Couples Therapy: Talk Therapy or Skills-Based?

Studies have shown that receiving couples therapy, especially before conflicts are acute, is almost universally helpful. In fact, a staggering 99 percent of couples reported improvements from therapy, and the vast majority wish they’d started sooner. Getting treatment for conflicts within relationships seems to be a worthy investment, whichever form of treatment you choose. However, with a wide variety of approaches available, finding a couples therapist can be overwhelming.

What's the Most Effective Couples Treatment?

To name just some of the methods available for couples treatment, there are skills-based therapies, such as the Gottman method, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and psychodynamic therapies—not to mention the many humanistic and integrative approaches.

As you consider the many modes of treatment available, one important question you and your partner will want to ask yourselves is: Do you prefer a more structured, time-limited, solutions-focused approach, or would you prefer a more exploratory form of talk therapy?

To take a typical couple as an example: Justin and Laura have been together for 10 years, and both complain of feeling estranged from one another. Laura believes that Justin was more loving and open during their courtship but that, over time, he has come to take her for granted and that any expression of her needs and desires pushes him away further. Justin, meanwhile, feels that Laura is never satisfied with him and is frequently critical and that she is equally unavailable to him, especially sexually.

The pair is trying to decide between a short-term, skills-based approach like the Gottman method and psychodynamic talk therapy.

The Gottman Method

In his Seven Principles to Making Marriage Work, John Gottman boldly criticized the most common forms of couples therapy and, citing his own research with his wife, Julie Gottman, with whom he spent decades observing couples in their laboratory, offered a new approach he claimed would be more effective. That approach became rather famously known as the Gottman method.

The Gottman method is a highly structured and solutions-focused style of treatment that isolates seven principles for making marriage work:

1. Sharing love maps
2. Nurturing fondness and admiration
3. Turning toward each other
4. Keeping a positive perspective
5. Managing conflict
6. Realizing life goals
7. Creating shared meaning

Therapy begins with an assessment of how the couple interacts together and then goes on to offer the couple tools to improve communication and conflict resolution. The Gottman method identifies four common destructive behaviors that can imperil the health of a couple, referred to as The Four Horsemen of the Apocalypse:

1. Criticism
2. Contempt
3. Defensiveness
4. Stonewalling

Once these patterns are recognized, treatment focuses on finding “antidotes” to such behaviors or alternative behaviors that are growth-promoting rather than harmful. This style of therapy is very goal-focused and often includes exercises and homework assignments where clients try out these new tools.

The Gottman method is evidence-based and has been proven effective, especially for couples seeking a relatively quick and practical approach to reducing conflict in their relationships. The approach is best suited to those who are willing to follow the rules and accept therapist-imposed frameworks, but it may not work as well for those who dislike formal structure or want more individual attention.

Returning to our couple, Justin and Laura, the Gottman method could be useful in helping Laura express her needs in less critical language while alerting Justin to the ways he can stonewall and become defensive in avoiding dealing with Laura’s concerns. It could also help the couple grow less estranged by establishing shared meanings, fostering mutual appreciation, and by getting to know each other better through building love maps (the story of your partner’s inner life).

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Psychodynamic Couples Therapy

Most forms of couples therapy can trace their roots to psychoanalytic theory, which is the oldest and most developed form of talk therapy. Many clients think of psychotherapy as Freudian analysis, but in fact, Sigmund Freud’s ideas have been critiqued and modified for decades, and more modern styles of treatment involve an open and very human face-to-face dialogue in which the needs of the individual—and couple, in this case—largely shape the work.

Still, psychodynamic work centers on certain core beliefs held by Freud, above all, a belief in the unconscious. Namely, many of the fears and wishes that drive us, along with the patterns we repeat, lie outside of our conscious understanding or control. Therapists who use a psychoanalytic approach are constantly searching for the deeper underlying sources of feelings and behaviors and tend to spend a fair amount of time on patients’ histories and drawing connections between past and present relationships.

The many thinkers who have influenced the modern psychoanalytic canon also have rich ideas about love that inform modern couples' treatment. For Freud, what drives people to love a specific someone is often a resemblance to an early love object (typically a mother or father), which opens the door to certain childhood patterns of relating that can influence the adult couple. To use psychoanalytic terminology, we tend to project aspects of our early relationships onto our adult ones. Later thinkers (Ronald Fairbairn, Philip Bromberg) further developed the idea that our formative relationships are internalized and create aspects of ourselves or roles we fall into—"I’m always the one being blamed," "I’m always the rejected one"—that gets played out between the members of the adult couple, leading to distress and a sense of not being seen.

For this reason, relational psychoanalytic couples work (in particular) invites clients to recognize such patterns, especially where one person feels they are a victim of the other, and move to the point of truly seeing and recognizing the other. From that, a sense of shared responsibility and interconnectedness can emerge.

When it comes to couples therapy, most psychoanalytic therapists take a client-centered approach and consider each individual in their uniqueness while also keeping track of how the partners interact dynamically and affect each other. Many of the ideas that appear in the Gottman method are utilized in some form in psychotherapy as well but in a less structured or rigid way. Psychodynamic approaches are more free-form and take longer but are meant to create a deeper understanding of oneself and one's partner in order to enact fundamental change. The approach is also well prepared to deal with obstacles in the treatment—attachment to old habits, underlying anger—that become part of the work of the treatment itself.

Returning to our couple once again, psychodynamic therapy could be helpful to Justin and Laura by allowing them to see which patterns of behavior are being enacted, unknowingly, between the two of them. Perhaps Laura was the neglected child in her household and interpreted Justin’s preoccupation as a lack of love. Perhaps Justin was often made to feel inadequate as a child and finds Laura’s dissatisfaction with him overwhelming, causing him to shut down. Psychodynamic therapy can help each member of the couple see what fears and expectations they’re bringing into the relationship and can resolve some of the long-standing issues that might interfere with real change if unaddressed.

To find a therapist, visit the Psychology Today Therapy Directory.