When a relationship is stuck in repeated arguments and cold wars, go to couples therapy together: waiting it out almost never fixes itself

Couples stuck in a relationship who finish couples therapy together are clearly more satisfied with the relationship; about seven tenths improve. Couples who only wait in line show basically no change. But effects fade: by year 5, about half are still clearly better, and about one quarter have already separated or divorced.

Cost

Costs money. Charged per session; fees differ by place and hospital; this item does not write figures. Studies usually go once a week; one trial ran about 8 months end to end. The hard part is that both must go and finish.

Benefit

A 2020 meta-analysis pooled 58 studies and 2092 couples. After couples therapy, the before–after change in relationship satisfaction was g = 1.12 (credible range 0.92–1.31); the authors called it a large effect. g is an effect size; see the README glossary. For couples assigned to wait, over the same period g = 0.12 (−0.04 to 0.29), with no clear improvement. Couples who started worse improved more. A 2012 review wrote that couples therapy brought improvement for 70% of treated couples. Another randomized trial took 134 couples in long-term, serious discord through about 8 months of two kinds of behavioral couples therapy. At completion, satisfaction change was d = 0.90 and 0.71. By year 5, 50.0% and 45.9% of couples in the two approaches still had clear improvement. The authors call that clear improvement “clinically meaningful improvement.” At the same time, 25.7% and 27.9% had already separated or divorced.

Notes

The controversy is how long effects last. Another meta-analysis that took only randomized trials had g = 0.60 at completion and 0.44 at six months. By 12 months only behavioral couples therapy still had data, g = 0.06 — almost none retained. Another review pooling 20 meta-analyses said clinically meaningful effects appeared in 40% to 50% of people. “Seven tenths improve” and “four to five tenths clearly improve” use different standards; do not mix them. The 5-year trial had no no-treatment control, so you cannot tell whether divorce rose or fell. The 2020 pool was all opposite-sex couples, and no domestic randomized trial was found; discount when applying this to yourself. Where to go in China: the Mental Health Law requires psychotherapy to be done in medical institutions; counseling staff may not provide psychotherapy. Ask hospital psychiatry or psychology departments whether they offer couples therapy. Outside hospitals, first ask about credentials and training. With domestic violence, do not start together. A 2016 meta-analysis said its conclusions apply only to mild-to-moderate situations where both sides hit because of conflict. Violence marked by control of the other person and serious harm is outside its scope. The field also worries about retaliation after going home from a session. If you have been hit, see Section 8, item 43 first (when you are subjected to domestic violence). How to speak when arguing is in item 17 of this section (argue about the matter not the person); thinking through whether to leave is in item 15 of this section (cost of leaving). The beneficiaries are you and your spouse.

Sources · 5

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2. Lebow JL, Chambers AL, Christensen A, Johnson SM (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145-168. doi.org/10.1111/j.1752-0606.2011.00249.x
3. Christensen A, Atkins DC, Baucom B, Yi J (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225-235. doi.org/10.1037/a0018132
4. Rathgeber M, Bürkner PC, Schiller EM, 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.org/10.1111/jmft.12336（争议方）；Shadish WR, Baldwin SA (2003). Meta-analysis of MFT interventions. Journal of Marital and Family Therapy, 29(4), 547-570. doi.org/10.1111/j.1752-0606.2003.tb01694.x（争议方）；Karakurt G, Whiting K, van Esch C, Bolen SD, Calabrese JR (2016). Couples therapy for intimate partner violence: a systematic review and meta-analysis. Journal of Marital and Family Therapy, 42(4), 567-583. doi.org/10.1111/jmft.12178
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