Couples Therapy FAQ: Your Questions, Answered
For many couples, therapy helps. Couples therapy gives partners a shared space to work on communication, rebuild trust, or figure out where the relationship is heading, guided by a trained therapist. It works best when both partners engage in good faith and it is not the right first step when there is abuse. This page answers some of the most common questions couples ask before starting, including the ones that are harder to say out loud.
At-a-Glance: Couples Therapy
At a glance
A note on safety. If there is abuse in your relationship, couples therapy is not the right first step. Contact the National Domestic Violence Hotline at 1-800-799-7233 (text START to 88788), call 911 in immediate danger, or reach the 988 Suicide and Crisis Lifeline.
What it is
What is couples therapy?
Couples therapy is a form of therapy where partners work with a trained therapist to transform destructive conflict into productive communication, foster mutual understanding/validation/empathy, and strengthen or rebuild emotional and/or physical intimacy in the relationship. Therapists work to help reduce criticism and blame and focus instead on creating emotionally safe exchanges to understand each other, the roots of the others’ needs and collaborate on solutions. Therapists often use evidence-based approaches like the Gottman Method or emotionally focused therapy (EFT). It can help with many concerns, from communication and trust to navigating a major life change.
What's the difference between couples therapy and marriage counseling?
Couples therapy and marriage counseling are often used interchangeably. Sometimes marriage counseling focuses specifically on couples who are married or planning to marry, while couples therapy covers a broader range of relationship types and situations.
What approaches do couples therapists use?
Couples therapists most often use the Gottman Method or EFT. The Gottman Method strengthens relationships by building friendship behaviors, improving communication, managing conflict constructively, and creating shared meaning. In practice, that might look like learning to repair small ruptures instead of letting them harden, or building a shared ritual for the end of a hard day. EFT focuses on the emotional patterns that keep partners stuck, then helps them build a more secure connection underneath the pattern. In practice, that might look like naming the pursue-and-withdraw cycle that shows up in the same fight over and over, and finding what each partner actually needs when it starts.
Does it work
Does couples therapy work?
For many couples, yes. Research on couples therapy, including approaches like the Gottman Method and emotionally focused therapy, finds that a majority of couples report meaningful improvement. A 2012 review by Lebow and colleagues in the Journal of Marital and Family Therapy concluded that about 70% of couples who participated in couples therapy experienced improvement in their relationship. A 2022 comprehensive meta-analysis of EFT by Spengler and colleagues in Couple and Family Psychology found large effect sizes across randomized and controlled studies. It works best when both partners engage in good faith, and "working" can mean a stronger relationship or, sometimes, the clarity to part more healthily. It is not a guarantee, and it is not appropriate during active abuse.
Does couples therapy work after cheating or infidelity?
Couples therapy can help partners recover from infidelity when the affair has ended and both intend to work on the relationship. Therapy gives you a structured place to rebuild trust, understand what happened, and decide together whether to move forward.
Is couples therapy worth it?
Many couples find it worth the effort. It can build communication skills, surface patterns you couldn't see from inside the relationship, and prevent problems from repeating. Even if the relationship does not continue, therapy can help partners separate more amicably.
When to go
When should we go to couples therapy?
Recurring conflict, ongoing disconnection, a major transition, or wanting to strengthen your relationship are all valid reasons to start couples therapy. You do not need to wait for a crisis. Starting earlier often means fewer sessions and less to unwind.
Do we have to be in crisis, or can healthy couples go?
Healthy couples benefit from therapy too. Many use it proactively to sharpen communication, deepen connection, and build skills that help prevent future problems. Think of it as maintenance for the relationship, not only repair.
What to expect
What happens in couples therapy?
Couples therapy usually starts with an assessment and a shared set of goals. From there, sessions become more structured and focus on the skills that support those goals. Between sessions, you may have short assignments, such as a regular check-in with your partner or practicing a new communication skill.
What happens in the first session?
The first session is largely about the therapist getting to know both of you, your relationship, and what brought you in. You'll talk through your concerns, your history as a couple, and your goals for treatment. It's also a chance to start seeing whether this therapist feels like a fit.
Will we have individual sessions too?
Sometimes, depending on the therapist's approach and your goals. Some therapists meet with each partner one-on-one as part of the initial assessment to hear their perspective and history. Individual sessions can also be useful when a personal experience, trauma, or other sensitive topic could benefit from focused support before returning to joint work.
How long and cost
How long does couples therapy take?
Couples therapy often takes around 12 to 20 sessions over several months, though this varies. The approach, the complexity of your concerns, and each partner's commitment all shape the timeline.
How much does couples therapy cost?
The cost of couples therapy depends on whether you use insurance and your specific plan. At Octave, most couples-therapy clients pay an average of $32/session through insurance, 40 million Americans are in-network, and FSA and HSA are accepted. Without insurance, costs vary by provider. Exact costs vary by plan and are always confirmed before care begins.
Does insurance cover couples therapy?
Insurance coverage for couples therapy varies by plan. Some plans cover couples therapy when it is part of treatment for a diagnosable mental health condition; others do not cover couples therapy on its own. Octave can verify coverage with your insurance provider before you start.
Online vs. in-person
Is online couples therapy as effective as in-person?
Research suggests online couples therapy can be effective. A 2022 study by Kysely and colleagues in Frontiers in Psychology found comparable outcomes across relationship, mental health, and therapeutic alliance measures for couples treated via videoconferencing versus in person. Some couples find it easier to stay regulated on video. Octave offers virtual, in-person, and hybrid formats. See the in-person vs. virtual therapy page for more.
Will we break up?
Does couples therapy lead to breakup or divorce?
Therapy does not cause breakups. It can bring clarity about what is and is not working, which sometimes leads couples to decide to separate. That decision comes from you, not the therapy.
Will the therapist take sides?
A good couples therapist stays neutral and works with the relationship, not one partner against the other. Their role is to create a space where both of you feel heard and to help you understand each other more accurately.
Getting a reluctant partner to go
How do I get my partner to go to couples therapy?
If your partner is reluctant, invite rather than demand. Share why it matters to you, name what you hope to work on, and suggest starting with a single session before committing to more.
Can I start couples therapy on my own?
Yes. Individual therapy can help you understand your own needs, communication patterns, and role in the relationship. It can be a useful first step if your partner is not ready yet, and what you learn on your own often shifts the relationship as well.
When it's not appropriate (safety)
When is couples therapy not the right step?
Couples therapy is not the right first step when there is active abuse, whether physical, sexual, emotional, financial, or coercive control. Joint sessions can increase danger in an abusive dynamic, so the appropriate path is individual support and a domestic-violence resource. If you feel afraid of or controlled by your partner, contact the National Domestic Violence Hotline at 1-800-799-7233 (or text START to 88788). Untreated addiction and an ongoing, undisclosed affair are also situations where another step usually comes first. In addition, during times when there is untreated substance abuse or there are significant unsupported mental health conditions, couples therapy is unlikely to be effective without first establishing individual well-being.
Can couples therapy make things worse?
With a skilled therapist, couples therapy is structured to stay productive. Some sessions are hard, but the therapist's job is to keep the work moving forward. Couples therapy is not appropriate during abuse.
How Octave supports you
Octave's couples therapists are fully licensed, average 10+ years of experience, and draw on evidence-based approaches like the Gottman Method and emotionally focused therapy. Octave does not work with trainees or pre-licensed associates. 89% of clients report a strong therapeutic alliance with their matched provider. Most couples-therapy clients pay an average of $32/session through insurance, 40 million Americans are in-network, and FSA and HSA are accepted. Matching typically happens within one to three business days, and virtual, in-person, and hybrid sessions are available. Octave is therapy only; if your situation involves abuse, addiction, or a need for a prescriber, our Care Concierge team can help point you toward the right resources. Exact costs vary by plan and are always confirmed before care begins.
Sources
Kysely, A., Bishop, B., Kane, R. T., McDevitt, M., De Palma, M., & Rooney, R. (2022). Couples therapy delivered through videoconferencing: Effects on relationship outcomes, mental health and the therapeutic alliance. Frontiers in Psychology, 12, 773030\. https://doi.org/10.3389/fpsyg.2021.773030
Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145–168. https://doi.org/10.1111/j.1752-0606.2011.00249.x
Spengler, P. M., Lee, N. A., Wiebe, S. A., & Wittenborn, A. K. (2022). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81–99. https://doi.org/10.1037/cfp0000233
