Cognitive-behavioural conjoint therapy for PTSD

Domain II · Behavioural & cognitive · Candice Monson, Steffi Fredman · 2012

What it is

Cognitive-behavioural conjoint therapy for PTSD (CBCT for PTSD) is a manualised, time-limited couple therapy. It treats one partner's PTSD and the couple's relationship together, with both partners present in every session. It comes from cognitive processing therapy and cognitive-behavioural couple…

Format

• Format. The standard format is 15 conjoint sessions of about 75 minutes each, usually weekly. Both partners attend every session. One partner has PTSD. Most of the evidence comes from couples where the other partner does not have PTSD. The manual also covers couples where both partners have PTSD.
• Individual. PTSD (self-report plus the partner's collateral report) and comorbid conditions in both partners.

Who practises it, and how they are trained or regulated

• Version followed: the 15-session manual by Monson & Fredman (2012), Cognitive-Behavioral Conjoint Therapy for PTSD: Harnessing the Healing Power of Relationships (Guilford), using its published session titles, with session contents taken from Monson's CBCT training slides (2019 versions). The 8-session Brief CBCT (B-CBCT) and the weekend multi-couple retreat format (AIM-CBCT) are noted as variants. The full manual…

Evidence status, as the guide reports it

• Format. The standard format is 15 conjoint sessions of about 75 minutes each, usually weekly. Both partners attend every session. One partner has PTSD. Most of the evidence comes from couples where the other partner does not have PTSD. The manual also covers couples where both partners have PTSD.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• forced positivity, or one partner pushing "silver linings".
• infidelity or betrayal that has not been dealt with (see 5.9).
• the conversation drifting into old grievances. Redirect to the prompt.
• new disclosure of aggression during this session. Assess it privately (5.1).
• the partner's hurt from years of distance surfacing. Validate it, then hold to the theme.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.