www.camh.net

Skip Navigation Links
Français

Helping Professionals


Couple and Family Counselling at the Problem Gambling Service

The Problem Gambling Service counsels not only the individuals experiencing a gambling problem, but also offers counselling for other members of their family.  Most commonly, we see gambling clients with their partners, but we also treat other family constellations: parents, siblings, children and extended family members. Since 2004, the Problem Gambling Service has treated more than 200 couples. (For more information on treatment of collateral clients, click here.)

Counselling couples and families is complex in any treatment field. In problem gambling, the issues seen in other counselling domains also exist, and are often complicated by particulary acute financial, legal and interpersonal stresses that often accompany problem gambling. Typically, couples and family counselling for problem gambling will be provided by experienced practitioners, who have competence in family treatment AND problem gambling-specific treatment approaches. (For information on family systems theory, click here.) 

Couple and family counselling: Presenting clinical issues

We often encounter these dominant themes when working with families and couples:

  • relationships impacted by the gambling problem and related behaviours, past and current
  • loss of trust and respect, loss of secure bond and relationship injuries, with resulting experience of distress, pain, anger and depression
  • extremely high levels of stress, for individuals and families
  • financial abuse of family members
  • poor communication and problem-solving, disrupted functioning
  • disrupted roles and family hierarchies
  • boundary issues, including enmeshment and distancing
  • lack of intimacy and other supportive and positive aspects of healthier relationships
  • threat to continuance of relationships
  • disrupted, inadequate or harmful parenting practices
  • troubled children or adolescents
  • strained extended family relationships
  • conflict, anger, possible abuse/violence
  • developmental issues (e.g., young adults unable to establish independence, older adults losing retirement to gambling).

Couple and family counselling: Recommended theoretical approaches, strategies and techniques

  • cognitive behavioural and brief solution–focused approaches
  • systems theory and structural family therapy
  • transactional analysis
  • attachment theory and emotionally focused–therapy   
  • culturally competent counselling
  • feminist theory

Couple and family counselling: Some recommended strategies

  • See couple separately during first session, even if briefly, to determine if violence is an issue and if there are hidden agendas such as intent to separate.
  • See couple together to assess relationship dynamics in action, to identify joint goals, and to work on issues outlined above.
  • Separate couple for one or more sessions if anger / lashing out is at a level that may be harmful to prospective recovery. In individual sessions:
    • allow venting
    • provide support
    • address individual issues that are impacting on relationship
    • coach communication skills that may be more effective in getting needs met
  • Include children / extended family as needed to address family issues
  • Address children’s / parenting issues where possible, or refer. 
  • In the case of troubled children and adolescents, family may need additional specialized services / supports (e.g., children’s mental health centre, liaison with school system).

Couple and family counselling for problem gambling: Recommended treatment modalities

Cognitive behavioural interventions

In addition to the usual complement of skills and education that a therapist requires to work with families, the Problem Gambling Service has also had success in working with families using gambling-specific CBT interventions:

  • Reflect and validate feelings and perceptions of both/all parties by remaining neutral: think of the relationship as the client.
  • Address immediate functional issues in order to stabilize the situation and reduce stress to manageable levels (e.g., financial or housing crises). These urgent issues will have to be addressed very early in treatment to establish enough security to allow for other discussions.
  • Encourage complete disclosure of gambling and debts by the individual with the gambling problem.

Whenever possible, promote a collaborative rather than unilateral approach to managing finances:

  • Gambling family member takes shared, adult responsibility for addressing financial issues, planning, etc.
  • Non-gambling family members are not saddled with unfair burden.
  • Gambling family member can be encouraged to request specific support from partner or other family member (e.g., their handling of immediate cash and credit.
  • Non-gambling individuals can also be encouraged to request specific support (e.g., control of vital bills in order to promote sense of safety).
  • Address immediate fears and anxieties on non-gambling family members’ parts regarding gambling and related behaviours (usually related to loss of trust and of security):
    • define these fears/anxieties in specific and concrete terms, and relating to the present time (e.g., upcoming week)
    • help partners and or family members negotiate realistic actions needed to reduce these fears; assign these to the individual with the gambling problem 
    • frame assignment as taking responsibility for calming partner’s anxieties, rather than being infantilized by powerful spouse
    • reinforce realistic expectations: will not eliminate stress but will reduce it.

Identify positives from present or past and build from these: this family is still “together” somehow, despite the obvious difficulties. How they are still “together” is the strength they possess collectively.

Improve workload balance between partners and among family members. There will be an education piece needed for this, as they may have lost sense of what is a functioning family with all members contributing their share.

  • Encourage connection of each partner to supports outside the relationship.
  • Separate discussions regarding emotional issues and past hurts from day-to-day discussions in order to make both more effective:
    • Identify a time (often in counsellor’s office) to process emotional issues / past hurts, with expectation that both parties will stay present and engaged, and will listen and respond.
    • Set aside the rest of the week for day-to-day, present-focused interaction.

Click here for more information on CBT and problem gambling counselling.


Couple and family counselling for problem gambling: Structural interventions

These techniques explicitly and implicitly reinforce or create a view of the relationship as between two adults, both capable of responsible behaviour. Such techniques:

  • Address imbalances in power and control, and inappropriate roles. Be especially reflective of your own cultural bias and the cultural values of your clients.
  • Note and/or reflect pattern of interaction (e.g., blame/pursue, withdraw/defend). Identify circularity, “stuck” interactions.
  • Identify these patterns as the common adversary. Elicit emotional bases for these patterns and address.
  • Clarify boundary issues (e.g., what spouse can and cannot do to help or to control situation; what problem belongs to whom.
  • Encourage appropriate individuation and personal growth (leading to interdependence, healthy boundaries).
  • Address distancing by improving communication, increasing positive interactions.

Couple and family counselling for problem gambling: Transactional analysis

Use charts as a visual metaphor to:

  • provide vocabulary for change efforts
  • address role imbalances
  • improve communication
  • promote respectful interaction

Couple and family counselling for problem gambling: Brief solution-focused techniques

  • Use scaling questions to identify progress over time.
  • Use small changes to create shifts and break out of rigid interactional patterns. 
  • Look for exceptions to offer hope and clarify goals.

Click here for more information on problem gambling counselling and solution-focused brief therapy.

Couple and family counselling for problem gambling: Attachment theory and emotionally focused therapy

  • Identify, reflect and validate emotions related to adult attachment needs, which have been impacted by gambling.
  • Identify and reflect stuck or rigid cycles of interaction based on insecure attachment.
  • Work toward security of bonds, mutual accessibility and responsiveness.

Couple and family counselling for problem gambling: Culturally competent counselling

Explore the following:

  • group(s) the family identifies with (e.g., cultural, community, ethnic, religious)
  • belief systems relating to gambling, problem gambling, money, family / gender roles, emotional problems, family troubles, help seeking
  • impacts of immigration, such as dislocation, isolation, trauma, financial pressures
  • generational or acculturation issues
  • extended family and community as part of family system
  • cultural elements that are or could be supportive
  • integrate this information into process; address issues raised; adjust content and approach accordingly

For more information on problem gambling and ethno-specific counselling, click here.

Couple and family counselling for problem gambling: Feminist theory

Assess for interaction of gender roles and gambling/recovery; address.

  • Note that gender issues may be particularly salient in the case of a female gambling spouse whose gambling provides some sense of independence.
  • Note also a culture of male privilege that allows a male to gamble with impunity and/or limits a spouse’s influence on a gambling partner.
  • Issue interacts with culture with regard to family hierarchy; see above.

Click here for more information on problem gambling counselling and feminist theory.

Couple and family counselling for problem gambling: Therapist attributes


In addition to other addictions and mental health or social work qualifications, to be effective and competent in working with this client group, the Problem Gambling Service recommends: 

  • Formal training and comfort using the modalities outlined.
  • Training in couples counselling approaches.
  • Good skills at assessing underlying emotional content and relationship dynamics.
  • Able to make the relationship the client, rather than the individuals involved.
  • Able to make good use of supervision.

Key principles to keep in mind:

Family members’ goals for treatment and respective stages of change are often at odds. Covert agendas are common. Goals for treatment need to be clarified and validated, and common ground identified, or success will be limited.

Engagement

  • Engagement is enhanced by offering non-judgemental reflection of each members’ painful struggles in the relationship, and the emotional needs that are not being met.

Retention

  • Brief solution-focused techniques early in therapy bring small positive changes quickly.
  • Continued focus on both partner’s needs.

Assessment and Treatment—see above

Follow-up

  • Common to move to less frequent sessions as the couple or family members develop skills.
  • Couple may return at longer intervals for “tune-up” sessions.


Couple and family counselling for problem gambling: Treatment barriers

Individuals in the family or the marriage are each suffering from multiple severe losses, and are often unable to support each other through the work to come. It may be that they have become each other’s “problem” rather than offering protection and support. Their goals in counselling may be at odds with each other.

Other possible treatment barriers for families and couples include:

  • Cultural norm of solving problems within the family
  • Therapist inability to understand and incorporate cultural worldview of the clients.
  • Continued gambling or dishonesty; refusal to reveal complete financial situation.
  • Hidden information / agendas from any party in counselling, including separation plans, affairs.
  • Unsafe situation, including violence / threats to safety / financial abuse.
  • Chaotic family situation with consequent difficulties attending appointments.
  • Relationship injuries too severe or prolonged for re-establishment of meaningful levels of trust.
  • Some mental health issues, including depression, anxiety and any psychotic illnesses.

Back to table of contents


DISCLAIMER: Information on this site is not to be used for diagnosis, treatment or referral services. CAMH does not provide diagnostic, treatment or referral services through the Internet.
CAMH accepts no responsibility for such use. Individuals should contact their personal physician, and/or their local addiction or mental health agency regarding any such services.
Technical enquiries: webmaster@problemgambling.ca