What happens in couples therapy: the first session and after

What is couples therapy, and what is it not?

Couples therapy makes the pattern between you visible, and nobody establishes who started it. I do not tell you which of you is right.

• The pattern. One raises a problem, the other hears an accusation, the first pushes harder because they feel unheard, and you are both somewhere you have been many times before.
• The work. You interrupt that sequence slowly enough for each of you to see your own part in it, then practise something different while somebody is in the room to help.
• A skill. It is closer to learning a skill than to being assessed.
• No view on staying. I do not have a view on whether you should stay together.
• Deciding as well as repairing. Some couples use the work to test whether the relationship carries what each of them needs, and some use it to separate without destroying what is left.

If you are unsure about staying together, say so in the first session, because it changes what the work is for. Read more about falling out of love and divorce therapy.

What happens in the first session?

The first session is mostly listening. A couples session with me lasts 2 hours, which is long enough to get past the opening argument and into whatever sits underneath it.

• Why now. I ask what brought you here now, and something usually did.
• What each of you wants. I ask each of you, in front of the other, what you want to be different, and the answers are often further apart than couples expect.
• Before the argument. I ask what happens just before an argument starts, and what each of you does first.
• What you have tried. I ask what you have already tried, including the things that worked for a while.
• The unsaid. I ask whether anything is currently unsaid that would change the work if it came out.
• What I noticed. Towards the end I say what I have noticed: the sequence you seem to repeat, and where in it there is room to do something else.

You also get a sense of whether you want to work with me. Read more about finding the right therapist.

What happens in the room when an argument starts?

I slow the argument down, because it shows me the thing you came about. That is far more useful to me than a careful description of it afterwards.

• You speak to me first. Couples who begin by speaking to each other often begin by arguing.
• Then to each other. Later I ask you to turn and say something directly to your partner, usually a sentence more honest than the one you would normally use.
• I interrupt. I stop a familiar sequence before it completes, so that everyone in the room looks at what just happened, and you are allowed to interrupt me too.
• At slow speed. What did you hear just then, what did you mean, and what happened in your body before you answered?
• The past. Your childhood comes in only where the past is doing something in the present, such as one of you going silent under pressure since long before this relationship.
• An affair. The order of the work changes: the person who was deceived needs to know what happened, and the person who deceived them wants to move on faster than is possible.

A relationship is repaired in the conversation, and the analysis of it comes second. Read more about trust in a relationship.

What if only one partner wants to come?

You start alone, because one person changing how they respond changes the system.

• Individual work about the relationship. You look at what you are contributing, what you are tolerating, what you want, and whether you have said it out loud.
• No verdict. It does not produce a verdict on an absent partner.
• The reluctant partner. Sometimes they come later, once they see that therapy is not a tribunal.
• If they never come. The work becomes about what you want to do about that.

Read more about couples therapy alone.

Does couples therapy actually work?

Research supports couple and family therapy in broad terms, and it is weaker than most websites imply about any particular method.

• The outcome research. A review of 225 outcome studies published between 2000 and 2009 concluded that the research supports claims of effectiveness, and pointed at uneven quality and a publication system that favours positive findings.
• The working relationship. Across 295 studies of adult psychotherapy, covering more than 30,000 patients, the quality of the working relationship between client and therapist was consistently associated with how well therapy went.
• Across the board. That held across countries, methods and whoever was doing the rating.
• The question to ask. Ask which school of couples therapy a person follows, and ask whether the 2 of you are able to work with this particular person.
• The title. In Denmark, psykoterapeut is not a protected title, so ask any therapist what they trained in and for how long.

Read more about whether couples therapy is worth it.

How do I ask my partner to come to couples therapy?

Say what you want, and leave out what your partner is doing wrong. An invitation that arrives as evidence of a fault lands as an accusation, and the answer is no.

• The sentence that works. “I miss you and I do not know how to get back to you.”
• The sentence that fails. “You need to deal with your anger” is heard as a summons to a trial, even when it is true.
• Make it small. One session is easier to agree to than an open-ended commitment to therapy.
• Write one sentence each. Before the first session, each of you writes down, separately, the one sentence you most want your partner to understand, and brings it along unseen.
• Review out loud. If the sessions have changed nothing at all, I say so and the conversation turns to what else might help.

If it is unable to wait, read more about acute couples therapy.

These steps fail when the invitation is heard as an accusation however you phrase it, or when your partner refuses outright. Then you come alone, and that is what the session is for.

Questions people ask

How long does a couples therapy session last?

It lasts long enough to get past the opening argument and into what sits underneath it. The current session length is on the couples therapy page.

Do both partners have to want to come?

No, one partner starts alone, and that still changes how the relationship works. Couples therapy alone is designed for exactly that situation.

Is one session to see what it is like possible?

Yes, and plenty of couples do that. One session does not resolve anything, but it tells you whether both of you are able to talk in the room, which is the thing to find out first.

Will the therapist tell us who is right?

No. I tell you what I see happening between you, which is more useful and much harder to argue with.

Is couples therapy in English possible?

Yes, I work in English and Danish. Sessions take place in the room in central Copenhagen and online.

Sources

• Stratton and colleagues, Couple and family therapy outcome research in the previous decade: what does the evidence tell us?, Contemporary Family Therapy, 2015
• Flückiger, Del Re, Wampold and Horvath, The alliance in adult psychotherapy: a meta-analytic synthesis, Psychotherapy, 2018
• Videnscenter for Psykoterapi, Hvem udøver psykoterapi?

How this article was written. I choose the subject and the angle. An AI assistant researches and drafts. Nothing is published until I have read it, corrected it and stood behind every clinical statement in it. The professional and clinical judgement is mine and mine alone.