Cognitive Behavioral Couple Therapy (CBCT) Chapter 9

Application of CBT (Chapter 9)

• CBT for marital problems
• Problem: Couple Therapy

Outline

• Importance of CBCT
• Function of CBCT
• The Role of CBCT Therapists
• Objective of CBCT
• CBCT in Action
• Guidelines for couple therapists
• Assessment in CBCT
• Intervention Used in CBCT

Objective of Lecture

• Develop therapeutic and practitioner skills necessary to plan, devise, and implement a psychological intervention using the cognitive behavioral couple therapy approach
• Develop the ability to explain the cognitive behavioral model to clients and apply it to their specific circumstances

Cognitive Behavior Couple Therapy

• CBCT emphasizes the importance of working on cognitive, emotional, and environmental factors that affect a couple's functioning to enhance their relational well-being
• Identifying and challenging processes that play roles in partners' interactions
• Taking into account external factors that affect couples

Interrelations of Behaviors, Cognitions, and Emotions in CBCT

• CBCT interventions aim at helping couples identify, regulate, and express intense or negative emotions arising in and out of sessions

CBT for Couple Therapy

• [YouTube video link]

The Role of CBCT Therapists

• CBCT therapists have different roles depending on the stage of therapy and clients' needs
• A directive approach might be needed for crisis interventions
• Therapists can take a didactic role, teaching communication and problem-solving skills
• Therapists act as guides, helping partners identify interrelations between cognitions, emotions, and behaviors
• Therapists facilitate expression of emotions and feelings

Objective of Therapy

• Establishing and maintaining the therapeutic alliance with both partners (fair speaking time, neutrality, empathy, managing secrets)
• Psychoeducation in the first session
• Identifying cognitive distortions
• Cognitive restructuring
• Communication and problem-solving skills

CBCT in Action

• Three main therapeutic mandates in couple therapy: Alleviation of distress, Ambivalence resolution, Separation intervention
• Therapeutic mandates can be classified and revised during treatment to address changing needs

Conflicts and Violence

• Positive interaction patterns are crucial, with the improvement of communication and problem resolution to minimize conflicts within couples.

Infertility

• Psychological consequences, especially high stress levels, depression, low self-esteem, marital, and life dissatisfaction

Individual Problems

• Any comorbid psychological disorder (e.g., mood disorders, depression, emotion dysregulation, PTSD, OCD)

Ambivalence Resolution Mandate

• Exploration of emotions, beliefs, and expectations regarding the continuation of the relationship
• The therapist helps define a new therapeutic mandate (relationship improvement or separation) based on the partner's decision

Separation Mandate

• Psychoeducation on dealing with separation consequences and feelings after separation
• Problem-solving techniques and communication training

Guidelines for Couple Therapists

• Safety of each partner and children (if applicable) is the primary concern
• Assess if couple therapy should continue or if individual therapy is more appropriate
• Ongoing severe violence contraindicates couple therapy and specific procedures are needed to control aggressive behavior and protect the victim

Assessment in CBCT

• Formulate case conceptualization (identifying concerns, individual/dyadic/environmental factors, existing strengths)
• Understanding both partners' goals and perspectives in therapy
• Determining the suitability of CBCT or proposing an alternative course of action (e.g., individual therapy)

Assessment Methods (Clinical Interviews)

• Semi-structured clinical interviews for couple history, environment, and partner functioning
• Allow therapists to question partners' reactions and emotions during sessions

Phases of the Assessment Interviews

• Introduction of CBT, objectives, and structure
• Gathering information on the couple's concerns
• Assessing each partner's goals (improve or separate)
• Couple's relationship history (how it evolved, duration, significant events, etc.)
• Assessment of couple's physical and social environments
• Couple's sexual functioning

The Therapist Meets with Each Partner Separately

• Gathering information about psychological/social functioning
• Developmental and family history, past relationships, medical/psychological health, substance use, potential trauma, and education/professional functioning

Couple Session Feedback

• Cognitive behavioral formulation of the couple's function
• Interpretation of the concerns and highlighting positive aspects
• Developing treatment mandates and goals in collaboration with the couple

Self-Report Measures

• Access to information otherwise unknown
• Fast and affordable assessment of many factors
• Self-report questionnaires (e.g., Dyadic Adjustment Scale, Inventory of Specific Relationship Standards, Communication Patterns Questionnaire, Revised Conflict Tactics Scales, Experiences in Close Relationships, Childhood Cumulative Trauma Questionnaire)

Direct Behavioral Observation

• Observe couple interactions during sessions and problem-solving tasks
• Note positive/negative behaviors (e.g., criticism, support)
• Encourage interaction to assess couples' interaction patterns
• To discuss specific concerns and engage in decision-making discussion examples can aid.

Intervention Used in CBCT

• Communication training
• Problem and conflict resolution
• Cognitive restructuring
• Identification and expression of emotions
• Acceptance and tolerance of differences

Communication Training

• Identify problematic conversations and emotions
• Assign partners as speaker/listener roles
• Guide the speaker in expressing feelings
• Encourage listener openness, non-judgment, and empathy

Problem and Conflict Resolution

• Partners define the problem
• Therapist helps understand meaning and underlying needs
• Brainstorm solutions to increase interest, appreciation, and consideration
• Selecting a solution that fulfills both partners' wishes

Cognitive Restructuring

• Identify and confront distorted ways of processing information
• Guide partners to challenge distortions through shared experiences
• Inquiry about evidence supporting the cognition
• Weighing advantages/disadvantages and considering worst-case scenarios to reduce negative predictions

Identification and Expression of Emotions

• Identify and enhance tolerance of negative emotions
• Recognize how emotions impact couple functioning
• Help couples identify sources of dissatisfaction
• Foster intimacy between partners
• Encourage partners to express positive/negative emotions

Acceptance and Tolerance of Differences

• Accept potential differences/incompatibilities
• Offer new ways of looking at problems through empathic joining and unified detachment
• Encourage understanding and expression of emotional perspectives
• Discontinue accusations to develop a more objective view of problems and differences

Tolerance Strategies

• Stop partners from trying to change each other
• Reinforce positive behaviors
• Improve communication and problem-solving

Mindfulness-Based Interventions

• Enhance acceptance of differences
• Increase relationship satisfaction and closeness
• Alleviate relationship distress

CLOS Skills

• Plan and follow the best evidence-based therapies (EBTs) of CBT
• Use effective strategies according to psychological problems and ethical/cultural considerations
• Adhere to professional characteristics (patient safety, group work, therapeutic relationships) to administer psychological tests and psychotherapy

Reference

• [Reference link]

Explore the applications of Cognitive Behavioral Couple Therapy (CBCT) in addressing marital issues as outlined in Chapter 9. This quiz covers the significance, function, and interventions utilized in CBCT, providing insights into the role of therapists and essential guidelines for effective couple therapy. Enhance your understanding of how cognitive and emotional factors influence relationship dynamics.