Mental Health
What Really Happens in Couples Therapy?

What Really Happens in Couples Therapy?

6 min read


Caitlin Harper

Have you ever wondered what goes on in couples therapy? Whether you already see a therapist individually and you’re wondering how it works for couples or you’re not sure what happens in therapy at all, it can be daunting to get started when we don’t know what goes on behind closed doors.

We’ve tapped our community of therapists for insight about what couples therapy is, what therapy-goers can expect when they get started, plus some anonymized examples from actual sessions so you can see the range of topics covered. Whether you’re new to therapy in general or new to couples therapy, here are a few examples of what really happens in a couples therapy session.

What is couples therapy?

“Therapy is the process in which a trained professional uses their skills and abilities to support individuals, couples, and groups in the process of healing and transition throughout the life cycle,” says Melissa Weisel. “It is a safe place where the client or clients are the focus, and their goals and wellbeing are primary, unlike most other relationships and settings.”

In couples therapy, a licensed therapist—often an LMFT, or Licensed Marriage and Family Therapist—with clinical experience working with couples helps two or more people involved in a romantic relationship resolve conflicts, work on communication skills, learn about one another’s behaviors and pasts, and overall strengthens the relationship.

“Individual therapy often answers two questions concurrently: ‘Why am I the way that I am?’ and ‘How do I want to be?’” says Aleigh Miranda. “Couples therapy often answers slightly different questions: ‘Why do we continue to get stuck?’ ‘How will we get through this?’ ‘How can we reconnect with one another?’ and at times, ‘Is this the right relationship for us?’ In our work together, we will seek out the answers to these questions and find our way to a relationship that feels intimate and loving.”

Is couples therapy only for relationships that are struggling?

This might be one of the biggest misconceptions about couples therapy and we’re happy to tell you that no, you don’t need to wait until your relationship is on the rocks to benefit from couples therapy.

“Therapy is the chance for a person, couple, or family to evaluate where they are in their lives to then have the ability to work on improving already established strengths, while also working on areas of improvement,” says Nicole Maldonado.

A therapist can help you learn more about your partner, your own needs, and how to communicate them. You’ll be able to explore things that might be present in your partner’s past that resurface in ways that might surprise both of you. Ultimately, working with a therapist can help you and your partner grow closer and more intimate together.

And if you are struggling? That’s fine too!

If there is an issue you know you want to work on, even if it’s just that you’re in a bit of a rut, therapy can provide a safe, secure container for you both to explore and a third party to help you process. Therapy can help you understand what has helped shape who your partner is today, learn what makes them tick, learn how to de-escalate if an argument does come up, learn how to share hobbies with your partner, and help you both learn how to better communicate your wants and needs.

Our relationships have a huge impact on our entire lives; if you’re experiencing relationship distress, where one or both partners are dissatisfied with their intimate relationship and that is characterized by conflict, this can result in higher levels of psychological and physical health concerns in both partners. Relationship distress and negative health outcomes are cyclical; not only does relationship distress lead to negative psychological health outcomes such as depression, anxiety, and substance abuse, it can also result from situations where couples must respond to and cope with these concerns.

If you’re truly struggling, a therapist can help. Still not sure if couple’s therapy might be right for you and your partner? This quiz can give you some insight.

How does couples therapy work?

“The therapeutic process is like a conversation,” says Linda Charlaff. “I actively take part in this conversation by listening to what you are saying and interpreting what I hear. I may offer a different point of view or help you reframe your experience in a way that is helpful to you. I will always actively listen to you and ask questions so that I can understand your experience from your perspective. In couples therapy, I will help you speak to each other and, if necessary, help you understand what you are saying to each other. I want you to both feel heard.”

Your therapist will start with some standard questions, plus gather additional background on your upbringing, family life, and the history of the relationship. They’ll help you explore and define the topic that brought you to therapy and involve all members of the relationship in the treatment planning process.

“In a couples counseling session, I want you to talk directly to your partner,” says Carol Meylan. “I also try to ensure that each of you has time to share your experience and that neither of you feels dumped on or blamed.”

A therapist will work with you on both gaining insight as to why an issue exists, but also how behaviors are going to change in order to move forward. Sometimes therapists will assign homework to complete in between sessions as well.

How long will we be in couples therapy?

Marriage and family therapists regularly practice short-term therapy—twelve sessions on average, but, as with most things in therapy, your treatment will be as unique as your life situation.

“I would recommend committing to at least six months (if meeting weekly) in order to experience some degree of lasting transformation,” says Shenell Sarwon. “However, I find that those who may have a trauma background or couples who have experienced severe relationship ruptures, such as infidelity, typically benefit most from committing to regular sessions for at least a year.”

About half of the treatment provided by marriage and family therapists is one-on-one with the other half divided between marital/couple and family therapy, or a combination of treatments.

“Sometimes people need a one-time consultation about a discrete problem,” says Carol. “But in most cases, I suggest that you commit to six to eight weekly sessions before considering extending time between sessions. In my experience, couples benefit from on-going weekly or biweekly sessions for a minimum of six months.”

What are some common topics addressed in couples therapy?

While the topics you might cover in therapy are as unique as your relationship, here are a few common areas:

  • Communication styles or breakdowns
  • Beliefs and values such as religious beliefs, family upbringing, or relationship expectations
  • Sex, intimacy, and spending time together
  • Money and finance, such as spending, saving, salaries, gambling, and more
  • Health and illness such as cancer, living with chronic illness, and mental health
  • Parenthood, children, fertility, and family planning
  • Extended family, sibling relationships, parents, and in-laws
  • Relationship roles or gender roles
  • Infidelity

Here are a few anonymized examples from couples therapy sessions

It’s important to remember that if you don’t see something that resonates with you here, that your experience and needs are still totally valid. It’s impossible to have examples of everything we might experience, and your therapist will honor your relationship and tailor your treatment to your needs. 

“A heterosexual couple came into treatment after a three years of marriage, stating that they had difficulty communicating and trusting one another,” says Lindsay McGarril. “After a few sessions, I made some direct observations that it appeared as though each of them fell into the trap of mindreading and often assumed to know what the other was thinking/feeling. They were at first surprised by my comment, but eventually admitted that this was true and that it usually led to a lot of arguments and dismissed feelings. We were able to brainstorm ways in which they could be more communicative with one another and not jump to conclusions, or take the other’s actions personally.”

“I worked with a couple that was experiencing a lot of stress in their relationship,” says Madison McCullough. “Our work together focused on creating a space where each of them committed to listening to one another. As the therapist, I held each member of the couple accountable to this commitment, and reflected back what I was observing. Through this work, we learned that they each had different expectations for each other and the relationship that were not being communicated, which resulted in arguments when those expectations were not met. This process of listening and reflecting allowed the couple to learn new things about one another and clearly articulate their needs.”

“A heterosexual couple came to therapy to work on their communication,” says Stephanie Rodriguez. “When exploring further about their communication style, they talked about ways they avoided talking about their conflicts, but then would ‘blow up over seeing a dish in the sink.’ I responded to them by saying, ‘It seems like there has been a pattern of avoidance between the two of you, but then your triggers are expressed really quickly at times. What happens after that? How would you say this way of communicating has affected your relationship?’”

Whether you’re looking to strengthen a great relationship or improve one that’s on the rocks, therapy can help

Couples therapy can help strengthen communication, increase understanding, cultivate respect, and deepen intimacy between you and your partner.

“I view my role not as expert, but facilitator in helping individuals and couples achieve improved communication and more satisfying relationships,” says Daniel Sieber.

Your therapist is there to help both of you resolve conflicts, more accurately express yourself and your feelings, and navigate any issues that might come up.

“When I work with couples,"says Carol, "it is a joy to witness conflictual partners begin to show each other appreciation and understanding.”

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About the author

Caitlin is an organizational change strategist, advisor, writer, and the founder of Commcoterie, a change management communication consultancy. She helps leaders and the consultants who work with them communicate change for long-lasting impact. Caitlin is a frequent speaker, workshop facilitator, panelist, and podcast guest on topics such as organizational change, internal communication strategy, DEIBA, leadership and learning, management and coaching, women in the workplace, mental health and wellness at work, and company culture. Find out more, including how to work with her, at

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