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Theme 1: Both partners being willing to engage in treatment together
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Theme 2: Logistical Barriers, including scheduling, financial considerations, transportation, childcare, and availability of treatment
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Theme 3: Fears and beliefs about partner involvement
Assuming one's partner is not interested or would not be helpful in treatment Beliefs that if the partner were to participate, that they would not be helpful Patient and partner fears about being blamed or held responsible for alcohol and/or relationship problems Patient fears about disappointing or causing excessive burden to the partner
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Theme 4: Perceived Lack of Support From Others
Family, partner, or friends not encouraging treatment seeking because they are not aware that the patient has a drinking problem Family, partner, or friends discouraging treatment because of secondary gains resulting from the patient continuing to drink
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Theme 5: Treatment preferences, treatment fears, and information about treatment
Lack of information that couples treatment is an option Beliefs that therapy or a therapist is would not be helpful Concerns about disclosure of private information to individuals outside of the relationship, to the therapist, and even to one's partner Coming from a culture or community in which substance and/or couples treatment is heavily stigmatized
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Table 4. Interpersonal/Couple Level Barriers to Entry into Couples Treatment of Alcohol Problems
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Theme 6: Relationship Factors
Relationship functioning, including level of commitment, concerns about relationship worsening or dissolving, and fears of confrontation or increasing risk of relationship violence
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