Dr. Andrew Christensen on Integrative Behavioural Couple Therapy

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/01/28

Andrew Christensen is Distinguished Research Professor of Psychology at the University of California, Los Angeles (UCLA). At UCLA, he conducts research on couple conflict and couples therapy and teaches couple therapy. He is a licensed clinical psychologist in the state of California and has a part-time private practice devoted to couples counseling and therapy. Dr. Christensen is devoted to the advancement of evidence-based treatments for couples in distress. Along with the late Neil S. Jacobson, he developed Integrative Behavioral Couple Therapy (IBCT), an empirically supported treatment for couples. Since 1993, he has been studying the effectiveness of couple therapy, especially IBCT, usually with federal grant support. In 2010, the US Department of Veteran’s Affairs adopted IBCT as one of its evidence-based treatments for couples.  Since then Christensen has been training VA therapists in IBCT and evaluating the impact of this therapy in the VA. Along with Neil Jacobson and Brian Doss, Christensen wrote a self-help book for couples based on IBCT: Reconcilable Differences (translated into French, Greek, Korean, Italian, Polish, and Portuguese). He also wrote a book for therapists on IBCT: Acceptance and Change in Couple Therapy (translated into Korean), which was recently revised and titled Integrative Behavioral Couple Therapy. With Brian Doss of the University of Miami, he developed an online intervention for couples: OurRelationship (available in English and Spanish). Christensen discussed his co-development of Integrative Behavioral Couple Therapy (IBCT) with the late Dr. Neil S. Jacobson. Created in the 1990s to address limitations of traditional Behavioral Couple Therapy, IBCT emphasizes emotional acceptance and evocative change over rigid, rule-governed strategies. It helps couples navigate conflicts like demand-withdraw dynamics while fostering mutual engagement and emotional safety. Christensen highlighted IBCT’s effectiveness, demonstrated through rigorous studies, including a five-year follow-up, and its adoption by the U.S. Department of Veterans Affairs. He also discussed IBCT-inspired innovations, like the OurRelationship online program, and the therapy’s emphasis on safety and self-reflection. 

Scott Douglas Jacobsen: Today, we are here with Dr. Andrew Christensen, a distinguished research professor of psychology at the University of California, Los Angeles (UCLA), specializing in clinical psychology. Christensendiscussed Integrative Behavioral Couple Therapy (IBCT), which was co-developed with the late Dr. Neil S. Jacobson. What inspired the development of this new methodology? How did it evolve in collaboration with Dr. Jacobson? 

Dr. Andrew Christensen: Neil and I began developing IBCT in the early 1990s because of the limitations of earlier approaches to helping couples. We were trained in behavioural couple therapy (BCT), also called behavioural marital therapy. Over time, the term was updated to encompass all types of romantic couples, whether married or not. While BCT was effective for some couples, many did not benefit significantly. Additionally, even among those who experienced positive outcomes, there was often a risk of relapse.

We developed IBCT to address these shortcomings in what was, at the time, the most widely practiced and empirically supported treatment for couples: Behavioral Couple Therapy (BCT). BCT encourages positive change by teaching couples to communicate better and solve problems more effectively. However, it lacked an important element: emotional acceptance.

There are limits to how much individuals are willing or able to change.. Certain aspects of a person’s character are deeply ingrained and shaped by genetics and life experiences. Interestingly, some traits we later wish our partners would change are often the same qualities that initially attracted us to them.

For instance, consider a couple we’ll call Jack and Jill. Jack might have been drawn to Jill’s vibrant, emotional energy—her ability to feel deeply and express herself passionately brought excitement to their relationship. Meanwhile, Jill might have been attracted to Jack’s calm, steady demeanor, which provided stability. However, as time passes, Jack might feel overwhelmed by Jill’s emotional fluctuations. At the same time, Jill might grow frustrated with Jack’s perceived lack of enthusiasm or spontaneity. This scenario highlights how positive traits can also have a downside. Often, we are drawn to our partner’s strengths but later wish they would change the challenges associated with those traits.

This understanding led us to focus on emotional acceptance as a cornerstone of IBCT. Some characteristics in a partner are unlikely to change substantially, especially not quickly or dramatically. While change is possible over time, emotional acceptance is vital for addressing those enduring aspects of a partner’s personality. This focus on acceptance became a defining feature of IBCT.

Another important factor was the approach to change. Traditional BCT relied on a “rule-governed” approach, which involved teaching couples specific communication techniques and providing guidelines for effective interaction. For example, couples might be instructed to use “I” statements to express their feelings more constructively.

So rather than saying, “You always do this,” you say, “I feel X when you do this particular Y.” Or, rules about listening. For example, you listen and don’t interrupt your partner. Before sharing your piece, you summarize what your partner has said so they know you’ve understood them, even if you don’t agree. These are the kinds of communication rules we taught, along with rules for problem-solving. We also encouraged specific behaviours.

We would give assignments to do positive things for each other. This is a rule-governed approach to change, which can be helpful. However, integrative behavioural couple therapy (IBCT) incorporates those strategies while introducing completely different ones. To explain that, let me step back and discuss the challenges of rule-governed change.

For instance, partners can be sensitive to whether something feels genuine. A common complaint in couples is, “You’re not affectionate enough,” or “I want you to be more sexual with me,” or “I want you to be more complimentary,” or “I want you to be more interested in what’s going on with me.” These desires are difficult to address through rule-governed behaviour. Assigning couples to have sex twice a week, kiss every night, or offer a positive comment daily—whether they feel it or not—often backfires. Partners may resist doing these things or feel that even if the other complies, it’s not heartfelt but rather done because the therapist or the rules dictated it.

Part of the joy in relationships comes from feeling that our partner genuinely wants to be affectionate, sexual, or complimentary. A heartfelt apology or compliment feels meaningful, while a mechanical gesture often feels hollow or hurtful. These issues highlight the limitations of rule-governed behaviour.

To address this, we focus on a type of behaviour change that is more evocative than deliberate. Deliberate change involves intentional, direct efforts, such as assignments or learning communication techniques, where the therapist essentially says, “Here’s how to do it right—now go do it.” In contrast, evocative change aims to shift the emotional climate in the room, fostering more genuine positive change.

We help couples reduce defensiveness and openly discuss their feelings and vulnerabilities. However, this only works when both partners feel emotionally safe—safe enough to admit limitations without fear of criticism or attack. For example, suppose one partner acknowledges a personal flaw. In that case, they need reassurance that the other won’t use it as ammunition against them.

Creating this emotional climate isn’t as straightforward as giving assignments. Still, it allows couples to express thoughts and feelings they may have never shared—or even fully recognized—before. Sometimes, a partner’s emotions are filtered through a single lens, such as anger. They might express anger instead of revealing deeper feelings of hurt or disappointment.

By fostering a safe and open environment, the therapist can help uncover and address these underlying emotions, leading to more genuine connection and understanding between partners.

Jacobsen: You’ve mentioned the importance of emotional acceptance and evocative change. Could you explain how these elements combine in Integrative Behavioral Couple Therapy (IBCT)?

Christensen: Certainly, often, in couples, you hear their anger and resentment. However,  underlying that anger may be disappointment or hurt that hasn’t been expressed. We can create an environment where partners feel safe to discuss these deeper emotions. In that case, it opens the door to more honest and empathetic discussions. This can lead to evocative change, where partners soften toward each other, treat each other with more tenderness, and shift the emotional climate of their relationship. This, in turn, can spontaneously lead to greater affection and emotional closeness.

To summarize, these are the two key innovations IBCT brings compared to traditional Behavioral Couple Therapy (BCT): an emphasis on emotional acceptance and evocative change strategies. Traditional BCT and Cognitive Behavioral Couple Therapy focused primarily on direct, intentional, and rule-governed change. IBCT builds on that foundation with these additional elements, creating a more comprehensive and flexible approach.

Once we developed IBCT, we secured federal grants to conduct rigorous research. First, we completed a pilot study, followed by a large clinical trial conducted at UCLA and the University of Washington, where Neil Jacobson was based. These studies demonstrated the effectiveness of IBCT, not only in the short term but also in the long term. We conducted the longest follow-up study of a major clinical trial in couple therapy, spanning five years. The evidence strongly supports the benefits of IBCT for couples.

In 2010, the U.S. Department of Veterans Affairs adopted IBCT as one of its evidence-based treatments for couple distress. Since then, I have consulted with the VA and helped train therapists in IBCT for about 15 years.

IBCT was the foundation for an online program called OurRelationship (ourrelationship.com), developed under the leadership of Dr. Brian Doss, a professor at the University of Miami but with my assistance. This program was designed to make IBCT principles accessible to more couples cost-effectively. The online program has been tested through multiple randomized clinical trials and has proven effective in improving relationships. It can be done entirely self-guided or with the support of a relationship coach. Working with a coach enhances effectiveness and increases the likelihood of completing the program.

The program consists of 6 to 8 hours of activities organized into three phases: O, U, and R, corresponding to Observation, Understanding, and Response—the acronym OUR.

1. O Phase (Observation): In this phase, partners work individually to complete empirically supported questionnaires and receive personalized feedback about their relationship. They identify one or two core issues that need attention. At the end of this phase, partners come together, guided by the program, to share what they’ve learned.
2. U Phase (Understanding): Partners again work individually to explore why the identified core issue/s are problematic for their relationship. This phase involves a deeper analysis of the challenges from both perspectives, which we call the DEEP analysis. Specifically, the programs helps partners identify natural Differences between them that contribute to the problem, Emotional sensitivities in each that add emotional fuel to the problem, External stressors that make dealing with any problem more complicated, and finally, the Pattern of interaction in which they get stuck, which doesn’t solve the problem and often exacerbates it. After the partners complete this DEEP analysis of the problem,, the program facilitates partners’ sharing of their findings with each other.
3. R Phase (Response): In the final phase, partners explore ways they and their partners can make changes to address the core issues. The program guides them through creating a plan for these changes, which they share.

The program has undergone clinical trials sponsored by the Administration for Children and Families in the United States. It has shown effectiveness even at a one-year follow-up. It provides couples a structured yet flexible way to work through challenges and strengthen their relationship.

Jacobsen: I understand that the U.S. military has also adopted the OurRelationship program. Could you elaborate on its use among active-duty personnel and any challenges you’ve observed during the therapeutic process?

Christensen: The U.S. military has adopted OurRelationship program, which is now available to all active-duty personnel. The military recognizes that deployments and military life can create significant stressors on relationships. OurRelationship serves as an effective intervention for couples because it can be completed  online  with or without a coach, and thus provides a cost-effective way to help couples improve their relationships.

So, Scott, that’s an overview of IBCT and OurRelationship. I realize I’ve been talking at length—hopefully, not too much! Two things come to mind regarding your question about challenges. First, there are  clients that are not appropriate for IBCT.. Second, there are couples that present challenges in conducting IBCT. .

Jacobsen: What are some of the couples that are not appropriate for IBCT?

Christensen:. One common issue is when the partners have different agendas for the relationship. For example, if one partner wants to  leave the relationship while the other wants to work on it, it creates an obvious challenge.  IBCT is for couples who want to improve their relationship, even if they question whether it can be improved.  IBCT is not separation therapy or divorce therapy.

There are also exclusion criteria for IBCT. One key exclusion is intimate partner violence (IPV). If there is a level of IPV that poses a danger, the couple is not ready for IBCT. Couple therapy can be intense and evoke strong emotions, and we never want to contribute to violence inadvertently. As part of the assessment phase in IBCT, we evaluate the level of IPV and make a determination of whether it is safe to work with the couple..

It is possible to work with couples experiencing low-level violence if both partners are committed to ending the violence and taking responsibility for their actions. However, if there are dangerous levels of violence, the couple must address that issue first before entering therapy.

Other exclusion criteria include situations where one partner is actively suicidal or psychotic, as these require individual treatment before couple therapy can be effective.

Jacobsen: Apart from exclusion criteria, what challenges do you encounter with suitable couples for IBCT?

Christensen: High-conflict couples are a common challenge. When these couples start discussing their problems, the conversation can quickly escalate into an argument. Therapy should never devolve into a screaming match. In such cases, IBCT therapists must be directive to ensure the environment remains safe and that both partners have an opportunity to speak. If things escalate, the therapist may choose to see each partner individually until they calm down and can be brought back together.

Another challenge is when one partner insists that the primary problem lies with the other and that they have little or no role in the issues. Despite our efforts to broaden their perspective, this mindset can hinder progress. For therapy to succeed, both partners must recognize their roles in the relationship dynamics and be open to change.

These are just a few of the challenges we face, but IBCT is designed to work effectively even with these difficulties, as long as the couple is willing to engage in the process.

Jacobsen: Conflict in therapeutic sessions can sometimes seem influenced by gender dynamics. Are there any tendencies or patterns you’ve observed that are linked to gender? Additionally, do these dynamics differ in same-sex relationships, or do the patterns remain consistent regardless of gender?

Christensen: Yes, this is an important question. Alongside my work developing and studying couple therapy, I’ve long been interested in conflict patterns and have published extensively on this topic. A very common dynamic we see is the demand-withdraw pattern. In this pattern, one partner takes on the demanding or pursuing role—wanting to talk about issues and often being more critical—while the other partner assumes the withdrawing or shutting down role, avoiding the discussion altogether.

This pattern is prevalent in both heterosexual and same-sex couples. However, in heterosexual couples, it often has a gender linkage: men are more likely to adopt the withdrawal role, while women are more likely to take on the demand role. That said, these roles can be reversed depending on the context of the conflict. For example, in a young heterosexual couple, the man might take on a demanding role in matters related to sexual intimacy. At the same time, the woman may adopt the withdrawal role. Conversely, she might take on the role of demand in other areas of the relationship while he takes on the withdrawal role.

We’ve conducted cross-cultural studies showing that this gendered pattern also appears in other cultures, indicating that it’s not just a Western phenomenon. However, in same-sex couples, while the demand-withdraw pattern exists, it’s not gendered by definition. It simply reflects how couples, regardless of gender, navigate certain conflicts.

Jacobsen: Are there other common couple dynamics patterns similar to the demand-withdraw pattern?

Christensen: Absolutely. While the demand-withdraw pattern is one of the most frequently observed, it’s not the only one. Another common pattern is when both partners adopt a move-against stance, where they are both argumentative, critical, and escalating conflicts. This can lead to a cycle of mutual criticism and hostility.

On the other end of the spectrum, there’s a mutual withdrawal pattern, where both partners shut down emotionally and avoid engagement. This often results in awkward silences and unresolved tension. While less common than the other patterns, it’s still a significant challenge when it occurs.

There are also variations of these patterns. For instance, some couples exhibit what we call an anxious pursuit and withdrawal pattern. In this dynamic, one partner, often driven by anxiety about the relationship or fear of infidelity, becomes intrusive, asking questions like, “Where were you?” or “Who were you talking to?” Feeling overwhelmed by this pursuit, the other partner withdraws further, exacerbating the cycle. This is similar to the demand-withdraw pattern but with a more anxious, less confrontational pursuit.

What’s interesting about these patterns is how they vary in complexity. While I’m describing them in somewhat simplified terms here, the reality is that these dynamics often overlap and shift depending on the context of the relationship and the specific issues the couple is facing. In IBCT, we focus on helping couples identify these patterns and work toward more constructive engagement.

Jacobsen: Do you find that addressing these patterns early in therapy helps reduce session resistance or conflict?

Christensen: Yes, absolutely. One of the core principles of IBCT is helping partners see that relationship problems are co-created. This doesn’t mean they’re equally responsible—one partner might play a larger role than the other (although it is fruitless for a couple to argue about who has the larger role)—but it does mean that problems are inherently relational and best resolved by working together. Helping couples recognize this often reduces resistance and fosters a sense of shared responsibility.

Jacobsen: You mentioned earlier how patterns can shift during conflicts. How do these dynamics evolve or escalate during therapy sessions?

Christensen: Certainly, you may have a couple where one partner demands and the other withdraws. However, this dynamic can escalate. For example, the withdrawing partner may eventually blow up, shifting into a demanding role. In contrast, the previously demanding partner moves to withdraw or shut down. After such an escalation, both partners may withdraw entirely for a time. These patterns can develop and shift depending on the context and intensity of the conflict. I hope that explanation clarifies things.

Jacobsen: It does. Thank you. What about patterns you observe near the end of therapy? For instance, when predefined goals have been met, and the couple achieves a healthier homeostasis in their relationship, perhaps only requiring occasional checkups, what typically characterizes that stage?

Christensen: In IBCT, the goal is mutual, open, and constructive engagement. By the time we’re approaching termination, partners can typically share their thoughts and feelings openly while being curious and receptive to their partner’s perspective. The emotional tension that initially brought them to therapy has significantly diminished.

Often, a clear sign that therapy is nearing its end is when a couple no longer has significant issues to address. For example, I had a session just yesterday with a couple. We might consider termination soon because they had nothing substantial to discuss. They had a good couple of weeks, managed their issues independently, and didn’t feel the need to bring anything major to therapy.

That’s an encouraging sign. Therapy shouldn’t devolve into casual discussions about movies or unrelated topics. When couples consistently report they’re handling challenges independently, and we can observe that pattern over several weeks, it’s a good indicator that they’re ready to move forward without regular sessions.

Jacobsen: That makes sense. Given our time constraints, my last question is this: In what situations would you recommend that couples either not continue their relationship or delay entering one until certain relational or psychological patterns are resolved?

Christensen: The primary criterion for us in IBCT is safety, particularly physical safety. Unfortunately, a significant percentage of distressed couples experience some level of physical violence. Ensuring physical safety is paramount in couple therapy. Suppose a couple cannot maintain a physically safe relationship. In that case, I recommend they pause or end the relationship, as it’s too dangerous to continue without first addressing this issue.

While physical safety is non-negotiable, emotional safety is more nuanced. Even in the best relationships, there are times when partners may not feel entirely emotionally safe—for example, when bringing up a sensitive topic or expressing criticism about something a partner or their family member did. Emotional safety is more subjective and situational. In therapy, part of our work is to help couples develop greater emotional safety over time. Still, it’s rarely a binary issue like physical safety.

If physical violence is present and unresolved, however, the couple must prioritize safety before continuing the relationship or therapy.

Jacobsen: Apart from dangerous situations for the couple, how does IBCT approach the decision to end a relationship? Do you offer guidance, or is it more about helping clients reach conclusions?

Christensen: The decision to end a relationship is, ultimately, an existential decision. In IBCT, we don’t advise couples to stay together or separate because that responsibility lies with them. It’s a deeply personal decision that each partner must make for themselves. That said, we can discuss the pros and cons with them and reference what the literature suggests.

For instance, let me give you an example, Scott. Imagine one partner wants to leave the relationship because it’s no longer satisfying. They’ve tried therapy but feel they’re not improving enough and believe leaving is the best option. Meanwhile, the other partner desperately wants to save the relationship. They might cite various arguments—such as the potential impact on children—to justify staying together. One might say, “It’ll be better for the children if we stay together,” or, “Leaving would mean abandoning the family.”

Jacobsen: What’s IBCT’s stance in such situations?

Christensen: We emphasize that leaving or staying is their decision—not ours. Unless the relationship is harmful or dangerous to one or both partners, we don’t take responsibility for advising them to separate or remain together. Our role is to provide insights, help them explore the implications of their decision, and support their process of reflection. As to the particular question of the impact on the kids, we might explain that the nature of parental relationship is paramount in terms of the children’s functioning.  Parents can separate or divorce and have a functional co-parenting relationship or a horrible co-parenting relationships; similarly, the couple can remain together and have a good or bad co-parenting relationship.  What is particularly harmful is when there is violence between the parents (and between parent and child) and when parents try to ally with the children against the other parent so the child feels pulled between the two and pressed to see one parent as the good guy and the other as the bad guy.

Jacobsen: Thank you, Dr. Christensen, for sharing your expertise today. I appreciate your time and insights.

Christensen: You’re welcome, Scott. 

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