Cognitive-behavioural couple therapy

Domain V · Systemic, relational, group & community · Norman B. Epstein, Donald H. Baucom · 1990

What it is

CBCT treats couple distress as coming from three linked kinds of factor, all weighted equally:

Format

• Phase A: Assessment, about 3–4 sessions
• Format: One or two joint sessions.

Who practises it, and how they are trained or regulated

• Self-report measures covering dyadic adjustment, communication, violence, attachment and childhood trauma. Use standard licensed instruments; items are not reproduced here.
• Goals: Communication training (expresser and listener skills).
• Certification and fidelity. The sources mention no licensing or certification requirement for delivering CBCT. Training is through the books, handbook chapters and APA demonstration videos.

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?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• 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

• the replay re-igniting the fight. Slow down and use 4.11.
• cycles of attack and withdrawal shortening, and quicker repair after a slip.
• a theme recognised by both partners, after which incident-level fights drop.
• the agreed slots being skipped, and the number of arguments outside the slots going down.
• skills used to shut the other partner down, and whether escalation episodes become shorter.

Problems the guide addresses

• Partner aggression
• Low commitment, or each partner wanting a verdict
• Crisis (suicidality, homicidality, a newly disclosed affair)
• A secret disclosed in an individual session
• In-session escalation or emotional overwhelm
• Emotionally disengaged or vulnerability-avoidant couples
• Homework not done
• Ruptures: a partner feels you are taking sides
• Skills are there but are not used at home
• One partner's disorder dominates

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.