Interview with the authors of Reconcilable Differences
By Heather M. Pederson, PhD, and Amanda Edwards-Stewart, PhD
Dr. Andy Christensen, Professor of Psychology at UCLA and Dr. Brian Doss, Associate Professor of Psychology at the University of Miami, are the authors of the second edition of Reconcilable Differences, a couples’ self-help book that just came out this past Valentine’s Day. TFP interviewed the authors to learn about their vision behind the book, which is based on Integrative Behavioral Couples Therapy (IBCT), an evidenced-based model originally developed by Dr. Christensen and his late colleague, Dr. Neil Jacobson.
TFP: What prompted you to publish a self-help book?
Andy: The late Neil Jacobson and I developed IBCT and wanted some materials for couples to read as they went through the treatment. In fact, the original Reconcilable Differences was used in our clinical trial of IBCT. The reasons for the revision were several. Brian and I wanted to update it and make it more inclusive. Since our clinical trial included only married couples, who at that time were almost exclusively heterosexual, our book was focused on that population. In contrast, our revision is addressed to gay and lesbian couples and unmarried heterosexual couples as well as married heterosexual couples. We also learned more about how to present IBCT through a project that Brian spearheaded.
Brian: Andy and I were awarded a grant from the National Institute of Child Health and Human Development to develop a website called Our Relationship. The purpose of the grant is to test whether or not we can help couples with their problems through more of an automated format – part of a larger effort to disseminate IBCT more broadly. The biggest changes to the second edition came out of the work that Andy and I did together trying to translate a lot of the IBCT approaches and wordings to be more widely available and more understood by a wider audience. So that was another impetus of the second edition of Reconcilable Differences —was to try to update it with the things that we learned in building the website and pilot testing the website.
Andy: One of the key features that the second edition has that the first edition did not is a number of empirically supported couple evaluation questionnaires along with scoring and interpretative information so that the reader can do some self-evaluations of their own relationship. These questionnaires are also incorporated in the website.
TFP: Translating a therapy approach to a population-based self-help book can be very challenging, so what did you consider when approaching the challenge or learn from the first edition that helped with the second one?
Andy: It was particularly challenging with Integrative Behavioral Couples Therapy because IBCT, unlike some other approaches, is not a rule-governed kind of approach. We don’t give couples a set of rules for how to behave or how to deal with this or that kind of problem. ... “If you need to communicate better, do A, B and C.” … It’s very much focused on… partners’ emotional sensitivities and how those emotional sensitivities contribute to the heated conflict between them…. And so that was the challenge. In the first edition, as well as in the second edition, we presented many examples of common couple difficulties and tried to help the reader see the perspective of both partners in a particular interaction, conflict or struggle. A key component of IBCT is helping partners develop an understanding of the other partner’s position and ultimately have empathy for the other person’s position…
Brian: Another way we’ve tried to [translate IBCT] in the second version is to have couples focus on a single relationship problem, or what we call a “core issue”. We wanted to encourage couples to apply a lot of the lessons, and the more general examples that the book provides, to their specific relationship. To do this, we take them step by step through a three-step process. First, we have them answer questionnaires and give them feedback on their answers - generally letting couples know how they relate to other couples. For example, where do they seem to be having bigger problems, versus less severe problems? Second, we help them develop what we are calling the DEEP Understanding, which stands for Differences, Emotional sensitivities, External stress and Patterns of communication. Acceptance can come from understanding that the “core issue” have arises from natural differences from your partner. It can come from understanding that your partner is actually in the same type of emotional pain that you’re in. Or it can come from recognizing that the external stress you’re under or the way you’re trying to talk about the problem is making it worse. So we were trying to attack it from a couple of different angles to make sure that something fit and something felt good for a couple. Finally, we encourage readers to think about concrete changes they can make to improve their relationship.
TFP: The book deals with some topics and processes that might be difficult for a lay couple to address in their relationship. What kinds of couples do you see being able to use this book without the assistance of a trained professional?
Andy: The easy and simple answer to your question is less distressed couples. Less chronically distressed couples are more likely to benefit from the self-help… Most clinical scholars support a stepped care kind of approach where some people can benefit and deal with their problems successfully with a very low-level intensive intervention and some people require much more intensive intervention….
Brian: I completely agree with a stepped care model…I think the book Reconcilable Differences is targeted for couples where acceptance is the primary mechanism of change... From our conceptualization of how relationship distress occurs, an initially small difference or minor irritation becomes more severe over time in part because of couples’ unsuccessful efforts to change it. Those failed efforts push people further and further away from each other so that, at some point, couples stop fighting over the initial problem and become more distressed by the resulting efforts to change each other. …I think Reconcilable Differences [and IBCT] both do a really good job of refocusing couples on the initial problem – it helps them get unstuck again. …
TFP: Another question is how IBCT is similar to or different from other empirically supported couples therapies such as Emotionally Focused Couples Therapy (EFT)?
Andy: IBCT has had some interesting parallels with emotion-focused couples therapy but some substantial differences. I think a huge difference has to do with their theoretical bases. EFT is based on an attachment model of relationships, at least the Sue Johnson version of EFT, while the theoretical model behind IBCT is a social learning, behavioral analysis model. And so the theoretical underpinnings are very different. Another difference is in the structure of the approach, with EFT having a more structured, step-by-step approach to intervention. IBCT views partners as having unique genes and social learning histories, so that there is not a step-by-step sequence that we can take all couples through in doing IBCT. Our treatment is dictated by the DEEP analysis we do of the problem and also how the couple responds to the treatment interventions.
Brian: EFT does a really good job of helping couples develop an understanding of issues around closeness and distance. “I want more intimacy in the relationship and my partner wants less, how do we make sense of that?” In some ways, the adult attachment framework underlying EFT forms a stronger theoretical foundation than does IBCT to understand those types of issues. However, in my experience, if you’re dealing with other types of issues like power or power and control, …or ‘the scientist and the artist,’ it’s harder to apply an attachment framework for those kinds of issues. There, I think a broader conceptualization that accounts for how couples can polarize around many types of initial differences is more helpful. So I would argue that the IBCT’s framework is broader and can address more types of presenting problems.
TFP: What are you planning in the future for the research and dissemination of IBCT?
Andy: Since 2010 when the US Department of Veteran’s Affairs (VA) adopted IBCT as one of its evidenced based treatments, I have been heavily involved in training VA therapists in IBCT. As part of that effort, we are collecting outcome data and hope to publish some studies on how IBCT works with Veteran couples. Many of these couples present substantial challenges because one of them may have an individual disorder such as PTSD or depression... But Brian can speak more to the dissemination.
Brian: We see both the second edition of Reconcilable Differences and the website as important ways to expand the reach of IBCT. Those are both important ways in which we are trying to expand what we can do outside of the therapist’s office. The majority of couples who divorce never seek couples therapy from anybody, whether that be a clergy member or a mental health professional. [It would] be wonderful to see the effectiveness of the book compared to a trial of couple therapy… or nothing at all. It’s an interesting question to me - of the number of people who purchase Reconcilable Differences, how many will actually finish it? I think that is the biggest barrier to self-help of any type—that it really does rely on the self. However, we know from other studies that reading books designed to help people with other problems, such as depression and anxiety, can be helpful. Additionally, our initial results from our web-based program – which includes less than an hour of staff support – indicate that more than 80 percent of couples complete it and show gains. So, overall I’m optimistic that we can move help for distressed relationships outside of the therapist’s office and into the hands of couples.