Integrative Behavioral Couple Therapy: Where Acceptance is Key“There are two sides to every story.” This timeless saying couldn’t be truer when it comes to conflict in a relationship.

In fact, it’s how couples therapists Andrew Christensen, Ph.D, and the late Neil Jacobson, Ph.D, start off their 2002 book Reconcilable Differences. Well, actually, they share a third side: their objective take on a couple, which usually includes some truth from both stories.

In the late 1990s, Christensen and Jacobson developed a type of couples therapy called integrative behavioral couple therapy (IBCT), which combines techniques from behavioral couples therapy with new strategies to cultivate acceptance.

Recently, Christensen, a professor of psychology at UCLA, and colleagues (2010) published their findings from a five-year study that compared the efficacy of IBCT to traditional behavioral couples therapy (TBCT). Impressively, this was the most comprehensive couples study to date and the largest evaluating couples therapy.

IBCT helps couples gain a better understanding of each other’s emotions. As the authors explained in their study:

IBCT assumes that relationship problems result not just from the egregious actions and inactions of partners but also in their emotional reactivity to those behaviors. Therefore, IBCT focuses on the emotional context between partners and strives to achieve greater acceptance and intimacy between partners as well as make deliberate changes in target problems.

But acceptance is still at the foundation, which is a plus for change, as Christensen and Jacobson write in their book:

… When acceptance comes first, it paves the way for change. When you and your partner experience greater acceptance from each other, your resistance to change often dissolves. You may be more open to adapting to each other and accommodating in ways that reduce conflict. You may be able to communicate more clearly and negotiate and problem-solve more effectively since you are no longer adversaries.

It’s this focus on acceptance that distinguishes IBCT from TBCT. TBCT helps couples make positive changes, learn how to communicate and problem-solve. But according to Christensen and colleagues (2010):

IBCT was developed, in part, to address concerns about long-term maintenance of gains (Jacobson & Christensen, 1998) through a focus on emotional acceptance and an emphasis on natural contingencies. For example, rather than teaching couples the “right way” to communicate and reinforcing that communication, as in TBCT, IBCT therapists process partners’ reactions to each other’s communication, letting those responses (natural contingencies) shape each other’s behavior.

A Closer Look at IBCT

IBCT consists of two phases: evaluation and treatment. In the evaluation phase, the therapist meets with the couple for the first time to talk about why they’re there, next individually with each partner and then together to provide feedback and their perspective of the concerns and goals. The couple decides whether they’d like to continue with therapy. Here’s how this session tends to work, according to the IBCT website:

The therapist may gather some final information in the beginning of the session, but most of the session is devoted to feedback from the therapist, in which he or she describes the couple’s difficulties and strengths and how therapy will try to assist the couple. A major part of the feedback session is the therapist’s formulation of the couple’s problems, a conceptualization of the major themes in the couple’s struggles, the understandable reasons why the couple has these struggles, how their efforts to resolve the struggles so often fail, and how therapy can help. The couple actively participates in this feedback, giving their reactions, adding information, and correcting the therapist’s impressions as needed.

If the couple agrees to work with the therapist, they move to the treatment phase, which focuses on exploring both positive and negative current issues that are part of a bigger pattern in their relationship. A few examples from the website:

For example, if a major theme concerned partners’ difficulties in achieving emotional intimacy, the couple might discuss a recent incident in which they were able to achieve a sense of closeness with each other or an incident in which one or both reached out to the other but felt rebuffed. Similarly, if a major theme involved frequent struggles over decision-making, they might discuss a recent incident where they were able to reach agreement on a matter or an incident where they got into a negative, escalating conflict about an issue on which they disagreed.

Couples also explore how their past has shaped their present behavior. For instance, one partner regularly doesn’t call the other to update them on their plans. Their discomfort with calling actually dates back to feeling suffocated when their overbearing family demanded to always know where they were. Another partner hates bringing up any potential disagreement because they grew up in a non-confrontational family where any conflict was seen as bad and swept under the rug.

Therapy typically lasts from six months to a year with 26 sessions. (Research shows that 26 sessions, including the evaluation phase, helps most couples.)

Christensen and Jacobson laid out the protocol for IBCT for therapists in their 1998 book Acceptance and Change in Couple Therapy: A Therapist’s Guide to Transforming Relationships.

The Long-Term Study

Published in the April 2010 issue of the Journal of Consulting and Clinical Psychology, the five-year study followed 134 chronically and seriously distressed couples from Los Angeles and Seattle. Interestingly, the researchers turned away nearly 100 couples because they weren’t essentially unhappy enough. They wanted to test IBCT on the most distressed couples.

Partners were typically in their early 40s, and 68 couples had children. Couples were randomly assigned to either the traditional therapy condition or IBCT. The IBCT couples also read Christensen and Jacobson’s Reconcilable Differences. Couples were stratified based on their distress (66 couples were moderately distressed; 68 were severely distressed).

Both groups received up to 26 sessions. Researchers assessed each couple’s status and their marital satisfaction about every three months during therapy and every six months for five years after therapy.

Immediately after completing therapy, both groups showed the same marital satisfaction. (Researchers ascertained marital satisfaction with a measure that asks about a couple’s degree of consensus on important issues, tension in the relationship, affection and activities and interests shared by the couple.) Overall, almost two-thirds of couples improved.

At two-year follow-up, IBCT was significantly superior to traditional therapy but the difference wasn’t dramatic. At five years, these differences dissolved.

The reason differences vanished? According to an article in APA’s Monitor on Psychology, which interviewed Christensen:

Christensen attributes this decline in IBCT’s impact to a lack of booster sessions, which would be given in the real world when couples report a crisis or find themselves slipping back into old ways. The researchers deliberately did not build in such sessions, he says, because adding them would have overly complicated the research design.

Also, at the five-year follow-up, half of the couples still showed significant improvements, and about one-forth separated or divorced.

Taking IBCT Online

In the near future, IBCT won’t only be offered at a therapist’s office. Christensen and psychologist Brian Doss, Ph.D, a professor at the University of Miami, received a five-year grant from the National Institute of Child Health and Human Development to adapt IBCT into an Internet-based program for couples and to test its effectiveness.