Addiction A-Z

Integrative behavioral couples therapy

Integrative behavioral couples therapy (IBCT) is a relatively new form of psychotherapy for couples.  It was developed by the late Neil S. Jacobson, a clinical psychologist and professor at the University of Washington, and Andrew Christensen, clinical psychologist and professor at UCLA.  The therapy is based on traditional behavioral couples therapy (TBCT, but with the addition of a primary focus on emotional acceptance.  This addition has made the therapy more beneficial to couples by producing more lasting effects than TBCT.

Behavioral therapies like IBCT stem from the basic premise that all behavior – good or bad, desirable or undesirable – is learned.  Anything that is learned, therefore, can be unlearned.  Of course, that’s a bit oversimplified as humans are complex creatures and other factors come into play as well.  Integrative behavioral couples therapy recognizes this fact.  Rather than focusing solely on the goal of positive behavioral changes in the relationship, it also focuses on the goal of emotional acceptance as well.  When both partners in a relationship learn to genuinely accept each other, positive changes occur more readily as well as more naturally.

Comparing TBCT to IBCT

In order to better understand the power of integrative behavioral couples therapy, it helps to consider the key tenets of both therapeutic approaches.  The basic tenets of TBCT include:

  • Merely talking about problems won’t solve them; taking action is the key to change.
  • Negotiating desired changes (which often involves creating new “rules”) and agreeing to put them into practice (which often involves contracts in behavioral therapy) is how relationship problems are addressed. Therapy helps couples do this by improving their communication and problem-solving skills.
  • Problematic patterns of behavior in relationships can be changed in most cases.
  • Learning new, positive patterns by way of compromise leads to a happier relationship.
  • Most couples can accomplish these things and have a happier relationship as a result.

Traditional behavioral couples therapy has helped many couples improve their relationship with each other.  However, the improvements that resulted from the therapy are often short-lived. Jacobson’s concern with TBCT was that far too many couples eventually reverted back to being discontented and distressed in spite of treatment.

In fact, follow-up studies found that as many as 1/3 of couples who had received TBCT indicated their relationship was more troubled than it was prior to therapy just two years later. Not only that, more than a third of the couples who had received TBCT ended up divorced within four years of treatment.  These statistics were a strong indicator that something significant was missing in the treatment approach.  For most people, the goal of therapy is lasting positive change, not just short term improvements that don’t stick.

Jacobsen and Christenson developed integrative behavioral couples therapy in an attempt to improve the shortcomings of traditional behavioral couples therapy.

Basic Tenets of IBCT – The basic tenets of IBCT are similar to TBCT in many ways.  However, they do include some key changes as well:

  • Talking about problems is often necessary in order to be able to reach a place of emotional acceptance.
  • Compromise doesn’t always work as a way to solve relationship problems. Creating rules for behavior can potentially make things worse by creating resistance and causing negative and rigid interactions between partners.
  • Adding emotional acceptance (and tolerance) to the process changes the dynamics of negotiation and compromise. Change is motivated by internal factors (e.g. “I’m doing this because I’m a loving husband”, and, conversely, “My husband is doing this because he loves me”), rather than external factors (e.g. “this is the new rule we agreed upon”).
  • Changing negative emotional responses to relationship problems – which has a negative effect (i.e. unhappiness and dissatisfaction in the relationship – is something most couples can do.
  • Most couples can do these things and have a happier, more satisfying relationship as a result.

Three Key Clinical Characteristics of IBCT

Integrative behavioral couples therapy has the following three key features:

  • It’s relies heavily on a functional analysis or case formulation of the couple’s problems
  • It emphasizes the importance of emotional acceptance as the foundation for lasting change.
  • The approach is “evocative” rather than “prescriptive” in nature.

Case formulation – The case formulation is essentially framing the couple’s problems into a new narrative that eliminates putting the blame on either person.  The therapist creates this new, unified story by considering both sides of the problem, as presented by each partner during the initial sessions.  The case formulation (or “DEEP analysis” as it’s sometimes called) is based on an assessment of the couple’s:

  • Differences – includes areas of incompatibility and disagreement
  • Emotional sensitivities – each partner’s vulnerabilities or “hot points” that feed into their differences
  • External stressors – outside factors that make the problems worse (e.g. relatives, work, other demands on each partner’s life, health issues)
  • Pattern of communication – the way in which the partner’s attempt to address the problems in the relationship (e.g. withdrawing, making demands, controlling)

Each of these four elements contributes to the negative emotions in a distressed relationship.  As a result, each partner starts feeling increasingly stuck, desperate, and hopeless.  The more they attempt to fix the problem, the worse it seems to get.

It should be noted that as therapy progresses, the case formulation or narrative will often change to some degree.  This is typically the result of the couple developing a better understanding of the problems in their relationship.

Emotional acceptanceTherapists use specific strategies (see “techniques” below) to help couples develop and enhance their emotional acceptance of each other. 

Evocative rather than prescriptive – This feature of IBCT refers to the use of therapeutic interventions and techniques that evoke and address the underlying emotions and experiences each partner has in response to the problem, rather than using strategies that prescribe or impose rules, in order to bring about positive and lasting changes.

The IBCT Therapy Process

Integrative behavioral couples therapy follows a structured protocol as outlined in the therapist treatment manual written by Jacobson and Christensen.  There are two primary phases of the therapy process – the evaluation and feedback phase, and the active treatment phase.

Evaluation and Feedback (Sessions 1 – 4)

The focus of the initial three therapy sessions is to learn about and assess the couple’s relationship problems and develop a “functional analysis” or case formulation.  A functional analysis refers to the determining what function or functions each problem serves in the relationship.

An important distinction between IBCT and TBCT is that IBCT focuses more on the negative effect the problems are having on the relationship, whereas TBCT focuses primarily the frequency and extent of the problems.

In order to understand the problem and develop a formulation, the therapist meets with both partners together for the first session and then each partner individually for the second and third sessions.  The therapist asked targeted questions to determine:

  • The degree of distress the couple is experiencing
  • The key areas of disagreement, and why those areas are so divisive
  • How committed the couple is to resolving these issues and staying together
  • The strengths of the relationship (i.e. what things have kept them together this long)
  • In what ways does the couple hope therapy can help

As can be imagined, the initial session often includes some venting on the part of one or both partners.  If one partner isn’t particularly keen on going to therapy, it’s not uncommon for him or her to be fairly silent (and perhaps a bit sullen) while the other partner lists all the problems in the relationship.  At the end of the first session, many IBCT therapists give each partner questionnaires to be completed prior to (and reviewed in) their individual sessions.  They may also recommend that both partners read a self-help book (over the course of therapy) related to couples therapy or relationship dynamics in general.  One book that’s frequently recommended is Jacobson’s and Christensen’s book Reconcilable Differences.

The second and third sessions are individual sessions.  The therapist reviews the questionnaires and listen’s to each partner’s perspective on the problems in the relationship.  Of course, each partner gives a somewhat different version of the problems.  The individual sessions also give each partner the freedom to talk very openly and honestly about their concerns and frustrations, without worrying about hurting or angering the other partner.

Two things the therapist looks for in the individual sessions is how much the partner is contributing to the problems and to what degree – if any – the partner is taking responsibility for them.  In some cases, one or both partners will blame everything on the other partner or go to the opposite extreme and blame themselves for everything.

The individual sessions also give the therapist an opportunity to assess for more serious issues that may need to be addressed and resolved before proceeding with IBCT, such as an ongoing affair, severe psychopathology, an active substance disorder, or domestic violence (including the fear of therapy triggering violence within the relationship).

During the fourth session, the therapist meets with both partners together to provide feedback based on the information obtained from the first three meetings.  The therapist’s goal is to present his or her interpretation of the problems in a way that makes sense to the couple (including the prominent themes and the function the problems serve within the relationship).  Two of the goals of this feedback are to remove individual blame and set the stage for the active phase of treatment.  The couple is encourage to respond to the feedback by giving their thoughts on it, correcting any misperceptions on the part of the therapist, and adding any information they feel might be important.

Active Treatment Phase (Remaining Sessions)

Once the evaluation and feedback phase of treatment is completed, the couple can decide whether or not they want to continue with the active phase of treatment.  Not all couples choose to continue, as they may feel that this particular treatment approach or the therapist isn’t a good fit for them.  Also, if the therapist has discovered any contraindications for treatment, these would be discussed in the fourth session and appropriate recommendations (e.g. drug and alcohol rehab, etc.) would be made at this time rather than continuing with IBCT.

The active treatment phase typically spans several months of weekly joint session, although an occasion individual session may be scheduled if warranted.  This part of treatment focuses on significant recent incidents that triggered strong emotions.  These incidents can be positive or negative, and represent the prominent themes in the couple’s relationship.  Upcoming events related to the current issues may also need to be discussed during this phase.

During the active phase of treatment, the therapist will use specific techniques and strategies to help the couple resolve their issues, improve their communication, and learn healthier ways of interacting with each other.

Strategies and Techniques Used in IBCT

There are three main techniques used by IBCT therapists to encourage and enhance emotional acceptance in the couples they work with:

  • Empathic joining
  • Unified detachment
  • Tolerance building

Therapists also use classic behavioral techniques (which are used in TBCT) as well, including:

  • Behavior exchange
  • Communication and problem-solving skills training

Following is a brief look at each of these interventions:

Empathic joining involves helping couples establish a more empathic connection with regards to the problems that are damaging the relationship.  Therapists help partners see the underlying “softer” emotions – e.g. hurt, disappointment, and fear – that are often obscured by the surface behaviors and “harder” emotions – e.g. controlling behavior, distancing, anger, and blame. Therapy is meant to be a safe environment for both partners to open up and express their vulnerable side.  This helps each partner see the issues with more empathy and understanding, which enables them to interact with and respond to each other in more caring and constructive ways.

Unified detachment helps promote acceptance by helping each partner consider the issues from a more objective and less emotional perspective.  Removing the emotion makes it easier to identify and understand the triggers, context, and sequence of behaviors and events that contribute to their conflicts.

Tolerance building also helps increase emotional acceptance.  There are several therapeutic techniques used in tolerance building, including:

  • Enacting negative behaviors in a therapy session (and observe the impact); this helps partners understand that they can control the intensity of the behavior (e.g. if they can say something in a more hurtful way, they can also say it in a less hurtful way)
  • Identifying the positive (i.e. functional) aspects of a problem
  • Faking negative behavior (this allows each partner to observe the impact their behavior when they’re calm rather than emotional; in other words, they can see it from a more objective standpoint)
  • Increasing self-care (this increases independence and, as a result, helps decrease the demands each partner makes on the other)

Behavior exchange – This is based on the behavioral theory that all social behavior is the result of some sort of exchange; for couples, positive changes occur when they are rewarded in some way.

Communication and problem-solving skills training – Therapists work with the couple to help both partners develop more effective ways of communicating and solving their problems.

What to Expect

The standard protocol for IBCT consists of the 4 initial sessions for the evaluation and feedback phase of therapy, followed by another 20 to 22 sessions for the active phase of therapy.  Like most forms of psychotherapy, sessions usually last an hour and occur on a weekly basis.  As you progress in treatment, your therapist may space the sessions out to every other week or once a month.  Overall, treatment usually lasts for at least 6 months and may last as long as 12 months depending on the spacing of the last few sessions.

Benefits of IBCT

Distressed couples who never seek help for their problems often end up divorcing or going their separate ways.  Some are able to resolve their issues on their own, at least to some degree.  Others stay together, but ongoing, unresolved conflicts continue to damage the relationship in many ways.  One or both partners may find themselves feeling as if they’re living a life of quiet desperation. Not only do both individuals in the relationship suffer, but their children do as well.

Integrative behavioral couples therapy can help couples find satisfaction, fulfillment, joy, and harmony in their relationship once again.  Other benefits include:

  • Greater empathy and willingness to look at situations from the other person’s perspective
  • Improved communication skills
  • Decrease in blaming the other person for the problem’s in the relationship
  • Greater acceptance and tolerance of each other’s flaws and mistakes
  • Increased willingness to forgive each other
  • Improved problem-solving skills
  • Increased self-awareness and understanding
  • Increased awareness of the impact one’s actions or words has on the other person, and willingness to take responsibility for his or her role in conflicts when they arise
  • Greater willingness and ability to work together on issues
  • Stronger commitment to the relationship

Potential Disadvantages of IBCT

As with all therapies, IBCT has several potential disadvantages.  Most of these are inherent in couples therapy in general:

  • Therapy takes a lot of work on the part of both partners in the relationship
  • The process won’t be easy and may even be emotionally painful at some points along the way
  • As with other types of therapy, shedding light on the problems in the relationship and working on them can actually cause things to get worse before they get better
  • Both you and your partner are likely to say or reveal something in therapy that’s hurtful; for example, it may come out in therapy that one partner had been thinking about divorce due to the problems in the relationship.  Such a revelation can be devastating for the other partner.  Also, blaming each other (which isn’t uncommon in the initial session) can elicit some very painful emotions.
  • Therapy doesn’t guarantee a happy ending. Some couples still end up going their separate ways after treatment.  This can result in one or both partners feeling like a failure or regarding therapy as a waste of time (which sadly means it’s unlikely they’ll seek help in the future if / when their next relationship is in trouble).

Problems that Can Benefit from IBCT

Couples seek treatment for a wide range of relationship problems and challenges that can address with IBCT.   These include (but aren’t limited to):

  • Frequent or constant verbal fights
  • Growing apart / Distancing on the part of one or both partners
  • Control issues
  • Clash of values (e.g. handling money, having children, parenting methods, gender roles, religious beliefs)
  • Jealousy
  • Past infidelity
  • Communication problems
  • Disagreements about how to handle external problems that are taking a toll on the relationship, such as a work demands or in-laws
  • Intimacy issues
  • Disagreements regarding priorities
  • Feeling disrespected, neglected, or taken for granted by the other person

Potential Contraindications for IBCT

Unfortunately, not all couples are appropriate for integrative behavioral couples therapy.  Often, this is because there is a more pressing issue that’s impacting the relationship that must be addressed or resolved before entering into IBCT.  Contraindications include:

Current or recent domestic violence – If one partner doesn’t feel physically safe in the relationship, addressing other issues isn’t likely to be beneficial.  Additionally, domestic violence is often about intimidation and control.  When one partner resorts to this tactic as a way to control the other, the couple won’t be able to work together on issues as needed because of the severe imbalance of “power” in the relationship.  Domestic violence issues need to be addressed and resolved before working on other issues in a couple’s relationship.

Substance abuse and addiction – If one or both partners is actively abusing alcohol or drugs, couples therapy may need to be postponed until he or she has been clean and sober for a period of time, or at least actively working on recovery.

Severe mental illness – Severe forms of mental illness in either partner, such as current psychosis, mania, depression with active suicidal ideation, etc. may be a contraindication for IBCT.  If the partner who is ill is being treated for the issue (e.g. seeing a psychiatrist and taking medication) or the issue has been stabilized for some time (e.g. someone with schizophrenia or bipolar disorder whose symptoms have been stabilized with medication or other treatment) then IBCT may be considered.

Restraining order – If one partner has a restraining order against the other (which usually means the offending partner must maintain a certain distance from the other), it will be impossible to participate in couples therapy.  Once the restraining order is lifted or modified (e.g. to allow joint therapy sessions), IBCT may be considered.

Infidelity – The damage caused by a past affair is an appropriate problem to address in IBCT.  However, if one or both partners is currently cheating on the other, then IBCT isn’t going to be helpful.  Having an affair and trying to heal a relationship at the same time is futile. It’s like trying to fix a flat tire while you keep punching holes in it.

Finding an Integrative Behavioral Couples Therapist

One of the best ways to find a therapist who offers IBCT is via the search directory of the IBCT website. You may also be able to find a therapist by searching online for integrative behavioral couples therapy (or therapist) in your city.

Considerations Prior to Starting IBCT

Therapy is never easy, no matter what the issue that’s being addressed.  Integrative behavioral couples therapy, like any other couples therapy, will tap into particularly sensitive issues. Bringing painful relationship issues to the forefront and addressing them head on can be a difficult process for any couple.  Secrets, blame, and resentments that have been brewing for a long time inevitably surface at some point.  Of course, addressing these issues is necessary but the process can be rocky at times.  A skilled therapist will help you successfully navigate these landmines.

When entering into couples therapy, it’s imperative that both of you are willing to be open and honest – not only with the therapist, but with each other.  Putting on a façade or sweeping aside the real issues that are bothering you will only hinder the process.   Feelings of shame and guilt are normal, but keep in mind that the therapist’s role is to help you rather than pass judgment.

Expect some ups and downs along the way.  You and your partner may feel very optimistic and closer than ever following a particular good therapy session, only to find yourselves questioning everything a week later after a particularly challenging session. Remembering that therapy is a process, in which “one step forward, two steps back” is not uncommon, will help both of you during those temporary setbacks.

One of the most important things to remember about couples therapy is this:  Even if you and your partner ultimately decide to end the relationship, that doesn’t mean your time in therapy was a waste.  You’ll still have learned valuable things about yourself, and about relationship dynamics in general, that can greatly benefit your next relationship. The skills and insight you gained from therapy – such as being more empathetic and accepting – can also go a long way towards ensuring a more amicable breakup or divorce.

Integrative behavioral couples therapy can help you and your partner overcome the challenges you’re facing, bring healing to your relationship, and help you rekindle and even strengthen the love and joy that brought you together in the first place.

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