When Progress in Behavioral Couples Therapy Is Insufficient: How the Therapist Responds

Problem	Criterion	Therapist’s Response
Relationship distress	Either partner, 3 weeks in a row, reports clinically significant relationship distress.	Focus on relationship enhancement and communications skills training.
Continued or renewed substance use	The substance-abusing partner reports substance use 2 weeks in a row or urges to use 3 weeks in a row.	Place greater emphasis on substance use issues. Encourage attendance at self-help meetings and more frequent contact with the individual counselor. Identify and reduce the stressors under- lying or contributing to cravings.
Noncompliance with homework	The couple fails to complete homework 2 weeks in a row.	Isolate and eliminate factors interfering with completion. Reduce the amount of homework to a level manageable by both partners.
Arguments about past substance abuse	Either partner reports such arguments 2 weeks in a row. This violates one of the major tenets of the intervention, which focuses on the future, not the past.	Encourage the non-substance-abusing partner to discuss these issues in Al- Anon meetings or with an individual counselor.
Angry touching	There have been episodes of mild physical aggression between partners.	Reiterate the couple’s commitment not to resolve conflict with physical aggression of any kind; emphasize conflict resolution skills. Severe violence (e.g., behavior causing injury or fear) is another matter. Refer partner to domestic violence treatment and cease BCT.