Ultimate Guide to Couples Counseling: How It Works

Updated: December 2025 | Reading Time: 12 minutes

If you’re considering couples counseling, you probably have questions. How does it work? What happens in sessions? Will it actually help? This comprehensive guide answers everything you need to know about couples therapy, from your first appointment to measuring success.

Whether you’re in Chicago or anywhere else, understanding the couples counseling process helps you make informed decisions about your relationship’s future.

Table of Contents

What Is Couples Counseling?

Couples counseling (also called couples therapy, marriage counseling, or relationship therapy) is a specialized form of psychotherapy where two people in a committed relationship meet with a trained therapist to improve their relationship dynamics, resolve conflicts, and strengthen their emotional connection.

Unlike individual therapy that focuses on one person’s mental health, couples counseling treats the relationship itself as the client. The therapist helps both partners understand their patterns, communicate more effectively, and develop healthier ways of relating to each other.

Who Provides Couples Counseling?

Qualified couples therapists typically hold one of these credentials:

Licensed Marriage and Family Therapists (LMFT) – Specialists in relationship dynamics
Licensed Clinical Social Workers (LCSW) – Trained in systems thinking
Licensed Professional Counselors (LPC) – With couples therapy specialization
Psychologists (PsyD or PhD) – With relationship therapy training

The most important factor isn’t the specific credential but rather the therapist’s specialized training and experience in working with couples. Many therapists receive additional certification in evidence-based approaches like Emotionally Focused Therapy (EFT) or the Gottman Method.

The 4 Core Components of Couples Therapy

While therapeutic approaches vary, all effective couples counseling includes these four elements:

1. Relationship-Focused Assessment

The therapist examines issues affecting your relationship as a unit, not just individual problems. This includes communication patterns, conflict styles, intimacy concerns, trust issues, and recurring arguments. The goal is understanding how you function together rather than identifying who’s “right” or “wrong.”

2. Collaborative Treatment

Both partners actively participate in sessions, sharing perspectives and working together toward common goals. The therapist creates a safe space where both voices are heard and validated, even when you disagree. This collaborative approach ensures neither partner feels ganged up on or blamed.

3. Solution-Focused Interventions

Couples therapy emphasizes practical solutions and positive change from the start. While understanding the past matters, the focus remains on building better patterns now and in the future. You’ll learn specific skills like active listening, emotional regulation, and constructive conflict resolution.

4. Clear Goal Setting

During initial sessions, you and your therapist establish specific, measurable objectives. These might include “reduce weekly arguments,” “rebuild trust after infidelity,” or “increase emotional intimacy.” Clear goals help track progress and determine when therapy has achieved its purpose.

What Happens in the First Session?

Many couples feel nervous about their first therapy appointment. Understanding what to expect can ease anxiety and help you prepare.

The Intake Process

Your first session (often called an intake or assessment) typically involves:

Relationship History: The therapist asks about how you met, your relationship timeline, major life events, and what brought you to therapy now. This context helps them understand your unique story.

Current Concerns: You’ll discuss the specific issues affecting your relationship today. The therapist listens to both perspectives without taking sides, helping clarify the problems you want to address.

Individual Backgrounds: Expect questions about your family of origin, previous relationships, cultural backgrounds, and personal histories. How we learned about relationships growing up significantly impacts how we relate to partners as adults.

Goals and Expectations: The therapist helps you articulate what you hope to achieve in therapy. What would success look like? What changes do you want to see?

Logistics and Boundaries: You’ll discuss session frequency, fees, cancellation policies, confidentiality limits, and communication protocols between sessions.

Determining Fit

The first session is also an opportunity for everyone to assess fit. A good therapist will be honest if they don’t feel qualified to address your specific issues. Similarly, you should feel comfortable with the therapist’s style and approach. If something feels off, it’s perfectly appropriate to seek a different counselor.

Before attending your first session, discuss with your partner what you each hope to gain from therapy. Being aligned (or at least aware of differences) in your expectations helps the process start productively.

Common Approaches to Couples Therapy

Your therapist may integrate several evidence-based approaches depending on your needs:

Emotionally Focused Therapy (EFT)

EFT helps couples understand and transform the emotional patterns underlying their conflicts. Based on attachment theory, this approach focuses on creating secure emotional bonds between partners. It’s particularly effective for couples who feel emotionally disconnected.

Gottman Method

Developed from decades of research on what makes relationships succeed or fail, the Gottman Method provides practical tools for managing conflict, increasing intimacy, and building friendship. This approach is highly structured and skills-based.

Cognitive Behavioral Therapy (CBT) for Couples

CBT helps partners identify and change unhelpful thought patterns and behaviors affecting the relationship. This approach works well for couples with specific behavioral issues or those who prefer a more educational, skill-building framework.

Imago Relationship Therapy

Imago therapy explores how childhood experiences shape relationship patterns and helps partners heal old wounds while deepening their connection. The focus is on understanding why you’re attracted to your partner and transforming conflict into opportunities for growth.

Most experienced couples therapists don’t stick rigidly to one approach but instead integrate techniques from multiple modalities based on what your relationship needs.

What Issues Does Couples Counseling Address?

Couples therapy can help with a wide range of relationship challenges:

Communication Problems

Poor communication underlies most relationship issues. Therapy teaches you to express needs clearly, listen actively, and avoid destructive patterns like criticism, defensiveness, contempt, and stonewalling (what researcher John Gottman calls the “Four Horsemen”).

Conflict and Frequent Arguments

If you’re stuck in repetitive fights about the same issues, therapy helps identify underlying patterns and develop healthier conflict resolution strategies. You’ll learn to argue constructively rather than destructively.

Trust and Infidelity

Recovering from infidelity or betrayal requires specialized support. Couples therapy provides a structured process for healing, rebuilding trust, and deciding whether reconciliation is possible.

Intimacy and Sexual Issues

Many couples struggle with mismatched desire, sexual dissatisfaction, or emotional distance. Therapy creates a safe space to discuss sensitive topics and address barriers to physical and emotional intimacy.

Life Transitions

Major changes stress relationships. Therapy helps couples navigate transitions like becoming parents, career changes, relocations, empty nest syndrome, retirement, or health challenges.

Blended Family Challenges

Second marriages and stepfamilies face unique dynamics. Therapy addresses co-parenting conflicts, boundary issues, and the challenge of integrating different family cultures.

Pre-Marital Preparation

Premarital counseling helps engaged couples start marriage with realistic expectations and essential skills. You’ll discuss finances, family planning, conflict styles, and long-term goals before saying “I do.”

Considering Separation

Discernment counseling helps couples on the brink of divorce gain clarity about whether to stay together or separate. This short-term intervention assists in making an informed decision about your relationship’s future.

How Long Does Couples Counseling Take?

This is one of the most common questions couples ask, and the honest answer is: it depends.

Typical Duration

Most couples attend therapy for 12-20 sessions over 3-6 months. However, duration varies significantly based on:

Severity of issues: Deep-rooted problems or trauma require more time than communication tune-ups
Commitment level: Couples who both fully invest progress faster
Therapy frequency: Weekly sessions produce faster results than monthly meetings
Specific goals: Premarital counseling may take 6-8 sessions, while infidelity recovery often requires 6+ months
Outside factors: Ongoing stressors can slow progress

Session Length

Standard couples therapy sessions last 50-60 minutes, though some therapists offer extended 90-minute sessions for intensive work. Frequency is typically weekly at the start, potentially decreasing to bi-weekly or monthly as progress occurs.

When Is Therapy Complete?

Therapy ends when you’ve achieved your identified goals and developed the skills to maintain relationship health independently. Some couples graduate completely, while others return periodically for “tune-ups” when facing new challenges.

How Much Does Couples Counseling Cost?

Understanding the financial investment helps you plan appropriately.

Average Costs

In Chicago and most major cities, couples therapy typically costs $150-$300 per session. Rates depend on:

Therapist credentials and experience
Geographic location (urban areas cost more)
Session length (90-minute sessions cost more than 60-minute)
Specialization (experts in specific areas may charge premium rates)

For specific fee information at Couples Counseling Chicago, visit our fee schedule page.

Insurance Coverage

Insurance coverage for couples therapy varies significantly:

What’s typically covered: Many insurance plans cover couples counseling when one partner has a diagnosable mental health condition (like depression or anxiety) that’s being addressed in the context of the relationship.

What’s often not covered: Pure “relationship enhancement” or premarital counseling without a diagnosis usually isn’t covered.

Questions to ask your insurance provider:

Does my plan include mental health or counseling benefits?
Does it cover couples counseling or marriage therapy?
How many sessions are covered per year?
What’s my deductible and copay?
Do I need a referral or pre-authorization?
Are there in-network providers, or can I see any licensed therapist?

Alternative Payment Options

Some therapists offer sliding scale fees based on income, payment plans, or package rates for multiple sessions. Many also accept HSA/FSA cards for tax-advantaged payment.

Does Couples Counseling Actually Work?

Research consistently shows couples therapy is effective for most relationships.

The Evidence

Studies indicate that 70% of couples who complete therapy report significant improvement in relationship satisfaction. Couples who engage in evidence-based approaches like EFT or Gottman Method show even higher success rates.

For a detailed exploration of outcomes and research, read our article on whether marriage counseling works and how long it takes.

Success Factors

Therapy works best when:

Both partners participate willingly: Dragging a reluctant spouse rarely produces results
You attend consistently: Skipping sessions disrupts progress
You complete homework: Practicing skills between sessions accelerates change
You’re honest: Holding back important information prevents real progress
You start earlier rather than later: Waiting until the relationship is near death makes recovery harder

When Therapy May Not Work

Couples counseling has limitations:

When one partner has already decided to leave and is just going through the motions
During active addiction without separate addiction treatment
In the presence of ongoing abuse (individual safety planning takes priority)
When partners have completely opposite goals (one wants to save the marriage, the other wants help separating)

A skilled therapist will assess whether couples therapy is appropriate or if other interventions are needed first.

Common Myths About Couples Counseling

Let’s debunk misconceptions that prevent couples from seeking help:

Myth #1: “Therapy makes things worse”

Reality: Good therapy may temporarily increase discomfort as you address difficult topics, but this is part of the healing process. Long-term outcomes show improvement, not deterioration.

Myth #2: “Therapy is only for couples in crisis”

Reality: Many happy couples use therapy for maintenance, premarital preparation, or navigating transitions. You don’t need to be on the brink of divorce to benefit.

Myth #3: “The therapist will take sides”

Reality: Ethical couples therapists remain neutral, supporting the relationship rather than individual partners. If a therapist seems biased, find a different one.

Myth #4: “Therapy is just venting to a stranger”

Reality: Effective couples therapy is structured, goal-oriented, and skills-based. While emotional expression matters, the focus is on learning new patterns and solving problems.

Myth #5: “If we need therapy, our relationship is doomed”

Reality: Seeking therapy demonstrates commitment to your relationship, not failure. The strongest couples proactively address issues rather than letting them fester.

Tips for Getting the Most from Couples Therapy

Maximize your investment with these strategies:

Before You Start

Discuss expectations together: Talk about what you each hope to achieve
Choose the right therapist: Research credentials, specializations, and reviews
Commit to the process: Agree to give therapy a fair chance (at least 6-8 sessions)
Address logistical barriers: Schedule sessions when both can consistently attend

During Therapy

Be honest and vulnerable: Therapy only works if you’re genuine
Avoid blaming: Use “I feel” statements instead of “You always” accusations
Listen to your partner: Really hear their perspective, even if you disagree
Do the homework: Practice new skills between sessions
Be patient: Change takes time; don’t expect instant results
Stay curious: Approach therapy as an opportunity to learn, not a chore

After Sessions

Process together: Discuss insights and reactions after leaving the therapist’s office
Practice new skills daily: Integration happens through repetition
Celebrate small wins: Acknowledge progress, even incremental improvements
Return if needed: View therapy as ongoing relationship maintenance, not just crisis intervention

Couples Therapy vs. Individual Therapy: What’s the Difference?

Sometimes people wonder whether they need couples therapy or individual counseling:

Choose Couples Therapy When:

Communication patterns are the primary issue
You’re experiencing relationship-specific conflicts
Both partners are willing to participate
The relationship itself needs attention
You’re facing major relationship decisions

Choose Individual Therapy When:

You’re dealing with personal mental health issues (depression, anxiety, trauma)
Your partner refuses couples counseling
You need clarity about whether to stay in the relationship
Personal issues are significantly impacting the relationship

Consider Both When:

Many couples benefit from concurrent treatment—each partner sees an individual therapist while also attending couples sessions. This combination addresses both personal growth and relationship dynamics simultaneously.

For situations where your partner won’t attend couples therapy, couples therapy for one can still create positive relationship change through your individual growth.

Specialized Couples Counseling Services

LGBTQ+ Affirming Therapy

LGBTQ+ couples face unique challenges including navigating societal discrimination, family acceptance, and finding affirming healthcare. Working with a therapist experienced in LGBTQ+ relationships ensures culturally competent, non-judgmental care.

In Chicago, Couples Counseling Chicago has proudly served the LGBTQ+ community for over 20 years. Learn more about our LGBTQ+ couples therapy services.

Online Couples Therapy

Virtual couples counseling via secure video platforms offers the same quality as in-person sessions with added convenience. Online therapy works well for busy couples, those with childcare challenges, or anyone preferring the comfort of home.

Culturally Sensitive Therapy

Cultural background significantly influences relationship dynamics, communication styles, and family expectations. Culturally responsive therapists understand these nuances and tailor their approach accordingly.

Questions to Ask When Choosing a Couples Therapist

Finding the right therapist makes all the difference. Ask these questions during your initial consultation:

What training and credentials do you have in couples therapy? Look for specialized certifications beyond basic licensure.
What theoretical approach do you use? Understand their methodology and whether it aligns with your preferences.
How much experience do you have with issues like ours? Specialists in specific areas (infidelity, LGBTQ+ relationships, etc.) often produce better results.
What does your typical treatment process look like? Understand session frequency, typical duration, and how progress is measured.
How do you handle situations where partners disagree? Assess their neutrality and conflict management skills.
What’s your philosophy on relationship success? Some therapists believe all relationships can be saved; others help couples make informed decisions about staying or leaving.
What are your fees and payment policies? Clarify costs, insurance, cancellation policies, and payment options upfront.

Trust your instincts. If you don’t feel comfortable after the first session or two, it’s appropriate to find a different therapist who’s a better fit.

Red Flags: When to Find a Different Therapist

Most couples therapists are ethical and competent, but watch for these warning signs:

Taking sides: The therapist consistently supports one partner over the other
Pushing their agenda: Imposing their values about what your relationship “should” look like
Lack of structure: Sessions feel aimless without clear goals or progress
Inappropriate disclosure: Sharing too much about their own relationship
Boundary violations: Any sexual or romantic interest in either partner
Discouraging questions: Becoming defensive when you ask about their approach or qualifications
Keeping you dependent: Therapy drags on indefinitely without clear progress or graduation plan

If you experience any of these issues, find a different therapist immediately.

Preparing for Your First Couples Counseling Session

Maximize the effectiveness of your first appointment:

What to Bring

Insurance information (if using insurance)
Any intake forms the therapist provided
List of current medications or diagnoses (if relevant)
Notepad for taking notes (if that helps you process)

What to Discuss Beforehand

Have a brief conversation with your partner about:

What you each hope to accomplish
What topics feel most urgent to address
Any concerns or anxieties about starting therapy
Agreement to give the process a fair chance

What to Expect

The first session focuses on information gathering. The therapist will ask about your relationship history, current concerns, and therapy goals. Don’t expect immediate breakthroughs—building rapport and establishing a treatment plan takes time.

Resources for Further Learning

Continue your relationship education with these resources:

Recommended Books

“The Seven Principles for Making Marriage Work” by John Gottman – Research-based relationship advice from a leading expert
“Hold Me Tight” by Sue Johnson – Understanding emotional bonds through EFT principles
“Getting the Love You Want” by Harville Hendrix – Explores how childhood shapes adult relationships
“Attached” by Amir Levine and Rachel Heller – Understanding attachment styles in relationships

Self-Assessment Tools

Couples Relationship Report Card – Evaluate your relationship’s current health
Couples Counseling FAQs – Answers to common questions

Additional Articles

Taking the Next Step

If you’re considering couples counseling, you’ve already taken an important step by educating yourself about the process. The decision to seek help demonstrates commitment to your relationship and willingness to invest in its future.

Remember: seeking couples therapy is a sign of relationship strength, not weakness. The most successful couples proactively address challenges rather than waiting until problems become insurmountable.

Ready to Start Couples Counseling in Chicago?

Couples Counseling Chicago has served Chicago’s North Side for over 20 years, helping couples strengthen their relationships, navigate challenges, and rediscover connection. Our experienced therapists provide compassionate, evidence-based care in a safe, non-judgmental environment.

Take the first step today:

Call: 773-598-7797
Visit: 655 W. Irving Park Rd, Suite #203, Chicago, IL 60613
Contact: Fill out our confidential contact form

We offer both in-person sessions in our Lakeview office and secure virtual therapy throughout Illinois. Evening and weekend appointments available.

Your relationship deserves expert care. Let us help you create the connection and happiness you both deserve.

Frequently Asked Questions About Couples Counseling

Can couples therapy help if only one person wants to go?

While couples therapy ideally involves both partners, individual work on relationship issues can still create positive change. Couples therapy for one helps you develop better communication skills, understand relationship patterns, and become a healthier partner. Sometimes when one partner makes positive changes, it motivates the other to engage. However, the most significant progress happens when both partners fully participate.

How do I convince my partner to try couples therapy?

Frame therapy as an investment in your relationship rather than an admission of failure. Use “I” statements: “I feel like we’re drifting apart and I want us to reconnect” rather than “You never listen.” Emphasize that therapy provides tools and skills you’ll use forever. Share that research shows couples therapy is effective. If your partner remains resistant, consider reading our article on what to do when your partner refuses therapy.

What if we’ve tried therapy before and it didn’t work?

Previous unsuccessful therapy doesn’t mean therapy itself doesn’t work—it may have been the wrong therapist, wrong approach, or wrong timing. Consider what didn’t work before: Was the therapist a poor fit? Were you both genuinely committed? Did you attend consistently? Finding a therapist who specializes in your specific issues and using a different therapeutic approach might produce better results. Many couples succeed in therapy on their second or third attempt.

Is it too late for couples counseling?

It’s rarely too late if both partners are willing to try. That said, earlier intervention produces better outcomes. If you’re contemplating divorce, discernment counseling can help you determine whether the relationship can be saved or whether separation is the healthiest choice. Even couples on the brink have successfully rebuilt their relationships with skilled therapeutic support.

Will the therapist tell us to break up?

Ethical couples therapists don’t make decisions for you. Their role is to help you understand your relationship dynamics, explore options, and make informed decisions about your future. Some therapists will help you determine whether staying together or separating aligns with your values and wellbeing, but ultimately the choice remains yours.

How often should we attend couples therapy?

Most couples start with weekly sessions to build momentum and establish new patterns. As progress occurs, many therapists recommend decreasing to bi-weekly or monthly sessions. Frequency depends on the severity of issues, your goals, and your budget. Consistency matters more than intensity—regular sessions produce better results than sporadic intensive sessions.

Can we do couples therapy online?

Yes! Online couples therapy is just as effective as in-person sessions for most couples. Virtual therapy offers convenience, eliminates commute time, and allows you to attend from the comfort of home. Many couples appreciate the flexibility of online sessions, especially when managing busy schedules or childcare. The key is ensuring you have a private space and stable internet connection.

Should we see the same therapist or different therapists?

For couples therapy, both partners see the same therapist together. This allows the therapist to understand your relationship dynamics and work with you as a unit. However, some couples also work with individual therapists separately while attending couples sessions together. This combination addresses both personal growth and relationship issues. Make sure your individual and couples therapists communicate (with your permission) to ensure coordinated care.

What if my partner lies in therapy?

Dishonesty undermines therapy effectiveness. If you notice your partner isn’t being truthful, you can address it directly in session: “I’m not sure that’s accurate—here’s what I observed.” Good therapists can usually sense when someone isn’t being genuine. If the lying continues and prevents progress, discuss this concern privately with the therapist to determine how to proceed. Couples therapy requires honesty to work.

Do we need couples therapy or individual therapy?

If your primary issue is relationship dynamics, communication, or conflicts between you, couples therapy is appropriate. If one or both partners have significant individual mental health issues (depression, anxiety, trauma, addiction), individual therapy may be needed first or concurrently. Many couples benefit from both—individual work on personal issues combined with couples therapy for relationship dynamics. A good therapist can help you determine the best approach.

How much does couples counseling typically cost?

In most urban areas including Chicago, couples therapy costs $150-$300 per session. Some therapists offer sliding scale fees based on income. Check whether your insurance covers couples counseling—many plans provide at least partial coverage when a diagnosable mental health condition is being addressed. For our specific fees, visit the Couples Counseling Chicago fee schedule.

What’s the success rate of couples therapy?

Research indicates approximately 70% of couples who complete therapy report significant improvement in relationship satisfaction. Success rates are higher for couples who attend consistently, complete homework assignments, and engage in evidence-based approaches like Emotionally Focused Therapy or the Gottman Method. Starting therapy earlier (before problems become entrenched) also increases success likelihood.

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This guide was last updated December 2025. Couples Counseling Chicago provides comprehensive relationship therapy services to couples throughout Chicago’s North Side, including Lakeview, Lincoln Park, Boystown, Wrigleyville, and surrounding neighborhoods. Our experienced therapists specialize in helping couples strengthen communication, rebuild trust, and create lasting positive change.