Behavioral Couples Therapy Assessment and Treatment Planning
As discussed in Gurman (2008) the best assessment methods in treating couples dealing with drug and alcohol abuse from a Behavioral Couples Therapy approach (BCT) incorporates three major components: Clinical interviewing, paper and pencil measures, and behavioral observations. The following will describe these three factors in depth as well as the importance of goal setting.
Clinical interviewing
Clinical interviewing is used to help build a working alliance with the couple as well as to gain important information related to the couple’s past and current relationship functioning, as well as history with and current involvement with substance abuse. Obtaining information related to the substance abuse, the functioning of the couple, as well as individual information is key in learning the partners’ degree of commitment to each other, to goals, and their readiness for change.
1) Interview Assessment of Substance Abuse
Key issues to address:
Other issues related to substance abuse to be addressed:
2) Interview Assessment of Relationship Problems: “The 7 C’s”
Gurman (2008) describes “The 7 C’s” as seven areas of interaction that act as prerequisites for long-term intimacy. These key areas are described as follows:
3) Individual Assessment
Performing an in depth psychosocial history of each member of the couple is recommended in addition to assessments of the couple as a whole (Gurman, 2008). Issues of confidentiality must also be addressed. Gurman (2008) suggests using a “Limited Confidentiality” agreement that stands outside of normal confidentiality protocol in which the therapist is upfront about not keeping secrets for the partners as well as having the right to terminate treatment or make referrals if information arises that affects the integrity of the therapy.
Paper and Pencil Methods
The second assessment method described by Gurman (2008) involves the use of empirical instruments to supplement and confirm information gathered by other methods of assessment. These instruments provide quantitative data that can be used to develop treatment plans and monitor progress. For example, the Michigan Alcoholism Screening Test to assess partner substance abuse, the Beck Depression Inventory for individual psychosocial functioning, and the Dyadic Adjustment Scale for relationship functioning are all examples of valid ‘paper and pencil’ methods.
Behavioral Observations/Communication Samples
This method of assessment involves the selection of a moderate-intensity issue to be addressed in session. The therapist analyses the couple’s interactions and communication style to gain a better understand of the real-life relational dynamics.
Goal Setting
When working with couples dealing with Substance Abuse, Gurman (2008) states primary treatment goals focus on eliminating substance abuse and strengthening relationship skills. Abstinence of substances is always the ultimate goal. However, sometimes it is effective to start with temporary abstinence or more responsible substance use to obtain commitment to treatment when working with more difficult clients. Goals always start with maintaining sobriety before working on strengthening the relationship, and then move toward relapse prevention near the end of treatment.
Common substance abuse related goals include:
Common relationship goals include:
Step-by-Step Outline of Behavioral Couples Therapy for Alcoholism and Substance Abuse
As discussed in Gurman (2008) the best assessment methods in treating couples dealing with drug and alcohol abuse from a Behavioral Couples Therapy approach (BCT) incorporates three major components: Clinical interviewing, paper and pencil measures, and behavioral observations. The following will describe these three factors in depth as well as the importance of goal setting.
Clinical interviewing
Clinical interviewing is used to help build a working alliance with the couple as well as to gain important information related to the couple’s past and current relationship functioning, as well as history with and current involvement with substance abuse. Obtaining information related to the substance abuse, the functioning of the couple, as well as individual information is key in learning the partners’ degree of commitment to each other, to goals, and their readiness for change.
1) Interview Assessment of Substance Abuse
Key issues to address:
- Type of substance abused
- Quantity of substance
- Frequency
- Extent of dependence/Need for detoxification
- What lead to therapy
- Experience with previous help seeking
- Goals of the substance abuser and family
Other issues related to substance abuse to be addressed:
- Medical problems
- Legal problems
- Financial problems
- Psychosocial distress
- Social/family problems
2) Interview Assessment of Relationship Problems: “The 7 C’s”
Gurman (2008) describes “The 7 C’s” as seven areas of interaction that act as prerequisites for long-term intimacy. These key areas are described as follows:
- Character Features – Refers to the basic personality partners bring to their relationship. Positive characteristics (i.e., humor, integrity, honesty, a good upbringing etc.) are rated more favorably than more difficult traits or experiences.
- Cultural and Ethnic Factors – The developmental and contextual environment the partners were raised in. Couples can either benefit or be challenged by their shared or conflicting backgrounds (i.e., race, religion, cultural gender roles and expectations, emotional expression, etc.)
- Contract – What each partner wants related to what they get from the relationship. An examination of the implicit, implied, or misunderstood arrangements that have developed in the relationship over time.
- Commitment – Examines “Stability” over time and “Quality”. Looks at loyalty and willingness to invest effort to the wellbeing of the relationship. Stability and Quality can be viewed as two separate continuums related to relationship commitment, with high levels in each category desired for optimal functioning.
- Caring – The degree of support, understanding, validation, and appreciation partners have and demonstrate to their mate. Activities, sexual satisfaction, and daily interactions are examined.
- Communication – Effective sharing and receiving of thoughts, feelings, and actions. Positive communication is seen as key in addressing any of the other “7 C’s”.
- Conflict Resolution – Working together to make decisions, solve problems, and address relational issues. Important aspects are accommodation, assertiveness, negotiation, compromise, emotional expression and regulation, and anger management.
3) Individual Assessment
Performing an in depth psychosocial history of each member of the couple is recommended in addition to assessments of the couple as a whole (Gurman, 2008). Issues of confidentiality must also be addressed. Gurman (2008) suggests using a “Limited Confidentiality” agreement that stands outside of normal confidentiality protocol in which the therapist is upfront about not keeping secrets for the partners as well as having the right to terminate treatment or make referrals if information arises that affects the integrity of the therapy.
Paper and Pencil Methods
The second assessment method described by Gurman (2008) involves the use of empirical instruments to supplement and confirm information gathered by other methods of assessment. These instruments provide quantitative data that can be used to develop treatment plans and monitor progress. For example, the Michigan Alcoholism Screening Test to assess partner substance abuse, the Beck Depression Inventory for individual psychosocial functioning, and the Dyadic Adjustment Scale for relationship functioning are all examples of valid ‘paper and pencil’ methods.
Behavioral Observations/Communication Samples
This method of assessment involves the selection of a moderate-intensity issue to be addressed in session. The therapist analyses the couple’s interactions and communication style to gain a better understand of the real-life relational dynamics.
Goal Setting
When working with couples dealing with Substance Abuse, Gurman (2008) states primary treatment goals focus on eliminating substance abuse and strengthening relationship skills. Abstinence of substances is always the ultimate goal. However, sometimes it is effective to start with temporary abstinence or more responsible substance use to obtain commitment to treatment when working with more difficult clients. Goals always start with maintaining sobriety before working on strengthening the relationship, and then move toward relapse prevention near the end of treatment.
Common substance abuse related goals include:
- Developing coping skills to avoid psychological and situational risks to sobriety
- Developing resources to enjoy substance free activities
- Maintaining sobriety and preventing relapse
Common relationship goals include:
- Learning effective communication
- Problem solving and conflict management
- Initiating caring behaviors
- Developing mutually rewarding activities
Step-by-Step Outline of Behavioral Couples Therapy for Alcoholism and Substance Abuse
- Information is collected on the couple (“7 C’s”), each individual partner, and through pencil and paper instruments.
- Clients and therapist meet for a “round-table” discussion of the therapist’s assessment findings with opportunity provided for the couple to correct, augment, or challenge the information. This meeting is designed to provide objective information and strengthen commitment to therapy.
- Determination is made deciding if Couples Therapy is appropriate (i.e., no threat of physical abuse, no on-going affairs, no severe substance abuse, physical, or mental problems exist).
- If Couples Therapy is appropriate, goals and treatment are formulated based on the tenets of maintaining sobriety, strengthening the relationship, and preventing relapse.
- If Couples Therapy is not appropriate, referrals to outside services are made.