Integrative behavioural couple therapy. Andrew Christensen. April 2015.
This was an interesting two-day workshop from an experienced American academic.
There are several brands of couple therapy, the one presented here is an adaption of pure behavioural couples therapy: it has been evaluated in a trial, was effective, but not more so than the original therapy.
The therapy has a ‘dyadic’, conceptualization at its heart, working hard not to see either party at fault. Incidents are brought alive in the session, and emotion driven maladaptive behaviour is modified. Private emotion driven behaviours, such as poor sexual engagement, is brought to the surface, and explored. Effective communication is encouraged, and strengths and positive behaviour is prompted.
Therapy goals can be to change things, or to accept things.
Homework exercises are based on encouraging naturally reinforcing behaviours rather than prescribing rule governed behaviours. For example’ what would have to happen that you would enjoy a date at the cinema’, rather than ‘I will to to the cinema with my wife’ on Tuesday.
Key idea is DEEP analysis.
Differences in libido, desire for closeness, interests cause problems
Emotional sensitivities are considered. As are,
External stressors. Which lead to,
Patterns of problematic interaction: moving away and against, hanging on, and moving against with others
In therapy an example of the problem is identified and subject to a DEEP analysis. Acceptance is encouraged for differences and sensitivities. Acceptance and change for external stressors. And change for problematic behaviours.
Couples cannot be treated if they are not living together, or one or both are not committed.
The structure of the therapy is 1 joint, and 2 individual sessions for assessment, 1 joint session for feedback, multiple treatment sessions and a relapse prevention plan.
In the assessment there is a focus on letting each speak, a neutral position, and the impact of the other’s actions; the relationship history is traced, measures are taken and a self help book is given out. If there is a current affair it must be ended, or the person must tell their partner. Feedback session is a DEEP analysis.
The homework is a weekly questionnaire, tracking progress and issues that come up.
The 3 main strategies are: CAB
Affective change-‘empathic joining’
Cognitive change-‘unified detachment’
Behavioural change ‘new coping’
Empathic joining is where therapist encourages shared feelings, and validation is encouraged.
Unified detachment is more of an intellectual discussion of a difficult experience describing the pattern using antecedent, behaviour and consequence analysis to encourage understanding and a shared perspective.
Direct change is where the therapist coaches new behaviours in the session and out, often focused on better communication, initially building on the skills the couple have got.
Additional strategies are increasing positive behaviours, (joint) problem solving, and communication training.
Can terminate when significant progress made and /or couples request it: can include follow-ups.
Reflection: my thoughts are that there is a need for couples therapy where I work in Nottingham. There are logistic problems in having two patients rather than one, and I felt doing the role-play that this was quite challenging work, like herding angry cats!
It is not advisable to do couple therapy if you have already been treating one partner, as there will be bias.
I would like to offer this approach, I need to advertise that if one patient’s problems is driven by couple discord this could be an intervention I could offer.
There is a very funny video about couple communication that could be used clinically and in training. http://youtube.com/watch?v=q6sMnQsv7Hk