Spouse-Aided Therapy

Description of the Strategy

Spouse-aided therapy is defined as any psychological intervention in which the partner of the patient with a psychiatric disorder (e.g., anxiety disorder, depression, substance use disorders) is actively involved in the treatment and the focus of the intervention is on [Page 559]the psychiatric disorder rather than on marital distress. This means that marital therapy directed exclusively to the marital difficulties of the couple without due attention to the specific psychiatric disorder involved is not discussed here. There are several advantages for spouse-aided therapy: (a) The spouse is informed about the psychiatric disorder and the kind of treatment delivered; (b) the spouse can give additional information about symptomatology of the patient and treatment progress; (c) the spouse can be emotionally supported, since living with a patient is often a heavy burden; and (d) the spouse can learn to deal more adequately with disorder-related situations, and in addition, if necessary, general communication between partners can be improved.

Strategies applied vary across the various disorders. In anxiety disorders, two different formats of spouse-aided therapy can be distinguished. In partnerassisted exposure, the partner accompanies the patient to each treatment session. The couple receives a treatment rationale in which the focus is on exposing the patient to phobic situations. The partner can assist in making a hierarchy consisting of gradually more difficult exposure tasks. At each session, the patient is given a number of exposure homework assignments. The role of the partner is to stimulate the patient to do these exercises, to help in confronting the phobic situations, to accompany the patient if necessary, and to reinforce the patient in mastering these exposure exercises successfully. Actual presence of the partner is gradually faded out during the exposure exercises. At the beginning of each new session, the patient's performance on the exposure tasks and the assistance of the partner are discussed with the couple, and new homework assignments are given. More difficult tasks are given only if tasks lower in the hierarchy have been performed successfully. The couple determines the pace at which the patient works through the hierarchy. Thus, treatment focuses on the phobia. Relationship problems, if any, are not discussed. Other spouseaided approaches in anxiety disorders have focused on interpersonal difficulties thought to maintain agoraphobic symptoms. These approaches include communication training and partner-assisted problem solving directed either at phobia-related conflicts or at general life stresses and problems.

Partner-assisted cognitive behavior therapy for depression is based on Peter Lewinsohn's and Aaron Beck's individual therapy of depression. It is assumed that depressed individuals do not engage in pleasant activities and hence do not get adequate reinforcement, resulting in mood disturbance. During spouse-aided therapy, partners join all sessions. Treatment focuses on the depression and on ways both partners can deal more adequately with depression-related situations rather than on relationship aspects per se. Therefore, partners are involved in devising reinforcing activities, in stimulating patients to engage in rewarding activities and participate in role playing. Furthermore, partners are asked to attend to the dysfunctional thoughts of the patient and to discuss these with both patient and therapist. In addition, partners are actively involved in designing behavioral experiments to test (irrational) beliefs and are encouraged to take part in challenging the assumptions held by the patient.

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