How Does Couples Therapy Work?

Couples therapy is a form of talk therapy designed to reduce distress and improve functioning within a relationship. Like other forms of talk therapy, couples therapy aims to relieve people’s distress and improve their functioning in an important sphere of life. Couples therapists often view relationship problems as relational rather than individual. From this perspective, difficulties usually arise from cycles of interaction that both partners unintentionally reinforce over time.

But unlike other forms of therapy, there are typically three parties in the room in addition to the psychotherapist: each of the partners in the couple and the relationship itself.

When is couples therapy helpful?

There are many reasons why couples seek therapy, but they often relate to couples having conflicting points of view on the same experiences and/or high levels of distress in one or both partners. Common reasons for couples therapy include:

• Frequent communication breakdowns or challenges
• Loss of trust (e.g., from infidelity, etc.)
• Major life transitions, such as marriage or parenthood
• Increased emotional distance or lack of intimacy

Often, one partner may be more motivated to attend therapy or feel more hopeful about change than the other. Therapy can still be effective in these situations, particularly when both partners are willing to start by attending sessions with a therapist.

Couples therapy is not limited to married couples or to relationships in crisis. It can also be helpful for relationships at many different stages, including those who are dating, engaged, or in long-term relationships. Couples therapy can also be particularly useful for partners navigating complex circumstances, such as blended families, cultural or religious differences, or mismatched expectations around roles, intimacy, or life goals.

In addition, therapy may be recommended when one partner is dealing with an individual concern, such as depression, substance use, or a chronic health condition, and the strain of that issue is affecting the relationship. In these cases, couples therapy can help partners better understand each other’s experiences and work together more effectively as a team.

What happens in couples therapy?

Most couples therapy is conducted with both partners present in sessions. Seeing or contacting one member of the couple separately is occasionally warranted but usually done only with the permission of the other person.

In couples therapy sessions, 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. 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.

There are a number of approaches to couples therapy that can also determine what happens in couples therapy sessions. Common therapeutic approaches include the Gottman Method, Emotion-Focused Therapy, and Imago Relationship Therapy. However, most couples therapists are trained in multiple modalities and flexibly draw on techniques from all of them as needed.

How does couples therapy differ from couples counseling?

Both couples therapy and couples counseling aim to help couples resolve relationship difficulties and handle conflict. In many cases, these terms are even used interchangeably, but there are important differences between the two.

Couples counseling usually focuses on a single current problem that partners face and is often completed with fewer sessions. In contrast, couples therapy involves a deeper process that explores the roots of partners’ current problems with the intent of resolving dysfunctional patterns of interaction. This usually requires more sessions, but it can be powerful in helping individual partners understand themselves and their own needs better so they can be a better partner.

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.

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, which can be either 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. There are also community agencies that offer couples therapy.

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 a therapist to work with, it is wise to consider an initial consultation with one or more professionals, all of whom should be willing to answer any questions you have about therapy.

Couples therapists are licensed mental health professionals, typically holding a master’s or doctoral degree in 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 may seek training or certification, such as in divorce counseling or sex therapy. 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 may approach sessions.