Significant Other Session
Tasks for Significant Other Session
- Offering significant others the opportunity to learn about the treatment in which the patient is involved
- Exploring strategies through which they can help the patient become and remain abstinent
Therapists may allow patients to invite a close family member or friend to attend up to two of the CBT sessions. The purpose of their attendance is to enhance the level of social support.
Significant other sessions are conducted within a cognitive-behavioral model.(This is drawn from the work of O'Farrell 1993 and McCrady and Epstein 1995.) Therapists should remember that the goals of these sessions are limited and should not reflect marital or family therapy. The goals of this session are to -
- Offer significant others the opportunity to learn about the treatment in which patients are involved.
- Explore strategies through which they can help patients become and remain abstinent.
Significant other sessions should be carefully planned in advance by patients and therapists together. Three key issues should be addressed:
- Who should attend the significant other session? In selecting significant others, patients and therapists should focus on identifying others who are likely to be able to provide support to the patient, as well as individuals who are close to the patient (spouses, partners, parents, siblings) and who are not substance abusers themselves. Significant others who are substance abusers are unlikely to offer substantial, meaningful support to the patients.
- What are the goals of the session? Unless clear goals are articulated and shared with the significant other in advance, the sessions may become a mere recounting of old wrongs and resentments, rather than focusing on planning for positive change.
- How can the significant other offer support? It is advisable for patients to think in advance about what kind of support they would like from the significant other. These should be as concrete and clear as possible.
Provide Information/Set Goals
Typically, therapists begin the session by greeting the significant others, praising them for coming in and offering support to the patient, providing some ground rules for the session, and reiterating the session goals. Substantial amounts of time should be allotted for answering questions about the treatment. Some significant others see this as an opportunity to relate complaints and express anger and distrust about the patient. Some limited "letting off steam" may be expedient and, if well managed, can enhance the patient's motivation to change (e.g., "What changes would you like Kris to make?" or "What concerns you about Kris' cocaine use?"). However, therapists should not allow destructive criticism or dredging up of old wrongs. This can be done by reorienting patients and significant others to the goals of the session as soon as is appropriate.
"It sounds like Kris' cocaine use has been of concern to you for some time; it has hurt the family finances, and you feel like you can't trust him. I'd like to move on now to spend some time talking about specific changes you both would like each other to make, to make it easier for Kris to stay clean and for your relationship to be more enjoyable for both of you."
As a prelude to exploring how significant others can help patients in their efforts to become abstinent, therapists should spend some time reiterating the CBT treatment model (topic 1) to establish a framework for the session. Patients should then describe the ways in which the significant other can offer support. These might include -
- Providing transportation to and from the clinic.
- Helping reduce cocaine and other substance abuse cues in the environment.
- Engaging in pleasant activities as a reward for sobriety and behavior change.
- Offering support and talking with them while they are experiencing craving or thoughts about cocaine.
- Helping patients make the "all-purpose coping plan" more concrete.
- Monitoring the patients' compliance with medication.
Patients should also be prepared for the significant other to ask for behavior changes; these usually start with continued abstinence but may include other things, such as helping more around the house, accounting for money, and so on. The changes requested should be stated clearly and as specifically as possible (e.g., "I'd like to have at least 15 minutes of quiet time with you every day" or "I'd like you to watch the kids one night a week so I can go see my mother").
The patient and significant other should be asked to develop a contract, with each person specifying the behavior changes desired from the other.