Couples therapy is an important tool for those who are dealing with communication problems, marital trouble, or who just want to discuss big topic issues in therapeutic environment. It helps couples talk openly about lingering feelings, bulldoze relationship roadblocks, strengthen intimacy, and grow as a unit.
Once you decide to try couples therapy, there’s another issue to think about: What’s the best couples therapy for us? What are the pros and cons of each? This is an important step, as you’ll need a therapist that dovetails well with your unique needs. But t’s easy to feel lost in a thicket of unfamiliar words describing the different types of therapy out there.
The first step? Relax. You don’t need to get too hung up on the pros and cons of couples therapy. Most therapists are versed in a variety of therapy techniques. It’s rare that a therapist exclusively adheres to a single approach — in fact, each of the therapists interviewed for this story said they draw from a mix of practices depending on the needs of the couples they work with.
“We’ve been trained on different therapies and we find that what each therapy really focuses on is useful in different situations,” says Debbie Lambert, California couples therapist and co-author, with her husband Craig, of the 2020 book The Mindful Couple. “It’s like having a larger toolbox.”
Still, arming yourselves with knowledge and understanding the differences between specific types of couples therapy can help you and your spouse get the help you need. If a therapist is certified in a certain type of therapy, it’s a sign they believe in that type of therapy and employ it in their counseling. Ultimately, however, the success of your relationship therapy depends on the couple and the therapists themselves.
“When you’re looking at a therapist or for a therapist, you want one that is just you have a good connection with and that gets good results,” Lambert says.
Here, then, a look at 10 common types of couples therapy and what each provides.
1. Emotionally Focused Therapy
Since Canadian psychologists Sue Johnson and Les Greenberg developed Emotionally Focused Therapy in the 1980s, EFT has been explored in decades of rigorous clinical research. EFT applies influential British psychologist John Bowlbly’s attachment theory — that people instinctively seek relationships for safety and comfort and follow patterns of relationship behavior learned in childhood — to couples.
As anyone who’s been in a relationship knows, people don’t respond to their partners with pure rationality. EFT aims to provide understanding of what drives our emotional responses in our relationship. “A lot of times couples want to fight about surface level things like you didn’t take the garbage out,” Florida therapist Jennifer Gigras says.
EFT usually entails a lot of conversation about the deeper meaning of emotions. “If you go into EFT, you’re going to hear a lot of, ‘so what I hear you saying is,’ and it sounds like you’re feeling this,’” California couples therapist and husband of Debbie Craig Lambert says.
EFT hinges on the hope that when couples express the underlying emotion to each other, they’ll deepen their connection and affirm the belief that the attachment is safe. “I can express my deepest fears and longings and emotions and they’re responsive to that,” Gingras says.
2. Imago Relationship Therapy
Couples who’ve benefited from Imago Relationship Therapy owe a debt of gratitude to Oprah Winfrey, who’s featured Imago on her show 17 times since the therapy’s introduction in the ‘80s. Imago arose from the marital discord between Harville Hendrix and Helen LaKelly, husband and wife therapists who wrote about repairing their relationship in the bestselling 1988 book Getting the Love You Want.
Imago concentrates on the connection between childhood experiences and adult relationships. “Imago is Latin, it means image,” Craig Lambert says. “Imago refers to the unconscious image of love that we developed in childhood. When we get married or have a significant other, we project that image. And usually that image is incorporating both the positive and the negative behaviors that we associate with love we received from our primary caregivers as children.”
Imago therapy connects formative childhood impressions with our behavior towards our partners. Imago practitioners believe our relationship with our parents informs our adult relationships. Through exploring the roots of your behavior in your relationship, you uncover underlying issues. Imago therapy views conflict as a positive. “Conflict is an opportunity for growth in the relationship,” Craig Lambert says.
If you go to go to an Imago therapist, expect a lot of back and forth talking during sessions and a lot of emphasis on listening. Lambert says people in Imago often realize that listening is a skill — and that it’s a skill they lack at first but gain over time.
“The beauty of Imago is that it kind of forces you into this really deep listening mode,” Lambert says.
3. The Gottman Method
University of Washington Professor Emeritus John Gottman applied his extensive training in mathematics and statistical analysis to his psychological research. The result was a data-driven approach to couples therapy that’s had a profound influence on decades of practice.
“The Gottman couples therapy method is a good approach for committed, long term couples, who have interests in building trust and continuing the marriage’s life,” Connecticut-based family therapist Katie Ziskind says.
Couples working with Gottman certified therapists first have to fill out an extensive assessment form that takes at least an hour and a half to fill out prior to meeting with the therapist. In the initial meetings, the therapist will continue to collect data, reflecting the deliberate, research-oriented roots of the Gottman method.
“There are very specific interventions and ways that they present information that makes it really easy to digest and present to the client,” Gingras says. “And then there’s applicable things that a client can walk out the door saying ‘Okay, I know I need to work on this.’”
4. Narrative Therapy
Narrative therapy spotlights the stories couples use to make sense of their world. We tell ourselves stories about ourselves and about others and those stories guide our behavior and decisions. Problems arise when the stories don’t conform to reality. Overly negative narratives for example, can foster self-defeating attitudes and spur bad decisions.
Narrative couples therapists try to help couples understand the stories they tell themselves about their relationship and write new stories if needed.
”A lot of times we make up a story about our relationship,” says Gingras. “So it’s about learning how to acknowledge the story that’s being told and rewrite a new story moving forward.”
5. Solution Focused Therapy
Solution focused therapy (SFT) is a means to an end. In SFT, couples come to therapy with a narrowly defined problem they work with the therapist to solve. In other words, if there are wide-reaching problems in the relationship, it might not be an ideal therapy. However, the solution-oriented conversations at the heart of SFT can have great results for couples who need help bridging a narrowly-defined difficult situation they’re facing. “[With SFT], you’re getting your clients to talk in a very solution-focused format,” Chicago family therapist Vanessa Bradden says. “And I find that to be quite empowering.”
6. Cognitive Behavioral Therapy
Cognitive Behavioral Therapy, which focuses on how thoughts influence behaviors, is a common form of therapy for individuals as well as couples. With its roots in the early 20th century and wide adoption by mental health workers, CBT is backed by extensive research.
CBT is driven by the idea that thoughts control your feelings and that feelings control your actions. If you can understand and change thoughts, you can change how you feel and how you act. In CBT therapy, therapists will first try to identify how couples think about problems and then help them learn how to change their modes of thinking. Therapists may have patients perform exercises to see how their thoughts influence their daily lives and how they can change.
“It’s about building tolerance for those differences and about building your acceptance of those differences,” Seton Hall University Professor of Psychology Corinne Datchi says. “And it’s also about building behavioral skills, like communication, problem solving, conflict management and allow the couple to remain connected to one another.”
7. Relational Life Therapy
Family therapist and author Terry Real, a specialist with men’s issues and depression, created Relational Life Therapy, which focuses on the influence traditional gender roles have on intimate relationships.
“You can imagine with men, for example, how our definition of men in our culture has created an environment that does not allow them to create intimacy and be in touch with their feelings and their emotions,” Lambert says, explaining how adhering to a traditional perception of masculinity can impede men’s ability to be connected and intimate with their partners. “And that’s what women oftentimes are asking for: deep emotional connection,” Lambert says.
8. Discernment Counseling
Discernment counseling can be viewed as a therapy of last resort. It’s meant for couples who don’t know if they should split up or stay together.
Developed by Bill Doherty at the University of Minnesota in the 2000s, it’s a brief form of therapy by definition, lasting five sessions or less. It can be used where one partner wants to end the relationship and the other hopes to preserve it. It helps couples consider all the options before they make a decision to work on it or terminate a relationship.
“Discernment counseling is really for those couples that are very ambivalent and they’re just kind of stuck in limbo,” Gingras says. “We don’t know what we really want. We don’t know if we want to stay, if we don’t know we can, we go and it’s supposed to move them towards making that decision.”
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