Congruence Couple Therapy for Pathological Gambling

  • Bonnie K. Lee


Couple therapy models for pathological gambling are limited. Congruence Couple Therapy is an integrative, humanistic, systems model that addresses intrapsychic, interpersonal, intergenerational, and universal–spiritual disconnections of pathological gamblers and their spouses to shift towards congruence. Specifically, CCT’s theoretical foundations, main constructs, and treatment interventions are illustrated in a progression of six clinical phases. Promise of CCT’s systemic conceptualization and interventions for pathological gambling and future directions in its continuing evolution are discussed.


Congruence Couple Therapy Pathological gambling Couple therapy Humanistic Experiential Spiritual Virginia Satir 



The author gratefully acknowledges funding from the Ontario Problem Gambling Research Centre for the two empirical studies on Congruence Couple Therapy from which this composite case is drawn. Special thanks to Bev West, David Gregory, Jason Solowoniuk and Florence Loh for their editorial assistance and comments in the preparation of this manuscript.


  1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author (Text Revision).Google Scholar
  2. Anderson, H., & Goolishian, H. (1988). Human systems as linguistic systems: Preliminary and evolving ideas about the implications for clinical theory. Family Process, 27, 371–393.PubMedCrossRefGoogle Scholar
  3. Banmen, J. (1994). Figure: The personal iceberg of the Satir Model. In handout distributed at workshop, A model for change: The Satir experience, April 10–15, 1995. Villa Maria, St. Norbert, Manitoba.Google Scholar
  4. Barber, J. P., Connolly, M. B., Crits-Cristoph, P., Gladis, L., & Siqueland, L. (2000). Alliance predicts patients’ outcome beyond in-treatment change in symptoms. Journal of Consulting and Clinical Psychology, 68, 1027–1032.PubMedCrossRefGoogle Scholar
  5. Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine.Google Scholar
  6. Bateson, G. (1979). Mind and nature, a necessary unity. Toronto: Bantam Books.Google Scholar
  7. Berger, P., & Luckmann, T. (1967). The social construction of reality. Garden City, NY: Doubleday.Google Scholar
  8. Blaszczynski, A., & Nower, L. (2001). A pathways model of problem and pathological gambling. Addiction, 97, 487–499.CrossRefGoogle Scholar
  9. Blaszczynski, A., & Steel, Z. (1998). Personality disorders among pathological gamblers. Journal of Gambling Studies, 14(1), 51–71.PubMedCrossRefGoogle Scholar
  10. Bowen, M. (1978). Family therapy in clinical practice. New York: Aronson Press.Google Scholar
  11. Brubacher, L. (2006). Integrating emotion-focused therapy with the Satir model. Journal of Marital and Family Therapy, 32(2), 141–153.PubMedCrossRefGoogle Scholar
  12. Cain, D. J. (2002). Defining characteristics, history, and evolution of humanistic psychotherapies. In D. J. Cain, & J. Seeman (Eds.) Humanistic psychotherapies: Handbook of research and practise (pp. 3–54). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  13. Carter, B., & McGoldrick, M. (Eds.) (1988). The changing family life cycle: A framework for family therapy. New York: Gardner Press.Google Scholar
  14. Ciarrocchi, J. W., & Hohmann, A. A. (1989). The family environment of married male pathological gamblers, alcoholics, and dually addicted gamblers. Journal of Gambling Behavior, 5(4), 283–291.CrossRefGoogle Scholar
  15. Coman, G. J., Burrows, G. D., & Evans, B. J. (1997). Stress and anxiety as factors in the onset of problem gambling: Implications for treatment. Stress Medicine, 13(4), 235–244.CrossRefGoogle Scholar
  16. Crisp, B. R., Thomas, S. A., Jackson, A. C., & Thomason, N. (2001). Partners of problem gamblers who present for counseling: Demographic profile and presenting problems. Journal of Family Studies, 7, 208–216.Google Scholar
  17. Darbyshire, P., Oster, C., & Carrig, H. (2001a). Children of parent(s) who have a gambling problem: A review of the literature and commentary on research approaches. Health and Social Care in the Community, 9(4), 185–193.PubMedCrossRefGoogle Scholar
  18. Darbyshire, P., Oster, C., & Carrig, H. (2001b). The experience of pervasive loss: Children and young people living in a family where parental gambling is a problem. Journal of Gambling Studies, 17(1), 23–45.PubMedCrossRefGoogle Scholar
  19. Dickson-Swift, V. A., James, E. L., & Kippen, S. (2005). The experience of living with a problem gambler: Spouses and partners speak out. Journal of Gambling Issues, 13, Retrieved October 6, 2007, from
  20. Elkins, D. N. (2001). Beyond religion: Toward a humanistic spirituality. In K. J. Schneider, J. F. T. Bugental, & J. F. Fraser (Eds.) The handbook of humanistic psychology: Leading edges in theory, research, and practice (pp. 201–212). California: Sage.Google Scholar
  21. Fals-Stewart, W., O’Farrell, T. J., Feehan, M., Birchler, G. R., Tiller, S., & McFarlin, S. K. (2000). Behavioral couples therapy versus individual-based treatment for male substance abusing patients: An evaluation of significant individual change and comparison of improvement rates. Journal of Substance Abuse Treatment, 18, 249–254.PubMedCrossRefGoogle Scholar
  22. Fiorentine, R., Nakashima, J., & Anglin, D. M. (1999). Client engagement in drug treatment. Journal of Substance Abuse Treatment, 17(3), 199–206.PubMedCrossRefGoogle Scholar
  23. Frankl, V. (1953). Man’s search for meaning. Boston, MA: Beacon.Google Scholar
  24. Franklin, J., & Ciarrocchi, J. (1987). The team approach: Developing an experiential knowledge base for the treatment of the pathological gambler. Journal of Gambling Behavior, 3(1), 60–67.CrossRefGoogle Scholar
  25. Gendlin, E. T. (1974). Experiential psychotherapy. In F. J. Corsini (Ed.) Current psychotherapies (3rd ed., pp. 317–352). Illinois: F.E. Peacock.Google Scholar
  26. Gendlin, E. T. (1981). Focusing (2nd ed.). New York: Bantam.Google Scholar
  27. Gergen, K. (1985). The social constructionist movement in modern psychology. American Psychologist, 40, 266–275.CrossRefGoogle Scholar
  28. Grant-Kalischuk, R., Nowatzki, N., Cardwell, K., Klein, K., & Solowoniuk, J. (2006). Problem gambling and its impact on families: A literature review. International Gambling Studies, 6(1), 31–60.CrossRefGoogle Scholar
  29. Gurman, A. (2001). Brief therapy and family and couples therapy: An essential redundancy. Clinical Psychology: Science & Practice, 8, 51–65.CrossRefGoogle Scholar
  30. Halford, K. W., Bouman, R., Kelley, A., & Young, R. (1999). Individual psychopathology and marital distress: Analysing the association and implications for therapy. Behavior Modification, 23, 179–216.PubMedCrossRefGoogle Scholar
  31. Heineman, M. (1994). Compulsive gambling: Structured family intervention. Journal of Gambling Studies, 10(1), 67–76.CrossRefGoogle Scholar
  32. Heinemann, M. (2001). Losing your shirt: Recovery for compulsive gamblers and their families (2nd ed.). Center City, MN: Hazelden.Google Scholar
  33. Hendricks, M. N. (2002). Focusing-oriented/experiential psychotherapy. In D. J. Cain, & J. Seeman (Eds.) Humanistic psychotherapies: Handbook of research and practice (pp. 221–251). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  34. Johnson, S. M. (2002). Emotionally focused couple therapy for trauma survivors: Strengthening attachment bonds. New York: Guilford Press.Google Scholar
  35. Johnson, S. M. (2003). The revolution in couple therapy: A practitioner-scientist perspective. Journal of Marital and Family Therapy, 29(3), 365–384.PubMedCrossRefGoogle Scholar
  36. Johnson, S. M., & Talitman, E. (1997). Predictors of success in emotionally focused marital therapy. Journal of Marital and Family Therapy, 23, 135–152.PubMedCrossRefGoogle Scholar
  37. Kim, S. W., Grant, J. E., Adson, D. E., & Shin, Y. C. (2001). Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49(11), 914–921.PubMedCrossRefGoogle Scholar
  38. Ladouceur, R., Gosselin, P., Laberge, M., & Blaszczynski, A. (2001). Dropouts in clinical research: Do results reported in the field of addiction reflect clinical reality? The Behavior Therapist, 24, 44–46.Google Scholar
  39. Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 357–361.Google Scholar
  40. Lee, B. K. (2002a). Well-being by choice not by chance: An integrative, system-based couple treatment model for problem gambling. Final Report. Guelph, ON: Ontario Problem Gambling Research Centre.Google Scholar
  41. Lee, B. K. (2002b). Congruence in Satir’s model: Its spiritual and religious significance. Contemporary Family Therapy, 24(1), 57–78.CrossRefGoogle Scholar
  42. Lee, B. K. (2002c). Development of a Congruence Scale based on the Satir Model. Contemporary Family Therapy, 24(1), 217–239.CrossRefGoogle Scholar
  43. Lee, B. K. (2002d). Evoking the universal human family in public acts of healing: Jesus of Nazareth and Virginia Satir. Pastoral Sciences, 21(2), 263–286.Google Scholar
  44. Lee, B. K. (2003). Well-being by choice not by chance: A family systems model for conceptualization and treatment of pathological gambling [Abstract and Poster]. In Final program of the 4th annual conference on gambling addiction, National Centre for responsible gambling and the institute for research on pathological gambling and related disorders. Las Vegas, NV: Harvard Medical School, December.Google Scholar
  45. Lee, B. K., & Nixon, G. (2007). Integrating narrative and symbolic representation in experiential process for identity change. Manuscript submitted for publication (copy on file with authors).Google Scholar
  46. Lee, B. K., & Rovers, M. (2008). ‘Bringing torn lives together again’: Effects of the first Congruence Couple Therapy application in pathological gambling. International Gambling Studies (forthcoming).Google Scholar
  47. Lee, B. K., Rovers, M. W., & MacLean, L. (2006). Training counsellors in Congruence Couple Therapy: A controlled evaluation study. Final Report. Guelph, Ontario: Ontario Problem Gambling Research Centre.Google Scholar
  48. Lee, B.K., Rovers, M., & MacLean, L. (2008). Training problem gambling counsellors in Congruence Couple Therapy: Evaluation of training outcomes. International Gambling Studies (forthcoming).Google Scholar
  49. Lesieur, H. R., & Blume, S. B. (1987). South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184–1188.PubMedGoogle Scholar
  50. Lightsey, O. R., & Hulsey, C. D. (2002). Impulsivity, coping, stress, and problem gambling among university students. Journal of Counseling Psychology, 49, 202–211.CrossRefGoogle Scholar
  51. Lorenz, V. (1987). Family dynamics of pathological gamblers. In T. Galski (Ed.) The handbook of pathological gambling (pp. 71–88). Springfield, IL: Charles Thomas.Google Scholar
  52. Lorenz, V. C., & Yaffee, R. A. (1988). Pathological gambling and psychosomatic, emotional and marital difficulties as reported by the spouse. Journal of Gambling Behavior, 4, 13–26.CrossRefGoogle Scholar
  53. Lorenz, V. C., & Yaffee, R. A. (1989). Pathological gamblers and their spouses: Problems in interaction. Journal of Gambling Behavior, 5, 113–126.CrossRefGoogle Scholar
  54. Makarchuk, K., Hodgins, D. C., & Peden, N. (2002). Development of a brief intervention for concerned significant others of problem gamblers. Addictive Disorders and Their Treatment, 1, 126–134.CrossRefGoogle Scholar
  55. Maslow, A. (1968). Toward a psychology of being (2nd ed.). Princeton, NJ: Van Nostrand.Google Scholar
  56. May, R. (1953). Man’s search for himself. New York: Dell.Google Scholar
  57. May, R. (1981). Freedom and destiny. New York: Norton.Google Scholar
  58. McCormick, R. A. (1994). The importance of coping skill enhancement in the treatment of the pathological gambler. Journal of Gambling Studies, 10(1), 77–86.CrossRefGoogle Scholar
  59. McCown, W. G. (2004). Treating compulsive and problem gambling. In R. H. Coombs (Ed.) Handbook of addictive disorders: A practical guide to diagnosis and treatment (pp. 161–194). Hoboken, NJ: Wiley.Google Scholar
  60. McCown, W. G., & Chamberlain, L. L. (2000). Best possible odds: Contemporary treatment strategies for gambling disorders. New York: Wiley.Google Scholar
  61. Meador, B. D., & Rogers, C. R. (1984). Person-centered therapy. In R. Corsini (Ed.) Current psychotherapies (3rd ed., pp. 142–195). Itasca, IL: F.E. Peacock Publishers, Inc.Google Scholar
  62. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: The Guildford Press.Google Scholar
  63. Monaci, M. G., Scacchi, L., & Gervasoni, M. (2005). Emotions and coping in gambling: A comparison between occasional and pathological gamblers. [Italian]. Bollettino di Psicologia Applicata, 245(1), 3–17.Google Scholar
  64. Nathan, P. E. (2005). Methodological problems in research on treatments for pathological gambling. Journal of Gambling Studies, 21(1), 111–116.CrossRefGoogle Scholar
  65. Nichols, M. P., & Schwartz, R. C. (1995). Family therapy: Concepts and methods (3rd ed.). Boston, MA: Allyn and Bacon.Google Scholar
  66. Oakley-Browne, M. A., Adams, P., & Mobberley, P. M. (2004). Interventions for pathological gambling (The Cochrane Library, Issue 1). Chichester, UK: Wiley.Google Scholar
  67. Perls, F., Hefferline, R., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. London: Souvenir Press.Google Scholar
  68. Petry, N. M. (2005). Pathological gambling: Etiology, comorbidity, and treatment. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  69. Petry, N. M., Litt, M. D., Kadden, R., & Ledgerwood, D. M. (2007). Do coping skills mediate the relationship between cognitive-behavioral therapy and reductions in gambling in pathological gamblers? Addiction, 102, 1280–1291.PubMedCrossRefGoogle Scholar
  70. Petry, N. M., & Steinberg, K. L. (2005). Childhood maltreatment in male and female treatment-seeking pathological gamblers. Psychology of Addictive Behaviors, 19(2), 226–229.PubMedCrossRefGoogle Scholar
  71. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66(5), 564–574.PubMedCrossRefGoogle Scholar
  72. Remen, N., May, R., Young, D., & Berland, W. (1985). The wounded healer. Saybrook Review, 5(1), 84–93.Google Scholar
  73. Rogers, C. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin.Google Scholar
  74. Sagorsky, L., & Skinner, W. (2005). Using motivational interviewing with clients who have concurrent disorders. In W. J. W. Skinner (Ed.) Treating concurrent disorders: A guide for counsellors. Toronto, ON: Centre for Addiction and Mental Health.Google Scholar
  75. Satir, V. (1988). The new peoplemaking. Mountain View, CA: Science and Behavior Books.Google Scholar
  76. Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir model: Family therapy and beyond. Palo Alto, CA: Science & Behavior Books.Google Scholar
  77. Savron, G., Pitti, P., & DeLuca, R. (2003). Mood states and personality traits in pathological gambling sample and their family members. Rivista di Psychiatria, 38(5), 247–258.Google Scholar
  78. Scherrer, J. F., Xian, H., Kapp, J. M., Waterman, B., Shah, K. R., Volberg, R., et al. (2007). Association between exposure to childhood and lifetime traumatic events and lifetime pathological gambling in a twin cohort. Journal of Nervous and Mental Disease, 195(1), 72–78.PubMedCrossRefGoogle Scholar
  79. Seeman, J. (2002). Looking back, looking ahead: A synthesis. In D. J. Cain, & J. Seeman (Eds.) Humanistic psychotherapies: Handbook of research and practice (pp. 617–636). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  80. Sexton, T. L., Weeks, R. W., & Robbins, M. S. (Eds.) (2003). In Handbook of family therapy. New York: Brunner-Routledge.Google Scholar
  81. Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment, 27, 99–121.PubMedCrossRefGoogle Scholar
  82. Steinberg, M. (1993). Couples treatment issues for recovering male compulsive gamblers and their partners. Journal of Gambling Studies, 9(2), 153–167.CrossRefGoogle Scholar
  83. Tam, E. P. C. (2007). A psycho-spiritual approach to Christian spiritual direction based on the Satir model of therapy. Hong Kong: Tao Fong Shan Christian Centre.Google Scholar
  84. Tillich, P. (1967). Systematic theology (3 volumes). Chicago: University of Chicago Press.Google Scholar
  85. Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21(1), 75–80.CrossRefGoogle Scholar
  86. Toneatto, T., & Ladouceur, R. (2003). Treatment of pathological gambling: A critical review of the literature. Psychology of Addictive Behaviors, 17(4), 284–292.PubMedCrossRefGoogle Scholar
  87. Toneatto, T., & Millar, G. (2004). Assessing and treating problem gambling: Empirical status and promising trends. Canadian Journal of Psychiatry, 49(8), 517–525.Google Scholar
  88. Vander Bilt, J., & Franklin, J. (2003). Gambling in a familial context. In H. J. Shaffer, M. N. Hall, J. Vander Bilt, & E. George (Eds.) Futures at stake: Youth, gambling, and society (pp. 100–125). Reno, NV: University of Nevada Press.Google Scholar
  89. Von Bertalanffy, L. V. (1968). General systems theory. New York: George Braziller.Google Scholar
  90. Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: Norton.Google Scholar
  91. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.Google Scholar
  92. Wiebe, J., Single, E., & Falkowski-Ham, A. (2001). Measuring gambling and problem gambling in Ontario. Ontario: Canadian Centre on Substance Abuse and Responsible Gambling Council.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.School of Health SciencesUniversity of LethbridgeLethbridgeCanada

Personalised recommendations