Types Of Couples Therapy: 15 Effective Techniques & Activities

Using online therapy and virtual counseling^[1] has become increasingly popular since the onset of the global pandemic, COVID-19. Couples need to know what type of help to seek. Relationships inherently come with individual and combined stressors which may have only increased in the shadow^[2] of the pandemic.

Here, we explain the most effective therapy techniques and methods and highlight some exercises couples can use outside counseling to strengthen their relationships^[2]. Though no one type is considered “the best couples therapy”, the following techniques have empirical evidence supporting their abilities to create positive effects.

5 Therapeutic Methods

First, a clarification, counseling is a broader category of treatment than therapy. Counseling is a setting in which therapy may or may not take place such as counseling with a religious leader or mediation with a lawyer. Therapy is the administration of a specific therapeutic method chosen by someone who has a license in a specialized area of mental health. 

Many therapy methods, which you can explore in Clinical Handbook of Couple Therapy, Fifth Edition^[4], have been proven to be efficacious in specific situations such as substance abuse, personality^[5] disorders, infidelity, and more. These five therapeutic methods have evidence of positive results for couples in distress.

The Gottman Method

Dr. John Gottman spent over 4 decades performing research, developing, and perfecting The Gottman Method^[5]. This is an emotion-centered and therapeutic approach that integrates many theories, including behavioral, emotional, and others to address the conflict between two people. 

This approach guides therapy couples in developing skills to solve problems in order to improve communication skills, intimacy, flexibility, and emotional stability.

Gottman intended his form of therapy to include levels a couple should work through when in counseling. Gottman’s “Love Maps” structure guides the couple to slowly rebuild the basics of the relationship first. 

Starting with fostering an awareness of the inner world of each other, then culminating in healthy intimacy within relationships, The Gottman Method has proven effective^[6] for improving marital relationships, compatibility, and the intimacy of the couple.

Emotionally Focused Therapy

Emotionally Focused Therapy^[7] (EFT) is, as its name implies, an emotion-centered approach surrounding ideas of insecurity and attachment. One or both individuals within a marriage or other relationship may have attachment insecurities. 

Therapists help the couple identify negative thoughts, and the root of the insecurity to help them change unhelpful patterns of interaction. This helps partners feel an increase in emotional security and closeness.

In a meta-analysis^[8] of 9 studies evaluating EFT, findings indicated improved marital satisfaction and communication both in the short-term and long-term. Also positively affected was sexual satisfaction^[9] (physical and emotional), as well as infertility^[10]-related depression, anxiety, and stress. 

Sexual^[11] issues can significantly impact any couple. Integrating both medical and psychological approaches has been shown to produce the best results. In fact, by combining EFT and some sex therapies (from a qualified sexologist or therapist), relationship satisfaction could be significantly improved.

Behavioral Couples Therapy 

Behavioral Couples Therapy^[12] is an integrative, cognitive, and behavioral approach that is based on the presence of a feeling of relationship injustice. The goal^[13] of BCT is to increase positive interactions, decrease negative behaviors, and give partners the communication and negotiation skills to balance the scales of justice they feel have been tipped.

In a counseling session, the couple’s therapist elicits each partner’s personal feelings, provides helpful coaching, and engages in behavior-shaping and reinforcing processes to slow the progression of potential oncoming problems. Digging into the heart of each partner’s humanity, emotions, and sense of intimacy, trust, and security enlightens individuals to know each other on a deeper level. Some common BCT types include group behavioral couples therapy, cognitive behavioral couples therapy, Imago relationship therapy, and narrative therapy.

When researched and reviewed, it has been shown to improve communication skills in both the short-term and long-term.

Specific types of BCT with empirical evidence include:

• Group Behavioral Couples Therapy^[14] – BCT in a group setting – effective for treating addictions^[15]
• Standard Behavioral Couples Therapy^[16] – BCT in a standard 2-person couple setting – effective with couples experiencing relationship distress
• Integrative Behavioral Couples Therapy^[17] – BCT that integrates acceptance and change – effective with partners experiencing violence-related^[18] distress
• Cognitive Behavioral Couples Therapy^[19] – BCT with an additional cognitive perspective – effective with partners experiencing numerous factors both within and outside the relationship
• Imago Relationship Therapy^[20] – CBCT that focuses on changing behaviors, thoughts, and interactions – effective when combined with other methods of therapy when empathy is missing
• Narrative Exposure Therapy^[21] – CBCT focuses on narrating through memories of trauma – effective when PTSD is experienced by someone in the couple

Cognitive Restructuring

Cognitive Restructuring is a method that brings awareness of negative cognitions, creates an accurate valuation of them, and replaces them with appropriately adaptive thoughts, valuations, and beliefs. This approach is highly collaborative and focuses on creating personal and relationship goals.

In a medically reviewed study, cognitive restructuring was used as an intervention for people diagnosed with OCD^[22]. By teaching a strategy to actively question compulsions and intrusive thoughts, participants with OCD showed significant improvement over their ability to control appraisals of and reactions to disruptive thoughts.

In couples counseling, CR can be used to teach a partner, husband, wife, or significant other the same active questioning methodology to practice for times when disruptive thoughts about the relationship impact one’s behavior within it. 

People who tend to perceive hostility even when none is present can benefit from a treatment variant called Imagery Enhanced Cognition (ICR^[23]), which uses imagery in combination with CR to have an even greater effect.

Schema Therapy

Childhood experiences have long been known to affect people’s psychological health into adulthood and throughout life. Schema Therapy^[24] (ST), based upon that understanding, aims to address interpersonal problems by first bringing clients awareness of their maladaptive schemas. 

In ST, couples therapists encourage couples to dig down deep and talk about the multisensory details, feelings, beliefs, etc., that are entrenched within each individual’s “inner world.” In this way, each partner in the relationship will more fully understand the other’s schema.

Jeffrey Young, an enormous contributor to the development of ST, holds that schemas fall within 5 basic categories:

• Connection and Acceptance
• Autonomy and Performance
• Realistic Limits
• Inner Directedness and Self-expression
• Spontaneity and Pleasure

Upon research of peer-reviewed studies, the authors of Schema Therapy with Couples concluded that ST not only guides therapists and counselors in the best direction for each couple’s relationship struggles; it can also lead to “immediate gains in couple sessions.”

A therapist may invoke imagery of childhood experiences, talk with a client about how that relates to current maladaptive behavioral patterns, guide the client through limited re-parenting, and work with the couple to include that information in the context of their relationship in the future.

10 Exercises And Activities

Couples can benefit from implementing these strategies as they continue to improve their relationship.

Create A Joint Commitment

Not only is it crucial to decide as an individual to commit to the couple and put it into practice, it is also powerful to state that commitment to one another and create a joint commitment to the relationship.

Create An Emotionally Safe Environment

No one likes to be blindsided. Creating a specific structure to guide conversations between individuals can go a long way toward making those conversations productive and positive. 

Setting up a structured counseling maintenance^[25] meeting for the couple to continue practicing skills learned in therapy sessions can go a long way toward providing emotional safety, fostering closeness, and creating deeper connections within the relationship.

If each person decides to put forth a personal best effort to focus on an emotionally difficult conversation calmly and supportively while providing reassurance and understanding, that sets a strong home base for dealing with future difficulties that come in life.

Turn Difficulties Into Opportunities. 

Einstein once said, “In the middle of every difficulty lies an opportunity.” In this context, it is up to each partner to take the opportunity to show her/his commitment to the relationship by focusing on doing everything she can to work toward a healthy relationship. 

It is far too easy for us as individuals to focus on our partners when trying to figure out what has gone wrong in a relationship. It is too easy to see everything the other partner hasn’t done or has forgotten to do. A relationship will rarely survive when each person in it is carrying the weight of everything else the other “should” have done.

Assuming positive intent from one another, each partner should work to dispel tendencies to hear or believe negative intentions from the other. Couples counseling can help lay the groundwork for how to work toward this. When each person can see the other giving full effort, it strengthens the relationship. 

Some may think it’s the other’s turn to give full effort if they have been pulling the couple along for a while. However, as Joseph Joubert wrote, “A part of kindness consists in loving people more than they deserve.” Putting that into action will develop fondness and admiration between the couple in a fresh way.

Create Purposefully Positive Experiences.

Typically, people in couples counseling are there because of an unhappy relationship. When couples begin counseling, it can be easy to stay focused on negative behavior patterns that need to be worked on. However, that is not going to foster emotional connection within a marriage and family, and it won’t improve partner communication skills either.

Again, it is important to actively decide to set “the hard stuff” aside for a specific time the couple decides upon. That way, neither is going to bring it up spontaneously, and neither has to worry about it being brought up unexpectedly like that. Couples can be more relaxed in each other’s presence in this way, and a clear message is sent that this purposefully positive time is a priority.

Set Common Goals.

Each partner has individual goals in life. When each partner’s goals get support from the other partner, they begin to fuse into goals important to both people in a marriage or relationship.

When people create goals for their own relationships within the setting of couples counseling, the counselor can remind the couple to keep accountable to those goals, which will likely lead to less future conflict.

Meeting goals means an opportunity to celebrate together. Missing goals means an opportunity to set new goals with each other and acknowledge each other’s efforts.

Stop Substance Abuse.

Alcohol and substance abuse are known contributors to relationship distress^[26]. If one partner or both partners face addictions, discernment counseling exists that should be considered. Substance abuse must be stopped for the relationship to improve.

In marriage counseling with addiction involved, the counselor will help couples understand the impact of the addiction on not only the user but also the user’s family.  Some couples involve their families as either a preventative measure against further substance abuse or as a source of support during the recovery process.

Music/Art/Dance Therapy

Taking time to do something fun together is likely to boost a sense of togetherness. In one study^[27], music therapy was combined with Cognitive Restructuring Therapy. Both short- and long-term positive effects were found, meaning relationship distress could be significantly reduced in couples with the use of music therapy.

Art-based^[28] therapy, when utilized with interventions such as sex therapy or emotionally focused therapy, has also anecdotally been claimed to be potentially useful for bringing couples closer together.

Physical attraction plays a part in relationships, and dancing can enhance healthy sexuality within a couple. Dance Movement Therapy (DMT^[29]) allows partners to communicate physically with one another and connect.

Contingency Contracting

As its name implies, contingency contracting^[30] involves the creation of a contract entered into by each partner in a marriage or relationship. It is a strategy used in couples counseling, marriage, and family therapists, and counseling for addictions. It has shown great benefit within the context of BCT and CBCT as well.

Creating a contingency contract can be a great way to put each partner’s expectations moving forward in black and white. That provides a solid touchstone in the future because both parties will have agreed to the positive and negative consequences for specific behaviors^[25] within it before they occur. Positive actions and efforts are recognized, which is good for each individual and the coupling unit alike.

Increase Positive Exchanges

Couples who communicate openly and positively are likely to experience healthy relationships. It can be as simple as changing the wording of a request. 

For example, “Get me the remote” is technically a demand. If that’s the method of communication received regularly, it makes sense for the speaking partner to be perceived as demanding. 

Upping the positivity can be accomplished by instead saying, “Would you mind getting me the remote?” That slight change in wording communicates respect for the other partner. It technically offers the receiving partner a choice to fulfill the request or not instead of demanding that the request be fulfilled.

Increasing positive behaviors^[25] such as this is a helpful way for each partner to show her/his willingness to put forth an effort for the betterment of the relationship.

Negotiate And Problem Solve

Problem-solving^[31] skills are of utmost importance within a marriage and family. Conflict is almost a guarantee throughout the course of life. Couples counseling or couples therapy may or may not be necessary to negotiate or problem-solve, but seeing a counselor can be helpful to show partners how to respectfully and efficiently resolve a conflict. 

Larger relationship problems may require marriage counseling so each partner feels safe to communicate needs or desires. The negotiation and problem-solving skills practiced in therapy can be implemented at home.

When two people connect and form a relationship, there are bound to be ups and downs, agreements and conflicts, strengths and pain points. That is normal. 

The exercises, techniques, and methods outlined in this article can be powerful when put into practice. Seeking professional help does not have to be scary. Couples therapy can help. 

Working in a relationship with a professional who will choose the right type of therapy for your relationship often leads to great success and happiness.

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