ADC 660 Module 6 Behavioral Couple Therapy Example

A Daily Promise and a Weekly Date: Behavioral Couple Therapy for Glen and Lisa

Student Name

Psychology and Addiction Studies Program, Aspen University

ADC 660: Addiction and Families

Instructor Name

Month Day, Year

A Daily Promise and a Weekly Date: Behavioral Couple Therapy for Glen and Lisa

Two weeks after Lisa's invitation, Glen agreed to an assessment at the Omaha program and began outpatient treatment. He had not had a drink in nine days. At their first joint meeting, Lisa said she was glad but did not trust it: "He's stopped before." Glen said he felt watched. Their counselor suggested behavioral couple therapy, known as BCT. Glen, Lisa and their counselor are teaching composites; below, the paper describes BCT and plans it for them.

Why Involve the Partner

Fals-Stewart et al. (2004) explained the reasoning behind BCT. Substance use and relationship problems feed each other: drinking causes conflict, distrust and distance, and conflict and distance become triggers for more drinking. A partner who has been hurt may monitor, criticize or bring up the past, which the drinker experiences as pressure, while the drinker's defensiveness confirms the partner's fears. BCT aims to reverse this cycle by having the partner actively reward abstinence and by rebuilding positive experiences in the relationship, so that sobriety and a better relationship support each other.

The Components

BCT typically runs for twelve to twenty weekly sessions (Fals-Stewart et al., 2004). Its core is the daily recovery contract. At a set time each day, the person in recovery states an intention not to drink or use that day, and the partner thanks them for it; both agree not to discuss past drinking or future fears outside sessions. Where a medication such as naltrexone is prescribed, taking it can be part of the daily exchange, witnessed by the partner. Attendance at self-help meetings and urine screens can be recorded on a calendar. Alongside the contract, partners practice noticing and acknowledging caring acts each day, plan shared rewarding activities each week and learn communication skills such as listening and expressing feelings directly. Later sessions develop a continuing recovery plan.

The Evidence

Powers et al. (2008) carried out a meta-analysis of twelve randomized trials comparing BCT with control conditions, mostly individual treatment. Overall, BCT was more effective at reducing how often people used and the harm their use caused, and at raising how satisfied couples were with their relationship. The advantage on substance use was small at the end of treatment and larger at follow-up, suggesting that the relationship changes BCT produces keep supporting recovery after sessions end. Fals-Stewart et al. (2004) reported further benefits in trials, including reductions in intimate partner violence and improvements in the adjustment of couples' children.

Rowe (2012) looked at the family therapy trials and reviews that appeared in the seven years after 2003. For adults, couple-based approaches such as BCT had the strongest support among family methods. For adolescents, family therapies such as multidimensional family therapy had a substantial evidence base, which is relevant to Tyler if his own use grows. Rowe noted that effective family approaches share a focus on concrete behavior change and on strengthening relationships, not on blame.

A Twelve-Week Plan

Weeks one and two: the counselor screens each partner privately for violence and fear, then introduces the recovery contract. Glen and Lisa rehearse it in session and agree on a time and place. Weeks three and four: they add the daily caring-acts exercise and record both the contract and the caring acts on a calendar. Weeks five and six: they plan shared rewarding activities, starting small, such as a Sunday walk. Weeks seven to nine: communication skills, including listening without interrupting and planning hard conversations, such as about money and Carol's loans. Weeks ten and eleven: they practice discussing the past in session, where it can be handled safely. Week twelve: a continuing recovery plan that names high-risk times, such as weekday evenings after Glen's commute, and what each will do if Glen drinks.

When BCT Is Not Suitable

Fals-Stewart et al. (2004) noted that BCT is not used where there is severe intimate partner violence or where one partner fears the other, since joint sessions could increase danger. Screening is done privately with each partner. BCT also assumes both partners want to stay together; where one is set on separating, other forms of help fit better. The counselor confirmed that neither applied to Glen and Lisa.

Lisa's Doubt and Glen's Sense of Being Watched

The couple's first exchange showed the cycle Fals-Stewart et al. (2004) describe. Lisa's checking, smelling his breath and asking where he had been, came from years of broken promises; Glen experienced it as being treated like a suspect, which made him want to withdraw. The recovery contract gave them a different routine. Instead of Lisa checking all day, Glen would state his intention once each evening and Lisa would thank him, and both agreed to save worries about the past for sessions. Within two weeks Lisa said she was checking less, and Glen said the evening exchange felt less like an inspection than he had feared.

Medication as Part of the Contract

Glen's doctor had prescribed naltrexone to reduce craving. Fals-Stewart et al. (2004) describe adding a medication to the daily contract, so that the partner sees it taken. Glen agreed to take his tablet at the kitchen table during the evening exchange. Lisa said this gave her something concrete to trust, and Glen found it helped him keep taking a medication he might otherwise have stopped once he felt better.

Where This Fits in the Tiers

BCT sits above the brief help described in the previous module and below longer-term family systems work. It suits couples like Glen and Lisa, where the person using is engaged in treatment, both partners want the relationship to continue and the problems are mainly those caused by drinking. Families with deeper or longer-standing patterns of conflict may need the more intensive therapy covered in the next module.

Conclusion

Fals-Stewart and colleagues describe BCT's methods: a daily recovery contract, shared positive activities and communication training. Powers and colleagues' meta-analysis found BCT more effective than individual treatment, with gains growing over time, and Rowe's review places it among the best-supported family approaches for adults. For Glen and Lisa, a twelve-week plan gives both partners tasks and builds trust before tackling the hardest conversations.

References

Fals-Stewart, W., O'Farrell, T. J., & Birchler, G. R. (2004). Behavioral couples therapy for substance abuse: Rationale, methods, and findings. Science & Practice Perspectives, 2(2), 30-41. https://doi.org/10.1151/spp042230

Powers, M. B., Vedel, E., & Emmelkamp, P. M. G. (2008). Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis. Clinical Psychology Review, 28(6), 952-962. https://doi.org/10.1016/j.cpr.2008.02.002

Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003-2010. Journal of Marital and Family Therapy, 38(1), 59-81. https://doi.org/10.1111/j.1752-0606.2011.00280.x