What to Expect From Couples Counseling

When a couple seeks out therapy, they’ve probably been struggling and stuck for some time.

Licensed therapists offer expertise and experience at helping couples work through issues, not altogether different from what an individual therapist might do for an individual who is struggling.

Whether the issue is conflict, communication, forgiveness for past hurts or something else, a couples therapist can guide a willing pair through the process of working issues out or deciding what to do next.

“People don’t go to therapy just with the equivalent of a headache in terms of the relationship problems,” said Everett Worthington, commonwealth professor emeritus for Virginia Commonwealth University, in Richmond. “I think when couples feel frustrated and can’t seem to make any headway on the problems on their own, then they start looking for some kind of help.”

What is a couples therapist?

The American Psychological Association (APA) describes couple and family psychology as a specialty that is “focused on the emotions, thoughts and behaviors of individuals, couples and families in relationships and in the broader environment in which they function.”

Marriage and family therapy is “brief; solution-focused; specific, with attainable therapeutic goals; and designed with the ‘end in mind,’” according to the American Association for Marriage and Family Therapy (AAMFT).
A therapist may be licensed by the AAMFT to work with couples and families after receiving a master’s or doctorate degree and getting some practical experience.

Couples therapy typically is short-term with an average of 12 sessions overall, according to AAMFT.

Often, the first line of help a person may seek is a trusted friend, family member or religious professional, Worthington said. For some, that is effective.

Others may still need solutions and seek out a professional therapist.

“By the time many couples get to professional therapists, they’ve been through a lot of advice, more or less helpful, usually less helpful if they’ve gotten to the place where they go to a professional,” Worthington said. “And, so, their relationship has had a lot more time to solidify the problems and so it becomes more challenging for them than if they went earlier on.”

What does a couples therapist do?

A couples therapist guides conversations with an aim toward working out specific problems between a couple or in a family. This can help improve troubled relationships among family members, according to the Mayo Clinic.
A therapist might help couples look at their ability to solve problems and express thoughts and emotions productively, according to the Mayo Clinic. During therapy, family roles, behavior patterns and strengths might also be explored.

This type of therapy can be helpful at any stage in a relationship, according to an article from the Cleveland Clinic. Even pre-marital counseling can help build communication and problem-solving skills, it noted.

That same article noted that APA reports that marriage counseling works for 75% of couples. For the 25% for whom it isn’t effective, most were either already actively separating or in abusive relationships.

What kinds of relationship problems can couples counseling help address?

Typical concerns include:

Conflict
Communication problems
Intimacy problems and infidelity
Forgiveness and reconciliation for past hurts
Falling out of love or growing apart
Depression, anxiety and individual psychological problems
Addiction or serious mental health issues being experienced by a family member
Major life adjustments, including a disruptive job change, infertility, financial distress, death of a loved one

Couples therapy could be lifesaving. In October, HealthDay reported on a study that found heart patients under severe marital stress were 67% more likely to have recurring chest pain in the first year after a heart attack.

Patients should “be aware that marital stress in their life could be affecting their recovery,” lead researcher Cenjing Zhu, a doctoral candidate in chronic disease epidemiology at the Yale School of Public Health in New Haven, Conn., said in that story.

What is a couples counseling session like?

Sessions typically last 50 to 60 minutes, according to the Mayo Clinic.

Often, the couple meets together with the therapist, but sometimes couples counseling is done individually, Worthington said.

Therapists take different approaches, either working with a couple on current issues or working backward from where those issues began, he said.

A couple typically gets a formal assessment before starting counseling and then a treatment plan they agree on. It may dictate, to some degree, what the sessions will cover, Worthington said.

“What we’re getting around to is trying to more generally figure out how to resolve differences so that they can apply this not just to the issue of the day but to all the issues,” he said.

While communication has long been considered critical to a relationship, having a strong emotional bond is really what can help a couple succeed, Worthington said.

He said couples need to form, maintain, grow and — when damaged — repair that emotional bond.

How to find a couples therapist

A word-of-mouth recommendation from a friend, family member or pastor can sometimes be a good choice.

An employee assistance program at your job may be able to offer suggestions. A health insurance company might have a list of providers. State or local mental health agencies are also good resources.

Someone seeking a couples therapist can also search by ZIP code on the Psychology Today website.

SOURCE: Everett Worthington, commonwealth professor emeritus, Virginia Commonwealth University, Richmond