If you or your children are not safe, get help now. Visit a nearby emergency service, hospital, or police station immediately. The line listed below is a gender-based-violence line.
Crisis numbers in the United States of America
- National Domestic Violence Hotline, funded under the Family Violence Prevention and Services Act: Tel: 1-800-799-7233
What couples counseling is
Couples counselling is talking therapy for two people seen together, with the relationship itself as the work.
Approaches generally share similar features 1. The counsellor takes an active part and works on the patterns that keep a difficulty going. They build an alliance with both of you at once.
The counsellor does not take a side.
Marriage and family therapist is a state licence title, not a statement about marriage. Each state writes its own version of it. New York's covers couple, parent-child, pre-marital and other personal relationships 2.
Four names cover this work here: couples therapy, couples counseling, marriage counseling and relationship therapy. Relationship distress is an ordinary reason for adults to seek therapy 3.
How does a session with two people work?
Both partners usually attend. Sessions run about an hour, most often weekly, and most approaches expect months of work rather than a single conversation 1.
Each approach sets its own rules for contact with one partner alone. Ask in your first email how the practitioner handles a private call or message from one of you.
No one model beats the rest for relationship distress 3. Ask how a practitioner works, and whether it fits the way the two of you talk.
Who is qualified to do this work?
The United States has no national licence and no national register. Each state and the District of Columbia writes its own licensing law and keeps its own register 4.
The titles are protected state by state. The wording differs across a state line.
New York is one example, and its wording stops at the state line. There the title licensed marriage and family therapist is reserved to a person licensed in the state 2. The same Article of New York law creates and reserves the title licensed psychoanalyst 5.
A practitioner seeing couples here is most often a licensed marriage and family therapist, a licensed professional counselor, a licensed clinical social worker or a licensed psychologist. Psychiatrists are medical doctors, and the state medical board licenses them 6.
Every state and the District of Columbia licenses marriage and family therapists. The register that answers for a practitioner is their own state's board, not New York's. Check them there, then ask about experience of seeing two people together.
Titles you will see include Licensed Psychologist, Licensed Clinical Social Worker and Licensed Marriage and Family Therapist.
How couples counsellors charge
You will have to ask. Each practitioner sets their own fee.
Ask the session length and the fee for two people, often a longer session than an individual one. If the two of you are in different places, ask whether they see couples online.
Where TherapyRoute publishes a cost guide for this country, the country page links to it.
Is couples counselling the right first step?
Joint sessions are not always the right first appointment. A careful practitioner screens before agreeing to see you together. The usual reasons are moderate to severe aggression between partners, active alcohol or other substance misuse, a continuing affair, and psychotic symptoms 1. Individual or specialist treatment comes first.
Couples sessions require safety. If one of you is afraid of the other, that is a safety question first. Going alone is a sensible beginning, not a sign you have given up on the relationship.
Couples counseling across the United States
A listing spelled counselling rather than counseling is the same work.
If nobody listed here can see you soon, widen the search. The country page and sessions online are the route, rather than a second town.
Frequently Asked Questions
What does couples therapy cost in the United States?
Our guide to what therapy costs in the United States sets out the usual ranges; ask each practitioner what a couples session costs.
Each state licenses practitioners and sets what they may do7. The titles whose fees you compare change at a state line.
Where a practitioner states a fee on their listing, that figure is their own. Ask before the first session. Ask too whether the fee runs per session or per person in the room.
Does couples therapy work?
Couple therapy is an effective treatment for relationship distress, and the main models reach broadly similar results3.
Behavioural, cognitive-behavioural, emotionally focused and integrative behavioural couple therapy meet the criteria researchers use for a well-established treatment8.
Those findings describe groups of couples in studies. They are not a forecast about any one relationship, and nobody listed here can promise you an outcome.
A state board licenses marriage and family therapy and the titles that go with it9. No register records the approach a practitioner works in6. The approach is a question for the practitioner. Ask a practitioner how they work with two people, and what they do when the two of you want different things.
What happens in a couples therapy session?
The practitioner works with what happens between you, not with one person's account of it.
Practice differs on what comes first. Some approaches open with a formal assessment that combines joint and individual meetings. Others use no set assessment stage1.
Most practitioners seeing couples here cannot prescribe medication. Psychiatrists, other doctors and nurse practitioners can prescribe. A few states also let psychologists with extra training prescribe.
Before you start, ask the practitioner these questions.
- Does the practitioner see each partner alone?
- How will you know the work has finished?
Will insurance pay for couples therapy?
Medicare Part B covers family counseling when its main purpose is to help with your treatment10. Medicare names marriage and family therapists among the providers it pays.
Other plans write their own rules, so ask yours whether it pays for a session with two people.
When should we go for couples therapy?
There is no threshold you have to cross first.
Distress between partners travels. It is associated with mood, anxiety and substance-use difficulties in the partners themselves, and with difficulties for children in the household1.
Couples come with a repeating argument, with an affair, with a decision about whether to stay together, and with none of those. You do not have to agree on the problem before you make contact.
If safety is the problem at home, the support section on this page carries the routes: your state, territory or tribal coalition11, and the courts12.
If the problem is safety rather than the relationship
Where there is violence or fear at home, these routes come before counselling.
The legal route is a protection order from a state, tribal or territorial court. The courts and the police of another state, tribe or territory must honour that order and enforce it 12. That holds if you leave the state you were living in.
Your state, territory or tribal coalition is the route to services near you. The federal Office on Violence Against Women runs no services of its own and points survivors to those coalitions, which connect them to local providers 11.
The Family Violence Prevention and Services Act funds shelters, those state coalitions and a national toll-free hotline 13.
Child protection is a state matter as well. The Child Welfare Information Gateway holds the reporting contact for each state's own agency 14.
Nearby places and related listings
- Couples therapists by city, the couples therapists page, not tied to a place
- Couples therapy in every United States city listed
References
[2] New York Education Law § 8403, Marriage and family therapy. New York State Senate.
[5] New York Education Law § 8405, Psychoanalysis. New York State Senate.
[6] TherapyRoute's own records.
[10] Medicare.gov, Mental health care (outpatient).
[11] Office on Violence Against Women, Resources for Victims and Survivors, US Department of Justice.
[12] 18 U.S.C. § 2265, full faith and credit given to protection orders. US Government Publishing Office.
Real choice. Authentic, independent, clinician-led care.
TherapyRoute is a clinician-led directory that champions independent practitioners who answer to you and their professional ethics. We don't take commissions, sell your data, or assign therapists by algorithm. You browse, compare, and choose.
Vincenzo (Enzo) Sinisi, Clinical Psychologist (HPCSA), Psychoanalyst (IPA/SAPA), Group Analyst (IGA)
