Is Couples Therapy Worth It? What the Research Really Shows

By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist

It is one of the most common questions couples ask before picking up the phone. Not 'which therapist should we see' or 'how many sessions will we need' but something more fundamental: does this actually work?

The question is reasonable. Therapy costs money, takes time, and requires both partners to show up and be honest about things that are often difficult to say. Before making that investment, people want to know whether it is worth it, or whether they are better off trying to sort things out themselves.

The short answer is yes, for many couples it is. The research on couples therapy is encouraging, including in studies of seriously distressed couples, in follow up studies lasting five years, and in ordinary clinics in the UK. The longer answer is more useful, because the same research also shows what makes therapy work better. This post looks at what the studies show, what helps, when to go, and what to expect, and it links to my other pieces where you want more detail.

What Does the Research Say?

The overall picture

A review of a decade of research on couple therapy concluded that it positively affects about 70 per cent of the couples who receive it. The same review found that the effectiveness of couple therapy is comparable to that of individual therapies and far better than no treatment (Lebow et al., 2012). It also found that couple distress is closely linked with depression and anxiety, and that couple therapy has an important role in treating a number of individual difficulties as well as relationship ones.

Some approaches have more research behind them than others. The review singled out Integrative Behavioural Couple Therapy and emotion focused therapy as especially promising and evidence based (Lebow et al., 2012). A later review of the research on Emotionally Focused Therapy concluded that it meets or exceeds the guidelines for classification as an evidence-based couple therapy (Wiebe & Johnson, 2016). Other approaches, including the Gottman Method, are widely used, and that does not mean they do not work. It means the strongest reviews I can point to have looked most closely at these two.

Even when couples are seriously distressed

One of the most reassuring studies followed 134 chronically and seriously distressed married couples for five years after they took part in a randomised trial of two forms of behavioural couple therapy. Both produced substantial improvements in marital satisfaction. At the five year follow up, the effect sizes relative to the start of therapy were large (d = 1.03 and d = 0.92). About half of the couples (50.0 per cent and 45.9 per cent) showed clinically significant improvement, and about a quarter (25.7 per cent and 27.9 per cent) were separated or divorced. The authors concluded that these results compared favourably to other long term results of couple therapy, and that both therapies produced substantial effect sizes even in seriously and chronically distressed couples (Christensen et al., 2010).

I find that study helpful for two reasons. It shows that benefits can last, and it reminds us that a good outcome does not always mean a couple stays together. I come back to that below.

In everyday practice in the UK

Trials are one thing. What about an ordinary clinic? A UK study followed 877 people who had completed at least two sessions of psychodynamic couple therapy at a clinic and measured their wellbeing and relationship quality. At the end of therapy, individual psychological distress had fallen significantly for both men and women, with a large effect size (d = 1.04), and relationship satisfaction had improved significantly, with a medium effect size (d = 0.58). The authors concluded that psychodynamic couple therapy was effective for individual and relational distress, with effect sizes similar in strength to those reported in randomised trials (Hewison et al., 2016).

An honest note about trials and everyday practice

It would not be fair to stop there, because researchers have also noticed a gap. Analyses of randomised trials find large improvements in how couples get on, but studies of couple therapy in routine practice find smaller effects, in the small to moderate range (Halford et al., 2016). The UK study above is one example where practice results looked similar to trial results, and others have been smaller. I read this as encouraging and not discouraging, because the same researchers set out what could close the gap. Their recommendations include clarifying whether a couple's goal is to improve the relationship or to decide about it, using standardised assessment of both partners and the relationship, and systematically monitoring progress and the therapeutic alliance (Halford et al., 2016). Those are things you can look for in a therapist, and the next section explains why they matter.

What Makes the Difference

Tracking progress, and listening to the feedback

In a randomised trial of 410 people attending a community family counselling clinic, couples whose therapists received regular feedback on their progress and the quality of the alliance did better than couples receiving treatment as usual. The feedback group showed significantly greater improvement, achieved nearly four times the rate of clinically significant change, kept their advantage at six month follow up, and had a significantly lower rate of separation or divorce (Anker et al., 2009). That is one of the strongest practical findings I know of in couple therapy, and it points to a simple question you can ask any therapist: how do you track whether our therapy is working?

The relationship with your therapist

A meta-analysis of 24 studies of alliance and outcome in couple and family therapy, seven of them couple studies, found a small to medium positive association between alliance and outcome overall (r = .26). In the couple studies the association was stronger (r = .37). The authors also point to something particular to couple work: alliances can become 'split', with one partner feeling much closer to the therapist than the other, so safety and a shared sense of purpose matter (Friedlander et al., 2011). Another study of 250 couples found that the alliance rated at the last session predicted outcomes for both partners, and that couples whose alliance started above average and grew were more likely to achieve reliable or clinically significant change (Anker et al., 2010). That sample was White, Euro Scandinavian and heterosexual, so I would be careful about how far it travels. I write more about this in how to choose a couples therapist in London.

Even a shorter, lighter format can help

An eight-hour online programme adapted from an empirically based, in person couple therapy was tested in 300 heterosexual couples, who were randomly assigned to start at once or to wait two months. Couples who took part reported significant improvements in relationship satisfaction (d = 0.69), relationship confidence (d = 0.47) and negative relationship quality (d = 0.57). They also reported better individual functioning, including fewer depressive symptoms (d = 0.71) and anxious symptoms (d = 0.94), especially when they began with difficulties in that area (Doss et al., 2016). This was a structured programme and not ordinary therapy, so it does not tell us about therapy sessions as such. What I take from it is that the methods behind couple therapy can help people in different formats, and that working on a relationship can have effects beyond the relationship.

When Is the Right Time to Come?

Research on help seeking fits a familiar picture. In a study that followed 213 couples through the first five years of marriage, 36 per cent sought some form of outside help during that period, and individual and relationship difficulties predicted increased use of relationship books and marital therapy in the following year (Doss et al., 2009). So, couples tended to look for help after difficulties appeared. This was a study of newly married couples in the United States, so it may not describe every relationship.

I want to be honest about one thing. I have not found a study I can stand behind that shows that going earlier produces better outcomes. What I can tell you is what I see in the room. In my experience, problems that have been present for months are generally more straightforward to work with than patterns that have been entrenched for years, and couples who arrive in crisis, after an affair, an ultimatum or a decision to separate, are starting from a harder place. Therapy is still worthwhile at that point. Many couples who come to therapy in genuine distress describe wishing they had come sooner, not because things were necessarily better before, but because they could see in retrospect how much earlier the patterns had been there to address. If you are not sure whether it is time, I wrote about this in when to go to couples therapy.

You Do Not Have to Be in Crisis to Come

One of the most persistent myths about couples therapy is that it is for relationships in serious trouble. In a study of 108 couples seeking therapy at a clinic in Montréal, the most common problems they reported were communication, emotional affection or distance, specific areas of the current relationship, and lack of physical affection or sex (Boisvert et al., 2011). Those are everyday difficulties, and not only crises. That was a single clinic, so it describes those couples and not all couples.

In my experience, many of the couples who get the most from therapy come not because something has gone badly wrong, but because they want to invest in something they value. Therapy can be a space to learn how to communicate better, to understand your partner more deeply, to navigate a significant life transition, or simply to make sure that patterns which feel manageable now do not set into something harder later. If the same argument keeps recurring, my piece on how to stop arguing with your partner is a useful place to start. None of that requires a crisis as the entry point.

Many couples who come to therapy in genuine distress describe wishing they had come sooner.

Who Benefits Most from Couples Therapy?

The research suggests that couples therapy can help across a range of situations, not only for those in serious difficulty. The points below are what I see in my own practice, and they are my view and not research findings.

Couples where both partners are willing to try tend to do better than those where one person is resistant or attending reluctantly. This does not mean both people need to feel equally optimistic about the outcome. Ambivalence and uncertainty are normal. But a basic willingness to try, and to show up honestly, makes a significant difference. If your partner is reluctant, I have written about what to do when your partner won't go to couples therapy, and there is a companion piece, an honest guide for the sceptic.

The fit with your therapist matters too. Finding a therapist who feels like a good fit for both partners, and who works in a way that makes both people feel heard rather than judged or sidelined, is important. It is entirely reasonable to meet with a therapist once and decide they are not the right person before committing to ongoing work.

What Couples Therapy Cannot Do

Being honest about the limits of couples therapy matters as much as making the case for it.

Therapy requires engagement from both partners. It cannot create motivation where none exists, and it cannot do the work on behalf of someone who is not genuinely present in the process. If one partner attends reluctantly and disengages between sessions, the progress will be limited.

Couples therapy also tends to work best when serious individual mental health difficulties are being addressed alongside the relationship work. Untreated depression, active addiction, or unprocessed trauma can significantly affect what is possible in a couples context. Sometimes individual therapy needs to happen at the same time, or to come first.

And occasionally, the outcome of honest therapeutic work is the recognition that a relationship is not viable. This can feel like therapy has failed. In practice, helping a couple separate with clarity, respect and less mutual damage than they might otherwise have caused each other is a meaningful and legitimate outcome. Many people describe it as one of the most useful things they did. The five-year study above is a reminder of this, since about a quarter of the couples had separated or divorced by follow up, and the study still counted the therapies as substantially effective.

What Happens in Couples Therapy?

The first session or two are usually assessment sessions. The therapist wants to understand what has brought you to therapy, what each of you is hoping for, and what the relationship looks and feels like from both perspectives. Most therapists will also want to meet with each partner individually at some point early in the process. I describe what to expect in more detail in your first couples therapy session in London.

Sessions are typically 50 minutes and held weekly. Consistency matters in couples work, more so than in individual therapy, because the relational dynamic between sessions is itself part of the material. Weekly sessions maintain a rhythm that allows the work to develop.

Different therapists work in different ways. Emotionally Focused Therapy focuses on the attachment bonds between partners and the emotional cycles that drive conflict. The Gottman Method draws on research into what distinguishes healthy relationships from distressed ones. Integrative approaches combine elements of both. What unites them is a commitment to helping both partners feel heard and understood, and to interrupting the patterns that keep couples stuck.

Progress is rarely linear. Couples often describe a period early in therapy where things feel harder before they feel easier. Old conflicts can be stirred up before they are resolved. This is common, and in my experience, it is part of the work and not a sign that it is failing. If cost is part of your thinking, I have also written about what couples therapy costs in London.

For LGBTQ+ and Diverse Relationships

Couples therapy is as relevant for same sex couples, non-binary partnerships, and those in ethically non monogamous or polyamorous relationships as it is for heterosexual couples. I want to be clear about the research, though. Several of the studies above were of heterosexual couples, and I would not assume their figures describe every relationship. What I can point to is research on what helps. In a study of 249 people in consensually non monogamous relationships, how clients perceived their therapist's practice predicted how helpful they found therapy and whether they ended it early. Clients pointed to the importance of therapists having knowledge about consensual non monogamy and using affirming, non-judgemental practice (Schechinger et al., 2018).

The dynamics are different and the context is different, and finding a therapist who understands that context without making assumptions or applying a monogamous or heteronormative framework matters. If you are in a relationship that falls outside the conventional, look for a therapist who names those specialisms explicitly, and who creates a space where your relationship is understood on its own terms. I write about this in gay couples therapy in London, lesbian couples therapy and what consensual non monogamy is.

So… Is It Worth It?

For many couples, yes. The research shows that couple therapy helps a substantial proportion of couples, that benefits can last for years, that it can help even when couples are seriously distressed, and that ordinary clinics can achieve results similar to trials. It also shows that how therapy is delivered makes a real difference, and that tracking progress and building a good working relationship with your therapist are things you can ask about before you begin.

The question worth sitting with is not really whether couples therapy works in the abstract. It is whether the two of you are willing to try. Willing to show up, to say difficult things, to hear difficult things, and to give the process enough time to do what it does.

If you are, and you find a therapist who explains how they will work with you and track your progress, you give yourselves a good chance of being better off for it.

About the Author

Mark Ryan is a BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist specialising in couples and relationship therapy across London. He works with couples at all stages, from those who want to invest in their relationship before problems arise, to those navigating serious difficulty, conflict, infidelity or the question of whether to stay together. His practice is inclusive and affirming, welcoming LGBTQ+ couples and those in diverse relationship structures. Mark works from private therapy rooms in Kensington, Pimlico and Angel, Islington.

He holds a BA (Hons) in Integrative Counselling and Psychotherapy and is accredited with the BACP (Member 405397) and the NCPS (Accredited Relationship Therapist NCPS495).

References

Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693 to 704.

Anker, M. G., Owen, J., Duncan, B. L., & Sparks, J. A. (2010). The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample. Journal of Consulting and Clinical Psychology, 78(5), 635 to 645.

Boisvert, M., Wright, J., Tremblay, N., & McDuff, P. (2011). Couples' reports of relationship problems in a naturalistic therapy setting. The Family Journal, 19(4), 362 to 368.

Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225 to 235.

Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., & Benson, L. A. (2016). A randomized controlled trial of the web based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285 to 296.

Doss, B. D., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2009). Marital therapy, retreats, and books: The who, what, when, and why of relationship help seeking. Journal of Marital and Family Therapy, 35(1), 18 to 29.

Friedlander, M. L., Escudero, V., Heatherington, L., & Diamond, G. M. (2011). Alliance in couple and family therapy. Psychotherapy, 48(1), 25 to 33.

Halford, W. K., Pepping, C. A., & Petch, J. (2016). The gap between couple therapy research efficacy and practice effectiveness. Journal of Marital and Family Therapy, 42(1), 32 to 44.

Hewison, D., Casey, P., & Mwamba, N. (2016). The effectiveness of couple therapy: Clinical outcomes in a naturalistic United Kingdom setting. Psychotherapy, 53(4), 377 to 387.

Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145 to 168.

Schechinger, H. A., Sakaluk, J. K., & Moors, A. C. (2018). Harmful and helpful therapy practices with consensually non monogamous clients: Toward an inclusive framework. Journal of Consulting and Clinical Psychology, 86(11), 879 to 891.

Wiebe, S. A., & Johnson, S. M. (2016). A review of the research in emotionally focused therapy for couples. Family Process, 55(3), 390 to 407.