Enhanced Cognitive–Behavioral Couple Therapy
In Enhanced Cognitive–Behavioral Couple Therapy, Dr. Donald H. Baucom demonstrates this approach to working with couples coping with relationship difficulties. Although regular cognitive–behavioral therapy has been useful in working with couples, it has largely neglected the broader patterns and core themes in intimate relationships, such as differences in needs for intimacy. In addition to focusing on a couple's interactive processes, enhanced cognitive–behavioral therapy attends to the two unique individuals, including all that each partner brings to the relationship, as well as to the context in which the relationship exists.
In this session, Dr. Baucom works with a couple who have a history of resistance to vulnerability, helping them to learn to open up and truly listen to each other.
This enhanced cognitive–behavioral therapy with couples is appropriate to the population of couples in general and has been used widely with a wide range of distressed couples. There is no typical couple per se, given that couples with a wide range of concerns are appropriate for this approach.
As is true with couples presenting for any approach to couple therapy, most distressed couples have significant communication difficulties, although at times these communication problems are the result of, rather than the cause of, relationship distress. Many distressed couples demonstrate an excess of a variety of negative behaviors toward each other, along with a deficit in positive interactions. Along with these behavioral patterns, one or both partners often have negative, distorted cognitions when interpreting the other partner's behaviors, attributing such behaviors to malicious intent, self-centeredness, and so forth. In addition, the partners often experience excess negative emotions regarding the relationship, ranging from anger, depression, anxiety, and disgust, although a number of couples appear disengaged with little emotional response to the other person.
With adaptation, this approach also is appropriate for use with couples in which one or both partners are experiencing significant individual psychopathology, such as clinical depression or anxiety disorders. This approach also can be altered and used to assist couples experiencing traumas such as infidelity or health-related crises.
A description of Dr. Baucom's approach to working with distressed couples is exemplified in the passage below taken from his and Dr. Epstein's book, Enhanced Cognitive–Behavioral Therapy for Couples: A Contextual Approach (Epstein & Baucom, 2002):
"Not surprisingly, various theoreticians, researchers, and clinicians have emphasized certain factors or phenomena in their discussions of committed relationships, highlighting some variables and minimizing others. Although a selective emphasis on certain phenomena is essential to provide coherence and to avoid creating an overwhelmingly complex theory, such a focused view means that other potentially important aspects of couples' lives are de-emphasized in each theoretical model. For example, our own theoretical approach—cognitive–behavioral couple therapy—has established itself as an empirically supported intervention for assisting distressed couples (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998). Even so, it has focused on certain phenomena in intimate relationships, while de-emphasizing other important aspects. During the years since we first published descriptions of our cognitive–behavioral approach (e.g., Baucom & Epstein, 1990; Epstein & Baucom, 1989), we have expanded our conceptual model and range of clinical methods. Our goal in this volume is to describe an expanded cognitive–behavioral approach to couple relationships that provides a broader conceptual perspective and addresses other important areas of couples' lives that have not received adequate attention in the cognitive–behavioral literature.
"First, although cognitive–behavioral approaches to couple relationships have provided useful information about specific behaviors and interactions that have been the targets of therapy (e.g., George does not talk with Jane much at dinner), it has largely neglected the broader patterns and core themes in intimate relationships, such as differences in needs for intimacy (a need for close contact, mutual disclosure, and other forms of sharing in another person's world). We will present a conceptual model that integrates this traditional focus on discrete, detailed behavior within the context of broader relationship patterns.
"Second, cognitive–behavioral perspectives have focused on couples' interactive processes, the ways that partners communicate with each other and respond to each other behaviorally. We concur with Karney and Bradbury (1995) that in addition to the dyad's interactive processes, it also is important to attend to (a) the two unique individuals and all that each person brings to the relationship and (b) the context or environment within which the relationship exists, including for example demands of children and work, relationships with extended family, physical health of the partners, and the nation's economy (see Figure 1-1). Therefore, we will discuss the uniqueness of each individual and how that individual's characteristics impact the couple's relationship. This discussion will include a consideration of individual differences among psychologically healthy and well-adjusted partners, as well as the role of individual psychopathology in couple functioning.
"Moreover, the environment exerts a significant impact on all couples, and in many instances, external and environmental stressors are major factors in understanding couples' current functioning. The loss of a job, a hostile work environment, or a family's move to an unfamiliar location all serve to place major demands and stress on a couple. Both major stressors and the accumulation of minor stressors can influence a couple's relationship. Therefore, we will give a broader consideration to the role of stressors and their impact on a couple's relationship (McCubbin & Patterson, 1983). In doing so, we will draw heavily from the stress and coping literature.
"Third, as the title suggests, cognitive–behavioral approaches have emphasized the roles of behavior and cognitions in relationships. Emotions have not been ignored but have been given somewhat secondary status, being viewed as the result of the partners' behaviors and cognitions. Consequently, by changing behavior and cognitions, the partners' feelings toward each other could be altered. Mate selection in Western cultures is based largely on love, affection, and other positive sentiments, and a major reason for ending relationships is deterioration in those subjective emotions. Consequently, we believe that it is essential to elevate the role of emotions in a discussion of couple functioning (Johnson & Greenberg, 1994b).
"Fourth, cognitive behaviorists have long differentiated between the positive and negative valences of specific behaviors and cognitions. However, even here, there has been a differential emphasis on positive and negative relationship phenomena. As we will discuss in subsequent chapters, strong evidence supports the centrality of negative cognitions and behaviors in understanding relationship distress. This evidence has led clinicians and researchers from a cognitive–behavioral perspective to give primary emphasis to alleviating negatives, with less emphasis and fewer interventions designed to maximize positives in the couple's relationship. We believe that in order for couples to derive maximum fulfillment from their relationships, an equal emphasis must be given to the role of positive behavior, cognitions, and emotions in relationship functioning." (pp. 10–12)
Donald H. Baucom, PhD, is professor of clinical psychology at the University of North Carolina-Chapel Hill, where he has served as the Pardue Distinguished Professor of Psychology. His research, presented in over 150 publications, focuses on couples and marriage, with an emphasis on the integration of basic research and applied treatment outcome investigations. He has helped to shape our understanding of the role of cognitions in intimate relationships, which has contributed to the development of cognitive–behavioral couple therapy. He has conducted and been involved in more couple-based treatment outcome investigations than any other investigator in the field.
Dr. Baucom helped to develop and evaluate the efficacy of couple-based interventions for the treatment of marital distress, recovery from infidelity, prevention of marital discord, enhancement of satisfied relationships, treatment of psychopathology within couple context, and the application of couple-based interventions to a variety of health problems. In addition to his empirical investigations, he has written and edited several books on couples treatment and observational coding of couples interaction, which are fundamental readings for the field. His two books on cognitive–behavioral couple therapy (Baucom & Epstein, 1990; Epstein & Baucom, 2002) are standard texts in the field.
Dr. Baucom's recent book on the treatment of infidelity (Snyder, Baucom, & Gordon, 2007) describes the only couple-based intervention designed specifically to address both individual and relationship consequences of infidelity that has been empirically examined and supported in clinical research. He recently published a book for the European community detailing strategies for working with couples in which one partner demonstrates significant individual psychopathology along with relationship distress (Hahlweg & Baucom, 2007).
Dr. Baucom has served as associate editor for Behavior Therapy and is on the editorial board of numerous journals. He is also is a noted teacher, speaker, and mentor, having received several awards for excellence in undergraduate teaching and given workshops throughout the world training professionals in couple therapy. In addition, he serves as an advocate for individuals with mental health problems and received the Mary Clarke Award for lifetime contributions to psychology in North Carolina. He maintains an active clinical practice working with couples and individuals around relationship difficulties and has been ranked by mental health professionals as one of the top practicing marital therapists in the United States.
- Baucom, D. H., & Epstein, N. (1990). Cognitive behavioral marital therapy. New York: Brunner/Mazel.
- Baucom, D. H., Epstein, N., & LaTaillade, J. J. (2002). Cognitive behavioral couple therapy. In A. S. Gurman & N. S. Jacobson (Eds.), Clinical handbook of couple therapy (3rd ed., pp. 26–58). New York: Guilford.
- Baucom, D. H., Epstein, N., Rankin, L. A., & Burnett, C. K. (1996). Assessing relationship standards: The Inventory of Specific Relationship Standards. Journal of Family Psychology,10, 72–88.
- Baucom, D. H., Gordon, K. C., & Snyder, D. K. (2005). Treating affair couples: An integrative approach. In J. L. Lebow (Ed.), Handbook of clinical family therapy (pp. 431–463). New York: John Wiley & Sons.
- Baucom, D. H., & Kerig, P. K. (2004). Coding couples' interactions: Introduction and overview. In P. K. Kerig & D. H. Baucom (Eds.), Couple observational coding systems (pp. 3–10). Mahway, NJ: Lawrence Erlbaum.
- Baucom, D. H., Sayers, S. L., & Sher, T. G. (1990). Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: An outcome investigation. Journal of Consulting and Clinical Psychology, 58, 636–645.
- Baucom, D. H., Shoham, V., Mueser, K. T., Daiuto, A. D., & Stickle, T. R. (1998). Empirically supported couples and family therapies for adult problems. Journal of Consulting and Clinical Psychology, 66, 53–88.
- Baucom, D. H., Stanton, S., & Epstein, N. (2003). Anxiety. In D. K. Snyder & M. A. Whisman (Eds.), Treating difficult couples (pp. 57–87). New York: Guilford Press.
- Epstein, N., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples: A contextual approach. Washington, DC: American Psychological Association.
- Snyder, D. K., Baucom, D. H., & Gordon, K. C. (2007). Getting past the affair: A program to help you cope, heal, and move on—Together or apart. New York: Guilford Press.
- Cognitive–Behavioral Couples Therapy
- Cognitive–Behavioral Family Therapy
Frank M. Dattilio
- Cognitive–Behavioral Therapy for Clients With Anxiety and Panic
Bunmi O. Olatunji
- Cognitive–Behavioral Therapy for Clients With Multiple Problems
Gayle Y. Iwamasa
- Couple Therapy for Depression
Mark A. Whisman
- Couples at an Impasse
- Emotionally Focused Therapy With Couples
Leslie S. Greenberg
- Integrative Behavioral Couple Therapy
- Older Couples
- Rational Emotive Behavior Therapy Over Time
- Schema Therapy With Couples
Jeffrey E. Young
- Treating Difficult Couples
Douglas K. Snyder
- Working With Couples Considering Divorce
William J. Doherty
- Couples Coping With Stress: Emerging Perspectives on Dyadic Coping
Edited by Tracey A. Revenson, Karen Kayser, and Guy Bodenmann
- Culturally Responsive Cognitive–Behavioral Therapy: Assessment, Practice, and Supervision
Edited by Pamela A. Hays and Gayle Y. Iwamasa
- Emotion Regulation in Couples and Families: Pathways to Dysfunction and Health
Edited by Douglas K. Snyder, Jeffry A. Simpson, and Jan N. Hughes
- Enhanced Cognitive–Behavioral Therapy for Couples: A Contextual Approach
Norman B. Epstein and Donald H. Baucom
- Personality-Guided Cognitive–Behavioral Therapy
Paul R. Rasmussen
- Therapeutic Alliances in Couple and Family Therapy: An Empirically Informed Guide to Practice
Myrna L. Friedlander, Valentín Escudero, and Laurie Heatherington