CBT for Marital Problems Lecture Notes PDF

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 + Int...

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 At the end of lecture, you will be able to: + Develop therapeutic and practitioner skills necessary to plan, devise and implement a psychological intervention using the cognitive behavioural couple therapy approach. + Develop the ability to explain the cognitive behavioural model to clients and apply it to their specific circumstances.  Cognitive Behavior Couple Therapy + CBCT emphasizes the importance of working on various cognitive, emotional and environmental factors that affect a couple’s functioning in order to enhance their relational well-being, objective are +Identifying and challenging the processes that play role in partners’ interactions +Taking into account the external factors that can affect them Interrelations of Behaviors, Cognitions and Emotions in CBTCT + CBCT interventions also aim at helping couples identify, regulate and express intense or negative emotions when they arise in and out of sessions  CBT for Couple therapy https://www.youtube.com/watch?v=JZH196rOGsc  The Role of CBCT Therapists + CBCT therapists hold different roles depending on the stage of therapy and the needs of clients + A directive approach might also be needed to deal with crisis interventions + Throughout sessions, CBCT therapists can also take a more didactic role, for instance, when they teach communication and problem-solving skills for couples + They will also act as guides when they help partners identify the interrelations between their cognitions, emotions and behaviors + Facilitator express emotions, feelings  Objective of Therapy Objectives are: + Establishing and maintaining the therapeutic alliance with both partners (by fairly allocating speaking time for each partner to express themselves, demonstrating neutrality and empathy, management of secrets between one partner and the therapist ) + Psychoeducation in first session + Identification of cognitive distortions + Cognitive restructuring + Communication and problem-solving skills  CBCT in Action Three main therapeutic mandates in couple therapy: 1. Alleviation of distress 2. Ambivalence resolution 3. Separation intervention. Therapeutic mandates can also be reliably classified and revised during the course of treatment to take into account the specific needs of couples which may change over time 1. Alleviation of Distress and Relationship Improvement Conflicts and Violence Positive interaction patterns in couples as well as the improvement of communication and problem-resolution techniques in order to diminish conflicts within couples Infertility Psychological consequences, especially high levels of stress, depression, low self-esteem, marital and life dissatisfaction Individual problems Any comorbid psychological disorder e.g. mood disorders, particularly depression, emotion dysregulation, post-traumatic stress disorder, obsessive-compulsive disorder etc 2. Ambivalence resolution mandate + Exploration of emotions, beliefs and expectations of each partner regarding the continuation of the relationship, while putting any harsh decisions or behaviors about the relationship on hold until a final decision is reached by both partners + The therapist then helps partners define a new therapeutic mandate based on their decision, whether it is relationship improvement or seperation. 3. Separation mandate + Psychoeducation on how to deal with the consequences of the separation as well as feelings towards one another after the separation + Problem-solving techniques and communication training Crisis intervention It can be required prior to CBCT stability and security before conducting any other intervention, for instance, when a partner  Guidelines for couple therapists Wright and colleagues (2008) have developed guidelines for couple therapists: + The first action to be performed is to ensure the safety of each partner, and by extension of their children, if applicable (e.g. suicidal and/or homicidal risk) + The therapist must then assess whether couple therapy should be continued or if individual therapy with a different therapist would be better suited to address these difficulties before starting or resuming CBCT + If ongoing severe violence occurs within a relationship and especially when it is perpetrated by one partner towards the other. Couple therapy is usually contraindicated, and specific procedures must be undertaken to control aggressive behaviors and protect the victim  Assessment in CBCT The main objective of assessment are: + Formulate of case conceptualization -- accomplished by defining the concerns for which partners have sought assistance, identifying the individual, dyadic and environmental factors at play in the difficulties reported as well as by discerning the couple’s existing strengths that might potentially facilitate the therapeutic process + Understanding both partners’ respective goals in therapy and perspectives with regards to the concerns they report in order to assess their level of commitment in their relationship and in therapy + Determine the appropriateness of CBCT for the clients or propose an alternate course of action. For instance, the therapist might recommend that one or both partners should first follow an individual therapy  Assessment methods Clinical interviews + Semi-structured clinical interviews includes therapists’ inquiry of the couple’s history and environment, as well as of the partners’ individual functioning and backgrounds + Clinical interviews also allow CBCT therapists to question partners’ reactions, emotions and cognitions as they occur in session or when couples are asked to describe their concerns  Phases of the Assessment Interviews Typically formed of three parts. One or two couple sessions in which both partners are present and one individual session with each partner followed by a feedback session for the couple Introduction of therapist, the objectives and structure of CBCT The therapist informs terms and conditions of couple therapy for example, in couple therapy process he/she would not be forced to keep a secret from one partner during treatment etc The therapist then collects information on the couple’s concerns for which they seek therapy. Assessing each partner’s goals one partner wants to improve the relationship and the other rather wishes a separation Couple’s relationship history e.g. how the relationship has evolved over time, duration of the relationship, on how partners met and what attracted them to one another, past hardships or significant events that they have experienced and that might have affected them as a couple , how they overcome Assessment of the couple’s physical and social environments that are likely to contribute to the couple’s problems and evaluation of the couple’s sexual The therapist will then meet with each partner separately in order to gather information on + Their personal history as well as their current psychological and social functioning + Each partners’ developmental or family history, anterior romantic relationships, medical or psychological health, substance use, possible stressful or traumatic events, academic or professional functioning + How all these factors affect, or not, their current relationship and perception of their partner such as sexual difficulties, extradyadic affairs or the presence of partner violence + Couple and the therapist meet for another session during which the therapist will offer feedback using a cognitive- behavioral formulation of the couple’s functioning and the factors that affect it, namely how each partner’s cognitions, emotions and behaviors influence one another and affect couple interactions + Feedback session to present his or her interpretation of the causes of the couple’s concerns and to highlight the positive aspects that partners have expressed about their relationship. + Therapist then sets the treatment mandates and goals in collaboration with the couple and proposes a treatment plan  Self-report measures It can help therapists have access to + Information that may otherwise remain unknown + Fast and affordable way to assess numerous constructs + Access to information that might not be disclosed during sessions + Self-report questionnaires that may be used in the assessment phase of CBCT depending on the problems reported by the consulting couple, for example  Couple satisfaction and adjustment---Dyadic Adjustment Scale  Partners’ cognitions---Inventory of Specific Relationship Standards  Communication patterns ---Communication Patterns Questionnaire  Levels of violence exhibited by each partner towards the other ---Revised Conflict Tactics Scales  The measurement of attachment --Experiences in Close Relationships  Adverse childhood experiences --- Childhood Cumulative Trauma Questionnaire  Direct Behavioral Observation + Observe couple’s interactions during sessions + Observe how partners behave towards one another in a problem- solving task + Take note of the positive and negative behaviors that partners initiate, for instance, with criticism or support when the other speaks + Creating tasks or exercises that will encourage partners to interact to better assess the couples’ interactions + For example, couples can be asked to discuss a specific concern or problem they report currently having, to share their thoughts on a specific matter as well as try to engage in a decision-making discussion  Intervention Used in CBCT 1. Communication training 2. Problem and conflict resolution 3. Cognitive restructuring 4. Identification and expression of emotions 5. Acceptance and tolerance of differences  1. Communication Training + Therapist helps the couple to identify a topic of conversation that is problematic, but does not involve overwhelming emotions + Partners are successively assigned the roles of speaker and listener + The speaker is guided in expressing his or her subjective experiences and feelings within the relationship + The listener is directed in demonstrating openness, non-judgment and to respond with empathy and respect through the use of non-verbal demonstrations, reflections and summaries in order to help the speaker further describe his or her feelings and thoughts and feel listened to while doing so + Therapist’s role consists of reinforcing partners efforts, providing partners with constructive comments or suggestions and modeling certain speaker or listener behaviors in order to help partners’ perfect communication and listening techniques + Where partners bicker during the session, the therapist must quickly take control of the situation and ask them about what did they feel and perceive that triggered the dysfunctional interaction  2. Problem and Conflict Resolution Five strategies are commonly used to help couples develop problem- solving skills 1) Partners must define and identify one problem on which they want to work 2) Therapist helps partners understand the meaning this problem holds for them by defining each partners’ underlying needs 3) Partners are asked to suggest as many solutions they can think of, using brainstorming, which is known to increase feelings of interest, appreciation and consideration in the relationship as well as being particularly useful in case of serious conflict or strict patterns of interactions 4) Partners are asked to select a solution together that will allow to fulfill both partners’ wishes, although it is possible they will not be equally satisfied  3. Cognitive Restructuring + Identifying and confronting the distorted ways in which partners process information + CBCT therapists also guide partners interacting in ways that will allow them to challenge their distortions by sharing their respective experiences on a particular issue Cognitive techniques also used in CBCT involve inquiring about the evidence that supports a cognition + Socratic questioning + Weighing its advantages and disadvantages + Considering the worst possible outcomes of negative predictions that partners make about their relationship CBT Couples Formulation  4. Identification and Expression of Emotions + Identify, modify and enhance tolerance of negative emotions + Emotions that are minimized, avoided, repressed or excessively expressed by partners are known to negatively impact a couple’s relational functioning and satisfaction + CBCT therapists can also help couples identify the sources of their relational dissatisfaction and, eventually, foster higher levels of intimacy between partners. + When emotions have been identified and understood, partners are encouraged to express them by using the communication skills previously learned + Techniques also include normalizing the expression of both positive and negative emotions, encouraging partners to care and support the other when he/she expresses emotions and guiding partners to stay focused on their emotional experiences rather than concentrating solely on more cognitive or behavioral aspects of an experience  5. Acceptance and Tolerance of Differences + Accepting the potential fundamental differences or incompatibilities between partners + Strategies to enhance acceptance aim at offering partners new ways of looking at their problems through empathic joining and unified detachment. + Empathic joining brings to light each partner’s sense of vulnerability by allowing them to express their perspective on a problem, while being listened by the other partner and the therapist, whose task is to encourage the expression of emotions, rather than accusations or comments on behaviors + Unified detachment encourages partners to discontinue accusations or blame by helping them develop a more objective and less emotional consideration of their problems or differences and by considering them as an “ it ” (e.g., an object, an animal, a nickname) rather than as a deficiency or a problem in the other  Conti… + Tolerance strategies have also been developed in order to stop partners from trying to change the other + Change strategies aim at reinforcing and prompting positive behaviors that partners already portray towards each other and include the improvement of communication and problem-solving skills by recreating a conflict they have already experienced and integrating the acceptance and tolerance strategies they have learned + Mindfulness-based interventions can also be used to enhance acceptance of differences--- have been proven to increase relationship satisfaction, sense of relatedness and closeness, acceptance of the partner and to alleviate relationship distress CLOs Skills 2.2 Plan and follow the best Evidence Based Therapies (EBT) of CBT model, effective strategies and behavioural experiments according to psychological problems and ethical and cultural considerations according to international standards. 3.1 Comply with professional characteristics of patient safety, group work, therapeutic relationships with professional behavior and leadership skills needed in administration of psychological tests and psychotherapy. Reference + Dugal, C., Bakhos, G., Bélanger, C., & Godbout, N. (2018). Cognitive-Behavioral Psychotherapy for Couples: An Insight into the Treatment of Couple Hardships and Struggles. http://dx.doi.org/10.5772/intechopen.72104