Couples therapy and ACT

Can ACT be used with couples?

Acceptance and commitment therapy (ACT) has been studied mostly as an individual therapy, and its use with couples is a newer and smaller field (Barraca et al., 2025). The first empirical study of ACT for couple distress treated two married couples in joint sessions, adapting core ACT interventions for that format (Peterson et al., 2009).

Since then, clinicians have developed ways of working that extend ACT’s processes to the relationship itself. This article sets out what ACT looks like when the couple, and the space between the two partners, is the focus of the work. You don’t need to be trained in systemic therapy or CBT to use it, and if you already work from either, it will sit alongside what you do.

Extending ACT interpersonally

In couples work, the ACT processes are extended to what happens between the partners. The pattern of interaction becomes the thing you assess and work with, and each partner’s inner experience matters because of how it shapes that pattern.

That changes what each process asks of a client. Acceptance includes making room for a partner’s vulnerability as well as your own. Defusion includes loosening the grip of judgements and criticisms about the partner. Perspective-taking widens to take in the relationship as a whole, so that the couple can step out of a me-versus-you position.

The aim is flexibility that runs in both directions, where one partner’s openness makes it easier for the other to be open in return. Two people doing their own flexibility work side by side, each in isolation, would miss that exchange, and the exchange is where much of the change in couples work happens.

How ACT understands relationship difficulties

Many couples who come to therapy are caught in a repeating pattern. What one partner does changes the context for the other, whose response then changes the context back. When one partner is fused with a story about the other, or working hard to avoid a feeling that closeness stirs up, it shapes the move they make, and that move shapes what comes back.

The drawing below is an illustrative example. Sam and Alex are a fictional couple, together eleven years, who keep having the same argument about time and attention.

Each partner’s move feeds the other partner’s storyAn illustrative threat-based cycle for a fictional couple, Sam and Alex

In the example, each move brings short-term relief. Sam’s criticism gets Alex’s attention for a few minutes, and Alex’s withdrawal eases the shame. That relief is negative reinforcement, and it keeps both moves going even as each one hands the other partner fresh evidence for their story.

Aversive and appetitive control

A useful distinction in ACT couples work is whether a behaviour is under aversive or appetitive control. Behaviour under aversive control is organised around escaping or avoiding something painful, and it tends to narrow what a person can do. Behaviour under appetitive control is organised around moving towards something wanted, and it tends to involve seeking, exploring and engaging, with a broader and more flexible repertoire (Louisiana Contextual Science Research Group, 2023).

The same behaviour can fall on either side. When Sam asks for an evening together, the request might come from wanting closeness with Alex, or from a need to make the loneliness stop. Alex will usually feel the difference, because a request under aversive control often arrives as a complaint.

In a cycle like Sam and Alex’s, both partners’ moves are under aversive control. Each partner is working to get away from a threat, and each escape move becomes a threat for the other. Much of the work is helping couples shift more of their interaction towards appetitive control, where they approach each other because of what they want to build together.

Intimacy as shared vulnerability

Contextual behavioural science offers a precise account of intimacy that fits this work well. Intimacy emerges when an interaction evokes and reinforces vulnerability in both directions, where vulnerability means socially risky behaviour, the kind that has been punished before, such as disclosing a fear or showing a need (Louisiana Contextual Science Research Group, 2023).

On this account, intimacy grows when that vulnerability is under appetitive control, and when two further conditions are met. The first is consent: each person asks for and receives enthusiastic agreement to the interaction. Empowerment matters too, meaning the interaction widens each person’s freedom, and the partner with more power carries more responsibility for making that possible.

For couples, this gives the work a concrete target. You are helping two people take small, consensual risks with each other, and helping each partner respond in ways that make the next risk more likely. When Alex says “I go quiet because I feel like I’m on trial” and Sam answers with curiosity, both partners learn that vulnerability can be met safely.

The core processes between partners

Each of the six ACT processes has an interpersonal form in couples work. The table sets the individual version beside the version you work with when the relationship is the focus.

Acceptance 

 

Defusion

 

Present-moment contact

 

Self-as-context

 

Values 

 

Committed action

 

The “between partners” is where most of the work sits. A partner who can defuse from “I’m unlovable” in individual therapy may still struggle to do it while their partner is sighing across the room, and couples work gives them practice in exactly that moment.

Function over content

Much couples work, whatever its theoretical home, gives real time to content: what the argument was about, what was said, who is right about the dishes or the in-laws. ACT puts more of its attention on function. The question is what a move is doing between the two partners right now, and where it is taking the connection.

When Alex goes silent in a row, the silence could be avoidance of unbearable vulnerability, or it could be self-regulation that lets Alex come back to the conversation. The two look identical from the outside. You help the couple notice the function and choose, with more flexibility, whether the move is taking them towards the relationship they want.

Asking the same functional questions of both partners, with the same curiosity, also protects the alliance. Neither partner hears the question as a verdict on them.

Values couples share

In ACT, values are directions a person keeps moving in, such as being honest when it is uncomfortable or being someone the other can turn to. In couples work there are two layers. Each partner has values about the kind of partner they want to be, and the couple has values about the relationship they want to build together, including how they treat each other when things are hard.

An apparent clash of values is often a clash of preferences sitting on top of values that can live together. Sam’s wish for more evenings together points to a value around closeness, while Alex’s need for space at weekends comes from a value around rest. Once both are named, the couple can look for moves that honour each of them.

It is worth watching for a partner using values as leverage, as in “if you really cared about us, you’d stop going out”. Bringing each person back to their own direction helps: what kind of partner do you want to be in this moment, whatever the other person does?

Living with lasting differences

ACT couples work treats a good deal of ongoing friction as workable. Some difference, and some grief about the partner you did not marry, is a more or less permanent feature of a long shared life. Reducing the kind of arguing that corrodes a relationship is still a reasonable goal. The question ACT keeps asking is whether the couple can keep moving towards the relationship they want, together, even when a hard conversation is in the room.

InterACT: one approach to ACT with couples

ACT has been adapted for couples in a number of ways. One structured approach is InterACT, developed by Lou Lasprugato, a licensed marriage and family therapist and peer-reviewed ACT trainer. InterACT reimagines the ACT hexaflex interpersonally for work with couples (Lasprugato, 2025). Its main ideas include:

• Yearnings. Deep, enduring longings or psychological needs sit at the centre of the formulation as drivers of behaviour. The model draws on the six yearnings described by Hayes (2019), such as the yearning for belonging, alongside attachment-based yearnings. A partner’s individual yearnings compete for attention with the yearnings the couple shares.
• Contextual clash cycles. InterACT’s term for repeating patterns like Sam and Alex’s, driven by survival mechanisms and influenced by sociocultural factors.
• The ACT couples matrix. An adaptation of the ACT Matrix (Polk & Schoendorff, 2014) used to structure the couples intake, bringing each partner’s painful inner experience, values and behaviour into view.
• Foundational skills. Four skills are shaped in session to disrupt unworkable patterns, including emotional openness to vulnerability and defusing from judgements about the partner.
• The therapist as an instrument of change. Explicit attention to how the therapist’s own flexibility shapes the work with two people in the room.

Is joint work right for every couple?

Screen for intimate partner violence and coercive control before joint work begins, ideally in individual sessions with each partner, and keep checking as therapy goes on. Where either is present, joint sessions can increase risk. Put safety first, follow your local safeguarding procedures and refer to specialist domestic abuse services.

The account of intimacy above adds a useful lens here. Vulnerability builds intimacy when it is consensual and when the conditions widen each person’s freedom, so a relationship in which one partner is afraid of the other cannot meet those conditions. It can also make sense to pause or change the format when one partner has already decided to leave, or when individual difficulties such as active substance misuse need their own treatment first.

What the research says

The evidence for ACT with couples is growing and still uneven. The first empirical study, with two couples, suggested ACT may increase marital adjustment and satisfaction and reduce interpersonal and psychological distress (Peterson et al., 2009).

A recent systematic review and meta-analysis included 17 randomised controlled trials. Compared with passive control groups, ACT was more effective for outcomes including marital satisfaction, marital intimacy, communication skills, anxiety and psychological wellbeing, though it showed no significant effect on marital conflict, conflict resolution or marital burnout (Barraca et al., 2025).

Larger and more varied studies are still needed. For now, the strongest case for ACT with couples rests on a well-tested model of psychological flexibility, extended to the one place where two people’s flexibility depends on each other.

References

• Barraca, J., Polanski, T., Duarte-Díaz, A., & Perestelo-Pérez, L. (2025). Acceptance and commitment therapy for couples: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 35, Article 100867. https://www.sciencedirect.com/science/article/abs/pii/S2212144724001479
• Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. Avery.
• Lasprugato, L. (2025). Interpersonally extending acceptance and commitment therapy for couples and intimate partners [Pre-conference workshop]. Association for Contextual Behavioral Science World Conference.
• Louisiana Contextual Science Research Group. (2023). Promoting appetitive learning of consensual, empowered vulnerability: A contextual behavioral conceptualization of intimacy. Frontiers in Psychology, 14, Article 1200452. https://doi.org/10.3389/fpsyg.2023.1200452
• Peterson, B. D., Eifert, G. H., Feingold, T., & Davidson, S. (2009). Using acceptance and commitment therapy to treat distressed couples: A case study with two couples. Cognitive and Behavioral Practice, 16(4), 430–442. https://www.sciencedirect.com/science/article/abs/pii/S1077722909000935 
• Polk, K. L., & Schoendorff, B. (Eds.). (2014). The ACT matrix: A new approach to building psychological flexibility across settings and populations. New Harbinger.