Does Couples Therapy Really Work? Exploring Research, Results, and Real-Life Impact

by | Apr 3, 2023

As a marriage and family therapist, I frequently encounter skepticism about the effectiveness of couples therapy. However, through my experience and the research I’ve conducted, I’ve found that its success often hinges on the unique dynamics of each relationship, the specific challenges faced, and the commitment of both partners to the therapeutic process. Couples therapy is an incredible resource designed to assist partners in working through relationship challenges, resolving conflicts, and deepening their emotional bond. As a marriage and family therapist, I have personally witnessed the remarkable impact couples therapy can have on relationships across various backgrounds. So, just how effective is it? In this article, we will delve into the research surrounding the efficacy of couples therapy, examine the factors contributing to its success, and address some prevalent criticisms. Ultimately, my goal is to help you understand the potential benefits and limitations of couples therapy so that you can make an informed decision about whether it’s the right option for you and your partner.

In the sections that follow, we will review key research findings, discuss real-life case studies, delve into factors that affect the success of therapy, and address common criticisms. Throughout, I will share personal anecdotes from my own practice to help illustrate key points and provide relatable examples. By the end of this article, I hope to offer a balanced and comprehensive understanding of the effectiveness of couples therapy, as well as a sense of hope and optimism for those considering it as a means to improve their relationships.

Research on the Effectiveness of Couples Therapy

As a marriage and family therapist, I have personally seen the positive impact couples therapy can have on relationships. My experiences are backed by numerous studies investigating the effectiveness of couples therapy.

One such article is a meta-analysis by Rathgeber and colleagues, titled “The Efficacy of Emotionally Focused Couples Therapy and Behavioral Couples Therapy: A Meta-Analysis.” A meta-analysis is a statistical method that combines the results of multiple studies on a given topic to offer a more comprehensive and accurate estimate of treatment effects. This particular meta-analysis examines the effectiveness of two types of couples therapy: emotionally focused couples therapy (EFT) and behavioral couples therapy (BCT). The authors included 21 studies and discovered that both EFT and BCT were effective in improving relationship functioning, with medium effect sizes of 0.43 for EFT and 0.45 for BCT.

In this context, the effect size signifies the degree of improvement in relationship functioning associated with each type of therapy. Emotionally focused couples therapy (EFT) had an effect size of 0.43, considered a medium effect size. This means that couples who participated in EFT experienced, on average, a moderate improvement in their relationship functioning. Similarly, the effect size for behavioral couples therapy (BCT) was 0.45, indicating a comparable degree of improvement in relationship functioning. Of note, both therapies were linked to significant improvements in individual outcomes, such as reduced symptoms of depression and anxiety.

Another noteworthy study titled “Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes” by Christian Roesler presents the findings of a nationwide naturalistic study in Germany. This study aimed to examine the efficacy of couple therapy in practice settings and identify potential predictors for various outcomes. The results demonstrated that couple therapy effectively improved relationship satisfaction and communication, reduced symptoms of depression and anxiety, and decreased relationship distress. The study also pinpointed several factors associated with better outcomes, such as a strong therapeutic alliance, a willingness to change, and a lower level of conflict at the onset of therapy.

The last study I’ll mention is a meta-analysis by Roddy et al., which discovered that therapy had a moderate to large positive impact on relationship satisfaction (d=0.65), communication (d=0.49), and psychological distress (d=0.43). This analysis included 79 studies involving a total of 6,371 couples and a variety of therapy approaches. The authors also found that the positive effects of therapy tended to endure over time, with follow-up studies indicating therapy’s effectiveness up to two years post-treatment.

These are just a few of the thousands of studies supporting the efficacy of couples therapy, and it’s why we do what we do and why couples therapy is recommended so strongly for couples at all stages of their relationship.

However, it’s also important to recognize that outcomes published in research studies don’t always match the real-world outcomes seen by patients and practitioners, and this can be for a number of reasons. The article “The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness” by Halford and colleagues examines the gap between the high efficacy rates of couples therapy reported in research and the often lower effectiveness rates seen in real-world practice. The authors argue that factors such as client and therapist characteristics, therapy protocols, and external barriers can impact the effectiveness of therapy in practice. The article concludes with recommendations for improving the effectiveness of couples therapy, such as focusing on client engagement and motivation, prioritizing therapist training and development, and addressing external barriers to therapy access. Overall, the article underscores the importance of bridging the gap between research and practice in order to ensure that couples receive the most effective treatment possible.

Although the research on couples therapy is generally positive, it’s crucial to recognize that therapy isn’t a one-size-fits-all solution. Factors such as the type of therapy employed, the severity and nature of the relationship problems, and the therapist’s experience and skill can all influence the effectiveness of therapy. Previous research offers robust support for the effectiveness of couples therapy in improving relationship functioning and overall well-being. While therapy may be challenging at times, it can provide hope and support to couples experiencing difficulties in their relationship. Couples therapy has the potential to bring about lasting change and foster stronger, healthier relationships for those who commit to the process.

As a practicing marriage and family therapist, I have learned that the success of couples therapy relies on several critical factors. From my experience, establishing a strong therapeutic alliance between the therapist and clients and having both partners actively participate in the therapy process are crucial. In therapy, couples can acquire new communication and problem-solving skills, develop a deeper understanding of each other’s needs and perspectives, and address unresolved conflicts and issues. By working collaboratively with the therapist and committing to the therapy process, couples can strengthen their relationship and build a more solid foundation for their future together.

Factors that Affect the Success of Couples Therapy

Couples therapy can be highly effective in improving relationship functioning and overall well-being, but its success can be influenced by a number of factors, including:

Motivation: Couples who are highly motivated to work on their relationship and are willing to actively engage in therapy tend to have better outcomes.

Therapist-Client Relationship: Couples who feel comfortable and safe with their therapist and who have a strong therapeutic alliance tend to have better outcomes. Selecting a therapist who is a good fit for the couple is important.

Severity and Nature of Relationship Problems: Couples who are dealing with longstanding issues, such as infidelity or trauma, may require more intensive or specialized forms of therapy. Couples who have a history of high conflict or who have experienced significant relationship damage may require more time and effort to see improvements.

Cultural Background: The cultural background of the couple may play a role in the success of therapy. Therapists must be culturally sensitive and understand the unique values, beliefs, and experiences of each partner to tailor therapy to the couple’s specific cultural context.

Financial and Practical Barriers: Couples who face financial constraints or who have limited access to therapy may struggle to receive the full benefit of therapy. Therapists can help by providing resources and information about low-cost or free therapy options, as well as flexible scheduling or online therapy.

By addressing these factors and working collaboratively with the couple, therapists can help ensure that therapy is effective and beneficial for both partners.

Factors that Affect the Success of Couples Therapy

Couples therapy holds great promise for enhancing relationship functioning and overall well-being. However, its effectiveness is subject to various factors. As a marriage and family therapist, I have observed how these factors can influence therapy outcomes, and I believe addressing them is essential for success.

Motivation: I’ve found that couples who are genuinely motivated to work on their relationship and actively participate in therapy typically see better outcomes. When both partners demonstrate a willingness to change and invest time and effort into the process, the results tend to be more positive and enduring.

Therapist-Client Relationship: Building a strong therapeutic alliance and fostering a comfortable and safe environment for couples is crucial. From my experience, couples who trust their therapist and feel understood are more likely to be open and willing to work through their issues. Finding a therapist who is a good fit for the couple plays a significant role in achieving success.

Severity and Nature of Relationship Problems: Couples grappling with deep-rooted issues, such as infidelity or trauma, might need more intensive or specialized therapy approaches. In my practice, I’ve noticed that couples with a history of frequent and significant conflict or considerable relationship damage often require more time and effort to see improvements. Adapting therapy to each couple’s specific needs is vital.

Cultural Background: A couple’s cultural background can play a role in the success of therapy. As a therapist, it’s crucial to be culturally sensitive and understand the unique values, beliefs, and experiences of each partner. By doing so, I can better tailor therapy to the couple’s specific cultural context, ensuring a more effective and respectful process.

Financial and Practical Barriers: Couples facing financial constraints or limited access to therapy may struggle to receive the full benefit of the process. In my practice, I strive to help by providing resources and information about low-cost or free therapy options, as well as offering flexible scheduling or online therapy to accommodate various circumstances.

By acknowledging and addressing these factors and working collaboratively with the couple, therapists can help ensure that therapy is effective and beneficial for both partners. In my experience, being attuned to the unique needs and challenges of each couple is essential for fostering meaningful and lasting change in their relationship.

Criticisms of Couples Therapy

Despite many studies demonstrating the effectiveness of couples therapy, there are critics who express doubt and skepticism about its overall efficacy. Various media reports, books, and commentaries have contributed to this debate, questioning the true impact of couples therapy.

A notable example is Esther Perel’s book “Mating in Captivity.” In this work, the psychotherapist argues that traditional couples therapy often fails to address essential issues of desire and eroticism in long-term relationships. Perel suggests that therapists should help couples balance the paradox between security and passion to create more satisfying relationships.

In 2010, Tara Parker-Pope wrote an article for the New York Times entitled “Seeking to Pre-empt Marital Strife” In this piece, she draws attention to the disparity between the success rates of couples therapy as reported in research studies and the real-world outcomes experienced by numerous couples. The article points out that couples therapy might not be as effective as research suggests, with a survey showing that a mere 19% of couples who completed therapy felt “very satisfied” with the results.

These criticisms raise valid concerns about the limitations of couples therapy and highlight the need for therapists to continually refine their methods and cater to the unique needs of each couple. But it’s important to bear in mind the broader context and substantial evidence supporting the effectiveness of couples therapy, and to acknowledge that there isn’t a one-size-fits-all therapeutic approach suitable for every couple. As mentioned earlier in this article, research consistently demonstrates the positive impact of couples therapy. However, therapy success can be influenced by several factors, such as the therapist’s expertise, the couple’s commitment level, and the specific relationship challenges they encounter. Furthermore, these studies often examine a wide variety of therapeutic methods, suggesting that couples might find it advantageous to explore different approaches to determine which one best addresses their needs.

As a marriage and family therapist, I have personally witnessed the transformative impact of couples therapy on relationships. In my professional experience, couples who actively participate in the process and forge a strong therapeutic alliance with their therapist tend to see substantial improvements in their relationship functioning and overall well-being. Although couples therapy might not resolve every relationship issue, it has the potential to provide essential support, guidance, and tools for couples looking to enhance their relationships.

In conclusion, it’s important to weigh the criticisms of couples therapy against the extensive research supporting its effectiveness and the numerous positive experiences of couples who have benefited from therapy. As therapists, our duty is to remain receptive to new ideas and approaches, constantly improve our methods, and cater to each couple’s unique needs. By doing this, we can assist couples in navigating the intricacies of their relationships, fostering deeper connections, and achieving greater satisfaction.

Conclusion

My daily work as a relationship therapist in New York City has shown me the remarkable impact couples therapy can have on partnerships. It has the power to foster meaningful change and growth, leading to stronger, healthier relationships. While the success of therapy can vary depending on factors such as the therapist’s skill, the couple’s motivation, and the unique challenges they face, the extensive evidence supports the overall effectiveness of couples therapy. It’s important to acknowledge the limitations and criticisms in order to refine and improve therapeutic approaches continually.

By actively engaging in the process, developing a strong therapeutic alliance, and being open to trying different approaches, couples can gain valuable insights, develop healthier communication patterns, and strengthen their emotional connection. Although couples therapy is not a magical solution to all relationship problems, it offers a powerful and evidence-based approach for couples seeking to enhance their relationships.

As a therapist, I will always remain committed to learning and adapting my methods to best serve the diverse needs of the couples I work with, and your therapist should be doing the same! By combining empathy, introspection, and objectivity, we can continue to help couples navigate the complexities of their relationships, fostering deeper connections and greater satisfaction for both partners.

Mara Hirschfeld, LMFT
Mara Hirschfeld, LMFT
I'm a licensed marriage and family therapist and the proud founder of Holding Hope MFT. I created Holding Hope as a space for individuals and couples to delve into their deepest selves, free from the fears of judgment or shame. Through my writing, I strive to cultivate a deeper understanding of mental health topics, breaking down barriers and fostering a more supportive and informed community.

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