**3. The role of CBCT therapists**

CBCT therapists hold different roles that will vary depending on the stage of therapy and the needs of clients [19]. For instance, during the first sessions of CBCT, the therapist typically uses psychoeducation to inform clients about the approach and related intervention and acts as a facilitator by creating a safe and supporting environment where emotions or concerns may be expressed freely. He/she will also act as a collaborator to develop the treatment goals. However, a more directive approach will also be used by CBCT therapists to address dysfunctional interactions or the escalation of conflicts in order to create and preserve a safe environment for therapy and help partners understand what is going on and learn new ways of dealing with their disagreements [20]. A directive approach might also be needed to deal with crisis interventions (see Section 4.4). Throughout sessions, CBCT therapists can also take a more didactic role, for instance, when they teach communication and problem-solving skills for couples [12]. They will also act as guides when they help partners identify the interrelations between their cognitions, emotions and behaviors [17].

**4.1. Alleviation of distress and relationship improvement**

health-related problems partners might have.

to help them negotiate time-outs during conflict.

*4.1.1. Conflicts and violence*

Over the years, CBCT has accumulated strong empirical support for its efficiency to alleviate relationship distress and enhance couple functioning [18]. These therapeutic gains would also seem to persist years after the end of treatment [24]. Research has shown that the therapeutic goals couples formulate regarding alleviation of distress revolve around communication problems, dissatisfaction with manifestations of emotions and affection, sexual problems, financial problems as well as decision-making or problem-solving issues [25–27]. Since some of these concerns are quite frequent, they are typically addressed with the common CBCT interventions presented in the fifth section of this chapter. However, many couples also consult for difficulties that require a more distinct approach, some of which include the presence of conflicts and violence, extradyadic affairs, infertility as well as various psychological or

Cognitive-Behavioral Psychotherapy for Couples: An Insight into the Treatment of Couple…

http://dx.doi.org/10.5772/intechopen.72104

121

Many couples find it difficult to resolve their conflicts, and this difficulty heavily affects their functioning and satisfaction within the relationship [28]. Yet, it is how a couple handles disagreements that will determine how satisfied partners are with their relationship [29]. Accordingly, unresolved conflicts constitute one of the most frequent consultation motives for couple therapy [25]. As such, CBCT offers techniques aiming at the enhancement of positive interaction patterns in couples as well as the improvement of communication and prob-

Conflicts between spouses can also spiral into violence [31], for instance, when partners escalate theirs conflicts to a point where they will resort to psychological or physical violence. Indeed, partner violence is a serious challenge that many couples face but that is frequently under-reported or concealed by partners who may, for example, rather report consulting to address difficulties in dealing with conflicts [32]. During the assessment phase of CBCT, the presence of violence must systematically be assessed in order to decide whether or not CBCT should be conducted [33]. For instance, when partner violence is severe or perpetrated by one partner towards the other, couple therapy is usually contraindicated because it could lead to further violence. The therapists should then deliver a crisis intervention (see Section 4.4 for crisis intervention) [32, 33]. On the contrary, when partner violence is situational and minor to moderate and when both partners agree to cease all acts of violence during therapy, CBCT can be useful in preventing the escalation of conflicts to more severe forms of violence [33, 34]. Indeed, a few therapies using a CBCT framework or techniques have been developed to treat moderate intimate partner violence and show promising results in the reduction of mild-to-moderate violent behaviors [35–38]. Such therapies include interventions that promote positive interactions between partners, assertion and communication skills, increased imputability in conflicts and an understanding of the escalation of conflicts into violence. These interventions also seek to challenge the cognitive distortions that are entangled in conflicts and to help partners to better control their anger and other negative emotions as well as

lem-resolution techniques in order to diminish conflicts within couples [30].

In CBCT, the therapist undertakes the responsibility of establishing and maintaining the therapeutic alliance with both partners [19]. In order to lay the foundations for a healthy therapeutic alliance, the therapist is thus expected to swiftly orchestrate sessions by fairly allocating speaking time for each partner to express themselves [20], while demonstrating neutrality and empathy [21]. If situations occur in which therapists feel unable to remain neutral towards a couple and if it significantly hampers their ability to help partners, they should seek supervision. Special consideration must also be given to the management of secrets between one partner and the therapist, for instance, in cases when an ongoing extradyadic affair is admitted by a partner during the individual session of assessment (see Section 5.2 for the phases of the assessment interviews). In such situations, it is advised that the therapist takes a neutral position by explaining to partners that he/she cannot engage in therapy while withholding information that would affect the process of therapy or bring he/she in collusion with one of the partners against the other [20].
