Couples therapy: what to expect & how to make it work

• A big life change, like a baby, a move, illness or loss
• Arguments that keep going round in circles
• Closeness or intimacy has dropped
• Mental or physical health concerns affecting you both
• Parenting disagreements
• Trust has been hurt

If toxic patterns are spotted early and you both agree on them, real change can begin sooner. Some couples go before marriage, a new baby or retirement, simply to build skills.

If one partner is leaning toward leaving and the other wants to work on things, a short form of help called discernment counselling is designed for exactly that. See “Types of couples therapy” below.

The Gottman Method starts with a joint session, separate interviews with each partner, and questionnaires, followed by detailed feedback. Work then focuses on friendship, managing conflict and creating shared meaning.

Some parts of its “Sound Relationship House”

• Commitment and trust
• Creating shared meaning
• Fondness and admiration
• Knowing your partner’s inner world (love maps)
• Managing conflict
• Turning toward each other’s bids

EFT is an evidence-based approach drawn mainly from attachment theory. It helps couples see the negative cycle they get caught in, like one person pursuing while the other withdraws, and reach for each other in new ways.

A research review named Integrative Behavioral Couple Therapy, along with EFT, as especially promising evidence-based treatments for couples.

It is one of several approaches with growing research behind it. A therapist trained in it can explain how it works in practice.

Discernment counselling is short and focused on clarity, not fixing. Much of it happens in separate conversations with each partner. The goal is confidence about the next step: stay as you are, separate, or commit to couples therapy.

In an analysis of 100 cases, about half of the couples chose to start couples therapy to reconcile. Most of the rest chose to separate.

Web-based programs such as OurRelationship and ePREP were tested in a national trial with 742 lower-income couples. Both reduced relationship distress compared with a waiting list, across many different life situations.

They are not the same as therapy with a person, but they can be a lower-cost starting point.

Research has firmly linked relationship distress with depression and anxiety. Couples therapy has an important role in caring for many mental health conditions, alongside individual care.

In the 2020 analysis, greater distress at the start was linked to bigger gains. Feeling very far apart is not a reason to think it is too late to try.

The 2020 analysis noted that its studies included only opposite-sex couples. Less research exists on LGBTQ+ couples and many other relationships, although skilled therapists work with all kinds of couples.

Therapists often give “homework”, like planned time together, to rebuild closeness. Practising at home keeps sessions from turning into venting.

You and your therapist decide together how often and how long to meet. Expect gradual progress rather than a quick fix.

It takes a lot of mental and emotional effort to make lasting change. Feeling tired or raw after a session is common. Plan something gentle afterward, and tell your therapist how you’re doing.

Holding back, giving short answers or not being honest can stall progress. You don’t have to share everything at once, but try to say what is really going on.

Approaching problems as partners rather than opponents is one of the main shifts couples therapy aims for. Curiosity about your own reactions helps more than building a case.

Not practising between sessions is one of the common reasons therapy doesn’t reach its goals.

If you don’t click with your therapist, give it three or four sessions before changing direction. A poor fit can get in the way, and finding a better one is not failing.

If old issues come back later, it is okay to return to therapy down the road. That is a healthy choice, not a setback.

When one partner has already decided to end the relationship, counselling may turn into a place to share that decision rather than a route to repair.

That can still be valuable. Counselling can also help a couple work out whether separating is the healthiest path.

If one partner only goes because they feel forced, or doesn’t think the relationship is worth saving, therapy is less likely to reach its goals.

If your partner won’t go, you can still see a therapist on your own. Changing your own part of a pattern can shift things too.

Psychologists recommend individual therapy for conditions like depression or anxiety. Couples counselling can then help with how those struggles affect the relationship.

• An abusive partner may use what was said in therapy against you later
• The person being harmed may find it hard to judge how bad things are
• A therapist may miss the abuse and treat it as a shared problem
• Therapy feels safe, but that safety may not follow you home

Advocates at the National Domestic Violence Hotline can be a sounding board if you are thinking about couples therapy with a partner who hurts or controls you. Call 1-800-799-7233 or text START to 88788.

One-to-one support gives you a private place to make sense of what is happening and think about safety. See Domestic violence: the basics and Coercive control for more.

Much of the research on couples therapy has focused on opposite-sex couples, so it is reasonable to ask how a therapist works with couples like yours.

Questions you can ask

• “How much experience do you have with couples like us?”
• “How do you make sure both of us feel understood?”
• “What training have you had in LGBTQ+ affirming care?”

If culture, family expectations or faith matter to you, say so early. A good therapist will be curious about your values rather than replacing them with their own.

If you feel judged for who you are or how your relationship works, that is a good reason to look for another therapist. The right fit matters.

• EFT therapists: directory.iceeft.com (International Centre for Excellence in Emotionally Focused Therapy)
• Gottman-trained therapists: gottmanreferralnetwork.com (The Gottman Institute)
• Marriage and family therapists: TherapistLocator.net (American Association for Marriage and Family Therapy)
• Mental health services near you: FindTreatment.gov (SAMHSA)

AAMFT encourages people to contact several therapists and ask about their training, experience, fees and areas of expertise.

• “What approach do you use with couples?”
• “How do you handle it if one of us feels unsafe?”
• “How often would we meet, and for how long?”
• “What are your fees, and do you offer a sliding scale?”

Things to check

• Whether your insurance covers couples or family therapy, and under what conditions
• Whether your workplace has an employee assistance program (EAP)
• Whether the therapist offers reduced or sliding-scale fees
• Whether a local training clinic offers lower-cost sessions

Free, research-tested online programs can be another starting point if therapy isn’t affordable right now.

Your primary care provider, your insurance company, or FindTreatment.gov (SAMHSA’s locator for mental health services) can point you to options. Therapy: the basics helps you prepare.

Find A Helpline lists free, confidential helplines in many countries. In an emergency, contact your local emergency number.