Does couples therapy work? Understanding the process and journey of couples therapy

Couples therapy in many ways is not dissimilar from individual therapy. However, there is perhaps one fundamental difference I have observed in my years of practice and that is that couples usually tend to wait longer to access support, often until there is a point of deep crisis and distress.

We could spend a long while trying to hypothesis why that is. Stigma undoubtedly plays a part but I also wonder whether there is still skepticism about the effectiveness of couples therapy and perhaps some fear about what accessing couples therapy might uncover about your relationship.

What is couples therapy?

Couples therapy, sometimes also referred to as relationship therapy or marriage counselling, is a type of talking therapy that is aimed at helping couples work through particular aspects of their relationship. Couples therapy is not just for couples in crisis but it can be a helpful approach to strengthen your connection at any stage of your relationship.

There is often an unhelpful misconception that couples therapy is only for couples who are having problems in their relationship or are in crisis. However, research tells us that couples therapy can in fact be incredibly beneficial for any relationship at any stage. I would usually recommend that you seek couples therapy sooner rather than later, as leaving things until a point of crisis can mean that it can take longer for couples therapy to be effective or, in some cases, there may have been too many relationship injuries to be able to repair the relationship, even with the help of a skilled couples therapist.

Common topics addressed in couples therapy can range from communication difficulties, to infidelity, to clashes in values and frequent conflict. Goals are usually established with the couple at the beginning of therapy and can be reviewed during the course of therapy to ensure best results.

What happens in couples therapy?

Couples therapy can take different forms, depending on the approach your therapist is trained in. I am trained in a type of couples therapy called Emotionally Focused Couples Therapy, which was developed by Dr Sue Johnson.

The first session

The first session typically ranges from 50 to 90 minutes. It is an opportunity for the therapist to explain "ground rules" and the format of therapy and for you to share your history as a couple (how you met, what drew you together, any strengths and difficulties in the relationship) and identify some initial goals for the therapy. Each partner will speak in turn without interruption and the therapist will be responsible for holding the frame so that each partner can feel safe to explore in the therapy space.

The individual assessment sessions (session 2 and 3)

Following the initial session, your therapist will arrange one individual assessment session for each partner to meet you alone. This is so that the therapist can assess your individual histories more in details and assess personal risks and goals. These sessions are not scheduled to keep any secrets and in fact it is a feature of couples therapy that the therapist is in fact not able to "keep secrets", as honesty is at the core of the process. However, as couples often access couples therapy during periods of high distress and conflict, it can feel important to have a space away from each other to discuss personal histories and your view of the current difficulties with the therapist without worrying about having to mitigate what you share so as to not upset your partner.

Making a plan and agreeing on shared goals

Following the individual sessions, the couple and the therapist come back together in the room to agree on a way forward. At this stage, a decision is made on whether it is appropriate or not to proceed with couples therapy.

Whilst couples therapy can be very beneficial, there are times when proceeding with couples therapy is not appropriate. This usually happens in the following scenarios:

• If there are ongoing issues of infidelity and/or abuse

• There is a lack of commitment from one or both partners, or one partner is reluctant to engage in the therapy process

• There are unrealistic expectations about the therapy process or the couple cannot agree on shared goals

Creating a safe container and de-escalating the couple

Once you have agreed with your therapist that it is appropriate to proceed with couples therapy, the initial stages post-assessment will be focused on establishing safety in and out of the therapy room. Couples often seek couples therapy after long periods of conflict in the relationship and therefore it is important to find ways to de-escalate the conflict before developing better ways to communicate and resolve conflict.

Implementing changes

Once there is enough safety and de-escalation, you get into the heart of the therapy journey where, with the help of your therapist, you'll discover new ways to communicate about difficult topics, without triggering conflicts. This is usually a time where the couple notices conflict becomes less frequent or more quickly resolved between sessions, as techniques and strategies begin to integrate into your new routine.

Taking care of yourselves after each session

Your therapist will always aim to end sessions in a way that feels contained and safe for both partners. However, sometimes it can be helpful to think together about what might be helpful for each of you individually after a session and if having some time apart or some quiet time might be beneficial. This can enable each partner to process the sessions individually, before coming together again.

Integrating learning and moving forward after therapy

As therapy progresses, you will notice that new skills start becoming new habits and, whilst conflict will not be entirely absent, you may notice a quicker conflict-repair cycle, ultimately helping you feel closer as a couple and reduce distress. Most couples start noticing more significant changes after at least 8-12 sessions. However, where there are complex issues or individual histories of trauma, this can take longer.

So, is couples therapy effective? What the research tells us

The answer to this question really depends on the type of approach used for couples therapy. My training is in Emotionally Focused Couples Therapy (EFCT), which is an approach with very significant research support, suggesting that 90% of couples going through EFCT significantly improve their relationship and 70-75% of couples no longer fit criteria for relationship distress after a course of EFCT (you can find a summary of the research here).

So, if you are thinking about accessing couples therapy, EFCT really does work.

Helpful tips to maximise the positive impact of EFCT

• Be open and honest. Therapy is a safe space for you both to express yourselves and it is important that you don't hold back in discussing topics that are important to you and your feelings about the situation. By being open with your therapist and your partner during the sessions, it is easier for your therapist to help you find a roadmap to move forward.

• Commit to the process. Couples therapy, like any therapy, takes time. Change is not immediate and in some cases it may feel as though things get worse before they get better. It is important that you commit to the process and that you are patient and have realistic expectations about what you can expect from the sessions.

• Attend sessions regularly. One of the biggest barriers I observe in couples therapy is lack of consistency. Couples in conflict often have busy lives and it can be difficult to carve out time for a weekly session. It is important that you both agree on how you will be able to commit to weekly or bi-weekly sessions, as anything less regular is unlikely to be beneficial.

• Continue the work outside the sesssions. Therapy only happens for one hour a week. Therefore, whilst significant changes and insights can start to happen during your sessions, it is important for both of you to also commit to working on your relationship outside of the sessions, to see best results.

Ready to take the next steps?

If you are considering accessing couples therapy, I encourage you to book an initial consultation so that we can explore how couples therapy might be helpful for your relationship.

Every relationship requires nurture and care. There is no shame in accessing support. The investment you make in your relationship is something that can last for a lifetime and help you feel closer and more connected.