Couple Therapy for PTSD

Eileen Bailey Health Guide
  • Post traumatic stress disorder (PTSD) sometimes develops after a traumatic event, such as abuse, terrorist attack, combat or a natural disaster. Those who develop PTSD may have symptoms such as avoiding any situations that bring back memories of the event, reliving the event in their mind (while awake or through nightmares), feeling jittery or alert for danger at all times and a change in perception in the world around you. These symptoms can be debilitating – lasting for months or years after the event.


    How PTSD Impacts Relationships

    Those who experience man-made traumas, such as abuse, terroristic attacks, witnessing a crime or living through combat, can develop “a lasting sense of terror, horror, endangerment and betrayal.” [1] These feelings impact personal relationships and can cause the survivor to create emotional distance in relationships.

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    Survivors of trauma need support from their family and friends, especially if there is a significant other in their lives. Having a strong support network can help to prevent PTSD symptoms in those surviving a trauma.  According to Dr. Candice Monson, a profession at Ryerson University’s Department of Psychology, “There is increasing recognition that intimate relationships can play a vital role in the path to recovery for those with PTSD.” [2]


    Unfortunately, many of those with PTSD end up with relationship problems.  The U.S. Department of Veterans Affairs states that up ten percent of those with PTSD may have “lasting relationship problems” because of the intense feelings after the event.  They may emotionally distance themselves or find it hard to trust someone. They may find it hard to relax and be intimate or become overprotective, leaving their partner feeling smothered.


    Partners may also have a hard time dealing with PTSD. They may not understand why their spouse is pushing them away and feel hurt and betrayed.  Or, they may always feel tense and on edge, because their partner is always tense and on edge.  The partner might be angry because “he can’t get over it.”


    Cognitive Behavioral Conjoint Therapy

    Dr. Monson, with her colleague Dr. Fredman, developed a new treatment, cognitive behavioral conjoint therapy (CBCT), to treat both the survivor and his or her partner together. The therapy lasts for 15 weeks and is divided into three phases.


    During Phase 1 couples meet with the therapist twice a week, for 75 minutes each session.  The therapist provides education to the couple about PTSD, for example, how it affects relationships, teaches practical strategies for coping with PTSD symptoms together and reconnecting with one another.


    During Phase 2, sessions continue twice a week with sessions on reflective listening. They also begin to work on avoidance, or more specifically, to stop using avoidance of situations, places and people as a coping mechanism. After completing an inventory of activities and places they avoid because of the PTSD, they reverse the list so it becomes their “approach” list. Therapy also focuses on communication and problem solving skills.


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    During the final phase, sessions are reduced to once a week.   With the help of the therapist, the couple looks at trust, control, emotional closeness and physical intimacy to see how PTSD has affected these areas and to find ways to improve each area.


    Dr. Monson’s research has shown positive results from this type of therapy. Their research showed that this particular form of treatment helped not only to resolve symptoms of PTSD but also to improve the couple’s relationship – 81 percent of couples showed significant reduction of PTSD symptoms and 61 percent of couples indicated their relationship had improved significantly. [3]




    [2] [3] “Couple Therapy Effective for PTSD Patients,” 2012, Aug. 16, Kelly Fitzgerald,


    “Effect of Cognitive-Behavioral Couple Therapy for PTSD,” 2012, Aug. 15, Candice Monson et al, The Journal of the American Medical Association


    “Relationships and PTSD,” Date Unknown, Staff Writer, U.S. Department of Veterans Affairs


    [1] “What is PTSD?”  Date Unknown, Staff Writer, U.S. Department of Veterans Affairs

Published On: September 02, 2013