What is Couples Therapy, Really?
Couples therapy isn’t just about fixing problems, it’s about creating a space where two people can understand each other better. Whether providing in-person or telehealth services, we’re invited into the most intimate corners of our clients’ relationships.
At its core, couples therapy helps partners improve communication, resolve conflicts, and deepen their connection. Whether working with couples on thoughtful separation or those seeking to enrich an already stable relationship, our role is to facilitate conversations and reflections that might not happen otherwise.
Assessing Couples: Beyond the Surface
A thorough assessment provides the foundation for effective therapy. Consider these best practices:
Documentation Guidelines:
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If an intake assessment has already taken place within the past 6 months, create a progress note and conduct additional assessment within that framework.
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If a client is also being seen for individual treatment, it’s generally best that couples and individual sessions do not take place on the same day.
Cultivate Curiosity from Intake: Help partners understand that listening to each other’s answers can be beneficial to the beginning of treatment. Ask them to consider:
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When was the last time I shared this part of myself/my story with my partner? When was the last time I asked them about this part of themself/their story?
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How has my partner helped me feel supported in the more challenging parts of my story? What might I need from them to feel supported as I explore these things?
Essential Assessment Questions:
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Relationship Timeline: Ask couples to walk you through their relationship story. When did they meet? What attracted them to each other? What were their major transitions and challenges?
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Current Functioning: Observe how they interact in real time. Do they make eye contact? Who speaks more? How do they handle disagreement during the session?
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Goals Assessment: What does each partner want from therapy? Sometimes discovering misaligned goals is itself revelatory.
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What has the relationship looked like in the past?
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What do they envision for the future?
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Explore oppressions/disparities of privilege and their impact on the relationship.
Intersectionality: Relationships Don’t Exist in a Vacuum
Every couple brings their unique social identities into the therapy space. A Black woman married to a white man navigates different dynamics than two women from the same cultural background. A couple with significant income disparity faces different power structures than financially equal partners.
Consider how these factors impact your couples:
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Cultural Backgrounds: Different expectations around family involvement, gender roles, or conflict expression
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Sexual and Gender Identity: Unique stressors, family acceptance issues, or legal protections
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Socioeconomic Status: Access to resources, work-life balance challenges, financial decision-making
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Ability Status: Caregiving dynamics, accessibility concerns, medical decision-making
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Religious Differences: Values conflicts, holiday celebrations, child-rearing approaches
Many clinicians report that cultural differences in conflict style are frequently misinterpreted. For example, in interfaith couples, what might appear as “avoidance” versus “aggression” could actually reflect different cultural values around confrontation versus harmony. Recognizing these differences as cultural rather than personal can transform how couples understand their interactions.
Five Approaches That Actually Work
1. Mindfulness and Affect Regulation: Finding Calm in the Storm
We’ve all seen it—the couple who arrives at session already triggered, one partner rolling their eyes while the other speaks with thinly-veiled contempt.
Couples frequently present with established trigger patterns—one partner launches into criticisms while the other shuts down. Teaching couples to recognize their physical cues (such as rushed speech or shallow breathing) helps them learn to pause before conversations escalate, creating space for more productive communication.
Try this simple intervention: When tensions rise, ask both partners to place one hand on their heart, take three deep breaths, and silently name what they’re feeling. This quick reset helps bring their nervous systems back to a regulated state where productive conversation becomes possible.
2. Tracking Interaction Patterns: Breaking the Cycle
“We keep having the same fight about nothing!”
This common complaint points to the dance couples do without realizing it. Help them see their patterns by mapping out recent conflicts.
A common pattern emerges in many couples: When one partner comes home late, the other feels ignored and makes a sarcastic comment. The late-arriving partner feels attacked and becomes defensive. This is perceived as not caring, leading to hurt and withdrawal. The first partner then feels guilty but also resentful of being “the bad guy” and distances further. By bedtime, they’re both alone and disconnected.
Once couples can name their cycle “There’s our pursue-withdraw pattern again!” they gain the power to interrupt it.
3. Psychoeducation for Mentalizing: Getting Out of Mind-Reading Mode
Many relationship problems stem from partners believing they know exactly what the other is thinking (and it’s usually something negative).
“When your partner is quiet after work, you’ve shared that you think ‘They’re annoyed with me’ or ‘They regret our relationship.’ But I’m curious, could there be other explanations for their quietness?”
By helping partners question their assumptions and consider alternative perspectives, you develop their mentalizing skills, the ability to recognize that their partner has a separate mind with unique thoughts and feelings.
It’s helpful to normalize alternative interpretations: “Many couples assume silence means anger, when often it signals fatigue, overwhelm, or just a need to decompress.”
4. Stabilizing Techniques: Creating Safety in the Room
Whether in-person or virtual, therapy requires intentional structure. Be explicit about expectations:
For telehealth sessions, it’s important to address spatial arrangements: “For couples work, being in the same physical space whenever possible helps you practice the skills we’re building in real time.”
Set clear boundaries around technology: phones away, notifications off. For virtual sessions, ensure cameras are positioned to see both partners clearly.
Explain what couples therapy is and isn’t, it’s not about determining who’s right, but understanding each person’s experience.
Many couples find comfort in knowing what to expect: “Today we’ll check in briefly, then work on the communication exercise from last week, and end with setting intentions for the days between sessions.”
5. Circular Questions: Curiosity as an Intervention
Direct questions often trigger defensiveness: “Why didn’t you call?” Circular questions invite reflection: “What do you think happens for your partner when they don’t hear from you?”
Some powerful examples:
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“If I asked your partner what they think is most challenging for you in this relationship, what would they say?”
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“When you raise your voice, what changes do you notice in how your partner responds to you?”
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“If your relationship could tell its own story, what would it say about this past year?”
These questions help partners step outside their entrenched positions and see their relationship as a system where each person influences the other.
Clinicians
Remember that theory meets reality in the messy, beautiful work of couples therapy. Be prepared for:
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The couple who spends the first 10 minutes arguing about where to sit or who should speak first
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The partner who contacts you privately after sessions with “what we didn’t get to say”
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The silent treatment that happens in real time as one partner refuses to speak
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The couple who makes significant progress, then returns to old patterns during a crisis
Your authenticity, boundaries, and clinical judgment are your most valuable tools. When you’re stuck, return to curiosity about the couple, about your own reactions, and about the patterns unfolding before you.
Reflect on your own sessions: What approaches have you found most effective in your couples work? What challenges are you facing? Seeking consultation and continuing education in couples therapy modalities can further enrich your clinical skills and effectiveness.