Studying for the NCE – Behavioral Therapies – A Closer Look

For the second part of this paper, an article will be reviewed that is titled: “Behavioral Couple Therapy:  Building a Secure Base for Therapeutic Integration” (Gurman, 2013).   This article begins with a historical overview of how individual and couples-oriented behavioral therapies have developed.  At the conclusion of this paper, are comments on how Integrative Behavioral Couple’s Therapy can help a practitioner provide a secure base for couples.

A Historical Perspective

n an effort to dispel a historically negative caricature of behavioral therapy Gurman (2013) provides a historical review of behavioral therapy’s course of development.  According to Gurman (2013), despite the historical distrust of this method, approximately 80% of all couple and family therapists now utilize it (p115).   Next is a review of Gurman’s (2013) description of behavioral therapy’s development and application.

Individual Behavioral Therapy

Behavioral therapy’s origins begin with Pavlov’s classical condition and Skinners operant conditioning models.  During individual behavioral therapy’s first wave of development in the 50’s and 60’s, efforts were being undertaken to address the deficits of psychoanalysis (Gurman, 2013).  The stimulus-response learning perspectives of early behavioral therapy were nonetheless criticized as emphasizing first-order changes and a mechanistic in orientation (Gurman, 2013).  Bandura’s social learning theory introduced behavioral therapy’s second wave of development (Gurman, 2013).  In an effort to address a wider range of difficulties, cognitive variables were incorporated with behavioral therapy methods.   Finally during behavioral therapy’s third wave of development cognitive behavioral approaches were applied to an ever increasingly range of issues.  The influences of eastern thought and Buddhist practices were then integrated into many third wave therapies, including Acceptance and Commitment Therapy, and DBT (Gurnman, 2013).  In reaction to the early first-wave behavioral therapies, these third wave CBT therapies emphasized a holistic perspective that considers the importance of context.

Behavioral Couple’s Therapy (BCT).

Interestingly, the development of Behavioral Couples Therapy (BCT) followed a similar path as its individualized variant.  During its first wave of development Gurnman, (2013) describes Operant-Interpersonal Treatment for Marital Discord (OMIT, and Traditional Behavioral Couple Therapy (TBCT).  OMIT, closely resembling early forms of individual behavioral therapy and focuses on each partner’s responsibility.  OMIT focuses on changing behavior with techniques that include techniques and marital token economies, and Quid Pro Quo Contracts (Gurnman, 2013).  TBCT, also a first wave couples behavioral therapy, includes a rewards vs. cost perspective.   Skill development became the focus for TBCT, based on the notion that “nastiness begets nastiness” (Gurnman, 2013, 119).   Since Gotmann’s research has confirmed the uselessness of these early interventions, BCT has developed well beyond its historical origins.

Cognitive-Behavioral Couple’s Therapy (CBCT) constitutes the second wave of BCT’s evolution and development (Gurnman, 2013).   With this perspective the emphasis on skills training was now considered too limiting.  Internal psychological process including automatic thoughts and schemas gained attention in BCT’s ongoing development.  Internal belief structures, and each partner’s attachment history, gained new attention through CBCT.

Integrative Behavioral Couple’s Therapy (IBCT)– The Third Wave

Gurnman, (2013) concludes his paper with a description of BCT’s third wave approach: Integrative Behavioral Couple’s Therapy.  IBCT is a unique form of behavioral therapy that appreciates individual differences and facilitates empathy (Gurnman, 2013).  Central to this approach is non-judgmental perspective in which a holistic analysis is given priority.  The context of a given situation, is important in understanding why behaviors and interactions persist.  In IBCT, context refers to “the term used for changeable steams of events that can exert an organizing influence on behavior” (Gurnman, 2013).  Understanding the function and purpose of behavioral patterns means examining context.  This requires a close examining of a early child experiences, attachment histories and recurrent core themes or patterns in a relationship.

Unlike the earlier forms of Behavioral Couple’s Therapy (BCT) in its third wave of development, insights have been incorporated to address effectively Gotmann’s perpetual problems (Gurnman, 2013).   Functional analysis is useful in explaining how the effects of context and the causal historical underpinnings of ongoing interpersonal relationship patterns.  Techniques and skills taught therapy, can provide a secure and safe place to discuss issue openly during a session.  For example, carefully wording one’s words, by using “I” to discuss one’s feelings and “it” to describe problems in a neutral third-part context are convenient examples (Gurnman, 2013).   Other unique interventions include tolerance-building, which involves a process of learning to find new experiential meaning in the midst of ongoing unsolvable conflicts.  This technique is quite intriguing since it reflects an insight of the Gottman’s regarding masters and disasters and how they take in life experiences.

IBCT – Providing a Secure Base

In conclusion, I would like to make a few comments on IBCT and its ability to provide a secure base during therapy (Gurnman, 2013).  While earlier versions of BCT involve interventions that involve directly modifying thoughts and behaviors, IBCT utilizes a new approach (Gurnman, 2013).  The goal in IBCT appears to involve linking individual experiences with relational ones in an order for the couple to understand each other better.  A mutual understanding of context, provides for the development of more adaptive interactions, and greater empathy.  As a result, alongside pragmatic behavioral changes, are deeper insights that allow partners to develop a greater appreciation for one another.

Underlying this transformation, I’m quite intrigued by how Gurnman (2013) describes the therapist’s role in this process.  As Gurnman (2013) states, rather than micromanaging clients’ behavior, the therapist is watching ongoing functional patterns throughout therapy, and allowing this to play-out.  Gurnman, (2013), describes therapists as barometers, who are wholly present, maintaining a non-defensive and mindful stance throughout sessions.   From this perspective, Gurnman (2013) states that the functional analysis is enriched with the underlying meaning and affective functions of behaviors.  By “wondering aloud” (Gurnman, 2013, p133), within a safe environment, the therapist can introduce these insights to couples in session.

Finally, Gurnman (2013) concludes his article with the following comment:  “The therapist’s emotional resonance to such implicit experiences can greatly facilitate the identification of controlling variables in the couple’s problem themes” (p133).   This insight reflects a comment by Dr. Heitler in the assigned “Angry Couple” video (Holland & Schein, 1995).  In this video, we see Dr. Heitler becoming frustrated at one point during therapy with this angry couple.  She uses this emotional reaction, as a way of understanding and facilitating the variables that underlying their ongoing conflicts (Holland & Scheiin, 1995).  I had great appreciation for how Dr. Heitler was able to remain present and non-defensive throughout this process.  She used this emotional reaction as a guidepost for her interventional techniques (Holland & Schein, 1995).

References

Gurman, A. S. (2013). Behavioral couple therapy: Building a secure base for therapeutic integration. Family Process, 52(1), 115-138. doi:10.1111/famp.12014
Holland, J. (Director & Schein, L. (Producer. (1995).  The Angry Couple [Video File].
Psychotherapy.net. Retrieved November 11, 2015, from The Psychotherapy.net Collection.
Lebow, J. (2006, Sep). FROM RESEARCH TO PRACTICE, scoreboard for couples therapies. Psychotherapy Networker, 30 Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/233324408   ?accountid=28125

Share This: