Integrative Behavioral Couple Therapy An Acceptance-Based, Promising New Treatment for Couple Discord Neil S. Jacobson Department of Psychology University of Washington Andrew Christensen Department of Psychology University of California, Los Angeles Stacey E. Prince Department of Psychology University of Washington James Cordova Department of Psychology University of Washington Kathleen Eldridge Department of Psychology University of California, Los Angeles ABSTRACT Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord. James Cordova is now at the Department of Psychology, University of Illinois at Urbana—Champaign. After the completion of this article, but prior to its revision, Neil S. Jacobson died suddenly and unexpectedly. His untimely departure is a major loss not only for his family and friends but also for the field of marital therapy, to which he contributed so much. This research project was supported by Grant 5 R01 MH499593-02 from the National Institute of Mental Health. We thank Steve Clancy, Peter Fehrenbach, Joan Fiore, Susan Price, and Debra Wilk, who served as therapists for this project. Correspondence may be addressed to Andrew Christensen, Department of Psychology, University of California, Los Angeles, California, 90095. Electronic mail may be sent to [email protected] Received: February 2, 1999 Revised: September 12, 1999 Accepted: September 17, 1999 Traditional behavioral couple therapy (TBCT; also known as behavioral marital therapy) has been the Journal of Consulting and Clinical Psychology © 2000 by the American Psychological Association April 2000 Vol. 68, No. 2, 351-355 For personal use only--not for distribution. Page 1 of 811/27/2000http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.htmlmost widely studied approach to treating marital distress, and its efficacy has been repeatedly demonstrated in over 20 randomized clinical trials ( Baucom, Shoham, Meuser, Daiuto, & Stickle, 1998 ; Christensen & Heavey, 1999 ; Jacobson & Addis, 1993 ). Several of these clinical trials were conducted by Jacobson and colleagues using the version of TBCT summarized by Jacobson and Margolin (1979) . In an analysis of the clinical significance of various treatment approaches, Jacobson's version of TBCT yielded higher rates of success than the others examined ( Jacobson et al., 1984 ). This is not to say that TBCT is the only effective approach to couple therapy. In fact, as Baucom et al. (1998) have documented, other treatments, such as emotionally focused couple therapy ( Greenberg & Johnson, 1988 ), have shown promise. But TBCT is the only couple therapy to receive the highest designation as an "efficacious and specific intervention" ( Baucom et al., 1998 , p. 58). At the same time, these studies have also revealed significant limitations in both the clinical significance and the durability of TBCT. First, at least one third of the couples studied in randomized clinical trials of TBCT are clear-cut treatment failures, remaining in the maritally distressed range at the conclusion of therapy ( Jacobson & Addis, 1993 ). Second, even among those couples who improve, many do not maintain their improvement over a 2-year period ( Jacobson, Schmaling, & Holtzworth-Munroe, 1987 ). The purpose of the present study was to provide preliminary data on a new approach to treating marital distress, integrative behavioral couple therapy (IBCT), which was developed by Andrew Christensen and Neil S. Jacobson ( Christensen, Jacobson, & Babcock, 1995 ; Jacobson & Christensen, 1996 ). Whereas TBCT focuses on helping spouses "change" in light of their partners' complaints and requires active collaboration and compromise between partners, IBCT includes strategies to help spouses accept aspects of their partners that were previously considered unacceptable. However, despite the label, the purpose of "acceptance work" is not to promote resignation to the relationship as it is or mere acceptance. Rather, it is designed to help couples use their unsolvable problems as vehicles to establish greater closeness and intimacy. For couples who have difficulty changing their behavior, acceptance provides a viable alternative for building a closer relationship. For couples who do benefit from the traditional approach, IBCT can facilitate further progress by providing an alternative way to establish a closer relationship, given that there are problems in every relationship that are impervious to change. Paradoxically, acceptance interventions are also predicted to produce change in addition to acceptance, often more efficiently than the direct change inducing strategies that constitute TBCT, because at times the pressure to change may be the very factor that prevents it from occurring. Method Participating Couples and Therapists Participants in this study were 21 couples requesting therapy for marital distress. To be eligible for the study, couples had to be legally married and living together and both spouses had to be between 21 and 60 years old. In addition, each was required to score above 58 on the Global Distress Scale (GDS) of the Marital Satisfaction Inventory (MSI; Snyder, 1979 ), indicating clinically significant levels of marital distress. Couples were excluded if either spouse was in some concurrent form of psychotherapy ( n = 8), taking psychotropic medication ( n = 8), alcohol dependent ( n = 2), engaging in moderate to severe domestic violence within the past year ( n = 2, using criteria from Jacobson, Gottman, Waltz, Babcock, & Holtzworth-Munroe, 1994 ), or if the sole presenting complaint was
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