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Does Couples Therapy Really Work?

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LoveIn honor of Valentine’s Day, this month we’re discussing all things couples. Today’s post comes from Family Institute staff therapist Nikki Lively, MA, LCSW, one of the Institute’s couples counseling experts.


I was meeting with a couple last week who are relatively new to our work together in couples therapy. Towards the end of the session, one of the partners asked, “So, does couples therapy really work?” I asked him more about what he meant by “work” to which he replied, “Is it possible for us to be happy together again?”

These are both incredibly poignant questions, and I think representative of questions many people have about couples therapy. To answer this question, I want to share a summary of the research in the type of couples therapy I practice called Emotionally Focused Couples Therapy (EFT), as well as share my observations about what seems to lead to increased relationship happiness in couples therapy from my experience as a couples therapist.

First of all, the research on couples therapy has historically been somewhat limited because frankly, relationships are complicated, and the process of therapy difficult to operationalize for research. However, more recently, EFT research starting in 1999 and to the present has shown that using the road map of Adult Attachment Theory (for a good overview on the theory click here), therapists are able to understand the distress that couples are dealing with, and have effective methods to increase safety and security in relationships, and change the ways couples interact and bond with one another.

One exciting study that came out in 2013 involved MRI brain scans in women in distressed relationships before and after a course of EFT.  The female partner was put in an MRI machine and given a slight shock while holding her partner’s hand.  Before EFT, the contact with one’s partner did not ease her perception of the pain of the shock and there was a lot of brain activity on the MRI.  Post EFT, the same procedure was done, only this time, with contact from her partner, brain activity was diminished, and she reported that the same shock from before was much less painful.  More research needs to be done in this area, but these initial findings suggest that EFT can change our ability to receive comfort from our partner, and thus help repair adult attachment bonds! (To watch a video describing the study click here)

In my experience working with couples, I have also observed 5 key factors in couples who have made progress in couples therapy and report higher levels of relationship satisfaction after couples therapy:

  • One partner expressing their feelings leads to a change in the perception of the listening partner
  • Learning to express needs, generally, but specially for reassurance and affection directly
  • A stance of curiosity and interest in understanding of one’s partner better
  • Taking responsibility for one’s own experience
  • Cultivating openness to receiving validation and comfort from one’s partner

In my experience, it is completely normal for couples to enter couples therapy with the fantasy or hope that their partner will change, or with the belief that it is their partner who is “the problem”.    However, the couples who end up getting the most from couples therapy are those that use the therapy as a place to learn more about themselves (why do I react this way to my partner?), who stay curious about who their partner is and what makes them “tick” (vs. thinking they already know everything about their partner), and last but not least, those that cultivate a willingness to change their own behavior.

Couples therapy also seems to work best when it is aimed at the prevention of problems in the relationship. I recommend that couples come to therapy anytime they are headed into a major life transition such as moving in together, getting married, preparing to become parents, before retirement, etc. It’s easier to prevent hurts and resentments from building up than it is to heal them once wounds have already been created. This doesn’t mean that couples therapy cannot help couples who have struggled for a long time with their issues, but in these cases, couples therapy will likely take much longer as each partner builds up a tolerance for being vulnerable again in a relationship where they have learned to protect themselves from further hurt.  So come early and often to get the best results!

I hope this helps answer some questions about couples therapy, and if you are currently receiving couples therapy, that it helps inspire the courage to look more at yourself and how you can use your relationship as a place to heal and grow.


Nikki Lively, MA, LCSW, is a licensed clinical social worker with over 10 years of experience providing individual, couple and family therapy. She leads The Family Institute’s therapy group The Mindful Couple, where couples learn to live and love more effectively using the principles of mindfulness and Dialectical Behavioral Therapy (DBT). In this group, couples learn to understand why feelings of anger, sadness and/or distress are common and normal reactions in relationships, as well as skills for managing those reactions and communication strategies.

To read Nikki’s full bio or make an appointment, please visit our website.

The Family Institute offers affordable, effective mental health treatment for families, couples and individuals. Learn more about us on our website.

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