**1. Introduction**

Intimate relationships are of great significance for most adults and highly impact overall wellbeing and health [1, 2]. Indeed, satisfying intimate relationships can provide happiness, social support as well as buffer the repercussions of numerous stressors [2–4]. However, when these relationships are characterized by significant distress, destructive conflicts or general dissatisfaction with the relationship, they can also lead to deleterious consequences to physical and psychological health [1] as well as great suffering [2].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cognitive-behavioral couple therapy (CBCT) aims at assisting romantic partners who report distress in their relationship. Over the years, CBCT has been extensively evaluated in treatment outcome studies, which have repeatedly concluded in its effectiveness for decreasing couple distress and dissatisfaction as well as for addressing communication or problem-solving difficulties [5–7]. Studies have also found that such improvements seem to be maintained for up to 2 years by most couples [8].

see variations in their appreciation of their partner and of their relationship. Cognitions also depict the way partners process information originating from the others' behaviors, which guide their interpretation of events as well as expectations towards the other and the relation-

Cognitive-Behavioral Psychotherapy for Couples: An Insight into the Treatment of Couple…

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Work from Jacobson and Christensen [16] increased focus on acceptance strategies as a way to help partners recognize that they are different and eventually learn to respond constructively to difficulties or incompatibilities within the relationship. In 2002, Epstein and Baucom further enhanced CBCT by including work on partners' needs for intimacy and increased attention to emotions, not only as a result of modifications in the dysfunctional behaviors but also as a primary target of therapy. According to these authors, emotions can significantly impact relationships through various means: in their expression, through their impact on the interpretations (cognitions) made as well as by affecting behaviors expressed towards the other. Epstein and Baucom [17] also emphasized the importance of considering partners' vulnerabilities and the impact of the couple's environment as part of the multiple factors that can alter partners' cognitions, emotional responses and

A specificity of CBCT lies in its dynamic understanding that cognitions can influence intimate relationships through each partner's interpretations or appraisals of stressors and of their partner's behaviors [3]. Moreover, the interpretations partners make about the behaviors of the other will determine the positive and negative emotions experienced towards the other. As shown in **Figure 1**, these emotions are considered to influence future cognitions and behaviors [14]. As such, in CBCT, behaviors, cognitions and emotions are observed as inter-

In summary, the main objective of CBCT is to help couples understand their difficulties in order to enhance their relational well-being by identifying and challenging the processes at play in partners' interactions while taking into account the external factors that can affect them. To do so, CBCT not only relies on behavioral interventions in the treatment of couple difficulties, but also emphasizes the importance of working on various cognitive, emotional and environmental factors that affect a couple's functioning [18]. CBCT interventions also aim at helping couples identify, regulate and express intense or negative emotions when they arise in and out of sessions. By doing so, CBCT therapists help couples develop their ability to observe and change their automatic thoughts, assumptions and standards as well as identify the impact that their ways of behaving, thinking, interpreting and feeling have on their

**Figure 1.** Interrelations of behaviors, cognitions and emotions in cognitive-behavioral couple therapy.

related and equally important in relationship functioning [18].

ship [15].

behaviors.

relationship [3].

In this chapter, a comprehensive literature review of the theoretical underpinnings and clinical practices of CBCT will be presented. First, a description of the theory underlying CBCT and the role of CBCT therapists will be offered. Possible mandates and motives for consulting in CBCT will then be described, with particular attention to the specificities in CBCT for diverse populations. The assessment process used in CBCT will also be addressed, allowing readers to understand the particularities of psychotherapeutic work with couples. Subsequently, the main intervention techniques used in CBCT will be defined: communication training, problem and conflict resolution, cognitive restructuring, identification and expression of emotions, expression of affection and sexual problems as well as acceptance and tolerance of differences. The chapter will conclude with a critical analysis of CBCT and suggestions for future clinical developments.
