A Guide to Couples Therapy

The thought of starting couples therapy can bring up all sorts of emotions: fear, hope, embarrassment and more. Kate Crawford, Head of Therapy Services at One Therapy, sets out what couples therapy involves, so that couples can feel more comfortable knowing what they are entering into.

What is couples therapy

Couples therapy is simply talking therapy (or counselling) for couples. It is also known by other names, including couples counselling, relationship therapy, relationship counselling and marriage counselling.  Marriage counselling in particular has misleading connotations: the couple need not be in a marriage and the goal is not necessarily to stay together.

For couples who want to stay together…

If the couple want to stay together, the therapist will help them explore areas of conflict, supporting them to develop new skills and resolve issues, so that they can move forward with a more healthy relationship. For these couples, the sessions provide quality time together, where they can address such common issues as poor communication, financial problems and a lack of physical intimacy.

For couples who want to separate…

If the couple wants to separate, the focus will be on providing a calm space where they can gain insight and move on from their existing relationship in the least damaging way for themselves and those around them. A couples therapist can help them to communicate constructively at a time when it’s all too easy to descend into accusations and blame. Even if the relationship isn’t going to continue, it is still very important for both partners to feel heard.

If the couple has children, the therapist can help them to agree ground rules for co-parenting and provide insight around how and when to tell the children. The couples counsellor might also recommend a family therapist if they think that the couple’s relationship problems are having a negative impact on wider family life.

For couples who are undecided…

Often, couples come to therapy because they are undecided about whether to stay together or separate. Sometimes one partner wants to end the relationship while the other wants to continue. Therapy provides a space to reach an agreement together.
Sometimes the couple don’t know whether the relationship can be improved but they come to therapy to give it ‘one last chance’. This way, if they do then decide to separate, they can do so knowing that they have given it their best shot. And if they enter into new relationships in the future, they will take with them a great resource gained in therapy: improved relationship skills, awareness of their own negative patterns and a greater ability to resolve issues and increase intimacy.

What is the success rate of couples therapy?

This is an impossible question to answer, since there is no single definition of success in therapy. For some, success might mean agreeing to separate without recrimination. For others, it might might mean simply deciding to stay together. And for many, success lies beyond that decision and is about making a good relationship even better.

Is couples therapy effective?

An easier question to answer is whether couples therapy is effective at improving relationship satisfaction or reducing distress. Research strongly suggests that it is. Studies from various countries, covering a range of client types and different therapeutic approaches, indicate that couples therapy delivers significant improvements in relationship satisfaction as well as significant reductions in individual distress[i].

Who is couples therapy for?

Couples therapy is for any two adults who have (or have had) an intimate relationship. Their relationship can be monogamous or open. They can be gay or straight. They don’t need to be in a marriage or living together. They can be at any point in their journey together – the intimate relationship may be new, established or over.

When couples therapy is unsuitable

There are some people for whom couples therapy is not suitable. Where there is significant abusive or controlling behaviour, the partners’ safety must be prioritised. Because things said in a couples session may trigger an abusive episode, couples counselling is unsafe for these people. Instead, the abusive behaviour should be addressed through individual and/or specialist group therapy. Only when the behaviour has stopped should the partners consider couples counselling.

What happens in a couples therapy session?

The couple talks about whatever they think it would be helpful to talk about. Therapists may also suggest issues to explore. They give both partners equal time to talk and equal say in what is discussed. If the discussion escalates or the partners don’t seem to be hearing one another, therapists may teach couples to discuss things more constructively, to listen to and understand each other’s thoughts and feelings. The focus is on understanding the dynamics between the two partners, exploring what each partner finds distressing and why. With this understanding, the couple and therapist can then discuss what changes can be made.

Arguing over trivial things

Couples often say that they argue about silly, little things. The subject matter of these arguments may be small, but the arguments are always about deeper hurts. Couples counselling helps partners to understand these deeper hurts.

For example, You never take the bins out! might really mean You take me for granted. Or a partner who complains that You’ve been out three times already this week might really be saying I’m scared that you no longer enjoy spending time with me. Once the underlying hurt is identified, it is much easier for the partners to reassure each other and find solutions.

The impact of past relationships

Often these hurts link back to the partners’ previous relationships, whether with family members or past romantic partners. If someone has been hurt in a particular way in a previous relationship, they will be more sensitive to that particular flavour of hurt (betrayal, domination, withdrawal, etc) and when their partner does something to trigger that hurt – often inadvertently – the relationship suffers.

Through learning more about each other’s past hurts in therapy, couples can feel more empathy and find ways to avoid triggering each other’s pain.

It is not just sensitivities that partners bring with them from past relationships. People’s views on what relationships should look like and how partners should behave towards each other are all heavily influenced by their past relationships with family and previous partners. The couples therapist may encourage the partners to discuss how things were done in their own families – how domestic chores were shared, who made the financial decisions, how much physical affection was shown, whether feelings were discussed, and so on. We tend to grow up thinking our family life is normal and assuming that other families do things the same way we do. It can be illuminating for each person in the couple to realise that their partner brings a different, but equally valid, view of how families and relationships should look.

Getting stuck in unhelpful patterns

Couples tend to fall into patterns of behaviour that suit them for a while, but don’t work long term. For example one person may be in the habit (developed in past relationships) of being the strong one, putting other’s needs before their own. If they get together with someone who, through their past relationships, has taken on the role of the vulnerable one who needs looking after, it will work at first. They will both feel secure because they fit well together and can play the roles that feel familiar and comfortable to them.

However, dynamics like this usually become problematic with time. The looked-after partner may start to feel controlled or belittled; at the same time the partner doing the looking after may resent having to be the strong one day in, day out. When these dissatisfactions start to show, it can feel like the very foundations of the relationship are under threat. A trained therapist can help the partners to see what is going on with these patterns and find new, less rigid ways of relating to each other.

The importance of communication

Improving the couples’ communication is a key part of therapy: constructive, caring communication helps with the resolution of any relationship issue. There are many different communication techniques, and the right couples therapist will offer guidance on which would be particularly helpful for you and your partner. They will help you to resolve differences without attacking each other, to ask your partner questions that you may have been fearful of asking, to feel free to express things which you have avoided saying before and to feel heard.

Many couples find it hard to create one-on-one time to talk about their relationship. Daily life gets in the way, and when a relationship is going through tough times, it can feel scary to ask for time to talk. Couples in therapy often say that one of the main benefits is that it creates that.

How do I prepare for a couples therapy session?

There is nothing you need to prepare before you start couples counselling. A trained therapist will help you and your partner to talk about your relationship in your initial sessions.

That said, it can be really beneficial to spend a little time reflecting on your relationship before your sessions. You might ask yourself:

  • What has been painful for me in the relationship recently?
  • What negative patterns do we find ourselves in?
  • What would I really like to get from our therapy sessions?
  • What are the recurring themes of the arguments my partner and I have?
  • What do we find difficult to discuss?
  • What would I like my partner to do differently?

Some therapists like to give couples exercises to do at home between sessions, but it is always up to the couple to decide whether they want to do them – your therapist won’t force you to do anything you aren’t comfortable with. These might include verbal communication exercises or writing letters to each other, for example. If you and your therapist do decide that an exercise would be good for you, you will be given full instructions.

How bad do things need to be before starting couples therapy?

Many couples wait until they reach a crisis point before starting therapy. Common sense tells us that this isn’t helpful – problems are likely to get worse the longer they are left – but it’s very common for people to put it off even so.

Data gathered for Relate shows that, while 66% of people surveyed agreed that “Everyone could benefit from support with their relationships”, just 22% said that they would seek support if their relationship was under strain [ii].

So why do people put off going to couples therapy? There are many reasons, but most common among them are shame and fear.

Shame

In our society there is still a stigma around accessing therapy [iii]. As therapists, we emphasise that there is no shame in asking for support – in fact, it takes strength. Because of the stigma, people don’t talk freely about going to see therapists. If they did, most people would be surprised at just how many of their friends, family members and colleagues have had therapy.

When it comes to couples therapy, there can be additional shame about the state of the couple’s relationship. It may be helpful to remember that, for the majority of us, no one has sat us down and told us how to create a healthy relationship. We are expected to magically know how to negotiate domestic arrangements, how to parent together, how to manage differing libidos, how to trust, and so on.

For anyone who has grown up in a household where there was no healthy partnership for them to learn from, it is even harder to develop these abilities. There is no shame in not knowing how to do all these things, and much to be gained from a little expert help.

Fear

Individuals contemplating couples therapy often fear where it will lead. They might fear that it will be the first step towards their relationship ending; that they will be pressured into staying in a relationship they want to leave; or that they might say something that hurts their partner, or vice versa.

While these fears are valid, the reality rarely lives up to the fear. Couples generally leave therapy in agreement about whether to stay together or separate. They may well say things that hurt each other during the process, but they handle it and they grow as a couple through facing those difficult truths.

Couples may also fear how they will be seen by the therapist. Will they be judged for being angry, for being unfaithful, for having too much sex, too little sex or the wrong kind of sex, etc? A good therapist is non-judgemental and will understand the reasons behind your issues.

When to start therapy

The simple answer to the question When should we start couples therapy? is that, if you’re thinking about couples therapy, it’s probably a good time to start. The sooner you start, the sooner you can resolve your problems and feel happier. And they will be easier to resolve now than in six months’ time.

How long does couples therapy take?

Every couple is different.  The therapist uses the first few sessions to gain a thorough understanding of the couple and the problems they want to address. These early sessions are also helpful for the couple: it can be illuminating to hear your partner’s take on your relationship and cathartic to voice your own concerns.

How long it then takes to work through the issues really depends on how many there are, what those issues are, how well the couple communicate and where they want to get to. Some couples are satisfied that they have made enough progress after six weeks, others find the process so beneficial they stay for months or years.

The longer therapy is put off, the longer it can take

Of course, if a couple hasn’t been communicating well for a while, their problems are likely to have built up and become quite complex. Things can become increasingly difficult between them and they become anxious to transform the relationship quickly. This is unrealistic since resolving long-held, complex issues takes time, particularly if the partners are angry with each other, as is often the case by this point. It is better to come to therapy before reaching this point, but if things are left until a crisis point has been reached, expect the therapy to take a little longer.

What issues does couples therapy address?

Any issue that affects the couple relationship can be brought to couples therapy. Common issues include:

  • infidelity
  • communication problems
  • arguments
  • parenting conflicts
  • differing views of marriage
  • difficulties arising in blended families
  • loss of attraction
  • relationships with extended family
  • substance abuse
  • lack of affection
  • sexual issues *
  • money worries and disagreements
  • physical or mental health concerns
  • domestic arrangements
  • differing life goals
  • loss of trust

* Some sexual issues may benefit from psychosexual therapy (PST). You can read more about PST here. If you are unsure whether couples therapy or PST would be better for you, please enquire and we can discuss this with you in your initial consultation.

Linked relationship problems

Most couples come into therapy with multiple problems to be addressed, and they tend to be linked. Relationship therapy helps partners to understand these links. For example, if a couple is having sexual problems, an underlying cause may be that one partner is feeling angry, and that anger may be about that partner doing most of the childcare, or the other partner spending a lot of money, or a lack of non-sexual affection.

Similarly, it is common for couples to find that therapy brings unexpected benefits. For example, if they think the problem is that they argue over money, they may be pleasantly surprised to find that improving their communication around money also helps them understand each other more deeply and thus improves intimacy.

What types of therapy are used for couples therapy?

Various therapeutic approaches are used in couples therapy. Some of the most common approaches are outlined below. However, the therapeutic approach is generally less important than the relationship with the therapist – it is advisable to choose a therapist based on how you feel in the room with them, more than their theoretical approach.

Cognitive behavioural therapy

A cognitive behavioural approach focuses on changing unhelpful thoughts and behaviours. It often incorporates structured exercises, such as keeping a mood journal or identifying automatic thoughts. These are the thoughts that we jump to in a fraction of a second, often triggered by our partner saying or doing something that touches a nerve. They can lead us to feel emotions like hurt, anger or despair.

Couples counsellors teach their clients to identify the thoughts and behaviours that are getting in the way of them having healthy relationships. Couples can then challenge and change their own thoughts and behaviours, as well as requests changes in behaviour from each other.

Cognitive distortions

Cognitive behavioural techniques are particularly effective when a couple’s relationship problems stem from cognitive distortions. These are patterns of thinking that don’t accurately reflect reality. Examples include:

  • Catastrophising – assuming that the worst is going to happen, eg She’s bound to cheat on me like all the others have.
  • Mind reading – one partner thinking that they know what the other person is thinking, eg He thinks I’m stupid.
  • Should statements – thinking that something should be a particular way, eg A marriage should be harmonious at all times.
  • Magical thinking – believing that things will improve as if by magic, eg All we need is for her to get this new job, then everything will be okay.

Each of us tends to have particular cognitive distortions that we use more than others. Some of us are catastrophisers, some are inclined to mind read, and so on. Through relationship counselling, each partner can learn which distortions they habitually use and endeavour to correct their distortions.

Of course, habitual thoughts and behaviours such as these don’t just affect intimate relationships. Many people find that what they learn in their couples therapy sessions not only helps their relationship with their partner; it also helps in other areas of their life. For example, it may improve their self confidence, relationships at work, wider family life, self-esteem, and so on.

Psychodynamic therapy

A psychodynamic approach explores how a couple’s ways of relating to each other are influenced by their past relationships, particularly those with parents or caregivers. So if a partner catastrophises, for example, a psychodynamic therapist will go beyond identifying that and challenging the distortion; they will unpick where the tendency to catastrophise has come from. Perhaps they learnt it from a parent who themselves always feared the worst; or perhaps it was a coping mechanism developed when life with an alcoholic parent was intolerably unpredictable.

Using the therapeutic relationship

The psychodynamic therapist pays attention to how each member of the couple relates to them, the therapist. Since we tend to use similar patterns of relating across all our relationships, this gives the therapist clues as to what might be causing problems in the couple’s relationship.

For example, if the therapist feels drawn to mother one partner, this suggests that a similar dynamic is at work in the couple’s relationship, with that partner subtly prompting the other to look after them.

Or if a client repeatedly challenges the therapist, cancels appointments and often turns up late , that suggests the client does the same in the couple’s relationship. They unconsciously behave in ways that make it hard for their partner to stay in the relationship with them, possibly because they fear getting hurt, so they sabotage the relationship instead.

When the therapist points this pattern out to the client and highlights how it actually creates the hurt they are trying to avoid, they bring it from the client’s unconscious mind to their conscious mind. Once it becomes conscious, it is easier for the client to change. The relationship between the clients and the therapist can also be a useful – and safe – space to practice new behaviours. The client who pushes people away by cancelling and so on, can try out being more present in the relationship, turning up reliably and letting the therapist in. This will likely feel uncomfortable and possibly scary to the client at first, but the therapist will be able to stay alongside them and help with the discomfort while the client gradually gets used to this new, healthier way of relating.

Couple fit

A psychodynamic therapist may also explore the ‘couple fit’ – what each partner unconsciously hoped to resolve by entering into a relationship with the other. We have an unconscious drive to recreate problematic relationships from our past and ‘get it right this time’. So we choose partners with similarities to people from our past, usually our parents, in the hope that we can get it right with them.

Unconsciously, we think things like This time my critical father (partner) will give me the praise I crave or This time my disinterested mother (partner) will find me interesting, and so on. Those characteristics (the very reasons that we have chosen our partners!) then infuriate us because they are the things that we are most sensitive to. We react to them with the anger or hurt that has built up over many years in our relationships with our parents.

By exploring this in the counselling sessions, the therapist helps the couple to bring these unconscious processes into consciousness. The couple can then gradually separate their perceptions of each other from their perceptions of their parents.

Integrative couples therapy

This is probably the most common form of couples therapy in the UK. Integrative couples counsellors draw on a range of theories and techniques to best suit their clients needs. With their training in multiple approaches, the integrative therapist can offer cognitive behavioural exercises to clients who like to be given homework, explore psychodynamic concepts with those who want to dig into links with their childhoods, and so on. And of course, an integrative therapist may bring several different approaches into their work with a single couple, as required at different stages in the course of therapy.

Attachment-based therapy

Attachment theory grew out of psychodynamic ideas. It is a theory of how the relationships between us and our caregivers when we were infants shape our ways of relating as adults.

When a parent responds sensitively to their baby’s emotions and needs, the baby feels secure, and this helps the baby to feel good about themselves and develop healthy relationships with others. If a parent ignores their baby’s emotions and needs, responds only sometimes or responds inappropriately (for example getting angry with a baby that cries), the baby feels insecure and this affects their ability to develop relationships with others.

In this way, we develop different styles of attachment based on how attuned and responsive our infant caregivers are to us, and we carry those attachment styles with us into adult life. An attachment-based therapist will help clients understand their attachment styles and how they impact on the couple’s relationship.

Systemic or family therapy

Systemic therapy is often associated with family therapy, as it can be helpful for understanding the complex dynamics of multiple people living together. But it is also a helpful approach for looking at the simpler couple relationship.

The systemic approach considers problematic behaviours to exist not in the individuals, but in the relationships between the members of the family or the couple. It considers what the other members of the family system may be doing to encourage the problematic behaviour and how they respond when it happens.

It can be very hard for a person to change their own behaviour when the people around them aren’t changing the things they do to provoke or reward that behaviour. Addressing a problem in systemic couples therapy therefore requires both partners to make changes simultaneously.

Imago relationship therapy

Like psychodynamic therapy, Imago relationship therapy focuses on childhood experiences and how they impact both our choice of partner and the relationship that develops with them. It explores each partner’s image (or Imago) of love and how to behave in relationships, developed in childhood.

Conflicts within the relationship are seen as opportunities for the partners to grow. Imago therapists encourage their clients to communicate clearly, understand each other’s childhood wounds and help each other to heal.

Emotionally focused therapy

Emotionally focused therapy (or EFT) recognises our need to develop secure attachments to others, and the difficult emotions that arise when a person feels disconnected from their partner. An EFT therapist will help couples to recognise these moments of disconnection and explore how they respond to them.

Often, these moments lead to dialogues that can escalate, thus increasing the disconnection. EFT helps couples to change that pattern, by recognising their need for attachment and learning to communicate in ways that bring them closer.

How does couples therapy fit with individual therapy?

It is fine for one or both partners to have individual therapy alongside their couples therapy. This would need to be with separate therapists, however, not with the couples therapist. This is because it would create secrets and imbalances in the therapeutic relationship if the couples therapist also saw the partners for individual therapy. Some couples therapists see partners for occasional individual sessions as part of the couples therapy (because they think it will help the couple to move forward or if the other partner is unable to attend), others prefer not to.

How much does couples therapy cost?

Couples therapy appointments typically cost more than individual therapy (though less than double the cost). This reflects the fact that there are two clients, which makes the work more complex, and the further training needed to qualify as a couples therapist. Our fees for couples therapy sessions at One Therapy London can be found here.

How do we get started with couples therapy?

The first step is to make an appointment for an initial consultation with a couples therapist. This is an opportunity for the therapist to hear what you and your partner wish to address in therapy and for the two of you to get a feeling for the therapist.

Often, one partner wants to have couples therapy more than the other. A good couples therapist will recognise this and may explore with the couple why that is and what can be done to help the reluctant partner to feel more engaged in the therapy.

It is important to choose the right couples therapist for you. It’s very hard to ascertain this without meeting the therapist, but it is generally clear within the first session. Part of the purpose of the initial session is for the couple to decide whether the therapist is someone they can form a trusting relationship with. Trust your gut feeling when you are with the therapist: if you are able to open up without feeling judged, then the therapy is likely to go well.

Our couples therapists

Tom Leonard, Kim Goodwin-Wheatle, Kate Crawford, David Pena-Charlon, Mita Hiremath, Kira Jolliffe, Jennifyr Yap

Click to see all our therapists’ profiles.

References:

[i] David Hewison, Polly Casey and Naomi Mwamba, “The Effectiveness of Couple Therapy: Clinical Outcomes in a Naturalistic UK Setting”, Tavistock Relationships, 2017, https://tavistockrelationships.org/images/uploads/Tavistock_Relationships_Naturalistic_Study_Report_2017_Complete_FINAL.pdf. Notker Klann, Kurt Hahlweg, Donald H. Baucom and Christine Kroeger, “The Effectiveness of Couple Therapy in Germany: A Replication Study”, Journal of Marital and Family Therapy 37, no. 2 (April 2011): 200-208. Salvatore Garanzini, Alapaki Yee, John Gottman, Julie Gottman, Carrie Cole, Marisa Preciado and Carolyn Jasculca, “Results of Gottman Method Couples Therapy with Gay and Lesbian Couples”, Journal of Marital and Family Therapy 43, no. 4 (October 2017): 674-684. Racheal Tasker, “Does Marriage Counseling Work? 10 Surprising Statistics & Facts”, Journal of Couple & Relationship Therapy 14 (2015): 64-90.

[ii] David Marjoribanks and Anna Darnell Bradley, It takes two: Couple relationships in the UK, Relate, Relationships Scotland and Marriage Care, 2017, the_way_we_are_now_-_it_takes_two.pdf (relate.org.uk)

[iii] Marjoribanks and Bradley, It takes two: Couple relationships in the UK, 26-27.

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