Lee, Bonnie
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- ItemAddiction: a runaway phenomenon of our time?(SciTechnol, 2012) Lee, Bonnie K.An editorial that promotes research on therapy and rehabilitation for behavioral addictions. Addiction has become a worldwide problem, spreading beyond drugs and alcohol to encompass behaviors such as eating, gambling and shopping. An interdisciplinary approach is critical for understanding the wide scope of addictions and the processes of recovery and rehabilitation.
- ItemAge of addiction(Lethbridge Herald, 2011) Lee, Bonnie K.The Public Professor is written by faculty at the University of Lethbridge. It runs Saturdays.
- ItemAnalogous systems principles and concepts of traditional Chinese medicine and congruence couple therapy(Wolters Kluwer, 2020) Lee, Bonnie K.This article explicates the analogous principles and concepts between traditional Chinese medicine (TCM) and congruence couple therapy (CCT). Although originating out of vastly different times and places, TCM and CCT share a view of health based on systems understanding to facilitate the interconnections of the parts of an organism rather than focusing on eliminating symptoms. Both approaches aim to release Qi（气） and vitality by removing blockages through adjusting the interactions, adaptation, and balance of multiple elements and Yin-Yang energies. The goal is to liberate the Qi or life force through improved holistic balance and cooperation. While TCM focuses on interventions at the level of the body, CCT focuses on the attention, awareness, acknowledgement, and alignment of the four human dimensions consisting of the intrapsychic, interpersonal, intergenerational, and universal-spiritual. In light of the current trend toward increasing mental, substance use, and neurological disorders, in particular among countries of middle and low income, dialogue to explore these compatibilities between TCM and CCT is conducive to the continuous evolution of TCM and Western therapies to address not only physical health but also the exigencies of contemporary addiction and mental health care within a mind–body relationship matrix.
- ItemArt therapy for chronic pain: applications and future directions(Graduate Programs in Educational Psychology, University of Calgary, 2011) Angheluta, Anne-Marie; Lee, Bonnie K.Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing mind-body treatments such as art therapy. Art therapy for chronic pain is a nascent area of study, and this literature review endeavours to (a) evaluate the quality of literature investigating this area, (b) discuss how art therapy and other creative arts therapies treated the biopsychosocial dimensions of chronic pain, and (c) identify challenges and future directions for research on this topic.
- Item‘Bringing Torn Lives Together Again’: Effects of the First Congruence Couple Therapy Training Application to Clients in Pathological Gambling(Taylor & Francis, 2008-04) Lee, Bonnie K.; Rovers, MartinCounsellors (N=21) receiving their first training in Congruence Couple Therapy (CCT) applied CCT to 1–2 pathological gamblers (N=24) and their spouses conjointly at their Ontario treatment settings. Gamblers' and spouses' pre–post quantitative results indicated statistically significant reduction of gambling urges and behaviours and improvement in spousal relationship. However, contrary to hypothesis, spouses experienced a significant decrease in overall life satisfaction, specifically in the area of regrets, from pre-to post-treatment. Ratings of CCT by clients and counsellors indicated high satisfaction of CCT's effectiveness. Qualitative data based on client and counsellor sources substantiated quantitative findings and further revealed clinical changes in four key dimensions addressed by CCT: intrapsychic, interpersonal, intergenerational and universal–spiritual. Quantitative results are limited by absence of a control group and low sample size, but are compensated by a solid base of qualitative findings. Mixed methods yielded promising preliminary results of CCT's effectiveness in gambling behaviour and symptom reduction and in improved spousal relationship.
- ItemChanges in work status, couple adjustment, and recovery capital: secondary analysis of data from a Congruence Couple Therapy randomized controlled trial(Sage, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.Purpose: Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU). Method: Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed. Results: Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran’s Q = 5.429, P = .066) or TAU (Cochran’s Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group. Conclusion: Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.
- ItemChanges in work status, couple adjustment, and recovery capital: secondary analysis of data from a congruence couple therapy randomized controlled trial(Sage, 2022) Lee, Bonnie K.; Dei, Samuel M. O. D.PURPOSE: Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU). METHOD: Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed. RESULTS : Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran’s Q = 5.429, P = .066) or TAU (Cochran’s Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group. CONCLUSION: Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.
- ItemCharacteristics of seekers of couple therapy for alcohol use or gambling disorder(Wolters Kluwer Health, 2023) Lee, Bonnie K.; Shi, Yanjun; Ofori-dei, Samuel M.; Miftari, NaserObjective: This study examined characteristics of individuals with alcohol use disorder (AUD) or gambling disorder (GD) who were seeking couple therapy based on screening data from a randomized controlled trial on Congruence Couple Therapy at 2 out-patient addiction service sites in Alberta. Method: Screening data of couple therapy seekers (N= 171) were analyzed. Results: Seekers cited various motivations for seeking couple therapy including addiction-related relationship breaches and issues, the desire to recover from addiction together, concerns for the well-being of their children, and the lack of available couple therapy in addiction services until this trial. Significantly more females than males were first to indicate interest, and 77% of the sample had attended other treatment and mutual help programs in the past 12 months. The majority of the treatment seekers met DSM-5 diagnostic criteria for AUD and/or GD scoring in the moderate-severe range with nearly half of the seekers reporting a mental health diagnosis at least once in their lifetime. In addition, 30% of treatment-seekers reported past-year suicidal thoughts, citing their own addiction and their partners’ addiction as reasons and 57% of those individuals reported having a method/plan to carry out their suicide. Suicidal attempts in the past year was 8% based on the entire sample. Finally, 19% of treatment seekers reported experiencing intimate partner violence within the past 12 months. Conclusion: Addiction and couple relationship problems are closely connected. Despite the serious multiple concurrent concerns of seekers identified in this study, there is a general lack of couple therapy availability in addiction services. This study highlights the importance for addiction and mental health professionals to note the complex interaction of couple distress and addiction, understand couple therapy as a treatment modality, and make timely referrals for this vulnerable group.
- ItemConceptualizing and Treating Problem Gambling as a Family Issue [Abstract](Blackwell Publishing, 2009-10) McComb, Jennifer L.; Lee, Bonnie K.; Sprenkle, Douglas H.Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians’ experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic- based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.
- ItemCongruence Couple Therapy for alcohol use and gambling disorders with comorbidities (part I): outcomes from a randomized controlled trial(Wiley, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.; Brown, Matthew M. R.; Awosoga, Olu A.; Shi, Yanjun; Greenshaw, Andrew J.A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.
- ItemCongruence Couple Therapy for alcohol use and gambling disorders with comorbidities (part II): targeted areas and mechanisms of change(Wiley, 2022) Lee, Bonnie K.; Ofori Dei, Samuel M.; Isik, ErkanStudy of change mechanisms is important to advance theory development and to reveal the active components that make a critical difference in treatment. Improved outcomes in a randomized controlled trial that favored Congruence Couple Therapy (CCT) vs individual-based Treatment-as-Usual (TAU) were correlated within each group. Partial correlations were used to test for mediation effects. The aggregate correlation coefficient of improved variables in addiction and mental health, couple adjustment, emotion regulation (ER) and life stress was moderate for CCT and weak for TAU. CCT showed greater number of mediating effects among improved variables than TAU. The prominence of the process mechanism of improved ER with its mediating effects for addiction and psychiatric symptoms evidenced in both groups is noteworthy, but ER improvement was significantly associated with improved couple adjustment only in CCT. Reduction in life stress in CCT was associated with a broader range of improvements in CCT compared to TAU. Correlation patterns were substantiated by CCT participants’ endorsement of treatment targets emphasizing relationship, communication, emotion, problem solving, addiction and intergenerational issues of trauma. TAU participants reported significantly lower endorsements for these treatment targets. The correlation of ER and couple adjustment suggested as a key process mechanism should be further elucidated in future studies to differentiate relationship-based vs individual-based models and their respective outcomes for primary clients and partners. These findings are considered preliminary, requiring larger samples and advanced modelling among variables to provide a more profound mechanism analysis.
- ItemCongruence Couple Therapy for Pathological Gambling(Springer, 2009-01) Lee, Bonnie K.Couple therapy models for pathological gambling are limited. Congruence Couple Therapy is an integrative, humanistic, systems model that addresses intrapsychic, interpersonal, intergenerational, and universal–spiritual disconnections of pathological gamblers and their spouses to shift towards congruence. Specifically, CCT‘s theoretical foundations, main constructs, and treatment interventions are illustrated in a progression of six clinical phases. Promise of CCT‘s systemic conceptualization and interventions for pathological gambling and future directions in its continuing evolution are discussed. Keywords: Congruence Couple Therapy . Pathological gambling . Couple therapy . Humanistic . Experiential . Spiritual . Virginia Satir
- ItemCongruence couple therapy: an integrative approach in addiction and concurrent disorder treatment(2020) Lee, Bonnie K.; Northey, Korie-LynFamily engagement is a priority in addiction and mental health services, although compelling concepts and processes to involve families remain inadequate. Couple therapy is ostensibly missing in the menu of services available. To address this gap, the systemic principles and concepts of Congruence Couple Therapy integrate the treatment of adverse childhood experiences and addiction by working with the couple interaction. This presentation will encourage thinking and conversation on the importance, merits and barriers of placing couples and parents more centrally in treatment and evaluation, showcasing the voices and viewpoints of patients and counsellors who participated in a randomized controlled trial at two treatment sites in Alberta Health Services. A summary of the clinical outcomes from the trial will be shared.
- ItemCongruence in Satir's model: Its spiritual and religious significance(Human Sciences Press, Inc., 2002-03) Lee, Bonnie K.This article casts into relief the essentialist-existential philosophy implicit in Satir’s model of healing using Paul Tillich’s systematic philosophical framework. Parallels between Satir’s model of the person are drawn with Tillich’s ontological categories of essence and existence, individualization and participation, and destiny and freedom. Congruence as the integration of elements in three vital human dimensions: the interpersonal, intrapsychic, and spiritual-universal, is correlated with Tillich’s philosophical understanding of “salvation.” The religious quest is understood as a systemic, multidimensional process that brings the interactive and interdependent personal, interpersonal and spiritual dimensions into a restored unity. Thus Satir’s rehumanization project and Tillich’s religious quest are shown to coincide. KEY WORDS: Satir; Tillich; congruence; essentialism; salvation; religious; spiritual.
- ItemCouple therapy in substance use and gambling disorders: promoting health system change(Springer, 2020) Lee, Bonnie K.; Gilbert, Robert; Knighton, Rebecca A.Couple and family relationships are central in processes of substance use and gambling disorders, yet they remain inadequately researched and marginally addressed in services found in the health system. Multiple barriers exist that favour a focus on the individual due to organization structure and discourse, shortage of couple therapy training, and values and philosophy of addiction services. This article describes a successful strategic initiative to foster a partnership for researchers and health system decision-makers to promote a health system change. We identify impactful factors in a two-day integrated knowledge translation workshop bringing together practitioners, researchers, decision-makers and couples seeking services for gambling and substance use disorders. The initiative shifted awareness of decision-makers, built a network of collaborative relationships and created a consensus for action among stakeholders. This early integrated knowledge translation strategy opened up research partnership on a couple therapy randomized trial in the health system, training for counselors, and research opportunities for graduate students.
- ItemCouples seeking CCT treatment for alcohol and gambling problems in a randomized trial(University of Lethbridge, 2017) Lee, Bonnie K.; Shi, Yanjun; Gaelzer, Jessica; Awosoga, Olu A.; Christensen, Darren R.
- ItemDevelopment of a congruence scale based on the Satir model(Human Sciences Press, Inc., 2002-03) Lee, Bonnie K.The Congruence Scale derives from the construct of congruence, the goal of therapeutic change in the Satir model. Congruence is conceptualized as a state of awareness, openness, and connection in three human dimensions: the Intrapsychic, Interpersonal, and Universal-Spiritual. Procedures in developing the Congruence Scale are described. Results provide evidence of concurrent validity with the Satisfaction With Life Scale and the Outcome Questionnaire. Four factors of the Congruence Scale are extracted from factor analysis: Intrapsychic- Interpersonal, Spiritual, Creative, and Communal. Further research to confirm the reliability and validity of the congruent construct is recommended. KEY WORDS: Satir; congruence; scale development; intrapsychic; interpersonal; spiritual; creative; communal.
- ItemEmployment stress and couple adjustment among clients with disorders of gambling and alcohol use: themes of transfers in congruence couple therapy(Sage, 2022) Lee, Bonnie K.; Merali, Noor-KhanuBACKGROUND: 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 addicted clients. Skills and awareness gained in CCT promoted changes in addicted clients' employment functioning and coping with employments tress. 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.
- ItemEmployment stress and couple adjustment among clients with disorders of gambling and alcohol use: themes of transfers in Congruence Couple Therapy(Sage, 2022) Lee, Bonnie K.; Merali, Noor-KhanuBackground: 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 addicted 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.
- ItemEvoking the Universal Human Family in Public Acts of Healing: Jesus of Nazareth and Virginia Satir(Saint Paul University - Faculty of Human Sciences, 2002) Lee, Bonnie K.This article explores the significance of healing staged as public performances by Jesus of Nazareth and Virginia Satir. Two social science models, social construction of reality and anthropology of ritual, highlight the contribution of collectivities in the deconstruction and construction of worldviews and the legitimization of a change in social status and identity. The author argues that through publicly witnessed and experientially enacted healing acts, Jesus and Satir proclaimed and performed a universal human family that transcends the power of institutional definitions of persons. Within an expanded frame of cosmic and spiritual reference, Jesus' and Satir's public healing acts liberated individuals defined by their societies as displaced and deviant to a new identity of worth and belonging as reclaimed and esteemed members of a universal family of humankind sharing a spiritual heritage. In reconnecting persons to their personal, spiritual, and social resources, Jesus and Satir functioned not only as charismatic healers of their time, but also as spiritual leaders and agents of social change.