What can I expect from couples therapy?

Your relationship is stuck, you’ve had an affair, you’re constantly arguing, or you’re not speaking to each other properly anymore: There are many reasons for couples therapy. Usually, it’s because changes in the relationship can’t be handled alone, and couples want to find a loving relationship again. Here you’ll learn what couples therapy actually is, why couples choose it, and how it can be (successfully) achieved. 

What is couples therapy?

Couples therapy is a service for people in relationships experiencing conflict or relationship problems. There are various approaches and forms of couples therapy, but all aim to address and overcome conflicts and difficulties within the relationship. Depending on the couple’s individual focus and goals, different methods are used to strengthen the partners’ communication and relationship skills. For example, they learn to identify the triggers of conflicts, better understand and express their own and their partner’s needs, and manage problems and stress together. 

Sessions are usually held jointly, but occasionally the therapist may offer individual sessions for the partners. Couples therapy is not a legally protected term in Germany, so the boundaries between couples therapy, couples counseling, and marriage counseling are often fluid. There are no regulations regarding the training a couples therapist must have completed. However, it is usually psychologists, psychotherapists, or educators with additional training who offer couples therapy. Here you can read how to determine the training of couples therapists. 

Reasons for couples therapy

The reasons why people seek couples therapy are as diverse and individual as the people themselves. Couples therapy is sought when one or more partners are no longer happy in the relationship and the relationship needs to be improved. Common topics in couples therapy include:

1. Conflicts and arguments: Minor conflicts and arguments are normal and even helpful in any relationship. However, if serious, acute conflicts arise or if they are chronic, professional help can be helpful. Perhaps you argue about every little thing, blame each other, or hurt each other. Are there issues that keep coming up, causing you to go around in circles? Then professional help may be helpful.
2. Communication problems and misunderstandings: Communication problems and misunderstandings often arise when one’s own needs and desires are not properly understood and communicated. If we wish to be treated in a certain way, but this isn’t communicated properly, hurt feelings and disappointments can arise. This can lead to accusations and difficulties in understanding the other person. The general nature of communication can also be disrupted if, for example, you speak to each other in a passive-aggressive, demanding, or submissive manner. 
3. Loss of intimacy and emotional connection: For many couples, intimacy changes over the course of their relationship. Perhaps the desire for sex or physical interest in each other diminishes, an initial passion fades, or a deep connection is lacking. Many couples seek therapy because these issues place a strain on their relationship. 
4. Affairs and infidelity: For some, an affair or a partner’s infidelity means an immediate end to the relationship. Others may be hurt but want to work on their relationship and need professional help to start a conversation after a hurt experience and build trust in each other again. 
5. Life changes: If the life circumstances of one or more partners change, this can alter the roles in a relationship and put a well-established relationship structure to the test. Life changes such as the birth of a child, the departure of shared children, a job change, a move, retirement, or even a separation can be such difficult events and require the help of couples therapy. 

Is couples therapy with us still worthwhile?

Many couples don’t seek couples therapy at all, or only do so when conflicts and problems are already very advanced. Therefore, couples therapy is only partially effective. However, it does lead to improvements in the relationship for around two-thirds of couples in therapy. Therefore, under certain circumstances, it is always worth trying couples therapy. However, it is important that there is both the desire and a general willingness to change something about yourself and your relationship. It should be recognized that the “problem” does not lie solely with your partner. It is also helpful to seek couples therapy as early as possible; this makes improvements in the relationship and in general life satisfaction much more likely and can be achieved more quickly.

How does couples therapy work?

1. Initial consultation and goal setting

What exactly is discussed and worked on in couples therapy depends on the couple’s goals and is therefore tailored to each individual. The initial consultation and sessions are primarily about getting to know the therapist and clarifying why you are seeking support. Your willingness to work on your relationship, as well as goals and options within therapy, will be discussed. You should feel well cared for and understood by your therapist; this is important for successful therapy. 

Example Luisa and Tom:

Both in their mid-30s, they come to couples therapy. In the first session, they explain why they’re there and what they want from couples therapy: They’ve been in an intimate and passionate relationship for two years, but they repeatedly argue violently without knowing exactly why. Both want to understand and prevent the conflicts in order to maintain a harmonious relationship. In couples therapy, they describe their conflicts. 

2. Problem clarification and identification of relationship patterns

The next step is to clarify which factors lead to your problems and which conflicts contribute to them. Here, both partners are asked about their perspectives, which may differ. Often, at the beginning of therapy, both partners assume that the other person is “to blame” and needs to change. Therapy encourages the realization that problems in a relationship arise from the mutual relationship patterns of all partners. Through discussions, the therapist will identify the triggers and typical patterns, roles, and dynamics that contribute to the conflicts. Questions about your life stories, difficult experiences, and stresses in your life may also be asked.

Luisa and Tom:

It becomes clear that both are very impulsive, insulting each other over even the smallest things and blaming each other for the arguments. Eventually, Luisa withdraws and stops speaking to Tom, which makes him very angry.

3. Try new solutions

Once the relationship problems have been understood, the next step is to find and try out new coping strategies. These, in turn, depend on your individual difficulties and goals. Therapy aims to promote acceptance and understanding of your own difficult experiences and those of your partner. It may be uncomfortable at first to talk openly about your own needs and desires, so the therapists will give you plenty of space to do so. 

Luisa and Tom:

In therapy, the two first explore why they start arguing over even the smallest things and why it’s difficult for them to break out of the vicious cycle. They learn to identify their own needs and feelings and develop helpful communication strategies that they try out in everyday life.

4. Integration into everyday life

The coping strategies developed will be discussed and tested in advance during the sessions. To integrate what you’ve learned into your daily life, it’s important that you practice between sessions. This allows you to continually reflect on what works for you and what doesn’t, and where you still need support. 

Luisa and Tom:

Over the course of therapy, they continually reflect on how the strategies worked and learn to listen to each other better. This helps them better understand each other’s reactions, creating more harmony and closeness. 

Goals in couples therapy

Couples therapy is always tailored to the couple’s individual needs and goals, which is why the content can vary significantly. However, couples therapy aims to improve the relationship, which is why there are general goals that are often addressed in couples therapy. The overarching goal is usually to restore and maintain a fulfilling relationship and nurture it long-term.  

1. Communication skills and mindfulness

New coping strategies usually relate to a couple’s communication skills and conflict resolution abilities. In therapy, you learn, on the one hand, to be mindful of yourselves and to talk about your own feelings and needs, and, on the other, to listen properly. How to communicate properly can also be part of the therapy. For example, this might involve reducing passive-aggressive words or gestures, or stopping making accusations and using “you” messages.

2. See conflicts as an opportunity for growth

It’s helpful to view conflicts or difficult phases as an opportunity for growth. Conflicts are normal and important in every relationship because they demonstrate that partners’ ideas and needs differ. Even if compromises are necessary (on both sides!), they always offer the opportunity to change together as a couple. It’s also about developing shared goals for the relationship, not just individual goals. This way, you can influence change in a positive, fulfilling direction. 

3. Restoration of intimacy and sexuality

Improving intimacy can also play a role. To do this, we first clarify the difficulties and the needs and desires of each individual, and then work together to find solutions. The goal is to accept changes over the course of the relationship and improve the quality and meaning of closeness and intimacy.

Duration of couples therapy

How long couples therapy lasts depends on various factors, such as the severity of the conflicts, your goals, and your general willingness to make changes. Some couples benefit after just one or a few sessions, while others require significantly more time and support.

Costs of couples therapy

The costs of couples therapy are generally not covered by statutory or private health insurance. Furthermore, each therapist can set their own session fees. They usually range between €80 and €150 for a session (between 50 and 100 minutes). Counseling services for couples (for example, at ProFamilia or Diakonie) are less expensive or free. However, these are generally not as in-depth as couples therapy with trained therapists. 

Types and methods of couples therapy

There are various approaches and types of couples therapy, some of which are determined by the therapist’s training. In practice, however, therapists are usually familiar with many different methods and will choose them individually for and with you. So, you don’t necessarily have to decide beforehand which type or method is right for you. 

1. Emotion-focused couples therapy

Emotionally focused couples therapy methods are often used. The goal is to strengthen the bond between you and develop openness and understanding for one another. You reflect on old, unhealthy attachment patterns and overcome hurts so that you can learn new ones.

2. Systemic couples therapy

Systemic couples therapy views the individual partners as part of a system that is causing the difficulties. In couples therapy, the difficulties within the partnership system are understood and changed. The behavior of each partner is understood through context. Therapy involves, for example, taking the other person’s perspective, acknowledging differences, and looking at the conflict situation from a different perspective. 

3. Cognitive behavioral therapy for couples

Cognitive behavioral therapy methods are also used in couples therapy. These aim to identify and change unfavorable behavioral and thought patterns in partners. For example, misunderstandings and communication difficulties can be uncovered and improved, and appropriate conflict management can be learned.

4. Psychodynamic couples therapy

Psychodynamic approaches in couples therapy view conflicts in a relationship as the result of unresolved (unconscious) conflicts between the individual partners from the past that were not properly addressed and processed and are now flaring up again in the relationship. In therapy, you will learn about the origins of the conflicts in order to then find ways to better deal with challenges in the relationship. 

5. Imago couples therapy

Imago therapy is a relatively new approach to couples therapy, combining aspects of psychoanalysis, depth psychology, behavioral therapy, systemic therapy, cognitive therapy, and Gestalt therapy, as well as transactional analysis. It assumes that childhood experiences with attachment figures influence their later relationships, meaning that they essentially see an emotional reflection of their attachment figures in their partners. In therapy, you learn to understand and communicate your (previous) unmet needs and to develop together.