Couples Counseling Explained: What It Is and How It Works

Couples counseling, also called couples therapy or marriage counseling, is talk therapy with both partners taking part. Instead of one person working only on their own thoughts and habits, the relationship becomes the focus: how you talk, how you argue, how you repair after a fight, and what each of you needs from the other.

Many couples wait until things feel close to breaking before they call anyone. That is understandable, but it is not a requirement. People seek counseling for a long-running argument, a breach of trust, a big transition such as a move or a new baby, or simply a sense that they have drifted apart. It is open to any couple, married or not, who wants to work on their relationship.

This guide explains who provides couples counseling, what tends to happen in sessions, what the research does and does not tell us, and when it is not the right tool. It is general information, not a substitute for advice from a licensed professional who knows your situation.

Who provides couples counseling

Several kinds of licensed professionals work with couples. The U.S. Bureau of Labor Statistics (BLS) describes marriage and family therapists as professionals who work with individuals, couples, and families, and notes that even when treating individuals, these therapists focus on family systems. According to the BLS Occupational Outlook Handbook, all states require marriage and family therapists to be licensed. Licensure requires a master's degree, a state-specified number of hours of postdegree supervised clinical experience, a state-recognized exam, and annual continuing education.

Marriage and family therapists are not the only option. The National Alliance on Mental Illness (NAMI) describes psychologists, who hold a doctoral degree and are licensed by boards in each state, along with master's-level counselors and clinical social workers. Common licenses NAMI lists include LPC (Licensed Professional Counselor), LMFT (Licensed Marriage and Family Therapist) and LCSW (Licensed Clinical Social Worker). NAMI also notes that job titles and specialties can vary by state.

A "relationship coach" or "love expert" is not the same thing as a licensed clinician. Coaches and educators can be useful for skill-building, but if you are dealing with depression, anxiety, substance use, trauma or a relationship in serious distress, look for someone licensed to provide therapy where you live. Our guide Choosing a Couples Therapist: Credentials and Questions to Ask walks through how to check.

What happens in sessions

Every therapist works a little differently, but the first few sessions are usually about understanding the situation: what brought you in, the history of the relationship, what each of you hopes will change, and whether either partner has individual concerns that also need attention. It is reasonable to ask a therapist up front whether they will ever meet with each of you separately, and how they handle something one partner shares privately.

After that, sessions generally center on specific conflicts or patterns, worked through with the therapist's help. The National Institute of Mental Health (NIMH) lists common elements of psychotherapy, and several fit couples work closely:

• Examining interactions with others and teaching social and communication skills.
• Identifying ways to cope with stress and developing problem-solving strategies.
• Tracking emotions and behaviors to raise awareness of their impact on each other.

Some therapists also suggest practice between sessions, such as a structured way to raise a complaint or a short daily check-in. Sessions are where you learn and rehearse; the days in between are where new habits either take hold or fade.

Different approaches, one goal

There is no single "couples therapy." NIMH points out that there is no formal approval process for psychotherapies like there is for medications, and that therapists may use one primary approach or combine elements of several, depending on their training and the needs of the people they are treating.

Some models put most of their weight on changing specific behaviors and practicing communication and problem-solving. Others focus more on emotions, on acceptance of differences that are unlikely to change, or on the patterns a couple falls into during conflict. You do not need to master the models. You do need a therapist who can explain, in plain language, what approach they use, why they think it fits you, and how you will both know whether it is working.

What the research has found

Couples therapy has been studied for decades, and the findings are encouraging without being magic. Two named examples:

• A 2005 meta-analysis by William Shadish and Scott Baldwin in the Journal of Consulting and Clinical Psychology pooled 30 randomized experiments that compared behavioral marital therapy with no treatment for distressed couples. Behavioral marital therapy was significantly more effective than no treatment. The authors also found signs of possible publication bias, meaning effects reported in earlier reviews may have been somewhat inflated.
• A trial led by Andrew Christensen, published in 2010 in the same journal, followed 134 chronically and seriously distressed married couples for five years after roughly eight months of either traditional behavioral couple therapy or integrative behavioral couple therapy. At five years, 50.0% of the integrative-therapy couples and 45.9% of the traditional-therapy couples showed clinically significant improvement in marital satisfaction, while 25.7% and 27.9%, respectively, were separated or divorced.

Put plainly: in these studies many couples improved a great deal, some did not, and some separated. Counseling can improve your odds; it cannot guarantee a particular outcome, and a trustworthy therapist will not promise one.

Time, cost and access

There is no standard length for couples counseling. NIMH suggests asking a prospective therapist whether they recommend a specific time frame or number of sessions, how progress will be assessed, and what happens if you are not starting to improve. If you have been in therapy for what feels like a reasonable amount of time and are not getting better, NIMH's advice is to raise it with the therapist and, if needed, explore other professionals or approaches.

On cost, NIMH recommends asking about fees, whether the therapist accepts insurance, and whether there is a sliding scale based on income. Your health insurer may keep a list of participating mental health professionals, and university training clinics can be another option. Preliminary conversations, and many sessions, can happen in person, by phone or virtually.

When couples counseling is not the right fit

Couples counseling assumes both partners can speak honestly without fear of what happens at home afterward. When one partner is abusive, that assumption breaks down. The National Domestic Violence Hotline says it does not encourage anyone in an abusive relationship to seek counseling with their partner, explaining: "Abuse is not a relationship problem." The Hotline notes that an abusive partner may later use what was said in therapy against the other person.

If you are afraid of your partner, or you recognize patterns such as threats, intense jealousy, control over money or isolation from friends and family, contact the National Domestic Violence Hotline at 1-800-799-7233 (or text START to 88788). If you or your partner are in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline. Our guide When Couples Counseling Isn't the Right Step: Abuse and Safety covers this in more depth.

Key takeaways

• Couples counseling is talk therapy focused on the relationship, and it is open to any couple, not only married ones or those in crisis.
• Marriage and family therapists, psychologists, licensed counselors and clinical social workers all may work with couples; licensing is set by each state.
• Approaches vary, so ask any therapist to explain their method, goals and how progress will be measured.
• Research, including a 30-trial meta-analysis and a five-year randomized trial, supports couples therapy for distressed couples, but outcomes are not guaranteed.
• Couples counseling is not recommended when one partner is abusive; call the National Domestic Violence Hotline at 1-800-799-7233, and for crisis call or text 988.

Sources

• National Institute of Mental Health, Psychotherapies
• U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Marriage and Family Therapists
• National Alliance on Mental Illness, Types of Mental Health Professionals
• Shadish WR, Baldwin SA, Effects of behavioral marital therapy: a meta-analysis of randomized controlled trials, Journal of Consulting and Clinical Psychology (2005)
• Christensen A, Atkins DC, Baucom B, Yi J, Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy, Journal of Consulting and Clinical Psychology (2010)
• National Domestic Violence Hotline, Should I Go To Couples Therapy With My Abusive Partner?