Integrative Behavioral Couple Therapy (IBCT) is a relatively new approach to couple therapy that was developed by Andrew Christensen, a clinical psychologist and professor at the University of California, Los Angeles (UCLA), and the late Neil S. Jacobson, who was a clinical psychologist and professor at the University of Washington. IBCT has garnered promising scientific support and has been the focus of a major clinical trial on the outcome of couple therapy, sponsored by the National Institute of Mental Health and conducted at UCLA and the University of Washington.
Integrative Behavioral Couple Therapy is "integrative" in at least two senses: First, it integrates the twin goals of acceptance and change as positive outcomes for couples in therapy. Couples who succeed in therapy usually make some concrete changes to accommodate the needs of the other but they also show greater emotional acceptance of the other. Second, IBCT integrates a variety of treatment strategies under a consistent behavioral theoretical framework.
IBCT consists of two major phases, an evaluation/feedback phase and an active treatment phase. The first three sessions consist of an evaluation period where the therapist learns about the concerns of the couple. In the first session, the therapist usually sees both partners together, learns what brings the couple to therapy, and obtains a brief history of their relationship. The therapist may suggest couples read a self-help book during treatment that serves as a guideline for IBCT therapy: Reconcilable Differences by Andrew Christensen and Neil S. Jacobson (New York: Guilford Press)*. Also during this first session, the therapist normally gives each partner some questionnaires to complete and bring to their individual sessions, which are the next two sessions. In these individual sessions, the therapist explores each partner's relationship concerns and individual history. In the fourth session, the therapist sees both partners together for the "feedback session." 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.
After the feedback session, the couple can make an informed decision about whether the therapist and treatment seem right for them. Assuming they decide positively, then the active phase of treatment begins. Sessions at this point are almost always done jointly, with both members of the couple and the therapist. The focus is often on important recent incidents, positive or negative, that reflect their major theme or themes. 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. Upcoming incidents related to a couple's theme, such as a difficult, upcoming decision that the couple must make, and broader issues related to a couple's theme, such as how partners in a couple who struggles to achieve emotional intimacy react when their feelings are hurt, are also a focus of discussion. In these discussions, the therapist is often quite active, helping the partners communicate more openly, directly, and clearly, helping them identify the patterns that get them stuck, and assisting them in finding alternative ways of interacting.
The standard protocol for IBCT therapy is described in a treatment manual written for therapists: Acceptance and Change in Couple Therapy by Neil S. Jacobson and Andrew Christensen (New York: Norton). This standard protocol has been used in research on IBCT and includes 4 sessions for the assessment/feedback phase and an additional 20-22 sessions of active treatment. Typically sessions are conducted every week and last just short of an hour. Toward the end of therapy, sessions are often spaced more widely (e.g., every other week or longer). Thus, the typical course of therapy lasts between 6 and 12 months. The latest research on IBCT suggests that among couples chosen for therapy because they had serious and chronic distress, over two thirds of couples remain together and show significant clinical improvement at the end of therapy as well as two years after the end of therapy. Information about this research and other research documenting the effectiveness of Integrative Behavioral Couple Therapy can be found on the resources page.
With support from federal grants, Brian Doss of the University of Miami and Andrew Christensen of UCLA adapted IBCT to an online program for couples, called OurRelationship. Each partner works individually as well as together through the program. A nationwide clinical trial showed that the program has a significant positive impact on the individual partners and their relationship.