Valentine’s Day is all about the romantic, idealistic side of love. While it can be fun and meaningful to celebrate your relationship with your spouse or partner (if you have one), the reality is that relationships can be hard. The Hollywood, happily-ever-after ideal image of relationships makes for enjoyable movies, but it’s not realistic—in the real world it takes a lot of awareness and maturity to maintain a healthy relationship. 

Over 50 percent of marriages end in divorce, including close to 30 percent of first marriages—and the statistics are higher when one partner has a mental health condition such as bipolar disorder. So in addition to the chocolates, roses, and pretty red hearts, February might be a good time to consider whether your relationship could use some help. 

In this post I’ll demystify couples counseling by addressing the “who, what, when, where, why, and how” and help you decide if you might benefit. If you’re not in a relationship, the material may come in handy in the future or help someone you know. This article was inspired by and contains information from a continuing education seminar on couples counseling I took recently from relationship expert Jonathan Swinton. 

Who can benefit from couples counseling?

Just about anyone can benefit from couples counseling: couples who are having problems, couples who want to get their marriage off to a good start with premarital counseling, couples who want to prevent potential problems when they make a big change such as having a child. Even couples who have decided to split up can do so more amicably with the help of a professional third party. Relationships can be especially challenging when one partner has bipolar disorder—and couples counseling can help.

Although it can benefit most people, there are situations in which couples counseling won’t work or might even make things worse. These include situations where:

• There is ongoing infidelity.
• One partner has an addiction problem and refuses to get help.
• There is abuse, particularly extreme abuse with a clear perpetrator and victim (this includes emotional as well as physical abuse).

What is couples counseling like?

In some ways couples counseling is a lot like individual counseling: you talk with a trained therapist about problems you’re having, and the therapist helps. However, there are some significant differences:

• The therapist uses a systems approach. Therapists who work with couples and families are trained to understand problems from a family systems perspective—that is, the relationship dynamics among family members—rather than an individual perspective. They use theories and techniques from the field of marriage and family therapy, which can be very different from theories and techniques used in individual counseling.
• The therapist is on both sides. Whereas in individual counseling the therapist is fully supportive of the client, in couples counseling the therapist strives to find a balance between the conflicting needs and goals of each partner.
• Confidentiality works differently. In individual counseling, the therapist is required to keep what you tell them confidential. But most couples counselors have a “no secrets” policy. That means anything you tell them, for example in individual sessions or over the phone, can be shared with your spouse or partner.

When is couples counseling beneficial?

When there are relationship difficulties, couples counseling is more effective than individual counseling. That includes relationship problems related to a mental health problem—however, if the mental health problem preceded the relationship problem, it needs to be addressed through individual counseling as well.

Couples counseling is more helpful than individual counseling when there are relationship difficulties for a few reasons:

• It’s important for the therapist to get both sides of the story. If the therapist bases treatment for a relationship problem on one side of the story, it may be ineffective or even harmful—for example, the therapist might suggest a strategy that turns out to be a trigger for the other partner. Couples counseling helps both partners learn to function better as a team.
• It helps change the family system. Let’s say you have a mental health problem and are getting individual treatment. You’re resolving a lot of issues and doing well. That’s great, but members of the system you’re in may not recognize you have changed. They may keep treating you as the same person with the same problems—which can hold back your progress. Couples counseling can shift the dynamics of the system.
• It promotes accountability on the part of both partners. For example, in couples in which one partner has bipolar disorder, a dysfunctional dynamic can be created in which that partner gets the blame any time there’s a conflict. But if the person with bipolar disorder is in recovery and relatively stable, it’s likely both partners are playing a role. Such a relationship dynamic can be difficult to address in individual counseling. Couples counseling compels each person to see their part in the problem and helps the couple create a more functional dynamic (assuming both partners are willing to participate—which of course isn’t always the case).

Where does couples counseling take place?

Couples counseling usually takes place at a therapist’s office or clinic. Marriage and family therapy is the profession most closely associated with couples counseling. However, not all marriage and family therapists (MFTs) specialize in it. Other mental health professionals such as social workers (LCSWs), licensed professional counselors (LPCs, LPCCs, LCPCs, or LMHCs), and psychologists may also choose to specialize in it.

Whatever the license, be sure to find someone who is trained to do couples counseling. You can search online for someone in your area or ask your doctor or individual therapist for a recommendation. Two of the most well-known and respected leaders in the field of couples counseling are Dr. John Gottman and Dr. Sue Johnson. Depending on where you live, you may be able to find a therapist trained by one of them. You can search in The Gottman Institute’s directory or Johnson’s International Centre for Excellence in Emotionally Focused Therapy’s directory.

Why do couples counseling?

If you’re having relationship problems, there are several very compelling reasons to get couples counseling:

• Couples in healthy relationships live longer, have better physical and mental health, and report higher levels of satisfaction in their lives.
• Couples on the brink of divorce who stick it out and do the work it takes to improve their relationship have higher long-term life satisfaction than their counterparts who get divorced.
• Of troubled couples who work with a trained couples therapist, 70 percent report improvements in their relationship; of those on the brink of divorce, 75 percent are still together 5 years later.
• When a couple is having problems, they generally get worse without intervention.

Couples counseling can help you and your partner:

• Gain hope that your relationship can get better
• Improve communication
• Have more harmonious interactions and manage conflict more effectively
• Increase bonding, enjoyment, and fun
• Understand and overcome relationship stressors or triggers.

How much time and money does couples counseling take?

Time and money are two of the biggest concerns people have when choosing whether to go to couples counseling.

Time Commitment

Many couples expect immediate results from couples counseling. It’s very common for couples to quit after 2 or 3 sessions. In many cases this is a big mistake. For counseling to be effective, you have to stick it out for 3 to 6 months. You also need to commit time to doing homework assignments and practicing the skills you’re learning. When you think about what’s at stake—your marriage or partnership—a 3- to 6-month commitment to the process isn’t that long.

After your issues have been resolved, some therapists will also recommend regular “tune-up” sessions (say, quarterly or annually) as a way of maintaining the progress you’ve made and heading off potential problems.

Financial Commitment

Rates for couples counseling vary depending on geographic region, but an approximate range is $75 to $200 per session. Many couples automatically conclude they can’t afford it. While I’m sure that’s true in some cases, in many cases there are ways people can reprioritize their finances during the months they are in counseling. After all, what could be more important to spend money on than your relationship?

Using Health Insurance

A common question is whether you can use health insurance for couples counseling. This is a rather confusing and controversial issue. After reviewing a dozen or so posts by couples counseling and insurance experts, I’ll do my best to answer it.

It’s very rare for insurance companies to cover couples counseling per se. If the focus of treatment is your relationship, the diagnosis will be something like “partner relational problem.” Insurance companies base coverage on what they consider “medically necessary,” and that diagnosis usually isn’t considered medically necessary.

However, in cases in which one partner has a mental health condition such as bipolar disorder, insurers often cover couples sessions that are deemed medically necessary for that partner. For example, if relationship stress is contributing to symptoms and holding back recovery, addressing that stressor would be an important part of treatment. These sessions are called “family therapy” in insurance lingo and are considered different from couples counseling.

Unlike in couples counseling, in family therapy there is only one “identified patient.” Although you may be working on relationship dynamics, the focus of treatment is the mental health condition of the identified patient (not the relationship problem per se). Although this can be an appropriate option for some couples, there are potential problems with it. For example, the issue of who can access the medical record and authorize releases of information becomes confusing. I recommend asking your therapist the following questions so you can make informed decisions:

• Who is the client (one or both of us)?
• What diagnosis is being used and for whom?
• What are your confidentiality policies?
• Who will have rights to access the medical record and authorize releases?

Both insurance companies and therapists vary widely in their policies regarding payment for couples counseling. Some therapists require private pay for couples sessions and refuse to bring insurance into the picture—though some of them may be willing to negotiate an affordable rate. It’s important to understand your insurance benefits as well as your therapist’s policies.

Final Tips

Although couples counseling is usually effective, there are things you can do to increase the chances it will help. If you choose to go, here are some tips for getting the most out of it:

• Find a therapist you like. Up to 22 percent of the effectiveness of couples counseling is due to the therapeutic relationship. As with individual counseling, different therapists have different styles. Although it’s frustrating, you may need to visit more than one before you find a good match.
• Do the homework your therapist recommends.
• Go even if you don’t feel like it. I’ve had couples counseling myself, and it’s not exactly what I would describe as fun. It may be tempting not to show up—but try to think of it as short-term pain for long-term gain.
• Work on your end of the relationship problem and don’t blame your partner if they don’t appear to be doing as much work as you.
• Make a commitment to gaining self-awareness and resolving your own personal issues.

If you’re having difficulties in your marriage or partnership, don’t wait. Things don’t usually get better on their own. Even if you’re having mild problems, getting help now may prevent bigger ones. And if you’re planning to get married, premarital counseling can be a great way to get things off to a good start.

Here’s to happy and healthy relationships on Valentine’s Day and beyond!

You can find the rest of Carrie’s IBPF posts here or read additional articles on her Addiction.com blog. You can also visit the website for Counseling and More, her private practice, or Bipolar Beast, a company designed to empower people with bipolar disorder.