Couples Therapy: Does It Really Work?

If you are considering couples counseling but unsure about whether it will be worth your effort, you are not alone. Perhaps you have heard about the lack of success reported by a friend, or tried it already yourself without much benefit.  Here I will provide answers to some common questions that I frequently hear from those who are wondering about whether it works, and for whom it works.

Why are so many people skeptical about couples counseling?

It is understandable that many people are skeptical about the effectiveness of couples’ counseling. Prior to the 1980’s, the most common methods used in couples’ work had limited success. The average success rate for most couples was about 50%. Useful skills were learned, including how to listen to each other and to appreciate the other’s point of view. Attributions (explanations we give ourselves for the other person’s behavior) were transformed from negative (e.g.,” You are always late because you just don’t care enough to be on time”) to positive or neutral (“I get that you really have difficulty scheduling your time.”) The research of John Gottman helped to identify critical behaviors to avoid if you wanted to remain together “happily ever after”. These included cutting out the sarcasm and the contemptuous comments, while building the friendship as well as romance (Gottman, 1999,2015). This was all well and good, but not enough for lasting and profound change in relationships. Even when couples reported less distress at the conclusion of therapy, the new habits tended to drop off over subsequent months and the old problems returned. 

How effective is couples therapy?

The good news is that couples counseling as it is currently practiced using Emotionally-Focused Therapy (EFT) is now roughly 75% effective. This is true according to the American Psychological Association and is based on over 25 years of research. Outcome studies have included couples therapy for high stress clients such as military couples, veterans with PTSD, parents of chronically ill children, and infertile couples.  Results are also positive and substantial across different cultural groups.

How do we measure effectiveness?

The most common outcome measure has been self-report using a particular questionnaire called the Dyadic Adjustment Scale (DAS). This measure has been used since 1976 and provides a good comparison of success rates now versus those from past decades. The major positive outcome is the reduction of complaints (“relationship distress”) between partners. Post-treatment scores are compared to pre-treatment scores for the same couple, and also to the scores of couples who have been wait-listed for treatment.  The positive results have consistently been found to continue for at least two years after the conclusion of treatment.  (Johnson et al., 1999)

Who tends to be in the 25% “failure” group?

Couples who are in abusive relationships (whether it is physical or emotional abuse) should not expect improvement in therapy until the abusive behavior stops. Separate therapy is often recommended for each partner in order to work toward self-control or to maintain safety, depending on the individual’s needs. Likewise, EFT is not recommended for couples in the process of separating. The process of separating is contrary to the goals of EFT, i.e. establishing a more secure attachment. Substance abuse in the absence of physical or emotional abuse does not preclude couples therapy as long as the addicted person is actively working to manage the addiction.

 How does it work?

To briefly summarize, EFT is a systematic approach to changing the constricted patterns of interaction between distressed couples and thereby changing the emotional responses to each other. Unlike prior therapies which were directed at changing behaviors and thoughts, EFT leads to changes in emotional responses in a way that strengthens the emotional bond.  The goal is to establish a more secure attachment. In my experience, it requires a minimum six-month commitment.  Many couples require more time, depending upon other circumstances in their lives and the frequency of sessions.

How can one maximize the chances of a positive outcome?

Positive outcomes are most likely when the couple beginning therapy have a willingness to learn some basic skills and to become more self-aware as well as emotionally vulnerable to each other. Only very basic communication skills are necessary, such as using “feeling” words. Many people have difficulty distinguishing feelings from thoughts, usually because they were never taught to identify feelings as children. However, this skill can be learned, and it is encouraged during the therapy process.  A second important characteristic of successful couples is the ability to stop seeing each other as the opponent but rather as a team member, working to improve mutual contentment. Seeing yourselves as being “on the same team” increases cooperation and also each person’s willingness to be emotionally vulnerable. Thirdly, the ability to feel empathy for the partner is a critical part of the work in EFT. Each person needs to have compassion for the other’s feelings of vulnerability and past emotional traumas. Lastly, a pre-requisite for success in couples’ work is the willingness of each person to own their part in the problems as well as the process of bringing about positive change. Many individuals come to couples therapy with a list of complaints about the other person and a desire for the therapist to validate the complaints and then change the behavior of the other person. Although there are often valid complaints, nothing is resolved unless both individuals are open to change some aspect of their own behavior.

I hope this was helpful in answering some of your questions about couples counseling. Please feel free to contribute any other general questions in the comments section that follows.

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