Intensive couples therapy can be a powerful tool for helping struggling relationships get back on track. But not all couples who seek therapy end up with a happily ever after ending. What makes the difference between success and failure? As a clinical psychologist who has worked with many couples over the years, I’ve observed several key factors that tend to predict more positive outcomes.
Timing of treatment matters
One major factor is how long the couple waits before seeking help. Research shows that the average couple is unhappy for 6 years before getting counseling.1 By that point, negative interaction patterns are deeply entrenched and more difficult to change. The sooner a couple addresses their issues with a skilled therapist, the better their prognosis.
For example, I worked with a couple in their 60s, David and Linda, who came to therapy as soon as they noticed communication breakdowns and increased conflict. Their proactive approach allowed us to intervene early, before resentment had a chance to build. After a single intensive and 4 follow-ups spread over a one year period, they reported increased relationship satisfaction and felt equipped with new tools to navigate future challenges.
In contrast, I also saw a couple in their 50s, Gary and Lisa, who had been unhappily married for over a decade before pursuing therapy as a last-ditch effort. By that point, they struggled to have a single positive interaction and years of unresolved hurts had taken their toll. While therapy helped them gain some insight and make modest improvements, ultimately the damage was too great to repair and they decided to separate.
Commitment and motivation are essential
Couples who approach therapy with a sincere desire to look at themselves, take accountability, and make changes tend to have much better results than those who are just going through the motions. Both partners need to be willing to put in the hard work required, even when it gets uncomfortable.2
When I worked with David and Linda, they came to sessions with a learning mindset, ready to self-reflect and practice new skills. They followed through on homework assignments and actively supported each other’s growth. In contrast, Gary often deflected blame and Lisa seemed checked out, making minimal effort to integrate new relationship tools. Without two partners committed to the process, progress stalled.
Many couples believe that the work stops when an intensive ends, and as a result, they quickly resort back to their previous ways of relating. They then feel hopeless and helpless, not realizing that true consistent effort is required to re-program your brain and practice (and fail, then practice again) new habits until they become ingrained.
Not all couples are ready for couples therapy
Having a strong therapeutic alliance is vital – the couple needs to feel safe, understood and supported by their counselor in order to open up and do vulnerable work.3 Therapist-couple rapport can lead to increased engagement in sessions and improved follow-through on interventions.
When I first met with Gary and Lisa, they were used to working with an individual therapist, and were surprised when I asked permission to interrupt them and redirect them when necessary. Gary wanted to take center stage, expressing his personal opinions and rejecting research findings that didn’t line up with his experience. Lisa was quick to insist that she “had a right to express her true feelings,” even if these were contemptuous statements and criticisms. She also emotionally escalated quickly, and expressed resentment toward me, when my direct feedback style had her stop and calm down, before continuing. Emotional upset is common in couples therapy. What made this couple challenging is the frame of “genuine feeling” that Lisa put on her problematic language.
I worked hard that weekend, but despite my efforts, they made little progress. My hunch was that both were hoping I would side with them, proving them “right” that the other was the source of the problem. The notion that their mindset, interactional patterns, and capacity to self-regulate and accept influence were not easy notions to accept.
At the end of the intensive, I referred each of them back to their individual counselor, and offered to connect with their therapist to provide feedback.
It surprises many to learn that each person in a relationship needs to be prepared for couples therapy. Not every pair is ready to do this tough emotional work.
David and Linda came in ready to work. They felt I balanced the art of both challenging them and expressing empathy. This foundation of trust allowed them to take emotional risks and make significant breakthroughs.
Co-occurring issues must be addressed
For therapy to be effective, it’s critical to assess and treat any co-occurring mental health concerns or addictions that may be impacting the relationship. Left unaddressed, these individual issues will continue to fuel tension and unhealthy dynamics between partners.
Over the course of treatment, it became clear that Lisa was struggling with undiagnosed depression that was contributing to her irritability and disregulation. Her depression needed to be treated in order for her to be able to show up differently in his marriage. With David and Linda, there were no major mental health issues that could impede their work in couples therapy.
Some personality traits are associated with poorer outcomes
Certain individual characteristics have been correlated with a lowered chance of success in couples counseling. One longitudinal study found that low impulse control, tendency to externalize blame, and inflexibility were some of the top predictors of poor marital therapy outcomes.4
Indeed, in my work with Gary and Lisa, I noticed Gary had difficulty accepting ownership for his contribution to the problem. Instead, he projected blame onto Lisa. He rejected any efforts Lisa made to influence his thoughts, feelings, or actions. He seemed to reject the notion that he needed to make any changes and adapt to new ways of relating. He was quick to criticize his wife and she responded quickly and impulsively to escalate emotionally during their arguments. David and Linda, on the other hand, were slower to anger and more considerate in their communication – personality strengths that enabled them to de-escalate conflicts before they got too heated.
Unresolved family-of-origin trauma can impede progress
We all learn key lessons about love in our first relationships – those with our parents and childhood caregivers. When there have been attachment disruptions or dysfunction in our family-of-origin, we unknowingly bring these unhealed wounds into our adult partnerships.5
In Gary’s BIG BIG Book he reported a history of emotional neglect and physical discipline from his father. His trauma response to feeling unsafe was to insist he was right and get aggressive if challenged – a triggered reaction playing out with Lisa. Lacking models for secure intimacy, it was difficult for him to implement softer ways of engaging. While David and Linda certainly had their own baggage, their family backgrounds were relatively stable and healthy, giving them a head start on knowing how to meaningfully connect and apologize after ruptures.
The partners need to establish an emotional connection
Research by John Gottman, PhD, shows that healthy relationships are built on a strong friendship, characterized by knowing each other well, sharing fondness and admiration, and regularly turning towards one another.6 In therapy, for changes to stick, partners must develop positive feelings towards each other.
While Gary and Lisa had moments of remembering what drew them together, the majority of their associations were marked by disappointment, hurt, and mistrust. Without a reservoir of goodwill to draw upon, it was hard for them to give one another the benefit of the doubt or want to be vulnerable. David and Linda, in contrast, still delighted in each other’s company and were intentional about cultivating their connection with date nights and daily expressions of appreciation. This positivity renewed their energy for making relationship adjustments.
Embracing change is vital
If one or both partners are highly change-resistant, this can be a major stumbling block in couples work. An openness to trying new ways of being is needed in order to disrupt the dysfunctional dances couples often find themselves in.7
I noticed that Lisa had one foot out the door throughout her intensive weekend with Gary. Her ambivalence about the relationship made her less motivated to stretch beyond her comfort zone or practice the tools learned she was learning. David and Linda approached our work with more flexibility, welcoming the opportunity to grow as individuals and as a couple. This allowed them to adopt a whole new repertoire of communication and conflict-resolution strategies.
Summary
The success of couples therapy depends on a complex interplay of timing, motivation, therapist fit, individual issues, personality dynamics, family history, emotional connection, and willingness to change. While some factors are outside a couple’s control, others can serve as important guidelines for any pair considering counseling. By understanding these elements, partners can set themselves up for the best chance of restoring and revitalizing their relationship.
Footnotes
1. Gottman, J. M., & Gottman, J. S. (2015). 10 principles for doing effective couples therapy. W W Norton & Co.
2. 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.
3. Friedlander, M. L., Escudero, V., Heatherington, L., & Diamond, G. M. (2011). Alliance in couple and family therapy. Psychotherapy, 48(1), 25-33.
4. Baucom, B. R., Atkins, D. C., Rowe, L. S., Doss, B. D., & Christensen, A. (2015). Prediction of treatment outcomes from relationship adjustment and clinical factors in couple therapy. Journal of Consulting and Clinical Psychology, 83(1), 103-114.
5. Makinen, J. A., & Johnson, S. M. (2006). Resolving attachment injuries in couples using emotionally focused therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74(6), 1055-1064.
6. Gottman, J. M., & Silver, N. (2015). The seven principles for making marriage work: A practical guide from the country’s foremost relationship expert. Harmony.
7. Benson, L. A., McGinn, M. M., & Christensen, A. (2012). Common principles of couple therapy. Behavior Therapy, 43(1), 25-35.
