NJ-ACT - Andrew Christensen

Andrew Christensen Presents His

Integrated Behavioral Couple Therapy (IBCT)

By Milton Spett

Andrew Christensen and Neil Jacobsen’s IBCT integrates traditional couple change techniques with their new emotional acceptance techniques. In his 2009 Master Lecture for NJ-ACT, Dr. Christensen discussed the following components of IBCT:

A. The Primary Conflictual Theme. Traditional behavioral couple therapy asks each couple patient to change the behavior that distresses their partner. But IBCT identifies and attempts to change the long-standing patterns of distressing but functionally similar behaviors.

For example, a primary conflictual theme may be: Mary feels unloved and Joseph feels suffocated. Mary may become distressed by a wide variety of Joseph’s behavior that triggers her feelings of being unloved: coming home late, spending time with his same-sex friends, watching ball games on TV. And Joseph may feel suffocated by Mary’s demands (Or were they really “requests”?) for more time together. Rather than negotiate each of these behaviors, IBCT identifies the repetitive pattern, the “primary conflictual theme,” and teaches Mary and Joe how to resolve their suffocation/feeling unloved conflict.

Agreement on the primary conflictual theme helps to develop a “collaborative set,” an agreement that the problem is the way each partner relates to the other. The problem is not the behavior of just one partner.

B. Emotional Acceptance. If Mary feels unloved when Joseph comes home late, there are two ways to resolve this conflict. Joe can come home earlier (or call when he will be late), or Mary can stop feeling unloved, she can learn to emotionally accept Joe’s coming home late. Dr. Christensen presented three emotional acceptance techniques:

1. Empathic joining. Mary and Joseph each explain the emotions that underlie the conflict. For example, Joseph may reveal his fear of getting fired if he does not work late, and Mary may reveal her fear of abandonment after her father left her and her mother. In addition, the IBCT therapist reformulates couple conflicts as differences. Joseph’s tendency to be late is not “bad,” it is “different” than Mary’s emphasis on being on time.

2. Unified detachment. Mary and Joseph describe one of their conflicts in an unemotional, intellectual, neutral manner, as if they were describing some mechanical series of events. No blaming or criticizing is allowed.

3. Tolerance building. One strategy for tolerance building is to describe the positive aspects of Joseph’s behavior that upsets Mary. For example, his long hours at the office means she can rely on him to provide material comforts. Also, Joe can intentionally perform the behavior that upsets Mary as an exposure exercise to help Mary habituate to that behavior. In addition, when Joe exhibits the distressing behavior, Mary can remind herself of his positive qualities, possibly mitigating her upset over his negative qualities. Finally, Mary can be more tolerant if she understands how Joe’s earlier interpersonal experiences and current emotional vulnerabilities motivate the behavior she finds distressing

C. “Softer” Emotions. In his presentation to NJ-ACT, Dr. Christensen gave increased emphasis to the IBCT goal of helping patients to experience and express their softer emotions. “Softer” emotions include hurt, vulnerability, fear, and disappointment -- emotions that often underlie the surface anger. When couple patients express anger at their partner’s behavior, the IBCT therapist asks increasingly directive questions to uncover the patient’s softer emotions:

1. “How do you feel when Joe is late?” Mary: “I feel angry.”

2. “What else do you feel?” Mary: “I feel resentment.” (Wrong answer)

3. “I wonder if you also feel abandoned.” Mary (we hope): “I guess I do feel abandoned.”

D. The Fundamental Attribution Error. Social psychological research has found that people tend to attribute behavior, especially the behavior of others, to the other’s disposition, while they are more likely to attribute their own behavior to the situation. In other words “My partner did something that upset me because she is bad in that way.” But “I did something that upset her because the situation required me to do it.”

E. Traditional Couple Change Techniques. IBCT integrates the techniques discussed above with traditional couple change techniques such as increasing positive behaviors, communication training, and negotiation and problem resolution skills. IBCT explores each partners’ difficulties in making behavioral changes; asks what couple patients can do to help their partners make the requested changes; and searches for behavioral changes that are acceptable to the partner making the change.

Outcome research done by IBCT therapists has found that in the initial couple sessions, traditional couple therapy patients improve more than IBCT patients. But in later sessions IBCT couples continue to make progress while traditional behavioral couple therapy patients stagnate. At the conclusion of therapy and two years post-treatment, IBCT patients are about 10% more likely to show clinically significant improvement compared to traditional couple therapy patients.