Central London couples therapy

What is couples therapy?

Couples therapy, relationship therapy, couples counselling, marriage guidance counselling, they’re all pretty much the same thing. A couple (usually romantically involved but not always) talk to a therapist about their relationship. Sometimes couples come at a crisis point, wanting to explore whether they should stay together or not. Other couples are clear whether they want to stay together, but want help addressing particular issues in their relationship.

The therapist doesn’t have an agenda to keep the couple together, and won’t tell them they should split up either. It’s up to the couple to make any big decisions like that; the therapist’s job is to help them communicate better about their relationship so they can decide how they want to move forward.

What happens in couples therapy?

Couples therapy starts with an initial consultation, where the therapist listens to both partners equally, to understand what they want to address in the therapy. The initial consultation is also an opportunity for the couple to ask the therapist any questions they have and get a feel for whether the therapist is a good fit for them.

After the initial consultation, sessions are usually held weekly and are 50 minutes long. The therapist will ensure that both partners get equal airspace and the focus will be whatever the couple wants to talk about.

If you’ve had individual psychotherapy before, couples therapy can feel more directive and structured. For example, the therapist may suggest particular ways for the couple to communicate with each other or may intervene if things are getting heated between the couple.

If you’re open to it and I think it would be helpful, I may give you exercises to do between sessions. These might involve solo thinking, discussing something as a couple or interacting with each other in a different way, for example.

What are common issues in couples therapy?

In my experience, the most common issues brought to couples therapy include:

• communication problems

• escalating arguments

• loss of intimacy

• parenting issues

• infidelity

• financial disagreements

• domestic abuse

• separation and divorce

• fertility issues

• division of domestic labour

• mental health concerns

• relationships with wider family

• sex-related issues

• challenges of blended families

• loss of affection or empathy.

Communication is top of my list because every couple I see has problems in their communication, and improving the couple’s communication is my priority. If the partners can communicate well, it’s much easier to address their other issues.

What is the #1 reason marriages fail?

The latest (2023) data from the Office of National Statistics shows that the top reason given for divorce in England and Wales was unreasonable behaviour. The next most common reason was that the couple had already been separated for a number of years. This doesn’t tell us a whole lot in terms of what actually caused the relationships to break down.

Divorce Online conducted their own research into reasons for divorce, which gives us more insight. They listed the top 10 reasons their clients gave for getting divorced as:

• they stopped loving each other

• one partner was bad with money

• one partner had personal problems

• lack of love and affection

• lack of sex

• lack of communication

• addictions

• abuse

• money issues

• infidelity.

What are the signs of an unhealthy relationship?

Relationships are complex; there are many ways in which they can be unhealthy. To add another level of complexity, what works for one couple might feel unhealthy to another, so we can’t be black and white about this.

Some of the signs of an unhealthy relationship that I work on in couples therapy include:

• difficulty communicating constructively and respectfully - perhaps the partners misunderstand each other a lot and get annoyed with each other based on their misunderstandings

• a power imbalance - for example, one partner may feel like a parent in the relationship, while the other feels like a child

• abuse - whether verbal, physical, emotional or sexual, abusive behaviour in any relationship needs to be taken very seriously and addressed with care before tackling other issues

• inability to compromise - relationships require give and take, and if one or both partners are unwilling to compromise, everyday decisions become battlegrounds

• lack of consideration or empathy - a loving relationship requires each partner to understand the other’s feelings and treat them with care

• extreme levels of dependence or independence - it can be tricky to get a healthy balance between your individual lives and your life as a couple

• poor conflict skills - conflicts are inevitable in every couple, so both partners need the skills to resolve disagreements without damaging the relationship

• not accepting difference - sometimes people find it hard to accept that their partner is a different person to them, with different views and different ways of doing things

• lack of attention to the relationship itself - problems will fester and intensify if either partner is reluctant to reflect on the dynamics of the relationship and discuss them as a couple.

What is the success rate of couples therapy?

Success in couples therapy can mean various different things: satisfaction with the relationship, not splitting up, positive changes in behaviour, communicating better and so on. So there isn’t a single figure I can give you for the success rate of couples therapy.

Various studies have found that a majority of people report significant improvements following couples therapy. For example, a 2016 study by Tavistock Relationships noted significant reductions in distress as well as significant improvements in relationship satisfaction. Le Bow et al (2011) reported positive impacts for 70% of people in couples therapy. Doss et al (2016) demonstrated that couples who attended relationship therapy were significantly less likely to get divorced than average.

Is couples counselling worth it?

I’ve seen many, many couples enter therapy on the point of separation then rediscover their love for each other and learn the skills to live together happily. That and the evidence above mean I can confidently say yes, couples counselling is absolutely worth it.

How much does couples therapy cost?

Couples therapy tends to be more expensive than individual psychotherapy because it requires further training and expertise.

My fees are set out in How I work. I charge just 50% for initial consultations and nothing for introductory phone calls, so you can get a feel for whether I’m a good fit for you without paying much.

Can you get free couples counselling in the UK?

Although there are a few options for free couples therapy in the UK (through the NHS and charities), these are only available if you meet particular criteria, such as one of you being diagnosed with depression or being on low incomes. The majority of people having couples therapy in the UK pay for their sessions.

Can couples therapy sessions be online?

Yes. Many of the couples who have therapy with me choose to have some or all of their sessions online. You can be together in front of the same computer, or in different locations. I know it can be hard to find a time when you can both attend in person, particularly for parents and those who travel for work.

How can you rebuild a broken relationship?

That really depends on what’s happened to “break” the relationship. I would need to hear more from you about your individual relationship before deciding how best to tackle the problems.

Some of the ways I help couples rebuild their relationships are:

• improving communication to reduce misunderstandings

• providing strategies to reduce the risk of disagreements escalating

• using techniques to find compromises that are acceptable to both

• helping them to really listen to, and understand, each other at a deeper level

• identifying and changing unhelpful unconscious dynamics

• unpicking how each partner’s family and past influences their relationship style

• putting a stop to abusive behaviour

• increasing affection and intimacy

• addressing sexual issues

• rebuilding trust following infidelity.

How long do most couples do couples therapy?

There is a lack of reliable data on how long couples go to therapy for. The American Association for Marriage and Family Therapy quotes 12 sessions as the average, with 66% completing therapy within 20 sessions. However, this may be influenced by American healthcare models, health insurance funding limits, etc.

How many sessions a couple requires depends on many things: the range of problems they are experiencing, their ability to discuss issues without becoming argumentative, whether they continue the conversations between sessions, how good they want their relationship to be before ending therapy, how open they are to change and so on.

Couples therapy tends to be shorter-term than individual therapy, as it’s more solution-focused.

I work in an open-ended way, which means couples continue with me for as long as they want to, and are free to end therapy whenever they choose. Couples typically start to see some improvement within two or three sessions.

When should a couple seek therapy?

Sooner rather than later! If you are starting to see problems in your relationship, it’s much easier to address them now than at a later point when they will be more entrenched and resentment will have built up.

Doherty et al (2021) found that couples typically start therapy together around two years after problems start to damage their relationship. It’s certainly still possible to work through relationship issues at that stage if things haven’t deteriorated rapidly. If you want until your relationship is at breaking point, all is not lost but the route back to being happy together is harder and less certain.