Is Couple's Therapy Effective? It Depends

The question before us—is couple’s therapy effective?—is too broad, misleading, and meaningless in present form. What do we mean by the term “effective” and for whom, on what relationship problems, or issues, and in which set of circumstances? When we can answer these more refined questions—and we can—the consumers of relationship services will have a better sense of the direction of couple’s therapy and the research data will be more meaningful for them.

This post will wade through the complex research studies on couple treatments and share five critical factors that positively impact the effectiveness of this form of therapy.

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Incidentally, do you realize that the majority of potential couple-clients never choose any form of therapy, regardless of the severity of their problems? This is a real concern (Norcross & Goldfried, 2019).

At this point, it is time to present the five most important factors that contribute to treatment success within couple’s therapy.

1. The Model of Therapy is Overrated

Interestingly, the type of couple’s therapy model or system (e.g., psychoanalytic, CBT, family systems, and so on) does not seem particularly important or predictive of outcome success. Most models of couple’s therapy, as practiced by a competent therapist, seem to work on average equally well, considering the diverse range of couple-clients and the variety of problems presented for treatment (Norcross, & Lambert, (2019); Wampold, et al., 2015). As long as the therapist provides a rational and logical framework that provides explanations and solutions for their client’s problems, the particular model of therapy plays no significant part in contributing to positive outcomes.

2. Client Hope and Expectancy

The client’s hope that change is possible and that they can change is predictive for successful treatment. Further, a client’s expectancy or belief that a therapy program of treatment will work for them, is also predictive of a positive outcome.

One way therapists can increase hope and expectancy with couple-clients is by demonstrating passion for their particular therapy approach. If the client-couple believes and accepts the therapist’s point of view, the success of couple’s therapy increases. The therapist still needs to sell his or her approach and the best way to do that is to believe in it yourself and be enthusiastic about it with your clients. Passion works!

Further, if clients and their therapists engage and collaborate on the goals, procedures, and tasks of couple’s therapy, this also increases hope and expectancy and indirectly improves the success rate.

The bottom line is that the client’s hope and expectancy predict outcome success, not the type of therapy per se (Norcross & Lamber 2019).

3. The Type of Problems Presented

There is a wide range of couple problems presented for treatment. Some of the more difficult issues involve abuse, anger management, and active affairs by one or more partners. However, even these difficult-to-handle issues are treatable if both partners put a priority on committing to and improving their relationship and demonstrate a willingness to change, as needed.

Openness to change is more predictive of outcome success than the type of problem presented in most situations (Wampold, et al., 2015).

4. Client-Couple Readiness to Change

Readiness to change, which can be measured, is the client’s willingness to accept partial responsibility for the relationship problems and an openness to look within herself or himself to explore how their own actions contribute to the issues between partners.

Clients that are not ready to change often believe that their partner is the cause of their problems and that they are only there to be supportive. They want the therapist to fix their partner and reward them for their tolerance.

When you have couple-clients who are at different readiness to change stages, the therapist might do well to remember that different strategies might work better or worse depending on this level of motivation (Prochaska & Norcross, 2018). For example, a client that clearly is not ready to change might do better in an exploring and insight approach using single sessions whereas a client more ready to change might be better at taking measured action steps immediately, in single or conjoint sessions.

However, combining different strategies for different levels of change is complex and time-consuming within conjoint sessions. My best advice is to be supportive and empathic on whatever stage of change each couple-client is positioned and explain clearly the implications of these differences to the couple.

False expectations are not helpful. If necessary, some couple-clients might need time in individual sessions before joining their partner in conjoint sessions.

The good news is that readiness to change, as a measured concept, predicts therapy outcomes in a favorable way, if handed constructively by the therapist. (Prochaska & Norcross, (2018).

5. The Therapeutic Relationship

The relationship fit between the couple-clients and the treating therapist is a major predictor for therapy success or failure. Simply, bonding with your therapist increases the odds of a successful treatment outcome (Gurman, & Snyder, 2011).

In addition, therapists who provide ongoing feedback to their clients, as well as couple-clients who can do the same back to their therapist, may prevent ruptures within therapy.

For example, clients who can constructively let their therapist know that treatment is moving too fast, and they are experiencing high anxiety about this change of direction and speed, may open new levels of communications among all parties concerned.

There is strong evidence that a therapist’s openness and ongoing interest in hearing clients’ concerns about their mutual relationship predicts outcome success and may prevent ruptures or more easily repair them, within conjoint therapy.

However, even if a rupture does occur, therapists who are more open and less judgmental toward their clients have a better chance to recover from the treatment obstacles and rebuild their ongoing relationship (Gurman & Snyder, 2011).

Some Concluding Thoughts

Now that you have a better understanding of some of the major research findings influencing couple’s therapy, I hope this consumer information may be useful for you, if or when you choose to participate in this form of therapy. To find a therapist near you, visit the Psychology Today Therapy Directory.