The application of behavioral couples therapy to the assessment and treatment of agoraphobia: implications of empirical research.

The present review was undertaken to examine the literature regarding the role of the marital relationship in treatment of agoraphobia from a behavioral couples therapy (BCT) perspective. Both qualitative and quantitative analyses were conducted to evaluate (a) whether marital quality predicts treatment responsiveness and (b) how best to include the spouse in treatment of agoraphobia. Regarding the assessment of agoraphobics' relationship quality, it is recommended that subjectively experienced "satisfaction" with the relationship be distinguished from more descriptive measures of general and agoraphobia-specific relationship "adjustment." Treatment can include the partner as a "co-therapist" to assist with interventions directly targeted at the agoraphobia, or use BCT interventions to modify relationship interactions that might impede treatment gains. The application of BCT for these couples poses a number of challenges, including (a) the need to maintain a balanced treatment approach in an "unbalanced" system, (b) the need to target interventions at more than one treatment goal, and (c) the task of combining couple-focused interventions with those aimed at reducing phobic symptoms.