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Behavioral marital therapy, sometimes called behavioral couples therapy, has its origins in behaviorism and is a form of behavior therapy. The theory is rooted in social learning theory and behavior analysis. As a model, it is constantly being revised as new research presents.
Behavioral marital therapy started with simple research conducted on couples in the 1960s. Robert Weiss and Richard Stuart were the original authors of such research. [1] [2] In early 1970s Nathan Azrin published his concept of mutual reinforcement and reciprocity. [3] Azrin stated that (1) human behavior is maintained by reinforcement on the person who performed the behavior (2) people have a tendency to treat others as they are treated and (3) mutual reinforcement accounts at least partially for concepts like friendships, joy, and love. Neil Jacobson pioneered the behavioral marital therapy approach. He published a book with Gayla Margolin, which launched a social learning model of couples therapy. [4] In this model of therapy, partners learn to be nicer to each other through behavioral exchange (contingency contracts), communicate better and improve their conflict-resolution skills. Early support came when John Gottman found that as long as the ratio of positive to negative interactions remains at least five to one, the relationship is sturdy. When the ratio dips below there is a 94 percent chance that a couple will divorce. [5] Other authors have found a role for exchanges as well. [6] Behavioral marital therapy model remains the most researched model of family therapy and was found to be effective for treating marital discord and depression in women. [7] Parts of the behavioral couples therapy model, in particular strategic use of the communication skills to reinforce drug abstinence and open dialogue about treatment, were introduced as a method for getting drug abusing partners into treatment, a method known as Community reinforcement approach and family training. [8]
Early research suggested that the components of behavioral marital therapy worked as predicted. The social exchange component led to increases in marital satisfaction in the short run. The communication training program led couples to communicate better and produced more long term changes in contingencies between couple members. [9]
Disillusionment with the traditional model began with a study in which it was found that only 50% of couples responded to the therapy. [10] In addition, traditional couple therapy did not produce more significant outcomes compared to insight-oriented couple therapy. [11]
Integrative behavioral couple therapy (IBCT) was developed by Neil S. Jacobson and Andrew Christensen. The model represents a return to contextualism, functional analysis and Skinner's distinction between contingency shaped and rule governed behavior. [12] Integrative Behavioral Couple Therapy is "integrative" in at least two senses: First, it integrates the twin goals of acceptance and change as positive outcomes for couples in therapy. Couples who succeed in therapy usually make some concrete changes to accommodate the needs of the other but they also show greater emotional acceptance of the other. Second, IBCT integrates a variety of treatment strategies under a consistent behavioral theoretical framework. It is considered a third generation behavior therapy or sometimes called clinical behavior analysis.
Both the integrative and traditional behavioral couples therapy models have origins primarily in behaviorism. [13] While traditional behavioral couples therapy has more roots in social learning principles and the later model in Skinnerian behaviorism. The latter model draws heavily on the use of functional analysis (psychology) and the Skinnerian distinction between contingency shaped and rule governed behavior to balance acceptance and change in the relationship. [14] [15]
IBCT consists of two major phases, an evaluation/feedback phase and an active treatment phase. The first three sessions consist of an evaluation period where the therapist learns about the concerns of the couple. In the first session, the therapist usually sees both partners together, learns what brings the couple to therapy, and obtains a brief history of their relationship. The therapist may suggest couples read a self-help book during treatment that serves as a guideline for IBCT therapy. [16] Also during this first session, the therapist normally gives each partner some questionnaires to complete and bring to their individual sessions, which are the next two sessions. 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". The therapist may gather some final information in the beginning of the session, but most of the session is devoted to feedback from the therapist. In the fourth session, the therapist describes the couple's difficulties and strengths and how therapy will try to assist the couple. A major part of the feedback session is the therapist's 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 couple actively participates in this feedback, giving their reactions, adding information, and correcting the therapist's impressions as needed.
After the feedback session, the couple can make an informed decision about whether the therapist and treatment seem right for them. Assuming they decide positively, then the active phase of treatment begins. Sessions at this point are almost always done jointly, with both members of the couple and the therapist. The focus is often on important recent incidents, positive or negative, that reflect their major theme or themes. For example, if a major theme concerned partners' difficulties in achieving emotional intimacy, the couple might discuss a recent incident in which they were able to achieve a sense of closeness with each other or an incident in which one or both reached out to the other but felt rebuffed. Similarly, if a major theme involved frequent struggles over decision-making, they might discuss a recent incident where they were able to reach agreement on a matter or an incident where they got into a negative, escalating conflict about an issue on which they disagreed. Upcoming incidents related to a couple's theme, such as a difficult, upcoming decision that the couple must make, and broader issues related to a couple's theme, such as how partners in a couple who struggles to achieve emotional intimacy react when their feelings are hurt, are also a focus of discussion. In these discussions, the therapist is often quite active, helping the partners communicate more openly, directly, and clearly, helping them identify the patterns that get them stuck, and assisting them in finding alternative ways of interacting.
The standard protocol for IBCT therapy is described in a treatment manual written for therapists. [17] This protocol includes 4 sessions for the assessment/feedback phase and an additional 20–22 sessions of active treatment. Typically, sessions are conducted every week and last just short of an hour. Toward the end of therapy, sessions are often spaced more widely; the typical course of therapy lasts between 6 and 12 months.
While traditional behavioral couples therapy focused heavily on change, [18] integrative couples therapy attempted to balance change and acceptance. [19] This is achieved through helping couples to better understand each other's learning history and to produce more contingency shaped changes in session and less rule governed changes for the couple. This is accomplished through therapist interventions such as turning the problem into something that happens to the couple. Some of the current research suggests that contingency shaped behavior is easier to maintain then rule governed behavior for couples. [20] As to behavioral function, the greater the amount of escape /withdrawal behavior a couples members displays during demand situations the higher the amount of distress. [21]
Integrative behavioral couples therapy addresses topics such as intimacy in couples relationships [22] [23] [24] [25] and forgiveness in couples. [26]
A growing number of researchers are interested in the concept of behavioral momentum with couples. Couples seem to go through periods of ongoing improvement and other couples seem to go through periods of negative momentum. Theoretically, behaviorism has begun to focus more on romantic love. [27]
Integrative behavioral couples therapy seems to work slower in producing change initially but has led to a 71% improvement rate in couples. [28] In addition, Integrative behavioral couples therapy does not produce as much change as traditional behavioral couples therapy but it does produce more acceptance. [29] At two years 69% of the Integrative behavioral couples therapy group appears to be doing better, while only 60% of the traditional group does better, while marital satisfaction was also in greater favor for the integrative behavioral couples therapy group. [30] However, the traditional behavioral couples therapy group had a larger decline in negativity toward each other than did the integrative behavioral couples therapy group. [31]
Overall the state of the research of couples being treated specifically for marital infidelity is in its infancy. One study, looked at 19 couples who had an affair. This study found that both traditional behavioral couples therapy and integrative behavioral couples therapy were effective in increasing intimacy after the affair was disclosed. [32] The authors suggested that this is good news for couples. A greater reliance on behavioral conceptualizations of romantic love [33] intimacy and forgiveness [34] [35] may be helpful in easing the pain of such difficult situations. [36]
Behavior analysis uses direct observation to determine the areas for intervention. [37] [38]
The Association for Behavioral and Cognitive Therapies (ABCT) has an annual conference where couple researchers and therapists can present their recent work in the field. The ABCT Couples Special Interest Group is part of ABCT and is composed of researchers whose focus is intimate relationships or clinicians whose focus is couple therapy.
The Association for Behavior Analysis International (ABA:I) [39] has a special interest group in Behavioral Counseling which has many couples therapists. ABA:I has two conventions per year on in the U.S. and one Internationally. Couples researchers and therapists often present at these conferences.
The World Center for Behavior Analysis offers a certification in behavior therapy that covers Integrative Behavioral Couples Therapy. [40]
Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis followed by synthesis.
Couples therapy attempts to improve romantic relationships and resolve interpersonal conflicts.
Discrete trial training (DTT) is a technique used by practitioners of applied behavior analysis (ABA) that was developed by Ivar Lovaas at the University of California, Los Angeles (UCLA). DTT uses direct instruction and reinforcers to create clear contingencies that shape new skills. Often employed as an early intensive behavioral intervention (EIBI) for up to 30–40 hours per week for children with autism, the technique relies on the use of prompts, modeling, and positive reinforcement strategies to facilitate the child's learning. It previously used aversives to punish unwanted behaviors. DTT has also been referred to as the "Lovaas/UCLA model", "rapid motor imitation antecedent", "listener responding", errorless learning", and "mass trials".
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism’s theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.
Contingency management (CM) is the application of the three-term contingency, which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavior therapy (CBT) framework as well.
Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological insulin resistance towards treatment of diabetes.
Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.
Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.
Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre-school and school-age children's behavior problems.
Behavioral activation (BA) is a third generation behavior therapy for treating depression. It is one functional analytic psychotherapy which are based on a Skinnerian psychological model of behavior change, generally referred to as applied behavior analysis. This area is also a part of what is called clinical behavior analysis (CBA) and makes up one of the most effective practices in the professional practice of behavior analysis. The technique can also be used from a cognitive-behavior therapy framework.
A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and is deemed to be a core component of that profession. Mental health nurses, social workers, and some psychiatrists may also use formulations.
Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems. According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness". In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate". Common factors is one route by which psychotherapy researchers have attempted to integrate psychotherapies.
Donald H. Baucom, is a clinical psychology faculty member at the University of North Carolina-Chapel Hill. He is recognized for founding the field of Cognitive-Behavioral Couples Therapy. Baucom is also recognized as one of the top marital therapists and most prolific researchers in this field. Currently, Baucom's National Cancer Institute funded study, CanThrive, has the largest observationally coded sample of any couples study to date.
Jack A. Apsche was an American psychologist who has focused his work on adolescents with behavior problems. Apsche was also an author, artist, presenter, consultant and lecturer.
The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.
Clinical Behavior Analysis is one of several ABA subspecialty fact sheets produced by the BACB in partnership with subject matter experts (SMEs).
Family therapy is a branch of psychology and clinical social work that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.
Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.
Jay Lebow is an American family psychologist who is senior scholar at the Family Institute at Northwestern University, clinical professor at Northwestern University and is editor-in-chief of the journal Family Process. He is board certified by the American Board of Professional Psychology. Lebow is known for his publications and presentations about the practice of couple and family therapy, integrative psychotherapy, the relationship of research and psychotherapy practice, and psychotherapy in difficult divorce, as well as for his role as an editor in the fields of couple and family therapy and family science. He is the author or editor of 13 books and has written 200 journal articles and book chapters.
Co-therapy or conjoint therapy is a kind of psychotherapy conducted with more than one therapist present. This kind of therapy is especially applied during couple therapy. Carl Whitaker and Virginia Satir are credited as the founders of co-therapy. Co-therapy dates back to the early twentieth century in Vienna, where psychoanalytic practices were first taking place. It was originally named "multiple therapy" by Alfred Alder, and later introduced separately as "co-therapy" in the 1940s. Co-therapy began with two therapists of differing abilities, one essentially learning from the other, and providing the opportunity to hear feedback on their work.