Journal of Cognitive Psychotherapy: An International Quarterly

Volume 20, Number 4 • 2006

Introduction to the Special Issue on

Cognitive-Behavioral Couple Therapy
Norman B. Epstein, PhD
University of Maryland, College Park

C ognitive-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 out-
come 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 interac-
tions (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 behav-
ioral 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).

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340 Introduction

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 distinguish-
ing education from therapy, and describe exciting new initiatives toward providing prevention
programs for traditionally underserved populations. Dattilio departs from the common CBCT
focus on couples' current interactions to explore the influences that partners' family-of-origin
experiences have on their adult couple relationships and to describe procedures for assessing and
intervening with family schemas. LaTaillade reviews empirical knowledge regarding relationship
stressors commonly experienced by African American couples and provides guidelines for work-
ing in a culturally sensitive way with minority couples. Baucom et al. describe a stage model for
understanding couples' responses to a partner's infidelity and present their empirically supported
CBCT-oriented treatment approach. Finally, LaTaillade et al. describe another special application
of CBCT in the treatment of psychological and physical aggression. CBCT clearly has developed
into a highly relevant and flexible approach to understanding and treating a wide range of inti-
mate relationship problems and intervening early to prevent relationship conflict and distress.

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