couples behavioral therapy- final
TRANSCRIPT
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