Couple Therapy: What is the Evidence?

Just over 20 years ago Consumer Reports ranked marriage and family therapy lowest among all types of therapy for customer satisfaction. Fortunately, a lot of work has been done since then by scientist researchers and practicing clinicians. Today there are proven methods that provide results. 

Successful couple therapy methods fall into two categories: behavior based and emotion based. These types of couples therapy, when performed by trained and supervised therapists, increase couple satisfaction by 50 - 75% and drastically reduce divorce rates. Five years after receiving behavior or emotion based couple therapy less than 25% of couples divorced compared to 70% of couples who received either no therapy or just individual therapy.  This information is based on literature reviews of large scale, university based studies in North America and Europe.

Behavior based therapies, as the name implies, attempt to change couple's behaviors.  Couples in distress tend to demonstrate predictable, negative behaviors that make their problems worse. Examples of these behaviors include contempt ("You idiot! I hate everything you do!") and stonewalling (responding with silence or ignoring your partner). There are several more examples, but you might recognize those behaviors in you or your partner.

The therapist works with the couple both identify unhelpful behavior and communication patterns and learn more effective methods of interacting. Newer methodologies of behavioral couples therapy (known as integrative) also focus on acceptance of our partner's emotional responses and make use mindfulness techniques to learn to look at interactions more objectively.

Emotion Focused Couple Therapy is based on a broad range of research regarding the ways humans form and maintain attachment bonds.  Our first attachment bonds are with our parents or our primary caregivers. In adulthood we form attachment bonds with our spouses or romantic partners. 

At the core of all attachment relationships is the biological and emotional need for companionship and a person who will look out for us in times of trouble. We need to know someone out there cares about us, is there for us, and will respond to us when we call out for help. When the relationship feels threatened we respond with inborn behaviors designed to increase felt protection and safety. Sometimes these behaviors result in a cycle that puts us at odds with our partner.

In emotion focused therapies, we identify attachment needs and the emotions surrounding our interactions with our partners.  Therapists help partners clear up misunderstandings and rebuild trust in one another. 

Evidence is building that therapies that include emotional components may be more effective over the long term than processes that focus only on behavioral interventions. The emotional component seems to be important because the treatments more quickly identify long standing issues and encourage the couple to deal with those issues from the moment therapy starts.  Traditional behavioral therapies often allow the couple to avoid big issues and injuries by focusing on skills first. 

Bottom line: Both behavior based and emotion focused therapies work and provide long term results for couples. Not all couples will benefit, but strong evidence indicates therapy by a qualified, trained professional substantially increases couple satisfaction and reduces divorce rates.


Lebow, J. L., Chambers, A. L., Christensen, A. and Johnson, S. M. (2012), Research on the Treatment of Couple Distress. Journal of Marital and Family Therapy, 38: 145–168. doi: 10.1111/j.1752-0606.2011.00249.x