Does Couples Therapy Really Work?

On a once popular sit-com "King of Queens," when Carrie and Doug are fighting and recognize they have a problem, Carrie suggests couples therapy. Doug's response to her was: "No, I don't want to throw money down a rat hole." I found it funny, but for me, there was a sad ring of truth to it. I have heard too many stories of couples that sought help from a therapist and things get better for a few months, only to slide back in to old patterns or get divorced. So I found myself wondering, does couples therapy really work?

This is an important question that all to often doesn't get asked! As I studied the research, I found out that there are three major elements to answering the question: 1) couple characteristics, 2) therapist characteristics, and 3) the model of therapy the therapist uses. Unlike individual therapy, where the model used may not matter, research indicates that with couples therapy, an important element is the model of couples therapy.

Clinical trials indicate that some approaches to couples therapy produce little to no results, some produce good results that do not last for more than a few months, and some produce good results that last for years. For example, a therapist without a clear, organized model for working with relationship issues is likely to produce very limited results. In addition, many couples will drop out of this type of couples therapy.

A clear therapy model unfortunately does not guarantee results, as clinical studies indicate improvement rates for different models vary anywhere from 0% to 85%. In one broad review of over 150 clinical trials, the average number of couples that improved was reported at 55%, with only 35% of the couples reaching non-distressed levels. Going from luke-warm results to even worse results, those trials that include follow ups studies one to four years later often show significant declines in marital satisfaction. Deterioration rates anywhere from 30-60% are not uncommon and a "good" therapy can have high separation/divorce rates. For example, a trial of the APA-approved behavioral treatment model yielded an impressive 84% improvement at the end of therapy. Unfortunately, the results didn't last. After 4 years, 38% of the couples were separated or divorced. And this rather large number does not include those who deteriorated but did not separate.

Fortunately for therapists and clients, there are some good models of therapy that create lasting results. Three models that have shown excellent results in both the short and long-term are Emotionally Focused Couples Therapy, Integrated Behavioral Couples Therapy, and Insight-Oriented Couples Therapy. Not surprisingly, these three models are more similar than different.

The most thoroughly researched model, Emotionally Focused Couples Therapy (EFT), has decades of research studies that consistently indicate that the majority of couples improve (85+%) and that many couples (70+%) reach a recovered or non-distressed level. In addition, there have been several 2 year follow-up studies indicating that couples do not relapse. These results impressed me and were enough to convince me that the model works. The research was a key element in my choice to invest the years necessary to become an EFT therapist.

Should you be seeking couples therapy, my hope is that this research overview will create some optimism that couples therapy can work and that the information will be helpful in your process of selecting a therapist!

Post References

Dunn, R. L., & Schwebel, A. I. (1995). Meta-analytic review of marital therapy outcome research. Journal of Family Psychology, 9, 58-68.

Goldman, A., & Greenberg, L. (1992). Comparison of integrated systemic and emotionally focused approaches to couples therapy. Journal of Consulting and Clinical Psychology, 60, 962-969.

Gottman, J. M., Ryan, K. D., Carrère, S., & Erley, A. M. (2002). Toward a scientifically based marital therapy. In H. A. Liddle, D. A. Santisteban, R. F. Levant & J. H. Bray (Eds.), Family psychology: Science-based interventions (pp. 147-174). Washington, DC: American Psychological Association.

Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317-344.

Wesley, S., & Waring, E. M. (1996). A critical review of marital therapy outcome research. The Canadian Journal of Psychiatry, 41.