Couples therapy (also referred to as marital therapy, marriage counseling, couples counseling, etc.) is a specialized type of family therapy where romantic partners are the targets of the intervention or therapy. Family therapy is a specialized type of group therapy where more than one client who is related is treated by one or more therapists at the same time (in the same sessions).
Therapists or counselors who perform couples therapy come from diverse backgrounds, including specialized marriage and family therapy programs, clinical psychology programs, counseling programs, social work programs, etc. In addition, the therapist or counselor performing couples therapy can use any number of different counseling or therapeutic orientations that can include the cognitive-behavioral paradigm, psychoanalytic paradigm, humanistic paradigm, etc.
Individuals seeking the assistance of couples therapy would be best advised to choose a therapist who has training and experience in this type of intervention. It is important always to ask the potential therapist or counselor about their background and credentials before committing to treatment with them. This can ensure that the therapist has the right background to address the couple’s specific needs.
Why Couples Therapy?
Long-term relationships require an investment of time, energy, and commitment. In most cases, partners can address issues without professional help. However, in some cases, partners may need professional assistance to give them a different perspective on their issues and to help them work together.
According to the book Couples Therapy, Multiple Perspectives: In Search of Universal Threads, research suggests that couples who enter counseling or therapy are often struggling for years with their issues before they make a commitment to get professional help (with the average being 4-6 years). This tendency for couples to not seek professional help when they need it indicates that in many cases couples who finally commit to getting professional help may have already waited a long time, and there may be significant damage that cannot be addressed by even the most skilled therapist. The emotional bond between the partners may be weakened to the point where there are high levels of resentment and less commitment to change.
Research into the factors that are associated with successful therapeutic or counseling outcomes indicates that both the working bond between the therapist and clients, and the motivation and commitment of the clients regarding wanting to change and being willing to work toward change, are important factors in successful treatment outcomes. When couples have waited too long and decided that they no longer wish to invest the time and energy into maintaining the relationship, even the most skilled and committed therapist is significantly challenged in helping them.
Part of the issue is that there is a misconception that getting into therapy should be a last ditch effort for couples. Nothing could be further from the truth.
While couples therapy can be effective at resolving serious long-term issues for couples, it is not a panacea that can correct every issue. Like all interventions, it works best if it can be initiated early enough for the individuals involved in the treatment to benefit from it.
Assumptions and Goals of Couples Therapy
Therapists specializing in couples therapy first attempt to learn and understand how the particular structure of the relationship is related to the issues that have brought the couple in for treatment and then they address those issues. Issues that bring couples in for treatment can be quite varied and can include feelings of resentment, declining displays of affection, financial issues, infidelity, and substance abuse issues. The ultimate goal of the therapist is to strengthen the relationships between the couple, help them to communicate, and address their particular issues in a manner that reduces stress and allows the couple to work together.
Although different therapists who use different approaches will vary in their conceptualization and approach in how to address the specific issues of the couple, according to the book Couples Counseling: A Step by Step Guide for Therapists, there are some assumptions that couples therapists generally follow regardless of their theoretical orientation:
- The partners represent separate individuals who have an independent existence as well as being part of the family unit. An individual’s personal experience can either contribute or detract from their bond and relationship with their partner.
- The couple’s relationship is also a separate and intertwined entity that interacts with both individuals.
- Events occurring to a member of the couple not only affect them as a person but can also influence their partner.
- Events that are shared by the couple also affect them individually.
- Events can affect the relationship in a negative fashion and result in dysfunctional relationships. There can be numerous issues here that can include keeping secrets, isolation, issues with trust, issues with attention, issues with control, and the development of alliances outside the relationship.
The above issues can be related to numerous factors associated with the relationship, including issues with infidelity, seemingly being indifferent to one’s partner, financial issues, other disagreements, etc. When these issues affect the couple, they may also affect the individual. Feelings of depression, anxiety, or being overstressed, etc., can lead to the development of other issues, including problems with substance abuse or infidelity. The couples therapist attempts to understand the issues from both the individual perspective of each member and from the perspective of the couple as a unit. Then, the therapist attempts to restore or develop a more functional approach to dealing with issues and to having the couple work together on their problems. The idea is to get the couple to work together as a unit and not to place blame on either one of them, although in some instances, it may be clear that one member of the partnership is acting in a manner that contributes to the problem to a greater degree than the other.
According to the book Counseling and Therapy for Couples, the therapist then attempts to:
- Establish clear goals for the therapy based on the needs and desires of the couple
- Focus on the specific issues affecting the couple
- Treat the relationship itself as opposed to focusing on one individual separately (In some cases, the therapist may recommend individual therapy for one or both of the members of the partnership if the therapist deems that they need additional and more specialized treatment.)
- Attempt to adopt a change-oriented and solution-focused approach to treatment
The process typically begins with an interview and assessment of the relationship, including its history, the values of the members, their cultural background, etc. The therapist then assists the couple in identifying the specific issues that need to be addressed and developing goals for treatment. The therapist attempts to help the couple gain insight into the dynamics of the relationship that affect and maintain their issues and then tries to help them change these problems.
Even though understanding the needs and patterns of the relationship is important for the couple, it is also important that the therapy is solution-focused and addresses the specific issues that brought the couple to the therapist. The therapist typically works with couples in sessions in order to help them understand one another, develop new skills, and address their goals. The therapist then assigns homework to the couple that helps them address their issues in the real world.
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Who Should Be Involved in Couples Therapy?
Couples therapy is appropriate for any relationship. Couples therapy can be effective over all ages, all ethnic groups, and all socioeconomic statuses. In addition, couples who are dating, engaged, married, living together for years, etc., are able to experience the benefits of couples therapy. The therapy can be used to resolve current problems, address issues with parenting, address issues with conflict, issues with stress, etc., to apply the skills they have learned in therapy to their day-to-day interactions.
Most couples come away from couples therapy with gained insight into their relational patterns, increased emotional expression, and the skills necessary to communicate and problem-solve with their partners more effectively.
The book Foundations of Couples, Marriage, and Family Counseling lists numerous benefits of couples therapy that include:
- Understanding how to resolve conflicts in a healthy manner
- The development of communication skills that will foster a healthy relationship
- Learning how to be assertive without being offensive
- Learning how to express one’s needs without resentment or anger
- Learning acceptance and forgiveness
- Actually processing and working through unresolved issues, as the therapeutic environment allows the couple to express their feelings in a safe environment
- A deeper understanding of oneself and of one’s partner
- The ability to address and work through a crisis (e.g., the death of an important family member)
- Increased honesty and trust
- The development of a supportive environment where partners learn to avoid issues with isolation and apathy
In general, five major areas are addressed:
- The intervention helps both partners conceptualize their relationship in a more objective manner, stop blaming, and understand that what happens to them happens to them together. The partners change their views of the relationship in a more positive manner and approach their relationship in a manner more conductive to keeping them together as a unit.
- Dysfunctional behaviors are modified, such that the partners learn to act in manners that do not need to psychological, physical, or emotional harm. In some cases, such as domestic violence, the therapist may recommend that one partner be referred to a shelter. In other cases, the therapist can work with partners on the relationship aspects and may recommend individual treatment, such as anger management or substance use disorder treatment for a partner, depending on the issue being addressed.
- Communication is improved by fostering closeness and commitment to one another. Often, the therapist coaches the partners on how to communicate in a more supportive and effective manner. Empathy and understanding are stressed.
- Emotional isolation or avoidance is decreased. The therapist assists individuals who are reluctant or even fearful to express their feelings to their partner to learn to do so in a manner that promotes sharing and intimacy.
- The therapy emphasizes the strength of the relationship and each partner, and uses these strengths to help the individuals develop themselves and their relationships.
By working through issues together, the couple can reconnect with one another, learn to address future issues in a healthy manner, and resolve any feelings of resentment or anger that detract from the relationship. The goal of the therapist is to help the couple develop a more proactive and healthier approach to dealing with their issues and to keep the couple working together as a unit. However, couples therapy cannot fix every issue.
When Couples Therapy May Not Be Effective
Counseling or therapy is not magical. A large meta-analytic study published in the journal Contemporary Family Therapy in 2015 supported the overall effectiveness of couples therapy, but not every couple in therapy experienced a successful outcome. Just becoming involved in therapy and going to sessions is not sufficient for the resolution of issues. The Clinical Handbook of Couple Therapy lists several conditions that often detract from the effectiveness of couples therapy.
- The therapist does not recognize that one of the members needs to address specific personal issues that affect the couple, such as past abuse or trauma, substance abuse issues, or specific mental health disorders, such as depression, an anxiety disorder, a personality disorder, etc.
- One or both partners are reluctant to discuss the personal details of their problems with the therapist. Often, this falls on the therapist to get the couple to disclose their issues; however, some couples/individuals may never be forthright or comfortable discussing their personal feelings, issues, etc.
- One or both partners continue to practice infidelity despite attending sessions.
- One of the partners is not committed to working on the relationship (e.g., one of the partners is forced into attending sessions, has already decided that they want a divorce, is not motivated to do the work, etc.).
- The goals of the intervention are not clear and the couple or the therapist has not identified specific goals to be accomplished.
- The therapist or the particular intervention is a bad match for the clients. Typically, the therapist should recognize this and suggest that the couples try a different approach or refer them to a more suitable therapist.
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