Will couples therapy work for you?
Thursday, May 16, 2024. Revised and updated.
The Golden Age of Couples Therapy…
Does couples therapy work? Will couples therapy work for you?
Sixty years ago, even though they felt an urgent need, surveys suggested Americans were disappointed with the couples therapy available then.
Back then, couples therapy was the poor stepchild of individual and family therapy. That’s not surprising, given that there wasn’t a shred of science behind it.
And frankly, the leading practitioners of couples therapy were, by contemporary standards, incompetent.
But demand for couples therapy was high…and growing.
However, that’s all changed. Over the past twenty years or so, there has been too much couples therapy to choose from. This again invites the important question: Will couples therapy work for you?
How effective exactly?
Nowadays, according to a study conducted by the well-known psychotherapy researcher David Orlinsky of the University of Chicago, the vast majority of therapists in the USA and overseas conduct couples therapy. But what about research about the effectiveness of all these new couples therapies?
Unfortunately, there hasn't been much with the noteworthy exception of science-based couples therapy (Gottman Method and Emotionally-Focused Couples Therapy).
One of the reasons why there hasn’t been much of an emphasis on research is because an unhappy marriage isn’t considered a “mental disorder” by DSM-V. As a result, government funding for research isn’t anywhere near a priority.
This is too bad for several reasons. Despite sporadic private-sector research funding, we live in a golden age of Couples Therapy.
New research is demonstrating that not only is science-based couples therapy effective in saving marriages and keeping families intact, it’s also helpful in treating individual mental health problems such as depression and anxiety.
Even though research dollars are in short supply, we now know a great deal about what works and doesn’t work in couples therapy. And we are learning more every day.
The magic 5:1 ratio for couples
Marital satisfaction can be expressed in a near-magical mathematical ratio of 5 to 1. The ratio of positive to negative behaviors in happy marriages is at least 5 positive interactions to each 1 negative interaction. Now, these 5 positive behaviors can be any small acts of kindness. Gottman has expressed this fact in the axiom “small things, often”
Gottman Couples Therapy tells us that reports that if this ratio falls below the 5-to-1 level, couples are likely to become unhappy. In highly distressed couples, the ratio hovers around an anemic 0.8 positive acts for every negative one. Dr. Gottman also noticed that some happy couples may even surpass the 5-to-1 ratio.
Gottman and other independent researchers have confirmed this ratio time and time again. If anything, one of the true gifts of science-based couples therapy has been the awareness of how mundane, moment-to-moment interactions can be profoundly significant. Learning how to increase the ratio of positive to negative exchanges with your spouse is a teachable skill.
Same damn thing over and over again…vs. one damn thing after another…
Good couples therapy will help you communicate skillfully, keeping your partner’s nervous system in mind (as they attend to your nervous system as well).
A spirit of collaboration emerges that effectively manages old problems. With good couples therapy, dysfunctional patterns do not repeat themselves in a Groundhog Day of gridlocked resentments.
Gottman discovered that even happy couples never actually “solve” most of their problems. Conflicts typically arise from the same repetitive issues.
The notion of skillful management not only alleviates gridlock but also reframes and normalizes conflict as the management of “perpetual problems.”
Gottman’s research also teaches couples to express their differences in a way that doesn’t evoke old grudges or sink into a personal attack. It offers couples a way out of criticism, defensiveness, and the never-ending attack-defend cycle.
Fair fighting and repair attempts
Good, science-based couples therapy installs fair fighting and repair skills. Emotionally focused Couples Therapy (EFT) teaches couples how to lower their defenses during conflict, while the Gottman Method focuses on an awareness of physiological responses and more appropriate patterns of communication. In our opinion, the best couples therapists are well-trained in both methods.
The Gottman Method also invites couples to notice the level of acceptance and goodwill they have toward one another.
Gottman refers to this as having either a “positive or negative sentiment override,” referring to their overall positive or negative regard for one another. Pointing out the sentiment override helps establish a greater level of self-awareness.
Attachment Science indicates that spouses with a Secure Attachment style are more likely to create a similarly secure attachment in marriage. Thirty years of EFT research tell us that a good marriage emerges from deep, responsive, resilient, interdependent connections between partners.
“All happy families are alike; each unhappy family is unhappy in its own way.” Leo Tolstoy
More often it works “good enough!”
Research tells us that couples must only share their expectations to a “good enough” degree.
Shared meaning is important, but that meaning can vary widely. Tolstoy got it exactly wrong. All happy, satisfied couples are different…it’s the unhappy couples are sadly similar.
Unhappy couples display high levels of what Gottman calls the four horsemen of the marital apocalypse: defensiveness, criticism, contempt, and stonewalling.
Will couples therapy work? What does the research say?
Research studies show that couples therapy is generally effective in reducing marital distress. William Shadish and Scott Baldwin conducted a pretty comprehensive metanalysis. They found that the overall effect sizes for couples therapy were impressive, typically helping 75% of couples.
But, as I mentioned earlier, what’s also exciting is the role couples therapy plays in helping to treat anxiety and depression.
Steven Beach, Daniel O’Leary, and Neil Jacobson and his team independently both discovered that science-based, behavioral couples therapy was also an effective treatment for a spouse’s depression that was increasing marital conflict.
The studies showed that individual therapy treated individual depression, but only couples therapy had any effect on marital unhappiness. Couples therapy became the treatment of choice for spouses struggling with both depression and a troubled marriage.
Gottman's Method of Couples Therapy and its forerunner, Integrative Behavioral Couple Therapy, stresses the need to develop skills for managing conflict and accepting perpetual problems that can be managed but can’t be changed. Both of these cognitive-behavioral methods show wide success with most couples.
Emotionally-Focused Couples Therapy, with its focus on attachment, is also clinically proven effective.
Don’t wait… It only makes the job more difficult
Couples therapy is notoriously challenging.
The average couple entering couples therapy has been actively unhappy for nearly 7 years.
Studies by Lynne Knobloch-Fedders and William Pinsof show that the best results come from the earliest treatment. That’s why It’s said that science-based couples therapy is 70-92% effective. It’s clear from the many research studies that the earliest treatment predicts the best outcome. Experience matters. Choose your couples therapist with care.
But your marital mileage may vary. Marriage is hard work sometimes. Science-based couples therapy doesn’t promise marital bliss for all couples. But many highly distressed couples often improve to what they would comfortably describe as… “good enough!”
Be Well, Stay Kind, and Godspeed.
Will couples therapy work for you?
RESEARCH:
Jacobson, Neil S., and Andrew Christensen. Acceptance and Change in Couple Therapy: A Therapist’s Guide to Transforming Relationships. New York: Norton, 1998.
Johnson, Susan M. The Practice of Emotionally Focused Couple Therapy: Creating Connection. 2nd edition. New York: Brunner-Routledge, 2004.
Snyder, Douglas K., A. M. Castellani, and Mark A. Whisman. “Current Status and Future Directions in Couple Therapy.” Annual Review of Clinical Psychology 57 (2006): 317-44.
