Couples Therapy: How It Works, What It Helps, and More

Are you and your partner going through a rough patch? Whether because you’re having trouble communicating, arguing more than usual, dealing with trust issues, or having dwindling intimacy, couples therapy may be a helpful resource if you and your partner are struggling to see eye to eye.

Couples therapy is a form of psychotherapy (aka talk therapy) that involves simultaneously treating two people who are in a committed relationship with each other, according to the American Psychological Association (APA).

“With couples therapy, the focus of the therapist’s attention is on the dynamics between two people, rather than one person,” explains Linda Carroll, a licensed marriage and family therapist, board-certified life coach, and author of Love Skills. “So, it’s all about the relationship, not the individual.”

When married people undergo couples therapy, it’s commonly referred to as “marital therapy,” the APA notes.

People might seek out couples therapy for a variety of reasons, but at its core, the therapy aims to help both partners better understand each other.

“Couples therapy provides a safe space where a third party is present,” explains Jaime Bronstein, a licensed clinical social worker, licensed relationship therapist, and author of MAN*ifesting. “The therapist helps to reflect, helping the couples see what’s really going on in their relationship.”

There are many different treatment strategies that can be used in couples therapy, and the goals of therapy may vary depending on the couple’s preferences and the therapist’s philosophy, Carroll adds.

“For instance, some therapists would say the goal of couples therapy is to save a relationship, but I don’t take that point of view,” Carroll explains. “For me, the point is to help the two people understand what got them into this situation and how to help them out. Then, they should decide what should happen in the relationship.”

Many therapists adopt an integrative approach to couples therapy, which involves blending techniques from different treatment models into therapy, according to research published in Family Process.

Some specific types of therapies that may be utilized in a couples therapy session, says Bronstein, include:

• Cognitive Behavioral Therapy (CBT) This form of therapy helps couples identify and change harmful thought patterns and behaviors.
• Emotionally Focused Therapy (EFT) This type of therapy aims to rekindle a secure emotional and physical bond within a couple.
• The Gottman Method This form of therapy seeks to improve couples’ emotional connection, friendship, and conflict management skills.
• Imago Relationship Therapy This type of therapy helps couples learn to stop blaming, judging, and negatively reacting to one another and to be more understanding and empathetic with each other.

In addition to different therapeutic models, couples can choose to have in-person or virtual sessions. While online treatment sessions may be more convenient for some, others may prefer more traditional interactions. Importantly, research suggests there are typically no significant differences in outcomes among couples who undergo videoconferencing sessions versus face-to-face therapy.

The aforementioned research published in Family Process notes that couples therapy has been adapted in recent years to meet the unique needs of many different types of marital and relationship pairs, including LGBTQ+ couples and stepfamily couples.

Couples therapy isn’t just for those in crisis. It may be helpful for any couple wanting to improve relationship skills in some way, says Carroll.

“There was an old idea that people who went to couples therapy did so because there was something wrong with them,” Carroll explains. “I think that’s changed, and now people realize that it is so much about learning skills.”

While many healthy relationships can benefit from couples therapy, the treatment is commonly associated with assisting partners who are experiencing a slump, roadblock, or challenge or some sort. According to The Gottman Institute, therapy may help couples struggling with:

• Unhelpful communication habits
• Persistent arguing
• Emotional disconnection
• Trust or commitment issues
• Attachment insecurities
• Sexual intimacy problems
• Difficulties with family members, friends, or co-workers
• Differences in parenting styles that result in conflict
• Financial disagreements
• Unequal decision-making
• Perceived unfairness in the division of household chores
• Difficult childhood memories

Though the sessions generally focus on the couple as a whole, therapists might also address one individual’s mental health concerns if they are affecting the relationship.

Mental health professionals note that couples therapy can be helpful for some couples in which one or both partners have a mental health condition, the Anxiety and Depression Association of America (ADAA) states. Research suggests participating in couples therapy may help improve symptoms of anxiety and depression among couples. Individual therapy can also be helpful in addressing issues that may be stressful for the significant other, per ADAA.

Couples therapy usually works best when both partners are motivated to understand what’s hindering their connection and find solutions, notes Carroll. “It works especially when, instead of focusing on what their partner is doing ‘wrong,’ they are brave enough to wonder about their own contributions to the problem,” she explains.

Several studies on couples therapy have shown it can be beneficial for relationships in various ways. However, The Gottman Institute notes, couples stay in unhappy relationships for six years on average before seeking help. The longer couples wait to get help, the less likely it is that couples therapy can help salvage the relationship.

Research suggests couples therapy can improve both relationship satisfaction and commitment. A summary of evidence from 18 studies, published in Canadian Agency for Drugs and Technologies in Health, showed that couples therapy can help improve communication, relationship satisfaction, problem-solving, and resolution of needs and feelings.

In a review published in May 2020 in the Annual Review of Clinical Psychology, researchers found couples therapy can reduce relationship distress in about 60 percent to 80 percent of participants. However, these investigators found that the impact of couples therapy tends to be smaller in actual clinical practice than in carefully controlled research studies, and dissipates afterward for about half of couples.

Another research article, published in the Journal of Marital and Family Therapy, concluded that the improvement rate of couples counseling is around 70 percent.

Though the data appears promising on couples therapy, Carroll says it’s important to keep in mind that successful outcomes may differ from couple to couple and are often difficult to quantify.

“‘Successful’ might be that the couple decides not to be together, and they’re caring and kind about how they part,” Carroll explains. “Or, ‘successful’ might be that they learn new ways to be together and improve their relationship.”

Here’s what you should know before starting couples therapy.

What’s a Couples Therapy Session Like?

Therapy sessions are typically catered to fit each couple’s needs and goals. The sessions might differ in style and structure from couple to couple, depending on the couple’s preferences, the issues being addressed, the expertise and values of the therapist, and other factors.

Therapy sessions commonly take place once a week for about an hour and may involve some homework, according to the research in Family Process. They can be conducted virtually or in-person. The therapy may continue for just a few sessions or go on for years, but most approaches aim for a 3- to 12-month course of treatment.

A hallmark practice in couples therapy is prompting each partner to openly discuss their perspective on their relationship. “Each person has the opportunity to share what’s on their mind, whether it’s the pain points in the relationship, issues that need resolution, or a topic they don’t feel comfortable discussing unless a therapist is present,” says Bronstein.

When the couples communicate, the therapist acts as a mediator and doesn’t take sides, according to the University of Rochester Medical Center. The role of the therapist is to guide both parties, so they can talk about and understand each other’s feelings and learn important relationship skills in a safe environment.

In Carroll’s practice, the skills she aims to help her clients learn depend on the needs of each couple. They may include:

• How to give and accept appreciation, even when you’re upset
• How to talk about a complaint
• How to listen to a complaint without getting defensive
• How to build and nurture a relationship, even when you don’t feel like it

How to Find a Couples Therapist

According to the University of Rochester Medical Center, couples who are looking for a therapist should seek out a licensed mental health professional who specializes in couples therapy, such as the following:

• Licensed clinical social workers (LCSW)
• Licensed marriage and family therapists (LMFT)
• Clinical mental health counselors (CMHC)
• Psychiatrists (MD, DO)
• Psychologists (PhD)

Carroll says it might also be helpful to check out a prospective therapist’s web page. “Listen to any podcasts or interviews they do and see if you can find out what their beliefs are and how they align with yours,” she suggests.

Both the American Association for Marriage and Family Therapy and American Psychological Association provide directories for locating qualified therapists. Asking friends or trusted acquaintances for recommendations may also be an effective way to find a therapist, Bronstein adds.

How To Prepare for a Couples Therapy Session

Before starting couples therapy, it’s a good idea to set goals for how you’d like to achieve a more peaceful, productive relationship, says Bronstein. Planning out what you want to talk about could also be helpful. “I always recommend making bullet points of things you want to discuss in the session,” she says.

You may be given homework assignments to complete between sessions, but sometimes this depends on the couple’s preferences, notes Carroll. In some cases, for example, one person may welcome homework, while the other is opposed to taking on any obligations outside of therapy.

“If they are both eager, I give them homework. If there’s some kind of resistance with one, I give them something very small every day, such as make one acknowledgement of something you appreciate about the other person,” Carroll says.

Who Shouldn’t Try Couples Therapy?

Bronstein says some couples may not benefit as much as others from couples therapy, including those who are experiencing any of what she calls the “three As,” which are:

• Addiction
• Affairs
• Abuse

Sometimes in these situations, couples therapy could do more harm than good, she says. “For example, a couple who is experiencing domestic violence, if they go to therapy, it could exacerbate the problem, and the victim could be in more danger if the abuser gets angered because of therapy,” Bronstein explains.

She recommends individual therapy first for people struggling with addiction, affairs, or abuse, so the person can heal or recover before working on their relationship with someone else, or to work with a professional to form a plan to leave an unsafe relationship if needed.

That said, some practices do offer specialized services for couples facing these types of situations.

Carroll adds that partners who don’t have the right motivations for trying couples therapy might not be good candidates for it. “What many people do is they come in with an agenda that they are going to show their partner the error of their ways, and they’re not willing to put that aside, and it just doesn’t work,” she explains. “You’re not going to convince somebody else to be different.”

These top resources can help you find and navigate couples therapy services:

American Association for Marriage and Family Therapy (AAMFT)

AAMFT is a professional association that represents more than 72,000 marriage and family therapists in the United States, Canada, and beyond. Its website hosts a directory of marriage and family therapists that can help you find a therapist near you.

The Gottman Institute

The Gottman Institute, founded by Dr. John Gottman, PhD, and Julie Schwartz Gottman, PhD, is a research institute committed to increased understanding of relationships and developing evidence-based interventions to promote loving and healthy relationships. It offers a wealth of resources for couples, including a directory of Gottman couples therapists, its “Gottman Love Notes” newsletter, and its Small Things Often podcast with quick relationship tips.

American Psychological Association (APA)

APA is the leading professional and scientific association representing psychology in the United States. It offers a Psychologist Locator tool that can help you find a couples therapist in your area.