6.6 When to Seek Help

“We should probably see someone.” You’ve thought it but haven’t acted. Maybe it feels like admitting failure. Maybe you’re not sure it would help. Maybe you don’t know where to start. Here’s what you need to know.

The Delay Problem

Here’s a concerning reality: couples often wait years from when problems begin until they seek professional help. Research suggests this delay averages anywhere from 2-6 years depending on the population studied.

Years of accumulating resentment. Years of entrenched patterns. Years of eroded trust.

By the time most couples reach a therapist’s office, they’re not dealing with the original problem anymore. They’re dealing with years of failed repair attempts, defensive reactions, and hardened positions.

Early intervention matters. The research is clear: couples who seek help sooner have better outcomes.

Signs You Need Professional Help

How do you know when it’s time? Research and clinical experience point to these indicators:

Gottman’s Four Horsemen Are Present

If your conflicts regularly feature:^[1]

Criticism — Attacking character rather than behavior
Contempt — Mockery, eye-rolling, disgust, superiority
Defensiveness — Denying responsibility, counter-attacking
Stonewalling — Shutting down, refusing to engage

These patterns predict relationship failure with remarkable accuracy. If they’re your norm, professional help is warranted.

The Same Fights Keep Happening

You’ve had the same argument dozens of times. Neither position has changed. You’re not resolving — you’re just repeating.

Repetitive conflict often indicates underlying issues that the surface argument doesn’t address. A therapist can help identify what’s really happening.

Emotional Distance Has Set In

You’re roommates, not partners. Conversation is logistical, not connecting. Physical intimacy has disappeared or feels obligatory. You feel lonelier with them than alone.

Trust Has Been Broken

Infidelity, significant deception, broken promises — trust violations don’t heal through time alone. They require specific repair work that’s hard to do without guidance.

Major Life Stress Is Overwhelming You

New baby, job loss, health crisis, relocation — sometimes life throws more at you than you can handle as a couple. External support helps you weather the storm without destroying each other.

One or Both Partners Are Considering Leaving

If divorce or separation is on the table, therapy offers a structured space to either repair or separate consciously.

Individual Mental Health Is Affecting the Relationship

Depression, anxiety, trauma — individual issues inevitably affect relationships. Couple therapy can address the relational impact while individual therapy addresses personal healing.

Does Couples Therapy Actually Work?

Yes. The research is robust.

The Numbers

A comprehensive meta-analysis of 58 studies found couples therapy produces large effects on relationship satisfaction — pre-to-post effect sizes of 1.12.^[2] That’s a substantial improvement.

Across different research reviews:

60-80% of distressed couples benefit from behavioral or emotion-focused approaches^[3]
Gains are generally maintained at follow-up (6 months to 2 years)^[2]
Effects are comparable to individual therapy for individual issues

Different Approaches, Similar Outcomes

Here’s something important: no single therapy approach is demonstrably superior to others.^[4]

A meta-analysis comparing Emotionally Focused Therapy (EFT) and Behavioral Couples Therapy (BCT) found no significant differences in outcomes.^[5] Both work.

What this means: the specific approach matters less than:

Finding a qualified therapist you both trust
Committing to the process
Doing the work between sessions

The Major Approaches

Emotionally Focused Therapy (EFT)

Developed by Sue Johnson, EFT focuses on attachment and emotional bonds. The goal is creating secure attachment between partners.

Research support: Pre-post effect sizes between d = 0.73 and 1.10 in randomized controlled trials. Meets criteria for evidence-based treatment.^[6]

Best for: Couples dealing with disconnection, attachment injuries, difficulty with emotional vulnerability.

What it looks like: Identifying negative interaction cycles, accessing underlying emotions, creating new bonding experiences.

Gottman Method

Based on John Gottman’s decades of research, this approach uses assessment tools and specific interventions based on the Sound Relationship House model.

Research support: Studies show significant improvements in marital adjustment and intimacy, with effects maintained at follow-up.^[7] Particularly effective for trust repair after infidelity.^[8]

Best for: Couples wanting structured, research-based interventions. Especially effective for rebuilding trust.

What it looks like: Assessment using Gottman questionnaires, learning specific skills, building friendship and intimacy systematically.

Cognitive Behavioral Couples Therapy (CBCT)

Focuses on changing thought patterns and behaviors that contribute to relationship distress.

Research support: Effect sizes ranging from d = 0.53 to 0.95 across meta-analyses. As effective as individual CBT for depression when depression affects the relationship.^[9]

Best for: Couples with clear behavioral patterns to change, co-occurring anxiety or depression.

What it looks like: Identifying unhelpful thoughts, behavioral experiments, communication skills training.

Integrative Behavioral Couples Therapy (IBCT)

Combines traditional behavioral techniques with acceptance strategies.

Research support: 71% of couples showed reliable improvement or recovery by end of treatment in a major trial.^[10]

Best for: Seriously distressed couples, especially those who’ve tried other approaches.

What it looks like: Balancing acceptance of unchangeable differences with targeted behavior change.

What Predicts Success?

Research identifies factors that predict better outcomes:^[11]

Positive Predictors

Strong therapeutic alliance — Both partners trust and connect with the therapist
Willingness to change — Openness rather than defensiveness
Lower initial conflict — Less severe problems are easier to address
Both partners engaged — Therapy works best when both participate actively
Early intervention — Seeking help before patterns calcify
Doing homework — Practicing between sessions

Negative Predictors

Severe contempt — The strongest predictor of poor outcomes
One partner already checked out — Can’t repair if someone has decided to leave
Active addiction — Needs to be addressed first or concurrently
Domestic violence — Requires specialized intervention; couples therapy alone is contraindicated
Unwillingness to examine self — Blaming only the partner

Barriers and How to Overcome Them

Research identified six categories of barriers to seeking help:^[12]

Cost

The barrier: Couples therapy is expensive, often not covered by insurance.

Solutions:

Many therapists offer sliding scale fees
Community mental health centers often provide couples services
Online options tend to be less expensive
Consider it an investment — divorce is far more costly

Logistics

The barrier: Scheduling is hard; both people need to be available.

Solutions:

Evening and weekend appointments
Online/telehealth therapy (research shows it’s equally effective)^[13]
Prioritizing it like any important appointment

Partner Unwillingness

The barrier: One partner (often the man) refuses to go.

Solutions:

Frame it as an investment in the relationship, not an admission of failure
Start with yourself — individual therapy can shift relationship dynamics
Ask what specific concerns they have and address them
Some therapists offer individual sessions first to build trust

Not Knowing Where to Start

The barrier: How do you find a good couples therapist?

Solutions: (See detailed section below)

Stigma

The barrier: Feeling like needing help means you’ve failed.

Solutions:

Reframe: seeking help is a sign of commitment, not weakness
Remember: most couples who seek therapy benefit
Consider: you’d see a doctor for a physical problem — why not a relationship specialist for a relationship problem?

Unclear Process

The barrier: Not knowing what to expect.

Solutions: (See detailed section below)

Finding the Right Therapist

What to Look For

Credentials:

Licensed Marriage and Family Therapist (LMFT)
Licensed Clinical Social Worker (LCSW) with couples training
Psychologist (PhD/PsyD) with couples specialization
Licensed Professional Counselor (LPC) with couples focus

Training in evidence-based approaches:

Gottman Method Certified Therapist
Certified EFT Therapist
Training in CBCT or IBCT

Experience with your specific issues:

If infidelity is involved, ask about their experience with it
If one partner has a mental health condition, ask about their approach

Questions to Ask

What is your approach to couples therapy?
What training do you have in couples work specifically?
How do you typically structure sessions?
What’s your experience with [your specific issue]?
How long does therapy typically last?
What do you expect from clients between sessions?

Red Flags

Takes sides or blames one partner
Has no specific training in couples work
Can’t explain their approach
Rushes to solutions without understanding the problem
Makes you feel judged

Where to Look

Psychology Today therapist finder (filter for couples/marriage)
Gottman Institute referral network
ICEEFT (International Centre for Excellence in EFT) directory
Referrals from friends or your individual therapist

What to Expect

First Session

History taking — how you met, relationship timeline
Understanding the current problem — what brings you in now
Each partner’s perspective
Assessment (some approaches use questionnaires)
Discussion of goals

Typical Structure

Sessions usually 50-90 minutes
Weekly is most common initially
Both partners attend most sessions
Some approaches include individual sessions
Homework between sessions

Timeline

Most approaches suggest 12-20 sessions minimum
Some issues resolve faster; others take longer
Progress isn’t always linear — things sometimes get harder before easier
Maintenance sessions may be recommended

What You’ll Do

Learn about your patterns
Practice new skills (communication, repair, etc.)
Have difficult conversations in a safe space
Work on issues between sessions
Track progress and adjust approach

Online Couples Therapy

Research shows telehealth couples therapy is as effective as in-person therapy.^[13]

Advantages

More accessible (no commute, easier scheduling)
Can do it from home (more comfortable for some)
Often less expensive
No childcare needed

Considerations

Need private space where you won’t be interrupted
Technology issues can disrupt sessions
Some people prefer in-person connection
Not ideal for severe crisis situations

Options

Video sessions with a private practice therapist
Platforms like BetterHelp Couples or ReGain
Some EAP (Employee Assistance Programs) offer telehealth couples sessions

When Therapy Isn’t Enough

Sometimes couples therapy reveals that the relationship shouldn’t continue. That’s not failure — that’s clarity.

Therapy Might Lead to Separation If

Core values are fundamentally incompatible
One partner is unwilling to change
Trust cannot be rebuilt
The relationship involves abuse
You’re staying for reasons other than wanting to be together

Discernment Counseling

If you’re not sure whether to work on the relationship or leave, discernment counseling is specifically designed for this. It helps partners decide which path to take rather than assuming repair is the goal.

Conscious Uncoupling

If separation is the outcome, therapy can help you end well:

Minimize damage, especially if children are involved
Process grief and loss
Learn from the relationship for future ones
Co-parent effectively if applicable

What This Means for You

Consider seeking help if:

The Four Horsemen are present in your conflicts
You’re having the same fights repeatedly
Emotional or physical intimacy has significantly declined
Trust has been broken
You’re overwhelmed by life stress
One or both of you is considering leaving

To find help:

Look for licensed therapists with specific couples training
Ask about their approach and experience
Consider online options for accessibility
Don’t give up if the first therapist isn’t a fit

What to expect:

Initial assessment and goal-setting
Learning about your patterns
Practicing new skills
Doing work between sessions
Progress that may not be linear

Reflection

Think about your situation:

Which warning signs apply to your relationship?
What barriers have prevented you from seeking help?
If you’ve considered therapy before, what stopped you?
What would need to happen for you to take the step?

One Thing to Try

Have the conversation about therapy this week.

If you’ve been thinking about it, bring it up. Not in the middle of a fight — during a calm moment.

Try: “I’ve been thinking about whether we could benefit from talking to someone. Not because we’re broken, but because I want us to be as good as we can be. What do you think?”

If your partner is hesitant, ask what their concerns are. Address them specifically. Suggest trying a few sessions to see if it helps.

The couples who thrive aren’t the ones who never need help. They’re the ones who recognize when they do — and act on it.

References

Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality and Social Psychology, 63(2), 221-233. doi:10.1037/0022-3514.63.2.221
Roddy, M. K., Walsh, L. M., Rothman, K., Hatch, S. G., & Doss, B. D. (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology, 88(7), 583-596. doi:10.1037/ccp0000514
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. doi:10.1111/j.1752-0606.2011.00249.x
Shadish, W. R., et al. (1993). The effects of family and marital psychotherapies: A meta-analysis. Journal of Consulting and Clinical Psychology, 61(6), 992-1002. doi:10.1037/0022-006X.61.6.992
Rathgeber, M., Bürkner, P., Schiller, E., & Holling, H. (2019). The efficacy of emotionally focused couples therapy and behavioral couples therapy: A meta-analysis. Journal of Marital and Family Therapy, 45(3), 447-463. doi:10.1111/jmft.12336
Wiebe, S. A., & Johnson, S. M. (2016). A review of the research in emotionally focused therapy for couples. Family Process, 55(3), 390-407. doi:10.1111/famp.12229
Nasiri, M., Abbaspoor, Z., & Golmohammadian, M. (2018). Examining the effectiveness of Gottman couple therapy on improving marital adjustment and couples’ intimacy. Iranian Journal of Psychiatry and Behavioral Sciences, 12(2), e8737. doi:10.5812/ijpbs.8737
Irvine, T. J., et al. (2024). A pilot study examining the effectiveness of Gottman Method Couples Therapy over treatment-as-usual approaches for treating couples dealing with infidelity. The Family Journal, 32(1), 51-72. doi:10.1177/10664807231210123
Fischer, M. S., Baucom, D. H., & Cohen, M. J. (2016). Cognitive-behavioral couple therapies: Review of the evidence. Family Process, 55(3), 423-442. doi:10.1111/famp.12227
Christensen, A., et al. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72(2), 176-191. doi:10.1037/0022-006X.72.2.176
Roesler, C. (2020). Effectiveness of couple therapy in practice settings and identification of potential predictors for different outcomes. Family Process, 59(2), 390-408. doi:10.1111/famp.12443
Hubbard, A. K., & Anderson, J. R. (2022). Understanding barriers to couples therapy. Journal of Marital and Family Therapy, 48(4), 1147-1162. doi:10.1111/jmft.12589
Doss, B. D., et al. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285-296. doi:10.1037/ccp0000063

This completes Module 6: Staying Together.

Go back to: Relationship Maintenance Rituals

Or start from: Module 1: Know Yourself First