On a once popular sit-com “King of Queens,” when Carrie and Doug are fighting and recognize they have a problem, Carrie suggests couples therapy.  Doug’s response to her was: “No, I don’t want to throw money down a rat hole.”  I found it funny, but for me, there was a sad ring of truth to it.  I have heard too many stories of couples that sought help from a therapist and things get better for a few months, only to slide back in to old patterns or get divorced.  So I found myself wondering, does couples therapy really work?

This is an important question that all to often doesn’t get asked!  As I studied the research, I found out that there are three major elements to answering the question: 1) couple characteristics,  2) therapist characteristics, and 3) the model of therapy the therapist uses.  Research indicates that with couples therapy, an important element of treatment success can be attributed to the treatment model used.

Clinical trials indicate that 1) some approaches to couples therapy produce little to no results, 2) several produce good outcomes but the results only last for a few months, and 3) a few produce good results that last for years.  For example, research indicates that a therapist without a clear, organized model for working with relationship issues is unlikely to produce significant results.  In addition, many couples will drop out of this type of couples therapy.

A therapy model unfortunately is still not enough to guarantee results, as clinical studies indicate improvement rates for different couples therapy models vary anywhere from 0% to 85%.  In one broad review of over 150 clinical trials, only half the couples improved, with only one third of the couples reaching non-distressed levels. In addition, those trials that include follow up studies from 1 to 4 years later often show significant declines in marital satisfaction over time.  It is common to see deterioration rates anywhere from 30 to 60 percent, and often, “successful” treatments (at termination of therapy) don’t last, as indicated by high separation/divorce rates upon study follow up.  For example, a trial of the APA-approved behavioral treatment model that yielded an impressive 84% improvement at the end of treatment, demonstrated that for many, the results didn’t last. After 4 years, 38% of the couples were separated or divorced. And this number does count those couples whose relationship deteriorated but did not separate.

You might then ask, “So is there hope for us?”

Fortunately for both therapists and clients, there are some proven models of therapy that create lasting results.  Three models that have shown excellent results in both the short and long-term are Emotionally Focused Couples Therapy, Integrated Behavioral Couples Therapy, and Insight-Oriented Couples Therapy.  Not surprisingly, these three models are more similar than different.

Emotionally Focused Couples Therapy (EFT), has decades of research studies that consistently indicate that the majority of couples improve (85+%) and that many couples (70+%) reach a recovered or non-distressed level.  In addition, there have been several 2 year follow-up studies indicating that non-distressed couples do not relapse.  These results impressed me and were enough to convince me that the model really works.  The research evidence was a key element in my choice to invest the time, effort, and money necessary to become an EFT therapist.

Should you be seeking couples therapy, my hope is that this research overview will create some optimism that couples therapy can work and that the information will be helpful in your process of selecting a therapist!

Post References

Dunn, R. L., & Schwebel, A. I. (1995). Meta-analytic review of marital therapy outcome research. Journal of Family Psychology, 9, 58-68.

Goldman, A., & Greenberg, L. (1992). Comparison of integrated systemic and emotionally focused approaches to couples therapy. Journal of Consulting and Clinical Psychology, 60, 962-969.

Gottman, J. M., Ryan, K. D., Carrère, S., & Erley, A. M. (2002). Toward a scientifically based marital therapy. In H. A. Liddle, D. A. Santisteban, R. F. Levant & J. H. Bray (Eds.), Family psychology: Science-based interventions (pp. 147-174). Washington, DC: American Psychological Association.

Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317-344.

Wesley, S., & Waring, E. M. (1996). A critical review of marital therapy outcome research. The Canadian Journal of Psychiatry, 41.