COLLABORATIVE COUPLE THERAPY (CCT)

CCT assumes that in a relationship every moment provides opportunity for intimacy, but problem arises when partners do not confide with each other their thoughts and feelings and engage in compensatory fall-back measures.

CCT also assumes that relationships undergo shifts of cycles. When partners are confiding, they are in ‘empathetic cycle’, when not confiding they are in the ‘withdrawal cycle’ and when they are not confiding and are also blaming they are in the ‘adversial cycle.’

CCT thus differentiates between distressed couples and healthy couples on the basis of time spent in the last two cycles and their ability to return to the collaborative phase.

The role of a therapist is unique in this therapy. The therapist let him/ her get affected by the negative interaction pattern of the couple and undergoes negative cycles. He again and again pulls himself/ herself out from the negative cycles. During this process the therapist is able to find out the inner struggle of the clients that has resulted in the symptomatic behavior.

In CCT, the therapist sometimes serves as the spokesperson of each partner. The therapist encourages the partners to express their inner thoughts and feelings, but when they are not able to do this, he does on their behalf. This helps the partners to understand each other.

CCT Points that when the partners’ are able to express their thoughts and feelings; positive and negative, of the moment on a day-to-day basis their relationship strengthens.

The goal of CCT is to increase the expression of thoughts and feelings between partners. CCT defines intimacy as letting you partner know who you are at the moment. Expression of thoughts and feelings creates a joint platform for the partners to deal with their issues collaboratively. So the partners become part of the solution rather than part of the problem.

Sometimes when partners are difficult to engage in collaborative talk, the CCT helps them to do so after sometime i.e. by holding the recovery conversation.

CCT can also be used as a preventive measure for the well functioning couples. Teaching then to engage in their inner struggle or self- conversation will help them to understand themselves and their feelings and will also help in realizing their partner’s perspective. 

Couple Therapy- Addressing Depression....

Depression is very common in today’s world. It affects not only the individual who has it, but also the partner and other members of their family.

The impact of depression varies depending on the severity of depression. Some couples suffer badly because of one partner’s major depression. They are either living parallel lives or are living separately. If they have children the latter are the worst affected. Such couples get caught in a vicious circle in such a way that untreated depression deteriorates their relationship and deteriorating relationship aggravates depression and hopelessness. At some stage it becomes difficult to pinpoint the actual cause and effect.

Major depression continues to reoccur and it becomes a life-time challenge, taxing the couple emotionally, financially and socially.

It has been observed that individual or partner-involved therapy may not be effective in major depression. Couple therapy, especially Behaviour Couple Therapy  may, however, prove effective since it takes into account the reciprocity of relationship distress and depression. It aims to change the relationship to alleviate depression. BCT is based on the reasoning that thinking, feeling and behaviour are inter-related and a change in one brings a change in the other two. Since behaviour is observable and measurable, BCT stresses to change the behaviour. It focuses on changing the communication, problem-solving skills, cognitive functioning and intimacy.

BCT assumes that depression develops when people do not get an appropriate positive reinforcement after showing the desired behaviour. Various experiments have demonstrated that performance level decreases when the organism fails to get a certain reward that it used to get earlier. Depression also develops when people are not able to avoid aversive stimuli. Experiments have proved that an animal develops helplessness when his instrumental behaviour fails to terminate an aversive stimulus.

BCT focuses on changing the relationship patterns of couples which may have caused helplessness and hopelessness and so indirectly it treats the depression. BCT also collaborates with pharmacological treatment if symptoms are severe and there are safety issues.

The assessment process of BCT is very intensive. The therapist assesses both; the relationship functioning and individual functioning. The assessment is rather an intervention in itself as the therapist tries to create positive feelings and hope in the couple. BCT applies various techniques to have a clear cut assessment of the severity of the problem. Therapist interacts with the couple, asks questions, takes history, and enquires about their future plans. He/she also talks to each partner separately. In addition therapist uses various self-report questionnaires.

Since BCT acknowledges that  all these techniques have their own limitations to give accurate data as depressed people have pessimistic view about themselves and others, so it asserts to rely on the clinical observation of the therapist for the final conclusion. Therapist actually utilizes negative appraisals in determining the cognitive patterns and the areas of dissatisfaction of each partner.

In the last part of assessment,  the therapist shares the observation and assessment with the couple, conveys to them the importance of their role in the treatment process, gives rationale of BCT and set certain rules for the treatment sessions. Of the two main rules; first is that till the treatment is over they will postpone any plans for separation and the second is that they will not keep any secrets from each other.

All techniques of BCT are well structured. Sometimes giving some psycho-education is also helpful. Positive reinforcement is given after thorough investigations.

BCT also stresses on communication. This is very important because depressed people are passive and they avoid interaction. Partners are also trained to resolve small problems together and are encouraged to resolve complex issues.

BCT is an optimistic approach. When it is used in collaboration with medical therapy it can give significant positive results. 

Couple Therapy- Addressing Illness.

A ‘Bio-Psycho-Social’ model is found very effective in helping couples coping with medical problems.

This model suggests that all the three factors, biological, psychological and social, play significant roles both in health and disease.

In many cultures a connection of mind and body has been well recognized since long. That is why several techniques to strengthen mind and will-power are in vogue.

Similarly, the contribution of community or social support is also well recognized in the healing process.

The role of a family therapist is of great importance here. All over the world people take the help of a therapist in dealing with issues related with disease and illness.

In the above model, the couple is considered as a ‘unit of care’. So the focus is on the couple and not just on the individual who is coping with the disease. In case of a chronic illness, a successful management depends on how well the couple is able to adapt to the prevailing conditions. Some illnesses demand major shift in roles and lifestyles and that may create a lot of stress on the couple.

The main task of the therapist is to assess the level of functioning of the couple. For this, a lot of information is collected by the therapist. He directly communicates with the patient and the partner and talks about their perception about the disease, their current challenges and losses. He encourages them to tell the story of their illness. For them, hearing each other’s experiences is very therapeutic in itself. The therapist also collects couple’s history of the disease, their earlier ways to deal with disease and illness, their current fears and expectations etc. The therapist may also take the help of other professionals to collect data and genograms. All this information not only helps the therapist but also the couple to better understand them in the light of current situation.

This model of therapy generally presents two goals; the first one is helping the couple accept that the illness is there and that they both have to deal with it as a team that requires active involvement and commitment. The therapist helps them to know what is in their control and what is not. This type of understanding reduces their sense of helplessness. The second goal is to create a social support system for the couple, both within the family and the community in general.

The therapist also facilitates communication among the partners, between the couples and the health care system and between the couple and social support system. A lack of communication must not come in the way because it aggravates the problem and the recovery. The therapist, therefore, 

arranges sessions with friends, extended family members and other families facing similar problems. 

With this kind of therapy, the couple is able to take charge of their lives and develops a way to live a ‘new’ normal life by ‘putting illness in its place.’

The therapist also discusses the principles of ‘keep the doors open’ of brief psychotherapy with couples to give them a sense of security that whenever they need they can contact and take help of their therapist.