Everything You Need to Know About Couples Therapy

“For better or for worse” – that’s what you’re getting into when you commit to your partner. 

“For better or for worse” is a perfect encapsulation of relationship dynamics – it means there’s no giving up when rough times abound, as they often do.

But, what if things get too hot to handle? What if you can’t deal with some issues solely by yourselves? 

What’s important here is to be aware that there’s an end in sight. You can always ask for help when the going gets tough.  

Who needs couples therapy?

Some of you may think, why bother, right? Why waste money when you can talk it out at home? Why invite a stranger into your most private domain when you can try to resolve your problems yourselves? 

But the larger truth is that a lot of couples don’t actually know how to communicate with each other. Others have simply forgotten how over the years. 

So they keep fighting about the same stuff, over and over again, never reaching a conclusion. Or they’ve lost their sense of mutual intimacy and trust for some reason, and don’t know how to rebuild it, even though they keep trying. But there’s no end result in sight. 

And here’s where you should actually invite a stranger to your most private domains. 

Couples therapy is a great option for people struggling with communication issues, infidelity, lack of trust, lack of intimacy, waned desire, marital financial issues, illness, major life changes… 

Couples therapists serve as a third eye to the whole thing. They’re a much welcomed, unbiased observer that can pinpoint the black holes of your communication attempts. They can tell you precisely where it all gets lost. Therapists support you through the vulnerable and sometimes painful process of acknowledging the deeper issues behind your fights, lack of trust, and intimacy issues. And, they serve as great mediators when you’re still in your early phases of (re)learning how to communicate with each other effectively. 

The therapist’s agenda is to help partners be emotionally honest with each other and to understand their feelings better. They help couples engage with the difficult emotions and experiences of their marriage and learn how not to be afraid of them or run away at the first obstacle. 

Types of Couples Therapy

It’s important to stress that there are different approaches to couples therapy. Relationship dynamics differ from couple to couple. Hence some types of couples therapy will be better suited for you and your partner than others. 

That’s why it’s a good idea to learn a bit about the different types of therapy before engaging in one. Alternately, have your therapist give you a short introduction, if possible. Identifying the different types of couples therapy and knowing the differences between them can help you and your partner get the right kind of help. 

For the sake of keeping things short, I included only three types of couples therapy, just to give you a basic overview. There are a lot more of them, however. 

Once you inform yourself about the types of couples therapy, try to talk them out with your partner. Think about them long and hard – look at their pros and cons, their differences and similarities. 

Also, make sure to ask your therapist for advice on the approach(es) they use, and which one you should choose. 

In any event, your therapist will evaluate the relationship you have with your partner and tailor the approach towards your unique situations and relationship dynamics. 

Therapists rarely use only one approach though. They’ve been trained to combine a variety of practices that depend on the individual needs of the couples that become their clients. 

NOTE: If in your search you come upon therapists that are certified in one type of therapy, it means that they’re experts in this approach and that they believe in its efficacy. Ultimately, though, you should definitely look for a good connection with your therapists, and be able to notice good results after a while. If you don’t have that, find another therapist, but don’t give up easily. 

Emotionally Focused Therapy (EFT) 

Emotionally Focused Therapy (or EFT) was developed in the 1980s by psychologists Sue Johnson and Les Greenberg. 

EFT starts from the assumption that human needs and human emotions are connected. It also states that the problems in a relationship largely have to do with insecurity and insecure attachment between (one or two of) the partners. 

According to EFT, partners fear their needs won’t be met by one another. And so, the aim of this kind of therapy is to help both parties understand and overcome their insecurities, to come up with ways they can change how they interact with their partners, as well as how they respond emotionally, in the good hope that all of this will help bolster a more secure emotional bond. 

According to EFT, emotions have an adaptive potential, which means they can be worked on and (re)activated. Ultimately, this can help partners change the emotional states that lie at the root of their troubled relationships. 

EFT stresses the need for couples to express the underlying emotions that they’re not so willing to express. Once they’re able to do this, they will manage to deepen the connection with their partners and believe in a safe attachment. 

It basically means you can freely express your deepest desires and fears, while being assured that your partner will be open, attentive, and responsive to them (not in any judgmental way). 

Imago Relationship Therapy 

If you’ve watched Oprah Winfrey’s show, chances are you’ve encountered the term Imago Relationship Therapy, since she’s one of the many celebrities that have advocated for this method of couples therapy almost religiously. 

This well-known form of couples therapy that was developed in the 1980s by Dr. Harville Hendrix and Dr. Helen LaKelly Hunt “focuses on relational counseling to transform any conflict between couples into opportunities for healing and growth”.

If you can’t trust a pair of discordant therapists and learn how they coped with a troubled marriage and learned to get out on the other side, then who can you trust? 

The Imago Relationship Theory strongly focuses on our childhood experiences – the bonds we’ve built in childhood without parents or guardians. It tries to work out how, later on, these bonds reflect in our intimate relationships. 

“Imago” is Latin for ‘image’, so Imago is a reference to the image of love or attachment that stems from our childhood and that we all carry with us. Hence, when we find our significant other, we tend to project that image, with all its good and bad sides. 

In Imago therapy, conflict is used as a means for relationship growth

That’s also one of the reasons why at the center of this therapy is the importance of conflict. Conflict is used here as an important tool for the growth of a relationship. Imago therapy teaches how to use it effectively to bring couples closer rather than tear them apart. 

This therapy puts a lot of focus on listening as well. It claims that listening is a skill which can be learned. For Imago therapy, this is one of the most important parts of couples’ communication that can play a vital role in the betterment of that communication. 

If you want to find more about this type of therapy visit Dr. Hendrix and Dr. LaKelly Hunt’s website and/or try getting their book Getting the Love You Want (1988), where they discuss how they’ve managed to repair their relationship. 

The Gottman Method

The Gottman Method was named after renowned scientists  Dr. John Gottman and Dr. Julie Schwartz Gottman.

Prof. Dr. John Gottman has had extensive training in mathematics and statistical analysis, in addition to his research in human psychology. That’s also the reason why he and his wife came up with an approach to couples therapy that was primarily data-driven. It’s safe to say that this approach had a major influence on couple’s therapy practices for decades after its initiation. 

The Gottman couples therapy method is particularly convenient for committed couples who’ve been together for a long time and want to work on rebuilding their trust and keeping their marriage strong and stable.  

This type of couples therapy includes an extensive assessment form which will take you somewhere between 1-2 hours to complete. This is done before meeting your therapist. In the first couple of meetings with your therapist, they will also try to collect some more data, continuing the spirit of the Gottman research-oriented method. 

Therapists following this method will make it easy for you to follow them and their process of working. They will also present specific ways, skills, and techniques you can do to mend your relationship and help you put them into daily practice.

What to Expect in Couples Therapy

One statistic says that couples will be unhappy for about six years before they seek help in couples therapy. I suggest you don’t wait this long and accept that some issues you simply can’t resolve yourself. That’s where therapists enter into the picture and try to save the day. Of course, therapists won’t be able to save the day without your help as well. 

One of the great things about couples therapy is that it makes both of you equally aware of your problems and generally avoids the “victim” perspective. This is because it encourages couples to see their relationship with both its good and bad sides. It starts from the viewpoint of two people, instead of one, which is usually the aim of an individual’s therapy. 

In couples therapy, both spouses will get the same amount of time and attention, coupled with sympathy and understanding about any complaints and underlying issues they have. You can also schedule individual sessions if you find it necessary. Your therapist can do the same if they think it might benefit your relationship in some way. 

Oftentimes couples are hesitant when it comes to couples therapy. They are afraid of being vulnerable or disclosing too many touchy aspects of their marriage. But there’s nothing to worry about. Therapists are very versed when it comes to the beginning of therapy. They understand how hard it is to make the first step and ask help from someone who’s basically a stranger. 

That being said, let’s take a look at what you can expect to see in couples therapy!  

They’ll Start With Simple Questions (First)

Therapists like to begin with simple chatter. They will often ask light questions about what you do, how old you are, how long you’ve been together, etc.. 

In the first session, they’ll also ask you why you’ve decided to seek therapy in the first place. 

You may think this is too direct a question to start things off with. However, for them, it’s crucial that they do an internal sketch of your relationship and the fervent issues you may be facing. 

Some therapists also like to ask why you decided to seek help now, rather than at the very beginning, when you first started to have the problems that now weigh most heavily on your relationship. 

Therapists will also ask partners to individually assess their marriage. 

They’ll Start Big and Gradually Move Towards the Specific Issues 

What therapists do is put things into perspective. They always put the wider context of your relationship into perspective juxtaposing it with the specific problems you’re having. 

So, they’ll first ask you how you two met -which serves to relax you a little bit, but also to remind you of the beginning of your relationship, of the good times, the times when you saw your partner with fresh eyes. 

After that, they’ll slowly work towards the present and zoom in on the current, most pertinent issues you’re having. 

They Will Ask About Your Families

This is only after you’ve had a couple of sessions (sometimes even in the second or third one). So you can expect questions like were there any divorces in the family, for example. If you have any kids they’ll ask a bit more about them as well. 

Also, it’s very probable that they’ll ask about your parents too. The goal here is to see the differences and similarities between yours and your partner’s family background. 

Source: Photo by Nik Shuliahin on Unsplash

Of course, keep in mind that after the first session (or at least the first 2-3 sessions) the therapist will focus on issues that might’ve sprung up during the week that’s in between the sessions. 

With this parallel “investigation” the therapist will most likely lead you to find out the origin of your emotional baggage for yourselves. This is also the time when you’ll be confronted with the fact that you have emotional baggage, in the first place. 

They Will Start With Practical Advice/Solutions/Suggestions

So, your therapist has by now identified the root of your problems, as well as the patterns emerging from them. Great work! What follows next is that they’ll try to guide you into developing skills that will help you manage your marital issues and relationship.

You will learn:

  • how to improve your communication skills
  • how to be more patient with one another and also how to be more forgiving
  • how to build trust, 
  • how to be honest and open towards each other 
  • how to be less self-centered and work towards the common good of the relationship
  • how to defuse and better manage your stress levels 

The great thing about this is that it helps you remember – this is something most couples know how to do at the beginning of their relationship! With time, however, because of different life events and stressors, they’ve forgotten it, swept it under the rug. Couples therapy is great at reminding you of this.

Developing Goals and Creating a Clear Timeline 

Every couple has different goals. Some couples want to rebuild intimacy, others want to rebuild trust, and some want to rekindle desire… Some goals are oriented towards developing specific skills, like communicating better. Some deal with major life changes, like moving to a different city/country, facing an illness, changing a job, etc. 

Some couples even use goals to end their relationship. This might sound a bit weird or counterintuitive to some, I understand. But sometimes the best way to save a relationship is to end it. Realizing this by yourselves, with the help of therapy, can help you do it in a healthy way. 

It’s also normal for your goals to change during therapy. What this means is that the goal(s) you had at the beginning might not be the one(s) you have at the end. 

Once you do this, once you outline your goals, your therapist will help you make a timeline. This timeline will help you reach them in a given amount of time, without any pressures though. It’s there to give you a sense of the possibility of achieving something that might not seem as achievable at the beginning. 

The End of Counseling

With time (usually after the second or third month of therapy), you’ll notice how your therapist sort of withdraws. This is a good thing. It means that they’ve opened up space for you to freely work on your issues without outside help. 

It means that you’ve (re)learned to communicate and that you approach your arguments and your fights differently, in a more constructive way. This also usually marks the end of your couples therapy sessions. 

And the great thing is that you learn so much along the way! You learn about your relationship, about your partner, and also, a lot about yourself as well. 

NOTE: Have in mind that some couples may need more than a couple of months of therapy. Some couples may need to make it part of their lives for a longer amount of time (even years at times). And that’s ok. Every couple is different. Every couple has different dynamics and ways of functioning. Both you and your partner, as well as your therapist, will work out how much longer you’re going to do couples therapy. 

Commonly Asked Questions Related to Couples Therapy

Since a lot of people want to know more about couples therapy, I wanted to answer some of the most frequently asked questions about it. Consider it a FAQ section for all of you peeps out there that are tiptoeing around the question of whether you should visit a therapist and everything else that comes along with it. 

So, let’s see what those questions are! 

How Much Does Couples Therapy Cost?

In short, couples therapy can cost somewhere between $50 per hour and $250 per hour. 

Most of the sessions last for about an hour, but of course, this can be extended or shortened. Some may last a bit less, and some more (if that’s your agreement or a rule of the counselor/therapist). In any event, the cost will be adjusted according to the duration of each session. 

Basically, this means that if the therapist charges $100 per hour (which is also per session), and you end up talking 2 hours, you will pay $200. I wanted to make this clear because some people get confused. They think if the sessions are consecutive. That one after the other in one day counts as one session and that they’ll pay less. But that’s not the case, because you usually pay by the hour. Of course, you’ll have to discuss this with your counselor beforehand anyways. 

Sometimes you may also receive a discount if you sign up for 6-12 weeks couple’s therapy sessions. That way it may cost you somewhere between $400 and $2500 all in all. 

Can insurance cover the costs of couples counseling? 

Usually no. Most of the insurance companies out there won’t cover your marriage counseling sessions. There have been some changes recently, however. 

Nowadays it’s becoming more and more common for insurance providers (mostly the larger ones) to provide some sort of coverage regarding couples therapy. You will need to discuss this in more detail with your insurance company. See if you can come to some sort of agreement and whether your policy will cover some of the couples therapy costs. 

NOTE: There are some situations where if your partner suffers from mental illness, the insurance company provides some sort of reimbursement for the therapy (all or part of it), protected under the federal Mental Health Parity Act.

Source: Photo by Crew on Unsplash

What is the Difference Between Marriage Counseling and Couples Therapy? 

Both marriage counseling and couples therapy are popular solutions for spouses that are having a particularly rough patch in their relationship. 

And while they may seem like similar ways of dealing with marital problems, in reality, they’re actually pretty different. 

All in all, both of them require a licensed professional who’s had formal (and/or academic) education on marital issues, relationships, and how the human psyche works in general. In both cases, couples will be asked to sit down with this professional and share their troubles. 

Now, let’s look at what’s the actual difference between couples therapy and marriage counseling. Basically, marriage counseling focuses on the now of the relationship. It deals strictly with married people and tackles issues that keep recurring in a marriage. It’s designed to help couples communicate better. It equips couples with skills that help them recognize what their problems actually are. They also help them figure out how to address these problems specifically. 

Couples therapy, on the other hand, goes more to the root of the problem and tries to see where it all started. It turns towards fights and disagreements you might’ve had in the past as well. 

It’s also different from marriage counseling because it takes you, as an individual, into consideration too. It makes you address some issues you might have with yourself (ones that you may be dragging from childhood, let’s say). Through that, it attempts to understand why you act the way you do in a relationship.

Couples therapy will go into more depth about the background details of your marital issues. It’ll attempt to answer why you have specific fights in your marriage. It will also help you understand and work on the areas of your marriage that need serious improvement. 

How Do Couples Do Long Distance Therapy?

Long-distance couples therapy is becoming more and more popular as we speak. Nowadays, of course, this is mostly because of the coronavirus crisis, but even before that, online couples therapy was gaining momentum. 

What’s more, this type of therapy is usually cheaper than the regular one, while being just as effective. It also allows therapists to devote more time to more patients. 

There are millions of couples nowadays that are living in long-distance marriages, and it’s normal that they will face issues in their marriage. Besides the usual marital issues, long-distance can put additional pressure on your relationship, and seeking professional help can be a really good idea. 

Sites like Talkspace and BetterHelp are among the most popular online platforms for couples therapy. 

How does online couples therapy work?

The structure of online couples therapy depends on the platform you’re using or the individual type of work a therapist is doing. So, for example, online counseling/therapy programs such as the ones I mentioned above will offer you options to chat with your therapist on a daily basis. They will also enable you to have daily check-ins, video call sessions, chat sessions, or phone sessions. You’ll also find options for email communication. 

You can do online therapy both individually and with your partner, or combine individual and partner sessions. It’s really up to you and how flexible the therapist is to tailoring the sessions to your own needs. But basically, the sessions last like a regular therapy session – about 50 minutes, although it’s possible to adjust this if necessary. 

There are also plenty of therapists that focus on particular issues you can choose from and be matched with. No more waiting lists or cues to get the help you need! 

How Can Couples Therapy Help Older Adults? 

This is, unfortunately, a very under-researched and neglected topic. But older adults are also often in need of couples therapy. Lingering problematic patterns of behavior of one or two of the spouses, financial issues, illness in the family, low libido/decreased sex drive… All of these are problems older adults face. 

Source: Photo by Renate Vanaga on Unsplash

Couples therapy for older adults can help spouses deal with old resentments, and work on ongoing problems in their marriage that have been present for years, maybe even decades. 

It can help older adults to better manage their emotions and aid them in their joint transitioning into old age and all the challenges that it may bring. 

Lots of couples spend their life together without developing proper communication skills. Couples therapy for older adults may contribute to their development. 

This is especially challenging for couples where one of the spouses is facing a cognitive-impairing disease, such as dementia and Alzheimer’s. In this case, you will need to find a therapist that has a deeper knowledge of these types of medical diagnosis. You may also want to consider doing it in close collaboration with a specialist in the field. 

In any event, couples therapy for older adults can contribute to making couples who’ve been together for decades lead happy and satisfactory lives in their golden years. It can allow them to manage stress and any misconceptions about how the life of older adults should be. 

What Is Sex Therapy for Couples? 

Well, as you might’ve guessed by its name already, sex therapy revolves primarily around the issues of sex in a marriage. 

It’s still a talk therapy, so don’t get any ideas. However, it’s a talk therapy that aims to help couples deal with any pertinent problems regarding their sex life. They often deal with sexual dysfunction of any kind. These problems may be caused by a range of medical, personal, interpersonal, and psychological factors. 

And so, in sex therapy, you might expect the therapist to help you overcome any physical or emotional hurdles you may be facing. You’ll be able to get to a point where you and your spouse can enjoy a healthy and pleasurable sex life. 

You should definitely think of sex therapy as a kind of psychotherapy, because, again, it works by way of talking through your underlying concerns and emotions. 

And not only can this practice be highly beneficial, helping you get through any uncomfortable past experiences and managing any underlying problems that might lead to sexual dysfunction, but it can also be pretty educational too! 

You get to find out stuff you didn’t know before about desire and what constitutes a healthy sex life. You’ll be in a space where you get to talk freely about sexuality and your desires, needs, fantasies. It’s very likely that you’ll become more comfortable sharing them with your partner. And, you might also encourage your partner to listen in an open and non-judgmental way. 

You can do sex therapy by yourself or with your partner, or interchangeably. It’s up to you and also how your therapist thinks it’s best to do it. 

What are the differences between sex therapy and couples therapy? 

Well, sex therapy is pretty much focused on a couple’s (or individual’s) sex life. Couples therapy, however, encompasses a more general approach to couples’ problems. 

If you find you’re dealing more specifically with issues regarding your love life, then visiting a sex therapist might e a better idea. But, if you feel like you need to work on several aspects of your marriage, then I’d suggest you try a couples therapist. 

Final Thoughts

Right now you might say we’re in the golden years of couples therapy. What does this mean? Well, it means it’s flourishing and it’s capable of helping more and more couples as time goes by. 

If you’re a struggling couple that’s been facing marital/long-term relationship issues for years, and you find yourself stuck in a rut, the solution is simple. 

Ask for help. Contact a therapist, have an evaluative session, change them if you don’t click. Just try something. If real-life sessions are too expensive for you, try online counseling. If you can’t afford that as well, try couples therapy exercises you can do at home. You can also check out these couples therapy podcasts and see how other people are dealing with it. There’s always something that can be done. 

The worst thing is to just suppress your negative emotional states, or ignore them, and even rationalize them. When it comes to navigating a long-term relationship, this will only end in frustration and resentment.

What you can do instead is open up, acknowledge your past trauma and/or emotional baggage. Once you acknowledge it and become able to articulate it, you’ll also be less afraid of it. Or not afraid at all. 

Couples therapy will help you get to this point, and it’ll also stop these issues from being a nuisance to your relationship. 

Just look at all problems as locks yet to be opened. Every lock has a key, right? Just as every (marital) problem has a solution. 

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