How Does Couples Therapy Work?

Like other forms of talk therapy, couples therapy aims to relieve people’s distress and improve their functioning in an important sphere of life. But unlike other forms of therapy, there are typically three parties in the room in addition to the psychotherapist. There is each of the partners in the couple, and there is the relationship itself. In a very dynamic high-wire act, the couples therapist impartially balances the needs and interests of all three.

Typically, couples seek therapy because they have conflicting points of view on the same experiences, and one or both partners is highly distressed. It’s not unusual for one partner to want therapy more than the other or feel more hopeful about it.

What happens in couples therapy?

Most couples therapy is conducted conjointly—that is, with both partners present in sessions. Seeing or contacting one member of the couple separately is occasionally warranted but almost invariably done to gain information important to the relationship and with the permission of the other. Sometimes an individual seeks couples counseling as a way to prompt a change in a troubled relationship, most commonly because their partner is unwilling to participate in therapy.

The therapist is likely to ask many questions, including some about each partner’s family of origin and some that challenge an individual’s beliefs or perspective. Couples therapists do not take sides in disputes, but they may call out individual behaviors that contribute to joint problems. Relational science has firmly established that both partners play a role in most couple problems.

Therapy usually aims at bringing partners closer together or ending a partnership intelligently. In the process of resolving dilemmas, partners learn to have compassion for their partner and themselves, learn ways of constructively managing their own negative feelings, and rekindle the feelings that originally attracted them to each other.

Between sessions, couples are typically asked to practice at home the insights, behaviors, and problem-solving skills they gain in therapy.

A range of approaches for couples in distress

There are a number of approaches to couples therapy that have undergone some degree of empirical testing. They may reflect different theories about relational behavior, but they have one goal—to improve couple functioning and make relationships a source of deep meaning and satisfaction for both partners. Most couples therapists are trained in multiple modalities and flexibly draw on techniques from all of them as needed. These include:

• The Gottman Method: Developed by psychologists John Gottman—who pioneered ways of measuring interaction processes—and his wife Julie Gottman, therapy emphasizes the outsize power of negative emotion to harm a relationship, the importance of frequent bids for connection or response, the vital need for repairing the damage done by missing those bids, and the value of sharing their inner worlds. Partners learn how to express affection and respect as a means of building closeness and make “love maps'' reflecting their partner’s psychological world.
• Emotion-Focused Therapy regards the restoration of a distressed couple’s physical and emotional bond as the best lever for change in the relationship. Drawing on attachment theory, the therapist encourages partners to access and express what lies under their anger or alienation. That disclosure of vulnerability becomes a powerful means for stirring the responsiveness of a partner. With contact restored, couples have a renewable source of mutual comfort, allowing them to jointly solve whatever problems they face.
• Imago Relationship Therapy has as its theme “getting the love you want.” Its goal is to enable partners to fulfill the ideal of love they developed early in life through attachment to caregivers. Partners take turns listening and speaking; repeating or mirroring what the other says to demonstrate understanding; validating their partner’s perspective; and tapping into their feelings.

How does couples therapy differ from couples counseling?

The two types of care overlap significantly—they both aim to help couples resolve relationship difficulties and handle conflict—and the terms are commonly used interchangeably, even by clinicians. But there are important differences between the two. Couples counseling usually focuses on a single current problem that partners face and is often completed in six sessions or less.

Couples therapy involves a deeper process that explores the roots of partners’ current problems with the intent of resolving dysfunctional patterns of interaction. Often it has to undo the emotional damage that partners have inflicted on each other. Typically, it helps individual partners understand themselves and their own needs so they know how to ask the other for what they want and know how to support their partner well.

The average duration of couples therapy is 12 sessions, but relationship dynamics are complex, and much depends on the goals of the couple. Repairing a relationship after infidelity can take a lot of hard work by both partners (and the therapist!) and require some time.

Specific variations of couples therapy have been developed to focus on such relationship problems as infidelity, intimate partner violence, and sexual difficulties. In addition, couple-based therapy has been found helpful for such individual problems as depression, health issues such as chronic pain and cardiovascular disease, substance abuse, and even PTSD.

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How do I find a good couples therapist?

In couples therapy, as in individual therapy, the relationship between therapist and client is vital, so it is important to find a couples therapist whose approach feels comfortable—but who is also willing to question either partner’s beliefs or behavior when necessary. Before selecting one to work with, it is wise to consider a consultation interview with one or more therapists, all of whom should be willing to answer any questions you have about therapy and address concerns to your satisfaction.

Couples therapists are licensed mental health professionals—holding a master’s or doctoral degree in medicine, psychology, counseling, social work, or marriage and family therapy. They are not only well-trained in an array of psychotherapeutic modalities but have specific academic education in relationship science and family systems and supervised clinical training in interpersonal dynamics. Some therapists seek training and certification by the American Association for Marriage and Family Therapy (AAMFT). Couples struggling with problems relating to sexuality may want to seek a couples therapist who has additional certification from the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Selecting a therapist who has experience with couples having problems similar to yours can speed up the therapeutic process, so it is advisable to ask a prospective therapist what kind of training they have and how they approach couples with problems like yours.

How much does couples therapy cost?

Couples therapy, like individual therapy, can cost between $150 and $400 per one-hour session, usually conducted weekly by a private practitioner. Some therapists may be willing to accept a reduced fee, so it is always worth asking whether the therapist has a sliding fee scale. There are some couples therapists who condense an entire course of therapy into an intensive two- or three-day period, often over a weekend, and charge accordingly.

Unfortunately, couples therapy is not usually covered by insurance because it is rarely deemed medically necessary. There are, however, ways to get quality therapy at affordable rates. One way is to seek treatment at a couples therapy training institute or organization, free-standing or attached to a university. Therapy is conducted by trainees, but they are supervised in real-time by experts who are actively coaching them; you are the beneficiary of their expertise. There are also community agencies that offer couples therapy. The Psychology Today Therapy Directory has a comprehensive list of therapists who serve couples as well as individuals and indicates whether or not they specialize in couples therapy.

Couples therapists, whatever their fee structure, are quick to state that couples therapy is almost always worth the cost. It is, they point out, much cheaper than a divorce.