Structure of Therapy Process
Behavioral Couples Therapy many not the best treatment approach with all substance busing individuals and their partner. However if the partners are committed to be successful towards abstinences within the relationship than BCT may be appropriate. BCT does have criteria for if this approach should be used. Since BCT is a skills-based there must be a level for commitment from each partner.
Criteria for BCT to be used:
Treatment Intervention Process & Outline
Role of Therapist
Since BCT is a skill-based intervention approach and highly structured, the therapist should be highly knowledgeable in cognitive-behavioral therapies. The structure of the sessions have a component of psycho-education and skills-based agenda. The therapist plays many roles during the process of BCT, such as a teacher, consultant and subject matter expert regarding behavior modification, substance abuse recovery, relationship improvement and relapse prevention. The therapist must establish a working alliance with the couple during each session.
The working alliance in a mutual atmosphere includes:
Essential Clinical Skills
The therapist must have the ability to communicate clearly and have education, supervision, training and work independent in three major areas. These areas include:
Common and Important Therapist Errors
The therapist must be able to assess the required level of care for the couple seeking help. If there is failure to do this it presents the therapist as lacking the essential clinical skills noted earlier. In addition to these skills the therapist must address the substance abuse issue first. The therapist must be careful not to impose their own values onto the couple. It is important for the therapist to recognize that goal and treatment planning is a collaborative approach. Due to the nature of a relationship dealing with substance use, the couple can start with the blame game during their sessions. The therapist must be firm and directive when confronting each partner. Therapist should not underestimate the degrees of anger and resentment that have built up between the couple. During the treatment process the therapist can avoid problems by not overestimating the initial competence and coping skills of the couple. It is important to encourage couples to do the agreed homework assignments and learn how to talk effectively about their substance use issues and patterns.
Behavioral Couples Therapy many not the best treatment approach with all substance busing individuals and their partner. However if the partners are committed to be successful towards abstinences within the relationship than BCT may be appropriate. BCT does have criteria for if this approach should be used. Since BCT is a skills-based there must be a level for commitment from each partner.
Criteria for BCT to be used:
- Partners must be married, cohabiting or can be separated but trying to reconcile for at least one year.
- Neither partner can have any cognitive impairments or psychosis
- Couples cannot have history of physical aggression
- Both partners must have their main goal to be abstinence from drugs and alcohol
- BCT works best with only one partner having the substance abuse issue.
Treatment Intervention Process & Outline
- 30% of couples that are cohabitating are good candidates for BCT
- 80% of couples agree with this type of intervention approach
- BCT can be offered as a 6 and 12 session treatment formats involving individual-couple, small group or with outpatient practitioners.
- Individual session’s 50-60 minutes
- Group session’s 60-90 minutes
- Couples are typically in therapy 12-20 weeks over 5-6 months
Role of Therapist
Since BCT is a skill-based intervention approach and highly structured, the therapist should be highly knowledgeable in cognitive-behavioral therapies. The structure of the sessions have a component of psycho-education and skills-based agenda. The therapist plays many roles during the process of BCT, such as a teacher, consultant and subject matter expert regarding behavior modification, substance abuse recovery, relationship improvement and relapse prevention. The therapist must establish a working alliance with the couple during each session.
The working alliance in a mutual atmosphere includes:
- Validation for what the substance abuser and their partner have gone through to get to the point of coming to treatment.
- Offering guidance and encouragement for the journey ahead
- Providing clear and well defined expectations for the partners’ treatment related attitudes and behaviors.
- Preserving effective control of emotional expression, especially at times of heightened interactions.
Essential Clinical Skills
The therapist must have the ability to communicate clearly and have education, supervision, training and work independent in three major areas. These areas include:
- The therapist must have knowledge about the principles and patterns of substance abuse. The must be familiar with biomedical, physical and emotional effects different substances have on a individual. The therapist must also take into considerations, social, legal and cultural issues that may be associated with substance use for both the using and non-using partners.
- The therapist must be trained to be an effective couple’s therapist. The therapist should be able to provide treatment planning to promote positive behavioral exchanges between the couple. The therapist should be able to reduce or eliminate partners’ behaviors and dyadic interactions that negatively impact the relationship while teaching effective communication and problem solving skills throughout the treatment progress. The therapist must be able to monitor and shape the partners’ motivations and attitudes to achieve and maintain sobriety.
- The therapist should know the limits of the BCT. The therapist must take into consideration the multiproblems a couple faces during their journey of treatment. During the treatment process the therapist must be aware of when one or both partners presents risk factors due to the multiproblems within the couple’s relationship. The therapist should have a network built to provide access to other professional services such as for matters including legal, medical, biomedical, and physical.
Common and Important Therapist Errors
The therapist must be able to assess the required level of care for the couple seeking help. If there is failure to do this it presents the therapist as lacking the essential clinical skills noted earlier. In addition to these skills the therapist must address the substance abuse issue first. The therapist must be careful not to impose their own values onto the couple. It is important for the therapist to recognize that goal and treatment planning is a collaborative approach. Due to the nature of a relationship dealing with substance use, the couple can start with the blame game during their sessions. The therapist must be firm and directive when confronting each partner. Therapist should not underestimate the degrees of anger and resentment that have built up between the couple. During the treatment process the therapist can avoid problems by not overestimating the initial competence and coping skills of the couple. It is important to encourage couples to do the agreed homework assignments and learn how to talk effectively about their substance use issues and patterns.