People ask me some version of "Does couples therapy work?" on almost every first phone call. What they usually mean is, "Is this going to be worth it for us, or are we going to spend a lot of money and end up in the same place?"

Fair question. The general answer is encouraging. A 2012 review in the Journal of Marital and Family Therapy led by Jay Lebow looked back at ten years of studies and found that couple therapy helps about 70 percent of the couples who get it.

But 70 percent means some couples don't improve, and nobody wants to be in that group. So I think the better question is what's going on in the couples where it does work.

Most good approaches do the same few things

If you've shopped around for a couples therapist, you've seen the alphabet soup. EFT, Gottman, IBCT, and so on. Each one has its own book and its own training, and the well-researched ones get roughly similar results. Back in 2012, Lisa Benson, Meghan McGinn, and Andrew Christensen at UCLA went looking for the reason, and wrote it up in a paper in Behavior Therapy. They found five things the strongest approaches all do in some form.

The first is helping a couple see their problem differently. Almost everyone shows up with a version of the story where their partner is the main issue. Over time a good therapist helps you see the loop you're both in, like one of you pushing to talk and the other pulling away, and how each move sets off the next. Once you can see the loop, you can start working on it together.

The second is slowing down the stuff that makes fights worse. Sarcasm, name-calling, walking out mid-sentence. In early sessions a lot of my job is just catching those moments and pausing them.

The third one is my favorite to watch. It's getting to the feelings people have been sitting on. A lot of anger in couples is protecting something more tender, like feeling unimportant or scared of being left. When someone finally says that part out loud, the other person almost always softens. I've seen it change the temperature of a room in about ten seconds.

The fourth is practical communication. How to bring up a complaint without it landing as an attack, and how to listen when every part of you wants to defend yourself.

And the fifth is paying attention to what's still working. Most couples who come in have real strengths they've stopped noticing. A good therapist points those out and builds on them.

So if you're comparing therapists, I wouldn't get too hung up on which method is listed on their website. I'd pay more attention to whether they're doing those five things with you.

What you bring matters too

The single biggest thing is probably the relationship you both have with your therapist. A 2011 meta-analysis by Myrna Friedlander and her colleagues combined 24 studies of couple and family therapy and found that a stronger bond with the therapist went along with better results. In the smaller set of couple-only studies, that connection was a bit stronger.

In practice, that means you both need to feel the therapist is being fair. It's really common for one partner to start feeling like the therapist is on the other person's side. If that happens, say it in session. I'd always rather hear it than have someone quietly stop showing up.

Timing matters as well. A lot of couples wait until someone is halfway out the door. We can still do good work at that point, but it's an uphill climb. If you've noticed you're having the same fight every few weeks, that's a perfectly good time to come in.

Honesty is another one. If there's something active going on that your partner doesn't know about, like an affair that hasn't ended, therapy tends to stall without anyone quite knowing why. You don't have to put everything on the table in the first session. It just has to come out eventually for the work to go anywhere.

And then there's what happens between appointments. You're with a therapist for maybe an hour a week. The couples who make the most progress are usually the ones who try things out at home, even when it goes badly the first few times.

Sometimes couples therapy isn't where to start

If one of you is pretty sure you want out and the other wants to fight for the relationship, regular couples therapy can stall. There's an approach called discernment counseling that's designed for exactly that spot, and a therapist can help you figure out which makes more sense.

If either of you is afraid of the other, couples therapy may not be safe. Any good couples therapist will check on this privately, and they may suggest individual support first. If you're in danger right now, you can reach the National Domestic Violence Hotline at 1-800-799-7233.

And if one of you is dealing with something like active addiction or a serious depression, that may need its own treatment first, or at least alongside the couples work.

Common questions

How long does couples therapy take?

It depends a lot on what you're coming in with. Some couples notice a difference within a few sessions. Bigger things, like recovering from an affair, usually take longer. Your therapist should be talking with you about progress as you go, so you're never guessing.

What kind of couples therapy is best?

The well-studied approaches work about equally well. How you click with the therapist matters more.

My partner won't come. Should I go alone?

Yes, you can. Seeing a couples therapist on your own can still change things at home. Patterns take two people to keep going, so when one of you starts responding differently, the other usually has to adjust.

Can therapy make things worse?

It can feel worse for a little while, because you're finally talking about things you've both been avoiding. That's pretty normal. If it starts to feel unsafe, or like you're going in circles, bring it up with your therapist.

If you're wondering whether it could help you

Couples work is the heart of what we do at Constellation Therapy Seattle. If you and your partner have been going back and forth about whether to try therapy, book a consultation with one of our therapists. We're in Fremont on N 36th Street, and that first conversation is a low-pressure way to see if we're a good fit.