Every Question You Have About Couples Therapy, Answered
Many people have questions about what it is like to be in couples therapy. Below, I have answered many common questions and concerns that I have heard over the years. Keep in mind that these answers apply to standard couples therapy - weekly or biweekly therapy. Couples therapy intensives, which are days-long therapy sessions within a short time frame, would have different answers (learn more about couples intensives).
Disclaimer: This blog is educational and provides general knowledge - I am not your therapist and cannot know your specific situation, so your own experience with couples therapy may vary from what I discuss below.
How long will we be in couples therapy?
It is impossible to answer this question with an accurate answer - you might feel you have accomplished your goals in 12 sessions, or you may stay in therapy for years to really transform your relationship. The following considerations impact how long you may stay in therapy:
How long have you and your partner been together, and how long have you struggled with the issues you are bringing into therapy? Therapy is not a quick fix. If you have been together for 10 years, for instance, and you have struggled with communication for 8 of those years, keep in mind that you are probably not going to find a magic solution to your problems in one month.
The first 1-4 sessions are typically assessment sessions: your therapist needs to get to know you and your relationship history and watch the way you interact with each other before moving into interventions.
Couples with trauma histories (either individual and/or shared) can generally expect to spend more time in couples therapy than those without - especially if you have never processed those experiences together before now.
Starting therapy at a weekly frequency yields better results and can take less time than couples who start coming in at a lower frequency. It may take longer to reach your goals if you are coming in biweekly or monthly.
Finally, how willing you are to engage with the process impacts your length of time in therapy. It is more than okay to be unsure of the process and need time to build trust and safety with your therapist, but if you are unwilling to ever do things differently and try connecting in new ways, you will not make progress and may feel stuck in therapy.
Do we really need couples therapy? Who is it for?
I cannot tell you how much you really need it, but it is almost never a bad idea with a therapist who is a good fit for you (minus a few exceptions below). Do you want to feel heard and understood in a safe setting? Do you want to feel like a stronger team? Do you want to learn new skills and gain insight into why the two of you interact the way you do? Do you want to improve communication and conflict resolution? Do you want to feel more safe and secure in your relationship? If the answer to any of these questions is yes, then couples therapy is for you!
Who is couples therapy not for?
Couples therapy is generally not appropriate in the following scenarios:
an ongoing affair from either partner
an addiction (like drug or alcohol abuse) is active in one or both partners
one partner is going through severe and untreated mental illness
domestic violence/abuse is happening
It is always best to consult your individual therapist and/or prospective couples therapist to understand how their approach works and understand your specific needs if you feel like your relationship is borderline with one of these situations.
Is it true that it will get worse before it gets better?
Sort of. It is often true that you feel worse before you feel better in therapy. Why does this happen? It is because couples therapy asks you to be honest with each other, stop avoiding conflict, and quit holding back feelings. (If you had already known how to do this and had positive responses from each other while doing this, you probably would not be coming into couples therapy, so this is typical!) If you have become accustomed to withdrawing from each other, swallowing your emotions, and keeping thoughts to yourself, it is not going to feel pleasant to have your therapist guide you through sharing all of these responses with each other. The good news is, once you have started to learn how to really listen to each other and take in what your partner says, this anxiety lessens and you start to feel less fearful of what will come out of your sessions. In fact, you might start to look forward to sessions, knowing that you are entering a safe place where you will really be heard and cared for.
Are you going to tell us who is right and who is wrong?
Nope! If you are an appropriate couple for couples therapy, we are not interested in who is right and who is wrong - in fact, we do not think about your therapy that way at all. We conceptualize the pattern or interaction that happens between you as the problem, but not either one of you individually. This does not mean we will not ask you to take accountability for your actions when warranted, but we do not view one of you as “the bad guy” and cause of all your relational problems. The cycle that exists between you two and the way you interact when a triggering event pops up - this is what we want to change. (Note: This changes when we are talking about an abusive relationship and those couples are typically not appropriate for couples therapy.)
Is there even a point to trying couples therapy when all we do is fight?
If you both want to try new ways of interacting and are willing to put in effort, yes, there is a point to trying! High levels of conflict at the start of therapy do not predict how successful you will feel at the end of a round of therapy. (Side note: we also do not believe that success in couples therapy is always staying together; couples therapists are here to help figure out what is possible and healthy for your relationship, which sometimes means splitting up.)
Many people worry that intense conflict, some ambivalence, anger, and maybe even hatred make couples therapy pointless - not true at all. In fact, the one feeling that is the strongest indicator of couples therapy not helping is when one or both partners feel apathy. Once you feel apathetic and no longer care about the relationship or the therapy, then there is no point.
Two additional options if standard couples therapy does not seem like a good fit:
If you are splitting up with your partner but you are going to be coparenting, it may be valuable to seek out a therapist who can work with you both around that.
If you are unsure if you are willing to commit to new things in couples therapy and/or stay together, you can try discernment counseling sessions first.
Do we have to tell our couples therapist everything?
No, you do not have to share anything with your therapist that you are not comfortable with; in fact, I tell all of my clients we will move at a pace that respects their comfort level and we do not have to talk about topics that you do not trust me with, now or ever. However, please know that if there are major things impacting your relationship that you do not share with your therapist, we will be missing a piece of the puzzle. You may or may not feel that you are making progress toward your goals with your therapist working with an incomplete picture. More than once I have had couples not share a major incident that is impacting their connection until a little further along in the therapy - and this is perfectly okay! Just know that your therapist cannot help you with something they do not know about yet.
Is it normal to have individual sessions within couples therapy?
Yes, this is very normal. Many couples therapy models include 1-2 couples sessions and 1 individual session per partner in the assessment phase of therapy. This is to help us get to know you as a couple and as individuals. We get to build trust with you in these individual sessions and give you the space to speak about sensitive topics that might be harder to share in front of your partner. Now, it is important not to share secrets your partner does not know with your couples therapist, because your therapist cannot hold secrets from either one of you. An individual session with your couples therapist can be a great opportunity to share more about your family background and any sensitive (but not secretive) parts of your life and relationship.
Why can’t I find someone to take my insurance for couples therapy?
There are several reasons. First, many therapists are generally turning away from insurance companies (myself included) due to the poor treatment that therapists can receive from insurance companies.
Pay from insurance companies is rarely what we actually need or should command based on the years of schooling, trainings, and experience we have, nor is it enough to pay off student loan debt and pay for our own personal and business expenses.
Insurance companies also dictate the treatment we provide to our clients, may not pay us in a timely manner, and can decide after the fact that they are not going to cover a service and “claw back” that money from us.
Now, with couples therapy specifically, there are a few additional considerations that lead many to not accept insurance for this service:
Primarily, insurance does not technically cover what is truly couples therapy. In very rare cases will insurance cover the diagnosis that indicates real couples therapy, which is treating the relationship as the client. If you have successfully used insurance to pay for couples therapy, your therapist had to designate one of you as the identified client and give you a diagnosis (one that is not relationship problems) and technically treat you for that disorder with your partner present. Their treatment plan and notes have to support this course of treatment.
Additionally, the code that we use to bill this service is typically paid at a lower rate than individual therapy.
