Behavioural couples therapy

Behavioral Couples Therapy (BCT) – Recovery Research Institute

Behavioral Couples Therapy (BCT)

Behavioral Couples Therapy is a form of behavior therapy that incorporates both the partner and the individual seeking help for alcohol or other drugs.

The goal of Behavioral Couples Therapy (BCT) is to improve the couple’s relationship while building support for abstinence. This means increasing positive activities and improving communication between partners, with both acceptance and change, to facilitate success in recovery from alcohol and other drugs.


Behavioral Couples Therapy consists of typically 12-20 weekly outpatient couples sessions over a 3- to 6-month period. Sessions can begin as soon as the partner suffering from addiction seeks help (e.g., after detoxification, during/after treatment). To increase positive activities, commitment to the relationship, and improved communication, therapists will give instruction and model behaviors such as listening, expressing emotions, negotiating requests, doing random acts of kindness, and give couples appreciation exercises and homework assignments for practice.

One hallmark of BCT in promoting abstinence is ‘recovery contracts.’ These contracts involve the couple in daily rituals to reward abstinence.

(O’Farrell & Schein, 2000)
Example exercise

Behavioral Couples Therapy is founded on the idea that behaviors do not occur in isolation, and results from rewards and consequences present in the environment. Rewards and consequences work to reinforce certain behaviors while inhibiting other behaviors. Family members of individuals with an alcohol or other drug use disorder have the ability to reward abstinence. When one partner has a substance use disorder, couples often have extensive relationship problems that create high levels of dissatisfaction, aggression, and instability (Fals-Stewart, O’Farrell, & Birchler, 2004). Relationship dysfunction is also associated with increased problematic substance use and increased rates of relapse (Maisto, O’Farrell, Connors, McKay, & Pelcovits, 1988). Behavioral Couples Therapy works to disrupt harmful patterns and restructure couple interactions in ways conducive to long-term, stable abstinence.


Traditional Behavioral Couples Therapy first took shape in the 1960s and 1970s, inspired by the behavioral and social learning movements that focused on operant conditioning techniques to address a variety of problematic behaviors. In 1969, the first case study applying a behavioral technique to a couple’s relationship problems was conducted (Stuart, 1969), and by 1973, researchers had begun to apply behavioral change techniques with an emphasis on skills training to treat relationship distress (Weiss et al., 1973). In the early 1970s, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) called for studies to test the effectiveness of couples and family therapy to improve substance use disorder outcomes (Keller, 1974).

Historically, substance use disorders have been viewed as an individual problem (a moral or character flaw of the individual), and thus have been treated individually and in isolation. However, research from the last three decades has worked to identify the important role partners and families play in the origin and maintenance of addictive behavior. In BCT, addiction is conceptualized as existing within part of the larger family system, treating couples or families as a single unit or whole.


A large and growing body of evidence supports the effectiveness of Behavioral Couples Therapy. Dozens of randomized clinical trials have found evidence for Behavioral Couples Therapy being more effective than both the placebo or no treatment at all (Baucom et al., 1998; Christensen & Heavey, 1999;Baucom et al., 2003; Shadish & Baldwin, 2005; Snyder et al., 2006). Research also has shown Behavioral Couples therapy to increase abstinence rates and improve relationship functioning better than classic individual-based treatment, while also reducing social costs, domestic violence, and emotional problems in children of the couple (O’Farrell & Schein, 2000).

  • Fals-Stewart, W., O’Farrell, T. J., & Birchler, G. R. (2004). Behavioral Couples Therapy for substance abuse: Rationale, methods, and findings. Science & Practice Perspectives, 2(2), 30-41. doi: 10.1151/spp042230
  • Gabbard, G. O. (2009). Textbook of psychotherapeutic treatments. American Psychiatric Association Publishing.




First Name

Last Name


151 Merrimac St., 6th Floor. Boston, MA 02114


Facebook-f Linkedin-in Twitter

Clinical Processes in Behavioral Couples Therapy

  • Journal List
  • HHS Author Manuscripts
  • PMC4766977

Psychotherapy (Chic). Author manuscript; available in PMC 2016 Feb 25.

Published in final edited form as:

Psychotherapy (Chic). 2014 Mar; 51(1): 11–14.

Published online 2013 Dec 30. doi: 10.1037/a0033823

PMCID: PMC4766977


PMID: 24377400

Author information Copyright and License information Disclaimer

Behavioral couples therapy is a broad term for couples therapies that use behavioral techniques based on principles of operant conditioning, such as reinforcement. Behavioral shaping and rehearsal and acceptance are clinical processes found across contemporary behavioral couples therapies. These clinical processes are useful for assessment and case formulation, as well as teaching couples new methods of conflict resolution. Although these clinical processes assist therapists in achieving efficient and effective therapeutic change with distressed couples by rapidly stemming couples’ corrosive affective exchanges, they also address the thoughts, emotions, and issues of trust and intimacy that are important aspects of the human experience in the context of a couple. Vignettes are provided to illustrate the clinical processes described.

Keywords: behavioral couples therapy, behavior observation, behavior shaping, acceptance

Behavioral couples therapy (BCT) is a broad term for couples therapies that use behavioral techniques based on principles of operant conditioning, such as reinforcement (Gurman, 2008). Whereas all couples therapies are focused on reducing relationship distress, we argue that BCTs such as traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979), integrative couple behavioral therapy (IBCT; Jacobson & Christensen, 1996), and the program developed by John M. Gottman (1999) use the common clinical processes of behavioral shaping and rehearsal as well as acceptance to increase reinforcing interactions and rapidly and efficiently stem the negative and corrosive interactions frequently seen in couples presenting for therapy.

The process of behavioral shaping and rehearsal begins with behavioral observation by the clinician. Observing the interactions of the partners plays an important role in assessment, case conceptualization, and determining which interpersonal behaviors will require shaping and rehearsal. Whether using a formal behavioral coding system, such as the Specific Affect Coding System (Coan & Gottman, 2007), or more global classes of couple behavior, such as negativity, positivity, and withdrawal, the clinician is looking for behaviors that have been shown to distinguish distressed couples from satisfied couples (Gottman & Notarius, 2000). Distressed couples have been found to exhibit more negative affect, such as criticism, defensiveness, contempt, stonewalling, and belligerence, in dyadic interactions, and show more rapid and longer-lasting hostility responses (Gottman, 1999; Carrere & Gottman, 1999; Gottman & Notarius, 2000). Distressed couples also frequently fail at repairing conflict (Gottman & Notarius, 2000). Although satisfied couples will also show some negative affect, they exhibit positive affect, such as interest, validation, affection, and surprise or joy, at a ratio of 5:1 to negative affect (Gottman, 1999).

Once the clinician has observed the behavioral interactions of the couple and determined the behavior (e.g., target behavior) to be changed, the clinician will begin by modeling desired behaviors for the couple, and then shaping the couples’ displays and providing feedback as they practice the more positive exchanges. This stage of the process allows the therapist to act as an educator, coach, and commentator, and will slow the escalation of conflict, making conflict repairs easier for the couple. Behavior shaping follows from the assumption that couples experience conflict and distress because the couples lack the skills to communicate functionally (Epstein & Baucom, 2002; Geiss & O’Leary, 1981). Behavior shaping has been found to be superior to traditional communication training (e.g., reflective listening; Baucom, Sayers, & Sher, 1990; Cornelius & Alessi, 2007; Halford, Sanders, & Behrens, 1993) because the collaborative nature of behavior shaping produces long-lasting changes in communication patterns (Baucom & Hoffman, 1986; Wheeler, Christensen, & Jacobson, 2001). Each approach may differ in the exact form of the clinician shaping. For example, TBCT takes a more rule-governed approach to communication training (Sevier, Eldridge, Jones, Doss, & Christensen, 2008), setting rules for how couples should interact and reinforcing approximations toward the goal. IBCT, on the other hand, dictates a more contingency-shaped approach to communication training, in which the clinician explores partners’ reactions to messages and shapes more effective communication. Comparisons between the TBCT and the IBCT approach have found that the TBCT approach leads to a more rapid decrease in the amount of negativity expressed by partners, but IBCT engenders more long-term changes in relationship functioning (Baucom, Sevier, Eldridge, Doss, & Christensen, 2011; Sevier et al., 2008). The best of both worlds may be the use of both rule-governed and contingency-shaped changes to communicating. For example, encouraging the couple to avoid using specific behaviors that are corrosive to relationships and to practice behaviors that predict future satisfaction and stability, thus allowing the reinforcing properties of the improved interactions to potentiate future positive exchanges. In its most specific form, this process can include educating couples about such behaviors through modeling and then skillfully shaping couple interactions to exhibit behaviors such as interest, validation, affection, and surprise or joy and pure anger, and avoid exhibiting behaviors such as contempt, belligerence defensiveness, or criticism (Gottman, 1999; Gottman, Coan, Carrere, & Swanson, 1998).

In the following vignette, names and details of individuals have been changed to protect confidentiality, but the partners are in their mid-20s, have been married 5 years, and have an 18-month-old child. They are presenting for treatment with complaints of escalating conflict and multiple life stressors. The couple has a history of infidelity early in the relationship and issues of honesty and trust continue to create distress. The Dyadic Adjustment Scale (DAS; Spanier, 1976) was used at intake to measure relationship satisfaction. Scores of 97 or greater on the DAS indicated good relationship satisfaction. Individual scores for the husband and wife indicated that both were experiencing distress, scoring 93 and 83, respectively. After several months of treatment, the husband and wife’s scores on the DAS had improved to 107 and 95, respectively.

In the following vignette, the clinician, acting as an educator, has modeled the desired behavior for the couple and, acting as a coach, provided feedback on what was observed; and shaping the display of behaviors that predict satisfaction and stability by suggesting alternatives when appropriate.

Therapist: Let’s discuss a conflict that has caused tension in your relationship. I’d like you to practice is using the positive behaviors we talked about. Remember, they are sadness, anger, interest, affection, validation, and surprise, or joy. Also, avoid using the negative behaviors that we discussed: contempt, defensiveness, criticism, belligerence, and stonewalling. I will be your coach throughout the discussion. I may stop the conversation to give suggestions along the way. Are you ready?

Patty: I think so. Can we talk about chores around the house?

Travis: (Smiling) This should be interesting.

Patty: Well, I know it has caused a few arguments over the past week.

Travis: Yeah.

Patty: And I get mad when you say you’ll do something—like the dishes—but you don’t. Or you say, “Yeah, I’ll get to that when I’m done with this email,” but then it never happens.

Therapist: Travis, take care in not shutting the conversation down with sarcasm. Patty, can you be a little more specific? I think you are making a specific complaint, but it was couched in terms of always and never.

Patty: Okay. Travis, take last night. I was trying to get our daughter to sleep, and the dishes were in the sink, and I asked you to help with them and you said you would. I got busy and forgot about it, but later that night I went to get some water from the sink it was still full of dishes!

Travis: Yeah, I didn’t get around to it. I got sucked into work and lost track of time.

Patty: But that’s how it always goes!

Therapist: Okay, let me step in here because I heard some criticism and defensiveness. How might the two of you respond differently? Maybe with validation?

Patty: Let me try again. Travis, I was angry when I saw that the dishes weren’t done. I know that you are busy with those online courses and that it takes a lot of your time. I know how important it is for you and for our family, but sometimes I need help around the house. It hurts when I can’t trust you to follow through; I mean last night it did.

Travis: Last night I got caught up in my work. And I know that it wasn’t just last night, but that it happens a lot. I want to do better, but I don’t know how when we argue.

In the previous vignette, the husband displays contempt through sarcasm in his statement, “This should be interesting,” defensiveness (excuse making) later in the exchange, and the wife displays criticism in her use of “never” and “always” when expressing displeasure at what her husband has done and later when she states that she “can’t trust” him. The clinician attempts to shape more desired displays on two occasions. In the first instance, the clinician stops the couple, asking the husband to reduce his displays of contempt (sarcasm) and defensiveness, and asking the wife to reduce her display of criticism by asking her to be more specific and avoid using statements that include “always” and “never.” The clinician then allows the discussion to continue and waits to see if the couple will spontaneously display the desired behavior. When this does not happen, the clinician then prompts the couple to use validation in the continuation of the discussion. Because the clinician does not want the displays of the desired and more productive behavior to be contingent on his reinforcement, the clinician allows the experience of being heard and understood through the use of validation to reinforce the future displays of such behavior.

Acceptance, a core component of many BCTs and particularly central to IBCT (Gurman, 2008), is a process incorporated into contemporary versions of BCT to improve the weaknesses of TBCT. Although initial research found that TBCT was effective in improving marital satisfaction, subsequent investigations found that a majority of TBCT couples had relapsed shortly after the termination of therapy (Wheeler, Christensen, & Jacobson, 2001). To address this shortcoming in TBCT, Jacobson and Christensen proposed a reconceptualization of BCT that encouraged couples to accept those aspects of a partner that cannot be changed and commit to changing those aspects of themselves that can (Dimidjian, Martell, & Christensen, 2002). In IBCT, acceptance is considered a central process of change and is not meant as a resignation or defeat, but as an acknowledgment of the inherent realities within a relationship. What matters is not solving the unsolvable problem, but changing the affective displays exhibited when these conflicts are discussed. Through this process, couples are encouraged to show compassion toward and empathic understanding of their partners, and accept ongoing conflicts as opportunities to work together as a way of building intimacy through shared struggle. These ideas proposed by Jacobson and Christensen in IBCT are similar to those proposed by Gottman (1999) in his “Building the Sound Marital House” treatment approach, in which he discusses research findings that the majority of couples (69%) experience ongoing problems that have no solution. Gottman (1999) suggests focusing therapeutic attention on the affect displayed and the manner in which these problems are discussed rather than trying to solve the problems themselves.

The use of acceptance within BCT has been a subtle, but significant, shift in treatment that has resulted in striking influences on treatment efficacy. For example, compared with TBCT, couples who received acceptance-focused IBCT demonstrated greater improvements in marital satisfaction and overall functioning, were less blaming, and used more soft emotions and less harsh emotions when discussing conflict (Cordova, Jacobson, & Christensen, 1998; Jacobson, Christensen, Prince, Cordova, & Eldridge, 2000). More recent investigations of acceptance as a mechanism of change within TBCT and IBCT have also found that increases in the acceptance of partner target behaviors (behaviors in which the other partner desires change) were related to increases in relationship satisfaction for the couple. Additionally, even though couples in both treatments experienced a significant relapse in target behaviors in the second half of therapy, the relapse was more harmful to the relationship satisfaction of TBCT than of IBCT (Doss, Thum, Sevier, Atkins, & Christensen, 2005). These findings suggest that acceptance may also provide a sort of “inoculation” affect against declines in satisfaction that may accompany the natural ups-and-downs that occur over the course of a long-term intimate relationship. In addition, just as in a wide variety of individual therapies in which acceptance of the client is a necessary component for change to occur (Gilbert & Leahy, 2007; Miller & Rollnick, 2013), acceptance appears to function similarly for couples. Acceptance in one partner has been shown to mediate the behavior change in the other partner (Dimidjian, Martell, & Christensen, 2002; South, Doss, & Christensen, 2010). It appears that as partners decrease their efforts to change each other, they become less emotionally reactive, thereby increasing the likelihood of behavior change.

In the following vignette, Travis and Patty are encouraged to identify those conflicts that are not likely to change, and rather than trying to solve the problem, approach the conflict as an opportunity to join together and take each other’s perspective.

Therapist: When you think about issues that often become conflicts for the two of you, are any of those things that you don’t ever seem to solve?

Travis: Yes. As you know, we’ve had to deal with the fallout from my past infidelity. I was wrong to cheat on Patty, and I’ve tried to make amends. We’ve worked hard on this and it hasn’t been easy. It just feels like there is still a distance between us.

Therapist: Patty, what are your thoughts on this?

Patty: Travis knows how I feel. When it happened, it shattered my trust in him and although I’ve been able to regain trust in Travis, it isn’t like it used to be. I’m committed to this relationship, but I know that I carry the scars from what happened.

Therapist: I see. Although you both want to make this relationship work, there is some hurt that still surrounds the past infidelity. It sounds like it may never go away. In spite of your best efforts, the emotional pain from the betrayal is still a part of your relationship. How do you experience those emotions?

Patty: It mostly happens when I find myself questioning if Travis is being honest with me. Like when he says he will do something, and he doesn’t follow through, or when he comes home late from work. I find myself questioning if he is lying to me again. It leaves me feeling suspicious and lonely.

Therapist: And how do you end up acting toward Travis in these moments?

Patty: I guess I pull away from him and become a bit more distant.

Travis: I know what Patty is talking about. I can tell when she is feeling that way. Even though she’s in the room with me, it’s like all of a sudden I’m sitting with a stranger and not my wife. I feel like I’ve done something wrong, but I don’t know what.

Therapist: How do the two of you usually deal with these emotional situations?

Travis: We don’t deal with them very well. I’ve tried to change the mood by acting sweet or funny, but it doesn’t help. Sometimes I get angry. Mostly I just wait it out.

Therapist: I wonder what it would feel like to talk about the emotions instead of trying to change how you feel. Patty, you could tell Travis when you feel hurt or distrustful; and Travis, you could tell Patty when you feel distanced from her. Each of you can try to understand where the other is coming from. It is awful hard to change our emotions, but we can change how we act when they occur. I wonder if turning toward each other for support might allow these events to play out differently.

Patty: We could try it.

Therapist: Okay. Let’s practice with a role play once and get an idea of how it might feel to have such a conversation.

Travis: Okay. I’ll start. Patty, you’ve gotten quiet all of a sudden. Are you feeling hurt and worried?

Patty: Yes. You didn’t call before you left work like you said you would and it made me worry about what is going on.

Travis: I am sorry to make you worry again. I’m sorry that this has happened to you and to us, and that you continue to have fears. I am completely committed to you, our relationship, and to making it better for us. I will continue to work on following through better.

Patty: Thank you.

Therapist: How did that feel for the two of you? Patty?

Patty: I felt less abandoned because he noticed how I was feeling and reached out to me.

Therapist: Travis, how about you?

Travis: I was nervous at first about talking to her about it; like I’d get blasted in bringing it up. In the end, though, I’m glad I did. I feel closer to Patty.

In the previous vignette, the couple has chosen an ongoing area of difficulty to learn about the practice of acceptance. The therapist begins this discussion by modeling acceptance through expressing empathy for the couple in acknowledging that there is still pain surrounding the past infidelity and that they both want the relationship to work. The effect of this on the couple is quickly evident, in that the tone of the conversation softens and they begin to see the problem as belonging to “them” rather than something that either one of them is doing. This change is exemplified by the husband’s interest in the reason his wife became quiet and validation of the wife’s worry. An unanticipated bonus in this exchange was the reinforcement the wife offered her husband for reaching out to her, both in not reacting negatively to his query, and in thanking him for his efforts to reach out to her.

The techniques of behavior observation, behavior shaping and rehearsal, and acceptance are elements of the clinical process in BCT that, when used in combination, create effective and efficient change in distressed couples by rapidly stemming the negative and corrosive behaviors often exhibited by couples presenting for therapy. These process techniques are useful within specific stages of treatment: the behavior observation portion of behavior shaping can be used in the service of assessment and case conceptualization, behavior shaping can be used as an intervention for communication skills training, and acceptance can be used as an intervention for some chronic conflicts. Additionally, they can also be used more generally throughout therapy to address conflicts and issues as they arise. We also believe, as demonstrated through the included vignettes, that a behavioral approach to couples therapy adequately addresses not only core issues within a relationship, such as communication and conflict resolution, but also the thoughts, emotions, and issues of trust and intimacy that are important aspects of the human experience (Epstein & Baucom, 2002).

B.C.F. is supported by a National Institute on Alcohol Abuse and Alcoholism Institutional Research Training Grant (1 T32 AA018108-01A1; McCrady, PI).

Daniel J. Fischer, Department of Psychology, University of New Mexico.

Brandi C. Fink, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico.

  • Baucom DH, Hoffman JA. Clinical handbook of marital therapy. New York: Guilford Press; 1986. The effectiveness of marital therapy: Current status and application to the clinical setting; pp. 597–620. [Google Scholar]
  • Baucom DH, Sayers SL, Sher TG. Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: An outcome investigation. Journal of Consulting and Clinical Psychology. 1990;58:636–645. [PubMed] [Google Scholar]
  • Baucom KJW, Sevier M, Eldridge KA, Doss BD, Christensen A. Observed communication in couples two years after Integrative and Traditional Behavior Couple Therapy: Outcome and link with five-year follow-up. Journal of Consulting and Clinical Psychology. 2011;79:565–576. [PMC free article] [PubMed] [Google Scholar]
  • Carrere S, Gottman JM. Predicting divorce among newly-weds from the first three minutes of a marital conflict discussion. Family Process. 1999;38:293–301. [PubMed] [Google Scholar]
  • Coan JA, Gottman JM. The specific affect coding system (SPAFF) In: Coan JA, Allen JB, editors. Handbook of emotion elicitation and assessment. New York: Oxford University Press; 2007. pp. 267–285. [Google Scholar]
  • Cordova JV, Jacobson NS, Christensen A. Acceptance versus change interventions in behavioral couples therapy: Impact on couples’ in-session communication. Journal of Marital and Family Therapy. 1998;24:437–455. [PubMed] [Google Scholar]
  • Cornelius TL, Alessi G. Behavioral and physiological components of communication training: Does the topic affect outcome? Journal of Marriage and Family. 2007;69:608–620. [Google Scholar]
  • Dimidjian S, Martell CR, Christensen A. Integrative behavioral couple therapy. In: Gurman AS, Jacobson NS, editors. Clinical handbook of couples therapy. 3rd. New York: Guilford Press; 2002. pp. 251–277. [Google Scholar]
  • Doss BD, Thum YM, Sevier M, Atkins DC, Christensen A. Improving relationships: Mechanisms of change in couple therapy. Journal of Consulting and Clinical Psychology. 2005;73:624–633. [PubMed] [Google Scholar]
  • Epstein NB, Baucom DH. Behavioral factors in couples’ relationship problems. In: Epstein NB, Baucom DH, editors. Enhanced cognitive-behavioral therapy for couples: A contextual approach. Washington, DC: American Psychological Association; 2002. pp. 27–63. [Google Scholar]
  • Geiss SK, O’Leary KD. Therapist ratings of frequency and severity of marital problems: Implications for research. Journal of Marital and Family Therapy. 1981;7:515–520. [Google Scholar]
  • Gilbert P, Leahy RL. The therapeutic relationship in the cognitive behavioral psychotherapies. New York: Routledge; 2007. [Google Scholar]
  • Gottman JM. The marriage clinic: A scientifically-based marital therapy. New York: Norton; 1999. [Google Scholar]
  • Gottman JM, Coan J, Carrere S, Swanson C. Predicting marital happiness and stability from newlywed interactions. Journal of Marriage and Family. 1998;60:5–22. [Google Scholar]
  • Gottman JM, Notarius CI. Decade review: Observing marital interaction. Journal of Marriage and Family. 2000;62:927–947. [Google Scholar]
  • Gurman AS. Clinical handbook of couple therapy. 4th. New York: Guilford Press; 2008. [Google Scholar]
  • Halford WK, Sanders MR, Behrens BC. A comparison of the generalization of behavioral marital therapy and enhanced behavioral marital therapy. Journal of Consulting and Clinical Psychology. 1993;61:51–60. [PubMed] [Google Scholar]
  • Jacobson NS, Christensen A. Acceptance and change in couple therapy: A therapist’s guide to transforming relationships. New York: Norton; 1996. [Google Scholar]
  • Jacobson NS, Christensen A, Prince SE, Cordova J, Eldridge K. Integrative behavioral couple therapy: An acceptance-based, promising new treatment for couple discord. Journal of Consulting and Clinical Psychology. 2000;68:351–355. [PubMed] [Google Scholar]
  • Jacobson NS, Margolin G. Marital therapy strategies based on Social Learning and Behavior Exchange principles. New York: Brunner/Mazel; 1979. [Google Scholar]
  • Miller WR, Rollnick S. Motivational interviewing. 3rd. New York: Guilford Press; 2013. [Google Scholar]
  • Sevier M, Eldridge K, Jones J, Doss BD, Christensen A. Observed communication and associations with satisfaction during traditional and Integrative Behavioral Couple Therapy. Behavior Therapy. 2008;39:137–150. [PubMed] [Google Scholar]
  • South SC, Doss BD, Christensen A. Through the eyes of the beholder: The mediating role of relationship acceptance in the impact of partner behavior. Family Relations. 2010;59:611–622. [Google Scholar]
  • Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family. 1976;38:15–28. [Google Scholar]
  • Wheeler JG, Christensen A, Jacobson NS. Couples distress. In: Barlow DH, editor. Clinical handbook of psychological disorders: A step-by-step treatment manual. 3rd. New York: Guilford Press; 2001. pp. 609–630. [Google Scholar]

What is couples therapy?

Published: 09/10/2021 in Family Psychology and Family Therapy

Couple therapy is a form of psychotherapy that can help you and your partner improve your relationship. If you're having relationship difficulties, you can seek couples therapy to repair your relationship. Couples therapy can address a wide range of relationship problems, including recurring conflicts, feelings of separation, romance, sex-related problems, or difficulties related to external stressors.

Couples therapy can help you at any stage of your relationship, regardless of marital status, age, race, creed or sexual orientation.

Some forms of this therapy include marriage counseling, premarital counseling, and family therapy. This is usually a short-term form of therapy.

Types of couples therapy

  • Emotional EFT - Focuses on improving attachment and bonding between you and your partner. A therapist helps you understand and change the behaviors that lead to feelings of disconnection.
  • The Gottman Method - This method involves dealing with conflict situations and teaching you and your partner problem-solving skills. It aims to improve the quality of friendship and the level of intimacy between you and your partner.
  • The Ellen Wachtel Approach - is a power-based approach that focuses on the positive aspects of a relationship. It focuses on self-reflection rather than blame.
  • Psychodynamic therapy for par explores the hidden hopes and fears that motivate you and your partner to help you understand each other better.
  • Behavioral Therapy – Also known as Couples Behavior Therapy, this form of therapy involves shaping behavior by reinforcing positive behavior that promotes stability and satisfaction, and discouraging behavior that promotes negativity.
  • Cognitive behavioral therapy (CBT) - Also called Cognitive Behavioral Therapy for Couples (CBCT), this form of therapy involves identifying and changing thought patterns that negatively affect behavior.


Psychotherapists often take a holistic approach to treatment, mixing methods from different forms of therapy, depending on your needs.

Some of the strategies a family therapist can use are:

  • Getting to know you: The therapist creates a sense of security by getting to know you and your partner. Actively and collaboratively works with you to help you better understand yourself and your partner.
  • Revealing Feelings : The therapist helps you and your partner identify feelings and communicate them to each other in words.
  • Exploring the past: couples therapy may include exploring your past as this can help you better understand your fears, motivations, and relationship behaviors. It can also help eliminate unresolved conflicts affecting your present.
  • Solution Focus: Your therapist will work with you and your partner to resolve problems, correct negative behaviors, and focus on the positive aspects of the relationship.
  • Learning skills: couples therapy can help teach you and your partner anger management, problem solving, and conflict resolution skills. The goal is to equip you and your partner with the tools to help you solve problems that arise.

How couples therapy can help

Couples therapy can give you and your partner the opportunity to discuss and resolve issues related to several aspects of your relationship, which may include:

  • Relationship roles: couples therapy can help you explore the roles you and your partner play in a relationship and identify unhealthy dynamics. It can also help eliminate differences in expectations.
  • Beliefs and Values: couples therapy can help you and your partner talk about your beliefs, values, and religious feelings, and how these aspects affect your daily life.
  • Finances: can be a major source of conflict in a relationship. Family therapy can promote open dialogue and transparency about income and spending habits.
  • Time spent together: You and your partner can solve problems that prevent you from spending time together. You can discuss the activities you enjoy doing together and how you can make your time together more enjoyable.
  • Children: If you and your partner disagree about whether you want to have children or how you want to raise them, couples therapy can help you resolve these issues. It can also help with stressors such as difficulty conceiving or adopting children.
  • Family Relationships: couples therapy can help you and your partner deal with conflicts with other family members.
  • Sex and intimacy: If you and your partner have problems with sex, intimacy, or infidelity, couples therapy can offer you a safe space to share your feelings and needs.
  • Health problems: physical or mental illness can be difficult for you and your partner. Couples therapy can help you deal with stress in your relationship.
  • External stressors: therapy can also help you and your partner deal with conflicts caused by external factors that may be making your relationship worse.

Benefits of couples therapy

Benefits of couples therapy include reducing relationship stress and increasing relationship satisfaction. People report feeling more connected, more secure with their partner, spontaneous and playful in relationships. When people feel more secure in their relationships, they can become more assertive and adventurous in other areas of their lives.

Here are some of the benefits that couples therapy can offer:

  • Understand each other better: Couples therapy can help you understand yourself and your partner better. It can help both of you express your feelings, hopes, fears, priorities, values, and beliefs.
  • Identifying Relationship Problems: Your therapist can help you and your partner identify problems that lead to repetitive conflict, lack of trust, and feelings of alienation.
  • Improving communication skills: therapy can help you and your partner communicate with each other. It can help you express yourself and ask for what you need without attacking or blaming your partner.
  • Conflict Resolution: Your therapist can help you and your partner deal with your problems and resolve them.
  • Strengthen Friendship and Attachment: Couples Therapy can help strengthen friendship, attachment, attachment, and intimacy between you and your partner.
  • Stop dysfunctional behavior: Your therapist can identify dysfunctional behavior and help you resolve it.
  • Learn Skills: couples therapy is a short-term therapy aimed at equipping you and your partner with skills to help you prevent and manage future conflicts.
  • Increased relationship satisfaction: couples therapy can help improve the overall quality of your relationship so that you and your partner are happier together.


According to a 2014 review, couples therapy can help with relationship satisfaction, communication, forgiveness, problem solving, and meeting needs and feelings.

Emotionally Focused Therapy is particularly well supported by research on a wide range of issues. Multiple studies have shown that couples who receive 8 to 12 sessions report reduced stress and increased relationship satisfaction for both partners, with benefits continuing even two years after treatment.

Things to consider

Ideally, couples therapy requires the participation of you and your partner. However, if your partner is not open to it, you can also opt for couples therapy alone to better understand your relationship and how you can improve it.

If you and your partner do this together, you may find that one or both of you also need separate therapy sessions to help you deal with couples therapy problems.

If you or your partner are having other problems, your therapist may suggest specialized therapies to help you.

Getting Started

If you feel that marriage therapy will benefit your relationship, discuss it with your partner and see how they react. If there is resistance, explain why it's important to you and how you think it can help your relationship.

The next step is to find a psychologist. Family therapy is often provided by licensed therapists, known as couples and family therapists.

Ask your partner what days and times are right for him. Try to find a psychologist who is conveniently located if you and your partner prefer in-person sessions.

Your therapist will work with you and your partner to find therapy goals. While couples therapy usually includes sessions together, your therapist may also do individual sessions with you or your partner. They may also assign homework.

Read more Here system where a change in one family member results in a change in the entire system and vice versa. Each family has its own structure and mechanisms of existence that strive for balance. Based on this context, the symptoms of a mental disorder may have some function in the family or be a consequence of the failure of the system. Which symptoms, in which context, which family member develops is a matter of chance, they can be cured by treating relationships in the family.

Children and adolescents in family therapy

Children and adolescents perceive and understand the world a little differently, they only learn to cope with the difficulties associated with themselves and others, they have less experience and skills for this. Children have fewer words to describe their feelings and needs and use more non-verbal communication. Since in youth a person is receptive to everything new, he is more easily influenced by the environment, both positive and negative. The smaller the child, the more he depends on the mother, parents and family. The well-being of the child largely depends on the well-being of the family. A person is born from relationships for relationships, in the formation of his worldview and picture of the world, close relationships play a critical role. When a child reaches adolescence, peers become in some respects more important than family members, but family support is still important in gaining independence.

In order to obtain effective results in solving problems with the psyche of a child and adolescents, it is necessary to involve the family. In family therapy, symptoms are seen as symbolic of family problems. It's not something wrong with the child: the mistake arose in the drawing of family relationships. Not all problems have an ideal solution and it is not always possible to achieve a complete order, but it is always possible to find the most appropriate solution to the problem at the moment. Difficulties may arise at different stages in the development of the family and the child, and the approach inherent in the family offers an opportunity to deal with them.

Who is it for?

Family therapy can be used for relationship difficulties, such as couples. Couples therapy is for couples who want to maintain their relationship but are trapped in repetitive patterns of conflict. Some couples come to therapy when the end of the relationship is more or less decided, and therapy can help ease the pain of a breakup. Whereas therapy should be thought about much earlier, when the positive still outweighs the negative.

It is possible to alleviate the situation when the balance in the family is disturbed due to the departure of a family member or the arrival of a new family member, or if the family has undergone significant changes and has not been able to adapt to them.

Family therapy is also used in the presence of various mental disorders in the family, such as psychosis, bipolar disorder, anorexia, alcohol abuse.

You can go to a family therapist alone, but the best result will be if you go with the whole family. First, you can contact the therapist and briefly describe the problem, trusting his assessment, and find out which family members are needed.

Duration and regularity of therapy

The number of sessions and how often they should take place depends on the situation that has developed in the family. At the first meeting with the therapist, it is reasonable to specify a certain number of sessions and a goal.

Learn more