Behav ior al

Marital
Model
Marriage and Family
Therapy
PSY 210
by:
Raven C. Shea, RPm
Jezza Mae C. Ramos
Krizzia Louise bE
Cabrera
 TABLE OF
CONTENTS
History & Definition & Goals of
Leading Key Aspects of the
Figures BCT Therapy

Case Application Appropriate Importance of

& Clinical Candidates for BCT
Procedure for BCT 2
BCT
History
&Leadin
g 2
H isto rical O rigin s o f B eh avio r
T h erap y
B eh avio r th erap y evo lved fro m b eh avio rism

Ivan P. Pavlov, a Russian physiologist, w a s

recognized for his study of conditioned reflexes,
which progressed to classical co n d itio n in g.

2
 John B. Watson & Rosalie
Rayner
demonstrated the use of classically conditioned
emotional responses in the case of “Little
Albert.”

concluded that many phobias are probably true

conditioned emotional reactions either of the
direct or transferred type.

2
 RICHARD B.
STUART
presented the first published application of
behavioral principles to couple problems.

Stuart hypothesized that successful marriages could be distinguished

from unsuccessful ones by the frequency and range of positive acts
exchanged reciprocally by the partners.

Stuart’s (1969) treatment consisted of obtaining a list of positive

behaviors that each person desired from the partner and instituting an
agreement for the two individuals to exchange tokens as rewards for
enacting the desired behaviors.
2
 ROBERT
LIBERMAN
utilized behavioral principles in his work with couples and
families, applying a social learning framework

Liberman added the strategies of role rehearsal and modeling of

alternative interpersonal communication patterns to his
treatment of dysfunctional family relationships

Liberman advocated the use of behavioral analysis throughout

the course of therapy, allowing the treatment to be modified as
needed.

2
 Burrhus Frederic
Skinner
developed operant conditioning

Positive & Negative

reinforcement

2
 Definition &
Key Aspects of
BCT

2
 What is Behavioral Marital
Model?
BCT is designed for married or cohabiting individuals seeking
help for alcoholism or drug abuse. BCT sees the substance-
abusing patient together with the spouse or live-in partner.

Therapy works by focusing on four components: criticism,

contempt, defensiveness and stonewalling. The therapist will
focus on how one person may attack the other’s character
and it focuses on the generalizations that are often made.

2
 Key Aspects of
T he
BCT
p u rp o se o f B C T is to su p p o rt
ab stin en ce an d im p ro ve
relatio n sh ip fu n ctio n in g.

T h e Recovery Contract supports abstinence.

B C T in creases p o sitive activities an d

im p ro ves communication.
B C T fits well with self-help groups,
recovery m ed icatio n s, an d o th er 2
 Goals of
the
Therapy
2
 3 primary Goals of
BCT
To eliminate abusive drinking and drug abuse;

To engage the family’s support for the patient’s efforts

to
change and
•
To change couple and family interaction patterns in
ways conducive to long-term, stable abstinence and a
happier, more stable relationship. 2
Case Application
& Clinical
Procedure for 2
Case: Substance-abuse

2
behavioral approach assumes that family members can reward
abstinence and having better relationships and communication
will lead to lower risk of relapse

12-20 weekly outpatient couple sessions over a 3-6 month period.

BCT can start immediately after detoxification or a short-term intensive

rehab program or when the substance abuser seeks outpatient
counseling.
2
M a r y was a 34-year old teacher ’s aide in a n elementary
school who h a d a serious drinking problem a n d also
sm o ke d marijuana daily.

ad. m itted to a d etox ific ation u n it at a

c om m u n ity hospital aft er being caught drinking at
work a n d being suspended from her job.

H e r h u s b a n d J a c k worked in a local warehouse a n d

was a light drinker with no drug involvement.
2
T h e y have been married for 8 years.

J a c k was considering leaving the marriage, whe n the

sta.ff at the detoxifi cati on unit referred them to the
B C T program.

2
S ubstance-Focused Interventions in
BCT
Daily Recovery Contract

Other Support for Abstinence

Relationship-Focused Interventions in BCT

2
 Substance-Focused Interventions in BCT

Daily Recovery Contract

1.Trust discussion. The client states his or her intention not to drink or use
drugs that day, and the partner expresses support for the client's efforts
to stay abstinent. This is practiced in every session.
Thank you for not drinking or using drugs the last day.
I have not used drugs in the last 24 hours and I intend
I want to provide you the support you need to meet
to remain abstinent for the next 24 hours.
your goal of remaining abstinent today.

2.Contract review. The couple reviews contract elements.

3.Adherence record. The couple records performance of the daily
contract on a calendar.
2
Other support for
abstinence

Crisis intervention for substance use

- client may reach out to therapist outside a
session
-may be agreed upon in early sessions

2
Relationship-Focused Interventions in
BCT
Creating an atmosphere of change

The counselor facilitates remembering the earlier situation of the couple

before their problems began.

2
Relationship-Focused Interventions in
BCT
Increase positive activities
Catch Your Partner Doing Something Nice

Each partner records one caring behavior performed by the other partner
in a daily log. The counselor models how to acknowledge the caring
behavior, and the couple practices at home.

Planning Shared Rewarding Activities

Partners make a list of activities that they can do together, with their children, or
as a family. The counselor models planning an activity and instructs the couple
not to discuss conflicts during the activity.
2
Relationship-Focused Interventions in
BCT
Increase positive activities
Caring day” assig nment

The counselor instructs each partner to give the other a “caring day” during the
coming week by performing special acts that show caring for the partner.

Behavioral exchange

Every positive behavior is rewarded or reciprocated by another positive behavior

of the partner.

2
Teaching Communication Skills
Listening Skills

The counselor instructs the couple to summarize the content and feelings of
the speaker's message and then to check whether the message received was
the message intended by the partner. The couple practices during the session
and at home.

Communication Sessions

The counselor assigns private, face-to-face (no texts, emails, phone calls)
sessions; partners take turns expressing their views without interruption

Expressing Feelings Directly

The counselor invites the couple to express both positive and negative
feelings directly instead of blaming or avoiding and models using “I” 2
statements.
Teaching Communication Skills

Negotiating Requests

The counselor shows how to make positive, specific change requests and
negotiate for mutual (not coerced) agreement. The couple practices during the
session.

Conflict resolution

The counselor teaches problem-solving and conflict resolution skills.

2
 Maintenance and Relapse
Prevention
Create a continuing recovery plan.

-create a continuing recovery plan before treatment ends; the plan lists
behaviors and activities the couple would like to continue

Anticipate high-risk situations

-identify situations where the partner with S U D is at risk for a return to use and
early warning signs of a possible return to use
-couple discusses and rehearses coping strategies to use to prevent returns to
use.

Create a written relapse prevention plan

-create an action plan that includes specific steps each partner will take
and emergency contact information 2
-couple discusses and rehearses how to manage a return to substance
Appropriate
Candidates
for BCT 2
it is suitable only for couples who are committed to their
relationships.
married

if not married, cohabiting in a stable relationship

for at least 1 year;

if separated, attempting to reconcile.

is skill-based and relies heavily on participants’ abilities to receive

and integrate new information, complete assignments, and
practice new skills.
.Alcohol and substance abuse 2
Im portanc
e of
BCT 2
BCT is the family therapy method with the strongest research
support for its effectiveness in substance abuse (Epstein &
McCrady, 1998).

BCT produces greater abstinence and better relationship

functioning than typical individual-based treatment and reduces
social costs, domestic violence, and emotional problems of the
couple’s children.

Ten (10) times greater than that observed for aspirin in

preventing heart attacks, an effect considered important in
medical research. (Rosenthal, 1991).

2
References
2
 References
Behavioral C ouples Therapy. (2022). Recovery Research
Institute. https://www.recoveryanswers.org/resource/behavioral-couples-therapy/?
fbclid=IwAR1Yyc6BUaWyOvGKWj5viTIINYf1FfBjODCm2cyiQj_p3zXhqwdUp09MWEg#:~:text=Be
havioral%20Couples%20Therapy%20is%20a,while%20building%20support%20for%20abstinence

Behavioral Couples Therapy. (2022). Theravive. https://

www.theravive.com/therapedia/behavioral-couples-therapy?fbclid=IwAR12EhW-
E9FJFcxc8i77DeijfYXymiklORcI0D_87BLaFk9eHbxlwTBAXo#:~:text=How%20Behavioral%20Cou
ples%20Therapy%20Works,generalizations%20that%20are%20often%20made

Gurman, A. S ., Lebow, J. L., & S nyder, D . K. (2015). C linical Handbook of C ouple Therapy,
Fifth Edition (Fifth ed.). The Guilford Press.

Heights, C. (2019, September 5). Behavioral Couples Therapy: What is it and How Does it
Work? Cumberland Heights.
https://
www.cumberlandheights.org/blogs/what-is-behavioral-couples-therapy-and-how-does-it- 2
work/?fbclid=IwAR3vZ0v3lQq_pCuHY35eF7kbGHMun15gV2KMrWkOs1MGweI7D7aoMSvF2cU
 References
O' Farell, T..J. et al., (2006). Behavioral Couples Therapy for Alcoholism and Drug Abuse. Guilford
Publications.

Keitner, G. I., Heru, A. M., & Glick, I. D. (2009). Clinical Manual of Couples and Family Therapy. Van
Haren Publishing.

Metcalf, P. D. L. P. C. S. L. S. C. S. C., PhD, & Linda Metcalf, P. D. L. P. C. S. L. S. C. S. C.

(2018).
Marriage and Family Therapy, Second Edition. Springer Publishing.