Condition

Couples Therapy: Methods, Evidence, and When to Go

Summary

Couples therapy — also called marriage or relationship counseling — is a structured, usually time-limited treatment in which both partners work with a trained therapist to change patterns of conflict, communication, and emotional connection. A 2020 meta-analysis of 58 studies (2,092 couples) found large gains in relationship satisfaction (within-group Hedges g = 1.12), and a review of the field estimated that about 70% of couples improve with treatment. The most researched approaches are emotionally focused therapy (EFT), the Gottman Method, and integrative behavioral couple therapy; gains are often maintained for years, though some couples relapse and may benefit from booster sessions.

Written by Gale Editorial · grounded in the cited clinical sources below · Updated 2026-07-07. How we write.

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What couples therapy is

Couples therapy — also called marriage counseling, couples counseling, or relationship therapy — is a structured, usually time-limited form of psychotherapy in which both partners meet together with a trained therapist to change patterns of conflict, communication, and emotional connection. It is typically provided by a licensed marriage and family therapist (LMFT), psychologist, licensed clinical social worker (LCSW), or licensed professional counselor (LPC) with specific training in working with couples.

Unlike individual therapy, the relationship itself is the focus of treatment. Sessions center on the interaction between partners — how conflict starts, escalates, and resolves — rather than on one person's diagnosis. Two approaches in particular, emotionally focused therapy and integrative behavioral couple therapy, have accumulated enough controlled research to be considered evidence-based couple treatments 1.

Relationship distress is common. In 2023 there were roughly 673,000 divorces in the United States (a rate of 2.4 per 1,000 people; 45 reporting states and D.C.) alongside about 2.0 million marriages 7. Many more couples experience serious distress without separating, and couple distress is closely linked to individual conditions such as depression and anxiety 1.

What couples therapy treats

Couples seek therapy for a wide range of reasons. Common ones include:

  • Communication that has broken down or turned hostile
  • Recurring conflict over the same issues — money, parenting, sex, in-laws, household labor
  • Rebuilding trust after infidelity or another breach
  • Loss of emotional or physical intimacy, or feeling more like roommates than partners
  • Navigating a major transition: a new baby, illness, job loss, relocation, or blending families
  • Deciding whether to stay together or separate

Couples therapy is also used as part of treatment for individual mental-health conditions. Relationship distress and disorders such as depression and anxiety frequently occur together and can worsen one another, and addressing the relationship can help both 1. Therapy is not only for relationships in crisis; many couples use it earlier, to strengthen a stable relationship or work through a specific decision.

How well couples therapy works

Couples therapy has a substantial research base. A 2020 meta-analysis pooled 58 studies covering 40 unique samples and 2,092 couples and found large improvements in relationship satisfaction — a within-group effect size of Hedges g = 1.12 for couples who received therapy, compared with essentially no change (g = 0.12) in waitlist control groups 2. Gains extended to communication, emotional intimacy, and partner behavior, and were durable across both short- and long-term follow-up. Couples who started more distressed tended to improve the most 2.

A broad review of the field estimated that couple therapy positively affects about 70% of couples, with effectiveness comparable to individual therapies and far superior to no treatment 1.

Improvement is not always permanent. In a randomized trial of 134 chronically and seriously distressed couples, roughly half remained clinically significantly improved five years after treatment (50.0% for one approach, 45.9% for the other), while about a quarter had separated or divorced (25.7% and 27.9%) 3. Satisfaction tended to rise during treatment, hold for the first couple of years, then erode somewhat — one reason some clinicians recommend booster or maintenance sessions to sustain gains 3.

Methods: Gottman, EFT, and behavioral approaches

Several distinct, well-researched methods share the goal of changing how partners interact.

Emotionally focused therapy (EFT) is a brief, attachment-based approach that treats relationship distress as a disruption of the emotional bond between partners. The therapist helps each person identify the vulnerable emotions underneath conflict and express them in a way the other can respond to, reshaping negative cycles into more secure connection. EFT meets or exceeds the criteria for classification as an evidence-based couple therapy 4.

The Gottman Method grew out of decades of observational research on what distinguishes stable relationships from unstable ones. It targets destructive interaction patterns — often summarized as criticism, contempt, defensiveness, and stonewalling — and builds skills for friendship, conflict management, and shared meaning. An outcome study of 106 gay and lesbian couples found significant improvement in relationship satisfaction after eleven sessions of Gottman Method therapy 5.

Integrative behavioral couple therapy (IBCT) combines concrete behavior-change strategies with work on emotional acceptance, helping partners change what they can and accept what they cannot. It is one of the two most extensively studied couple therapies 13. Its predecessor, traditional behavioral couple therapy, and cognitive behavioral couple therapy (CBCT) focus more directly on communication skills and structured problem-solving.

No single method is clearly best for every couple; across studies the strongest predictor of benefit tends to be engagement in treatment rather than the specific brand of therapy 2.

Online and telehealth couples therapy

Couple interventions can be delivered remotely as well as in person. In a randomized trial, 300 couples — a sample generally representative of the U.S. in race, ethnicity, and education (all heterosexual couples) — used OurRelationship, an eight-hour web-based program adapted from an in-person, evidence-based couple therapy with brief coach support. Compared with a waitlist, participating couples improved significantly in relationship satisfaction (Cohen's d = 0.69), relationship confidence (d = 0.47), and negative relationship quality (d = 0.57) 6. They also reported gains in individual functioning, including depressive symptoms (d = 0.71) and anxious symptoms (d = 0.94), particularly among those who began with difficulties in those areas 6.

Remote delivery lowers common barriers — travel, scheduling, cost, and the difficulty of finding a couples-trained therapist locally — and lets both partners attend from the same or different locations.

When to consider couples therapy — and when it is not the first step

Couples often wait a long time before seeking help, and earlier engagement — before patterns harden — generally gives therapy more to work with. Therapy can be useful for strengthening a stable relationship, working through a specific decision, or recovering after a rupture, not only when a relationship is failing.

For couples who are unsure whether to stay together, discernment counseling is a short, structured process designed to help partners decide between staying as they are, separating, or committing to a course of couples therapy — rather than starting open-ended treatment while one partner has, in effect, one foot out the door.

Couples therapy is not the appropriate first step when there is ongoing intimate partner violence, coercion, or fear of a partner. Conjoint sessions can increase risk when one partner is being harmed or controlled, and safety-focused individual support is recommended first. Anyone experiencing abuse can contact the National Domestic Violence Hotline at 1-800-799-7233 (text START to 88788), which is free, confidential, and available 24/7.

What to expect

A course of couples therapy usually begins with an assessment: the therapist meets with both partners together and often with each partner individually to understand the relationship's history, strengths, and current difficulties. Treatment is collaborative and goal-oriented, and most evidence-based approaches are relatively brief; how long a course lasts varies with the method, the couple, and the issues involved. In one outcome study of Gottman Method therapy, couples improved over a course of about eleven sessions 5.

Both partners generally attend, and the therapist stays even-handed rather than taking sides. Providers typically list the specific methods they are trained in — such as EFT, the Gottman Method, or IBCT — along with their state licensure (LMFT, psychologist, LCSW, or LPC). Telehealth is one route to a couples-trained therapist where in-person options are scarce.

Example practice profiles

6 example practice profiles focus on couples therapy →

Common questions

The terms are used interchangeably. Both describe treatment in which partners work together with a therapist on their relationship. 'Marriage counseling' historically referred to married couples and 'couples therapy' to any committed relationship, but in practice the labels overlap and the methods are the same.

The evidence is generally strong. A 2020 meta-analysis of 58 studies and 2,092 couples found large improvements in relationship satisfaction (within-group Hedges g = 1.12) versus little change in waitlist controls, and a review of the field estimated that about 70% of couples improve with treatment. Outcomes are not guaranteed, and some couples relapse over several years, which is why booster sessions are sometimes recommended.

Emotionally focused therapy (EFT) is attachment-based: it works on the emotional bond between partners, surfacing the vulnerable feelings beneath conflict so partners can respond to each other differently. The Gottman Method is skills- and research-based: it targets specific destructive patterns (criticism, contempt, defensiveness, stonewalling) and builds friendship, conflict-management, and shared-meaning skills. Both are evidence-supported; the better fit depends on the couple and the therapist's training.

Most evidence-based approaches are relatively brief, though how long a course lasts varies with the method, the couple, and the issues involved; in one outcome study of Gottman Method therapy, couples improved over a course of about eleven sessions. Some couples continue with periodic booster or maintenance sessions after the main course of therapy to help sustain their gains.

Yes. Couple interventions can be delivered by video or through structured web programs. In one randomized trial of 300 U.S. couples, an eight-hour web-based program adapted from in-person couple therapy produced significant improvements in relationship satisfaction and in individual functioning compared with a waitlist. Remote delivery also reduces barriers such as travel, scheduling, and finding a couples-trained therapist locally.

Couples who are unsure whether to stay together sometimes begin with discernment counseling — a short, structured process that helps partners decide among staying, separating, or committing to a course of couples therapy — rather than starting open-ended therapy while one partner is ambivalent. In a long-term trial, about half of chronically distressed couples remained significantly improved five years after treatment, while roughly a quarter separated or divorced.

Couples therapy is generally not recommended as a first step when there is ongoing intimate partner violence, coercion, or fear of a partner, because joint sessions can increase risk to the person being harmed. Safety-focused individual support is recommended first. The National Domestic Violence Hotline (1-800-799-7233, or text START to 88788) is free, confidential, and available 24/7.

Related conditions

Anxiety: Symptoms, Types, and Treatment · Depression: Signs, Causes, and Treatment · LGBTQ+ Affirming Therapy: What It Means and What the Evidence Shows · Substance Use Disorder: Spectrum, Diagnosis, and Treatment

Specialties

Behavioral Health: What Therapists and Psychiatrists Treat

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When to seek care

  • —Any physical violence, threats, intimidation, or fear of a partner — couples therapy is generally not recommended while abuse is active; contact the National Domestic Violence Hotline at 1-800-799-7233 (text START to 88788)
  • —Thoughts of self-harm or suicide in either partner — call or text 988 immediately
  • —Coercive control: monitoring, isolation, or control of money, movement, or communication
  • —Substance use that is escalating conflict or endangering the relationship — SAMHSA's National Helpline is 1-800-662-4357
  • —Escalating conflict that feels unsafe or that neither partner can de-escalate
  • —Relationship distress accompanied by depression, anxiety, or hopelessness in either partner

If you or your partner are in immediate danger, call 911. For thoughts of suicide or self-harm, call or text 988 (Suicide and Crisis Lifeline), available 24/7. For domestic violence, call the National Domestic Violence Hotline at 1-800-799-7233 or text START to 88788 — free, confidential, and available 24/7.

General health information, not medical advice. Synthetic demonstration content.

References

  1. 1.Lebow JL, Chambers AL, Christensen A, Johnson SM (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy. doi:10.1111/j.1752-0606.2011.00249.x ✓Couple therapy positively affects about 70% of couples; effectiveness comparable to individual therapies and superior to no-treatment controls; couple distress is linked to individual disorders such as depression and anxiety; emotion-focused therapy (EFT) and integrative behavioral couple therapy (IBCT) are the two evidence-based couple treatments
  2. 2.Roddy MK, Walsh LM, Rothman K, Hatch SG, Doss BD (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology. doi:10.1037/ccp0000514 ✓Meta-analysis of 58 studies / 40 unique samples / 2,092 couples; within-group relationship-satisfaction effect size Hedges g = 1.12 for treatment vs g = 0.12 for waitlist; gains durable across short- and long-term follow-up; couples with greater baseline distress showed larger gains
  3. 3.Christensen A, Atkins DC, Baucom B, Yi J (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology. doi:10.1037/a0018132 ✓RCT of 134 chronically and seriously distressed couples; pre-post satisfaction effect sizes d = 0.90 (IBCT) and d = 0.71 (TBCT); at 5-year follow-up 50.0% (IBCT) and 45.9% (TBCT) clinically significantly improved, 25.7% and 27.9% separated or divorced; gains largely maintained early then eroded, suggesting booster sessions
  4. 4.Wiebe SA, Johnson SM (2016). A Review of the Research in Emotionally Focused Therapy for Couples. Family Process. doi:10.1111/famp.12229 ✓EFT is a brief, attachment-based couple therapy that meets or exceeds the guidelines for classification as an evidence-based couple therapy
  5. 5.Garanzini S, Yee A, Gottman J, Gottman J, Cole C, Preciado M, Jasculca C (2017). Results of Gottman Method Couples Therapy with Gay and Lesbian Couples. Journal of Marital and Family Therapy. doi:10.1111/jmft.12276 ✓Outcome study of 106 gay and lesbian couples showing significant improvement in relationship satisfaction after eleven sessions of Gottman Method Couples Therapy
  6. 6.Doss BD, Cicila LN, Georgia EJ, Roddy MK, Nowlan KM, Benson LA, Christensen A (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology. doi:10.1037/ccp0000063 ✓RCT of 300 U.S. couples — generally representative of the U.S. in race, ethnicity, and education (all heterosexual couples) — using the 8-hour web-based OurRelationship program vs waitlist; improvements in relationship satisfaction (d = 0.69), confidence (d = 0.47), negative relationship quality (d = 0.57), and individual functioning including depressive (d = 0.71) and anxious (d = 0.94) symptoms
  7. 7.National Center for Health Statistics (CDC/NCHS) (2024). FastStats: Marriage and Divorce. Centers for Disease Control and Prevention. link ✓2023 U.S. provisional data: 2,041,926 marriages (rate 6.1 per 1,000) and 672,502 divorces (rate 2.4 per 1,000, 45 reporting states and D.C.)

https://www.gale.care/conditions/couples-therapy · 7 sources. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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