PACT

Domain V · Systemic, relational, group & community · Stan Tatkin

What it is

PACT is a conjoint couple therapy that Tatkin calls non-linear and poly-theoretical. It draws on five domains: attachment, arousal regulation, neurobiological development, therapeutic enactment and therapeutic narrative. Its aim is a secure-functioning relationship. The Institute defines that as a…

Format

• Format.
• Both partners attend every session.

Who practises it, and how they are trained or regulated

• The Institute's Level 2 training organises PACT treatment into three parts: the first session, the middle sessions and the end session, each with its own "overarching principles", plus creating a treatment plan. The page names these parts and their skills but does not give their contents step by step. Below, Stage A corresponds to the first session, Stages B–C to the middle sessions and Stage D to the end session.…
• Partners sit on rolling (wheeled) chairs in an open area so the therapist can move them and see their whole bodies. The Institute requires certification and Level 3 candidates to confirm their office has rolling chairs and video capability.
• Stage D: consolidation and the end session. Build shared rituals and collaborative solutions, and the governing agreements of the couple bubble: morning and bedtime routines, reunions, being each other's go-to person, managing third parties, and fighting well. The Level 2 training has separate "principles" and skills for the end session and for creating a treatment plan, but the page does not describe them. The…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• words that the face contradicts.
• one partner designing it and the other complying.
• whether they can end in relief rather than stalemate.
• sham agreements to end the discomfort. Check both faces.
• surprise that lands as mockery. Repair at once (section 5).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.