Will couples therapy work for you?
Sixty years ago, even though they felt an urgent need, surveys suggested that Americans were disappointed with the couples therapy available at that time.
Back then, couples therapy was the poor step-child to individual and family therapy. That’s not surprising. In those days, 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’s actually too much couples therapy to choose from. Which again invites this important question..will couples therapy work for you?
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?
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.
Which is too bad for a couple of 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.
Marital satisfaction can be expressed in a near-magical mathematical ratio; 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 sort of small acts of kindness. In fact, 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.
This ratio has been confirmed time and time again by Gottman, as well as other independent researchers. 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.
It was Gottman who discovered that even happy couples never actually “solve” most of their problems. Conflicts typically arise from the same repetitive issues.
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. Gottman’s research offers couples a way out of criticism and defensiveness and the never-ending attack-defend cycle.
Good, science-based couples therapy installs fair fighting and repair skills. Emotionally-Focused Couples Therapy (EFT) teaches couples how to lower their defenses during the conflict, while the Gottman Method focuses on an awareness of physiological responses and more appropriate patterns of communication. The best couples therapists, in our opinion, are well-trained in both methods.
Gotman Method also invites couples to notice the level of acceptance and goodwill they have toward one another.
This is what Gottman refers to as having either a “positive or negative sentiment override,” referring to the overall positive or negative regard they have for one another. The value in pointing out the sentiment override is that it helps to establish a greater level of self-awareness.
Attachment Science indicates that spouses who have a Secure Attachment style are more likely to be able to create a similarly secure attachment in marriage. 30 + years of EFT research tells us that a good marriage emerges from a deep, responsive, resilient, interdependent connections between partners.
“All happy families are alike; each unhappy family is unhappy in its own way.” Leo Tolstoy
Research tells us that couples need 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 that are sadly similar.
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 and Daniel O’Leary, and Neil Jacobson and his team-each 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 the individual depression, but only the 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 Method Couples Therapy, and it’s forerunner, Integrative Behavioral Couple Therapy, stress 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 as well.
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 we say 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!”
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.
Daniel is a Marriage and Family Therapist. He currently sees couples at Couples Therapy Inc. in Boston, Massachusetts, three seasons in Cummington (at the foothills of the Berkshires...) and in Miami during joint retreats with his wife, Dr. Kathy McMahon. He uses EFT, Gottman Method, Solution-focused and the Developmental Model in his approaches.