What to Expect from Couples Therapy: A Realistic Guide from a London Therapist
By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist
Most couples arrive at therapy nervous. They have often waited longer than they wish they had, and they rarely have a clear picture of what the process actually involves. There is also a common worry, usually unspoken, that the therapist will take sides. The honest answer is that I do take a side, but not the one couples expect. My client is the relationship and what the two people in front of me have said they want from it. That stance shapes everything that follows, and it is one of the most useful things to understand before you begin. This article walks through what couples therapy looks like in practice, from the first conversation to the last.
The honest bottom line
Couples therapy is a structured process, not an open-ended chat. It usually unfolds in three phases. An assessment phase, where the therapist gets to know the relationship and each partner. A working phase, where most of the change happens. And an ending phase, where the gains are consolidated. Most couples see meaningful change within twelve to twenty sessions. Some need fewer. Some need more, particularly where there has been a major rupture such as an affair or where one or both partners are carrying significant individual difficulties alongside the relationship work.
The research is reassuring on this. Meta-analyses of couples therapy outcomes consistently find that around two-thirds to three-quarters of couples who complete a course of therapy report meaningful improvement, and most of those gains hold up over time. Couples therapy is one of the better-evidenced interventions in the psychological field.
Before the first session
Most couples start with a free thirty-minute consultation, either in person or by video. The consultation is a chance to ask questions, get a sense of how the therapist works, and decide whether the fit feels right. Both partners are welcome to attend the consultation, and ideally they do, but it is not unusual for one partner to make first contact. The first session itself is covered in more detail in a separate article. What follows here is what comes after that.
The assessment phase
The first two or three sessions are an assessment. The therapist learns the history of the relationship, the background each partner brings to it, the issues that have brought you to the room, and what each of you is hoping the work might change. Some therapists also offer an individual session with each partner during this phase, partly to understand each person more fully and partly because some things are easier to say one to one before bringing them back to the couple.
It is common to feel both relief and discomfort during assessment. Relief because the issues are finally being named in a contained setting. Discomfort because the act of putting things into words tends to stir more up before it settles. This is normal and it is not a sign that therapy is making things worse. It is a sign that the work has begun.
The working phase, where the actual change happens
The working phase is the longest part of couples therapy and the hardest. It is also where the change actually happens. In practice, the work tends to involve a few specific things, often happening at the same time.
Identifying the recurring cycle. Most couples have one. It is the same argument, dressed differently, that keeps coming back. A good couples therapist helps the couple see the cycle in slow motion, name the moves each partner makes in it, and recognise what is happening underneath.
Slowing down conflict so each partner can hear the other. Most conflict between long-term partners happens too fast for hearing to occur. The therapist sits in the gap and slows the conversation down enough for each person to be understood, often for the first time in a long time.
Working with the feelings underneath the surface arguments. The argument is rarely about what it appears to be about. The feelings underneath, often older than the relationship itself, are where the genuine work lives.
Repairing specific ruptures. Where there have been particular hurts, including infidelity, broken agreements, or sustained periods of disconnection, the work involves repair as well as understanding.
Trying new patterns between sessions. Couples therapy is not only what happens in the room. The change is consolidated in the small attempts each partner makes between sessions to do things differently.
The working phase is also the phase in which most couples want to quit. The honeymoon of the first few sessions has passed, the surface relief has worn off, and the deeper material is uncomfortable. Pushing through this stage, rather than ending prematurely, is usually where the real value of the work appears.
How long does it take?
There is no single answer, but the research and clinical experience point to the same range. Most couples see meaningful improvement within twelve to twenty sessions. Some couples do well with fewer, particularly where the issues are recent and the underlying connection is still strong. Others need more, particularly where:
The difficulties have been present for many years. Long-standing patterns take longer to shift than recent ones.
There has been a major rupture such as an affair or a serious breach of trust. Trust repair after betrayal typically needs longer than the couple initially expects.
One or both partners have significant individual difficulties such as depression, anxiety, or unresolved trauma that interact with the relationship.
Sessions are usually weekly during the working phase. Some couples move to fortnightly later in the work, particularly during the ending phase.
Relationship therapy isn’t only for couples in trouble
What progress actually looks like
Progress in couples therapy rarely looks like the picture people arrive with. Most couples imagine that progress means they will stop arguing. In practice, progress usually looks like something more specific and more useful.
Arguments are shorter. Repair happens sooner. Each partner can name what they need without performing it as a complaint. The recurring cycle is recognisable when it starts, and at least one of you can step out of it before it escalates. There is more curiosity and less defensiveness. The relationship begins to feel like a place where difficulty can be metabolised, rather than a place where difficulty is the problem.
Progress is also rarely linear. Most couples have weeks where things feel better and weeks where they feel worse. The trajectory matters more than any single session. If you and your therapist are watching the trajectory together, the wobbles along the way are tolerable.
The ending phase
Endings in couples therapy are often the part people pay least attention to, but they matter. A good ending is planned, not abrupt. The final few sessions are used to consolidate what has changed, identify the patterns to watch for, and agree how the couple will manage the ruptures that will inevitably happen in future. Some couples come back for top-up sessions months or years later when life throws something new at them. This is healthy, not a sign of failure. Couples therapy is not meant to be a one-time inoculation.
When couples therapy ends a relationship rather than saves it
Sometimes the work clarifies something difficult. That the relationship, in its current form, has run its course. This is not a failure of therapy. It is one of the things therapy is for. A skilled couples therapist can help with that ending in a way that minimises further damage, particularly where there are children involved, and helps both partners step into the next chapter of their lives with less harm done and more understood.
Most couples who come to therapy do not end the relationship. But for the small number who do, having had the conversation in a contained, structured setting is far better than the alternative.
How to get the most from couples therapy
A few things genuinely help. Show up consistently. Therapy works best when the sessions are not constantly being rearranged or missed. Do some reflection between sessions, even if it is only five minutes on the way home. Be honest with your therapist about what is not working, including about the therapist themselves. A good couples therapist will welcome that conversation. And choose a therapist who fits, which is not a small consideration. If you are unsure how to do that, there is a separate guide on how to choose a couples therapist in London.
Common questions briefly answered
Will the therapist take sides?
In couples therapy my client is the relationship and what the two of you have said you want from it. That is not the same as being neutral. If one or both of you is operating in a way that works against the goals we have agreed, my job is to name it and go after it. So no, I do not take sides between the two people in the room. But I do side with the relationship and the work we have contracted to do. In practice this means I may challenge one partner more directly in a given session and the other partner more directly in the next. Couples often find that reassuring once they understand it. It means I am not a referee keeping score, and I am not a passive presence either. I am working for the thing you both came in to build.
What if my partner will not engage?
This is more common than people realise and it is not a deal-breaker. There is a separate article on what to do when your partner will not go to couples therapy, and another written specifically for the sceptical partner themselves.
How much does it cost?
Couples therapy fees in central London vary, and so does what you get for them. There is a full guide to how much couples therapy costs in London covering typical price ranges and what they reflect.
Is it worth it?
The research is fairly consistent that couples therapy works for most couples who complete a course of it. The longer answer, including who benefits most and where the limits are, is in a separate piece on whether couples therapy is worth it.
A final word
Most couples who come to therapy have been thinking about it for a long time before they pick up the phone. The uncertainty about what the process involves is one of the things that keeps people stuck. If you have read this far, you already have a clearer picture than most couples do on their first day. That is a perfectly good place to begin.
If you would like to talk about what couples therapy might look like for your relationship, you can book a free thirty-minute consultation. Consultations are available in person at the Kensington, Pimlico, or Angel locations, or online by video.
About the Author
Mark Ryan is a BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist based in London. He runs Rise and Grow Therapy, a private practice specialising in couples and relationship therapy, with consulting rooms in Kensington, Pimlico, and Angel, Islington. He works with couples of all backgrounds and configurations, with particular experience supporting LGBTQ+ relationships and sex-positive practice. His primary modalities include integrative relational psychotherapy and Imago Relationship Therapy.
To explore whether couples therapy might be right for your relationship, you can book a free thirty-minute consultation, in person or online.
References
Hewison, D., Casey, P., and Mwamba, N. (2016). The effectiveness of couple therapy: Clinical outcomes in a naturalistic United Kingdom setting. Psychotherapy, 53(4), 377-387.
Snyder, D. K., Castellani, A. M., and Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317-344.
