Introduction to the Special Issue on Cognitive-Behavioral Couple Therapy
Epstein, Norman B., Journal of Cognitive Psychotherapy
Cognitive-behavioral couple therapy (CBCT) has come a long way since texts by pioneers such as Richard Stuart (Stuart, 1980) and Neil Jacobson and Gayla Margolin (Jacobson & Margolin, 1979) provided detailed clinical guidelines for working with distressed couples from an empirically supported social learning framework. During the 1980s, influences from cognitive therapy (Beck, Rush, Shaw, & Emery, 1979) and basic social cognition research led to partners' cognitions about each other and events in their relationship taking on major roles in theory and clinical practice of CBCT (Baucom & Epstein, 1990; Rathus & Sanderson, 1999). Controlled outcome studies indicated that behavioral interventions involving behavior change contracts between partners and training in communication and problem-solving skills produced significant improvement in couples' behavioral interactions and subjective relationship satisfaction; furthermore, substituting a few sessions of cognitive restructuring for some sessions of behavioral interventions produced comparably favorable, if not superior, impacts (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998). Behavioral and cognitive-behavioral couple therapies are considered evidence-based approaches and are widely used among couple therapists from diverse theoretical orientations (Northey, 2002).
In spite of these encouraging signs, CBCT has faced a number of challenges. First, the outcome studies indicated sizable numbers of couples for whom behavioral interventions failed to produce statistically or clinically significant improvement or for whom relapses were evident at follow-up assessments (Baucom et al., 1998). Second, alternative approaches to couple therapy that focus on insight in a more psychodynamic manner (Snyder & Wills, 1989; Snyder, Wills, & Grady-Fletcher, 1991) or on partners' attachment needs and emotional aspects of couple interactions (Johnson & Denton, 2002) exhibited effects equal to or at times better than effects found with CBCT. It became clear that the traditional conceptual model and clinical methods of behavioral couple therapy and CBCT had some limitations. Consequently, substantial efforts have been devoted to broadening the scope of CBCT to more comprehensively meet the needs of distressed couples. Jacobson and Christensen's (1996) integrative behavioral couple therapy (IBCT) strikes a balance between traditional behavior change strategies such as problem-solving skill training and strategies geared toward helping individuals accept aspects of their partner and relationship that are not realistically likely to change. Epstein and Baucom (2002) have enhanced CBCT by increasing the focus on emotional aspects of couple functioning, building relationship strengths as well as addressing problems, and working with multiple levels of a couple's relationship context, including characteristics of the individual, the dyad, and the couple's physical and interpersonal environment. Furthermore, CBCT has been applied to a variety of presenting problems, such as substance abuse, depression, anxiety disorders, and domestic abuse (Gurman & Jacobson, 2002).
The articles in this special section exemplify the current breadth of CBCT. Markman et al., who have long been leaders in the application of CBCT to prevention of marital problems, describe the present state of the preventive education field, discuss important issues in distinguishing education from therapy, and describe exciting new initiatives toward providing prevention programs for traditionally underserved populations. …