What happens in couples therapy?



What happens in couples therapy? For some couples it as simple as a walk on a beach. Others say that this is where relationships go to die. What really happens there? If someone asked me this question 17 years ago, when I was starting out as a couple therapist, I would talk about a safe environment and acceptance. It is true. You need a safe environment and an accepting therapist to facilitate change. That is the minimum. It will not get the job done!

If you ask me now ‘What happens in couples therapy?’, I would say ‘You either get a competent therapist or a not-so-competent one.’ There is a difference. You cannot always tell the difference in the first session or two, unless you know the telltale signs.

So, to answer the question ‘What happens in couples therapy?’ – there are two scenarios. Scenario one – a competent therapist will help move the needle forward as therapy unfolds. It will take anywhere between 6 to 12 sessions for them to complete the process. Sometimes longer. There is such a thing as a difficult case. Scenario two – an incompetent therapist will be going in circles with you, session after session. There is no end to scenario two, unless you end it.

Let us now look at what happens in couples therapy when you have a competent therapist.

1. A competent therapist will not connect with one partner better than the other.

If the therapist shows judgment and makes you feel inferior to your partner (or superior to your partner!), especially in the first session when they don’t really know the whole story, you are probably seeing an incompetent therapist. They may be a good person. However, they do not really know what they are doing as a couples therapist. Even if you were the one who felt superior, seek another specialist. You will pay for that imbalance later.

You will end up in a game of “courtroom”. Subconsciously, you will compete with your partner for the therapist’s approval. There may be a warm feeling of acceptance by the therapist when they take your side. Guess what? At the same time, your partner feels flat on the floor with someone’s foot on their chest! You are less likely to fix your relationship like that. You are more likely to grow apart and sometimes end up in a real courtroom. A first sign of a competent therapist is that they can empathize with both partners more or less equally. Both of you need to feel heard and included.

Here is the kicker – many incompetent therapists can be warm and likeable. You may leave the first session feeling that you have a safe and professional environment. Basically, you will feel good about the first session. Do not rush labelling that therapist competent though. The truth is that you will connect with most people who are truly likeable. Think of a good salesperson. They will make you feel like they are your friend. That does not mean that the person is competent in couples therapy. I will reiterate – a really likeable person who is qualified to provide couples therapy may not be competent in it. Below I describe what to look for, in addition to the person being likeable.

2. A competent therapist will structure sessions.

Seasoned couple therapists have learned how to run each session. They do not let couples fight in front of them. You can fight at home, for free!

The therapist needs to take charge and run the session. Starting from session one. They need to skillfully lead the process. You are the expert on what happens in your life. The information you provide is up to you. They are the expert on the process of couples therapy. They need to run it. So, if the therapist lets you, or your partner, run the session, they are incompetent. Again, they may be a very good person. They may be likeable. They are probably not yet competent in couples therapy.

3. A competent therapist will describe what they are doing in simple language.

You need to know what is going on. You need to understand what is happening and where the process is going. By the end of session one, a competent therapist should be able to tell you in simple terms how they will lead you through the process towards your goal. Every competent therapist does it differently. However, they need to tell you how they will approach helping you as a couple. Where they will take the case. How they are going to go about it. Imagine someone asking you “What are you doing in couples therapy?” You should be able to answer in simple language.

Let me give you an analogy. Imagine coming to a medical doctor who specializes in, let’s say, cardiology. In your first meeting you provide them with all the information about your symptoms. They get your ECG and ultrasound results. Imagine them talking to you for an hour. You really like their personality. Can you imagine coming back to that physician if you don’t know what their initial opinion is? What is the treatment plan? How will they go about it? A skillful cardiologist will give you enough information to describe it in simple terms. They will not confuse you with unnecessary details that you are not yet ready to understand. There will be no confusing language. You will probably get a good understanding of what the process looks like. Follow up meetings will provide even more clarity.

Why would you come back to a couples therapist (whose personality you liked) who did not help you understand in simple terms what the process looks like? Will you give them blind trust? You probably won’t with your physical heart and your life. Why would you do it with your emotional heart and your relationship?

4. Each session is a continuation of the previous one.

Let me explain. In the first session, a competent therapist will explain to you how they will approach your case. In session two, they start exactly where they said they would. There are exceptions. If you want to say something that you maybe forgot to say in the first session, they need to take a detour and listen to you. If you had a crisis between session one and two, they need to address it. Otherwise, they need to start moving that needle forward, like they promised they would.

One of they best ways to tell an incompetent therapist is if they start each session by asking about your week. You describe it. Then they say something smart about it, on a good day. Next week is a Groundhog Day again. How was your week? You tell. They comment. Repeat twenty to thirty weeks. Congratulations! You are going in circles. This is what happens in couples therapy if the therapist is incompetent.

A competent therapist will also check in with you about your week. They need to know if something special happened. Where you are now. There is a crucial difference though. They will not make the full session out of it! A specialist will probably summarize the first session to get back on the same page. A competent therapist will remind you about the treatment plan. They will work the treatment plan into what happened to you during the week. That happens session after session. You feel a sense of continuity. The needle is moving forward.

Do not settle for a Groundhog Day! It will probably not end as well as the movie.

5. A competent therapist will uncover and address the underlying issues.

This is an absolute must. Incompetent therapists focus on superficial issues. Competent therapists dive deeper into the underlying issues. Circling back to the original question “What happens in couples therapy?” The answer is two-fold. If everything goes well, you dive deep into the real issues. Those are the issues that create symptoms in your relationship. If things do not go well, you stay on the surface while building irritation and impatience with the process.

How does a competent therapist uncover the underlying issues? They know where to look. When you come to couple therapy as clients, your relationship is like a dark room to the therapist. An incompetent therapist will be wondering around the room looking for a switch. They may hit it eventually or not. A competent therapist knows where the typical switches are. They check those spots with purpose. A specialist is less likely to miss the signs that will lead to the underlying issues. They will probably illuminate your relationship.

What else happens in couples therapy?


Please note that some cases are so difficult that even a competent specialist may end up stuck in the process. That can happen. Psychotherapy is a very complex and sometimes uncertain matter. There are two scenarios here. Can you tell that I like scenarios? Scenario one – the therapist communicates to you that there is an impasse. You discuss options together. Scenario two – you bring it up to the therapist or discontinue treatment. If you believe you have a competent therapist who is struggling with your case, I strongly recommend bringing it up to them. Discuss it with them openly. It will feel awkward at first. You will probably be glad you did it.


Overall, there is nothing to be really afraid of in couples therapy. It is not the place “where relationships go to die!” The therapist (even an incompetent one) does not have the power to create issues that were not there in the first place. Talking about issues may uncover some unpleasant truths and feelings. That is correct. It may feel temporarily uncomfortable, especially if you have an avoidant attachment style. It could also end up being an interesting exploration, especially if the right switches light up.