Chapter 17
INTEGRATIVE BEHAVIORAL
COUPLE THERAPY
Andrew Christensen and Shirley Glynn
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Integrative behavioral couple therapy (IBCT) was
developed in the 1990s by Andrew Christensen and
the late Neil S. Jacobson (Christensen, Jacobson,
& Babcock, 1995; Jacobson & Christensen, 1998).
It grew out of their dissatisfaction with traditional
behavioral couple therapy (TBCT; Jacobson &
Margolin, 1979), the most empirically validated
treatment at the time (Christensen & Heavey, 1999).
Although firmly situated within behavioral theory,
IBCT, as compared with TBCT, broadened the
conceptualization of couple distress and thus the
assessment of that distress, pushing past the notion
that the ratio of positive to negative events was the
key to understanding couple distress. IBCT also
expanded the conceptualization of the goal of couple
intervention, moving beyond the idea that the key to
successful therapy was promoting simple behavior
change (i.e., increasing positive behaviors and
decreasing negative behaviors) and incorporating
the therapeutic objective of emotional acceptance.
Because of this emphasis on emotional acceptance,
IBCT is more closely linked to third wave behavioral
approaches than to either traditional behavioral or
cognitive behavioral approaches.
Since its development more than 25 years ago, the
efficacy of IBCT has been examined in comparison
with TBCT as well as wait-list controls. The effective­
ness of IBCT in the real world has been examined in
a system-wide dissemination effort through the U.S.
Department of Veterans Affairs (VA). In addition,
http://dx.doi.org/10.1037/0000101-017
APA Handbook of Contemporary Family Psychology: Vol. 3. Family Therapy and Training, B. H. Fiese (Editor-in-Chief)
Copyright © 2019 by the American Psychological Association. All rights reserved.
APA Handbook of Contemporary Family Psychology: Family Therapy and Training,
edited by B. H. Fiese, M. Celano, K. Deater-Deckard, E. N. Jouriles, and M. A.
Whisman
Copyright © 2019 American Psychological Association. All rights reserved.
IBCT has been adapted into a 6- to 8-hour online
program for couples at www.ourrelationship.com,
and tested via a nationwide clinical trial. In this
chapter we examine the theoretical background
for IBCT, contrasting it to traditional and cognitive
behavioral approaches. We describe the assessment
and treatment strategies of IBCT and the efficacy
studies that evaluated its success. Finally, we discuss
the recent efforts at dissemination through VA and
through the online program for couples.
CONCEPTUALIZATION OF COUPLE
DISTRESS AND INTERVENTION
Every approach to couple therapy rests on a theory
or at least a conceptualization of couple distress and
a related theory or conceptualization of intervention
in that distress. In this section we describe how
IBCT views distress and intervention.
Couple Distress
Scholars studying close relationships focus on
interpersonal interaction as the essence of relationships
(Kelley et al., 2002). The back and forth interactions
between partners is what constitutes their relationship.
Barring extrasensory perception on the part of either
partner, partners can only experience what the other
person does or does not do. Certainly, each person
has many cognitive, emotional, and physiological
reactions to what his or her partner does or does not
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do, but each is privy to those reactions only through
the observable interaction. Thus, this interpersonal
interaction takes a central position in analyses of
close relationships and in IBCT.
From an IBCT perspective, problems occur in
close relationships when one partner’s (P’s) actions or
inactions lead to negative responses such as anger and
disappointment in the other (O), which in turn leads O
to respond in ways (e.g., critical comment, withdrawal)
that produce negative responses in P. Occasional
occurrences of such negative reactions are typical
in any relationship and do not become problems
until they are repetitive and intense. When couples
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experience these negative interactions repetitively and
intensely—when they form a negative cycle or pattern
of interaction—then the partners are likely to define
their relationship as having problems and may seek
intervention for those problems.
Interaction in romantic relationships, and indeed
interaction in any dyad, is influenced by three
broad, distinguishable factors: the characteristics
that P brings to the relationship, the characteristics
that O brings to the relationship, and the physical
and social context in which the relationship occurs.
IBCT conceptualizes these three factors as well as
the interactions they influence through a conceptual
framework called the DEEP understanding or
DEEP analysis. DEEP is an acronym that refers to
Differences between partners; Emotional sensitivities
in partners and the subsequent emotional reactions
that partners bring to the relationship; External
circumstances, particularly external stressors, that
provide the context for the relationship; and the
Pattern of interaction that is influenced by the DEE
and which in turn influences the DEE.
Differences between partners can refer to any kind
of characteristic in which they vary and that influences
their interactional behavior. For example, differences
can refer to (a) personality differences such as P being
more extraverted than O; (b) differences in preferences
such as P being more frugal than O; (c) differences
in interests, such as P having greater enthusiasm for
outdoor activities than O; (d) differences in family
connection, such as P having stronger connection to
his or her family of origin than O; or (e) any other
kind of important differences such as those in libido,
cultural identity, or emotional expression. IBCT tends
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to focus primarily on differences since it is these
disparities that are more likely to create problems for
partners. However, similarities can occasionally lead to
difficulties as well. For example, both partners may be
very cautious about taking financial risks and hesitate
to buy a home until prices have escalated beyond their
financial means. They may then criticize each other for
not pushing more to take a risk on real estate.
The second part of the DEEP refers to emotional
sensitivities or vulnerabilities that partners bring to
the relationship. Common sensitivities that affect
relationships are fears of abandonment by the other,
concern that the other may cheat, lack of confidence
in one’s attractiveness to the other, a tendency
to easily feel rejected by the other, being “thin-
skinned” and thus reactive to any kind of criticism or
disappointment from the other, and strong reactivity
to any kind of control or influence by the other. These
sensitivities can make differences between partners
even harder to manage. For example, if one partner
is a saver and the other is a spender and they each
have sensitivities associated with this difference, then
navigating the difference will be especially difficult.
Imagine if the saver has a history of economic
deprivation that makes him or her especially fearful
of potential future financial difficulties; his or
her saving preferences would be driven by strong
emotional concerns. If the partner of the saver—
the spender—has a history that renders him or her
especially emotionally reactive to feeling controlled
by the other, then the spender may have difficulty
accommodating the saver’s concerns.
The third part of the DEEP, external circumstances,
refers to the context of the relationship. IBCT focuses
primarily on external stressors, since these are the
circumstances that most often create difficulties for
couples. External stressors typically refer to concerns
such as job pressures, challenges generated by
family members or friends, economic conditions, or
illness. If, for example, the spender and saver couple
experience some economic setback, such as loss of
money in the stock market, unemployment, or a
reduction in work hours, the challenge the partners
face in dealing with financial issues will even be
more daunting.
The final part of the DEEP, the pattern of
communication, refers to the manner in which a

couple tries to solve the problems created by their
differences, emotional sensitivities, and external
stressors. Optimally, the spender and saver couple
would deal with the challenges presented by their
differences, emotional sensitivities, and external
stressors around money by engaging in detailed
discussion and planning of how much each person
can spend individually as well as how much they
will spend jointly, and then executing the agreed-
upon plan. Of special interest in IBCT are patterns
of communication that do not effectively deal with
a couple’s challenges and that may even make them
worse. For example, suppose the saver gets mad
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at the spender when he or she learns of certain
purchases by the spender, and the spender reacts
by hiding his or her purchases or refusing to talk
about them. This may lead to greater anxiety on
the part of the saver, who then tries to monitor the
spender more closely and challenge him or her
more adamantly, which could in turn lead to even
less disclosure, more resentment, and perhaps even
more purchasing on the part of the spender. Such a
pattern could then escalate further until spender and
saver are stuck in a vicious cycle of interaction that
leads to alienation.
A key aspect of the pattern of interaction in
distressed couples is what Rohrbaugh and Shoham
(2015) highlight as ironic processes. From their
standpoint, each partner behaves in ways that would
seem to achieve his or her goals. The saver monitors
the spender and challenges him or her on purchases
as a way of controlling expenditures. The spender
hides his or her purchases as a way of having the
freedom to spend without negative reaction from the
saver. However, these well-intentioned efforts often
backfire, resulting in the saver having less influence
over purchases and the spender facing increased
negative reaction from the saver. Rather than solving
the problem created by their differences, emotional
sensitivities, and external stressors around money,
their pattern of interaction has exacerbated that
problem. Their external stressors may even increase
if their financial resources are reduced due to their
lack of cooperation on a budget.
Because of the factors conceptualized in the DEEP
analysis, couples often feel “stuck” or “trapped”
in their pattern of interaction, repeatedly doing
Integrative Behavioral Couple Therapy
what from their perspective should be helpful but
that in fact does not resolve the problem. In fact,
the pattern of communication and the resulting
frustration often makes the problem worse in several
ways. First, the couple’s interactions may escalate
in intensity so that their voices and their emotions
both rise. Second, they may become more polarized
on the issue as a result of their pattern of interaction.
For example, the saver may become more anxious
about money and thus more focused on saving,
while the spender may feel threatened regarding
his or her autonomy and become more focused on
spending without influence from the other. Third, the
partners may begin to vilify each other’s positions, so
that they view the other in terms of deficiencies rather
than differences. The saver may see the spender as
immature and irresponsible, while the spender views
the saver as uptight and unable to enjoy life. Finally,
a central conflict can metastasize so that tension
around one conflict begins to color other aspects of
their lives that were formerly pleasurable or conflict-
free. The partners become alienated from the other.
Feeling hopeless and helpless to solve the problem,
they may seek therapy.
Intervention in Integrative
Behavioral Couple Therapy
Because it is a behavioral approach to therapy for
couples, IBCT shares the broad theoretical foundation
of behaviorism (see Volume 1, Chapter 4, this
handbook) with TBCT (Jacobson & Margolin,
1979) and with traditional cognitive behavioral
couple therapy (CBCT; D. H. Baucom & Epstein,
1990; see Chapter 16, this volume). However, IBCT
differs from these two behavioral approaches in its
definition of problems, its targets of change, and its
strategies of change.
A hallmark of behaviorism was its focus on clearly
defining specific, observable, molecular behavioral
targets of change. Rather than considering therapy
an effort to alter character traits or unconscious
conflicts, therapy was viewed as an effort to change
specific behavioral actions. As applied to couples,
this emphasis on behavioral targets meant that TBCT
focused on changes such as reducing the frequency of
verbal criticism of appearance and dress, for example,
or increasing the frequency of physical affection such
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as hugs and kisses. In CBCT, the focus on specific,
molecular targets was expanded to include thoughts,
such as negative attributions about the partner (“You
are only nice to me when you want something from
me”) or negative interpretations of the partner’s
actions (“You didn’t listen to me so you must not care
much about me”). In contrast, in IBCT, the focus is
on broad molar patterns of behavior, such as those
described in the DEEP analysis. For example, a
couple might be described as being in a broad pattern
where P is in a demanding pursuit of O, while O
is in a resentful retreat from P. IBCT would involve
describing behavioral exemplars of that pattern, but
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would not assume that the pattern was fully described
by those particular exemplars. More importantly, in
IBCT, it is assumed that behaviors within a broad
pattern often have a similar functional value. For
example, the various critical and pursuing behaviors
of P may be a way to seek engagement from O. If O
does engage with P in a meaningful way, perhaps
some of the negative actions of P, such as P’s criticism,
may decrease on their own without ever being
specifically targeted for change.
A second hallmark of early behavioral approaches
to couples related to the focus on specific target
behaviors was that the goal of therapy was to
increase the frequency of positive behaviors that
partners wanted from each other, and to decrease
the frequency of negative behaviors that they found
aversive. Increasing the ratio of positive to negative
behaviors was a clear goal of TBCT and was thought
to be a causal determinant of relationship satisfaction
(Jacobson & Margolin, 1979). As noted previously,
CBCT not only focused on positive and negative
behaviors, but also broadened the scope to include
positive and negative thoughts about the partner.
Improvement in ratios of positive to negative
behaviors and thoughts is certainly valued in
the practice of IBCT, and some behaviors such
as vio­lence and cruelty must change. However,
for most couples, each partner’s long-standing
characteristics mitigate against the possibility of
eliminating most negative behaviors and thoughts
or increasing most positive behaviors and thoughts
that partners might desire. Furthermore, in IBCT, it
is assumed that most of the negative acts or thoughts
that partners wish to abolish in the other are not
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egregious, but are rather garden-variety slights,
rejections, criticisms, and frustrations that may occur
in daily intimacy. Egregious acts that do sometimes
happen in relationships are often the result of an
escalation that began with those more common
emotional injuries. In IBCT, it is further assumed
that the problems everyday negative behaviors
and thoughts create are a function not just of the
noxiousness of the behaviors or thoughts, but also
of the partner’s sensitivity and reactivity to them. In
other words, a sensitive person may get upset at a
critical partner’s remarks not just because they are
cutting, but also because he or she is reactive. Thus,
a major goal in IBCT is emotional acceptance of the
other and his or her behavior as well as change in
that behavior. In addition, IBCT assumes there is an
interplay between acceptance and change. Partners
who push too hard for change may actually decrease
the chances of change, whereas acceptance may
foster change. And, if some change does take place,
acceptance becomes easier.
A final characteristic of IBCT that distinguishes
it from TBCT and CBCT has to do with the strategy
of change. TBCT and CBCT focus on deliberate or
rule-governed behavior, whereas IBCT focuses on
spontaneous or contingency-shaped behavior
(Skinner, 1966). In the former, people engage
in behaviors because they have been taught that
they should, and they know their performance of
these behaviors will be reinforced. For example, a
student may pay attention in class despite a lack of
interest in the material because he or she knows the
material could be included on an exam. In contrast,
in contingency-shaped behavior, people engage in
behavior as they are guided by the contingencies
occurring in the immediate situation. In this case,
for example, a student may pay attention in class
because he or she finds the material fascinating and
wants to discuss it with a partner.
As a strategy of change, TBCT and CBCT employ
rule governed-behavior by identifying a behavioral
target, instructing partners to engage in that behavior
or training partners in the performance of that
behavior, and then shaping and reinforcing the
resultant behavior. Common strategies in TBCT and
CBCT include communication training, in which
partners are taught effective ways to communicate

about and solve problems, and cognitive restructuring
in CBCT, in which negative thoughts are identified
and challenged. In contrast, IBCT attempts to create
both acceptance and change through contingency-
shaped behavior. IBCT guides couples through a
discussion of emotionally salient material, such as a
recent conflict, and exposes or highlights previously
overlooked but important material that might change
the nature of the interaction. For example, a wife may
have felt rejected by her husband when they were
out with another couple who were very physically
affectionate and her husband did not even hold her
hand. As the therapist helps the couple explore this
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difficult scenario, particularly the emotions they
experienced during the event, perhaps the husband
reveals that he felt uncomfortable and awkward
around this new couple, and his wife reveals that
seeing the other couple’s easy display of affection
made her feel bad about their own relationship. Such
a discussion may lead the wife to be more accepting
of her husband’s difficulty in displaying affection, or
the husband to be more tender toward his wife. If any
positive change results from the discussion, it would
not be because it was deliberately targeted and trained
by the therapist, but because new, important material
was disclosed or discussed in a way that naturally led
to the changes.
DESCRIPTION OF EVALUATION AND
INTERVENTION IN INTEGRATIVE
BEHAVIORAL COUPLE THERAPY
IBCT consists of four phases: assessment, feedback,
active treatment, and termination. During the
assessment phase, partners are seen together and
individually and complete various questionnaires
to provide the therapist with information about
their concerns. Following this assessment, the
IBCT therapist provides the couple with feedback
about their relationship and an overview of how
IBCT would proceed. Assuming the couple makes
a decision to continue, then the active intervention
phase of IBCT occurs, which almost always involves
multiple joint sessions with both partners. During
the termination phase, the couple may taper off their
contact with the therapist until the final termination
session, which is similar to the feedback session
Integrative Behavioral Couple Therapy
but focuses on positive changes that have been
made during therapy and the maintenance of those
changes. We will now describe each of those phases.
Assessment Phase
The initial session is always conducted jointly so the
therapist can learn about each partner’s perspectives
on the presenting complaints and make a connection
with each partner. After hearing about these
presenting complaints, the IBCT therapist may
summarize his or her initial understanding of the
concerns before transitioning into the couple’s
relationship history. The IBCT therapist attempts
to learn what attracted the partners to each other,
what holds them together despite their concerns,
when those concerns developed, and what may
have triggered the concerns. At the end of the initial
session, the IBCT therapist gives each partner a
series of questionnaires to complete and bring back
to the individual session. These questionnaires
assess, at a minimum, (a) overall satisfaction in the
relationship, (b) intimate partner violence in the
relationship, (c) commitment to the relationship,
and (d) problems in the relationship. Currently,
the authors use the Couples Satisfaction Inventory
(CSI-16; Funk & Rogge, 2007) to assess satisfaction,
the Couple Questionnaire (Christensen, 2009) to
assess violence and commitment, and the Problem
Areas Questionnaire (Heavey, Christensen, &
Malamuth, 1995) to assess problems that may
not have been mentioned in the interview (these
questionnaires may be freely obtained at http://
ibct.psych.ucla.edu/questionnaires.html).
During the individual session with each partner,
the IBCT therapist collects the questionnaires listed
above and follows up on the presenting complaints
to obtain more information about each partner’s
perspectives. The IBCT therapist also explores
salient and relevant features of each partner’s
history, such as previous psychological treatment,
psychiatric medication, and significant events
that might be related to the current problems. For
example, perhaps infidelity by a parent or infidelity in
a previous romantic relationship has made a partner
sensitive to issues around trust. During both the
initial joint session and the individual sessions, the
IBCT therapist identifies one or two core issues and
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tries to fill in the pieces of a DEEP analysis of these
core issues.
Also during the individual sessions, the IBCT
therapist explores possible intimate partner
violence by examining questionnaire responses to
violence items and by asking partners about any
incidents of such violence. With the occurrence
of intimate partner violence, which is common in
distressed relationships, the therapist must evaluate
whether couple therapy can proceed safely and
effectively. The usual criteria for concluding that
couples cannot engage in couple therapy safely and
effectively is whether there has been injury and/or
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intimidation previously. If either partner has been
injured or is afraid to voice her or his feelings openly
for fear of physical reprisal, then couple therapy
is usually contraindicated, particularly if injury or
intimidation has occurred in the last year.
Another issue routinely assessed in the individual
session is commitment to the relationship. IBCT
therapists need to know if partners want the relation­
ship to succeed and are willing to put in effort to
make it succeed. Partners often are ambivalent,
but if either partner has “checked out” of the
relationship or is unwilling to make any efforts to
improve the relationship, IBCT cannot proceed
since it is a treatment for relationship improvement
and not relationship dissolution. In the context
of commitment, therapists often inquire about
affairs. IBCT focuses not just on sexual affairs
but on any significant relationship that is hidden
from a partner. If there were past affairs but there
are no current affairs and the commitment to the
marriage is strong, the therapist can discuss with
the partner the pros and cons of revealing the past
affair, but revelation is not mandatory for the IBCT
to proceed. However, if there is a current affair,
the IBCT therapist insists that the partner end the
affair or reveal it to the other person, or both.
IBCT cannot be conducted effectively if there is a
significant, secret relationship in competition with
the relationship for which therapy is sought. If
the partner agrees to end the affair but not reveal
it to the other partner, the therapist arranges for
periodic individual meetings with each partner
during treatment so that therapist can be sure that
the affair was indeed discontinued.
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Feedback Phase
After the initial session and the individual sessions
with each partner, the IBCT therapist consolidates
the information obtained from those interviews and
from the questionnaires the partners completed, and
constructs an outline of feedback for the couple.
This feedback, which takes place during the fourth
session with both partners present, consists initially
of a clinical conceptualization of the problems. This
conceptualization includes the following:
1. Level of distress. The therapist discusses how
happy or unhappy each partner is and may
provide them with the scores on the CSI-16 along
with appropriate norms (e.g., showing the couple
that their scores place them in the borderline
range between satisfied and dissatisfied couples).
2. Commitment. The therapist discusses the partners’
level of interest in improving the relationship and
their willingness to work on the relationship.
3. One or two core problems and the corresponding
DEEP analysis. This is the key part of the clinical
conceptualization. The IBCT therapist shares his
or her initial views of the DEEP analysis of the
couple’s core problems, presenting the analysis
tentatively and encouraging partners to elaborate
or alter the analysis as they see fit. The therapist
may also elaborate on how the pattern of inter­
action has impacted the partners, polarizing
them in their positions, leading them to view
each other negatively, alienating them from each
other, and making them feel trapped or stuck and
thus hopeless or helpless.
4. Strengths. The IBCT therapist discusses key
individual and relationship strengths that the
couple maintains that will help them deal with
their difficulties.
After the clinical conceptualization has been
thoroughly discussed with the couple, the therapist
describes the active intervention phase of IBCT.
The content of this phase of therapy is driven by
the couple, and namely those incidents and issues
of emotional salience to the partners. The therapist
helps partners discuss these emotionally salient
incidents and issues in a constructive way. As part
of this discussion, the therapist introduces the
Weekly Questionnaire (Christensen, 2010; available
at http://ibct.psych.ucla.edu/questionnaires.html),

a one-page survey that partners will be asked to
complete independently right before the session
each week and that will guide the therapy. The
questionnaire consists of four CSI items that allow
the therapist to monitor the satisfaction of the
couple with their relationship since the last session;
questions about whether there have been any
incidents of violence or destruction, any problematic
incidents around drug or alcohol use, and any major
events or changes (to allow the therapist to routinely
monitor these events if they occur); and questions
about interactions with their partner, including
the most significant positive event experienced
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with the partner, the most significant negative
event experienced with the partner, any upcoming
challenging event with the partner, and any other
issue of concern even though there may not have
been an incident about it since the last session. The
active phase of therapy will involve discussion of
these salient incidents and issues, with the therapist
playing an active role in the discussion.
After the therapist has discussed the clinical
conceptualization and the process of IBCT with the
couple, the partners are asked to go home and discuss
the therapy with each other. If they feel comfortable
with the approach and with the therapist, then they are
asked to confirm this with the therapist and the first
session of the active intervention phase is scheduled.
Active Intervention Phase
The goals of IBCT are both acceptance and change,
but the emphasis is on one or the other depending on
the aspect of the DEEP analysis under consideration.
Because differences and emotional sensitivities
are often related to personality characteristics that
are unlikely to change quickly if at all, emotional
acceptance is the IBCT goal for these. Sometimes
external circumstances and stressors can be changed,
but often they cannot be changed without creating
even greater distress. Therefore, acceptance or change
is targeted for these external factors, depending on
their role in the couple’s life. However, change is
the goal for the couple’s pattern of interaction. IBCT
helps couples interact about their difficulties so they
do not get stuck in their usual pattern of interaction.
As noted previously, the typical content of an
IBCT therapy session focuses on salient events and
issues in the couple’s life. The therapist collects the
Integrative Behavioral Couple Therapy
Weekly Questionnaire and examines the items to
see how their week has gone. If there were incidents
of violence or destruction, problems with drugs or
alcohol, or major changes, these events will be the
focus of the session at the beginning and, depending
on their importance, may occupy the entire session.
If none of these events occurred, then typically the
IBCT therapist would begin by discussing the most
important significant positive events that occurred.
If a positive event was significant for the couple
(e.g., they handled their core issue in a better way,
had sex for the first time in a long time), then the
therapist will give it significant attention, trying to
ensure that the couple receives sufficient reinforcement
and understands how they were able to bring about
such a positive event on their own. If the positive
event was not significant (e.g., the couple went to
a fun movie together), the therapist will not spend
much time on it, but will note how the couple is still
able to enjoy time together despite their difficulties.
The IBCT therapist then sets an agenda with
the couple based on the incidents and issues they
listed. Partners sometimes both list the same recent
negative or upcoming incident as a focus for their
discussion. If they have an urgent need to discuss
separate incidents or issues, the therapist ensures
that time is given to both. During the discussion of a
difficult incident or issue, couples often will fall into
their usual pattern of problematic interaction. The
therapist then shifts attention away from the incident
or issue to what is happening during the session—
namely, their problematic pattern of interaction.
Now, a central focus of therapy is happening in real
time and provides both a good opportunity and a
challenge for the therapist. Toward the end of the
session, the therapist summarizes the major points
that were discussed and what might be taken away
from the session. If the session was heated, the
therapist starts the process of ending it early enough
so that partners don’t feel cut off, and can discuss
whether they can leave the topic in the therapy session
or want to continue discussing it after they depart.
The therapist works to actively engage the
couple in constructive discussions of their difficult
incidents and issues, but their typical pattern of
problematic interaction is the default setting for
these discussions. In place of this default pattern of
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problematic interaction, the IBCT therapist tries
to substitute compassionate discussions, analytic
discussions, and practical discussions. These are
conceptually separate discussions and will be
discussed as such in this section of the chapter.
However, in practice, the discussions are blended.
To facilitate these three types of discussions,
the therapist often begins by having all interaction
directed at him or her. If partners talk to the
therapist rather than to each other, the therapist
has the greatest control and can ensure each
partner’s perspective is heard and acknowledged,
can shift partners’ often blaming statements to the
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understandable emotions behind those statements,
can validate those emotions, and can transition
between partners to minimize defensiveness and
counterattacks. At certain points, the therapist
can switch the direction of the conversation so
that partners talk directly to each other. If an IBCT
therapist discovers an important but overlooked
emotion or perspective in one partner that might
change the dynamics of their interaction, the
therapist may encourage the partner to express that
emotion or voice that perspective directly to the
other partner, since direct contact may heighten
the power of the revelation. As partners get better
at discussing their concerns without reverting to
their usual pattern of interaction, the therapist may
encourage direct conversation between them, but
intervene when it goes off track.
A major intervention in IBCT is empathic joining,
which is designed to promote compassionate
discussions around emotional wounds that the
relationship has created. In empathic joining, IBCT
therapists help the couple engage in a heart-to-heart
discussion about a significant relationship event or
issue in which partners share feelings, some of which
they may not have shared previously or shared so
fully. To promote this compassionate discussion,
IBCT therapists are attuned to emotional reactions,
both surface reactions that are easily displayed as
well as the hidden reactions that are not so easily
revealed. For example, Bill may have shown the
surface reaction of anger and irritation on the way
home from a party where he thought his partner Sue
was flirting with another man. Sue did not think
she was behaving inappropriately, and a heated
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argument ensued. The therapist would acknowledge
the anger that Bill felt about what he perceived as
a violation of their relationship, and would also
acknowledge the reciprocal anger that Sue felt about
being, from her point of view, unjustifiably attacked.
However, the therapist would try to uncover and
develop other, hidden emotions that the partners
might also have been experiencing. Bill may have
felt like he was snubbed by Sue, or that she was
more interested in another man than in him. He may
have felt competitive with the other man. When
revealed through careful probing by the therapist,
Bill’s emotions might lead to a different reaction in
Sue than anger. Similarly, Sue may have had some
mixed feelings about the man she talked to or her
own behavior. Maybe she also felt that she had
moved into a “gray zone,” and felt a little guilty or
bad that it bothered Bill. Maybe she had been feeling
unappreciated or undesired by Bill and enjoyed the
attention of another man. This hidden material has
the potential to change the nature of the discussion
from argument (attack, defense, and counterattack)
to something more meaningful, during which
Bill and Sue can come to a greater understanding
and appreciation of each other that leads to some
emotional acceptance and possible change. Even if
the partners are unable in the moment to be more
open and vulnerable with each other or move to
a kinder and more understanding place with the
other, each partner gets understanding and validation
from the therapist, who may suggest possible hidden
emotions that could be going on in the other partner.
Each partner hears what the therapist says to the
other partner, and those therapist comments can
soften the interaction later, even if partners haven’t
been able to let down their guard with each other or
show empathy for each other in the session.
A second major intervention in IBCT is unified
detachment, which is meant to promote analytic
discussions. In contrast to empathic joining, in
which the emphasis in the discussion is on mutual
emotional disclosure, in unified detachment the
emphasis is on sharing observations, perspectives,
thoughts, and analyses. As in empathic joining,
in unified detachment a significant relationship
experience (e.g., an incident or issue) is discussed,
but in a descriptive, nonjudgmental, dyadic, and

mindful way. IBCT therapists shift partners away
from discussions that are evaluative, blaming,
individually oriented, and responsibility-seeking.
How do IBCT therapists promote these kinds of
analytic discussions and keep partners from placing
blame and making judgments about their partner or
themselves? The therapist guides partners through a
discussion of the sequence of their behavior during
an incident or issue, taking care to have them
identify the “triggers” or “buttons” that escalated the
discussion or were turning points in the interaction
and finding out how the interaction ended and if
and how they were able to come together again.
Copyright American Psychological Association. Not for further distribution.
During these discussions, the IBCT therapist might
distinguish intentions from effects (“You were
genuinely trying to help her, but it sounds like what
you did, out of the best of intentions, made her feel
incompetent and put down”); make comparisons
and contrasts (“The incident yesterday was very
similar to the one we discussed last week, but you
got over it much more quickly; do you have any
idea why you were able to recover so quickly?”); or
employ irony (“Isn’t it ironic that you hurt her the
most when you are trying to be the most helpful?”),
metaphor (“It seems like your pattern is kind of
like a game of cat and mouse”), or humor (“Could
you two come up with a name for this pattern that
captures some of its craziness and irony?”). In its
ideal form, unified detachment enables partners to
step back and examine a relationship incident or issue
using a kind of joint mindfulness. When partners are
able to do this, they can view the problem as an “it”
rather than a “you,” they may feel a common unified
perspective on the problem, and they may experience
greater acceptance of the problem, which may soften
their interactions about it.
A third major intervention in IBCT focuses on
practical discussions that create direct change.
A variety of interventions are included in this
category; they attempt to improve communication
and problem-solving, encourage positive behavior,
increase tolerance for inevitable negative events,
and foster self-reliance. In contrast to TBCT, which
promotes direct change by teaching communication
and problem-solving skills, having couples specify
pleasing events for each other, and agreeing to
engage in those events more frequently, IBCT
Integrative Behavioral Couple Therapy
involves accessing the couple’s existing behavioral
repertoire. Because of data indicating that couples
often do not retain the communication skills
taught to them (Hawkins et al., 2008), and because
couples sometimes find the communication skills
uncomfortable or alien compared with their normal
way of talking, IBCT therapists prefer to focus on
positive communication abilities in each partner’s
current repertoire of behavior. In IBCT it is assumed
that behavior will be more durable if it is already
in the person’s repertoire and just needs to be used
appropriately. Therefore, IBCT teaches traditional
communication and problem-solving skills only
secondarily.
One common direct change strategy is to replay
difficult interactions that occurred during the week
or that happen in therapy. In the replay of these
interactions, IBCT therapists promote both unified
detachment and empathic joining strategies. For
example, the therapist may remind partners of
the usual pattern of interaction in which they get
stuck (unified detachment) and give them a general
prompt, such as, “Have the same general discussion
but try to do it better so you do not get stuck in your
usual bind.” To encourage empathic joining, the
therapist may give specific prompts such as, “Talk
more about yourselves and your own feelings,” and,
“Try to stay away from focusing on your partner and
what he or she did wrong or what he or she may
be feeling.” If the interaction starts going better but
gets off track, the therapist will intervene to help
partners understand what led them off track (e.g.,
what one partner said or did that triggered the other
partner and his or her emotional reaction). The IBCT
therapist may help each partner clarify the message
he or she wishes to give to the other partner and to
articulate that message in a way that the other person
can hear it. If the discussion involves problem-
solving and concrete changes might be beneficial, the
therapist encourages partners to suggest actions that
they could each take that might resolve the problem.
Again, in IBCT it is assumed that solutions that
come from the partners themselves and refer to their
own behavior are more likely to be maintained than
solutions suggested by the therapist. IBCT therapists
may also intervene to reinforce and complement
what the partners are doing, or to normalize the
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 Christensen and Glynn
difficulty that they are having in trying to engage
in a more constructive conversation. In these ways,
IBCT therapists guide couples through better,
more meaningful communication than they had
experienced previously.
To promote positive interactions between partners,
IBCT therapists routinely attend to the partners’ most
important positive interaction during the week. By
discussing these naturally occurring positive events,
IBCT therapists help partners understand what they
enjoy about each other and what gives the other
pleasure. Only secondarily would IBCT therapists
invoke the TBCT rule-governed strategy of formal
Copyright American Psychological Association. Not for further distribution.
behavioral exchange, in which partners specify
behaviors that they think the other would like,
review whether those behaviors are truly pleasing
to the other, are encouraged to engage in more of
those pleasing behaviors, and are debriefed about the
impact of those behaviors.
Tolerance interventions are another key IBCT
strategy, though these are typically only used
later in therapy as they are grounded in the prior
acquisition of other skills. When partners have
achieved a level of unified detachment so that they
can describe—without judgment or blame—the
pattern of interaction in which they get stuck
and recognize this pattern when it occurs or soon
after it has occurred, the couple may be suited for
tolerance interventions. These interventions reflect
the reality that most couples are not going to avoid
their troubling patterns of interaction completely,
but can experience them less intensely and recover
from them more quickly. To do so, partners need
to develop some tolerance for some of the other’s
triggering behaviors.
In a common version of a tolerance intervention,
an IBCT therapist asks partners to enact their
problematic pattern of interaction during the session.
For example, a couple that gets stuck frequently in
an accuse–defend pattern might be asked to engage
in that pattern during the session. Because the
catalyst for this pattern is the therapist’s instruction
rather than the usual triggering events, the couple
is unlikely to engage in the pattern with the usual
level of intensity that occurs during a conflict. The
partners may find it difficult to totally engage in
the pattern, and laugh at their difficulty in enacting
284
something that they often do so easily. This humor
can lead to greater unified detachment from the
pattern. If they are able to truly engage in the pattern
and they begin to get emotional, the therapist can
interrupt their enactment and debrief their emotional
reactions, perhaps achieving some empathic joining
between them. The couple might also discuss how
they can maneuver out of the pattern, and may
make some direct change based on the experience.
Thus, the tolerance intervention exercise leads to
possibilities to engage in the other three basic IBCT
intervention strategies.
Another version of a tolerance intervention is for
the therapist to encourage only one partner to engage
in the provocative behavior. For example, one partner
might be encouraged to criticize the other while
the therapist focuses on the reactions of the partner
being criticized. If the criticizer has trouble being
authentic, it may result in lightness and laughter
that promotes unified detachment. If the criticizer is
authentic enough to trigger an emotional reaction in
the partner, this provides an opportunity for empathic
joining. In either case, the therapist might engage the
couple in a discussion about how the partner could
react to the criticism in ways that do not lead to the
typical escalating criticism–defensiveness pattern,
thus allowing some direct change.
A final version of a tolerance intervention,
usually presented after one of the previously
described in-session interventions, is to ask one or
both partners to “fake” the provocative behavior
at home when they are not feeling it. The criticizer
might be asked to be critical sometime during the
week when he or she does not feel critical, or the
defender asked to be defensive sometime during the
week when he or she does not feel defensive. After
taking the provocative actions, the partners are to
observe the other person’s reactions to understand
the impact of their behavior when they themselves
are not emotional. As a result of these tolerance
interventions, partners often feel greater control
over their problematic patterns of interaction, so
that these patterns are not so disruptive.
Termination Phase
The last phase of IBCT is the termination phase,
which consists of several sessions spaced at lengthier

intervals followed by a final termination session.
In the clinical trial discussed in the next section,
for example, couples were allowed a maximum of
26 sessions that had to take place over the course of
no more than a year. However, there is no minimum
number of sessions that couples are required to
attend in IBCT. When significant progress has been
made such that the couple can manage issues so
well that that there is little of emotional significance
to discuss during the sessions, and/or when the
couple wishes to terminate, the termination process
should begin. Ideally, the IBCT therapist begins
seeing the couple at lengthier intervals for a few
Copyright American Psychological Association. Not for further distribution.
sessions as part of this process—every two weeks or
monthly, for example—to ensure that the couple can
maintain their progress. Then a termination session
is held during which the therapist reviews the DEEP
formulation of the couple’s core concerns again and
emphasizes the changes that have been made. The
termination session also involves discussion about
how to maintain the changes and how to handles
setbacks. At the end of the session the therapist
assures the couple that they can now manage on
their own, but lets them know that the door is
always open for booster sessions if needed.
RESEARCH ON THE EFFICACY
OF INTEGRATIVE BEHAVIORAL
COUPLE THERAPY
Two small clinical trials and one large two-site
clinical trial have provided data on the efficacy
of IBCT. Wimberly (1998) randomly assigned
17 heterosexual couples to either IBCT delivered in
a group format or a wait-list control group, and the
results showed the superiority of IBCT. Jacobson,
Christensen, Prince, Cordova, and Eldridge (2000)
randomly assigned 21 heterosexual couples to either
IBCT or TBCT, and found that IBCT performed as
well as or superior to TBCT. Based in part on these
latter findings, Christensen et al. (2004) randomly
assigned 134 heterosexual couples to IBCT or TBCT;
approximately half the couples were treated in
Seattle, WA, and the other half in Los Angeles, CA.
In order to provide a challenging test for these
couple therapies, only seriously and chronically
distressed couples were included. Approximately
Integrative Behavioral Couple Therapy
100 couples who wanted treatment were excluded
because they were not distressed enough or distressed
consistently; a follow-up showed that almost half of
those excluded couples later sought couple therapy
in the community. Also, approximately 100 couples
in which the male partner had engaged in moderate
to severe violence were excluded because they were
deemed unsafe for couple therapy. All partners
were given diagnostic interviews, but were excluded
only for a very few Axis I or Axis II disorders in the
Diagnostic and Statistical Manual of Mental Disorders,
4th Edition (American Psychiatric Association, 1994),
such as psychotic disorders and antisocial personality
disorder. To ensure that couples were given the
best possible treatment, only licensed, experienced
therapists were used; all were given extensive training
before and during the treatment program. Adherence
and competence procedures, as well as ratings of
adherence and competence, insured that IBCT and
TBCT were demonstrably different and competently
delivered. To assess the long-term and short-term
effects of treatment, multiple measures were taken
during treatment and every 6 months for 5 years
after treatment ended. No additional couple therapy
was offered during the follow-up period.
Measures of relationship satisfaction taken
during treatment indicated a significantly different
trajectory of change in TBCT and IBCT. Couples
in TBCT showed immediate positive effects of
treatment that than leveled off, whereas couples in
IBCT showed consistent improvement throughout
treatment. However, there were no significant
differences between the two conditions at the
end of treatment: Pretreatment to posttreatment
effect sizes on marital satisfaction were d = 0.90
for IBCT and d = 0.71 for TBCT (Christensen,
Atkins, Baucom, & Yi, 2010). For the first 2 years
after treatment termination, couples generally
maintained their treatment gains, but couples in
IBCT fared better than couples in TBCT, showing
significantly greater relationship satisfaction at each
6-month measurement period. However, during
the remaining 3 years of follow-up, couples in both
conditions lost some of their treatment gains, and
relationship satisfaction in the two groups merged so
that there were no significant treatment differences.
At treatment termination, 70.4% of IBCT couples
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 Christensen and Glynn
and 60.6% of TBCT couples showed clinically
significant improvement (reliable improvement or
recovery). However, at 5-year follow-up, only 50%
of IBCT couples and 45.9% of TBCT couples showed
clinically significant improvement, with 25.7% of
IBCT couples and 27.9% of TBCT couples divorcing.
None of these differences between conditions in
percent of clinically significant improvement were
statistically significant. Pretreatment to 5-year
follow-up effect sizes on relationship satisfaction for
those couples who remained together were strong:
d = 1.03 for IBCT and d = 0.92 for TBCT. The
authors concluded that for many of these seriously
Copyright American Psychological Association. Not for further distribution.
and chronically distressed couples, some booster
sessions might be needed to maintain treatment
gains, including the differences between conditions
that existed during the first 2 years of follow-up
(Christensen et al., 2010).
Although relationship satisfaction and stability
are considered the crucial outcomes for couple
therapy, the Christensen et al. (2004) clinical
trial also assessed other important variables. Self-
reported communication showed improvement
during treatment and maintenance for 2 years of
follow-up. Observational measures of communication
also showed improvement during treatment, with
TBCT couples showing greater improvement
in communication by the end of treatment and
IBCT couples showing better maintenance of
communication gains by the 2-year follow-up
(K. J. W. Baucom et al., 2011; Sevier et al., 2008).
Observational measures of communication were
not included at the 5-year follow-up. Self-reported
measures of individual functioning, specifically a
mental health index and a measure of psychological
symptoms, varied in expected ways over time with
marital satisfaction.
Particular subsets of couples in the clinical trial
were also examined across treatment conditions
to evaluate whether the treatment was effective for
different types of couples. Couples experiencing
low-level violence benefited from treatment without
any escalation of violence (Simpson, Atkins, Gattis,
& Christensen, 2008); couples experiencing infidelity
were at greater risk of separation than couples without
infidelity, but those who stayed together showed as
much benefit as those without infidelity (Atkins,
286
Eldridge, Baucom, & Christensen, 2005; Marín,
Christensen, & Atkins, 2014). Finally, couples with
children showed less conflict over child-rearing and
some improvement in child adjustment, although
the latter was not maintained over follow-up (Gattis,
Simpson, & Christensen, 2008).
Several demographic, intrapersonal, and inter­
personal variables were examined as possible
predictors of both pretreatment satisfaction and
change in satisfaction. Although several variables,
particularly interpersonal variables, were associated
with initial satisfaction, very few consistently
predicted change in satisfaction, particularly at long-
term follow-up. Higher relationship commitment
and longer length of marriage were the only variables
predictive of long-term positive outcome across
treatment conditions (Atkins, Berns, et al., 2005; B. R.
Baucom, Atkins, Rowe, Doss, & Christensen, 2015).
Two potential mechanisms of change were
examined: change in the frequency of behavior that
couples targeted as important, and change in the
acceptance of that behavior. Targeted behaviors could
be either positive behaviors that a partner wanted
increased or negative behaviors that a partner wanted
decreased. Change would therefore mean that the
targeted behavior actually increased or decreased
appropriately, and acceptance would mean that
partners were more comfortable with the occurrence
of the behavior. Both change and acceptance were
linked with positive outcome in both treatments,
with change more strongly linked with outcome
early in therapy and acceptance more strongly linked
with outcome later in therapy. As predicted, TBCT
generated greater changes in frequency of targeted
behavior, whereas IBCT generated greater changes in
acceptance of targeted behavior (Doss, Thum, Sevier,
Atkins, & Christensen, 2005).
Trained observer ratings of video-recorded
therapy sessions throughout both IBCT and TBCT
were collapsed into two broad categories: positive
behaviors, such as collaboration and positive effect,
and negative behaviors, such as blame and negative
pressure to change. Analyses of these data revealed
a boost–drop pattern for couples in TBCT, in which
increases in constructive behavior (more positive
behavior and less negative behavior) early in therapy
were followed by decreases in these behaviors later,

but a drop–boost pattern for couples in IBCT, in which
decreases in constructive behavior early in therapy
were followed by increases in these behaviors later in
therapy (Sevier, Atkins, Doss, & Christensen, 2015).
This pattern probably reflects the different sequence
of intervention in the two treatments. TBCT starts
out with a focus on improving positive behavior
and delays discussing difficult issues until later in
therapy, while IBCT begins with whatever concerns
the partners wish to focus on, which is often their
difficult issues.
Copyright American Psychological Association. Not for further distribution.
IMPLEMENTATION OF INTEGRATIVE
BEHAVIORAL COUPLE THERAPY
There have been two major efforts to move beyond
efficacy studies and examine the effectiveness of
IBCT in the community.
Integrative Behavioral Couple Therapy
Rollout in the U.S. Department
of Veterans Affairs
Family problems and couple distress are among
the most common precipitants of veterans seeking
mental health treatment (Batten et al., 2009; Khaylis,
Polusny, Erbes, Gewirtz, & Rath, 2011; Meis et al.,
2013). To meet the increasing need for couple
and family counseling within VA, a large national
clinician training initiative was launched in 2006.
The goal of the training program was to provide VA
mental health line staff with expertise in evidence-
based couple and family interventions nationally
throughout the VA system.
Several criteria were used to select the couple
therapy intervention to be disseminated in VA clinics.
The intervention needed to have a robust evidence
base, an accessible manual, and be consistent with
the foundational training of most VA mental health
clinicians, which was primarily cognitive behavioral.
Further, the developer of the intervention had to be
willing to collaborate closely with VA on the project
to assure that the treatment met the unique needs
of veterans. A review of the scientific literature on
couple therapy for relationship distress suggested
that IBCT might most closely meet the suitability
criteria for dissemination in VA. The integration of
acceptance and behavioral change strategies was
Integrative Behavioral Couple Therapy
seen to be an additional benefit of the IBCT model.
VA serves a broad population of veterans, but most
are middle age or older, and many have longstanding
relationship and mental health challenges. A model
that could foster acceptance as one strategy to reduce
relationship discord was seen as consistent with the
needs of this population.
A formal training program in IBCT for licensed
VA mental health clinicians was initiated in 2010.
Licensed mental health clinicians from throughout
the VA system were invited to apply for the program,
consisting of 3 to 4 days of intensive face-to-face
IBCT training, which emphasizes both didactic
and experiential learning. The intensive training
is followed by a 6- to 8-month formal consultation
period, in which trainees see a minimum of two
couples for IBCT and attend weekly small group calls
during which they are provided feedback on their
work by expert IBCT consultants who have listened
to audiotapes of their therapy sessions and rated
them using a standardized fidelity and competence
rating scale. Program evaluation data on veteran and
partner couple satisfaction are routinely collected
throughout the treatment, and application to the
program is competitive.
To date, 12 VA IBCT trainings have been held,
including 412 trainees; each training typically
included approximately 30 licensed mental health
clinicians. These trainees have engaged and collected
at least baseline data on 692 veteran couples. Thus
far, 82% of the eligible trainees (n = 288) have success­
fully completed the consultation and achieved a
good level of proficiency in IBCT, as reflected by the
fidelity score ratings of their sessions. Couples who
attended more than just the initial IBCT session
attended an average of nine sessions, including the
four assessment sessions.
Veteran couples achieve benefits from attending
IBCT. For example, data from the couples seen by
the last two cohorts of trainees (n = 60) indicate
significant improvements in couple satisfaction
for each partner, as measured on the CSI-16 from
baseline to Week 4 and to Week 8, with within-
treatment effect sizes ranging from .31 to .48,
and longer courses of treatment being associated
with greater improvements in martial satisfaction.
These data are particularly impressive in that one
287
 Christensen and Glynn
or both partners in almost all of those couples has
one or more diagnosed mental disorder. These data
suggest IBCT can achieve benefits even in real-world
settings with relatively less experienced therapists.
Online Version of Integrative
Behavioral Couple Therapy
Relationship distress is widespread: About one third
of married partners are distressed at any given time
(Whisman, Beach, & Snyder, 2008), and about half of
first marriages end in divorce (Copen, Daniels, Vespa,
& Mosher, 2012). Although evidence-based couple
therapies have shown that they can reliably improve
Copyright American Psychological Association. Not for further distribution.
relationship satisfaction, only a small portion of
distressed couples seek out therapy. A recent survey
indicated that only 19% of couples have sought
couple therapy to improve their current relationship
and only 37% of divorced couples reported seeking
couple therapy prior to ending their marriage
(Johnson et al., 2002). Presumably because of
convenience and cost, people are more interested in
seeking relationship help from relationship-oriented
websites than from couple therapy (Georgia & Doss,
2013). If an online program could reliably improve
relationship satisfaction, it may dramatically increase
the reach of couple intervention.
With this notion of expanded reach in mind,
Brian Doss, Andrew Christensen, and their
graduate students developed an online version
of IBCT (Doss, Benson, Georgia, & Christensen,
2013), www.ourrelationship.com, supported by
a grant to Brian Doss from the National Institute
of Child Health and Human Development. The
program requires approximately 6 to 8 hours of
each partner’s time and consists of questionnaires,
exercises, animation, video examples, audio,
text, and graphics tailored to partners’ responses
and designed to engage partners and maintain
their interest. The program consists of three
phases described by the acronym OUR: Observe,
Understand, and Respond. In each phase, partners
work individually through most of the phase and
then come together toward the end of the phase for
a conversation directed by the program. During the
observe phase, partners complete questionnaires
about their relationship, get feedback about their
responses, and then come together to decide on
288
one or two core problems on which they wish to
focus throughout the remaining program. During
the understand phase, partners develop a DEEP
analysis of their core issue or issues and then share
this understanding with each other in a conversation
at the end of the phase. Finally, in the respond
phase, partners receive guidance on acceptance
and change, on communication strategies, and on
problem-solving strategies specific to their particular
issue. Partners separately develop a plan for altering
their usual pattern of communication, problem solve
their specific issues, and then come together and
share their ideas with each other with the goal of
creating a joint plan. At four points in the program,
partners talk by phone or videoconference for about
15 minutes with a staff coach who answers questions
about the program, encourages partners in their
progress through the program, and helps them with
any difficulties. These “coach calls” are carefully
scripted, are done by nonprofessionals, and are
designed to avert the conversation from becoming
couple therapy.
A nationwide clinical trial was conducted on this
program (Doss et al., 2016), in which 300 distressed,
heterosexual couples were randomly assigned to
either the OurRelationship program or to a 2-month
wait-list control group. These couples were roughly
representative of the U.S. population in terms of
race, ethnicity, and education. Eighty-six percent of
the couples completed the program and rated their
satisfaction with the program high. Comparisons
between treatment and control groups indicated
that the OurRelationship program led to significant
increases in relationship satisfaction (d = 0.69) as
well as improvements in individual functioning,
such as reduced depressive symptoms (d = 0.50) and
anxiety symptoms (d = 0.21) and increased perceived
health (d = 0.51), work functioning (d = 0.57), and
quality of life (d = 0.44). The program is being
adapted for low-income families and a clinical trial
with those families is underway.
CONCLUSION
Although it emerged from traditional and cognitive
behavioral couple therapies, IBCT is different from
those therapies in its theoretical emphasis, its

assessment and evaluation protocol, and its interven­
tion strategies. This chapter has documented these
differences and in so doing has described IBCT.
The chapter also discussed the body of efficacy and
effectiveness research that validates the positive
impact of IBCT. IBCT has taken exciting new
directions, extending its reach through dissemination
in the U.S. Department of Veterans Affairs and
through an online program. Further, as noted, this
online program is being adapted for low-income
couples and a major clinical trial with these couples
is being conducted.
Copyright American Psychological Association. Not for further distribution.
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