Conjoint Therapy for Trauma Survivors

Last week I had the privilege of hearing Dr. Candice Monson speak on the topic of Evidence-based and Promising Psychotherapies for PTSD. Candice is a professor of Psychology at Ryerson University and is one of the foremost experts on traumatic stress. She is a co-author of the book, Cognitive Processing Therapy for PTSD: A Comprehensive Manual which is a resource I have been using for mahy years in my clinical practice treating trauma.

Cognitive Processing Therapy addresses the beliefs individuals hold and how they integrate their traumatic experience into pre-existing beliefs and experiences. She spoke of what is known as “Hindsight Bias”, which consists of thoughts:

• I must have done something to deserve this
• It’s my fault
• I could have prevented this.

When these thought patterns are combined with pre-existing negative beliefs:

• I’m a bad person
• People can’t be trusted
• I have no control over anything

It will invariably reduce the person’s ability to recover from a traumatic incident.

This type of cognitive therapy is precisely the underpinning of my book, Psychological Abuse Recovery: Healing from Emotional, Psychological And Narcissistic Abuse. This type of therapy can be seen as a reality therapy for trauma, with concrete steps to restructure unhelpful thoughts and beliefs into something more realistic:

• Bad things happen to good people
• I have some power
• Good people do bad things
• I have learned from my experiences
• I didn’t know what I know now
• I was a trusting person and I did the best I could
• I’m worthy of love, respect and consideration just like anyone else
• If I fought back,  it might have had a bad outcome

Since PTSD is highly associated with relationship problems, and a negative family environment is associated with worse outcomes, it is important to also involve family members in treatment. This type of therapy is called Cognitive Behavioral Conjoint Therapy.

However, in my work with trauma, involving family members who are emotionally and psychologically abusive is often more harmful and potentially dangerous. So how does a therapist decide?

Dr. Monson answered this question succinctly: Using an instrument Conflict Tactics Scale, one of the most widely used instrument in research on family violence, the therapist can get a clear picture of the severity of conflict and violence in the relationship. If there is violence, do not proceed with the conjoint therapy.

If there is no violence but the therapist suspects there is emotional and psychological abuse, it’s imperative to specifically ask about the client’s feelings of safety. If one partner feels emotionally unsafe, does the other partner acknowledge their aggression as a problem? If they do acknowledge it is a problem and are genuinely interested in changing, a therapist might consider proceeding. If they do not see it as a problem, Cognitive Behavioral Conjoint Therapy is not the correct course of action.