Andrew Christensen

Traditional Versus Integrative Behavioral Couple Therapy for Significantly and Chronically Distressed Married Couples

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.

Integrative behavioral couple therapy: An acceptance-based, promising new treatment for couple discord.

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.

Why Do Couples Seek Marital Therapy

If therapists know why couples seek marital therapy, they can more effectively tailor their therapies to improve treatment outcome. Unfortunately, there have been no systematic studies to date on couples reasons for seeking therapy. In a survey of 147 married couples seeking marital therapy, the most commonly reported reasons were problematic communication and lack of emotional affection. Within individual couples, spouses showed little agreement on their reasons for therapy, suggesting that careful and individual assessments should be made of each spouse. There was only partial overlap of couples reasons for seeking therapy, questionnaires of relationship problems, and previous studies of therapists reports of couples problems, indicating that traditional methods of assessment may not fully capture why couples are seeking therapy.

Common principles of couple therapy.

The similarity in efficacy of evidence-based couple therapies suggests that it may be useful to identify those treatment principles they hold in common. Expanding on the previous description of a unified protocol for couple therapy (Christensen, 2010), this article outlines five common principles: (a) altering the couples view of the presenting problem to be more objective, contextualized, and dyadic; (b) decreasing emotion-driven, dysfunctional behavior; (c) eliciting emotion-based, avoided, private behavior; (d) increasing constructive communication patterns; and (e) emphasizing strengths and reinforcing gains. For each of these five elements of the unified protocol, the paper addresses how and to what extent the most common forms of evidence-based couple therapy carry out this principle. Implications for clinical practice, treatment research, and basic research on intimate relationships are discussed.

Prediction of Response to Treatment in a Randomized Clinical Trial of Marital Therapy

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy.

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.

Observed Communication in Couples Two Years after Integrative and Traditional Behavioral Couple Therapy: Outcome and Link with Five-Year Follow-up.

OBJECTIVEnTo examine changes in observed communication after therapy termination in distressed couples from a randomized clinical trial.nnnMETHODnA total of 134 distressed couples were randomly assigned to either traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979) or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Videotaped samples of each couples interactions were coded from pre-therapy, post-therapy, and 2-year follow-up assessments. At these 3 time points, each partner chose 1 current relationship problem to discuss. Relationship satisfaction was assessed at 2-year follow-up, and clinically significant treatment response and marital status were assessed 5 years after treatment.nnnRESULTSnObserved negativity and withdrawal decreased from therapy termination through the 2-year follow-up as expected, but problem solving did not change, and observed positivity decreased. IBCT produced superior changes from post-therapy to the 2-year follow-up assessment compared with TBCT. Post-therapy levels and changes in communication over follow-up were associated with wife satisfaction at 2-year follow-up; only post-therapy to 2-year follow-up changes in communication were associated with husband satisfaction at 2-year follow-up. Post-therapy levels of problem solving and changes in wives positivity from pre-therapy to post-therapy were associated with 5-year relationship outcomes. We found some counterintuitive results with positivity, but they were no longer significant after controlling for withdrawal.nnnCONCLUSIONSnWe found support for improvements in observed communication following treatment termination, with IBCT demonstrating greater maintenance of communication improvement over follow-up. We found limited evidence of associations between communication and relationship outcomes at 5-year follow-up.

Research Issues and Strategies

The investigation of family interaction and psychopathology presents a number of challenges. Any study in this area faces special difficulties because of the nature of the family, of psychopathology, and of their interaction. Families present methodological problems because they are an unusual unit of analysis. Most researchers examine the individual as the central unit of analysis, but studies of the family must focus on larger units, such as the dyad, the triad, and the entire family system. Systems for measuring and categorizing the person, although far from satisfactory, do have a history and tradition that gives the researcher options from which to choose. For example, the DSM-III provides a taxonomy of individual disorders that, despite its inadequacies, has some consensual validity across practitioners and researchers in the field. Nothing comparable exists for families or for interactional pathology.

Molar labeling interventions: Two case studies

Abstract The efficacy of molar labeling interventions, a novel cognitive-behavioral approach to the treatment of emotionally disturbed children, was investigated in two case studies. In Study I, supervised paraprofessional childcare workers employed the experimental intervention in a short-term residential treatment center. In Study II, parents were taught to employ the experimental treatment to alter the within-home behavior of their child. Both studies evidenced rapid treatment effects on multiple target behaviors and generalization to non-target responses. In Study II, there was some evidence of 4-month maintenance of treatment effects as well as generalization to extra-therapeutic settings. In sum, these initial investigations provided promising, though preliminary, demonstrations of treatment efficacy.