Introduction - Who Is BCT For?

Brief Couples Therapy: Group and Individual Couple Treatment for Addiction and Related Mental Health Concerns

In the Introduction:

The clients who have engaged in the BCT treatment program, in both the individual and the group conditions, have come from a variety of backgrounds, but all of them have had problems with substance use and many have had concurrent mental health issues. Prior to being in couples treatment, the person with the substance use problem has had treatment or has met his or her personal drug-use goal, or both. This has enabled the work of the sessions to be focused on the relationship issues connected to substance use to a greater extent than on the individual client’s use. Therefore, we recommend that therapists using BCT ensure either that the substance-using partner has met his or her personal substance goal and has received individual treatment or that the client is currently receiving treatment for substance use. Nevertheless, lapses during the course of this treatment, or any, may occur, and these should be dealt with during sessions in the context of their impact on partners’ relationships.

BCT is designed to assist couples who have made a commitment to remaining in their relationship and who have demonstrated a willingness to work on the issues that brought them into counselling. For example, a couple may enter therapy in order to re-establish trust that has been lost due to substance use, and it can then be important for each partner to be prepared to explore the ways in which trust has been altered as he or she begins to look at moving forward as a couple.

Contraindications include threats of violence; instability with regard to mental health issues, such as being suicidal or having active psychoses; and couples who are not invested in working through issues. Each of these contraindications should be assessed during the initial assessment interview, and with respect either to the threat of violence or acute mental health problems, referrals should be made to appropriate services. It is expected that clients with current mental health issues have reached a level of stability that would allow them to participate in a couples group treatment, and that they would be connected to a primary therapist for any ongoing mental health problems, such as depression, mania, anxiety or personality disorders.

When one or both partners are not committed to working towards change in the relationship, this therapy protocol may be inappropriate for them, particularly the group format — for example, when one partner refuses to stop or decrease his or her substance use so that work can be done on relationship issues. Some elements, like the Miracle Question, may help couples clarify commitment issues and decide whether or not they want to work together towards positive change; yet if it seems likely that a couple’s objective is to separate, that goal would sidetrack the group process. In that case, counselling would be best managed through individual couple sessions. If a couple are undecided as to their commitment to making changes in their relationship, we would suggest that they could participate in the group if they met the following criterion: they would need to be prepared to commit to working together for the duration of the sessions to explore whether or not change were possible.

Brief Couples Therapy

Acknowledgments

Introduction

References

Appendix A: The Background of the Integrative Model

Introduction - Who Is BCT For?

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