The SSA’s Rob Calder and Natalie Davies describe behavioural couples therapy.
Behavioural couples therapy helps couples to change patterns of behaviour and substance use. It is based on the idea that a person’s actions, and those of their family, friends and partners, are interlinked.
How do you deliver behavioural couples therapy?
Behavioural couples therapy should be delivered for a minimum of 12 weeks, and requires both partners to attend therapy sessions. A referral for behavioural couples therapy can be made through the GP or local NHS trust. In addition, some Relate services offer behavioural couples therapy, and funding may also be provided as part of a social work care package, although this will probably depend on the person’s local NHS trust.
Behavioural couples therapy isn’t for everyone and is, by definition, unsuitable for people who are not in a relationship. There also has to be a sense of safety for behavioural couples therapy to work. So, an assessment should be made to ensure that all participants can attend therapy in a way that is, and feels, safe.
To become trained in behavioural couples therapy and other family therapies in the UK you have to complete a 4-year part-time, or 2-year full-time course. To enrol, you will need a professional qualification in psychiatry, psychology, social work or similar. The process to being accepted onto a course can be competitive. However, in 2020, Health Education England supported 57 trainees across the country to complete an MSc in family therapy. The Association for Family Therapy accredits courses in systemic therapies, and their website lists courses across the UK. There are also courses to enhance your skills in working with families where you don’t become a qualified family therapist.
Is behavioural couples therapy effective?
Both the Orange Clinical Guidelines and NICE guidelines outline strong evidence in support of using behavioural couples therapy for drug and alcohol treatment. It is one of just two interventions, along with contingency management, highlighted by the Orange Clinical Guidelines as having “particularly strong evidence for effectiveness when indicated for use in the treatment of drug dependence”.
A meta-analysis from 2008 found that behavioural couples therapy was better than individual therapies for couples seeking help, but noted a lack of evidence in relation to low-severity drinkers. A review of systematic reviews published in The Lancet in 2013 found that family therapies were effective and that there was some evidence that behavioural couples therapies could also be effective. The most recent meta-analysis from 2020 reported that behavioural couples therapy was better than treatment as usual, but also noted some evidence of publication bias (whereby studies that did not find anything might not have been published).
Equality and diversity considerations
In some circumstances, issues within the family (such as domestic abuse and child protection issues) can exclude people from behavioural couples therapy. A risk assessment should always be conducted to ensure that couples can participate safely, and that participation in therapy would not risk inadvertently distributing responsibility (and therefore blaming victims) for abuse or violence.
Domestic abuse used to be a strict exclusion criterion, but is now more commonly worked with. Service providers are likely, however, to exclude couples where a perpetrator does not take any responsibility for their actions or where weapons have been used.
Where can I read more?
- A book by Janet Reibstein and Reenee Singh provides strategies for delivering behavioural couples therapy to inter-cultural couples. Book chapters include teaching couples how to break patterns and prepare them to establish new ones, and training couples to communicate effectively.
- Kate Thompson, a couples psychotherapist, wrote an article for Drink and Drugs News magazine about how behavioural couples therapy can strengthen relationships and reduce problems with drinking.
- Article published in Psychotherapy discussed the clinical processes used in behavioural couples therapy, and how these can be expected to address “not only core issues within a relationship, such as communication and conflict resolution, but also the thoughts, emotions, and issues of trust and intimacy that are important aspects of the human experience”.
by Rob Calder and Natalie Davies
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