Dr. Andrew Christensen, distinguished research professor of psychology at UCLA and co-developer of Integrative Behavioral Couple Therapy (IBCT), explains how IBCT balances acceptance and change in treating relationship distress. He walks clinicians through the assessment and feedback process and the DEEP formulation, describes the three core interventions—empathic joining, unified detachment, and practical problem-solving—and discusses treatment length, termination, and training resources.

Published On: 10/19/2026

Duration: 44 minutes, 20 seconds

Learning Objectives

After completing this educational activity, participants should be able to:

• Describe the core principles of Integrative Behavioral Couple Therapy and explain how acceptance-focused and change-focused interventions are integrated in treating relationship distress.
• Distinguish rule-governed change from contingency-shaped change and explain how in-session emotional experiences can facilitate more constructive couple interactions.
• Identify the components of the IBCT DEEP formulation—differences, emotional sensitivities, external circumstances, and patterns of interaction—and describe their role in assessment and treatment planning.
• Describe how empathic joining, unified detachment, and practical discussions are used to help couples address emotionally significant conflicts more constructively.

Topics Covered in This Interview

• The distinctive challenges and advantages of conjoint couple therapy
• How IBCT developed from traditional behavioral couple therapy
• Integrating acceptance and change in relationship treatment
• Why behavioral assignments and communication skills may not produce enduring change
• How partners’ differences can be sources of both attraction and conflict
• Rule-governed behavior versus contingency-shaped change
• Facilitating spontaneous change through emotionally meaningful in-session interactions
• How therapists decide when to emphasize acceptance or direct change
• The IBCT assessment sequence: conjoint interview, individual sessions, and feedback
• Assessing intimate partner violence, commitment, and competing relationships
• The DEEP formulation: differences, emotional sensitivities, external circumstances, and patterns of interaction
• Identifying recurring conflict cycles and developing a shared, less blame-focused understanding
• Collaboratively setting the agenda for active treatment sessions
• Empathic joining and the development of compassionate conversations
• Unified detachment and examining patterns of conflict together
• Practical discussions and preparing for challenging situations
• Experiential learning versus direct instruction in couple therapy
• Treatment duration, outcomes, termination, and follow-up sessions
• IBCT training opportunities and the OurRelationship online program

Abbreviated Interview Transcript

Abigail Rasol: Today we’re joined by Dr. Andrew Christensen, who is a distinguished research professor of psychology at UCLA and one of the leading experts in IBCT. Along with the late Dr. Neil Jacobson, Dr. Christensen developed Integrative Behavioral Couple Therapy, which is an evidence-based approach that uniquely emphasizes both acceptance and change in helping couples navigate conflict and distress.

Dr. Christensen has spent more than three decades studying the effectiveness of couple therapy and refining IBCT. His work has helped bring the treatment into widespread clinical practice, including its adoption by the U.S. Department of Veterans Affairs as an evidence-based treatment for couples. He’s also the co-author of Reconcilable Differences, a self-help book for couples based on IBCT, and Integrative Behavioral Couple Therapy: A Therapist’s Guide to Creating Acceptance and Change.

So we’re thrilled to be joined by Dr. Christensen today to discuss the foundations of the treatment, how it understands relationship distress, how therapists can help couples balance acceptance with meaningful change and everything in between. Thank you, Dr. Christensen, for joining us.

Andrew Christensen, PhD: My pleasure.

Abigail Rasol: Most of our listeners probably have not heard of IBCT and may not be very familiar with couple therapy in general. Could you speak to the general premise of couple therapy, then explain what IBCT is, what it was developed to address, and how it conceptualizes couple distress?

Andrew Christensen, PhD: A little bit about couple therapy first. A key part of couples therapy is that you see the couple, for the most part, together. It is largely a conjoint therapy, unlike most therapy, which involves a therapist and one individual. There are many advantages of seeing the couple together versus seeing an individual, as well as many challenges to that.

The big advantage is that when a couple comes into treatment and you see them together, the problem that they have is going to appear between them in the session. In other words, they’re likely to get into the same kinds of arguments or disagreements, or hurt each other’s feelings in the same ways they do outside of therapy. You will see the problem as it happens.

So that’s a real advantage, but it’s also a challenge because many therapists are a little bit overwhelmed or don’t know quite how to handle a couple, particularly a very volatile couple that gets into an angry dispute or begins accusing each other.

There are probably three or four evidence-based treatments for couples. IBCT is one of them; another is traditional behavioral couple therapy. There’s also emotion-focused couple therapy. A couple of others also have some evidence supporting them.

What is Integrative about Integrative Behavioral Couple Therapy?

Abigail Rasol: My understanding is that IBCT grew out of traditional behavioral couple therapy. So if you could explain a little bit about how it has modified the more traditional treatment, what was missing from the traditional approach that led to the development of IBCT and what is the integrated piece in IBCT? What does the “I” stand for?

Andrew Christensen, PhD: It’s integrated in a couple of ways. One is it integrates strategies for promoting change with strategies for promoting acceptance. And then it integrates two different kinds of mechanisms of change, and I will get to that in a moment. But let me deal with the first point.

First, it integrates strategies for creating change. Traditionally, behavioral couple therapy and cognitive behavioral couple therapy were oriented toward change. You wanted to do things like increase the number of positive interactions they had. You encouraged couples to go on date nights or to do the things that each of them wanted to hear or say. You taught them communication skills and problem-solving skills. It was a skills-training approach oriented toward change: helping them deal with conflict or struggles with communication skills and problem-solving skills, and then improve the mutual reinforcement in the relationship by emphasizing partners engaging in these guided behavioral assignments. An assignment might be, “Abigail, give your partner three positive surprises this week.” So that’s the change focus.

Now, the acceptance focus. The late Neil Jacobson and I initially practiced traditional behavioral couple therapy, but we found limitations in that approach.

One limitation is that you can often achieve some change in couples. You can increase their positive interactions and so forth, but often it doesn’t last. Initially, partners may want to please the therapist, so they complete the assignments. But the changes taper off, particularly after therapy ends.

So that’s one problem. Another problem is that there are some things that partners are either unable or unwilling to change. To give you an example, I may want my partner to not be so emotional, and yet perhaps that is part of my partner’s fabric and DNA.

My partner may want me to be more adventurous and maybe that’s not fundamental to my DNA. So there are changes that people sometimes want in the other that are very hard for the other to do, certainly on any consistent basis and so they may be unwilling to make those changes.

Thus, you reach stalemates. That is where we saw a need to include emotional acceptance. And most couples who’ve been in long-term relationships have come to accept certain things about their partners that they may not have liked so much in the beginning.

Or what’s even more interesting is that some of the things that attract us to our partners are also the things that bother us. And let me give you an example. For example, it is not uncommon for an emotional person to get together with a steady, stable person who is not very emotional.

And that can be an attraction between the two of them in addition to whatever else attracted them, in that the emotional person brings a little spice and vibrancy to the more stable kind of person, whereas the stable person brings some balance and stability to the emotional person.

And so that can be a real source of attraction. But of course, with any quality, there can be a downside. Sometimes Mr. or Ms. Stability gets upset with Mr. or Ms. Emotional. And likewise, Mr. or Ms. Emotional gets upset that Mr. or Ms. Stability is so absent of feelings.

That is why it is important to bring acceptance into the picture: virtually every positive quality you appreciate in your partner also has a downside.

So we’ll use Jack and Jill, the famous nursery rhyme couple. Let’s say Jack is a very ambitious person, and that was attractive to Jill. And Jill was very much a homebody and could create a nice home environment and that was a source of attraction. So those are great qualities, both of them.

But then Jill may be upset that Jack is always out in the world and leaving all the home stuff to her, or Jack may be upset that she doesn’t appreciate all the work he’s doing and all the achievements he’s making in the world. And so there’s a downside to every quality.

Maybe Jack is upset that Jill is not achieving more in the world or bringing more income into the family and it’s all on his shoulders. So the point is that there’s clearly a need in a long-term relationship for emotional acceptance.

The question then became how to bring about that acceptance. And this leads to the two other things that IBCT integrates.

Two Mechanisms of Change

Andrew Christensen, PhD: IBCT, I mentioned, integrates two mechanisms of change. A mechanism of change refers to the dynamics of how someone actually changes.

The traditional change approach was based on a teaching-and-learning model: Teaching communication skills, giving people directives. “Why don’t the two of you do a date night this week?” Here’s the right way to talk to your partner. Here’s the right way to problem solve. Here are good things to do to enhance your relationship. Go out on date nights, give your partner a kiss every night, and so forth. So that’s rule-governed behavior.

That’s one mechanism of change, and that was the mechanism of change that was used by traditional behavioral couple therapy. There’s another mechanism of change, mentioned by the late great B.F. Skinner, and that’s called contingency-shaped change, in which behavior changes in response to contingencies in the current situation. Let me give you an example.

Let’s say Jack and Jill are in therapy, and Jill would really like more affection. Jack seems cold. Perhaps they were affectionate early in their relationship, but now he is not very affectionate. Now, a rule-governed approach would involve the therapist reviewing the kinds of affection Jill likes and the kinds Jack is comfortable giving, then encouraging him to engage in more of those affectionate behaviors.

Now, that can be beneficial. But the major problem is that Jill may experience that as Jack just following the rules, that it’s not coming from the heart. Does he really want to touch her, be affectionate with her, or is he just following the advice of the therapist?

Sometimes, when your partner is “going through the motions,” it doesn’t feel very good. It’s not really reinforcing. This comes up often in the sexual behavior of couples, because part of the pleasure is seeing that you are making your partner happy and fulfilled, just as your partner is making you fulfilled.

So that brings us to this other strategy of contingency-shaped change. Rather than giving people instructions and directions and teaching them “here’s how we’re going to communicate,” it’s trying to change what happens in the session, in the experience of the session, to elicit more constructive interaction between the two.

Contingency-Shaped Change in Action

Abigail Rasol: Can you give an example of how that would work in the session?

Andrew Christensen, PhD: Let’s say in the session, Jill angrily talks about how Jack is never affectionate with her. Jack defends himself: “I was affectionate last time,” or “She’s always in a bad mood.” Jill responds, “I’m in a bad mood because you’re so cold.” They go back and forth. Suppose you intervene and help Jill talk about her anger over the lack of affection, what she is missing, what affection means to her, and how it feels to her.

Or maybe you go with what it felt like in the earlier times when they were affectionate. Now, it doesn’t always work but sometimes then what happens is she becomes less angry. She becomes softer. She talks about what she’s missing in the relationship, what she really yearns for in the relationship, and it makes it easier for Jack to hear, and then maybe he’s able to talk rather than defending himself or counterattacking her.

You have created a different kind of conversation and communication, but it wasn’t through a rule-governed approach. It’s through a contingency-shaped approach.

And the same thing would apply to acceptance. Sometimes when people hear about IBCT emphasizing acceptance, they think that we tell people, “This is what you should accept in your partner. This is what you shouldn’t accept.”

But we don’t tell partners what they should accept because then it’s a forced thing. We try to help partners understand each other better in a more emotionally connected way, and so that acceptance then comes from that.

When Jack understands that he was attracted to Jill because of a quality that sometimes bothers him, but that part of it remains appealing, it may become easier for him to accept it. And likewise with Jill toward Jack.

So those are the ways we integrate change and acceptance, but we also integrate strategies of rule-governed change, teaching people here’s how to do it, here’s what you should do more of.

We also try to create a different kind of conversation between them experientially, in the moment.

Balancing Acceptance and Change

Abigail Rasol: In thinking about this balance of acceptance and change, correct me if I’m wrong, but it sounds like there are essentially no criteria that the therapist uses to determine when to work on acceptance versus change? Is that up to the clients?

Andrew Christensen, PhD: No, it’s more when couples come into therapy, they’re usually in a difficult pattern of interaction. They’re struggling with each other, so they’re usually not in a good place to bring about enduring change.

And so we typically start with acceptance-focused interventions. Early in treatment, after assessment and feedback, we focus on acceptance-based interventions because we want to soften people up, help people understand each other better, help people be more empathic with each other.

And then sometimes what happens is they make some spontaneous change, and that’s the best kind of change because that’s more likely to be enduring. If I tell Jack to be more affectionate with Jill, that change is less likely to last because he is doing it partly as an assignment. If he starts feeling differently about Jill and experiences affection toward her differently, that change is more likely to endure.

And so if we talk about some of the issues with their struggles without emphasizing change, then sometimes there’s spontaneous change that brings about a better relationship, and that’s better. Sometimes we never get to change-focused interventions really, and that’s great.

Abigail Rasol: You touched briefly on this in the different stages in the treatment, and I’d like to follow you in that direction.

The Assessment Process

Abigail Rasol: You mentioned an assessment process. What does that look like in IBCT? What are you assessing for? How long is that process? Bring us into that.

Andrew Christensen, PhD: Assessment and feedback constitute a more structured phase of IBCT. So we always start off with a conjoint session.

We bring the partners together. We want them to start on equal footing rather than one partner getting a head start and telling us what the problem is and their take on the problem. In that initial session, we of course find out about what the presenting problem is, a little bit about the history of the presenting problem.

We also learn a little about the history of the relationship. At the end of the first session, we give them questionnaires to complete and bring back. The next two sessions are individual sessions, one with each partner. Now, the individual sessions are for several reasons.

One is we want to be sure that working with them in couple therapy is not dangerous. We want to assess for intimate partner violence.

We also assess commitment. Sometimes one partner comes to therapy to end the relationship and if that’s the goal, we want to find out about that. Related to commitment, we want to know whether there are competing relationships. In other words, whether one partner is having an affair.

So those are things that need to be assessed individually. The questionnaires ask a little bit about those dimensions. But we also, in the individual session, find out more about their view of the presenting problem which they feel a little bit freer to talk about with just us rather than with their partner present.

We learn about their relationship history in the first session and their personal histories and perspectives on the problems in the individual sessions. The fourth session is the feedback session.

And that’s where the therapist provides the couple the conceptualization of their problems and outlines what treatment will look like. At the end of the feedback session, the therapist asks whether the couple wants to proceed with treatment given that they know now about their problems, and what the active phase of IBCT is going to look like.

How Does IBCT Conceptualize Distress?

Abigail Rasol: It sounds like that’s a pretty foundational piece of the treatment and how you formulate treatment. What is the IBCT conceptualization of distress and what role does that play?

Andrew Christensen, PhD: That’s absolutely right. That’s a good way of putting it. It’s a foundational part of assessment and treatment. The IBCT conceptualization is what we call a DEEP analysis. Now, DEEP is an acronym, but it’s also meant to imply that it’s not a superficial analysis.

Let’s look at the four components of DEEP. So one component of the DEEP is the D, the differences. No matter how carefully you select your partner, you’re always going to find a partner that has some things in common with you, but some important differences. So we look at the differences. During the assessment process, we try to narrow down to one or two core issues or themes. For instance, a couple may constantly argue about work-life balance. So one partner thinks the other is a workaholic and not helping at home and they repeatedly battle over it.

Or there can be a core issue of one partner wants more sexual intimacy and feels the other is turned off to them and there’s a constant struggle about that or about child rearing. You can imagine a variety of different struggles that couples have. So we narrow it down to one or two core struggles, and then we look at what are the key differences between partners on, let’s say, this core issue.

What are the personality differences? Sometimes the differences are related to culture. I remember one Asian couple I worked with, the husband, who was much more traditional, felt when his father died, he had to have his mother come and live with him. He would be a bad son if he didn’t do that. His wife, however, did not like her mother-in-law. She was comfortable with him maintaining contact and caring for his mother, but having her live with them was beyond the pale for her. There can be many bases for these differences.

So we try to see what are the core differences related to this core problem and how we understand them. In other words, how did they arise? Culture, their background, their child-rearing.

Now, the second component of the DEEP analysis, the first E, is emotional sensitivities.

Our genetic inheritance and experiences growing up make us sensitive to certain things. In the extreme we can be super sensitive, almost an allergic reaction to certain things.

So we try to identify not only the differences related to their core conflict, but the emotional sensitivities and also a little bit about how they came about those emotional sensitivities. So that’s the E part of it.

The next E is external circumstances. And we often think of external circumstances in terms of stressors.

But something can be a stressor for one partner and not the other. So for example, let’s say with Jack and Jill, Jack has this sensitivity about trust. And let’s say Jill’s sensitivity is being controlled, she’s a very vivacious, charming person, and she doesn’t want to be controlled and told who she can talk with and so forth. And now let’s say the external circumstances are such that she has to do a lot of traveling in her work, or has to have a lot of late-night meetings with male colleagues.

Now, maybe she likes those circumstances, but they’re very stressful for Jack because each one is an opportunity for her to get attracted to somebody else and threaten the relationship.

Or we can think of external stressors that are stress for both of them. So they have money problems, and one lost his job or they lost some money in the stock market, and now they’re really at each other’s throats about spending money. Those are the D, E, and E.

So in IBCT, the differences, the emotional sensitivities, and the external circumstances, particularly stressors, are what create the problem that the couple has.

P: Perpetuating the Problem

Andrew Christensen, PhD: And then the P is the pattern of interaction or pattern of communication, and that is how the couple tries to deal with this problem.

Often with distressed couples, the way they deal with it makes the problem worse. So let’s take Jack and Jill and the issue of trust. Let’s say Jack understandably tries to deal with his anxiety about what Jill is doing by checking up on her, looking at her credit cards, asking her numerous questions.

“Who was at the dinner tonight? What did you talk about? How old is he, and how much do you see him?” And Jill doesn’t like that. She’s being interrogated, and having to account for what she did, and she thinks what she did was totally innocent.

And so Jill starts sharing less with Jack because she doesn’t want to get the 20 questions. So she doesn’t tell him about when she has a meeting and just says she has to work late. And then when Jack senses that she’s hiding things from him, he gets more and more investigative, which leads Jill to withdraw more from Jack, which adds to his anxiety and adds to his interrogation.

And yet she’s trying to avoid all the uncomfortable interactions, so she withdraws from him, doesn’t share things with him, and the problem they have starts getting worse as a result of their attempts to deal with it. It’s that old line: the attempted solution becomes part of the problem.

So now in our feedback session the therapist identifies the core issue, and goes over the DEEP analysis, but it’s very much an interaction. It’s not the therapist lecturing the couple on this model or anything like that.

The therapist gives examples. “Jack, I remember you telling me your mom cheated on your dad. Jill, I remember you telling me your first boyfriend was so controlling.” You tell them some of the examples they told you that maybe support the ideas. You’re very open to their additional information or even their disagreement. But usually we don’t get much disagreement because when you listen to couples closely, usually it makes sense for a couple.

And what happens in doing that, in getting this DEEP analysis, the couple is now seeing the problem in a similar way. Whereas maybe Jill saw the problem as Jack being this really insecure guy, or Jack seeing the problem as Jill being this really flirtatious not really committed woman. Those are their attributions that are very blame-focused, and we try to get them into a common understanding with the DEEP analysis.

Abigail Rasol: What comes after the DEEP analysis?

Andrew Christensen, PhD: Following the DEEP analysis, what we talk about is what therapy is going to look like. We give them a one-page questionnaire that they’re going to fill out over each week. And it’s doing a couple of ratings of how the week went or how things went since the last session. We always check on whether there was any violent episode between them, any drug and alcohol problem between them, or any major change. Like losing a job or some loved one, being ill, things like that. Because we want to address those first. But assuming those are all no, then what we focus on is the most positive thing that happened between the two of them, because we always want to give some attention to anything positive.

If it was especially positive, you give it a lot of attention. For instance, if they had sex for the first time, if they had an intimate discussion that they haven’t had in a long time. If they handled a problem that normally is a big deal for them and they handled it better, we’d want to give a lot of attention to what they did that made it go better.

Then we go to the key issues that they rank. What was the most difficult interaction they had? Is there an issue they would like to talk about even though there wasn’t an incident in this past week about it?

Maybe they want to talk about their sex life even though there wasn’t any sex life this week. Maybe they want to talk about finances even though they’ve avoided it because it’s difficult for them. And then finally, is there any upcoming event that would be challenging for them that they want to talk about?

Maybe Jill’s old boyfriend is coming to town and so that’s going to be challenging. So the couple indicates the most difficult incident between them, any issue that they would like to discuss even if there wasn’t an incident, and any upcoming events, and then they rank order, so that the couple always chooses the agenda of what we’re going to talk about.

In therapy, the therapist’s goal is to help them have a constructive interaction about these emotionally significant events, because the ones we talk about are always emotionally significant. The positive event, emotionally significant in a positive way. The negative event because it was upsetting to them. The issue because it’s so hard to talk about on their own, or the upcoming event because it’s going to be challenging emotionally for them.

Then in the active phase of therapy we use that agenda to help them have more constructive conversations. The key test of couple therapy is this: Can I help the couple have a more meaningful, constructive conversation about a difficult topic than they’re able to have alone?

It’s catching them in the moment, when it’s a difficult topic, and seeing if I can help them talk about it. It’s a difficult topic because it arouses strong emotions in them. When Jill talks about Jack’s spending, it upsets her, and then it upsets him that she’s accusatory about his spending, and he gets defensive, and they fall into their usual pattern. Helping them talk about it more constructively than that is the mark of successful couple therapy in IBCT.

Facilitating Healthier Conversations

Abigail Rasol: From a theoretical perspective, it makes a lot of sense that, your role is to help the couple facilitate more productive and healthy conversations. How does that work in practice? What techniques or interventions are you using that really helps to facilitate that conversation in a healthier way than they would otherwise be able to have on their own?

Empathic Joining

Andrew Christensen, PhD: In general, we try to promote three kinds of conversations. One of our interventions is called empathic joining. And in that intervention, we try to promote a more compassionate discussion. So it’s very emotion-oriented. It pulls out what partners are feeling, tries to get at some of their deepest feelings, even their hurt or their anguish about things.

It doesn’t mean that immediately they’re going to be empathic with each other, but the therapist can be empathic with both of them. The therapist tries to explore and understand the hurts and wounds that each partner has experienced and show understanding for that.

Unified Detachment

Andrew Christensen, PhD: So that’s one discussion we try to promote, a compassionate discussion. A second discussion we try to promote is what we call the strategy of unified detachment. It’s promoting dyadic mindfulness. It’s trying to get the couple to step back from their conflict and take a look at it from a distance. It’s like metaphorically putting down their weapons, getting some binoculars, getting up on a little hill and looking down at their interaction.

And then we have them go through a sequence. What is the sequence of conflict? Okay, this bad argument that happened Tuesday night, it started, Jill came home and said this and she was upset by that and then Jack responded to this and that really triggered her and then she went to this and we see how the argument unfolded.

And when couples do that jointly, what it does is it becomes very clear that their interaction is always a duet, never a solo. Both partners contribute to it. Even in the extreme, let’s say Jill comes home and she had a horrible day and so she is angry at Jack for some small thing.

So we can say that in that case, Jill started it. But then Jack immediately is part of it. He gets defensive, and he attacks her, and he makes it worse than it is. That doesn’t mean it’s Jack’s fault for getting defensive or Jill’s fault for being upset. We just try to help them look at what happens between the two of them, what triggers each of your emotions and gets you on this bad cycle that you get into.

A Practical Discussion

Andrew Christensen, PhD: The third kind of discussion we have is a practical discussion, and that’s where we get to direct change. Practical discussion of what concretely can you do to make this better? What concretely can your partner do to make it better?

It comes up really nicely with preparing for challenging events, because that’s a concrete event of how can they manage this visitation by her mother, which always creates a problem between the two of them. How can they handle this better this weekend when she comes and visits? And so often that’s a very concrete way that we can try to bring about change.

Those are the three kinds of discussions we try to promote, and that’s in place of their usual pattern of interaction.

Abigail Rasol: So would you say that part of the therapy is this active in-the-moment education of what a productive conversation looks like, and by your facilitating that conversation in the room, you are essentially teaching them how to have those conversations in a more productive way out of the room?

Experiential Learning in IBCT

Andrew Christensen, PhD: I’m hesitant to use the teaching word. They are learning, but it’s through experience, not because I stood up and lectured, “Here’s the way to talk to your partner.” Teaching implies a didactic, here’s-how-to-do-it approach, as opposed to an experiential one. With emotions, I would argue that learning needs to be experiential. I can tell people “When you’re upset with your partner don’t be so upset with them and you’ll have a better interaction with them.”

Now, do you think people can follow that? No, of course not. And so you have to give people experience, quote unquote, “in the line of fire.” It is learning. It’s definitely learning that we can talk to each other better, but it’s not teaching in the sense of I didn’t give them a lecture about that.

Abigail Rasol: It is more about experiential learning through having those healthier conversations.

Andrew Christensen, PhD: And that’s what makes couples therapy so challenging, getting back to our first point, but makes it so engaging as a couples therapist. You have to be on your toes, particularly with a complicated couple to be aware of what’s going on emotionally with each partner and how to facilitate that.

So it’s not easy. Even after doing it, many years, you meet some really challenging couples.

Abigail Rasol: Individual therapy is not easy, so I can imagine that when you have two people that you are both dealing with in terms of the therapist-patient relationship, but then the inter-patient relationship that adds a whole layer of complexity.

Could you speak a little bit to what the treatment timeline looks like? Are we looking at a relatively short, brief treatment? Are we looking at years? What does that progression look like and how variable is it based on the case?

The Treatment Timeline: 12 Sessions Can Be Enough

Andrew Christensen, PhD: There is no defined limit. In our clinical trial with five years of follow-up data, working with moderate to severely distressed couples, we gave them 26 sessions over about six to eight months and that showed effectiveness that lasted for a full two-year follow-up. There was a little bit of loss over five years. But they weren’t allowed to come back into treatment because we wanted to look at how they did over a five-year period without any additional treatment by us.

So it gave us a notion that sometimes couples need to come back for a tune-up session, if you will. But now in our work in the VA, treatments in the VA tend to be shorter. It tends to be about 12 sessions. And so we’re able to make some change, not as big a change as we did in our clinical trial, but some significant clinical change in couples after about 12 sessions.

So I would generally say a total of 12 to 24 sessions, but some couples want to continue for longer than that. As long as they are benefiting, we are not going to end therapy simply because they have reached a certain number of sessions.

Gauging Readiness for Termination

Abigail Rasol: What are usually your markers that a couple is ready to terminate the treatment, and do you initiate that termination as a therapist, or do you really leave it up to them?

Andrew Christensen, PhD: It can be either. One cue is when a couple no longer has significant emotional material to discuss. Another is when they’re able to handle their issues as they arise during the week: “We had a little spat the other night, but then we talked about it and we were able to get past it.”

That tells you this couple may be ready to finish. Often the therapist can bring it up but it’s always ultimately the couple’s decision. Of course, the couple can also say they have learned something and do not want to explore further.

When couples terminate, they always are invited back if they need, as I said, a tune-up. Occasionally, couples will come back, and usually it’s for one or two or three sessions, and then they’re fine again.

IBCT Training for Clinicians

Abigail Rasol: I’m curious if you could speak a little bit to what the landscape of IBCT looks like in terms of how accessible that treatment is to generalist clinicians and to professionals in the field in general. Where can they expose themselves to training opportunities? How disseminated is it? How accessible is it?

Andrew Christensen, PhD: For the last 16 years the U.S. Department of Veterans Affairs, which is the largest provider of healthcare in the country, has adopted IBCT as its evidence-based treatment.

And for 16 years I’ve been doing trainings of therapists in the VA. The VA is trying to have an IBCT therapist at basically all the major facilities to be able to do couples therapy, at least one. And so it’s very widespread in the VA and that’s been the focus early on.

More recently we’ve made a model of training in IBCT similar to what we do in the VA available for non-VA clinicians. And it is available at the IBCT website, ibct.org. There’s an upcoming training in October, so people can go on and see if they want to do that. And it’s a fairly intensive training.

You get American Psychological Association CEUs for it. But it’s fairly intensive. There are two levels. Level one involves about 20 hours and familiarizes you with IBCT; you do a lot of discussion and role-playing with an IBCT consultant. And then level two is where you actually work with couples, video or audio tape your sessions, and are guided through that by an IBCT consultant.

Free IBCT

Andrew Christensen, PhD: About 15 years ago a colleague of mine, Brian Doss, and I adapted IBCT to an online experience that can be done totally self-guided or with the help of a coach. Over 5,000 couples have gone through it as part of randomized clinical trials.

So it’s been supported by federal research for 15 years. It’s not as effective as IBCT in person, but it’s helpful for couples and it’s so much less expensive. Right now we’re offering it for any couple in Los Angeles County and any couple in the counties near my colleague who’s at the University of Miami. There, it’s free, supported by a government program, the Administration for Children and Families, which has been supporting this work for 15 years. Elsewhere, it’s available very inexpensively.

It is useful for couples who are not ready for couple therapy but want an introduction to it. It’s a cheap, easy introduction for them. It’s very good for therapists to use if one partner wants couples therapy but the other partner is reluctant.

We also have an individual version of that. And there’s special versions for military couples, for LGBTQ+ couples. It requires six to eight hours of your time, usually over about two months.

And again, it can be done totally self-guided or it can be done with a trained coach who has about five calls with you, about a half an hour each. So I do want to make that available to therapists because it’s helpful to have that.

Therapists can find out more at OurRelationship.com.

Abigail Rasol: And we will absolutely link those resources for our listeners in the caption for this episode as well.

I think that is all the time that we have today. Thank you so much, Dr. Christensen, for joining us. Thank you to our listeners for tuning in.

References

1. Christensen, A., Doss, B. D., & Jacobson, N. S. (2014). Reconcilable differences: Rebuild your relationship by rediscovering the partner you love—without losing yourself (2nd ed.). Guilford Press.
2. Christensen, A., Doss, B. D., & Jacobson, N. S. (2020). Integrative behavioral couple therapy: A therapist’s guide to creating acceptance and change (2nd ed.). W. W. Norton & Company.
3. Jacobson, N. S., & Christensen, A. (1996). Acceptance and change in couple therapy: A therapist’s guide to transforming relationships. W. W. Norton & Company.
4. Christensen, A., & Doss, B. D. (2017). Integrative behavioral couple therapy. Current Opinion in Psychology, 13, 111–114. https://doi.org/10.1016/j.copsyc.2016.04.022
5. Jacobson, N. S., Christensen, A., Prince, S. E., Cordova, J., & Eldridge, K. (2000). Integrative behavioral couple therapy: An acceptance-based, promising new treatment for couple discord. Journal of Consulting and Clinical Psychology, 68(2), 351–355. https://doi.org/10.1037/0022-006X.68.2.351
6. Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72(2), 176–191. https://doi.org/10.1037/0022-006X.72.2.176
7. Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225–235. https://doi.org/10.1037/a0018132
8. Baucom, K. J. W., Sevier, M., Eldridge, K. A., Doss, B. D., & Christensen, A. (2011). Observed communication in couples two years after integrative and traditional behavioral couple therapy: Outcome and link with five-year follow-up. Journal of Consulting and Clinical Psychology, 79(5), 565–576. https://doi.org/10.1037/a0025121
9. Baucom, B. R., Atkins, D. C., Rowe, L. S., Doss, B. D., & Christensen, A. (2015). Prediction of treatment response at 5-year follow-up in a randomized clinical trial of behaviorally based couple therapies. Journal of Consulting and Clinical Psychology, 83(1), 103–114. https://doi.org/10.1037/a0038005
10. Doss, B. D., Benson, L. A., Georgia, E. J., & Christensen, A. (2013). Translation of integrative behavioral couple therapy to a web-based intervention. Family Process, 52(1), 139–153. https://doi.org/10.1111/famp.12020
11. Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285–296. https://doi.org/10.1037/ccp0000063
12. Christensen, A., & Heavey, C. L. (1999). Interventions for couples. Annual Review of Psychology, 50, 165–190. https://doi.org/10.1146/annurev.psych.50.1.165

Resources Mentioned

• IBCT Official Website — Information about the treatment model, clinician training, and consultation.
• OurRelationship Program — Online, IBCT-based relationship intervention available in self-guided and coach-supported formats.

The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of three quarter (.45) AMA PRA Category 1 Credits^TM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity.