Marriage Counselling: A Lifeline for Relationship Distress

Marriage counselling is a talking therapy for two people in a committed relationship. A trained counsellor, psychologist, psychotherapist or family therapist works with both partners on what keeps going wrong between them, and on what each person now wants. Most of the work happens with both partners in the room.

What the practitioner is called depends on where you live. The American Psychiatric Association's patient information says family and marriage counsellors specialise in problems that come up in families and married couples, and that sessions typically focus on specific issues.¹ The number of sessions varies widely, so ask at the first contact how that counsellor usually works and roughly how long.

TherapyRoute is run by clinicians and lists therapists in more than 58 countries. This page sets out what the work involves, what the research supports, and what to check about a practitioner before you book.

What happens when you make contact

When someone asks for couple therapy, both partners typically attend most sessions.² The first call is already part of the assessment. Therapists ask whether there is a history of violence and whether the caller has safety concerns, and may see each partner separately first.²

Confidentiality between the two of you is settled early. A caller may reveal a secret such as an affair or a plan to divorce, so the counsellor sets out early whether secrets will be kept.² Practice differs between counsellors. Knowing the rule before the first session lets you decide what to say and when.

If you are frightened of your partner, or if you have thoughts of harming yourself, contact a local emergency service or one of these helplines and suicide hotlines worldwide before arranging joint sessions. Joint work is not the right first step where there is fear of violence.

Relationship distress, and where the line falls

The World Health Organization's ICD-11 requires substantial and sustained dissatisfaction with the intimate relationship before relationship distress with a spouse or partner is recorded.³ ICD-11 also notes that occasional relationship dissatisfaction and disagreements occur in most relationships.³ The threshold does not depend on how loud the arguments are. It depends on whether the dissatisfaction is sustained and affects other parts of your life.

ICD-11 also requires the dissatisfaction to disturb at least one major area of functioning: behaviour, thinking, emotion, physical health, social contact or major life roles.³ In practice that looks like:

• conflict that is constant, or withdrawal and neglect that has become the norm
• reading your partner's intentions negatively as a matter of course
• persistent anger, sadness or flatness
• pain or other physical symptoms a doctor cannot explain medically
• pulling out of social life
• work, study or caring for others starting to suffer

This is a clinical threshold, not a self-test. It is useful mainly as a picture of what a counsellor listens for when you describe the last six months.

What brings couples to counselling

An affair, or the discovery of one, is a common reason for the first call. So is a decision that has stalled: whether to move in together, whether to have a child, whether to separate. Chronic conflict about the same two or three subjects brings in couples who can predict the argument before it starts.

Drift is less obvious and also common. A public-health guide to the family life cycle notes that nurturing your relationship and your individual growth can sometimes be ignored while parenting adolescents.⁴ Neither partner decides to stop paying attention. The attention simply goes elsewhere for a few years.

Sometimes the couple is not the presenting problem at all. When a therapist suspects marital difficulties are contributing to a child's referral problem, they will arrange to see the couple without the children present.⁵ Parents often arrive at couple work through a child's difficulty rather than their own.

Does couple counselling help?

Research has consistently shown that couples therapy reduces relationship conflict and increases relationship satisfaction.⁶ That is a finding about groups of couples, not a forecast for any particular one. Counselling does not guarantee that a relationship continues, and some couples use it to separate with less damage to themselves and their children.

The wider case for making this help available rests on how common distress is. In Western cultures, about one-third to half of couples separate or divorce, and about 20 per cent of couples who stay married experience relationship distress.⁷ Figures differ by country. In Australia, about a third of marriages end in divorce, and cohabiting couples separate at three to five times that rate.⁶

There is also a physical health argument. That same review of the epidemiological research reports that people in mutually satisfying relationships have better physical and mental health than those who are distressed or separated.⁷ Longitudinal research found that less distressed and satisfied partners had better cellular immune function than partners in more distressing relationships two years later.⁸

How counsellors work

A 2022 review of research published between 2010 and 2019 rated four approaches well-established for couple relationship distress: behavioural couple therapy, cognitive behavioural couple therapy, emotionally focused therapy and integrative behavioural couple therapy.⁹ Most counsellors draw on more than one. What matters more than the label is whether the counsellor can explain how they work and whether you can settle with them.

Emotion-focused couples therapy has long been recognised as efficacious for couple distress.¹¹ Johnson and colleagues pooled the strongest trials: a 1999 meta-analysis of the four most rigorous emotionally focused therapy studies reported a 70 to 73 per cent recovery rate for relationship distress.¹⁰ Those were small, carefully selected trials, and everyday practice is messier than a trial.

Gottman-informed work leans on measurement. In a technical report he published himself, Gottman tested the Sound Relationship House scales in a first study of 51 couples, against the Locke-Wallace Marital Adjustment Test and two further established measures; two of the sixteen scales were reported as too unreliable to be used on their own.¹² If your counsellor hands you long questionnaires in the first sessions, this is usually why.

Not every approach holds up equally for couples. Some studies have concluded that solution-focused brief therapy did not produce statistically significant results for couple and family problems.¹³ A counsellor who works that way for couple distress is working outside the strongest evidence, which is worth asking about rather than assuming.

Attachment ideas run through much of this work, and they are best treated as rough descriptions. Someone with an avoidant pattern may go quiet when a conversation turns to feelings, and someone with an anxious pattern may press harder for reassurance as their partner withdraws. These are descriptions of what people do under strain, not fixed types, and they shift as the relationship changes. A counsellor who tells you which box you are in is doing less useful work than one who shows you the loop the two of you make together.

The listening exchange, step by step

One skill comes up in almost every approach, under different names. It is deliberately slow, and it is the piece most couples can practise at home.

1. One of you speaks. The other stays quiet until the end, even while disagreeing.
2. The listener then says back what they heard, in their own words, without adding their side of it.
3. The listener asks whether that was right, or whether anything was missed.
4. Only once the speaker agrees they have been understood do you swap roles.

The hard part is step two. Summarising what your partner said is not agreeing with it, and the exchange fails the moment the summary carries a rebuttal in its tone. This is straightforward when things are calm and very difficult during a fight, which is where a counsellor is useful: they stop the exchange at the point it turns and start it again.

Acceptance and compromise follow from the same ground. A workable compromise is one both of you can live with, rather than one you tolerate quietly and resent later. It is easier to reach once each of you can state the other's position accurately. Some differences never resolve. Couple work often ends with two people managing a difference well rather than agreeing about it.

Marriage counselling, couples counselling, relationship coaching

Marriage counselling and couples counselling describe the same work. The field has moved from labelling this work marital therapy to couple therapy, and couple now covers a much broader diversity of couples.¹⁴ Whether you are married, dating, engaged or living together makes no difference to what happens in the room, so choose on the practitioner rather than on the word.

Relationship coaching is a different matter. Coaching is generally goal-focused and, in most countries, is not a regulated health profession, so a coach may hold no clinical training and no registration. If either of you has a mental health condition, or if there is violence, addiction or an affair in the picture, a registered practitioner is the safer choice.

Check the title where you actually live

Who may use which title is set nationally, and the rules genuinely differ. In the United Kingdom the Health and Care Professions Council protects the titles practitioner psychologist, counselling psychologist and clinical psychologist, and keeps a register you can check.¹⁵ In the United States licensing sits with each state, and states generally require 3,000 hours of supervised experience for psychologists, at least 1,500 of them postdoctoral.¹⁶

Two consequences follow for anyone about to book. First, a title that is protected in one country may be unregulated in the next, so a credential that sounds familiar is not self-explaining. Second, the check is national: find the register or licensing board that covers your own country or state, and look the person up by name before the first session. Ask which body they are registered with, and what their registration number is. A practitioner who is registered will answer that in one line.

If one of you does not want to go

Reluctance is ordinary and usually has a reason worth taking seriously. Naming it out loud tends to work better than persuading.

• Fear of being blamed. A couple counsellor works with the pattern between two people rather than allocating fault. Say that to a reluctant partner; it is often the whole objection.
• Privacy. Talking about a marriage in front of a stranger is uncomfortable for many people. Ask about confidentiality on the first call and pass the answer on.
• Cost and time. Ask about session length, frequency, reduced fees and online sessions before ruling it out.
• Doubt that it works. The evidence above is a fair summary: helpful on average, not guaranteed.
• Nothing to fix. Where one partner sees no problem, going alone is a reasonable next move rather than a defeat.

Attending on your own is a real option. You cannot change a relationship single-handed, but you can look at your own part in the pattern, get clearer about what you want, and decide what you will do if nothing shifts. Some people return later with a partner who was willing once the therapy stopped being an accusation.

Finding a couples counsellor

You can search for marriage counselling in your own country on the TherapyRoute directory. Our guide on how to find the right therapist covers choosing between practitioners in more detail.

Four questions are worth asking before you commit:

• Which register or licensing body are you on, and under what number?
• What training have you done in couple work specifically, rather than individual therapy?
• How do you work, and what happens in a first session?
• What is your policy on seeing us separately, and on anything one of us tells you alone?

Questions people ask

How long does couple counselling take?
It depends on what you bring and how long it has been going on. Ask at the first contact how that counsellor usually works, and agree a point at which the two of you review whether it is helping.

Can it make things worse?
It can be uncomfortable. Subjects that have been avoided for years come into the room, and the weeks after a hard session can feel worse before they feel better. Tell your counsellor if that is happening rather than stopping without saying so.

What does it cost, and is it funded?
Fees and any public or insurance funding differ by country, by region and by practitioner. Ask what a session costs, whether there is a reduced-fee place, and whether any public service or medical scheme where you live contributes.

What should we avoid saying in session?
Nothing is off limits, though absolutes such as "you always" and "you never" invite a defence rather than a reply. Contempt and mockery do the most damage. If you notice yourself reaching for either, that is worth saying out loud instead.

Team TherapyRoute

References

• [1] American Psychiatric Association. What is psychiatry: types of mental health professionals. psychiatry.org/patients-families/what-is-psychiatry.
• [2] Integrative Systemic Therapy in Practice. Requests for Couple Therapy (pp 58-58).
• [3] WHO - Clinical Descriptions and Diagnostic Requirements for ICD-11 (CDDR, 2024). QE51.0 Relationship distress with spouse or partner. (pp 730-731).
• [4] HealthLink BC. The family life cycle. healthlinkbc.ca/healthwise/family-life-cycle-0.
• [5] Multisystemic Therapy for Antisocial Behavior in Children and Adolescents. Chapter 3 (pp 80-87).
• [6] Kysely et al. (2021). Couples therapy delivered through videoconferencing: effects on relationship outcomes, mental health and the therapeutic alliance. Frontiers in Psychology. frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.773030/full.
• [7] Journal of Family Therapy. Review of systemic evidence-based practices for adult-focused problems. doi.org/10.1111/1467-6427.12481.
• [8] Shrout, M. R. Close relationships, stress and health: biological pathways. pmc.ncbi.nlm.nih.gov/articles/PMC8474672.
• [9] Doss, B. D., Roddy, M. K., Wiebe, S. A. and Johnson, S. M. (2022). A review of the research during 2010-2019 on evidence-based treatments for couple relationship distress. Journal of Marital and Family Therapy. pubmed.ncbi.nlm.nih.gov/34866194.
• [10] Cain, Keenan & Rubin - Humanistic Psychotherapies: Handbook of Research and Practice (2nd ed, 2016, APA). Chapter 11 Empirically Supported Humanistic Approaches to Working With Couples and Families (pp 379-386).
• [11] Cain, Keenan & Rubin - Humanistic Psychotherapies: Handbook of Research and Practice (2nd ed, 2016, APA). Chapter 2 Effective Humanistic Psychotherapy Processes and Their Outcomes (pp 75-82).
• [12] Gottman, J. M. (n.d.). Reliability and Validity of the Sound Relationship House Scales. Self-published technical report. johngottman.net.
• [13] Meta-analysis of solution-focused brief therapy outcomes. pmc.ncbi.nlm.nih.gov/articles/PMC11683447.
• [14] The evolution of couple therapy as a discipline. pmc.ncbi.nlm.nih.gov/articles/PMC10087549.
• [15] Health and Care Professions Council. The professions we regulate: protected titles. hcpc-uk.org/about-us/who-we-regulate/the-professions.
• [16] Congressional Research Service (R43255). The mental health workforce: a primer. congress.gov/crs_external_products/R/HTML/R43255.web.html.