness and readiness to engage. This research suggests that couples can learn to manage each other’s highs and lows. In fact, just as they can understand each other’s attachment styles, they can understand their moods and energy levels.

The Intersection of Differences


Informed by these three areas of research, I began to synthesize and integrate them into my therapy practice. I called my work a psychobiological approach. I became increasingly interested in how the different areas intersected.

For example, suppose a partner has the kind of insecure orientation I call an “island.” She would tend to pull away from her partner when she feels threatened by his approach, intrusion or demand. Primitive parts of her brain dominate in moments of threat as her arousal climbs. Her attachment blueprint contains memories that remind her that withdrawal and distancing are the best strategies for protecting herself. She can’t stop this reflex on her own and may not be able to repair the damage her distancing causes to her relationship — at least, if she hasn’t yet learned to do so.

Now suppose the other partner has the kind of insecure orientation that I call a “wave.” He would feel threatened by his partner’s withdrawal and, in order to calm down, would reflexively advance on his partner. He cannot stop this reflex on his own and may be unable to repair the damage his clinging behavior causes to the relationship.

Sounds hopeless, yes? Actually, islands and waves can work beautifully together if they understand each other’s psychobiological reflexes and are skillful at managing them in the other person.

Keeping Relationships Strong

Of course, that’s a very cursory description that barely touches on the richness of the psychobiological approach I have worked with over the past decade, and which I am now teaching to other clinicians. But hopefully it gives at least a glimpse into the essence of what I call a secure-functioning relationship, which is based on the principles of sensitivity, fairness, justice, collaboration and true mutuality. In a secure-functioning relationship, artners are in each other’s care and are experts on one another.

The good news is that even if couples don’t currently operate out of that framework, they can learn. It is not necessary for either or both partners to be secure in order for them to become a secure-functioning couple. Of course, having a trained therapist can help. However, not all couples require therapy to improve their relationship.

I would add that I’ve been a prime beneficiary of this approach. All the work I did paved the way for my current marriage, in which I now enjoy a secure-functioning family. My wife, Tracey, and I consciously built a relationship that would be secure and lasting. We agreed to place our relationship first and protect each other in public and in private. We are each other’s primary go-to people. We repair injuries promptly and tell each other the truth in a timely manner. These and other agreements have created a foundation of safety and security that keeps our relationship strong.

Stan Tatkin is the author of Wired for Love and Your Brain on Love, and co-author of Love and War in Intimate Relationships. He has a clinical practice in Southern California, teaches at Kaiser Permanente and is an assistant clinical professor at UCLA. Tatkin developed a Psychobiological Approach to Couple Therapy® (PACT), and together with his wife, Tracey Boldemann-Tatkin, founded the PACT Institute. Read More
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