An Introduction to Integrative Behavioral Couple Therapy (IBTC)

Woood couple Graphics courtesy of Bliss TherapyOpens in new window

All couples disagree about money, household chores, and parenting styles over the course of their relationships; however, not all couples become severely and stably distressed as a result of these disagreements.

Integrative behavioral couple therapy (IBCT) is an empirically validated approach that integrates the twin goals of acceptance and change as positive outcomes for couples in therapy.

Within integrative behavioral couple therapy (IBCT), we conceptualize the primary source of dysfunction in terms of how conflicts unfold in the relationship (the couple’s dynamic), as opposed to the content of the conflicts themselves. If a couple develops a maladaptive or dysfunctional dynamic, over time it can become so entrenched that it is activated regardless of the seriousness of the disagreement (e.g., what movie to watch versus whether to have children) and, eventually, regardless of the nature of the interaction itself (e.g., a disagreement, supportive discussions, telling each other about your day).

Once a dysfunctional dynamic generalizes in these ways, each partner’s behaviors in the dynamic become increasingly extreme and, each time the dynamic is activated, the pattern escalates more quickly.

Typically, by the time a couple seeks couple therapyOpens in new window, they have become quite polarized in their views of their relationship problems and in the behaviors they exhibit when their dynamic is triggered. A key element of IBCT is to understand why topics of disagreement are causing problems and distress for a given couple. Rather than focusing on specific problematic behaviors reported by each partner, we develop a contextual understanding of these behaviors that occur in a given interaction, as well as the environmental events triggering (antecedents) and reinforcing (consequences) problematic behaviors.

Through this functional analysis, we begin to conceptualize their distress within a broad formulation comprising three key elements: themes, a dynamic process of polarization, and mutual traps. The relationship theme (e.g., respect and acceptance, closeness and distance, power and control) refers to the nature of the incompatibilities between partners that underlie seemingly disparate areas of disagreement (household chores vs. demonstrations of affection).

These recurring themes can trigger a polarization process, characterized by dysfunctional interpersonal dynamics (e.g., a demand-withdraw dynamic). Over time, these dysfunctional patterns often result in a mutual trap, wherein the couple has been unable to successfully address their incompatibilities and, consequently, they feel trapped in this dynamic, disconnected from each other, and dissatisfied with the relationship.

Not surprisingly, the IBCT therapist’s formulation of the couple’s relationship typically differs markedly from either partner’s perspective at the beginning of couple therapy. Thus a primary therapeutic goal is to help couples reformuate their conceptualization of their problems and sources of distress in a way that facilitates change. The hope is that, over time, they begin to realize that all couples disagree from time to time and that, ultimately, the topics of disagreement are not the sources of their distress, rather, the problem lies in the polarization that has developed and the ensuing feelings of entrapment and helplessness.

The IBCT therapist helps the couple understand and recognize the problematic interpersonal dynamic that has developed over time and the underlying themes that typically trigger this dynamic.

Through this ongoing conversation based on the therapist’s reformulation, the couple may begin to recognize that the dysfunctional relationship dynamic is the primary source of distress, whereas differences of opinion are natural and not intrinsically problematic.

To the extent that each partner can begin to foster empathy and compassion for one another and move toward accepting their differences, they can begin to build a closer, more intimate relationship because of their differences, rather than in spite of them.

When this occurs, partners’ emotional reactions to each other begin to change, which in turn facilitates a shift in their interpersonal dynamic and, ultimately, promotes increased relationship satisfaction.

In IBCT the primary focus is on promoting emotional acceptance, and four therapeutic techniques are used in service of this goal.

  1. Empathic joining around a problem is designed to increase empathy for one’s partner’s perspective and to facilitate expressions of more vulnerable, underlying, “true” emotions during conflict. Techniques include helping each partner move from expressing hard emotions and experiences (e.g., anger, defensiveness, resentment) to soft ones (e.g., hurt, sadness, fear), and encouraging the use of nonblaming language when discussing areas of conflict.
  1. Unified detachment is designed to facilitate discussions of conflict in an objective, intellectual way rather than repeating the automatic emotional reactions and dysfunctional dynamics that normally occur during those discussions. Techniques include talking about the dynamic as a separate entity or an “it” in the room and using humor and metaphors to capture themes or dynamics (e.g., the North-Going Zax and the South-Going Zax).
  2. Tolerance building is designed to reduce each partner’s emotional reactions to the other’s aversive behavior. Strategies include having couples have of changing the other’s aversive behavior. Strategies include having couples role-play conflicts within and outside of the therapy room, and having them “fake” aversive behaviors at home to observe the impact of these behaviors on their partner.
  3. Finally, self-care strategies are intended to not only increase a given partner’s individual functioning but also to shift the focus from wanting one’s partner to change to the need to take care of oneself. Techniques include encouraging pursuit of individual interests and increasing one’s social support network.

Ideally, by employing emotional acceptance strategies, spontaneous change will begin to occur such that the couple experiences a shift in their dynamic, the themes become less central to their relationship, and they begin to develop great intimacy and satisfaction.

When spontaneous change does not occur, the therapist then implements traditional behavioral techniques to promote therapeutic change. For example, behavior exchange techniques such as promoting small, concrete, positive behaviors outside of the therapy room typically result in small, temporary increases in relationship satisfaction.

Communication skillsOpens in new window and problem-solving skillsOpens in new window training can also be useful components of therapy. Indeed, in some cases, couples require training in these basic behavioral skills before they can effectively engage in discussions aimed at promoting emotional acceptance.

During an IBCT therapy session, couples engage in one of four types of discussions, which is determined by the couple based on what is most salient to them at the beginning of each session.

Types of discussions include a recent negative interaction, a recent positive interaction, an upcoming event that the couple anticipates will lead to conflict, or a general discussion of relationship dynamics and themes. When appropriate, homework may be assigned (e.g., for tolerance building or self-care techniques), and couples wanting to take a more proactive role outside of the therapy room can work from the book Reconcilable Differences (Christensen & Jacobson, 2000), a book written for couples from an IBCT perspective.

A typical course of therapy includes four phases. During the assessment phase, we meet with a copule conjointly for two to three sessions, meet with each partner individually for one session, and have each partner complete a series of questionnaires.

We evaluate each partner’s level of distress, how committed each partner is to the relationship and to couple therapy, common areas of conflict, why conflict is a recurring problem for the couple (i.e., themes and dynamics), individual and relationship strengths (the “glue” holding the couple together), and whether IBCT is appropriate for the couple.

Next we conduct a feedback session during which we summarize information from the assessment phase in a collaborative manner, adjusting our overall case formulation based on feedback from the couple.

The third phase typically consists of 20 to 25 therapy sessions, during which we pursue the therapy goals agreed upon during the feedback session. The final termination phase consists of two to three sessions, during which we discuss the couple’s progress to date and anticipate future setback or challenges. Typically, all sessions are conjoint except for the individual session during the assessment phase.

Other individuals (e.g., family members) are not included (unless we are transitioning from couple therapy to family therapy). However, we have occasionally conducted one or two additional individual sessions when we believed it to be necessary and appropriate (e.g., when a partner seems to be holding some critical information back in conjoint sessions that is impeding progress).

If we do meet with a partner individually, we first set up ground rules with both partners and ensure that they are both comfortable with the idea of an individual session. We also clarify that the content of the individual session will be shared with the partner during the ext conjoint session. Furthermore, we never have more than one individual session in a row.

The primary role of an IBCT therapist is to facilitate productive discussions about areas of disagreement through actively monitoring and guiding interactions. We are active participants in the discussions, particularly during the early stages of treatment when couples are still exhibiting their dysfunctional dynamic.

We help guide couples to reformulate their relationship problems in terms of interpersonal dynamics and promote emotional acceptance of differences by implementing the previously reviewed therapeutic techniques. Essentially, it is our job as therapists to create a safe environment for our clients to express their differing views, to understand their partner’s perspectives, and to foster acceptance of their differences.

It is also our responsibility as IBCT therapists to model validation, nonconfrontation, compassion, empathy, and acceptance in order to help promote these behaviors in our clients.

See also:
  1. Tremblay, G. C., & Philips, M. (2009). Child, family and couples therapy. In D.C.S. Richard & S.K. Huprich (Eds.), Clinical psychology: Asessement, treatment, and research (pp 329 – 349). San Francisco: Elsevier.
  2. Byrne, M., Carr, A., & Clark, M. (2004). The efficacy of behavioral couples therapy and emotionally focused therapy for couple distress. Contemporary Family Therapy, 26, 361 – 387.
  3. Greenburg, L.S., & Johnson, S.M. (1988). Emotionally focused therapy for couples. New York: Guilford.
  4. Jacobson, N.S., & Addis, M.E. (1993). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consultign and Clinical Psychology, 61, 85 – 93.
  5. Johnson, S., & Lebow, J. (2000). The “coming of age” of couple therapy: A decade review. Journal of Marital and Family Therapy, 26, 23 – 38.