Yes. For most couples who feel safe with each other, couples therapy works well on average. A 2020 meta-analysis of 58 studies found it had a large effect on relationship satisfaction, and gains generally lasted. Couples on waitlists did not significantly improve. Several approaches have strong evidence. Therapy doesn't help every couple, though, and it isn't recommended where there is abuse.
This article is part of our guide to getting help for your relationship. It looks at what the research actually found, its limits, and what you can do to make therapy more likely to work for you.
What does the research show?
The research shows that couples therapy reliably improves relationship satisfaction for many couples. Its effects are about as strong as those of individual therapy for individual problems.
The big picture: meta-analyses and reviews
A meta-analysis pools results from many studies to get a more reliable answer than any one study can give.
- Roddy and colleagues (2020) pooled 58 studies covering 40 samples and 2,092 couples. Over 70% of those studies had not been in earlier meta-analyses. Couple therapy had a large effect on relationship satisfaction from the start to the end of treatment. Couples randomly assigned to a waitlist did not significantly improve over the same period [1]. Therapy also improved communication, emotional intimacy and partner behaviors. Gains were generally maintained at short- and long-term follow-up.
- Lebow and colleagues (2012) reviewed a decade of research. They reported that couple therapy positively affects about 70% of couples who receive it. They described its effectiveness as comparable to individual therapies and far better than no treatment [2].
A closer look: a five-year follow-up of seriously distressed couples
Short-term results are one thing. What happens years later? One of the most useful studies followed 134 married couples, all chronically and seriously distressed, for five years after therapy [3]. Couples were randomly assigned to about eight months of either traditional behavioral couple therapy or integrative behavioral couple therapy.
- At five years, 50% of couples in integrative behavioral therapy and about 46% in traditional behavioral therapy showed clinically significant improvement in satisfaction.
- About 26% to 28% of couples were separated or divorced.
- Integrative therapy did somewhat better for the first two years. After that, the two approaches converged.
That's an honest picture. Even very distressed couples made substantial gains, and many kept them. Some couples did not improve, and some separated.
The limits of the evidence
Good evidence still has gaps, and it's worth knowing them:
- Who was studied. All the studies in the 2020 meta-analysis were of opposite-sex couples [1]. Results likely apply more broadly, but there is less direct evidence for same-sex couples.
- Research therapy vs. everyday therapy. Trials use trained therapists following a specific approach, often with supervision. Therapy in the community varies more.
- "Success" isn't always staying together. Studies usually measure satisfaction. For some couples, a good outcome is a clear, respectful decision to part.
Which approaches have evidence?
Several approaches have strong support. No single one is proven best for every couple. A 2022 review of research from 2010 to 2019 rated four approaches as "well-established" treatments for relationship distress [4]:
| Approach | Core idea |
|---|---|
| Behavioral Couple Therapy (BCT) | Increase positive behaviors and teach communication and problem-solving skills |
| Cognitive Behavioral Couple Therapy (CBCT) | Change unhelpful thoughts and behaviors that keep conflict going |
| Emotionally Focused Therapy (EFT) | Understand and reshape the emotional cycle beneath fights, drawing on attachment research |
| Integrative Behavioral Couple Therapy (IBCT) | Combine behavior change with acceptance of differences that won't fully go away |
The same review rated Insight-Oriented Couple Therapy as "possibly efficacious." It rated several shorter programs as well-established or probably efficacious: the Marriage Checkup, OurRelationship and Hold Me Tight [4].
Emotionally Focused Therapy has a large research program. Reviewers concluded it meets or exceeds the guidelines for an evidence-based couple therapy [5]. Read our explainer on Emotionally Focused Therapy.
The Gottman Method is widely practiced. It starts with a thorough assessment of the relationship and uses interventions based on the Sound Relationship House theory [6]. It grew out of John Gottman's long-running observational research on couples. See the Gottman Method explained.
The practical takeaway: look for a therapist trained in a recognized couples approach, rather than chasing one "best" model.
What predicts success in couples therapy?
Some things that predict success are outside your control. Many are not. Here's what research points to.
A strong alliance with both partners
The alliance is the working relationship between you and the therapist: trust, agreement on goals and a sense of working together. A meta-analysis of 48 studies in couple and family therapy found that stronger alliances were linked to better outcomes [7]. "Split" alliances, where one partner feels much more connected to the therapist than the other, were linked to poorer outcomes. The link was also stronger when families sought help voluntarily rather than being required to attend.
What this means for you: it matters that both of you feel the therapist understands you. If one of you feels ganged up on, say so early.
Tracking progress
In a randomized trial at a family counseling clinic, couples were assigned to usual therapy or to therapy with regular progress feedback. In the feedback group, clients and therapists reviewed short ratings of progress and of the alliance at sessions [8]. Couples in the feedback group improved more. They had nearly four times the rate of clinically significant change, and lower rates of separation or divorce at follow-up.
What this means for you: ask your therapist how you'll track whether therapy is working. Be honest when it isn't.
Commitment
In the five-year follow-up of behaviorally based therapies, higher commitment was linked to a lower chance of divorce or separation [9]. Commitment doesn't need to mean certainty. It can simply mean both people are willing to show up and try for a set period.
Starting distress doesn't rule you out
In the 2020 meta-analysis, couples who started with greater distress tended to make larger gains [1]. That's worth holding onto if you feel you've left it too late.
Getting the most from couples therapy
You can improve your odds. Most of it comes down to choosing well, showing up honestly and practicing between sessions.
- Choose a trained couples therapist. Look for a licensed clinician with specific training in a couples approach. Our guide on how to find a good couples therapist covers credentials and questions to ask.
- Agree on a goal for the first few months. "Fight less" is vague. "Talk about money without shouting" or "decide whether we can rebuild trust" gives you something to work toward.
- Speak up about the alliance. If either of you feels misunderstood or judged, raise it in session. Good therapists welcome it.
- Track progress. Ask how progress will be measured, and check in on it every few sessions.
- Do the work between sessions. Practice what you learn. A short weekly check-in at home keeps the momentum going. See how to do a weekly relationship check-in.
- Give it a fair trial, then reassess. If several months pass with no change, discuss it openly. Sometimes a different therapist or approach is the answer.
- Be honest about the big things. Affairs, addiction, money secrets and safety concerns all change the plan. Therapists can only work with what they know.
If one of you isn't sure you want to stay together, ordinary couples therapy can stall. Consider discernment counseling first. If your partner won't come at all, see what to do when your partner won't go to therapy.
When couples therapy is not recommended
Couples therapy is not the right tool when one partner is abusive, controlling or frightening to the other. The National Domestic Violence Hotline does not encourage anyone in an abusive relationship to seek counseling with their partner. It explains that abuse is not a relationship problem, and that therapy cannot fix the unequal power at its heart [10]. It also notes that an abusive partner may later use what was said in therapy against their partner [10].
If you feel afraid of your partner, contact the National Domestic Violence Hotline: call 1-800-799-7233, text START to 88788, or chat at thehotline.org. If you're unsure whether what you're experiencing is abuse, read healthy, unhealthy or abusive?
When to get professional help
If you're wondering whether couples therapy would help, that alone is a good reason to book a consultation. Strong signs include repeating fights, contempt or shutting down, an affair, addiction, depression, or one of you thinking about leaving. If you're weighing therapy against self-help, our comparison of couples therapy vs. a couples app may help. For crisis support, go to Help Now. If anyone is thinking about suicide, call or text 988.
This article is for education and is not a substitute for professional help. If you're struggling, a licensed couples therapist can help. If you're unsafe, visit Help Now.