Integrative Behavioral Couple Therapy

Integrative Behavioral Couple Therapy (IBCT), developed by Andrew Christensen and Neil S. Jacobson, is part of what Steve Hayes has called the third wave of behavior therapy. The first wave of behavioral approaches, derived from operant and classical conditioning, sought to create change directly by altering observable antecedent or consequent stimuli such as rewarding desirable behavior. The second wave, coming on the heels of the [Page 863]cognitive revolution in psychology, emphasized interpretations of behavior in addition to the overt behavior. The third wave emphasizes acceptance, mindful awareness, and direct experience. Rather than trying to control internal negative experiences, third-wave approaches emphasize greater awareness of those experiences, direct exposure to them, and acceptance of them. This entry reviews IBCT and applies its central concepts to interpersonal relationships.

IBCT begins with an evaluation or assessment phase that normally consists of three sessions—a joint session with both partners and an individual session with each partner in which the couple's presenting problems, a brief history of their relationship, and a brief history of each partner's family background are obtained. Following this evaluation period is a feedback session, in which IBCT therapists provide the couple with an overview of their understanding of the couple and recommendations for treatment. The key feature of this feedback is a dyadic conceptualization of the couple's difficulties, emphasizing the key interaction cycles in which the couple gets stuck and the differences between partners and their individual vulnerabilities that fuel this cycle. For example, partners may be locked in a cyclical pattern of demand-withdraw interaction, in which one partner seeks discussion of the relationship while the other avoids those discussions. The “demander” may seek greater closeness in the relationship, fueled in part by a fear of abandonment by the other, whereas the “withdrawer” seeks greater autonomy, fueled in part by a fear of being controlled.

In the research protocol for IBCT, the feedback session is followed by about 20 sessions, typically once a week, of active treatment intervention. These treatment sessions normally involve both members of the couple and are directed at emotionally salient events and issues in the couple's relationships, such as recent examples of their interaction cycle. In the previous example, the therapist and couple might address recent incidents of the demand-withdraw pattern between the couple as they dealt with a situation in which the demander wanted more closeness or the with-drawer was seeking greater independence.

In IBCT, there are three major strategies designed to foster greater awareness and emotional acceptance between partners—empathic joining, unified detachment, and tolerance building—and three major strategies for fostering deliberate change in partners—behavioral exchange, communication training, and problem-solving training. To promote empathic joining, IBCT therapists try to create a safe environment in which they can elicit partners' unexpressed, or rarely expressed, vulnerable emotional reactions. These reactions may in turn elicit more sympathetic responding by the partner. To promote the joint mindfulness of unified detachment, IBCT therapists have partners step back from their interactions and look at them more objectively, engaging the couple in a joint effort to describe nonjudgmentally the major moves that each partner makes that serve as triggers for the behavior of the other. Partners may have difficulty being empathic with one another or taking a nonjudgmental approach to the other's behavior, but the IBCT therapist maintains a consistent nonjudgmental and empathic approach to both. A variety of strategies are incorporated in tolerance building, such as a discussion of the positive and negative consequences of each partner's characteristics that are upsetting to the other. During behavioral exchange, partners are encouraged to define specific actions each could take that would better the relationship and are encouraged to engage in those behaviors, and the impact is then debriefed. Communication training involves active instruction and practice in speaker skills, such as nonblaming description of problems, and listener skills, such as active listening strategies of paraphrasing and reflection. During problem-solving training, partners are given instruction and practice in defining problems, brainstorming potential solutions, and negotiating agreements. Typically in IBCT, the strategies for promoting emotional acceptance are initiated prior to the strategies for fostering direct change. Often the strategies for promoting emotional acceptance provide the necessary improvement for the couple. As couples near the end of their treatment, sessions may be spaced at greater lengths such as every 2 to 4 weeks to see how couples manage without regular contact with the therapist. A final session involves a review of treatment progress, often centered around the formulation provided in the feedback session.

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