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Congruence Couple Therapy for Pathological Gambling

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Abstract

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.

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References

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author (Text Revision).

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine.

    Google Scholar 

  • Bateson, G. (1979). Mind and nature, a necessary unity. Toronto: Bantam Books.

    Google Scholar 

  • Berger, P., & Luckmann, T. (1967). The social construction of reality. Garden City, NY: Doubleday.

    Google Scholar 

  • Blaszczynski, A., & Nower, L. (2001). A pathways model of problem and pathological gambling. Addiction, 97, 487–499.

    Article  Google Scholar 

  • Blaszczynski, A., & Steel, Z. (1998). Personality disorders among pathological gamblers. Journal of Gambling Studies, 14(1), 51–71.

    Article  PubMed  Google Scholar 

  • Bowen, M. (1978). Family therapy in clinical practice. New York: Aronson Press.

    Google Scholar 

  • Brubacher, L. (2006). Integrating emotion-focused therapy with the Satir model. Journal of Marital and Family Therapy, 32(2), 141–153.

    Article  PubMed  Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • Carter, B., & McGoldrick, M. (Eds.) (1988). The changing family life cycle: A framework for family therapy. New York: Gardner Press.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 http://www.camh.net/egambling/issue13/index.html.

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Fiorentine, R., Nakashima, J., & Anglin, D. M. (1999). Client engagement in drug treatment. Journal of Substance Abuse Treatment, 17(3), 199–206.

    Article  PubMed  CAS  Google Scholar 

  • Frankl, V. (1953). Man’s search for meaning. Boston, MA: Beacon.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Gendlin, E. T. (1974). Experiential psychotherapy. In F. J. Corsini (Ed.) Current psychotherapies (3rd ed., pp. 317–352). Illinois: F.E. Peacock.

    Google Scholar 

  • Gendlin, E. T. (1981). Focusing (2nd ed.). New York: Bantam.

    Google Scholar 

  • Gergen, K. (1985). The social constructionist movement in modern psychology. American Psychologist, 40, 266–275.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Gurman, A. (2001). Brief therapy and family and couples therapy: An essential redundancy. Clinical Psychology: Science & Practice, 8, 51–65.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Heineman, M. (1994). Compulsive gambling: Structured family intervention. Journal of Gambling Studies, 10(1), 67–76.

    Article  Google Scholar 

  • Heinemann, M. (2001). Losing your shirt: Recovery for compulsive gamblers and their families (2nd ed.). Center City, MN: Hazelden.

    Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • Johnson, S. M. (2002). Emotionally focused couple therapy for trauma survivors: Strengthening attachment bonds. New York: Guilford Press.

    Google Scholar 

  • Johnson, S. M. (2003). The revolution in couple therapy: A practitioner-scientist perspective. Journal of Marital and Family Therapy, 29(3), 365–384.

    Article  PubMed  Google Scholar 

  • Johnson, S. M., & Talitman, E. (1997). Predictors of success in emotionally focused marital therapy. Journal of Marital and Family Therapy, 23, 135–152.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 357–361.

    Google Scholar 

  • 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 

  • Lee, B. K. (2002b). Congruence in Satir’s model: Its spiritual and religious significance. Contemporary Family Therapy, 24(1), 57–78.

    Article  Google Scholar 

  • Lee, B. K. (2002c). Development of a Congruence Scale based on the Satir Model. Contemporary Family Therapy, 24(1), 217–239.

    Article  Google Scholar 

  • 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 

  • 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.

  • 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).

  • 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).

  • 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 

  • Lee, B.K., Rovers, M., & MacLean, L. (2008). Training problem gambling counsellors in Congruence Couple Therapy: Evaluation of training outcomes. International Gambling Studies (forthcoming).

  • 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.

    PubMed  CAS  Google Scholar 

  • Lightsey, O. R., & Hulsey, C. D. (2002). Impulsivity, coping, stress, and problem gambling among university students. Journal of Counseling Psychology, 49, 202–211.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Lorenz, V. C., & Yaffee, R. A. (1989). Pathological gamblers and their spouses: Problems in interaction. Journal of Gambling Behavior, 5, 113–126.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Maslow, A. (1968). Toward a psychology of being (2nd ed.). Princeton, NJ: Van Nostrand.

    Google Scholar 

  • May, R. (1953). Man’s search for himself. New York: Dell.

    Google Scholar 

  • May, R. (1981). Freedom and destiny. New York: Norton.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • McCown, W. G., & Chamberlain, L. L. (2000). Best possible odds: Contemporary treatment strategies for gambling disorders. New York: Wiley.

    Google Scholar 

  • 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 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: The Guildford Press.

    Google Scholar 

  • 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 

  • Nathan, P. E. (2005). Methodological problems in research on treatments for pathological gambling. Journal of Gambling Studies, 21(1), 111–116.

    Article  Google Scholar 

  • Nichols, M. P., & Schwartz, R. C. (1995). Family therapy: Concepts and methods (3rd ed.). Boston, MA: Allyn and Bacon.

    Google Scholar 

  • Oakley-Browne, M. A., Adams, P., & Mobberley, P. M. (2004). Interventions for pathological gambling (The Cochrane Library, Issue 1). Chichester, UK: Wiley.

    Google Scholar 

  • Perls, F., Hefferline, R., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. London: Souvenir Press.

    Google Scholar 

  • Petry, N. M. (2005). Pathological gambling: Etiology, comorbidity, and treatment. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Remen, N., May, R., Young, D., & Berland, W. (1985). The wounded healer. Saybrook Review, 5(1), 84–93.

    Google Scholar 

  • Rogers, C. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin.

    Google Scholar 

  • 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 

  • Satir, V. (1988). The new peoplemaking. Mountain View, CA: Science and Behavior Books.

    Google Scholar 

  • Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir model: Family therapy and beyond. Palo Alto, CA: Science & Behavior Books.

    Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • Sexton, T. L., Weeks, R. W., & Robbins, M. S. (Eds.) (2003). In Handbook of family therapy. New York: Brunner-Routledge.

  • Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment, 27, 99–121.

    Article  PubMed  Google Scholar 

  • Steinberg, M. (1993). Couples treatment issues for recovering male compulsive gamblers and their partners. Journal of Gambling Studies, 9(2), 153–167.

    Article  Google Scholar 

  • 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 

  • Tillich, P. (1967). Systematic theology (3 volumes). Chicago: University of Chicago Press.

    Google Scholar 

  • Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21(1), 75–80.

    Article  Google Scholar 

  • Toneatto, T., & Ladouceur, R. (2003). Treatment of pathological gambling: A critical review of the literature. Psychology of Addictive Behaviors, 17(4), 284–292.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • Von Bertalanffy, L. V. (1968). General systems theory. New York: George Braziller.

    Google Scholar 

  • Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: Norton.

    Google Scholar 

  • White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

    Google Scholar 

  • 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 

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Acknowledgments

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.

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Lee, B.K. Congruence Couple Therapy for Pathological Gambling. Int J Ment Health Addiction 7, 45–67 (2009). https://doi.org/10.1007/s11469-007-9137-x

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