By the time a couple seek out therapist Esther Perel, they are often no longer talking about love. When I saw her speak at a crowded salon on the Upper East Side last month, she said that early in relationships, people fall hard – then reality sets in.
“You slowly begin to realize that person doesn’t necessarily conform to your expectations,” she told rapt listeners. “Expectations are resentments in the making.”
Many couples come to couples therapy “too late”, according to Perel. On the flip side, there can be plenty of judgment about a couple who start doing therapy together “too early”. Shouldn’t you still be in the honeymoon stage?
I don’t hesitate mentioning that I’m in individual therapy. But when I went to couples therapy in 2019, I found myself more reluctant to spread this news around. It felt different somehow to share that my partner and I needed help in our relationship.
Couples therapy occupies strange territory in an increasingly open mental health landscape. Some view it as a stodgy, old-fashioned exercise for people who are about to break up anyway. “People draw that conclusion from correlation: Betty and Joe down the street went to couples therapy, and they needed to get divorced,” said James Cordova, a psychology professor at Clark University who researches interventions for sustaining and maintaining relationship health over time.
Yet people clearly have a strong interest. Perel’s podcast Where Should We Begin has millions of listeners and in 2019, Netflix launched the show Couples Therapy, which is in production for its fourth season. In 2021, Google tweeted that searches for “how to date” had reached an all-time high, a search term that has only grown since then. We want to figure out how to have healthy relationships with each other, yet many people still don’t go to couples therapy, or wait to try it. “Folks will suffer inside a significantly distressed relationship for between four to six years before they even consider starting to seek couples therapy help,” Cordova said.
Cost is one reason that prevents people from seeking out all kinds of mental health interventions. But there are also misconceptions about what couples therapy is, who it’s for, when is the best time to go, and how long to go.
Who is couples therapy for?
Couples therapy is not only for married people or long-term relationships. “I see this as similar to disaster preparedness before a crisis,” said Kale Monk, a family and relationship scientist at The University of Missouri. “We need to be proactive in our relationship work.”
Monk was initially wary of working with couples because of the stereotype “that it’s a last-ditch effort to salvage the relationship”, he said. But when he started to work with couples, he saw how much people wanted to work on their connections with each other, and to understand why they kept running into the same conflicts.
There aren’t many services explicitly for these earlier stages of relationships, said Brian Doss, a professor of psychology at the University of Miami, and co-author on the therapy manual for integrative behavioral couples therapy. Historically, premarital counseling filled this role. But couples therapy today is relevant for people in all kinds of relationships, like polyamory or open relationships, queer couples and people who want to commit but aren’t interested in marriage or children.
As the options for people’s lives and partnerships grow, they might need more skills and more help at feeling connected to their partner, resolving conflicts, having the sex life they want, and determining what they want your relationship to look like. “The less society dictates what our relationships are supposed to be like, the more we have to figure out what we want, and what’s right for us,” Doss said.
When is the right time for couples therapy?
It can be confusing to know when to go, said Mara Hirschfeld, a licensed marriage and family therapist based in New York. “There is an assumption that we shouldn’t go to therapy too soon,” she said – but also that we shouldn’t go when it’s “too late” to save the relationship.
People can use outside help at pivotal moments: before they move in together, deciding about children, marriage or meeting each other’s families.
For many couples, issues can and do arise in the earlier stages of a relationship, even a few months in. “When things start to get real, people start opening up to one another about their vulnerability,” she said. “You start to get into the attachment layer of the relationship where it stops coming from just lust and admiration and we start getting real.”
You can go any time when those kinds of conversations and feelings begin to arise. As a practice, it is less about salvaging moribund marriages at all costs, and more for learning basic communication and relationship skills, working through big life transitions, and recognizing what a large role relationships play in our mental health, relationship scientists told me. This means you don’t have to go forever, and that there’s no such thing as going too early.
What happens in couples therapy?
Couples therapy won’t be the same for every pair, since each partnership will be bringing different issues to their sessions. You can expect to start with a combination of solo and paired sessions that establish your relationship history, who you are as an individual, and who you are together. But there are some common skills at the root of all couples therapy, said Monk, who did his PhD in relationship science, researching how to make relationships work.
He focuses mostly on the importance of prevention work, and “relationship maintenance”, or building up skills to communicate or resolve conflicts before any huge issues arise. Relationship “maintenance” is the “what to do” in the early stages of a relationship to upkeep its health and functioning, like you would bring a car to regularly get its oil changed, Monk said.
Monk has shown that how well or poorly couples communicate is associated with the quality of their relationship later on, and that poor communication is connected to people splitting up. Research on federally funded couples education found that couples who did premarital counseling were more likely to seek help sooner when issues arose.
Although there are different approaches to couples therapy, a review from 2022 wrote that many therapists end up mixing techniques. As with other kinds of therapy, there’s a sweet spot of finding a therapist you connect with and one who is able to help you with the specific problems your relationship is having. People who do online relationship programs benefit from them as well.
What’s the end goal of couples therapy?
A couples therapist shouldn’t have any preconceived idea of what should happen to the relationship, Hirschfeld said. But on-again, off-again relationships aren’t great for your mental health, Monk’s work has shown. Going to a couples therapist can help people figure out how to work through their issues, or decide to split up for good. Some people learn through couples therapy that the relationship isn’t going to work, then have a safe and supportive environment to work through what that means. Hirschfeld was actually the couples therapist that I went to with my ex, and we ended up breaking up.
Couples therapy is useful even if the relationship doesn’t continue. For many people, the issues that come up in one relationship will rear their head in others: with future partners, family members, bosses or friends. “Why not work on those things now?” Monk said.
What should I look for in a couples therapist?
It’s important to find someone who is actually trained in couples therapy, said Amber Vennum, an associate professor of couple and family therapy. It’s different from individual psychotherapy because the process is not just about the two people, but also the dynamic between them. When we consider how well we are doing mentally, we often consider how we’re feeling individually. For couples and family therapists, mental health is relational.
As when looking for an individual therapist, find someone that both you and your partner feel a connection to, and can see yourself trusting to reflect your dynamic back to you. Their role isn’t to serve as emergency resuscitation to your relationship; couples therapy should be thought of like an annual physical check-up or dental cleaning appointment. “The complicated nature of being in an ongoing, close relationship with another human being is ultimately too much for any of us to try to take care of entirely on our own,” Cordova said.
