PACT Therapy: How It Works, Cost, & What to Expect

How Does PACT Therapy Use Attachment Theory?

To develop PACT, Dr. Stan Tatkin took important developments from interpersonal neurobiology and merged them with a re-appreciation of attachment theory as it applies to the romantic pair bond.¹ Dr. Tatkin sees our infant attachment experiences as influencing the development of our brain and nervous system, which colors how we relate to others in situations of deep intimacy, dependency, and trust.

By understanding well-researched attachment styles and mapping them on to romantic pair bonding, PACT is able to anticipate blind spots for individuals and areas of misattunement and misunderstanding. This knowledge of attachment and the related brain and nervous system tendencies can be re-trained through new experiences during PACT sessions as the therapist guides the couple to have more synchronous and fulfilling interactions.

While PACT therapy was developed originally to help couples in severe circumstances, it can be applied to almost any pairing.¹ This includes parents and children, siblings, or even friends.

What Happens During a PACT Therapy Session?

Common experiences you might have in PACT therapy include learning to read your partner’s expressions and gestures to assess whether or not their nervous system is settled or unsettled, and then learning through experiences in session how to move your partner’s nervous system from dysregulation into regulation, using things like eye contact, vocal inflection, physical proximity, and touch.

Moving Toward Collaboration

A PACT therapist watches how a couple moves through a disagreement, not just what the disagreement is about (money, sex, time, mess, or kids). Are they productive? Fair? Collaborative?

If at any point the couple is not working as a team to better understand each other and take better care of each other, the PACT therapist will interrupt the interaction and point out where things are going off track.

Through finding the disruptive patterns and correcting them, the couple learns how to attune to each other even during disagreements. Relationship conflict is normal in close relationships; PACT teaches the couple how to make a disagreement productive instead of a stalemate situation. Mutual respect is increased and couples feel truly and deeply cared for by the other, even in moments of disagreement.

Body Movement

PACT therapists use body movement and position in session because implicit memory shows up in posture and gesture before it shows up in words.² Explicit memory is conscious and can be recalled and explained verbally. Implicit memory, which guides us through most of our day, is fast, unconscious, and non-verbal.³

PACT therapists make sure to pay attention to posture, gesture, and movements made by the couple to better inform the dynamic, and may encourage the couple to experiment with different ways of greeting each other (hugs, other forms of non-sexual touch) or de-escalating using nonverbal or touch methods.

Highly conflicted situations can be unpacked in deeply meaningful ways by having clients recreate the “scene” in a PACT therapy session so that the implicit memories can be reactivated in real time for the therapist to work with.

Working Through Unfaithfulness

One of the most common reasons that couples come to therapy is infidelity – when one partner is unfaithful physically or emotionally. A PACT therapist is quick to see that there is more going on involving both partners’ histories of trust, betrayal, allegiance, abandonment, and even abuse.

The current betrayal, the affair, is taken in the context of both partner’s histories to deconstruct the larger meaning. It is only when the larger meaning can be revealed that the rupture can be truly repaired and the relationship can be “affair-proofed.”

What Is a Secure-Functioning Relationship in PACT Therapy?

A secure-functioning relationship is the explicit goal of PACT therapy. Dr. Stan Tatkin defines it as a two-person system built on teamwork, full collaboration, and mutual sensitivity, in which both partners protect each other in public and in private and make decisions that are fair and just for both. Rather than teaching communication scripts, the PACT therapist measures every interaction in session against this standard.

Tatkin developed the idea across his clinical work and books, most recently In Each Other’s Care (Sounds True, 2023), which applies secure functioning to the most common recurring fights couples have about money, sex, chores, kids, and betrayal. The core principle: partners agree to a shared set of guardrails, such as repairing hurts quickly and never using known vulnerabilities as weapons, so the relationship feels safe enough for both nervous systems to settle.

Secure functioning is also how PACT is starting to measure itself. The PACT Institute’s first formal outcome study, in progress as of 2025, tracks whether couples treated by PACT therapists actually move toward these outcomes, using standardized tools like the Outcome Rating Scale and PROMIS anxiety and depression measures. Ask a prospective PACT therapist how they define secure functioning for your relationship; the answer offers a preview of what your therapy will aim for.

What Can PACT Help With?

“PACT is effective for couples who are in the pursue/withdrawal cycle and who are open to attachment theory,” says Jason Polk, LCSW, LAC. “Explaining attachment theory and how that cycle plays out has been hugely beneficial for those couples. PACT encourages individuals to be responsible for their attachment reflexes (avoid/pursue) and it also gives them an ‘owners manual’ for their partner. This helps them avoid their partner’s vulnerabilities and know what they can do that can make their partner feel loved.”

Polk continues, “It’s also good for couples who are up for more of an interactive session. PACT encourages face-to-face interaction as well as exercises for connection and practice on being in the present moment and not on automatic pilot, because PACT teaches that when we’re on automatic pilot, we revert to old attachment templates.”⁸

Is PACT Therapy Worth It? What to Know Before Starting

PACT therapy asks more of couples than most models: sessions are longer, the work is emotionally direct, and the cost per session is higher. For a relationship that you hope spans 40, 50, or more years, that investment of time, money, and emotional effort can be warranted.

However, the dividends can be life-altering. Many clients who come to PACT report having failed with multiple therapists and types of couples’ therapy; however, they find substantial relief and change with this dynamic model, often in far fewer sessions.

While the total number of sessions is often less than other couple’s therapies, the actual sessions themselves are quite a bit longer. A typical PACT session is going to be two to three hours. This is because couples bring double the complexity, so a therapist needs double (or more) the time.

A successful PACT session not only shows you the problem, it takes time to move you out of the problem in a way that you can replicate on your own outside of therapy.

What to Expect at Your First PACT Session

In your first appointment, expect a lot of history-taking. PACT, like many psychodynamic therapy approaches, believes that our earlier experiences are formative and tend to factor significantly into our adult relationships. The therapist will guide you both through a series of questions ranging from how you met and why you chose each other to details about your parents’ relationship and your experiences in childhood.

Sessions are typically two to three hours long. Ask your therapist ahead of time how much time they want for the first session so you can plan accordingly. If a couple (or pair) has high levels of distress, sessions may need to be shorter (closer to an hour) but more frequent (instead of once a week, they may meet 2-3 times).

Although it’s completely optional, many PACT therapists will suggest you allow them to videotape sessions. This allows them to review footage after the fact. A couple’s therapist is trying to track two faces, two bodies and two nervous systems and sometimes, things are missed in real-time. Videotape allows them to analyze frame-by-frame what happened.

How Much Does PACT Therapy Cost?

Each PACT therapist sets their own rates, according to the PACT Institute. Couples therapy commonly costs $150 to $250 per hour in 2025, per Thriveworks pricing data, and because a PACT session usually runs two to three hours, couples should budget several hundred dollars per session, often $300 to $750.

Some insurances do cover couples therapy, but be aware that they may only cover one hour of the two-hour (or longer) session. Some insurances don’t cover any amount of couples therapy so you may need to be prepared to pay out of pocket.
How PACT Compares to Other Couples Therapies

PACT is one of several structured couples therapy models. Here is how it compares to the Gottman Method and Emotionally Focused Therapy:

How Do You Find a PACT Therapist?

PACT therapists can be found by searching an online directory and selecting “PACT” as a specialty in the search tool menu. PACT training has three levels: Level 1 (Foundations), Level 2 (Working with Difficult Couples), and Level 3 (Advanced Practicum taught by Dr. Stan Tatkin and Dr. Hans Stahlschmidt). Therapists who complete Level 3 can then apply to the separate PACT Certification Program, which includes mentored case presentations with Dr. Tatkin.

What to Ask a Therapist Before You Begin

Before beginning PACT therapy, as with any therapy, it’s important to ask the therapist some questions about their experience and methods.

Here are question to ask a PACT therapist:

• Have you worked with this particular problem before?
• What kinds of outcomes have you had?
• Do you have experience working with our particular problem?
• How many years have you been using PACT?
• Do you adhere exclusively to the model or blend it with others?

How Effective Is PACT Therapy?

Dr. Tatkin began training other therapists in the model in 2010. More than a decade later, PACT still lacks large published randomized controlled trials of its own, though the fields it draws on, attachment theory and interpersonal neurobiology, are extensively researched.^4,5,6

The PACT Institute’s first formal outcome study is now underway. It tracks couples with standardized measures such as the Outcome Rating Scale and PROMIS anxiety and depression scales, with the goal of establishing PACT as an evidence-based treatment. Results have not yet been published. There have been studies showing how the attachment system that is leftover from our childhoods can, indeed, be changed from insecure to secure using a skilled therapist as a guide.⁷ If this can be done with individuals, then theoretically, it should also be able to be shown in couples.

What Does PACT Therapy Look Like in Practice?

Implicit Memory Deconstruction

A couple arrives in therapy; his chief complaint is that she does not seem to feel loved by him. He insists he adores her and tells her this repeatedly but she says she doesn’t feel loved by him.

The PACT therapist explores the issue and asks when this conversation last occurred. The couple responds that it is most often at bedtime, while laying side by side. The husband reaches over to caress his wife’s hair or shoulder and tells her that he loves her.

The PACT therapist has the couple get into this position, side by side, with each of them on the side that they are in their own bedroom. The PACT therapist asks the couple to recreate the scene. As the husband reaches for the wife’s arm and begins to stroke it lovingly, telling her how much he loves her, the PACT therapist can see the wife stiffen.

The PACT therapist then asks what is happening and what she is experiencing. Immediately caught in that exact moment the wife can recall that her mother, who would often drink to excess at night, would come sit on that side of her at bedtime to tell her goodnight.

The wife begins to cry as she recalls how embarrassing it was for her that her mother would be intoxicated, and she wished her mother would leave her alone. This implicit memory is stored in the wife’s body and tied to bedtime and being touched on that side.

The PACT therapist asks the couple to change positions so that now the husband is on the other side of his wife. They do so and the husband is instructed to convey his affection to his wife while at the same time asking her to look into his eyes.

As she turns her head to meet his gaze, this reorients her brain to the present moment vs. allowing the memory from the past to come forward. The change in position further differentiates this experience for the wife. She is able to look into her husband’s eyes, see that it is him, and take in his words of care.

Repairing After an Affair

A husband begins to have inappropriate relationships while away on business. While he loves his wife and family, he feels compelled by the excitement and forbidden-ness of the affairs. This perplexes him as his wife is warm, attentive, and loving. Yet he finds himself engaging in repeated trysts with women who are emotionally unavailable and somewhat cold.

When the affairs come to light, the PACT therapist is able to ask the man “Who else did you feel that way towards in your childhood?” and immediately the man is struck. He tells the story of an emotionally distant father for whom he yearned for approval.

Then the PACT therapist asks about a history of sexual secrets. Again the man is immediately struck and reports that, although he has never told anyone, he was molested by a babysitter from 9-12 years old.

The PACT therapist is able to frame the affairs for both partners as acting out of both a fusion of sexual excitement with secrecy and shame as well as a yearning to win over a distant and cold parent. These unresolved traumas from childhood have emerged into the affair behavior.

The PACT therapist takes a careful history from the wife as well. The wife reveals that her parent’s marriage was broken up by an affair and that although she knew that her mother was having an affair by the time she was in high school, she deliberately turned a blind eye to it, not wanting to “break up the family.”

Thus, the wife begins to see how she could have been turning a blind eye to any signs of her husband drifting away from her emotionally or sexually.

Both partners can see the affair in a new light, one that is balanced, informed by history, and useful to the construction of new and healthier patterns. It is no coincidence that this couple also has a history of not being fully transparent with each other and turning to friends instead of each other when feeling vulnerable.

Final Thoughts On PACT Therapy

If you have tried other forms of couples therapy and can’t seem to make progress, then talking to a PACT therapist may be the next right step. If you’ve never tried couples therapy at all, there is no reason not to start with PACT. PACT is different from other forms of couples therapy, and sometimes different is just what is needed.