Behavioural couple therapy

Domain V · Systemic, relational, group & community · Stuart, Jacobson, Margolin · 1969

What it is

This entry covers two related behavioural couple approaches. Traditional behavioural couple therapy (social-learning marital therapy) treats relationship distress as a deficit of rewarding exchanges and of communication and problem-solving skills. Change is thought to come from deliberately…

Format

• Format: usually 12–20 weekly outpatient conjoint sessions over 3–6 months. BCT can be added to individual counselling or used as the only counselling. The 2006 manual includes a 12-session version (Appendix A).
• Phase 1, substance-focused (from the first session): the initial sessions cover assessment, commitment and starting BCT. The daily Recovery Contract begins, along with other abstinence supports (medication, meetings, screens). These continue throughout treatment.

Who practises it, and how they are trained or regulated

• Contraindications: current psychosis in either partner; acute risk of severe violence; a restraining order that bars contact (do not see the couple together until it is lifted or modified); a partner with a current substance problem. That last rule has been relaxed: couples where both partners have an alcohol problem have been treated when both want to stop.
• Training and fidelity: the guideline does not name a certification or licensing scheme. It points clinicians to the manual, an O'Farrell (1993) chapter on the first session, O'Farrell & Murphy (2001) on violence, a 1994 training videotape and trainer contacts. No requirement for certification before delivering BCT was found.
• Sequence: one secondary pastoral-counselling summary gives eight steps. (1) Each spouse completes a pre-counselling inventory. (2) Agree a therapy contract. (3) Hold a first joint session explaining that more positive interaction drives change. (4) Caring Days. (5) Communication training. (6) Quid pro quo contracting. (7) Mutual decision-making strategies. (8) Maintenance, with follow-up at about four-month…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• 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

• gains hold over the spaced sessions.
• early gains that delay work on core issues, a known limitation.
• requests for individual alliances. Working: both sign up to the rules.
• keeping score. Working: both carry it out and report feeling cared for.
• sidetracking into history. Working: written agreements that get implemented.

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.