Behavioral Couples Therapy for Alcoholism and Drug Abuse


Buy It Now!

Behavioral couples therapy proponents offer ‘user friendly’ guide
(July 2007 Issue)

"Behavioral Couples Therapy for Alcoholism and Drug Abuse"
By Timothy O’Farrell and William Fals-Stewart
The Guilford Press
New York, N.Y., 2006

By Paul Efthim, Ph.D.

Behavioral couples therapy (BCT) is a skills training approach for treating people with substance abuse problems and their spouses or domestic partners. Over the past several decades, BCT has garnered strong research support as an adjunct to individual substance abuse counseling and 12-step programs. Until recently, however, no user-friendly treatment guides have been available to implement BCT with this population. As a result, BCT has not been widely adopted.

Two key researchers and long-time proponents of BCT, psychologist Timothy O'Farrell of the VA Boston Healthcare System and co-author William Fals-Stewart, have produced a superb treatment manual, "Behavioral Couples Therapy for Alcoholism and Drug Abuse," that should help narrow the gap between research and practice. The authors have amassed an impressive clinical research base - 2,400 couples - which grounds their program on a solid foundation.

The BCT approach is a straightforward, highly structured model ideally suited to substance abuse programs and community clinics, which frequently rely on trainees, master's level clinicians and sometimes even bachelor's level counselors to deliver the bulk of patient care. O'Farrell and Fals-Stewart's model presumes that the patients are actively seeking sobriety, which may make it difficult to implement BCT in a typical office practice where patients have sought help for other identified problems and often are not ready for abstinence.

This large-format book is well organized and clearly written, with numerous illustrations, client handouts, posters, forms and even therapist scripts. The first eight chapters describe in practical, detailed fashion how to conduct a 12-20 session course of BCT. A typical couple involves a patient who has sought substance abuse treatment and his or her partner. The model begins with a "recovery contract" and other substance-focused interventions that continue throughout the therapy to promote abstinence. Next, relationship-oriented interventions are added to increase positive activities and improve communication. Finally, the BCT counselor helps the couple plan for continuing recovery to prevent or minimize relapse.

Later chapters address specific problems and challenges in working with couples around substance abuse. There is a useful chapter on partner violence that helps counselors assess types and severity of violent behavior and clarifies when couples treatment should not be attempted.

Additional topics addressed include using dealing with noncompliance, psychiatric co morbidity, couples where both are substance abusing, using BCT as a method of HIV risk reduction, parent skills training, patient selection criteria, addressing institutional obstacles to implementing BCT programs and variations on the standard program.

As its name implies, BCT is unapologetically behavioral in its orientation. Rather than delving into underlying causative factors and hidden emotions that fuel substance abuse and relational misery, BCT targets improvement in observable skills. Abstinence is emphasized as a primary goal that must be achieved before lasting change in relationship problems is possible. The patient is responsible for his or her sobriety; the partner is placed in a secondary role as witness and supporter.

The BCT approach may seem simplistic, but the authors have the data to prove its effectiveness. Across many studies, patients who receive BCT have more abstinence, happier relationships and lower risk of separation and divorce than those who received only individual counseling.

BCT is especially tailored to the early recovery phase of treatment. In both early and later periods of treatment, clinicians should also strive to address emotional and developmental considerations facing the couple. (Two recommended books in this domain are "The Heart of Addiction" by Boston psychiatrist Lance Dodes and "The Ways We Love" by Sheila Sharpe).

Substance abuse specialists, clinics, and those who aspire to such work will find "Behavioral Couples Therapy" a sound, thorough guide.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds a faculty appointment at the Massachusetts School of Professional Psychology.