Integrative behavioral couples therapy
Encyclopedia
Behavioral marital therapy, sometimes called Behavioral couple, or couples, therapy, has its origins in behaviorism
and is a form of behavior therapy. The theory is rooted in social learning theory
and behavior analysis. As a model, it is constantly being revised as new research presents.
and was found to be effective for treating marital discord and depression in women. Parts of the behavioral couples therapy model, in particular strategic use of the communication skills to reinforce drug abstinence and open dialogue about treatment, were introduced as a method for getting drug abusing partners into treatment (see Community reinforcement and family training
).
Early research suggested that the components of behavioral marital therapy worked as predicted. The social exchange component led to increases in marital satisfaction in the short run. The communication training program led couples to communicate better and produced more long term changes in contingencies between couple members
Disillusionment with the traditional model began with a study in which it was found that only 50% of couples responded to the therapy In addition, traditional couple therapy did not produce more significant outcomes compared to insight-oriented couple therapy
.
Both the integrative and traditional behavioral couples therapy models have origins primarily in behaviorism
. While traditional behavioral couples therapy has more roots in social learning
principles and the later model in Skinnerian behaviorism. The latter model draws heavily on the use of functional analysis (psychology)
and the Skinnerian distinction between contingency shaped and rule governed behavior to balance acceptance and change in the relationship
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. 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.
Integrative behavioral couples therapy addresses topics such as intimacy in couples relationships and forgiveness in couples.
A growing number of researchers are interested in the concept of behavioral momentum
with couples. Couples seem to go through periods of ongoing improvement and other couples seem to go through periods of negative momentum. Theoretically, behaviorism has begun to focus more on romantic love
is in its infancy. One study, looked at 19 couples who had an affair. This study found that both traditional behavioral couples therapy and integrative behavioral couples therapy were effective in increasing intmacy after the affair was disclosed. The authors suggested that this is good news for couples. A greater reliance on behavioral conceptualizations of romantic love intimacy and forgiveness
may be helpful in easing the pain of such difficult situations.
(ABCT) has an annual conference where couple researchers and therapists can present their recent work in the field. The ABCT Couples Special Interest Group is part of ABCT and is composed of researchers whose focus is intimate relationships or clinicians whose focus is couple therapy.
The Association for Behavior Analysis
International (ABA:I) ABA:I has a special interest group in Behavioral Counseling which has many couples therapists. ABA:I has two conventions per year on in the U.S. and one Internationally. Couples researchers and therapists often present at these conferences.
The World Center for Behavior Analysis offers a certification in behavior therapy that covers Integrative Behavioral Couples Therapy http://worldcenterba.com/index.html
Behaviorism
Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...
and is a form of behavior therapy. The theory is rooted in social learning theory
Social learning theory
-Theory:Social learning theory is derived from the work of Albert Bandura which proposed that social learning occurred through four main stages of imitation:* close contact* imitation of superiors* understanding of concepts* role model behavior...
and behavior analysis. As a model, it is constantly being revised as new research presents.
History
Behavioral marital therapy started with simple research conducted on couples in the 1960s. Robert Weiss and Richard Stuart were the original authors of such research. In early 1970s Nathan Arzin published his concept of mutal reinforcement and reciprocity Azrin stated that (1) human behavior is maintained by reinforcement on the person who performed the behavior (2) people have a tendency to treat others as they are treated and (3) mutual reinforcement accounts at least partially for concepts like friendships, joy, and love. Neil Jacobson pioneered the behavioral marital therapy approach. He published a book with Gayla Margolin, which launched a social learning model of couples therapy. In this model of therapy, partners learn to be nicer to each other through behavioral exchange (contingency contracts), communicate better and improve their conflict-resolution skills. Early support came when Gottman found that as long as the ratio of positive to negative interactions remains at least five to one, the relationship is sturdy. When the ratio dips below there is a 94 percent chance that a couple will divorce. Other authors have found a role for exchanges as well Behavioral marital therapy model remains the most researched model of family therapyFamily therapy
Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
and was found to be effective for treating marital discord and depression in women. Parts of the behavioral couples therapy model, in particular strategic use of the communication skills to reinforce drug abstinence and open dialogue about treatment, were introduced as a method for getting drug abusing partners into treatment (see Community reinforcement and family training
Community reinforcement and family training
Community reinforcement approach and community reinforcement and family training approach are behavior therapy approaches to treating substance abuse.-Research:...
).
Early research suggested that the components of behavioral marital therapy worked as predicted. The social exchange component led to increases in marital satisfaction in the short run. The communication training program led couples to communicate better and produced more long term changes in contingencies between couple members
Disillusionment with the traditional model began with a study in which it was found that only 50% of couples responded to the therapy In addition, traditional couple therapy did not produce more significant outcomes compared to insight-oriented couple therapy
Development of Integrative Behavioral Couple Therapy
Integrative Behavioral Couple Therapy (IBCT) was developed by Neil S. Jacobson and Andrew Christensen. The model represents a return to contextualism, functional analysis and Skinner's distinction between contingency shaped and rule governed behavior. 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. It is considered a third generation behavior therapy or sometimes called clinical behavior analysisClinical behavior analysis
Clinical behavior analysis has its origins in applied behavior analysis and behavior therapy. It is sometimes referred to as third-generation behavior therapy.-Current models in clinical behavior analysis:...
.
Both the integrative and traditional behavioral couples therapy models have origins primarily in behaviorism
Behaviorism
Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...
. While traditional behavioral couples therapy has more roots in social learning
Social learning
Social learning may refer to:* Observational learning , learning that occurs as a function of observing, retaining and replicating behavior observed in ones environment or other people....
principles and the later model in Skinnerian behaviorism. The latter model draws heavily on the use of functional analysis (psychology)
Functional analysis (psychology)
Functional analysis in behavioral psychology is the application of the laws of operant conditioning to establish the relationships between stimuli and responses...
and the Skinnerian distinction between contingency shaped and rule governed behavior to balance acceptance and change in the relationship
Overview of IBCT
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 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. 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.
Topics Addressed
While traditional behavioral couples therapy focused heavily on change, integrative couples therapy attempted to balance change and acceptance. This is achieved through helping couples to better understand each others learning history and to produce more contingency shaped changes in session and less rule governed changes for the couple. This is accomplished through therapist interventions such as turning the problem into something that happens to the couple. Some of the current research suggests that contingency shaped behavior is easier to maintain then rule governed behavior for couples As to behavioral function, the greater the amount of escape /withdrawal behavior a couples members displays during demand situations the higher the amount of distress.Integrative behavioral couples therapy addresses topics such as intimacy in couples relationships and forgiveness in couples.
A growing number of researchers are interested in the concept of behavioral momentum
Behavioral momentum
Behavioral momentum is a theory in quantitative analysis of behavior and is a comparative metaphor based on physical momentum. It describes the general relation between resistance to change and the rate of reinforcement obtained in a given situation.B.F...
with couples. Couples seem to go through periods of ongoing improvement and other couples seem to go through periods of negative momentum. Theoretically, behaviorism has begun to focus more on romantic love
Research on the efficacy of IBCT compared to Traditional Behavioral Couple Therapy
Integrative behavioral couples therapy seems to work slower in producing change initially but has led to a 71% improvement rate in couples. In addition, Integrative behavioral couples therapy does not produce as much change as traditional behavioral couples therapy but it does produce more acceptance. At two years 69% of the Integrative behavioral couples therapy group appears to be doing better, while only 60% of the traditional group does better, while martial satisfaction was also in greater favor for the integrative behavioral couples therapy group However, the traditional behavioral couples therapy group had a larger decline in negativity toward each other than did the integrative behavioral couples therapy groupWorking with couples after an affair Traditional Behavioral Couples Therapy vs. Integrative Behavioral Couples Therapy
Overall the state of the research of couples being treated specifically for martial infidelityInfidelity
In many intimate relationships in many cultures there is usually an express or implied expectation of exclusivity, especially in sexual matters. Infidelity most commonly refers to a breach of the expectation of sexual exclusivity.Infidelity can occur in relation to physical intimacy and/or...
is in its infancy. One study, looked at 19 couples who had an affair. This study found that both traditional behavioral couples therapy and integrative behavioral couples therapy were effective in increasing intmacy after the affair was disclosed. The authors suggested that this is good news for couples. A greater reliance on behavioral conceptualizations of romantic love intimacy and forgiveness
Forgiveness
Forgiveness is typically defined as the process of concluding resentment, indignation or anger as a result of a perceived offense, difference or mistake, or ceasing to demand punishment or restitution. The Oxford English Dictionary defines forgiveness as 'to grant free pardon and to give up all...
may be helpful in easing the pain of such difficult situations.
Behavioral Assessment of Couples
Behavior analysis uses direct observation to determine the areas for interventionProfessional Organizations
The Association for Behavioral and Cognitive TherapiesAssociation for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, nurses, and other mental-health practitioners, researchers, and students who...
(ABCT) has an annual conference where couple researchers and therapists can present their recent work in the field. The ABCT Couples Special Interest Group is part of ABCT and is composed of researchers whose focus is intimate relationships or clinicians whose focus is couple therapy.
The Association for Behavior Analysis
Association for Behavior Analysis
The Association for Behavior Analysis International is a nonprofit professional membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and...
International (ABA:I) ABA:I has a special interest group in Behavioral Counseling which has many couples therapists. ABA:I has two conventions per year on in the U.S. and one Internationally. Couples researchers and therapists often present at these conferences.
The World Center for Behavior Analysis offers a certification in behavior therapy that covers Integrative Behavioral Couples Therapy http://worldcenterba.com/index.html