How Well Does Couples Therapy Work?
There has been a good bit of debate in the field over whether couples therapy actually works. Many studies have shown good results for couples therapy when you compare couples receiving therapy to those who are waiting for it. However, prominant researchers like Jacobson have argued that these studies are misleading. A large number of these couples who are waiting for therapy deteriorate, with increased distress, arguments, and unhappiness. Thus, it is possible that the particular couples therapy theory being studied only helped couples stay the same or get a teeny bit better. However, when couples in treatment are compared to deteriorating couples without treatment, the couples in treatment look much better.

Jacobson and others did further studies to show this is the case. About a third, at most half, of couples report being generally happier after some kind of couples therapy, with the rest feeling about the same. While some have reached much higher numbers in terms of satisfaction, up to two thirds, they have done so by asking about satisfaction with very specific problems, as opposed to satisfaction with the marriage overall. Four year follow-ups show that, with some kinds of therapy, as many as 30% to 40% of the couples who received therapy end up divorced.

Jacobson also argues that while many kinds of treatment are effective for many kinds of people, exactly which treatment is the best one for any specific couple is very hard to determine. In general, younger couples, who are less distressed, more flexible in their gender roles, and more emotionally engaged do better in any kind of couples therapy. However, matching the right therapy to the couple in the office is not an exact science by any means.

Thus, Jacobson and other big-name researchers argue that couples therapy treatment methods should be held to a higher standard for evaluating the effectiveness of treatment, both for specific problems as well as for general marital happiness, and both for short term improvement as well as long term improvement. However, researchers like Gottman and Gurman point out that infidelity, violence, and other problems often bring couples to therapy in a state of extreme distress and crises. Most couples, when asked to trace their problems back through time, say that problems began five or six years before they finally decided to seek help. As a result, couples therapy is typically sought only by the couples in the worst shape.

Bottom Line: What this means is that couples therapy (as it stands now in the field) is really like a good cold medicine. You likely are already sick but fighting the cold when you decide to take the medicine. We will say the medicine is effective if 1) it can make the duration of your misery shorter, and 2) it has some fast-acting ingredients to bring some immediate relief. If it does these things, you'll likely take it again. However, cold medicine can not remove all symptoms; you know you'll have to tolerate some of the symptoms until the cold runs its course, and you don't expect cold medicine to prevent future colds.

Jacobson and others want to improve on the effectiveness of couples treatment, both for the short term and the long term. In our analogy, they want to produce the best cold medicine we can, one that might actually prevent future colds. Gottman and others want to focus on preventing couple distress, either by targeting it very early in its course, or by teaching couples effective and key relationship skills at the start of marriage/commitment. In our analogy, they want to prevent colds from developing by catching the early symptoms, or by innoculating you against colds, kind of like a flu shot.

So, what kinds of couple therapy are most effective?

Gottman's Sound Marital House Model de Shazer and Berg's Solution Focused Therapy Jacobson and Christenson's Integrated Behavioral Couples Therapy Johnson and Greenberg's Emotion Focused Therapy

Other links you might find interesting:
    History of Couples Therapy
    Research in Family Therapy
    Research in Couples Therapy
    Traditional Family Theory for Couples
    Allyn & Bacon Family Therapy Website - with some history of family therapy and of famous therapists, and links to web resources

See also
Jacobson, N. S., Addis, M. E. (1993). Research on couples and couple therapy: what do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61(1), 85-93

Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-Term Effectiveness of Behavioral Versus Insight-Oriented Marital Therapy: A 4-Year Follow-Up Study. Journal of Consulting and Clinical Psychology, 59(1), 138-141

Snyder D. K., Mangrum, L. F., & Wills, R. M. (1993). Predicting couples' response to marital therapy: a comparison of short- and long-term predictors. Journal of Consulting and Clinical Psychology, 61(1), 61-9.

Does couples therapy really work? The divorce rate says no, but a new breed of therapists offers hope - Time, 3/29/04

What Makes a Couple Seek Couples Therapy?
If you ask therapists what brings couples to therapy (Whisman et al, 1997), you get a number of answers:

• communication problems (87%)
• power struggles (62%)
• unrealistic expectations (50%)
• sexual problems (47%)
• lack of love (40%)
• individual problems (38%)
• affairs (28%)

If you ask which problems are toughest to treat, you find the following problems rank tops:

• lack of love
• alcoholism
• affairs
• power struggles
• individual problems
• abuse
• communication problems

If you ask which problems are most damaging, you find the following problems rank tops:

• abuse
• affairs
• alcoholism
• lack of love
• incest
• communication problems
• power struggles

If you ask couples what brought them to therapy (Doss et al., 2004), you get slightly different answers:

• emotional affection
• fears of divorce
• communication problems

While husbands and wives agree on the general reasons for coming to therapy, for the particular couple, the husband and wife seldom agree, except when the reason for seeking therapy is infidelity. Doss and colleagues (2004) also note that:

• only 10% of current marriages have sought counseling
• only 25% of couples seek therapy before divorcing
• about half of the couples who seek therapy have sought it before, and in those couples, infidelity and worries about divorce were more common
• wives tend to be more distressed than husbands when therapy begins

This is very consistent with previously published work. For the most part, few couples seek couples therapy, and the ones that do only come to therapy after marital problems have reached a crises point. Infidelity is one of the most damaging problems, and it is one of the most difficult to treat. Depression and anxiety, commonly seen as "individual problems," take a heavy toll on the marriage as well. Given that the effects of general couples therapy do not last long, couples that come to therapy may be "keeping their marriage afloat" with periodic therapy, staying just above the "divorce point" at which they would feel their relationship was so bad that they should call it quits.

As noted above though, Jacobson, Gottman, and others argue that the most effective couples therapy treatments can do more than "keep the marriage afloat."

See also:
Whisman, M. A., Dixon, A. E., & Johnson, B. (1997). Therapists’perspectives of couple problems and treatment issues in couple therapy Journal of Family Psychology, 11(3), 361-366

Doss, B. D., Simpson, L. S., & Christensen, A. (In Press). Why do couples seek marital therapy?. Professional Psychology: Research and Practice.

Whisman, M. A. (1999). Marital dissatisfaction and psychiatric disorders: Results from the national comorbidity study. Journal of Abnormal Psychology, 108(4), 701-706.

Parenting Problems ADHD Anger and Children Baumrind's Parent Typology Child Abuse resources from APA Child Abuse basic information Children and Depression Children and Web Privileges Children and Web Software Corporal Punishment in Children Dysfunctional Parents Dysfunctional Relationships Learning Disabilities Nature versus Nurture School Report 1 2 3 4 Shaken Baby Syndrome Sibling Sexual Abuse Spanking and Children Temperment and Children Violence and Children Child Focused Links Parent Focused Links Attachment Parenting Blog National Survey of America's Families - an in-depth look at differences in families and their well-being from 13 states, including low-income families National Youth Violence Prevention Resource Center Welfare, Children, and Families - from Johns Hopkins University Teen Pregnancy: Putting What Works to Work

Intimacy and Sex
Infidelity

Cohabitating and Marriage Issues
Dating at the Office
Cohabitating Couples
Gender Issues in Straight Couples
Work with Gay and Lesbian Couples
Deciding About Marriage

Links
The Life-Cycle Of Familial Relationships - info on cohabitation and marriage, and the satisfaction of couples
Report of estimates by marital status for selected health conditions (PDF) based on the 1999-2002 National Health Interview Surveys (NHIS)
The National Marriage Project - the site appears to be balanced and fair in its views, and includes papers such "Marriage & Family: What Does the Scandinavian Experience Tell Us?" and "Sex Without Strings Relationships Without Rings" and "Top Ten Myths of Divorce, 2001"
Alternatives to Marriage Project - a site featuring thoughtful analysis and statistical data regarding our ideas about marriage
The Current State of Marriage and Family - pages on cohabitation, marriage, and divorce from DuQuesne University

Better Couple Functioning
    Communication
    Cultural Clashes
    Family Dynamics
    Healthy Couples

Stress
    Reducing Stress
    Sleeping Better
    Time and Technology
    Reflective Happiness

Substance Abuse and Families 1 and 2

Thoughts of Divorce
General Divorce Points

Marriage and Divorce Module:
Marriage and Divorce
When Divorce Is Inevitable
Telling the Children
Divorced Mothers
Divorced Fathers
Children of Divorce and Adjustment
Step-Families: When Families Mend

You can also take a Marriage and Divorce Questionnaire

Divorce: why it happens, when it happens, and what to do about it

Consequences of Parental Divorce: Some of what we know about adults who come from divorced families

There are several books you may be interested in reading as well in our Book Review section

Remarried/Step-Families

What We Know About Remarriage and Step-Families Cohabitation, Marriage, Divorce, and Remarriage from    the CDC Step-Families: When Families Mend

Book Reviews
Economic Models of Parenting: Family Investments in Children's Potential: Resources and Parenting Behaviors That Promote Success

Review of Why You Should Give A Damn About Gay Marriage - by Davina Kotulski, Ph.D.

Discipline Without Shouting or Spanking

To Spank or Not To Spank: A Parents' Handbook

The Case for Marriage: Why Married People Are Happier, Healthier, and Better off Financially

Couples on the Fault Line

Book Review Why Marriages Succeed or Fail: And How You Can Make Yours Last