Employment Stress and Couple Adjustment among Clients With Disorders of Gambling and Alcohol Use: Themes of Transfers in Congruence Couple Therapy

Abstract

Background: Individuals with problematic gambling, alcohol and substance use commonly report lower employment rates and more employment-related problems such as job loss, work conflicts and poor performance. Method: A thematic qualitative analysis was conducted to extract employment-related themes from 21 sets of addiction counselors’ case notes of couple therapy sessions (average 10 sessions per case) from a randomized controlled trial of Congruence Couple Therapy (CCT). Case notes were examined for the types of employment issues to answer the research question: What are the interconnections of employment, couple adjustment and addictive behaviors as revealed in the CCT counselors’ case notes? Results: Five key areas of employment-related stress were identified: (1) unemployment, (2) financial concerns, (3) history of crime, (4) overworking and workaholism, and (5) workplace conflict. These themes interacted negatively with couple adjustment and addictive behaviors. Using CCT as an intervention, clients gained skills in 4 areas transferred to employment: (1) awareness of self, other and family of origin, (2) congruent communication, (3) work-family balance, and (4) enlisting spousal support. These themes intersected with enhanced work functioning and reduced stress, alcohol use and gambling. Conclusion: Employment problems negatively impacted addictive behaviors, couple adjustment and well-being of partners and clients. Skills and awareness gained in CCT promoted changes in addicted clients’ employment functioning and coping with employment stress. The domains of work and couple adjustment are mutually influential in increasing or reducing stress with implications for addiction recovery. CCT as a viable intervention for enhancing employment function should be further studied.

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial

“…About 22% reported household income not meeting living needs, 11% reported housing instability, and 35% were not working at the start of the trial. Unemployment posed additional stress to the couple's relationship and increased use of alcohol and/or gambling (Lee & Merali, 2022; Lee & Ofori Dei, 2022). Housing and financial instability were deemed to be negative indicators for engagement in CCT (Shi, 2021).…”

“…Counselors' feedback was collected at the completion of each case using the Case Termination Questionnaire and in three focus groups at three points in the study: after training, midterm, and after the completion of the trial. There was a consensus in their feedback on the acceptability of CCT in their practice in the health system (Lee et al, 2016Lee & Knighton, 2017). They cited it as a necessary service, its alignment with health system philosophy, effectiveness with addiction and mental health concerns, safety, the comprehensive and integrative nature of the systemic model, and increased job satisfaction (Lee et al, 2016).…”

Changes in Work Status, Couple Adjustment, and Recovery Capital: Secondary Analysis of Data From a Congruence Couple Therapy Randomized Controlled Trial

“…In doing so, it holds the potential to elevate concomitant outcomes in a positive direction that could spill over from couple adjustment and related RC into the work domain as suggested by findings from a parallel qualitative study that offered corroboration with the results of the present quantitative study. 34 …”

“…In a qualitative study of counselors case notes from a randomized controlled trial of a systemic treatment model, Congruence Couple Therapy, employment problems, and employment-related stress featured as central concerns to addicted clients in a large majority of CCT couple cases. 34 Tight linkages were found between employment stress with couple distress and addiction issues. The family-work interface has been studied for two decades in disciplines such as occupational psychology, 35 , 36 but has not been exploited for treatment and recovery in the addiction field.…”

“…A secondary qualitative study from the same CCT RCT drawing on CCT addiction counselors' case notes revealed that employment problems featured in 88% of couples, negatively impacting addictive behaviors, couple distress, and well-being of partners and clients in a systemic fashion that are intricately related. 34 With CCT's systemic intervention, interacting themes of increased awareness of self and one's family of origin influences, congruent communication, and the enlisting of spousal support are conducive to reducing employment stress and enhancing employment functioning. 33 These qualitative findings converge with our quantitative findings in showing the inter-relatedness of work and couple adjustment as well as other recovery variables of emotion regulation, mental health, and life stress.…”