In praise of integrated behavioral couples therapy
Thursday, April 18, 2024.
The IBCT model of couples therapy
Integrative Behavioral Couple Therapy (IBCT) was a promising approach to couple therapy that was developed by the late Neil S. Jacobson, who was a clinical psychologist, a professor at the University of Washington, and a friend and colleague of both Dr. John Gottman, and Sue Johnson, and Andrew Christensen, a clinical psychologist and professor at the University of California, Los Angeles (UCLA).
While Dr. Jacobson was alive, solid research confirmed the utility of the IBCT model. IBCT 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.
IBCT was unique among therapies at the time in that it promoted the notion of acceptance, a fundamental staple of ancient Stoic Philosophy and the Warrior’s Code. Soon, the Veterans Administration took a deep interest in the IBCT Model.
What do you mean by integrated?
The fundamental integration in the IBCT Couples Therapy Model is between the Scylla and Charybdis of human intimate life. Do I accept the things I can not change…and how do I change the things I can?
IBCT Couples Therapy efforts toward an expanding arc of emotional acceptance and openness to strategic change.
These are the sine qua non of the IBCT couples therapy approach. Other couples therapy models in the late 1980s focused on change.
IBCT focused on change and acceptance. It can be argued that the IBCT Model introduced a degree of mindfulness into couples therapy before mindfulness was trendy. Popular modern therapy models such as ACT may have also influenced by the IBCT Model.
Influences on the development of the IBCT model
One of the things I have always admired is the story of how the IBCT Model came to be.
While couples therapy research was rampant in the late 1970s, results were mixed. Jacobson’s acute dissatisfaction started in 1985, emerging from a profound disappointment with the outcome data of Traditional Behavioral Couples Therapy (TBCT).
Grad students seemed to be getting better results futzing around with TBCT than the so-called experts.
It was demoralizing.
Jacobson reports that he took a year off, read novels, and talked to many colleagues, such as a young student named Sue Johnson and her mentor, Les Greenberg. He acknowledges Johnson and Greenberg as powerful influences on him.
He also met with another young therapist named Dan Wile, who authored a sharp critique of behavioral couples therapy only a few years earlier in 1981.
The IBCT notions of “unified detachment” came directly from Wile’s Collaborative Couples Therapy model which posited the notion of a “platform.” Dan Wile, according to Dr. John Gottman, is the “greatest living couples therapist.” Dr. Jacobson also was generous with his praise of John Gottman as a significant influence on the ICBT Model.
In other words, the IBCT Model emerged from some of the best thinkers in contemporary Couples Therapy.
Neil received some grant money and brought on Andy Christensen, a friend and professor from UCLA.
“I always admired Andy’s work and liked him personally. What I admired most about his work was its integrity; he never overinterpreted his results, he replicated all of his findings, he was extremely cautious ( as a scientist should be) and, as a result, his findings stood the test of time.” Dr. Neil Jacobson.
The importance of the assessment phase in the IBCT model
There are two principal phases in the IBCT Model. An Assessment phase with evaluation, feedback, a treatment plan, and an active treatment phase.
During the initial three sessions, The therapist learns the “story of us” and how the couple moved through time together.
The IBCT Model anticipated Discernment Counseling. It respected and honored feelings of ambivalence uncovered during the assessment phase.
These initial sessions comprise an evaluation period during which the therapist discovers the “formulation,” the often dysfunctional pattern of communication that the couple engages in when addressing their concerns.
Also, during the initial session, the couples therapist typically hands each partner several questionnaires to complete and return for each session, the following two sessions. This is similar to Gottman Couples Therapy, which heavily influenced the IBCT Model.
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,” which is identical to the Gottman assessment protocol.
The feedback session is the time for the therapist to offer a 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 IBCT model is a collaborative undertaking…
IBCT resembles some Postmodern therapies in that the couple actively participates in this feedback process, offering their observations and reactions and adding additional information and appropriate corrections. The IBCT couples therapist is humble and desires nothing less than 100% buy-in from both spouses on the formulation.
The formulation was a Rubicon in ICBT therapy. It summarizes the couple’s “cycle,” as EFT would put it.
The more I do this…, the more you do that… If the couple accepted the formulation, they typically moved forward into weekly sessions with both spouses together.
At this point in the active treatment phase, I always felt that one of the intriguing aspects of IBCT was how closely it resembled Emotionally- Focused Couples Therapy.
Like EFT, The IBCT Model focuses on the daily inventory of experiences, good or bad, that reflect the major theme or themes of the couples’ particular attachment issues.
Think of the formulation in IBCT as the same idea as the Demon Dance in Emotionally-Focused Therapy.
The IBCT model is strength-based
IBCT therapy is always strength-based. The therapist is always panning for gold.
What worked the last time you confronted this problem…when have you had a similar issue and how did you handle it? In these discussions, the therapist is often quite active, helping the partners communicate more clearly, openly, and directly.
Therapy consists of locating the repetitive patterns that keep them stuck and helping them build skills in breaking out of their habitual pattern. IBCT couples therapy is an active model and more dyadically oriented like the Gottman Method. IBCT wants to teach couples skills and get out of their way. However, the IBCT Model also sought to carefully unpack demand/withdrawal patterns that are such seminal ideas in EFT.
The last research on IBCT suggests that among couples chosen for therapy because they had serious and chronic distress, over 70% of couples remain together and show significant clinical improvement at the end of therapy, as well as at the two-year follow-up after the end of therapy.
The World Center for Behavior Analysis offers a behavior therapy certification that covers Integrative Behavioral Couples Therapy. UCLA has a website devoted to the IBCT Model. It seems that the VA decided to train a large number of therapists in IBCT, and now the core majority of IBCT couples therapy practitioners work with veterans and their families and do not work with civilians.
The IBCT Model offers relatively few training events, and most of them are geared toward serving our veteran population. Dr. Andrew Christensen was a driving force in the research that led to the development of the ICBT Model, and he seems to be very much involved in ICBT to this day.
Unfortunately, because of the sudden death of Dr. Jacobson in 1999 at the age of 50 from a heart attack, this dynamic couples therapy model seems to have been eclipsed by the Gottman Method of Couples Therapy with the general public.
The late Neil Jacobson was a colleague and collaborator of Dr. John Gottman, and both men profoundly influenced each other’s thinking. There seems to be little enthusiasm online for an IBCT community of practice.
Unfortunately, the IBCT Model is an evidence-based couples therapy model that seems to have faded from the popular stage. Yet, paradoxically, some of the greatest minds today in couples therapy have contributed to it.
The IBCT model in academia
My couples therapy professor at Antioch focused exclusively on evidence-based couples therapy models.
He identified as an IBCT therapist, convinced that the essential model that Gottman expanded on was good enough for him. Thank you very much.
Maybe he liked being a bit contrary. He enjoyed many things about the IBCT Model; the careful focus on assessment, collaboration on the formulation, and how acceptance could help couples resolve otherwise impossible dilemmas.
He taught me well. I will never forget him telling me to stay curious and learn at least two couples therapy models to fluid proficiency. Jacobson’s IBCT Model was an important inflection point between the older cognitive/ behavioral therapies and the more nuanced evidence-based models we use today.
IBCT led the way in emphasizing the importance of assessment. It introduced notions of acceptance alongside the more popular idea of strategic change. It held a space for ambivalence to be heard long before the arrival of Discernment Counseling, and it had killer success rates even two years after follow-up.
IBCT remains a robust couples therapy model, and I am pleased that at least our veterans are reaping the benefits.
