Christiansen & Jacobsen's Integrative Behavioral Couples Therapy

Note: These are my notes from a "Master Clinician" session that Andrew Christiansen presenter at AABT in November of 2000.

He advocates a contextual perceptive - You change people by changing the context in which they operate. By joining the couple you can change the context. Usually couples enter therapy in an adversarial context and changing that context is valuable.

Traditionally, behavioral marital therapy has focused on change-oriented interventions (using reinforcement, increasing positive interactions, working on communication skills and negotiation, problem-solving training, etc.). Change can occur either through changing spouse A’s behavior or through changing spouse B’s reactions. Ideally through both.

Acceptance-oriented interventions can be a valuable addition. Not only is it hard to change many characteristics of individuals in distressed relationships but pressure for change is often a barrier to change. It is easier to change when you feel accepted. A balance between change-oriented interventions and acceptance-oriented interventions is called for.

A limitation of new “rules” whether proposed by the therapist or negotiated between the couple, is that they’re hard to use effectively in intensely emotional situations.
The protocol being used in the current clinical trial consists of up to 26 sessions with Ph.D. therapists getting individual consultation.

Assessment phase - four sessions: Joint session, individual session with each, joint feedback session. Initial session covers presenting problems, relationship history. Individual sessions - family/individual history.

Guiding formulation - problem isn’t one person’s fault, identify a central theme, identify characteristic interaction pattern, point out how this becomes a trap. The goal is to put things in a less adversarial context. The formulation is our best shot. It needs to be one that both members of the couple will accept. (it doesn’t have to be The Truth) Emphasize emotions that are not obviously expressed, try to make other’s behavior understandable.

Couple is given “Reconcilable Differences” and is to read the initial selection by the feedback session. They focus on emotionally salient events. Part of therapy is watching for problems which manifest this interaction pattern and debrief them. The therapist tries to shift the focus from “Why won’t you do what I want you to do?” to each preson expressing how they feel and looking for “the feelings behind the feelings.” When they manifest the same interaction pattern within the session, that’s particularly valuable. The goal is to develop a new understanding of the problem (a new story about the problem), a new emotional experience of the problem, and acceptance and change.

Empathic joining - encourage expression of unexpressed feelings, underlying feelings, “soft feelings” (fears, hurt, vulnerability, ...) Empathise with the pain without blame. Focus on what is valid in what they are saying (not on cognitive distortions, misintrpretations, ...) Respond empathically, try to elicit a softer response, try to get the individual more focused on their own response and less focused on the other’s behavior. The therapist must make a point of empathising with each, not take sides. By responding to each empathically, the therapist can increase the ability of each to empathise with the other.

Unified Detachment - use a descriptive, non-judgemental analysis. Talk in a detached way about the sequence of events, patterns. Compare and contrast how it goes on different occasions. Look at intentions vs actual effects. Use humor and metaphor. Goal is to focus on the problem as an ”it” not a “you,” to look at the behavior in context. Identify alternative responses, alternative sequence of behaviors and likely outcomes (but don’t press for change because pressure for change often triggers resistance, just highlight the payoffs of the alternatives and look for impediments that block alternative responses).

Tolerance Building - note positive aspects of negative behavior (raise possibilty that both are right in some way). Rehearse or fake the negative behavior (this changes the context, makes it easier to grasp the impact one’s behavior has, makes it easier to respond differently, increases sense of control, can be used to desensitize) then talk it over afterwards. Promote independence, self-reliance, alternative ways of getting needs met.

All of the traditional behavioral couple therapy techniques are fair game. However, the assumption is that first we need to get to the point that they’re working together to come up with solutions to problems. Once we achieve that, they may do fine on their own or they may need help on communication skills, problem-solving, ....

Replies:

Comparing Integrative Behavioral Couple Therapy and Cognitive Behavioral Couple Therapy, by Jim Pretzer, 06/28/02 And now there's Enhanced Cognitive-Behavioral Therapy for Couples, by Jim Pretzer, 06/30/02

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