Introduction - Tips on Implementing the Program

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

In the Introduction:

Who Will Use This Manual?
Who Is BCT For?
Why Is There a Need for Brief Couples Treatment?
Development of the Manual
The Integrative Model
Brief Couples Therapy (BCT)
Tips on Implementing the Program
How to Use the Manual

Differences between Group and Individual Couple Sessions

An important difference between individual and group sessions is the time allocated to each couple. There is more time available when working with an individual couple. This allows the therapist to clarify issues, work on a specific goal, explore in more depth differences and meanings, and highlight positive changes that may be occurring during the therapy sessions.

Individual couples do not experience feedback from other group members — a process found to be extremely valuable for couples in the group session. In the individual sessions, the extra time for in-depth exploration of issues may make up for this discrepancy.

The total number of sessions for clients in the group situation is nine (one assessment and eight treatment sessions), while the total number of sessions for clients in the individual situation is eight, because the assessment session and the first session are combined for individual couples.

The process of checking in and checking out can be simplified for individual couples by just asking the couple to identify how they are feeling at that moment.

The difference in materials for conducting individual sessions versus group sessions is minimal. For either type, therapists should review the checklists for each session. The checklists are written from the group position. Instructions that are more suited to conducting a group session may be ignored for the individual session. Following each session checklist and summary, there is also a Tips for Individual Couple Session sheet, which highlights any notable variation between the individual versus the group format.

Sessions should be scheduled on a weekly basis. Individual sessions, however, may be on a more varying timetable than group sessions. When there is a long gap between sessions, therapists should ask if anything has changed.

General Tips and Counselling Issues

The following are general recommendations about how to deal with some of the issues that may occur during Brief Couples Therapy (BCT). These recommendations are suggestions only, to be followed at the discretion of the user. When dealing with specific problems or crises, we expect that you will be guided by the ethical mandates of your profession and the procedures of the agency within which you work.

Check-in

When asking clients about “issues arising from the last session,” therapists should use their judgment about allowing as much time for this exploration as is needed without getting sidetracked from the aim of the session. Any lingering or ongoing issues that emerge should be woven into the content and process of the group as outlined in the protocol for that session.

Homework

For clients who have trouble with the reading level of the homework or with writing, or for those clients whose first language is not English, therapists may wish to adapt or translate the homework exercises to fit the needs of their clients. We have discovered that partners sometimes help each other with the homework. Although we generally encourage partners to do their homework assignments individually, occasionally it may be practical for partners to help each other, particularly with the clarification of instructions.
Although not encouraged, if someone has forgotten to do his or her homework in between sessions, the homework can be done during the session.
Couples should keep their homework between sessions. Often the homework from one session flows naturally into the homework for the next session, and it can be helpful for couples to refer back to previous session homework.

Time Management

Therapists should try to ensure that each couple is allotted equal session time. Occasionally, this is not possible. When one or more couples do not have the opportunity to fully share their homework or to discuss issues, therapists should utilize material from the couple who are currently sharing in order to advance the educational experience of that session. (e.g., because some couples find it difficult to grasp the point of the Miracle Question as an exercise in self-exploration of needs, goals and change, it can be useful for therapists to spend a greater amount of time exploring one couple’s miracle in the session to provide an example for others to practise outside of that session).

Missed Sessions

Couples should be informed as to the importance of making a commitment to attend the entire eight sessions, both for their own benefit and for the overall functioning of the group. When a couple have to miss a session, they should give as much notice as possible. Therapists may then wish to give homework instructions by phone. If more than one couple have to miss the same session, the therapists may decide to postpone that session. Occasionally, one partner may have to come to a session alone. That can be preferable to having both partners miss the session. However, therapists should clarify that the couples are expected to show up together and, when deemed necessary, the other partner should be contacted by phone to clarify her or his commitment. In the individual therapy sessions, if one partner shows up alone, the therapist should reschedule the individual couple session.

Management of Mental Health Crises

If a client should come to a session in a state of acute mental illness (e.g., suicidal, threatening or psychotic), appropriate contact should be made with the nearest emergency room or primary practitioner.

Management of Relationship Crises

Relationship crises may be related to ongoing mental health or substance use concerns. If the issue appears to be related to medication management, then the client should be referred to his or her primary medical practitioner. Some couples may come into sessions with occasional or recurrent relationship crises. In that case, focusing on session tasks can be an effective way to reduce the emotional intensity that deters couples from dealing with therapeutic issues. Communication skills are introduced in Session 5. Prior to that session, if ineffective communication skills seem to be impairing couples’ ability to work on their relationship, the Tips for Effective Communication sheet can be handed out, and a brief discussion can take place about practising effective communication skills between sessions. Couples should be reminded that there will be specific session time devoted to working on communication skills in upcoming sessions as well.

Substance Use

If a client shows up under the influence of drugs or alcohol, therapists may need to remind the client that he or she is required to show up sober and to ask the individual to leave that session. In such a case, the client should be contacted prior to the next session to re-establish the therapeutic alliance and the client’s commitment to the therapy. The focus of this treatment is the couple’s relationship rather than substance use; however, depending on the requirements of the agency, therapists may wish to ask about substance use during check-in and to keep track of it in the session progress note. Exploration regarding the impact of the reported substance use on the relationship should be incorporated into the session tasks, as opposed to becoming a separate focus.

Taping

Taping sessions, with appropriate consent, can be useful for peer review and team training. If you intend to videotape or audiotape sessions, always check your equipment prior to starting the session. Tapes should be kept in a locked cabinet and clients should be made aware of the duration of time tapes will be kept, as well as how and when tapes will be destroyed.

Brief Couples Therapy

Acknowledgments

Introduction