BEHAVIORAL COUPLES THERAPY

Stephanie Brinkerhoff-Riley

Jillian Carlson

Mary Kunkel

Melanie Phillips

OUTCOME IDENTIFICATION

Behavioral Couples therapy defined

Used with couples who are experiencing substance

abuse or alcohol abuse

Population: married, engaged, co-habituating couples

Kelley, M., Klostermann, K., Mignone, T., Pusateri, L., & Willis, K. (2011).

OUTCOME IDENTIFICATION:

WHY AND HOW

Developed in 1976 by Dr. Neil

Jacobson

How was it developed?

Why developed?

Create a “virtuous cycle”

Relationship functioning

Substance Abuse

BCT: SPECIFIC ASPECTS OF THERAPY

o12-session substance abuse

treatment program lasting 3-6

months that focuses on:

o(1) Support for Recovery,

o(2) Relationship Enhancement,

o(3) Communication Skills, and

o(4)Continuing Recovery

Birchler, R. J., Fals-Stewart, W., Gorman, C., & O’Farrell, T.J. (2006).

EBP IDENTIFICATION:

RELATED THERAPIES

Behavioral therapy for adults, children, individuals, or

couples is based on the principles of operant conditioning,

such as reinforcement and extinction

The importance of family roles and contributions to an

addict’s substance abuse treatment is widely accepted as

an integral part of success

The impact of co-occurring disorders has a serious,

lasting impact on marriages, partnerships, and family

relationships

EBP IDENTIFICATION:

INTENDED REACH AND SCOPE

BCT is intended to

assisted couples in

maintaining abstinence

from drugs and alcohol

together in order

reduce “reciprocity

causality”- alcohol and

drug use by one

partner contributes to

relationship distress

which perpetuates the

cycle of use

Relationship

dysfunction is linked to

substance abuse and

relapse. Therefore,

BCT creates a system

within relationships to

reinforce one another’s

positive behaviors of

sobriety and positive

communication

PROCESS

Utilizes behavioral shaping and rehearsal during sessions

(Fischer & Fink, 2014)

Clinicians observe couple’s interactions and identify

negative communication and affect to target in treatment-

criticism, defensiveness, hostility

Clinician models positive, alternative behaviors and

couple receives feedback on their use of communication

EBP IDENTIFICATION: CONSIDERATIONS

Content: Substance use

cycle within relationship

Activities: Role playing

Frequency: Would have to

revolve around insurance

reimbursement and the

client’s ability to pay for

services

Participant Information:

Court-ordered; Many

participants are arrested

with their partner and

CHINS cases require the

sobriety of all caregivers in

the home

Outcomes: Improve

relationship dynamic;

Decrease/eliminate

substance abuse by both

individuals

Setting: Office, Home

OVERVIEW

BCT with one substance-using partner

BCT with dual-using partners

BCT with women users

Individual BCT compared to group BCT

BCT with gay and lesbian couples

BCT with parents and the effects on children

ONE SUBSTANCE USING PARTNER

Most common couple type

used with BCT

Less drug use days than

Individual-based therapy

alone

Improved relationship with

spouse

(Klostermann & Fals-Stewart,

2008)

DUAL-USING PARTNERS

Seen as more difficult to treat than couples with one using

partner (O’Farrell & Clements, 2012)

Have not been included in past research (O’Farrell &

Clements, 2012)

Research suggests that BCT may be effective with dual-using

partners (O’Ferrell, Schumm, & Murphy, 2008)

WOMEN SUBSTANCE USERS

Not studied until after

2003 (O’Farrell &

Clements, 2012)

Partner support

BCT is effective for

women as well

(McCrady, Epstein,

Cook, Jensen, &

Hildebrandt, 2009; Fals-

Stewart, Birchler, &

Kelly, 2006)

INDIVIDUAL BCT VS GROUP BCT

Group BCT

Multiple couples have a session

together with one therapist

Group BCT had worse

outcomes (substance use and

marital satisfaction) than

individual BCT

(O’Farrell, Schumm, Dunlap, &

Murphy, 2016)

BCT WITH GAY AND LESBIAN COUPLES

Traditional BCT is used

No changes to the therapy

Has shown to be effective

Similar results to heterosexual couples

(Fals-Stewart,

et al., 2006)

BCT WITH PARENTS AND THE

EFFECT ON CHILDREN

Enrollment into BCT has many factors

Employment

Access to Childcare

Age of realization of problem

Male mental health

Children of parents who attended BCT had better

outcomes

Increased psychosocial health

(Braitman & Kelley, 2016; Fals-Stewart, et al., 2006)

ORGANIZATIONAL & COMMUNITY FIT

o Numerous agencies serving southwestern Indiana offer

services in prevention, intervention, and treatment of

addiction and general counseling for trauma and crises

o Commonalities:

o Treatment starts with individual assessment

o Group, individual and couples therapy offered

o Matrix Program

o Young Adult Program (18-21)

o Intensive Outpatient Treatment

o Inpatient Treatment

o Partial Hospitalization

o Founded by Protestants

o Heavy emphasis on family

o Strong Recovery Community

o Common belief addiction is a family disease

o Political and community leaders have substance use

disorders or work in helping professions and

understand addiction as a disease

o Community recognizes links between addiction and

crime, poverty, and negative child outcomes

o Community and agency leaders would likely support

a new approach to treating addiction

o City grants may be available to help agency expand

COMMUNITY FIT: EVANSVILLE

CULTURAL & POLITICAL

FEASIBILITY

CAPACITY AND RESOURCES:

LOGISTICAL REQUIREMENTS

Space: No additional

space would be

necessary to

implement this

treatment, as it would

only be necessary to

purchase seating for

a therapist and the

couple in any given

office

Equipment: Make

documentation

systems compatible

with the dynamic of

treatment and allows

for the appropriate

documentation and

billing

CAPACITY AND RESOURCES:

FINANCIAL FEASIBILITY

Providing training would be the only major cost

associated with implementing this treatment

Programs used for documentation and billing would be

required to have the capability to document the

sessions and individuals accordingly

The increase in revenue by treating more clients and

decrease in costs associated with providing treatment

offset the costs of training the appropriate number of

counselors in this practice and, and therefore this EBP

is financially feasible for many agencies

CAPACITY AND RESOURCES:

COMPETENCY AND SKILL

Adding such a

treatment is not only

financially feasible but

has the potential to be

financially beneficial.

The cost of providing

the treatment does not

change in that one

therapist is needed but

there are two

individuals receiving

and paying for

treatment

BCT shows very

encouraging outcomes

and therefore lessens

the need for repeated

treatments

CAPACITY AND RESOURCES:

AVAILABILITY AND AFFORDABILITY

OF TRAINING

Trainings for BCT can be found

through online training sources

BCT is gaining popularity, but

still requires some travel to in

person training

Marriage and Family Therapy

licensure is not required but may

add appeal for potential clients

and is readily available in the

region

CAPACITY AND RESOURCES:

COSTS AND BENEFITS

Alcohol related hospital

treatment and jail stays

decreased from $7,800

to $1,100 per year for

clients after two years

of treatment

For every dollar spent

on BCT, there was a

savings of $5.97

The total savings of a

family who engaged in

BCT (the cost of

treatment compared to

the health care and

legal costs without

treatment) was $5,053

MONITORING AND SUSTAINABILITY

How can we make sure BCT works?

BCT results in higher satisfaction rates from couples than

any other couples therapy

To continue the BCT success therapists need to….

Use structure with 3 parts: 1) review of relationship problems,

any substance use, and home practice (2) introduction of new

material and (3) assign home practice

Kelley, M., Klostermann, K., Mignone, T., Pusateri, L., & Willis, K. (2011)

MONITORING AND SUSTAINABILITY

Investigation needed in the following five areas:

(1) availability of BCT in community-based treatment

programs

(2) effects of BCT with dual drug-using couples

(3) effects of BCT with sexual minority couples

(4) active components underlying the effects of BCT

and

(5) BCT as a stepped care approach

Kelley, M., Klostermann, K., Mignone, T., Pusateri, L., & Willis, K.

(2011

ANY QUESTIONS??

REFERENCES Fals-Stewart, S., Birchler, G. R., & Kelley, M. L. (2006). Learning sobriety together: A randomized

clinical trial examining behavioral couples therapy with alcoholic female patients. Journal of Consulting and Clinical Psychology, 74, 579–591.

Klostermann, K., & Fals-Stewart, W. (2008). Behavioral couples therapy for substance abuse. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 1(4), 81.

McCrady, B. S., Epstein, E. E., Cook, S., Jensen, N., & Hildebrandt, T. (2009). A randomized trial of individual and couple behavioral alcohol treatment for women. Journal of Consulting and Clinical Psychology, 77, 243–256.

O’Farrell, T. J., & Clements, K. (2012). Review of outcome research on marital and family therapy in treatment for alcoholism. Journal of Marital and Family Therapy, 38(1), 122-144.

O’Farrell, T. J., Schumm, J. A., Dunlap, L. J., Murphy, M. M., & Muchowski, P. (2016). A randomized clinical trial of group versus standard behavioral couples therapy plus individually based treatment for patients with alcohol dependence. Journal of Consulting and Clinical Psychology, 84(6), 497.

O’Farrell, T. J., Schumm, J. A., & Murphy, M. (2008). Outcomes following behavioral couples therapy

for couples in which both partners have alcoholism versus couples in which only one partner has

alcoholism. Paper presented at the Annual Convention of the American Psychological Association,

Boston.

REFERENCES (CONT.)

Kelley, M., Klostermann, K., Mignone, T., Pusateri, L., & Willis, K. (2011). Behavioral

Couples Therapy for Substance Abusers: Where do we go from here? Substance Use

and Misuse, 46, 1502-1509.

Birchler, R. J., Fals-Stewart, W., Gorman, C., & O’Farrell, T.J. (2006). Behavioral Couples

Therapy for Drug Abuse and Alcoholism: 12-session Manual. Addiction and Family

Research Group Manual Series. 2, 1-425