Couples therapy and counselling

On average, yes. Couple therapy tends to bring a large improvement in relationship satisfaction, couples left on a waiting list don't improve much, and the gains generally hold up over short- and long-term follow-up¹. A pooled analysis of behavioural and emotionally focused couples therapy found a medium improvement, with no clear difference between the two². That analysis comes with a warning: publication bias may make the results look rosier than they are².

Real life is a bit less tidy than the lab. Reviews put it at 60–80% of distressed couples benefiting from behavioural and emotion-focused approaches. Effects are weaker in everyday clinical practice, though, and they fade after treatment for about half of couples³. A sizeable share of couples gain little from therapy, or get worse afterwards⁴.

So treat those percentages as rough averages, not a forecast for the two of you. Two things help:

• Ask how progress will be checked, and agree when you'll review it together.
• If it isn't helping after a reasonable time, say so to the therapist and consider other approaches.

When the same problems keep coming back and you can't sort them out between you. Rough patches are a normal part of sharing a life, so a bad month isn't a verdict⁵. But some patterns are worth noticing: recurring arguments that never get resolved, feeling dissatisfied and unhappy, or rows about parenting, family or money that go round in circles⁵. Concerns you can't resolve, communication breaking down and feeling unsupported are also signs a relationship needs attention⁶.

The usual advice is to act early. If you can't seem to improve communication on your own, consider talking with a relationship counsellor, because it's better to act early than to wait for things to get worse⁷. You don't have to wait until things are "bad enough".

Many couples hold off anyway. Cost is a common hurdle, and plenty of people feel their relationship is either not bad enough to deserve help or too far gone to benefit from it⁸. If cost or not knowing where to start is the snag, a doctor or a local relationship service can point you to options.

You can also begin small: pick a calm moment and say, "I've noticed we keep having the same argument. Could we try something different?"

Where there is abuse or fear. Couples counselling isn't recommended where one partner is abusive or controlling, or where either partner is afraid. Confidential support for the person at risk is the safer first step.

Constant jealousy, controlling who you see or how money is spent, put-downs and ridicule, and cruel or shouting words are signs of an unhealthy or abusive relationship⁵. They are not communication problems for the two of you to fix together. Couple therapists treat safety as the first question when violence comes up, and see little point in joint sessions where fear stops partners speaking freely⁹.

If you're unsure whether fear or control is part of your relationship, talk it through with a trusted professional on your own before any joint sessions. A partner may be able to see a shared phone, app or browser history, so look for help on a device you trust.

Joint sessions can also be a poor fit when one partner has already decided to leave. That's rarely clear-cut, though, and mixed feelings are common⁹. If you're unsure about staying together, say so openly.

Start with credentials. Many kinds of professionals offer therapy, including psychiatrists, psychologists, social workers, counsellors and psychiatric nurses¹⁰. Check that yours belongs to a recognised professional body or an accredited register where you live^11,12.

Then ask a few questions, ideally before you book:

• What approach do you use, and what's the evidence behind it? Integrative behavioural couples therapy and emotion-focused therapy are two approaches with especially promising results¹³.
• How will we know it's working, and what happens if we aren't improving?¹⁰
• How does confidentiality work, and what are its limits?¹⁰

Then there's chemistry. Rapport and trust are essential, because therapy gets personal¹⁰. After a few sessions you should know whether you're comfortable: not judged or criticised, and able to speak your mind. If not, say so to the counsellor, or change to someone else¹¹. Finding the right fit can take a try or two, and that's fine.

If one of you came along reluctantly, say so early so the therapist can address it. It's much easier to work with than a quiet "I'd rather be anywhere else."