Cognitive-Behavioral Conjoint Therapy for PTSD: A Case Study of a Transgender Male Co-Parenting With Former Spouse and Perpetrator of Domestic Violence

Abstract

Posttraumatic Stress Disorder (PTSD) symptoms have shown to contribute to intimate relationship discord (Taft et al., 2011). Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012) is an evidence-based treatment for PTSD effective at significantly decreasing PTSD symptoms and increasing relationship satisfaction among dyads (Macdonald et al., 2016). To date, there has only been one case study examining the effectiveness of CBCT for PTSD with a sexual minority couple, (same-sex female couple) leaving uncertainty of the effectiveness of this treatment for other sexual minority couples. This case study examined a married couple’s response to treatment, in which the patient identified as a transgender male and his spouse identified as a cisgender female. The patient was diagnosed with PTSD per a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total score of 45 (of a maximum of 80). On the CAPS-5, the patient reported a first sexual encounter rape at age 15, from his first marriage with his ex-husband, whom he was dating at the time, as his index trauma. Of note, the patient and his wife currently co-parent two children with the patient’s ex-husband, who perpetrated daily sexual assaults for years during their marriage. Pre-treatment relationship happiness for the couple was “a little unhappy” on the Dyadic Adjustment Scale (DAS) Relationship Happiness Scale. Patient was also diagnosed with Dysthymia and responded well to continued Bupropion for depression. Following completion of the 15-session CBCT for PTSD protocol, the patient’s diagnosis of PTSD was determined to be in remission as evidenced by a post-treatment CAPS-5 total score of 7. At post-treatment the patient rated his relationship happiness as “happy” and his partner “very happy” on the DAS. The couple demonstrated clinically meaningful changes in areas of PTSD and relationship happiness. Functional improvements were also reported in the patient pursuing new employment and hobbies, improved co-parenting between the patient and his wife, improved sexual functioning, and decreased depression symptoms. Treatment gains were maintained at a 1-month and 3-month follow-up. These results demonstrate the effective use of CBCT for PTSD with a sexual minority couple that has continued co-parenting contact with a perpetrator of domestic violence.