One of the most prominent sources of emotional distress is relationship conflict.
There is a direct correlation between anxiety, depression and addiction issues, and relationship stress (Lebow & Snyder, 2022).
It is no wonder that couples counseling has become increasingly popular. But cultural views of marriage and long-term relationships have shifted, making couples counseling more valuable than ever.
Couples have higher expectations of relationships in the 21st century and look to couples counseling to address interpersonal happiness, sexual satisfaction, gender roles, and better friendships within marriage (Doherty, 2020).
Since couples therapy has evolved into a widely practiced form of psychotherapy, we take our magnifying glass to it and share insights into how it works, common techniques, exercises, and even training opportunities if you’d like to learn more.
Couples counseling is a type of psychotherapy that includes marriage counseling, premarital counseling, and family therapy (Gupta, 2021). It is typically a short-term form of counseling that can help partners improve their relationship at any stage.
Couples counseling can help clarify relationship roles, assist with sex and intimacy issues, improve communication and connection, and help partners deal with life transitions or external stressors.
There are many approaches to couples counseling used today. Some of the more popular ones include (Gupta, 2021):
Emotionally Focused Therapy (EFT), which focuses on improving the attachment and bond between partners. Therapists help the couple understand and change patterns that lead to feelings of disconnection.
The Gottman method (Gottman & Gottman, 2017) addresses areas of conflict and equips individuals with problem-solving skills to improve friendship and intimacy.
Ellen Wachtel’s (2019) approach involves focusing on positive aspects of the relationship. It is a strength-based approach that emphasizes self-reflection rather than blame.
Psychodynamic couples therapy examines underlying hopes and fears that drive each person in the relationship. The idea behind this approach is that this will allow the couple to understand one another better and improve the relationship dynamic.
Cognitive-Behavioral Therapy (CBT) for couples involves identifying and altering thought patterns that cause conflict so that it can be resolved. Much like individual CBT, it focuses on changing cognitive distortions and reframing perspectives.
Does couples counseling work?
Couples counseling not only reduces specific relationship difficulties, but also improves coexisting emotional, behavioral, and physical health concerns (Babinski & Sibley, 2022). Self-report measures and pre–post assessments on communication, compatibility, and emotional wellbeing illustrate these benefits.
The Gottman method (Gottman & Gottman, 2017) incorporates basic science about relationships and empirical evidence into structured treatment plans. Attachment, communication processes, behavioral exchanges, and emotional wellbeing can improve with couples counseling.
One of the most evidence-based methods of couples therapy, the Gottman method is based on over 40 years of research that supports its efficacy (Gottman & Gottman, 2017).
Couples counseling has been shown to improve communication, decrease relationship distress, and improve intimacy and connection among partners (Shadish & Baldwin, 2003).
Pre- and post-test clinical trials have shown a decrease in anxiety and depression for individuals in couples counseling (Babinski & Sibley, 2022). It is evident that couples counseling benefits not only the relationship, but the individuals within it.
How Does Couples Counseling Work?
As mentioned, there are a variety of different approaches to couples counseling.
Most of them build on a biopsychosocial foundation that includes family history, cognition, emotion, and inner psychological processes, tapping into multiple levels of the human experience (Lebow & Snyder, 2022).
Some methods of couples counseling are structured and rigid, while others are more fluid and eclectic.
Like individual therapies, couples counseling follows a series of stages that begin with an initial step of assessment and building the therapeutic alliance (Lebow & Snyder, 2022). This is generally followed by a stage of promoting change to reduce distress and fostering positive connection and satisfaction. A concluding stage of termination guides the couple to maintain progress that has been made in treatment.
Couples therapy also uses an active therapy style with the goal of identifying and disrupting dysfunctional behavior patterns within the relationship. The dysfunctional patterns are replaced with supportive and functional ones through psychoeducation, role-play, and feedback (Lebow, 2014).
Couples counseling works to promote mutual empathy and understanding, teach partners to negotiate, and shift focus toward the strengths of the relationship (Lebow, 2014).
A couples therapist will help each partner understand individual contributions to the presenting problem and teach mindfulness or affect-regulation skills to help them navigate conflict constructively.
The effects of stress on our nervous system, brain, and bodily reactions heighten tensions and escalate negative emotion and interactions. If couples can find an optimal level of arousal to process and integrate experiences effectively, they can learn to resolve issues and make meaningful connections.
Use of these mindfulness worksheets with your clients, as they offer a variety of ideas to teach and practice mindfulness.
2. Tracking patterns
Tracking is a technique used to gain an understanding of the interactive patterns presenting in the relationship (Andrews, 2004).
Identifying patterns can help couples understand the way they relate to each other and how problem behaviors begin, and then create solutions to change the maladaptive patterns.
To use this technique, a therapist will ask the couple to describe particular situations to create “pictures” of what tends to happen between them. These pictures can be analyzed in an objective way to establish new behaviors and interactions.
3. Psychoeducation to promote mentalizing
Mentalizing refers to the capacity to reflect on and interpret one’s own behavior and that of others based on intentional internal mental states, such as beliefs, thoughts, and emotions (Fonagy et al., 1998).
The ability to mentalize one’s own experiences and those of others increases the ability to cope with internal and external stressors, regulate affect, and form stable interpersonal relationships.
4. Stabilizing techniques
Stabilizing techniques are those used at the beginning of therapy to establish a foundation and healthy therapeutic alliance between the therapist and the couple.
Taking a future-oriented, solution-focused approach to the initial assessment and intake can create a positive foundation to build upon (Andrews, 2004).
A therapist uses this technique when they set ground rules, explain the process and goals of therapy, and provide a grounded framework for counseling to begin.
5. Circular questions
Circular questions help clients understand dynamics that occur within the relationship. These questions explore the views of both partners.
Circular questions must include characteristics that help define the problem, elicit responses that suggest how situations have changed over time, invite consideration regarding how the interactions of one partner impact another, and include hypotheticals that invite the partner to change behavior (Andrews, 2004).
Example: Ask each partner what they view as the biggest issue in the relationship.
5 Best Exercises, Activities, and Worksheets
Throughout the process of couples counseling, a variety of exercises, activities, and worksheets can be implemented to increase connection, work on communication, and improve therapeutic outcomes.
1. The naikan reflection
The naikan reflection is an excellent activity to do with couples to improve the quality of relationships through a deeper understanding. This can lead to positive changes in behavior and communication.
Naikan reflection is based on three questions:
What have I received from …? What have I given to …? What troubles and difficulties have I caused?
This article on Naikan Therapy explains the concept in more detail.
2. Relationship journaling
Relationship journaling invites the couple to write about thoughts, feelings, and wishes related to the relationship. They can write about things that are going well, what they would like to see change, or specific reactions/disagreements that have occurred.
The couple will write individually and share the journal in session in the presence of the therapist. Tips and prompts for journaling can be found in our mindfulness journaling article and adapted for couples.
3. Communication
The Effective Communication Reflection worksheet explains aspects of effective communication and then asks guided questions to help individuals in a relationship address areas of weakness.
Communication is a crucial aspect of couples therapy, and this worksheet can be done in session or assigned as homework.
4. The four horsemen
Gottman and Gottman (2017) theorized that all relationship difficulties are rooted in “the four horsemen,” which are criticism, defensiveness, stonewalling, and contempt.
Conflict is resolved and an increase in connectedness occurs when couples can identify these interpersonal behaviors and learn antidotes to negate them. This video provides a brief introduction that can be used as a tool for psychoeducation.
Four horsemen of the apocalypse - The Gottman Institute
Used in session, couples can explore problematic coping styles and replace these with more effective ways of resolving and managing conflict.
10 Questionnaires & Questions to Ask Clients
Asking questions and having clients complete assessments and questionnaires can provide insight to both the therapist and the individuals in the relationship.
The first few sessions of couples counseling are generally guided by intake questions and gathering information about the relationship. After the intake, more specific areas of the relationship can be explored.
1. How deep is your love quiz
This questionnaire was designed to help couples learn and understand how committed they are to the relationship.
It distinguishes between lust and love and is great for counseling couples in early stages of relationships or for premarital counseling.
2. Learn about your partner
This fun worksheet asks a variety of questions about one’s partner. The idea is to see how many questions one partner can answer without asking the other.
After completing the worksheet, partners can share responses and fill in unanswered questions. This can create dialogue and an opportunity to learn new things about one another.
Couples will be able to identify how they give and receive love through physical touch, words of affirmation, quality time, acts of service, and receiving gifts.
4. Questions to ask
To develop a vision and direction for therapy and for the couple’s future, a therapist would ask:
What does your ideal partnership look like in five years?
It can also be helpful to have the couple focus on the strengths of the relationship in session. Ask questions like:
What are three things you appreciate about your partner?
What is your partner’s greatest strength?
To improve the relationship, use the following questions:
What positive relationship rules do you follow?
What do you wish your partner would do more?
How does your relationship affect your levels of joy?
What positive changes do you want to make in your life?
Behavioral Couples Therapy (BCT) is a form of therapy designed for relationships where one partner is addicted to alcohol or drugs (O’Farrell & Schein, 2000).
The goal is to improve the couple’s relationship and build support for abstinence through acceptance and change.
BCT typically comprises 12–20 weekly couples sessions over a three-to-six-month period. In these sessions, a therapist will teach and model communication behaviors, such as listening, expressing emotions, negotiating requests, and expressing appreciation (O’Farrell & Schein, 2000). Homework assignments are often given to practice these skills and increase commitment to both the relationship and staying sober.
A core component of BCT is a “recovery contract,” which involves daily rituals to reward abstinence (O’Farrell & Schein, 2000). The components of a contract general include daily affirmations, medication compliance, peer support and community involvement, weekly drug screens, positive weekly activities to support recovery and physical health, and sharing progress with one another on a calendar.
While substance use disorders have historically been viewed as an individual problem, research has demonstrated the important role that partners and families play in both the origin and maintenance of addiction.
BCT addresses addiction as something that exists within a larger family system and treats couples as a single unit (O’Farrell & Schein, 2000). BCT increases abstinence rates, improves relationship functioning and emotional problems, and reduces social costs and domestic violence better than individual treatments (O’Farrell & Schein, 2000).
Training in Couples Counseling: 6 Programs
Working with couples can be a complex and challenging task for therapists and health professionals. There are a variety of trainings, certifications, and opportunities to learn specific techniques and gain experience that can help in counseling relationships.
1. EFT training
This course is presented by its founder, Dr. Sue Johnson. EFT is an effective form of couples therapy that addresses attachment theory and how to help couples find secure and satisfying connections in relationships. You can also read more on Emotionally Focused Therapy Training which lists 16 course options.
2. AASECT certification
The AASECT offers a certification course for members interested in sex education, counseling, and therapy. This global organization is a leading resource for the field of human sexuality. Sex therapy is a highly specialized field of couples counseling and can be a wonderful addition to counseling training and education.
3. The Gottman Institute
The Gottman method of couples therapy is an evidence-based practice that has effectively helped thousands of couples navigate relationship difficulties and find healthy connections.
This training focuses on CBT for couples. The online certification provides a basic foundation for understanding relationships, communication, love languages, how to resolve conflict, and develop strategies for solving problems.
Relationship coaching has been used to help couples, those going through a divorce, and individuals not yet in a relationship but seeking a partner.
3. Couples Institute
This course provides ongoing written and verbal lessons. The Couples Institute also offers continuing education for a variety of healthcare professionals.
17 Exercises for Positive, Fulfilling Relationships
Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].
Here at PositivePsychology.com, we have an extensive collection of free and subscription worksheets specifically designed to help with couples counseling.
Among our free worksheets, you will find the Imago Workup Worksheet, which is based on Imago Therapy. It can help individuals as they look to enter a relationship or search for a partner. By examining past relationships, childhood experiences, and personal preferences, individuals can establish a healthy connection with a future partner.
All couples go through periods of conflict and emotional distress. Coping with difficult emotions is a foundational aspect of a healthy relationship. This worksheet helps individuals in a relationship cope with and respond to the negative emotions of a partner and navigate conflict in an effective way.
In addition, a recommended read is Building Healthy Relationships, which provides a variety of worksheets and a wealth of information to assist couples at all stages of a relationship. From getting to know your partner to developing healthy behaviors for intimacy and connection, a diverse selection of ideas and practical activities are provided.
If you’re looking for more science-based ways to help others build healthy relationships, this collection contains 17 validated positive relationships tools for practitioners. Use them to help others form healthier, more nurturing, and life-enriching relationships.
A Take-Home Message
Couples counseling includes different approaches and is an effective form of psychotherapy to improve relationships. It can be helpful at any stage of a relationship regardless of status or longevity. From premarital counseling to rebuilding a long-lasting marriage, this short-term form of therapy can be helpful.
Couples counseling addresses a wide range of relationship issues, including conflict, feelings of disconnection, infidelity, issues related to intimacy, and external stressors. Specialized forms of couples therapy such as BCT can help deal with issues of substance abuse.
Relationships are difficult, and they directly impact an individual’s mental and physical wellbeing. Getting help through counseling as a couple can improve all aspects of wellbeing for both partners and can help facilitate a lasting relationship.
Andrews, M. A. (2004). Clinical issues: Counseling techniques for speech-language pathologists. Perspectives on Language Learning and Education, 11(1), 9–13.
Babinski, D. E., & Sibley, M. H. (2022). Family-based treatments for attention-deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019. Journal of Marital and Family Therapy, 48, 83–106.
Doherty, W. J. (2020). The evolution and current status of systemic family therapy: A sociocultural perspective. In K. S. Wampler, R. B. Miller, & R. B. Seedall (Eds.), The handbook of systemic family therapy. Wiley.
Doherty, W. J., Kalantar, S. M., & Tarsafi, M. (2021). Divorce ambivalence and reasons for divorce in Iran. Family Process, 60(1), 159–168.
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective Functioning Scale (RF) [Database record]. APA PsycTests.
Gottman, J. M., & Gottman, J. S. (2017). The natural principles of love. Journal of Family Theory & Review, 9(1), 7–26.
Gupta, S. (2021, August 10). What is couples therapy? VerywellMind. https://www.verywellmind.com/couples-therapy-definition-types-techniques-and-efficacy-5191137.
Lebow, J. L. (2014). Couple and family therapy: An integrative map of the territory. American Psychological Association.
Lebow, J., & Snyder, D. (2022). Couple therapy in the 2020s: Current status and emerging developments. Family Process, 61(4), 1359–1385.
O’Farrell, T. J., & Schein, A. Z. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment, 18(1), 51–54.
Shadish, W. R., & Baldwin, S. A. (2003). Meta-analysis of MFT interventions. Journal of Marital and Family Therapy, 29(4), 547–570.
Wachtel, E. F. (2019). The heart of couple therapy: Knowing what to do and how to do it. Guilford Press.
About the author
Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.
Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.
One of the most prominent sources of emotional distress is relationship conflict.
As mentioned, there are a variety of different approaches to couples counseling.
Throughout the process of couples counseling, a variety of exercises, activities, and worksheets can be implemented to increase connection, work on communication, and improve therapeutic outcomes.
Behavioral Couples Therapy (BCT) is a form of therapy designed for relationships where one partner is addicted to alcohol or drugs (O’Farrell & Schein, 2000).
