Brief Couples Therapy: of This PDF Have Been Deleted

Brief Couples Therapy
Group and Individual Couple Treatment

for Addiction and Related Mental Health Concerns
Gloria Chaim
Sharon Armstrong
Joanne Shenfeld
Colleen Kelly
Selina Li
Due to copyright restrictions, pages 9 and 10

of this PDF have been deleted.
Brief Couples Therapy:
Group and Individual Couple Treatment for Addiction
and Related Mental Health Concerns
Gloria Chaim, MSW

Sharon Armstrong, PhD
Joanne Shenfeld, MSW
Colleen Kelly, MSW
Selina Li, MSW
A Pan American Health Organization / World Health Organization Collaborating Centre

Brief Couples Therapy: Group and Individual Couple Treatment
for Addiction and Related Mental Health Concerns
National Library of Canada Cataloguing in Publication
Brief couples therapy : group and individual couple treatment for

addiction and related mental health concerns / Gloria Chaim ... [et al.].
Includes bibliographical references.

isbn 0-88868-448-7
1. Substance abuse Treatment. 2. Marital psychotherapy.

I. Chaim, Gloria, 1955 II. Centre for Addiction and Mental Health.
rc564.b748 2003 616.86'0651 c2003-901095-3
pg117
Printed in Canada
Copyright 2003 Centre for Addiction and Mental Health
With the exception of the handouts and progress notes, no part of this work may be reproduced or trans-
mitted in any form or by any means electronic or mechanical, including photocopying and recording, or
by any information storage and retrieval system without written permission from the publisher except
for a brief quotation (not to exceed 200 words) in a review or professional work.
The handouts and progress notes may be photocopied and distributed for use with clients. This licence
is limited to the individual purchaser, for use with the purchasers own clients/patients and does not
extend to additional therapists or practice settings. The licence does not grant the right to reproduce
these materials for sale, redistribution or any other purposes (including but not limited to books,
pamphlets, articles, video or audiotapes and handouts or slides for workshops or lectures). Permission
to reproduce these materials for these and other purposes must be obtained in writing from the
Centre for Addiction and Mental Health.
This book was produced by:

development
Caroline Hebblethwaite, camh
editorial
Diana Ballon, camh
Sue McCluskey, camh
design
Nancy Leung, camh
production
Christine Harris, camh
marketing
Ronda Kellington, camh
For information on other Centre for Addiction and Mental Health resource materials
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Web site: www.camh.net

BRIEF COUPLES THERAPY iii
ACKNOWLEDGMENTS
EVALUATION TEAM REVIEWERS

Selina Li Charmaine C. Williams
Virginia Ittig-Deland Clare Bowles
Sharon Armstrong Darryl Upfold
David Denberg
PROJECT TEAM David Ravvin
Gloria Chaim Donna Akman
Joanne Shenfeld Elizabeth Hendren-Roberge
Selina Li Elsbeth Tupker
Sharon Armstrong Farzana Doctor
Colleen Kelly Genevieve McMath
Carolynne Cooper Jane Paterson
Tony Toneatto John Mancini
Virginia Ittig-Deland Lisa Freud-Goldman
Dennis Walker Pam Santon
Paul Stebbins
FIELD TEST SITES Sonia Panchyshyn
Centre for Addiction and Mental Health, Wayne Skinner
arf Division, Family Service (camh)
Addiction Services for York Region (asyr) We gratefully acknowledge the generous support
North York General Hospital, Branson Division, of the Stupp/Cohen Families Foundation and
Mental Health Outpatient Services (nygh) their initiative to create the Randy Stupp Fellowship
at the Centre for Addiction and Mental Health.
FIELD TEST PARTNERS
Pam Santon, (asyr)
David Ravvin, (asyr)
Lisa Freud-Goldman, (nygh)
Genevieve McNabb, (nygh)
iv BRIEF COUPLES THERAPY
CONTENTS
Acknowledgments ................................................................................................................................ vii
Introduction
Who Will Use This Manual? .................................................................................................................... vii
Who Is bct For? ...................................................................................................................................... vii
Why Is There a Need for Brief Couples Treatment? .............................................................................. viii
Development of the Manual .................................................................................................................. x
The Integrative Model ............................................................................................................................ x
Brief Couples Therapy (bct) .................................................................................................................... xi
Tips on Implementing the Program ...................................................................................................... xii
How to Use the Manual .......................................................................................................................... xiv
Assessment Session
Session Guidelines .................................................................................................................................. 3
Session Resources .................................................................................................................................. 5
Client Handouts ...................................................................................................................................... 13
Session 1: Introduction
Client Handouts ...................................................................................................................................... 23
Progress Note .......................................................................................................................................... 26
Session 2: Genogram/Family Tree

Client Handouts ...................................................................................................................................... 33
Progress Note .......................................................................................................................................... 34
Session 3: Miracle Question

Client Handouts ...................................................................................................................................... 40
Progress Note .......................................................................................................................................... 41
BRIEF COUPLES THERAPY v
Session 4: Goal Setting

Client Handouts ...................................................................................................................................... 48
Progress Note .......................................................................................................................................... 49
Session 5: Communication
Client Handouts ...................................................................................................................................... 56
Progress Note .......................................................................................................................................... 58
Session 6: Trust/Intimacy
Client Handouts ...................................................................................................................................... 64
Progress Note .......................................................................................................................................... 67
Session 7: Relapse Prevention

Client Handouts ...................................................................................................................................... 73
Progress Note .......................................................................................................................................... 74
Session 8: Conclusion
Progress Note .......................................................................................................................................... 80
References ............................................................................................................................................ 81
Appendix A: The Background of the Integrative Model ...................................................... 85

vii
INTRODUCTION
Who Will Use This Manual?

This manual was developed primarily as a tool for therapists and counsellors working in substance
use settings who would like to augment their practice by seeing couples. Clinicians intending to use
this program should be familiar with solution-focused therapy, as well as couple and family therapy.
Familiarity with cognitive behavioural interventions and communication theory would also be helpful.
The manual will also be useful for the practitioner who is seeing couples, and who would like to be
able to offer a focused, specific program for clients presenting with substance use issues. In this situa-
tion, familiarity with cognitive behavioural therapy, relapse prevention and motivational interviewing
for substance use is recommended.
CONCURRENT DISORDERS SETTINGS

Because the Brief Couples Therapy (bct) protocol was developed and is used within a concurrent setting,
we regard it as one aspect of a comprehensive approach to treatment for substance use and mental
health disorders. As such, bct focuses on substance use issues to a greater extent than on mental health
issues. However, whether or not clients present themselves as suffering from concurrent disorders,
therapists and counsellors will undoubtedly find themselves dealing with couples who have had to cope
with depression, mania, anxiety and other mental health issues. Thus, therapists should be aware of
the prevalence of concurrent disorders as described in this manual in the section Why is there a need
for Brief Multiple Couple Treatment? In particular, therapists should be cognizant of the likelihood
that clients may engage in their substance use or increase it when they are dealing with mental health
problems such as depression, anxiety, schizophrenia and personality disorders; and on the other side
of the coin, therapists ought to be aware of the possibility of the occurrence of symptoms of anxiety,
depression and psychotic episodes that are tied to problem substance use.
THEORETICAL AND PHILOSOPHICAL PERSPECTIVES

It is hoped that this manual will be a useful tool for clinicians who may adhere to a variety of differ-
ent philosophical and theoretical perspectives on human nature and change processes. Because the
underlying conceptual model is based on an integration of theoretical principles, we believe that the
techniques we are presenting are adaptable to different schools of thought. In this vein, we hope that
whatever your philosophy of human nature or your theoretical perspective regarding the processes
involved in counselling and therapy, you will find this a useful tool for practice. We presume that, where
deemed necessary, therapists will modify the wording of checklists and exercises to suit their particular
clientele, practices and philosophies.
Who Is BCT For?

The clients who have engaged in the bct treatment program, in both the individual and the group con-
ditions, have come from a variety of backgrounds, but all of them have had problems with substance
use and many have had concurrent mental health issues. Prior to being in couples treatment, the person
with the substance use problem has had treatment or has met his or her personal drug-use goal, or
both. This has enabled the work of the sessions to be focused on the relationship issues connected to
substance use to a greater extent than on the individual clients use. Therefore, we recommend that
therapists using bct ensure either that the substance-using partner has met his or her personal substance
viii BRIEF COUPLES THERAPY
goal and has received individual treatment or that the client is currently receiving treatment for substance
use. Nevertheless, lapses during the course of this treatment, or any, may occur, and these should be
dealt with during sessions in the context of their impact on partners relationships.
bct is designed to assist couples who have made a commitment to remaining in their relationship and
who have demonstrated a willingness to work on the issues that brought them into counselling. For
example, a couple may enter therapy in order to re-establish trust that has been lost due to substance
use, and it can then be important for each partner to be prepared to explore the ways in which trust has
been altered as he or she begins to look at moving forward as a couple.
Contraindications include threats of violence; instability with regard to mental health issues, such as
being suicidal or having active psychoses; and couples who are not invested in working through issues.
Each of these contraindications should be assessed during the initial assessment interview, and with
respect either to the threat of violence or acute mental health problems, referrals should be made to
appropriate services. It is expected that clients with current mental health issues have reached a level
of stability that would allow them to participate in a couples group treatment, and that they would be
connected to a primary therapist for any ongoing mental health problems, such as depression, mania,
anxiety or personality disorders.
When one or both partners are not committed to working towards change in the relationship, this therapy
protocol may be inappropriate for them, particularly the group format for example, when one partner
refuses to stop or decrease his or her substance use so that work can be done on relationship issues.
Some elements, like the Miracle Question, may help couples clarify commitment issues and decide
whether or not they want to work together towards positive change; yet if it seems likely that a couples
objective is to separate, that goal would sidetrack the group process. In that case, counselling would be
best managed through individual couple sessions. If a couple are undecided as to their commitment
to making changes in their relationship, we would suggest that they could participate in the group if
they met the following criterion: they would need to be prepared to commit to working together for the
duration of the sessions to explore whether or not change were possible.
Why Is There a Need for Brief Couples Treatment?

Brief Couples Therapy (bct) is an eight-session, structured treatment for couples with substance abuse
and related mental health concerns that can be delivered in either individual couple format with one
therapist, or in a group format of up to four couples with two therapists. Over the course of
eight weeks, couples learn to identify and reduce problems stemming from substance use, including
problematic family interaction patterns, and communication styles. They will begin to establish con-
crete, attainable goals, build trust and intimacy, and establish relapse prevention strategies.
COUPLE INVOLVEMENT
In both the areas of substance use and mental health treatment, there is a substantial literature support-
ing various types of family involvement and intervention as the main mode of intervention or as an
adjunct to it (Stanton & Heath, 1997; Baucom et al., 1998). Health Canadas Best Practices: Substance
Abuse Treatment and Rehabilitation (1999) supports the effectiveness of marital behavioural therapy as
well as group treatments. The effectiveness of couple involvement in the treatment of problem substance
use has been widely documented in the past two decades (Kaufman, 1985; Zweben et al., 1988; Montag
& Wilson, 1992; Shadish et al., 1993; Edwards & Steinglass, 1995; Pinsof & Wynne, 1995; Fals-Stewart
BRIEF COUPLES THERAPY ix
et al., 1996; Stanton & Shadish, 1997; Epstein & McCrady, 1998; OFarrell & Feehan, 1999; OFarrell &
Fals-Stewart, 2000). This research has shown that spousal involvement in treatment is effective in
motivating people with alcohol problems to enter and continue treatment. Moreover, it has shown that
different models of couple therapy have produced significant reduction in alcohol or drug use and
improvement in marital functioning. However, despite the growing evidence that spousal involvement
in treatment increases treatment retention and improves outcomes, addiction treatment continues
to be focused on the substance-using individual in most settings.
As treatment resources become increasingly scarce and waiting lists grow, it is crucial to develop
effective treatment interventions from both outcome and cost perspectives. It is also important to note
that the majority of the treatment literature does not address issues related to cultural and sexual
diversity. In order to address these gaps, camh is utilizing a number of brief treatment approaches
for a diverse clientele, and the treatment protocol presented in this manual is one of a number of
these brief treatment approaches.
GROUP FORMAT
Treatment groups have a long history and are widely used in the addiction field, as they have been
shown to result in decreased costs as well as improved outcomes (Roberts et al., 1999). In early
studies of couples group therapy for alcoholism, couples groups were introduced mainly as an
adjunct to inpatient programs. These studies provided some evidence for the efficacy of couples
group treatment for alcohol problems. Today, the emerging research evaluating couples group therapy
for outpatient treatment of alcohol problems suggests positive outcomes for couples treatment in the
group format (Corder et al., 1972; Cadogan, 1973; McCrady et al., 1979; Hahlweg et al., 1982; Bowers
& Al-Redha, 1990; Baucom et al., 1998; OFarrell et al., 1998; OFarrell & Fals-Stewart, 2000).
In view of the foregoing, some of the potential benefits of multiple couples therapy for addictions
are: decreasing waiting lists; reducing treatment costs and increasing treatment retention; improving
treatment outcomes (i.e., achieving substance use goals and improving couple satisfaction); provid-
ing a forum for demonstrating communication and problem-solving strategies; providing feedback
and positive reinforcement from peers, which may also improve treatment retention and outcomes;
modelling positive coping styles; and decreasing highly dysfunctional behaviours.
CONCURRENT DISORDERS
Estimates of lifetime drug-use disorders comorbid with alcohol dependence are as high as 80 per cent
(Epstein & McCrady, 1998). Here at camh, over 50 per cent of clients presenting for treatment in the
Addiction Programs reported drugs other than alcohol as their primary problem substance, and about
40 per cent reported more than one problem substance. About 50 per cent of these clients also screened
positive on the Psychiatric Screener (a screening tool in development at camh) for mental disorders
such as schizophrenia, mood, anxiety and eating disorders. Correspondingly high rates of comorbidity
have also been published by large-scale studies in the United States.1
In addition, as the general and treatment populations become more diverse, it is important that treat-
ment protocols and approaches address the severity and complexity of presenting problems, learning
styles and ethno/sexual/racial/cultural dimensions. Where suitable, group interventions are preferable
1 See Daley & Moss (Chapter 1; 2002) for prevalence rates of dual disorders in the United States.
x BRIEF COUPLES THERAPY
for the cost-benefit reasons outlined above. However, options for individual couple interventions and
other individual and family interventions need to be available as well.
For 20 years, the members of our team of experienced clinicians have been offering couple treatment
in the conjoint format for clients who present with substance use problems; and for the past five years,
we have offered this treatment for clients with concurrent disorders. Drawing upon the clinicians
experience, a bct treatment program incorporating cognitive, behavioural and systems approaches
is presently being researched and delivered. It is believed that this program will contribute to more
efficient service delivery, lower treatment attrition rates and better treatment outcomes. We are hopeful
that research utilizing the bct model of therapy outlined in this manual will generate a broader concep-
tualization of the needs of couples and families with substance use and mental health issues and that,
in turn, further refinement and extension of the treatment model will produce interventions that are
germane to wider family constellations and to broader ethno/sexual/racial/cultural communities.
Development of the Manual

An early draft of the manual was piloted in a research project at camh. Following further refinement,
the manual was distributed to clinicians at camh, as well as to therapists and counsellors from external
agencies, to test its usefulness with individual couples and multiple couple groups. A more complete
draft of the manual was reviewed by 19 different consultants, clinicians and researchers practising in
the areas of mental health, addictions, general family services and private practice. As a result of these
reviews, the manual was further refined and adapted to become a useful tool for clinicians working
with couples with addictions and mental health concerns. Currently, the manual is being utilized within
a multi-site research project comparing group versus individual couple therapy with a diverse sample
of couple clients.
The treatment model has been field tested at camh, North York General Hospital and Addiction Services
For York Region (asyr). A six-month outcome evaluation of the model is under way. Preliminary results
show that the program (in both group and individual formats) has been well received by the clients. From
the field test, we have also obtained qualitative data from the clinicians in the form of comments about
the usefulness of the manual, its readability and flow. As well, over 30 post-session problem-solving
debriefing meetings have been conducted with clinicians who are administering the treatment. Feedback
from these sessions has been incorporated into the development of this manual.
The Integrative Model 2

bct is based on the Integrative Model of family/couple treatment that grew from scrutiny of our own
practice in a family treatment team at the former Addiction Research Foundation, now the Centre for
Addiction and Mental Health (camh), where we work with a diverse population. Over the years, the
severity of presenting problems, and the frequency of comorbidity of substance use and mental health
concerns, have increased tremendously. As a result, we have adapted our model to working with clients
with concurrent disorders. The Integrative Model is seen as an effective way of intervening on multi-
dimensional levels, an important consideration when working with concurrently disordered clients and
their families.
2 See Appendix A for The Background of the Integrative Model.

BRIEF COUPLES THERAPY xi
Substance use and mental health are the presenting focus of family concern and the main targets
of intervention. At its core, the Integrative Model is an assimilation of theoretical assumptions and
techniques from the family therapies, solution-focused therapy and cognitive behaviour therapy
that were deemed relevant to the treatment of families and couples faced with substance use issues.
The hallmarks of the treatment approaches that the model draws upon are as follows:
observing cross-generational patterns of family interactions and their effects on present relationships
(intergenerational)
attending to boundaries and coalitions (structural)
tracking and attempting to change key patterns of interaction (strategic)
focusing on strengths, making small changes and creating solutions (solution-focused)
using self-monitoring and focusing on identifying and addressing cognitions and overt, observable
behaviour (cognitive behavioural).
Each perspective provides a unique orientation, and taken as an integrated whole, the Integrative Model
of therapy allows the clinician to fully address all the issues of concern; something that could not be
accomplished as efficiently by any of the treatment modalities alone. The Integrative Model is flexible,
making it applicable to families at all stages of clinical contact, from intake to termination, to families at
various stages of the life cycle and to different family configurations (multicultural, blended, single-parent,
etc.). New approaches and techniques can be incorporated into the model because it is non-prescriptive,
and provides the therapist with a number of intervention options rather than limiting the therapist to a
particular technique to be used in specific circumstances. The interplay of clinician preference, agency
factors, and client needs and strengths will influence the application of the model. This model has been
developed specifically for use with families experiencing problems related to concurrent disorders, and
is well suited to the range and depth of difficulties that can be present in these situations.
Brief Couples Therapy (BCT)

By incorporating the theory and techniques from the Integrative Model, bct is a powerful tool for couples
with substance use problems.
Often, couple and family therapists find themselves in the position of being referees for family or couple
boxing matches, when family members have become entrenched within their own positions and are
unable to see the problem from each others point of view. Alcohol and drug use can exacerbate this type
of blaming and positioning. Thus, the family systems perspective allows therapists to get a broader scope
in relation to reoccurring issues.
Therapists can use this broader awareness to help each member of the couple gain an understanding of
the frames of reference underlying the rigid positions that each has taken in his or her ongoing conflicts.
When the family systems framework is combined with solution-focused aims, such as looking towards a
more positive future and increasing self-efficacy, couples can begin to resolve complex substance-related
problems by looking at these problems from a different perspective and imagining possibilities for change.
Finally, principles that were derived from the social learning and cognitive behavioural modalities and
that inform the Integrative Model provide the substance that underlies skill-building strategies. These
strategies, we believe, help couples to increase positive communication and to enhance their relationship
between sessions.
xii BRIEF COUPLES THERAPY
Tips on Implementing the Program
DIFFERENCES BETWEEN GROUP AND INDIVIDUAL COUPLE SESSIONS

An important difference between individual and group sessions is the time allocated to each couple.
There is more time available when working with an individual couple. This allows the therapist to clarify
issues, work on a specific goal, explore in more depth differences and meanings, and highlight positive
changes that may be occurring during the therapy sessions.
Individual couples do not experience feedback from other group members a process found to be
extremely valuable for couples in the group session. In the individual sessions, the extra time for in-depth
exploration of issues may make up for this discrepancy.
The total number of sessions for clients in the group situation is nine (one assessment and eight treat-
ment sessions), while the total number of sessions for clients in the individual situation is eight, because
the assessment session and the first session are combined for individual couples.
The process of checking in and checking out can be simplified for individual couples by just asking the
couple to identify how they are feeling at that moment.
The difference in materials for conducting individual sessions versus group sessions is minimal. For
either type, therapists should review the checklists for each session. The checklists are written from the
group position. Instructions that are more suited to conducting a group session may be ignored for the
individual session. Following each session checklist and summary, there is also a Tips for Individual Couple
Session sheet, which highlights any notable variation between the individual versus the group format.
Sessions should be scheduled on a weekly basis. Individual sessions, however, may be on a more vary-
ing timetable than group sessions. When there is a long gap between sessions, therapists should ask
if anything has changed.
GENERAL TIPS AND COUNSELLING ISSUES

The following are general recommendations about how to deal with some of the issues that may occur
during Brief Couples Therapy (bct). These recommendations are suggestions only, to be followed at the
discretion of the user. When dealing with specific problems or crises, we expect that you will be guided
by the ethical mandates of your profession and the procedures of the agency within which you work.
Check-in
When asking clients about issues arising from the last session, therapists should use their judgment
about allowing as much time for this exploration as is needed without getting sidetracked from the
aim of the session. Any lingering or ongoing issues that emerge should be woven into the content and
process of the group as outlined in the protocol for that session.
Homework
1. For clients who have trouble with the reading level of the homework or with writing, or for those
clients whose first language is not English, therapists may wish to adapt or translate the homework
exercises to fit the needs of their clients. We have discovered that partners sometimes help each other
BRIEF COUPLES THERAPY xiii
with the homework. Although we generally encourage partners to do their homework assignments
individually, occasionally it may be practical for partners to help each other, particularly with the
clarification of instructions.
2. Although not encouraged, if someone has forgotten to do his or her homework in between sessions,
the homework can be done during the session.
3. Couples should keep their homework between sessions. Often the homework from one session flows
naturally into the homework for the next session, and it can be helpful for couples to refer back to
previous session homework.
Time Management
Therapists should try to ensure that each couple is allotted equal session time. Occasionally, this is not
possible. When one or more couples do not have the opportunity to fully share their homework or to
discuss issues, therapists should utilize material from the couple who are currently sharing in order to
advance the educational experience of that session. (e.g., because some couples find it difficult to grasp
the point of the Miracle Question as an exercise in self-exploration of needs, goals and change, it can
be useful for therapists to spend a greater amount of time exploring one couples miracle in the session
to provide an example for others to practise outside of that session).
Missed Sessions
Couples should be informed as to the importance of making a commitment to attend the entire eight
sessions, both for their own benefit and for the overall functioning of the group. When a couple have to
miss a session, they should give as much notice as possible. Therapists may then wish to give homework
instructions by phone. If more than one couple have to miss the same session, the therapists may decide
to postpone that session. Occasionally, one partner may have to come to a session alone. That can be
preferable to having both partners miss the session. However, therapists should clarify that the couples
are expected to show up together and, when deemed necessary, the other partner should be contacted
by phone to clarify her or his commitment. In the individual therapy sessions, if one partner shows up
alone, the therapist should reschedule the individual couple session.
Management of Mental Health Crises

If a client should come to a session in a state of acute mental illness (e.g., suicidal, threatening or
psychotic), appropriate contact should be made with the nearest emergency room or primary practitioner.
Management of Relationship Crises

Relationship crises may be related to ongoing mental health or substance use concerns. If the issue
appears to be related to medication management, then the client should be referred to his or her primary
medical practitioner. Some couples may come into sessions with occasional or recurrent relationship
crises. In that case, focusing on session tasks can be an effective way to reduce the emotional intensity
that deters couples from dealing with therapeutic issues. Communication skills are introduced in
Session 5. Prior to that session, if ineffective communication skills seem to be impairing couples ability
to work on their relationship, the Tips for Effective Communication sheet (page 64) can be handed
out, and a brief discussion can take place about practising effective communication skills between
sessions. Couples should be reminded that there will be specific session time devoted to working on
communication skills in upcoming sessions as well.
xiv BRIEF COUPLES THERAPY
Substance Use
If a client shows up under the influence of drugs or alcohol, therapists may need to remind the client
that he or she is required to show up sober and to ask the individual to leave that session. In such a
case, the client should be contacted prior to the next session to re-establish the therapeutic alliance and
the clients commitment to the therapy. The focus of this treatment is the couples relationship rather
than substance use; however, depending on the requirements of the agency, therapists may wish to ask
about substance use during check-in and to keep track of it in the session progress note. Exploration
regarding the impact of the reported substance use on the relationship should be incorporated into the
session tasks, as opposed to becoming a separate focus.
Taping
Taping sessions, with appropriate consent, can be useful for peer review and team training. If you intend
to videotape or audiotape sessions, always check your equipment prior to starting the session. Tapes
should be kept in a locked cabinet and clients should be made aware of the duration of time tapes will
be kept, as well as how and when tapes will be destroyed.
How to Use the Manual

The clinical materials used in Brief Couples Therapy (bct) consist of four types:
1. Session Guidelines
Objectives
Checklists
2. Session Resources
Materials
Summaries
Tips
3. Handouts (marked with h under page number)
4. Progress Notes.
The session checklists are to be used by counsellors. These checklists outline the key topics to be
covered in each session. The summaries that follow each checklist provide a handy outline that can
be used for in-session reference. Session checklists give the order in which in-session exercises are
usually completed, and they include examples of how to introduce, explain and utilize each of the
exercises. Therapists should read the appropriate checklist before each session. Note that the size of
the checklist-item descriptions is not necessarily associated with the amount of time required for the
in-session components. For example, the check-in description is quite short, but the actual time taken
to check in can vary considerably, depending on the size and needs of the group. Therapists should
plan ahead to ensure that adequate time is allotted for each component of the session. Comments,
tips and clinical interpretations from therapists who have used the materials and contributed to the
project are also included to facilitate use of the materials. Therapists should familiarize themselves
with all of the sessions in this manual prior to the first therapy session, so that they can re-order the
sessions to match the needs of the group or the couple as necessary.
BRIEF COUPLES THERAPY xv
The handouts included after each of the session checklist summaries provide clinical exercises and materials
that are to be used by clients. Most handouts are given to clients at the end of each session. It is intended
that they be completed as homework for the following session. The homework assignments will become
the focus of each session, so it is important that therapists emphasize the need for homework completion.
The progress notes list the key topics that are covered in each session. These notes provide an oppor-
tunity for reporting on client substance use and goal achievement. Additional space is also provided
for other issues that are specific to the particular client. The progress notes are designed to be efficient
and easy to use, while capturing pertinent clinical information.
With respect to the materials, the differences between individual and group sessions are minimal. For
either type of session, therapists should review the checklists prior to each session. The checklists are
written from the perspective of running a group. Tips for conducting an individual couple session
follow each checklist and summary.
ASSESSMENT SESSION
Session Guidelines
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Session Resources
ASSESSMENT QUESTIONNAIRES: DESCRIPTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Client Background Information Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Dyadic Adjustment Scale (Sample Items) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Alcohol and Drug Use Information Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Client Handouts
FACTS ABOUT COUPLES TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Due to copyright restrictions, pages 9 and 10

Dyadic Adjustment Scale (Sample Items)
have been deleted from this PDF file.
ASSESSMENT SESSION
Session Guidelines
CHECKLIST
Guidelines for the Counsellor Tips on What to Do with or Say to the Client
1. Describing the purpose of People have different ideas about what treatment is
brief couples therapy (bct) about. Let me tell you something about this program.
This program is for couples who are willing to look at
how alcohol and/or drug use affect their lives. It helps
couples improve their relationship by working on com-
munication, problem solving, conflict reduction and
other identified issues. It helps couples work on their
drug use goals and ways to deal with relapse. It is based
on the belief that your partner can help in your effort
to change your alcohol/drug use.
2. Describing how bct works This program is really to help you look at the impact
of your substance use on your relationship and how
your partner can help support you in your effort to
change your drug use. To help with that, the program
will involve eight sessions, which will begin following
an assessment appointment with a therapist. Topics
covered in these sessions will include family history,
communication, trust, goal setting, problem solving
and relapse prevention. Please attend the sessions
with your partner and arrive alcohol- and drug-free.
3. Describing Who Comes to bct (This is especially important when providing bct in
a group format.)
You might also be wondering what the people who

come into this program are like. While everybody
has their own unique situation, here are some of the
things we know about the people who come here . . .
(Give a general description of the clients seeking
treatment at your agency.)
4. Completing the Client Background This form can be completed as the couple is
Information Form interviewed for assessment information.
4 ASSESSMENT SESSION
5. Administering Standard Questionnaires Ask both clients to complete 2 forms: the Alcohol
and Drug Use Information Form and the Dyadic
Adjustment Scale (optional). If the das is used, we
recommend that you administer it before the Alcohol
and Drug Use Information Form, so that you can
score it while the clients are completing the latter form.
6. Feedback Summarize and interpret scores from the forms that

are used. Based on the overall assessment interview, go
over main issues for the couple and tie this feedback to
the treatment plan.
7. Preparation for the Next Appointment If group: do a general orientation for the group and
give them the start date.
If individual: set the next appointment and hand out

homework for Assignment 1 (Genogram/Family Tree).
Discuss any barriers to attending treatment.

ASSESSMENT SESSION 5
Session Resources
ASSESSMENT QUESTIONNAIRES: DESCRIPTION
Client Background Information Form

This form records the background information of both partners. The therapist can fill this in as the
couple are interviewed. This provides a structure for obtaining pertinent information that will be
useful for assessing the eligibility of the couple for bct and for the formulation of a treatment plan.
Dyadic Adjustment Scale (DAS)

The das is a 32-item self-administered measure of the quality of marriage and similar dyads. It can be
completed in about 10 minutes and has been widely used in research on the marital or dyadic relation-
ship. Content, criterion-related and construct validity were reported; and the scale was found to have an
overall reliability of .96 using Cronbachs coefficient alpha (Spanier, 1976; Spanier & Thompson, 1982).
The das score is computed by adding up the scores of all items. Total score ranges from 0 to 151. There
is no norm for determining the cut-off for happy or unhappy relationship. However, in a previous
study, the mean score of a divorced sample is 71, and the mean score of a married sample is 115. A
score below 71 may be indicative of a distressed relationship, and a score above 115 may be indicative
of a non-distressed relationship.
It is not necessary for therapists to use this scale in their assessments for bct. The authors used it
in conjunction with the associated research study. However, we also found it helpful as a clinical tool.
Clinically, the scale can be used in three ways:
as a very general indicator, to help formulate an overall impression of the quality of the relationship
to compare partners responses, and then use the similarities and differences as a starting point for
discussion
to identify specific problem areas by examining responses to individual items, and to use these
responses as a basis for discussion and the development of a treatment plan.
The das can be purchased from Multi-Health Systems.
Alcohol and Drug Use Information Form

This is a simplified version of the Drug Use History Questionnaire and Adverse Consequences of
Drug Use Scale contained in the standardized assessment package for assessing substance use at the
Centre for Addiction and Mental Health. This provides an evaluation of the substance use problem
in terms of frequency of drug use, as well as its adverse consequences.
CLIENT BACKGROUND INFORMATION FORM
Client Name: ______________________________________________ Client Name: ______________________________
File No.: ____________________________________________________ File No.: ____________________________________________________
Date of Birth | | | | | | | Date of Birth | | | | | | |

DAY MONTH YEAR DAY MONTH YEAR
Sex Male Female TG/TS Sex Male Female TG/TS
Education (years completed) | | | Education (years completed) | | |
Occupation ________________________________________________ Occupation ________________________________________________
Current Employment Status Current Employment Status

Full-time employment Full-time employment
Part-time employment Part-time employment
Self-employed Self-employed
Unemployed Unemployed
Homemaker Homemaker
Student Student
Currently living with (check all that apply) Currently living with (check all that apply)
Spouse/partner Spouse/partner
Children Children
Parents Parents
Other relatives/friends Other relatives/friends
Alone Alone
Number of past long-term | | | Number of past long-term | | |

relationships/marriages relationships/marriages
Length of marriage/ | | | MONTHS
living together OR
| | | YEARS
Number of children (from | | |

current/past relationships)
living with couple
Number of separations | | |
in this union
Primary Substance of Abuse Primary Substance of Abuse

(the one substance about which client is most concerned) (the one substance about which client is most concerned)
No drug use problem No drug use problem
Check only one Check only one

Alcohol problem Alcohol problem
Cocaine problem Cocaine problem
Heroin problem Heroin problem
Marijuana (Cannabis) problem Marijuana (Cannabis) problem
Tobacco problem Tobacco problem
Other drug(s) ________________________________________ Other drug(s) ________________________________________
Problem duration | | | MONTHS Problem duration | | | MONTHS
OR OR
| | | YEARS | | | YEARS
Other Substance of Abuse Other Substance of Abuse

(any other substances for which client has some concerns) (any other substances for which client has some concerns)
Check all that apply Check all that apply
Alcohol problem Alcohol problem
Cocaine problem Cocaine problem
Heroin problem Heroin problem
Marijuana (Cannabis) problem Marijuana (Cannabis) problem
Tobacco problem Tobacco problem
Other drug, specify: ________________________________ Other drug, specify: ________________________________
Currently receiving treatment for substance use Currently receiving treatment for substance use
(including AA or similar self-help groups)? (including AA or similar self-help groups)?
Yes Yes
No No
If YES, describe __________________________________________ If YES, describe: __________________________________________
Currently receiving treatment for emotional/ Currently receiving treatment for emotional/
psychological difficulties? psychological difficulties?
Yes Yes
No No
If YES, describe __________________________________________ If YES, describe __________________________________________
Previous Treatment for Alcohol/Drug Problem: Previous Treatment for Alcohol/Drug Problem:
Check all that apply Check all that apply
Detox Detox
Emergency Emergency
Outpatient Outpatient
Inpatient Inpatient
Others: ________________________________________________ Others: ________________________________________________
Commitment to Working on Relationship Issues:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Treatment Goals:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Domestic Violence Issues (past or present):
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Mental Health Issues:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Other information (Previous couple therapy; Legal issues, etc):
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
ALCOHOL AND DRUG USE INFORMATION FORM
Name: ______________________________________________________ Date: ______________________________________________________
Please answer the following questions about your alcohol and drug use:
Drug Type Used in past No. of days Has your use of this
12 months? used in past substance been a
90 days concern to you?
Yes No Yes No
ALCOHOL
CANNABIS
pot, grass, hash
COCAINE/CRACK
BENZODIAZEPINES
tranquillizers, Librium, Valium
PRESCRIPTION OPIOIDS
methadone, painkillers, Percodan,
Darvon, 292s, Dilaudid
OVER-THE-COUNTER CODEINE
PREPARATIONS
222s, Benylin
HEROIN/OPIUM
HALLUCINOGENS
acid, lsd, mushrooms, ecstasy
OTHER PSYCHOACTIVE DRUGS

e.g. antidepressants,
anti-alcohol drugs
Specify names:
(1) ________________________________________
(2) ________________________________________
(3) ________________________________________
As a result of your substance use, have you experienced the following problems in the past 90 days?
Yes No N/A
Problems with your health
Blackouts or memory problems, forgetting, confusion,

difficulty thinking
Mood changes, personality changes, substance-related

problems, flashbacks when using
Problems in relationships
Being verbally or physically abusive when using
Work or school problems

(NO JOB OR
NOT IN
SCHOOL)
Legal problems (substance-related charges)
Financial problems
Has your partners alcohol and/or drug use been a concern to you?
If yes, please specify:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
FACTS ABOUT COUPLES TREATMENT H
What is the program about?

Brief Couples Treatment:
is for couples who are willing to look at how alcohol and/or drug use and/or addictive
behaviours affect their lives
helps couples improve their relationship by working on communication, problem solving,
conflict reduction and other identified issues
helps couples work on their drug use goals and ways to deal with relapse
is based on the beliefs that substance use affects your relationship, that change in substance
use affects your relationship, and that changes in your relationship can have an effect on
alcohol or other drug use.
How does it work?

The program will involve eight sessions, which will begin following an assessment
appointment with a therapist.
Topics covered in these sessions will include family history, communication, trust, goal
setting, problem solving and relapse prevention.
Please attend the sessions with your partner and arrive alcohol- and drug-free.
You have an appointment with _______________________________________________
on ___________________________________________________________ at _______________________________
If for any reason you cannot keep your appointment, please call.
INTRODUCTION Session
1
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Client Handouts
DESCRIPTION OF TOPICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
FAMILY TREE GUIDELINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
INTRODUCTION Session
1
Session Guidelines
OBJECTIVES
Couples will:
understand the purpose, format and content of the Brief Couples Therapy (bct) treatment
introduce themselves and begin to engage with the group
identify some preliminary short- and long-term goals and expectations.
A safe, comfortable environment will be created through building group cohesion and reinforcing
common issues among participants.
CHECKLIST
1. Therapists Introduce Themselves Therapists will introduce themselves and describe

to the Group their role. This can be a general introduction about who
they are, their responsibilities and their role in helping
to facilitate the group.
2. Reviewing Participation in the Group Safety: This group is a place where you can start
Group Norms and Confidentiality talking about and hopefully solving some of the prob-
lems youre facing in your relationship. Because people
are going to be sharing things, it is important that we all
agree that what is said in the group stays in the group.
As you feel comfortable with us and with each other, you
may be sharing personal information, and we want to
make it safe for everyone to talk about your issues.
Confidentiality: Something that is important for us to

talk about is confidentiality. What is said in here stays
in this room. We need your permission to talk to or to
release information to others outside of the family treat-
ment team. However, there are some limits to confiden-
tiality. If you are going to harm yourself or others, or if
there are concerns about a child being at risk for harm,
or when records are subpoenaed by the courts, then
legally we need to break confidentiality. But aside from
those exceptions, your confidentiality is maintained.
Contact between Sessions: This city can be a small

place, and were asking you please not to have contact
with other group members outside the group while the
sessions are in progress.
18 SESSION 1 | INTRODUCTION
Respectful Communication: A group expectation is

that we all communicate in a respectful manner
(i.e., no put-downs).
Timekeeper: An important part of doing any group is

trying to keep everyone focused and to keep us all on
track. So we will be watching the clock and may have
to interject from time to time.
3. Client Introductions Introductions Using an Icebreaker: In todays session,

we are going to be talking a lot and getting to know one
another better. As a way of starting this, we would like
you to [introduce icebreaker].
Icebreaker Example: Think about the situation in

which you first met and identify a funny or happy
memory of that time.
4. Stating the Format and the Rules Attendance: This group will be meeting for about an
of the Group hour and a half once a week for eight weeks. Please
attend all sessions with your partner and arrive alcohol-
and drug-free. Well start at ___ p.m. Because the func-
tioning of the group as a whole relies on input from
each of the members, it is important that you commit
to coming to every group and that you arrive on time.
Format: The framework for todays group will be simi-

lar to each of the remaining sessions. All of you will
have the opportunity to talk about yourselves and your
families in turn. Each week, we will use a different
exercise to help you with communication, problem
solving, goal setting and other relationship-building
and relapse-prevention skills.
Roles: This is your group and you are here to help each
other out. Therefore what you have to say to each other
is very important. We (the therapists) are here to help
provide a safe environment and to encourage you to
participate.
5. Stating the Purpose of the The purpose of the group is to help couples with
Treatment Group substance use concerns to address the impact that
their substance use has had on their relationship and
to identify goals for change. It is also to help you focus
on the present, and to have you think about how
you would like your relationship to be in the future.
An additional purpose of the group is to provide a
SESSION 1 | INTRODUCTION 19
supportive context where participants can benefit

from others experience and feedback. Aspects of
supportive feedback are listening carefully, taking a
non-judgmental position and responding in a clear,
brief, specific manner, from an I position.
Hand out the Description of Topics sheet or show

a flipchart of the topics that will be covered in the
eight sessions.
6. Exploring Clients Expectations Ask all of the participants to state in turn their hopes
and Concerns and expectations for themselves as a couple during this
group and to briefly describe their drug use history,
treatment history and drug use goals. Therapists should
encourage clients to focus on couple-related goals.
7. Homework (Genogram/Family Tree) When handing out folders, instruct participants to keep
all homework in their folders and bring them each week.
The symbols used in the Family Tree exercise may be

changed to suit the needs of different agencies or clien-
tele. (For example, we use circles to denote females
and squares to denote males; these symbols may not
be useful for transgendered or transsexual clients).
Similarly, the sample Family Tree is only one example
of a possible family tree that might be used.
NOTE
Therapists who have not done a genogram/family tree
before should do one of their own to gain a better
understanding of the exercise.
Describe the genogram as a family tree, and explain

its purpose: We are going to do a type of family tree
that can be helpful for understanding family back-
ground and different patterns or issues that may be
important in your current relationship, but that date
back to your family of origin. Please use this sample
to help you to complete a family tree for your family,
going back to your parents or grandparents if you feel
this is important.
Demonstrate the use of a family tree: Prior to the

group, therapists will have copied some or all of the
Family Tree example, or a different example that
they made up, onto a flipchart sheet (width-wise
if possible). Put up the flipchart example, describe
the different components of the chart and explain the

linkages. We will share your family trees with the group
next week, as a way of getting to know each other better
and putting your current relationship into a broader
context. Please only include information you are com-
fortable sharing with the group; you may have other
information you want to share later with your spouse.
Hand out folder packages: This will be your folder for

you to keep your homework and refer to from week to
week. Inside you will find the Family Tree instruction
sheets and a blank flipchart page for your family tree.
8. Check-out Ask each group member to offer one word, thought

or feeling as a check-out for the evening. The therapist
may begin with I feel hopeful and go around the
room.
Session Resources
MATERIALS
one package per person, including one folder, the Family Tree example, instruction sheet, blank
self-adhesive flipchart page
Family Tree example on a flipchart sheet
flipchart, markers
liquid refreshments
SUMMARY
1. Therapists Introduce Themselves to the Group
2. Reviewing Participation in the Group Group Norms and Confidentiality

Safety
Confidentiality
Contact between Sessions
Respectful Communication
Timekeeper
3. Client Introductions
Icebreaker
4. Stating the Format and the Rules of the Group

Attendance
Format
Roles
5. Stating the Purpose of the Treatment and Group
6. Exploring Clients Expectations and Concerns
7. Homework (Genogram/Family Tree)

Describe the purpose of the Family Tree.
Demonstrate using the example on the flipchart.
Hand out folder packages.
8. Check-out
TIPS FOR INDIVIDUAL COUPLE SESSION
There is no group orientation. The assessment and introduction sessions are incorporated into
one session. This session may be longer than other sessions.
Read and follow applicable directions from checklists for both the Assessment and Session 1.
Cover the following information from Session 1 (Introduction):
Give information about participating in the program, topics, format, rules, confidentiality,
hopes and expectations.
In preparation for Session 2, describe the Genogram/Family Tree and the concept of homework.
Set the next appointment and hand out the Family Tree for completion prior to the next session.
DESCRIPTION OF TOPICS H
The topics to be covered over the eight sessions of this group:
Session Date Time Topic

1 Introduction Family Tree
2 Thinking about What Change Would Look Like

(Miracle Question)
3 Goal Setting
4 Steps towards Achieving Goals
5 Communication 1
6 Communication 2
7 Trust and Intimacy
8 Relapse Prevention
H FAMILY TREE GUIDELINES
SYMBOL REPRESENTS
male
female
marriage or partnership
child
divorce or separation
or person with drug or alcohol problem
distant relationship
close relationship
conflict
or death
Put age, or year of death, of each person in box.

Beside each box, put relevant information concerning:
Occupation Offender
Physical health Number of marriages, including common-law
Mental health Country of origin
Addiction Migration story
Victim of abuse
homemaker emigrated from
arthritis South America 1950
70 diabetes
72
labourer
SAMPLE FAMILY TREE
abused
alcohol
teacher chef
42 40 45
depressed
47
50
second marriage
12 13 6
17 16
Put age or year of death of each person in box.

SESSION 1 | INTRODUCTION
H
25
Progress Note: Introduction

Session date ____________________
DD/MM/YY
Patient/Client Name ______________________________________________ Health Record # ___________________
Patient/Client cancelled Specify action plan ______________________________

No show ______________________________
Therapist cancelled
Attended Session #1 of the BCT Program

This session was conducted in the following format Individual Group
This session covered the following (check one box)
NOT
COVERED COVERED
The program was introduced by the therapist(s)

Information about participating in the program and confidentiality was reviewed
Group topics, format and rules were reviewed
Introductions were made
Group members hopes and expectations for the group were discussed
In preparation for session 2, genograms and concept of homework were introduced
Check-out completed
Drug Use Goal(s): Abstinent Reduction Undecided No change N/A

Substance Use Since Last Session: Abstinent Non-abstinent Dont know N/A
Therapists (print name & credentials):

(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Next Session Scheduled for: ________________________________________________________________________
Treatment Terminated (patient/client initiated)
Treatment Terminated (therapist initiated)
Additional Notes:
FORM COMPLETED BY
NAME (PRINT) SIGNATURE AND CREDENTIALS DATE

GENOGRAM/FAMILY TREE Session
2
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Client Handouts
THE MIRACLE QUESTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
GENOGRAM/FAMILY TREE Session
2
Session Guidelines
OBJECTIVES
Couples will:
begin to understand the impact of substance use on their own relationship and their families of origin
begin to identify patterns of use and related problems in their own relationship
further identify and develop their treatment goals.
Group cohesion and commitment will continue to develop.
CHECKLIST
1. Check-in Ask about questions or issues arising from the last

session.
Name a thought, word or feeling that describes how

you are right now.
2. Stating the Format and Purpose Through the presentation of the family trees to the
of This Session group, you will begin to understand the impact of
substance use in your own relationship and in your
families of origin. This will help you to focus on areas
for change and relationship goals. We will begin this
process tonight with a review of your family trees, and
we will continue to explore goals and areas for change
in later sessions.
3. Reviewing Family Trees Each couple will present their family tree, which will
be taped to the wall. All of the family trees will be
explored with the group in terms of patterns of family
relationships, and positive and negative aspects of
these relationships. Group leaders will record common
themes and issues on a flipchart, keeping in mind
potential areas for change and treatment goals.
To the extent that it is comfortable for the client who is

sharing, explore relationship patterns, substance use,
and similarities and differences across generations that
may be influencing the current couple relationship.
Ask couples to identify two things of interest that

helped you to do this one pleasant surprise and one
not-so-pleasant surprise.
30 SESSION 2 | GENOGRAM/FAMILY TREE
4. Homework (Miracle Question) Couples are instructed to complete the Miracle

Question handout for discussion in the next session.
Note that the purpose of the Miracle Question is to
instil a sense of hope and agency in each individual.
It is not to encourage one partner to try to change the
other partner.
This exercise will help you to create a future vision

of your relationship. Please read each question, think
about an answer and then write down your response.
Each partner can have a different miracle. You will
share your miracle with the group in our next meeting.
5. Check-out Ask each group member to state one positive word

that he or she is thinking or a feeling that he or she
is experiencing. The therapist can begin with an
example such as Im feeling hopeful.
SESSION 2 | GENOGRAM/FAMILY TREE 31
Session Resources
MATERIALS
tape for taping family trees to the wall or a stand to put up family tree flipcharts
(Note: two stands would make it possible to put up flipcharts for both partners, side by side, for
further comparison of patterns and themes.)
Miracle Question homework sheet
(Note: if a client is unable to write, or if English is not his or her first language, the client may use
other methods to answer the Miracle Question, such as drawing symbols, writing in his or her
first language or making brief notes to jog memory.)
SUMMARY
1. Check-in
Discuss comments or issues arising from the last session.
2. Stating the Format and Purpose of This Session
3. Reviewing Family Trees

Focus on areas of change and treatment goals.
Review family trees.
Allot sufficient time approximately 10 minutes per person.
Group leader(s) record common themes and issues on a flipchart note potential
treatment topics and goals.
Explore patterns and themes with couples.
Identify one pleasant surprise and one not-so-pleasant surprise.
4. Homework (Miracle Question)

Describe the purpose of the Miracle Question.
Explain how to do it give examples of concrete miracles.
Remind couples they will be sharing their miracles with the group.
Hand out packages.
5. Check-out
TIPS FOR INDIVIDUAL COUPLE SESSION
Check-in: Ask the couple to talk about anything that came up for them as a result of the previous
session and then ask them about their week.
Family Trees: Discussion about the couples family trees is briefer in the individual sessions. Extra
time can be used to explore more fully and concretely the impact of past family patterns on the
substance use and on the present couple relationship. As well, extra time can be used to begin to
look at possible changes that the couple might want to make in their relationship.
Use the extra time to explore what pieces of the family history were known to the couple.
Ask them if they learned anything new or surprising about their own family or about their partners.
SESSION 2 | GENOGRAM/FAMILY TREE 33
THE MIRACLE QUESTION H

After thinking about your relationship, please take a few moments to answer the following
questions:
Suppose one night, while you were asleep, there was a miracle and your relationship issues
were resolved. When you woke up:
how would you know a miracle had occurred?
what sorts of things would be different?
how would you be thinking differently?
what would you be doing differently?
how would your family/friends know that a miracle had occurred?
You can provide as much detail as you need to describe what your life would be like after this
miracle. Try to think about your miracle in concrete terms (e.g., we will go for long walks
together or after we put the children to bed, we will spend time cuddling on the couch and
talking) as opposed to abstract wishes (e.g., we will be happy).
Also, be sure to focus on changes in your own behaviour when you are describing changes in
the relationship.
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Progress Note: Genogram/Family Tree

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED
Patient/Client homework of genograms was reviewed

Patient/Client discussed preliminary short- and long-term treatment goals
Homework assigned: _________________________________________________________________
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

MIRACLE QUESTION Session
3
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Client Handouts
GOAL ASSIGNMENT 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
MIRACLE QUESTION Session
3
Session Guidelines
OBJECTIVES
Couples will begin to:
identify any positive small changes within their relationship
focus on the future and form a vision of how they would like the relationship to be
focus on reasonable and achievable goals that will bring them closer to their vision.
CHECKLIST
1. Check-in Ask about issues arising from the last session.

you are right now.
2. Stating the Format and Purpose of By reviewing the miracles that youve written down, we
This Session hope to help you formulate a vision of how you would
like your relationship to be, and communicate this to
your partner and the group.
3. Reviewing Miracle Question Homework Ask couples to discuss their miracles. They may need
help keeping the focus of the discussion on themselves,
rather than their partners, and on concrete changes.
Encourage concrete, specific and behavioural answers;

specifically, ask them what would they be doing differ-
ently and not how they would be feeling different.
Therapists should listen for small, concrete expressions
(e.g., we would kiss each other goodbye when we leave
for work).
Ask people if any part of their miracle is already

happening, and if so, what is that like?
4. Homework (Goal Assignment 1) Couples are instructed to complete the Goal

Assignment 1 sheet for discussion in the next session.
Couples will individually select a personal goal and

a couple goal from their miracle, and write down the
steps needed to achieve that goal.
Therapists should encourage positive, action-oriented

goals (e.g., talk twice a week versus argue less) and
give clients examples of individual goals (e.g., I want
38 SESSION 3 | MIRACLE QUESTION
to handle problems more calmly) and couple goals

(e.g., we will go for a walk together once a week).
Instruct them to be specific in identifying steps that
will help them move towards their goal.
5. Check-out Ask each group member to offer one positive word,

thought or message that he or she got out of the session.
SESSION 3 | MIRACLE QUESTION 39
Session Resources
MATERIALS
pens and copies of Miracle Question exercise
homework sheets: Goal Assignment 1
SUMMARY
1. Check-in
Ask about comments or issues arising from the last session.
Ask participants to express a thought, word or feeling.

Miracle Question
3. Reviewing Miracle Question Homework

Ask couples to discuss their miracles.
Encourage clients to focus on themselves and to be concrete and specific.
There are no right or wrong answers couples may interpret the miracle differently.
4. Homework (Goal Assignment 1)

Describe the purpose of Goal Assignment 1.
Explain how. Give examples. Remind clients to think of steps towards goals.
Hand out packages.
5. Check-out
TIPS FOR INDIVIDUAL COUPLE SESSION 3
During the session, it is important to stress to clients that their miracle should be specific, concrete,
behavioural and about themselves, not their partner. Redirect clients to focus on the concrete,
behavioural elements of the miracle if they get sidetracked.
Because there is more time than in the group format, therapists should ensure that partners have
heard and understood each others miracle. Use this time also to clarify and explore what each would
be doing differently.
40 SESSION 3 | MIRACLE QUESTION
H GOAL ASSIGNMENT 1
Based on todays discussion, we would like you to think about what you want to be different,
both for yourself and in your relationship.
Please select a personal goal for yourself and a goal as a couple, and also note some of the steps
that would help you to achieve the miracle:
(Try to choose small, concrete and specific goals. The couple goal should not involve changing
the other partner.)
Personal Goal for Yourself Goal as a Couple
Steps to Achieve Goal Steps to Achieve Goal

SESSION 3 | MIRACLE QUESTION 41
Progress Note: Miracle Question

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED
Homework reviewed
Miracle question exercise completed and discussed
Homework assigned: _________________________________________________________________
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

GOAL SETTING Session
4
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Client Handouts
GOAL ASSIGNMENT 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
GOAL SETTING Session
4
Session Guidelines
OBJECTIVES
Each partner will:
select one personal goal and one couple goal
identify the steps needed to achieve his or her goals
Couples will have begun the process of engaging in the negotiation of their goals with each other.
Group cohesion and commitment will continue to develop.
CHECKLIST

you are right now.
2. Stating the Format and Purpose In todays session, we are going to be working on
of This Session personal and couple goals. As facilitators, we will give
you some feedback as you discuss your goals, and it
may also be helpful for group members to give each
other feedback on goals and on goal setting as we
go along.
3. Reviewing Goal Assignment 1 Ask each member to share his or her goals with the
Homework group. Have him or her scale the goals (1-10) in terms
of how close each goal is to being achieved. Also, note
where there are common goals among group members.
Some time for discussion and group feedback may
be required when a couples goals conflict.
Ask couples to choose a goal to work on together.
Encourage them to choose a goal that is clear, concrete

and attainable, and point out that goal achievement
is a step-by-step process. Ask couples to identify some
of the steps that will be required to achieve their goals.
Feedback from other group members may help couples
establish these steps.
46 SESSION 4 | GOAL SETTING
4. Homework (Goal Assignment 2) Couples are instructed to complete the Goal

Assignment 2 sheet for discussion in the next session.
Next week, we will review your progress and we will
do an exercise designed to help you work on your goals
with your partner.
(Therapists keep notes of each clients goals to be

reviewed in Session 7.)

is experiencing.
SESSION 4 | GOAL SETTING 47
Session Resources
MATERIALS
pens
homework sheets: Goal Assignment 2
SUMMARY
1. Check-in
Name a thought/word/feeling and/or discuss issues arising from the last session.
3. Reviewing Goal Assignment 1 Homework

Each group member shares personal goals and couple goals.
Have each client prioritize goals and choose one attainable goal.
Help couples work out the steps needed to attain goals.
4. Homework (Goal Assignment 2)

Hand out Goal Assignment 2 sheet. Instruct couples to complete it for next session.
5. Check-out
Use extra time to clarify goals, both personal and couple, that are small, concrete, attainable and
specific.
Stress that goals should be about themselves and should not involve changing the other partner.
Encourage clients to frame their goals in a positive, action-oriented way (i.e., our goal is to talk twice
a week versus our goal is to argue less).
48 SESSION 4 | GOAL SETTING
H GOAL ASSIGNMENT 2
1. Select a goal that you have identified through todays discussion and that you will work on
during the coming week.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
2. On a scale of 1 to 10, circle how close you are to achieving this goal now.
NOT
ACHIEVED FULLY
AT ALL ACHIEVED
| | | | | | | | | |
1 2 3 4 5 6 7 8 9 10
3. List specific steps you plan to take towards this goal.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
4. List progress/steps that you have taken over the course of the week.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
5. On a scale of 1 to 10, circle how close you are to achieving this goal at the end of the week.
NOT
ACHIEVED FULLY
AT ALL ACHIEVED
| | | | | | | | | |
1 2 3 4 5 6 7 8 9 10
SESSION 4 | GOAL SETTING 49
Progress Note: Goal Setting

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED
Goals based on homework discussed

Individual goal(s) identified
Couple goal(s) identified
Homework assigned: ________________________________________________________________
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

COMMUNICATION Session
5
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Client Handouts
LISTENING AND SPEAKING SKILLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
LISTENING AND SPEAKING SKILLS PRACTICE DIARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
COMMUNICATION Session
5
Session Guidelines
OBJECTIVES
Couples will:
start the process of working towards improving their communication within their relationship
start to work on improving their listening and speaking skills
identify the areas of deficiency that they would like to improve.
Individuals will practise listening and speaking skills and get feedback regarding what they did well and
what to improve from their partners and from the group.
CHECKLIST

you are right now.
2. Stating the Format and Purpose of The purpose of the session is for couples to learn or
This Session improve communication skills. In order to do this,
look at the steps (listed in the Listening and Speaking
Skills handout) that we would like you to use in order
to express yourself.
3. Reviewing Session Homework Discuss progress over the last week.
Discuss the steps and progress that each person has

made towards working on his or her goals.
Therapists keep track of client goals and progress for

later sessions.
4. Role Plays Give out the Listening and Speaking Skills exercise.
Based on issues or goals that couples defined in pre-

vious sessions, have them practise role plays using
the Listening and Speaking Skills exercise to help
improve their communicating within the relationship.
OPTIONS
a) If time does not permit each couple to practise role
plays, and if couples have varying skill levels, choose
one couple to practise in front of the group.
54 SESSION 5 | COMMUNICATION
b) Therapists choose a topic and role-play effective

communication on that topic for the group.
c) Do one role-play exercise with speaking skills only,
followed by a role play with listening skills only,
followed by both.
5. Homework (Listening and Speaking Couples are asked to continue working on Listening
Skills) and Speaking Skills before the next session.

is experiencing.
SESSION 5 | COMMUNICATION 55
Session Resources
MATERIALS
pens and copies of Listening and Speaking Skills exercise
SUMMARY
1. Check-in
3. Reviewing Homework
Keep track of client goals for later sessions.
4. Role Play and Practising Communication Skills

Hand out Listening and Speaking Skills exercise.
5. Homework (Listening and Speaking Skills)
6. Check-out
Use extra time to prioritize both personal and couple goals and to discuss specific steps in planning to
achieve these goals.
Have couples begin to practise listening and speaking skills in role-play discussions.
H LISTENING AND SPEAKING SKILLS

Use this handout to help you practise listening and speaking skills. These skills are important
parts of communication in any relationship. They are particularly helpful when speaking with
your partner. The use of active listening skills may help you better understand what your part-
ner is trying to tell you about his or her own feelings and thoughts. Using I language lets your
partner know how you feel about something, when you feel that way, why you feel that way and
how you would like things to be.
Active Listening:
1. Look at the other person. Make eye contact.
2. Show the person you understand by nodding your head and looking interested.
3. Ask questions when you want more information or when you dont understand.
4. Repeat, in your own words, what the other person has said. Then she or he will be able
to let you know if you understood what was said.
5. Show that you want to hear what the other person has to say.
6. Dont give advice unless you are asked for advice.
7. Although you may not agree with the other person, respect his or her point of view.
I Statements:
1. Use I statements to talk about your feelings.
2. Say one thing at a time.
3. When describing your reaction to something another person has said or done, focus on
the behaviour of the other person, not the whole person.
4. Try not to use general statements like you never or you always. Be very specific.
5. Be positive.
EXAMPLE
I feel frustrated when you drop your laundry on the floor. I would prefer that you put it in
the hamper.
A. Practise using I statements in the following format:

I feel ______________________________________________________ (emotion)
When you ________________________________________________ (behaviour)
I would prefer ______________________________________________ (specify need)
B. Practise using I statements in different ways, making sure to identify your own
emotions and/or your needs. When talking about your partner, be sure to specify your
partners behaviour(s).
SESSION 5 | COMMUNICATION 57
LISTENING AND SPEAKING SKILLS PRACTICE DIARY* H
Name Date Time Listening Speaking Outcome

Skills Skills
*Each time you practise using listening and speaking skills this week, complete this Practice Diary, filling out
the date and time, which skill(s) you practised, and any comments about how it turned out. Bring it with you
for discussion next week.
Progress Note: Communication

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED
Patient/Client completed check-in and reviewed homework

Therapist(s) introduced Listening and Speaking Skills exercise
Listening and Speaking Skills exercise completed and discussed
Homework assigned: ______________________________________________________
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

TRUST/INTIMACY Session
6
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Client Handouts
TIPS FOR EFFECTIVE COMMUNICATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
TRUST/INTIMACY EXERCISE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
TRUST/INTIMACY Session
6
Session Guidelines
OBJECTIVES
Couples will:
continue to work towards improving their communication within their relationship
continue to work on expressing their thoughts and feelings to their partners
practise expressing their thoughts and feelings to their partners and get feedback from the group.
begin to work on building trust and intimacy.
CHECKLIST

you are right now.
2. Stating the Format and Purpose of The purpose of the session is to review your homework
This Session and continue to work on improving your communica-
tion skills. We will also discuss the concepts of trust and
intimacy.
3. Reviewing Session Homework Discuss progress on listening and speaking skills

development over the last week.
Hand out Tips for Effective Communication to

facilitate further practice.
4. Practising Role Plays Participants are asked to continue to practise role plays.
These can be based on participants homework.
Encourage the use of I language and feedback from

other members as each couple takes a turn practising
role-play discussions.
5. Homework (Trust/Intimacy) Discuss the meaning of trust and intimacy before

handing out the exercise: Trust is important in a
relationship. There may be areas where there is no
trust. There are probably also areas where there is
more or a lot of trust.
We express intimacy in various ways (e.g., interacting

physically; sharing thoughts/feelings; taking care
of each other; spending time together). Trust and
62 SESSION 6 | TRUST/INTIMACY
intimacy are often connected and people need to have

trust in order to express intimacy.
Therapist may have couples brainstorm a list about

what trust and intimacy mean to them. Put this list on
the board.
Hand out the Trust/Intimacy assignment for couples to

work on before the next session.

that he or she is thinking or a feeling that he or she is
experiencing.
SESSION 6 | TRUST/INTIMACY 63
Session Resources
MATERIALS
pens and copies of Trust/Intimacy exercise
copies of Tips for Effective Communication
SUMMARY
1. Check-in
Discuss thought/word/feeling and/or issues arising from the last session.

Continue to improve communication skills.
3. Reviewing Session Homework and Practising Communication Skills

Discuss progress on listening and speaking skills.
Hand out Tips for Effective Communication.
4. Practising Role Plays

Encourage the use of I language.
Each couple takes a turn practising role play.
5. Handing Out Homework (Trust/Intimacy)

Discuss meaning of trust and intimacy before handing out exercise.
6. Check-out
Ask the couple for a specific situation that they could role-play using listening and speaking skills.
Encourage the use of I language.

H TIPS FOR EFFECTIVE COMMUNICATION
Three basic skills of good communication are:

looking
listening and
speaking.
Looking
Look at the other person. Make eye contact.
Pay attention to body language, such as facial expression and gestures. These things help you to
understand what the other person is expressing.
Show that you are listening by leaning forward, nodding your head, looking interested and
using encouraging phrases, such as uh-huh, go on or I see what you mean.
Listening
Pay attention.
Ask questions when you want more information or dont understand.
Repeat, in your own words, what the other person has said. Then she or he will be able to let
you know if you understood what was said.
Dont think ahead to what you are going to say. Dont rehearse what you want to say while the
other is speaking.
Dont interrupt. Remain silent when the other person speaks.
Show that you want to hear what the other person has to say.
Speaking
Use I statements.
FOR EXAMPLE:
I feel ______, when you ________, I would prefer _________.

Be very specific. Steer clear of general statements, like you never or you always.
Be honest about what you are thinking and feeling.
Avoid blaming, name-calling or advice-giving (unless the other person asks for your advice).
Focus on the issue at hand dont bring past arguments and issues into the current discussion.
Be positive and solution-focused. H

Although you may not agree with the other person, respect his or her point of view.
Other Hints
If the discussion escalates into an argument, take a break.
Make sure you agree on a time when you will come back to the discussion when you are both
feeling calmer.
Sometimes, it is easier to have a difficult conversation in a new or different location
(e.g., outside the home, in a coffee shop, etc.).
Practise talking about less difficult (or less loaded) issues first.
Be sure to spend time talking about positive things each day.
H TRUST/INTIMACY EXERCISE
In your relationship, list three areas where trust is important to you:
A. ____________________________________________________________________________
B. ____________________________________________________________________________
C. ____________________________________________________________________________
On a scale from 1 to 10, please rate how much trust there is in each of these areas:
A. NOT A GREAT
A LOT OF DEAL OF
TRUST TRUST
| | | | | | | | | |
1 2 3 4 5 6 7 8 9 10
B. NOT A GREAT
A LOT OF DEAL OF
TRUST TRUST
| | | | | | | | | |
1 2 3 4 5 6 7 8 9 10
C. NOT A GREAT
A LOT OF DEAL OF
TRUST TRUST
| | | | | | | | | |
1 2 3 4 5 6 7 8 9 10
What are some specific ways that you express intimacy and caring in your relationship?
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
What are some steps to building trust and intimacy in your relationship?
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Progress Note: Trust/Intimacy

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED

Therapist(s) introduced trust/intimacy exercise
Trust/intimacy exercise completed and discussed
Explored the issue of trust in the couples relationship and the way that it can be addressed
Discussed ways to build trust and express caring in relationship
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

RELAPSE PREVENTION Session
7
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Client Handouts
RELAPSE PREVENTION/MAINTENANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
RELAPSE PREVENTION Session
7
Session Guidelines
OBJECTIVES
Couples will:
continue to work towards improving their communication within their relationship
continue building trust and intimacy
begin to think about and define areas of relapse and relapse prevention.
CHECKLIST

you are right now.
2. Stating the Format and Purpose of The purpose of the session is for members to discuss
This Session trust and intimacy. The homework will focus on relapse
prevention.
3. Reviewing Session Homework Discuss progress on issues related to trust and intimacy.
Ask couples to talk about areas of trust and the degree
of trust in their relationships. Put the emphasis on
breaking issues into small, concrete steps, focusing on
how couples can move forward in an active way.
4. Homework (Relapse Prevention/ The focus of relapse prevention will be defined by

Maintenance) couples issues discussed over the course of the therapy,
such as the return to former patterns of behaviour,
including substance use and its potential impact on
the relationship. Hand out sheets with the following
questions:
What is a relapse for you as a couple (e.g., communi-
cation breakdown; loss of trust; loss of intimacy, etc.)?
What would be the clues that a relapse has happened?
Describe a plan for preventing relapse. Be specific.
Discuss the questions with the group members.

is experiencing.
72 SESSION 7 | RELAPSE PREVENTION
Session Resources
MATERIALS
pens and copies of Relapse Prevention exercise.
SUMMARY
1. Check-in

Discuss trust and intimacy.
Begin to think about possible plans for relapse prevention.
3. Reviewing Session Homework

Discuss issues related to trust and intimacy.
4. Introducing, Describing and Handing Out Relapse Prevention Exercise
5. Check-out
Use the time to explore and discuss issues relating to trust and intimacy.
SESSION 7 | RELAPSE PREVENTION 73
RELAPSE PREVENTION/MAINTENANCE H
What is a relapse for you as a couple (e.g., communication breakdown, loss of trust, loss of
intimacy, etc.)?
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
What would be the clues that a relapse might happen?
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Outline a plan for preventing relapse be specific!
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
74 SESSION 7 | RELAPSE PREVENTION
Progress Note: Relapse Prevention

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED

Therapist(s) introduced relapse prevention plan
Relapse prevention plan exercise completed
Discussed ways to cope with relapse and reviewed action plans
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

CONCLUSION Session
8
Session Guidelines
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
CHECKLIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Session Resources
MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
TIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Progress Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
CONCLUSION Session
8
Session Guidelines
OBJECTIVES
Summary session of issues and work done couples will review major issues and goals.
Couples will work on future goals and plans to prevent lapsing into problem patterns.
CHECKLIST

you are right now.
2. Stating the Format and Purpose of The purpose of this group is 1) to review the major
This Session issues and goals; 2) to normalize/formalize the
ending process; 3) to plan future goals and how you
can avoid returning to old patterns that are unhelpful
or problematic.
Some of the issues discussed over the past eight weeks

include goal identification, drug use patterns and
impact, building trust/intimacy, coping with differ-
ences/conflicts and relapse planning.
It is important to keep in mind that the end of any pro-

gram may bring out a range of feelings (e.g., sadness,
joy, anxiety and relief) both in the participant and in the
therapist. The ending of this group can be viewed as a
transition or a new beginning for the couples and their
relationship; it is a chance to follow through on the
change process that they have started by attending the
Brief Couples Therapy (BCT) program.
3. Reviewing Homework Discuss relapse prevention plans. Raise issues about

how a relapse could be handled and its impact on the
relationship.
4. Homework (Imagining Changes Six Ask the participants the following question: Lets
Months from Now) pretend it is six months later. What would you like to
be able to report about changes in your relationship?
Based on what the participants talk about, point out

that this is what they can then work on for the next
78 SESSION 8 | CONCLUSION
six months. What they have selected can be their vision

or miracle, and they can then continue to work on it as
if they were returning.
The therapist may summarize and underscore progress

made over the course of therapy.
5. Obtaining Feedback on Treatment What was most helpful about the treatment?
Do you have any suggestions on how to improve

these sessions?
Therapists take notes on clients feedback.
6. Check-out Give a Gift: imagine that there is a box of all sorts of

gifts on the table before you. Id like you to take a
minute and think of one tangible and one intangible
gift that you would like to take and give to the person
on your right.
SESSION 8 | CONCLUSION 79
Session Resources
MATERIALS
pens and copies of exercises or notes from previous sessions
SUMMARY
1. Check-in

Review goals and issues.
Plan to avoid negative patterns and habits.
Plan for the future.
3. Reviewing Relapse Prevention/Maintenance homework
4. Homework (Imagine Changes Six Months from Now)
5. Obtaining Feedback on Treatment
6. Check-out
Give a Gift exercise
Use the time for summarizing and highlighting progress achieved during the sessions.
Discuss how the couple can avoid relapsing into negative patterns and habits.
Checkout: ask the couple to identify one hope they have for themselves as a couple.
80 SESSION 8 | CONCLUSION
Progress Note: Conclusion

Session date ____________________
DD/MM/YY

No show ______________________________
Therapist cancelled

NOT
COVERED COVERED

Therapist(s) initiated review of groups progress from previous sessions
Discussed and celebrated work accomplished by participants
Future focus exercise completed and discussed
Group members were congratulated and thanked for their participation in the group
Check-out completed


(for group only)
1. ________________________________________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________________________________________
Outcome of Session:
Additional Notes:
FORM COMPLETED BY

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THE BACKGROUND OF
THE INTEGRATIVE MODEL
Appendix
A
The Integrative Model of treatment utilized in the Family Service at the Centre for
Addiction and Mental Health (camh) incorporates three evidenced-based approaches
that have been established as effective with a wide variety of populations and problems:
family systems theory and family therapy, solution-focused therapy and cognitive
behavioural therapy. Family systems theory is the overarching paradigm that informs
the conceptual framework of the Integrative Model, while cognitive behavioural and
solution-focused approaches make up most of the core interventions utilized in this
model. An overview of each of these approaches follows to highlight the backdrop
of the Integrative Model.
FAMILY SYSTEMS THEORY

Family therapy and family systems theory evolved from diverse avenues of inquiry
and practice, including social scientists interest in group dynamics of the early
1920s; the child guidance movement of the 1940s and 1950s; the experience of a
large number of social workers engaged in front-line work with troubled families
during this same period; the development of marriage-counselling centres; and
research into the relationship between family dynamics and schizophrenia (Nichols
& Schwartz, 1998). Of the latter, the Palo Alto group (Gregory Bateson, Jay Haley,
John Weakland) made a significant contribution to family systems theory and family
therapy, despite the fact that their perspective on family functioning with relation
to mental illness was different from the way that most practitioners would perceive it
today. (See Nichols & Schwartz (2001): Chapter 2, The Evolution of Family Therapy.)
Bateson was interested in cybernetics, anthropology and communications theory,
and he brought concepts such as report and command functions of a com-
municated message and the double bind message from these areas into the
emerging field of family therapy.
Cybernetics theory played a significant role as a founding principle of family systems

theory. In North America, prior to the middle of the 20th century, the family was
not seen as a useful or legitimate focus of clinical attention, but rather as a collection
of individuals; and it was the individuals themselves whose characteristics were of
concern to researchers and clinicians (McCollum & Trepper, 2001). Cybernetics,
developed by mathematician Norbert Weiner at mit (Nichols & Schwartz, 1998),
described the workings of self-correcting systems. The core concept in cybernetics
is the feedback loop, which is the process whereby information is fed back to the
system in order to maintain or alter the workings of the system. Negative feedback
among the parts of a system reduces deviation in the whole system, while positive
feedback amplifies deviation. One example of cybernetic operation is the way that
a thermostat controls the amount of heat produced by a furnace by getting feedback
from the environment through its heat sensor.
In adapting cybernetics theory to family functioning, Bateson shifted the notion of

causality with respect to family problems from linear to circular causality. Instead
of viewing family problems as the (linear) result of past events, Bateson described the
cause of family problems as part of ongoing, circular feedback loops (McCollum &
86 APPENDIX A | THE BACKGROUND OF THE INTEGRATIVE MODEL
Trepper, 2001). Bateson and his Palo Alto group infused the notion of the system into
family theory, generating a picture of the family system as one in which the whole
cannot be understood except through the relationship between its parts. In his view,
families include multiple sets of systems, and these systems interact continuously,
providing feedback that maintains or alters the system as a whole. When drugs and
alcohol are considered from the perspective of a systems approach, the behaviour
of the person with the substance use problem affects individual family members in
multiple ways and the reactions of family members affect the experiences and the
actions of the person who is using drugs or alcohol. This pattern occurs within the
family of origin and across extended systems as well.
FAMILY THERAPY
Family therapy encompasses several approaches to family functioning and therapy.
Included in these approaches to family therapy are the following: intergenerational,
structural, strategic, experiential and communications, feminist, social learning,
cognitive behavioural and psychoanalytic. What all of the family therapy approaches
have in common is the conceptualization of the family as a system, and a focus of
clinical attention on the relationships between people to a greater extent than on
intrapsychic phenomena and individual behaviour. From within this paradigm, the
Integrative Model draws primarily, but not solely, upon principles and techniques
from intergenerational, structural and strategic family therapies.
Intergenerational family therapy was conceived by Murray Bowen, who was one of
the most influential pioneers of the family therapy movement, and his theory of
family functioning was the most comprehensive within the family systems paradigm
(Nichols & Schwartz, 1998). Bowen (1978) argued that family members problems
were related to poor differentiation of self, which refers to a persons ability to
separate his or her emotional functioning from his or her intellectual functioning,
and he further postulated a multigenerational transmission process whereby
lower levels of differentiation get transmitted from one generation to the next.
Intergenerational family therapy, therefore, focuses on processes among generations.
The Family Genogram (or Family Tree) is a technique that is often used to explore
these processes.
Structural family therapy grew out of the clinical work of Salvador Minuchin (1974).
Minuchins perspective on family functioning and therapy was informed by his work
with underprivileged families and institutionalized children (Nichols & Schwartz,
1998). Minuchin proposed that problems were the result of dysfunctional structures
within the family. Thus, the goals of structural family therapy are to clarify boundaries,
subsystems and power hierarchies within the family (as well as the external social
forces that impinge upon the family) and to reorganize the family into a more
functional structure. These goals are accomplished first by joining with the family
from a position of acceptance and respectful leadership, and then restructuring the
family by utilizing techniques such as enactment, in which family members are
asked to role-play their relationship patterns, and reframing, or changing the labels
attached to behaviours from the perspective of understanding the family structure.
APPENDIX A | THE BACKGROUND OF THE INTEGRATIVE MODEL 87
Strategic family therapy is a brief, problem-focused therapy that was developed

by Jay Haley, who had worked with Salvador Minuchin, and Cloe Madanes, at the
Philadelphia Child Guidance Clinic. In 1974, Madanes and Haley opened the Family
Therapy Institute in Washington, D.C. (Nichols & Schwartz, 1998). Their brand of
family systems theory, which continues to be widely used, sees family interactions
as communication patterns. Haley (1976) described the notion of the behavioural
sequence. Behavioural sequences are the occurrences of problems in families,
viewed in terms of regular, predictable patterns of family interactions or events.
Haley suggested that if you change a step along the sequence of events, then you
will often change the outcome. In order to effect these changes, strategic family
therapists make use of a wide variety of creative techniques (Nichols & Schwartz,
1998; McCollum & Trepper, 2001), including reframing interventions to alter
family members perceptions of the problem and paradoxical interventions, which
utilize client resistance in the service of eliciting positive behaviour change by
encouraging its opposite.
As mentioned above, there are a number of other family therapy approaches that
are reflected to a lesser extent in the camh Integrated Model. Carl Whitaker is the
primary proponent of experiential family therapy, a somewhat atheoretical, sponta-
neous approach to family therapy, while Virginia Satirs approach, which has also
been described as experiential, is known as a communications therapy. Satir used
creative techniques such as family sculpting (role plays) to help family members
become aware of their familial roles and interrelationships (McCollum & Trepper,
2001). Social learning and cognitive behavioural approaches to family therapy
focus on the identification of skill deficits, behaviour modification and positive
reinforcement strategies, skill-building techniques, and specific behavioural goals,
such as problem solving and contingency contracting (Nichols & Schwartz, 1998;
McCollum & Trepper, 2001). Many of the pioneers of the family systems approach
were trained as psychoanalysts, including Nathan Akerman, Ian Alger, Murray Bowen,
Lyman Wynne, Theodore Lidz, Israel Zwerling, Ivan Boszormenyi-Nagy, Carl
Whitaker, Don Jackson and Salvador Minuchin (Nichols & Schwartz, 1998). There
are a number of different schools of psychoanalytic theory, including object rela-
tions theory, self psychology and Freudian theory. Overall, within the psychoanalytic
framework, behaviour is the result of intrapsychic factors to a greater extent than
external factors, and the goal of therapy is to free family members from the uncon-
scious forces that limit healthy functioning (Nichols & Schwartz, 1998).
Feminist family therapy adds a different perspective to the other approaches by

utilizing a feminist framework to deconstruct the gender biases and power hier-
archies inherent in the more traditional approaches, and to recognize the realities
of womens experiences. Proponents of the feminist family therapy perspective
are Marianne Walters, Betty Carter, Monica McGoldrick, Peggy Papp and Olga
Silverstein (McCollum & Trepper, 2001; Nichols & Schwartz, 1998).
88 APPENDIX A | THE BACKGROUND OF THE INTEGRATIVE MODEL
SOLUTION-FOCUSED THERAPY
Solution-focused therapy grew out of the other family systems approaches, primarily
from strategic family therapy. (See Nichols & Schwartz (Chapter 11; 1998) for a detailed
discussion of the historical line tracing the development of solution-focused therapy
from its roots in strategic family therapy.) The major figures spearheading this approach
are Insoo Kim Berg and Steve de Shazer, who were trained as brief therapists follow-
ing the strategic approach of Jay Haley and Cloe Madanes. The theoretical perspective
underlying solution-focused therapy is somewhat sparse, because the focus is on
generating solutions to problems rather than considering how these problems arose
(Nichols & Schwartz, 1998).
Solution-focused therapy is a brief therapy treatment that is technique-driven and future-

oriented. While problems are the source of therapeutic material, building and maintain-
ing solutions to these problems are the focus of therapy. Assessing motivation is an
important aspect of solution-focused therapy. A method for assessing motivation is
to determine whether or not the client is one of the following: a customer, who
recognizes that there is a problem and wants help to try and solve it; a complainant, who
sees that a problem exists and wants the therapist to make someone else solve it; or
a visitor, who denies that a problem exists and does not want the therapists help
(Berg & Miller, 1992).
Recently, solution-focused therapists have turned their attention to problem substance

use (Berg & Miller, 1992; McCollum & Trepper, 2001; Selekman, 2002). As in
solution-focused therapy for other problems and issues, solution-focused therapists
working with families of substance users focus on solutions rather than problems;
join empathically with family members; negotiate a contract; help clients create
measurable goals; help clients develop a vision; track problem-solution sequences;
and seek and enlarge successes (McCollum & Trepper, 2001).
Solution-focused therapists maintain a focus on positive elements of client behaviours.

Some of the techniques used in this therapy include searching out underlying con-
gruent meanings behind opposing goals and positions; using the Miracle Question
to develop a positive vision; scaling; tracking problem and solution sequences; listen-
ing for exceptions to the problem and calling attention to them; and complimenting
successes.
COGNITIVE BEHAVIOURAL THERAPY (CBT)

Cognitive behavioural therapy (cbt) is a blend of cognitive therapy and behaviour
therapy. Cognitive therapy, pioneered by Aaron Beck (1921-) and Albert Ellis (1929-),
asserts that change in behaviours and emotions occurs through change in thinking
(cognitions); behaviour therapy is based on principles of operant conditioning
(Skinner, 1953) and learning theory (Bandura & Walters, 1963). According to social
learning theory, human behaviour is learned, as opposed to being the result of innate
drives, and it is governed by eliciting factors. From the tenets of operant conditioning,
we know that behaviour is affected by its consequences, that reinforcements affect
the rate of target behaviours, and that contingencies define the relationship between
APPENDIX A | THE BACKGROUND OF THE INTEGRATIVE MODEL 89
a behaviour and its consequences. The addition of the cognitive approach to behaviour
theory meant an increasing emphasis on cognitions and the recognition of the need
for attitude change to promote and maintain behaviour change. The efficacy and
effectiveness of cbt for depression and anxiety has been borne out in an extensive
body of research (Antony & Swinson, 1996; Beck, 1976; Dobson, 1989).
Cognitive behavioural therapy tends to be relatively short term. The focus of the
therapy is on internal and external behaviours as opposed to explanations for behav-
iour, and it is problem-oriented (as opposed to insight-oriented or experiential).
Therefore symptoms, such as panic attacks, depressive ideation and alcohol or
drug use, are the legitimate focus of clinical attention. The goals of therapy include
restructuring of faulty thoughts, perceptions and beliefs, and developing positive
coping skills in order to foster emotional and behavioural change. cbt interventions
include challenging irrational beliefs, psychoeducation, communication and social
skills-building exercises, and homework assignments.
ISBN 0-88868-448-7
Brief Couples Therapy:

Group and Individual Couple Treatment for Addiction
and Related Mental Health Concerns
Brief Couples Therapy: Group and Individual Couple Treatment for Addiction and Related
Mental Health Concerns
This manual is a tool for therapists and counsellors working in substance use settings who
would like to augment their practice by seeing couples. It will also be useful for the practitioner
who is seeing couples, and who would like to be able to offer a focused, specific program for
clients presenting with substance use issues. The manual evolved from a research project at
CAMH and has been tested and reviewed by consultants, clinicians and researchers practising in
the areas of mental health, addiction, general family services and private practice. The program
consists of an assessment session followed by eight sessions, each of which includes session
guidelines, session resources, participant handouts and a template for recording progress notes.
Also available from the Centre for Addiction and Mental Health:
Couple Therapy: An Information Guide

This guide is intended for:
couples who are having difficulty resolving their problems and who want to explore the idea
of couple therapy
couples who have decided to try couple therapy but are unsure of how to find a therapist, or
what to expect from therapy.
As well as addressing questions that are commonly raised by couples considering counselling, this
guide addresses some of the issues that frequently arise in the course of therapy.
Topics include:
What is couple therapy?
Do we need therapy?
Common concerns about therapy
Finding a therapist.
Depression and Bipolar Disorder Family Psychoeducational Group Manual

This manual provides a framework for delivering an eight- to 12-week series of psycho-
educational sessions for families of clients with depression or bipolar disorder. It is intended for
clinicians/group therapists who have previous training and experience in facilitating clinical
group process, but who need content and structure to meet the specialized needs of this group.
Each session includes leaders notes, session content and handouts for the participants.
For information on these and other Centre for Addiction and Mental Health resource materials
or to place an order, please contact:
Marketing and Sales Services

Centre for Addiction and Mental Health
33 Russell Street
Toronto, ON M5S 2S1
Canada
Tel.: 1-800-661-1111 or 416-595-6059 in Toronto
2735/03/03 PG117
E-mail: marketing@camh.net
Web site: www.camh.net
A Pan American Health Organization / World Health Organization Collaborating Centre

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What is the purpose of the manual?

What is the purpose of the manual?

What does the manual consist of?

What does the manual consist of?

Brief Couples Therapy

Group and Individual Couple Treatment

Due to copyright restrictions, pages 9 and 10

Gloria Chaim, MSW

A Pan American Health Organization / World Health Organization Collaborating Centre

National Library of Canada Cataloguing in Publication

Brief couples therapy : group and individual couple treatment for

Includes bibliographical references.

1. Substance abuse Treatment. 2. Marital psychotherapy.

rc564.b748 2003 616.86'0651 c2003-901095-3

This book was produced by:

Web site: www.camh.net

EVALUATION TEAM REVIEWERS

Acknowledgments ................................................................................................................................ vii

Session 2: Genogram/Family Tree

Session 3: Miracle Question

Session 4: Goal Setting

Session 7: Relapse Prevention

Appendix A: The Background of the Integrative Model ...................................................... 85

Who Will Use This Manual?

CONCURRENT DISORDERS SETTINGS

THEORETICAL AND PHILOSOPHICAL PERSPECTIVES

Who Is BCT For?

Why Is There a Need for Brief Couples Treatment?

Development of the Manual

The Integrative Model 2

2 See Appendix A for The Background of the Integrative Model.

Brief Couples Therapy (BCT)

Tips on Implementing the Program

DIFFERENCES BETWEEN GROUP AND INDIVIDUAL COUPLE SESSIONS

GENERAL TIPS AND COUNSELLING ISSUES

Management of Mental Health Crises

Management of Relationship Crises

How to Use the Manual

Due to copyright restrictions, pages 9 and 10

You might also be wondering what the people who

6. Feedback Summarize and interpret scores from the forms that

If individual: set the next appointment and hand out

Discuss any barriers to attending treatment.

Client Background Information Form

Dyadic Adjustment Scale (DAS)

The das can be purchased from Multi-Health Systems.

Alcohol and Drug Use Information Form

CLIENT BACKGROUND INFORMATION FORM

Client Name: ______________________________________________ Client Name: ______________________________

File No.: ____________________________________________________ File No.: ____________________________________________________

Date of Birth | | | | | | | Date of Birth | | | | | | |

Sex Male Female TG/TS Sex Male Female TG/TS

Education (years completed) | | | Education (years completed) | | |

Occupation ________________________________________________ Occupation ________________________________________________

Current Employment Status Current Employment Status

Number of past long-term | | | Number of past long-term | | |

Length of marriage/ | | | MONTHS

Number of children (from | | |

Primary Substance of Abuse Primary Substance of Abuse

Client Name: ________________ Client Name:

File No.: File No.:

Occupation Occupation

Name: Date:

Patient/Client Name ____________________________ Health Record # _