A Full Guide To Couples Therapy: When You Should Go, What Happens There & More
Couples therapy can sound dramatic, but in reality, going to couples therapy or couples counseling can be a very healthy step for a relationship. It's usually a sign that a couple is interested in working on their relationship in a committed, intentional way. Here's a guide to what happens at couples therapy, how to know if you should go to couples therapy, and other frequently asked questions.
What is couples therapy?
Couples therapy is a type of psychotherapy focused on helping a couple work through challenges, understand their relationship better, and develop healthier ways of relating to one another. The therapist uses specific therapeutic techniques and interventions to support the couple's goals.
Many couples come to couples therapy because they're dealing with a specific challenge, such as communication issues, difficulties around sex, affairs, or considering a breakup. At core, marriage therapist Linda Carroll, LMFT, says it's about helping couples "get unstuck from painful dynamics that keep getting repeated."
What happens at couples therapy.
Typically, couples therapy involves talking through relationship challenges as a couple with a neutral party (your therapist) who is trained to help you get to the bottom of the issue, Carroll says. The therapist will ask specific questions to help partners communicate in a healthier, more honest way, understand each other's perspectives and feelings better, and develop new ways of approaching conflicts. They may also do guided couples activities.
A good couples therapist teaches couples how to ask for what they want without causing the other person to shut down, Carroll explains. "A therapist knows how to help couples get to the real trouble [at the heart of the issue] and can teach skills or appropriate referrals to help them through it," she says.
During her couples therapy sessions, she also teaches couples new relational skills, such as how to express desires as wants instead of criticisms. For example, you might learn to say, "I want you to be more affectionate and hold my hand" rather than "You never hold my hand."
She also watches for issues like clinical depression, which might look like disappointment in your partner at the outset but is a clinical condition that needs to be treated.
(Here's more on what happens on the first day of couples therapy.)
Success rates of couples counseling.
There's no definitive answer to how successful couples therapy will be. Some studies1 show relationship improvement from therapy. Other research2 shows there are both some couples who maintain a healthy relationship years after completing couples therapy, whereas other couples fall back into old negative patterns.
Marriage therapist Ian Hoge, LMFT, and Carroll both say that how successful couples therapy will be is entirely up to the individuals in question and their desire to work hard, learn new skills, and stay invested in the process. Some couples show up to sessions but don't practice the skills at home, and so they don't see improvement in their relationship.
"In many ways, this can be a trick question," Hoge adds. "Most people might define success as whether or not you stay together, but we all know that staying together doesn't necessarily define success."
Not all couples should stay together, so sometimes success in couples counseling means a couple realizing that it's time to end the relationship.
When should you go to couples therapy?
If you are having the same fight over and over again without resolution, Carroll says it might be time to see a therapist. You can also go see a therapist if you're feeling stuck about how to manage a hard decision together, if you're considering splitting up, or if there's been a major stressor on the relationship such as infidelity, financial strain, or trauma.
"Most people go to couples therapy when intimacy or communication is stuck and perhaps on life support," Hoge says. "The couple is usually at a crossroads, not knowing how to move forward or if they even want to move forward anymore."
But healthy couples can benefit from couples therapy too, he notes, as it's an opportunity to improve connection and communication. So you shouldn't just go if you're having trouble. Both Carroll and Hoge note that they see couples who just want to make their good relationships better and who want to learn new relationship skills.
Wanting the best relationship you can have is reason enough to begin couples therapy, Hoge says. Or as Carroll puts it: "Love is a feeling, but a healthy relationship is a skill set. Most of us don't learn these skills growing up, so we just expect love to carry us through. But it isn't enough. That said, love combined with skills usually is enough."
Signs you should go to couples therapy:
- Poor communication with your partner
- Feelings of boredom or numbness about your relationship
- Wanting to learn how to have healthy conflict
- Having the same fight over and over again without resolution
- A desire to improve your relationship
- Feeling distant from your partner
- Feeling like you're not getting something you need (for example, time or affection)
- Tackling a big life event (like moving, a new job, or a tough decision)
- Managing the transition from couplehood to new parenthood
- Managing the transition from parenthood to empty nesting
- The presence of a betrayal (an affair or unfaithfulness)
- Considering a divorce or wondering if you should break up
- A desire to set a strong foundation before marriage (premarital counseling)
- Feeling too attached to one another (codependency)
- The presence of past traumas that show up in your relationship
Can couples therapy make things worse?
Some people do have negative experiences in couples therapy. Some therapists lack proper training in couples therapy or simply have an ineffective approach that ends up making things worse for the couple. But other times, the process of going to couples therapy simply forces couples to have hard conversations and be vulnerable in a way they're not used to being, which they may interpret as "making things worse"—even if the process is helpful and healing for them in the long run.
Some couples do break up after couples therapy, but sometimes that's for best. Hoge notes that in his sessions, he's often paying close attention to helping a couple navigate whether they want to stay together or not. He says some people stay in a relationship just for their children or because they don't know how to make a change. In these cases, people can be more unhappy staying in a relationship than leaving one—and thus, a separation could be seen as a success.
"Some couples come to therapy and learn how to be better partners to each other and choose to stay together," Hoge says. "Some couples come to therapy and realize they don't want to be together anymore. A therapist is there to help you discover the best choice for you and your partner and help you navigate the process as mindfully and efficiently as possible."
How long should couples therapy last?
It can take some couples years of therapy to work through issues, while others need just a few months. The length of time depends on the severity of the problem, plus the amount of effort a couple is willing to put in. Some couples therapists also offer single sessions for couples who just want support through one specific conversation.
"Some couples only need a few sessions to resolve a clear and particular issue, and others appreciate continued maintenance or need regular support," Hoge says. "It usually takes at least a few sessions for couples to get comfortable working in this way, and a therapist needs time to experience and understand a couple's interpersonal dynamics."
Generally speaking, Carroll notes there's a difference between learning how to move on past a major betrayal versus learning how to set aside more time to enjoy together. But she notes that therapy is all about building new habits, which can take more time for some people than others. It involves practicing skills from couples therapy at home.
"Sometimes people get frustrated when things aren't better after just six sessions, but when I ask them how much they're working on the new skills… they say not at all," she says. "Coming to see a therapist is like going to a personal trainer. If you don't work out between sessions, it won't work as well."
How to find a couples therapist.
Couples therapy sessions are facilitated by a trained, licensed clinician, such as a licensed marriage and family therapist (LMFT), licensed professional counselor (LPC), or licensed clinical social worker (LCSW). They may call themselves couples counselors, marriage counselors, marriage therapists, or simply therapists. Just make sure to vet their credentials carefully, as some people may call themselves therapists when they do not actually have training or a license to practice.
You can search online for couples therapists in your city or state. Online directories offered by organizations like Psychology Today, The Gottman Institute, Alma, MyWellbeing, the American Association of Marriage and Family Therapy, the American Association of Sexuality Educators, Counselors, and Therapists, and others can also be good starting places.
Another place to get to know therapists today is through social media platforms like Instagram, where many practitioners share resources and relationship tips that might give you some insight into their philosophy and areas of expertise. Many therapists also share their recommendations for finding good practitioners on their pages. (Just make sure to always vet everyone's credentials thoroughly!)
It can also be helpful to receive referrals from people you love and trust, such as friends, family members, and health care providers.
It may take some time to find the right couples therapist who you both feel comfortable with and confident in, so be open to shopping around and speaking to a few different people until you settle on the right one who can really support your relationship.
Jenni Gritters is a health journalist and certified yoga teacher from Seattle, WA. She has a degree in psychology from Bucknell University and a master's degree in journalism from Boston University. She received her yoga teaching certification with Sendatsu Evolution. Gritters covers the science of healthy living, focusing on the newest scientific research about living a satisfying life. She runs a weekly column for Medium’s health magazine Elemental called "The Health Diaries", and she previously worked as an editor at The New York Times' product review site Wirecutter where she edited longform health, fitness, travel, and outdoors content.