Why most couples therapy doesn't work — and what RLT changes

If you've tried couples therapy and it didn't help, the story probably goes something like this. You sat on a couch for eight or ten sessions. Each of you told your side. The therapist nodded, reflected back what you'd said in gentler words, and asked how that made you feel. You felt heard — and then you drove home and had the same fight in the car.

Does couples therapy actually work?

In research conditions, yes. A 2020 review in the Annual Review of Clinical Psychology by Thomas Bradbury of UCLA and Guy Bodenmann of the University of Zurich found that 60 to 80 per cent of distressed couples benefit from the well-studied behavioural and emotion-focused approaches. The same review flags two problems: treatment effects are weaker in ordinary clinical practice than in controlled studies, and for about half of couples the gains dissipate after therapy ends.

What was, when it was published in 2010, the longest follow-up of couple therapy ever conducted shows what that looks like over time. Andrew Christensen and colleagues followed 134 seriously distressed couples for five years after up to 26 sessions of behavioural couple therapy. About two-thirds had improved significantly by the end of treatment. Five years later, about a third were what Christensen called “normal, happy couples,” and another 16 per cent were improved but not very happy.

Christensen considered that a good result, given how distressed those couples were when they started, and I think he's right. It is also a long way from the 80 per cent quoted on therapy websites — and those were trial conditions, with trained therapists, a tested model and supervision. Ordinary practice can look different. When Martin Seligman analysed a large 1995 Consumer Reports survey of therapy clients in the American Psychologist, people who saw psychologists, psychiatrists and social workers all did better than those who saw marriage counsellors. The survey is three decades old and has its methodological critics, but it points at the same gap.

Why most couples therapy doesn't work

The trouble is rarely the model. Bradbury and Bodenmann note that much of what helps couples may come from factors common to all the major approaches, which puts the weight on what the therapist actually does in the room. In my view, ordinary couples therapy tends to break down in five places.

You arrive six years late

The Gottman Institute reports that couples wait an average of six years of being unhappy before they get help. By then the fight is no longer about the dishes. Each of you keeps a file on the other, contempt has had years to settle in, and one of you may already be halfway out the door — which calls for a different starting point. A therapist who treats that couple as a couple with a communication problem is working on the wrong thing.

The therapist stays neutral

When Terry Real first learned couples therapy, he says, the cardinal rule was “Thou shalt not take sides”. It still shapes how many therapists work, and it sounds fair. In practice, a neutral therapist reflects both partners' complaints back in softer language, and the true thing — that one of you is contemptuous, or has been checked out for a decade, or is drinking — goes unsaid. Real's verdict on the traditional stance is that for a couple who are either too distant or fighting, it “just isn't active enough.”

You get insight, not skills

Understanding why you shut down is useful. It is not the same as knowing what to do instead at 9:40 on a Tuesday night when your partner brings up the credit-card bill. A lot of couples therapy produces good conversations in the office and no new behaviour at home — probably one reason the gains fade once the appointments stop, and why so many couples keep having the same fight.

The deep work gets sent somewhere else

When a partner's reaction plainly comes from childhood — the rage that belonged to a father, the freeze learned in a frightening house — many therapists refer that partner out to individual therapy. The other partner never sees the work. Real argues the opposite: people go deeper with their partner beside them, and the partner who watches that work often softens toward what they had only ever seen as bad behaviour.

Everyone gets handled gently

Therapists are trained toward warmth. That is a strength until it turns into protecting the partner who is doing the damage. Real's phrase for it is that most therapists “lean on the love part and they're a little shy on the truth part.” Couples feel the difference. The partner who has been carrying the relationship feels unseen, and the partner who needs to change is never really asked to.

What Relational Life Therapy does differently

Terry Real developed Relational Life Therapy largely through two-day intensives with couples on the brink of divorce who hadn't been helped by other therapy, and he has said that in doing it he was breaking most of the rules he'd been taught. The Relational Life Institute describes the model in three phases: waking the client up through “joining through the truth,” trauma work with the part of each partner that learned to cope in childhood, and building relational skills.

Joining through the truth

Real's core technique is telling someone a hard truth about their behaviour in a way that leaves them feeling you are on their side. In practice that means separating the person from the pattern: you are a decent person who has been behaving badly, and I'd like to help you stop. People can hear that sentence. Very few people can hear a list of their faults.

Problems are not always 50/50

RLT therapists take sides, and Real is explicit that not every problem is split down the middle. That doesn't mean picking a winner. Both partners hear the truth about their part, and the therapist's loyalty is to the relationship. The partner who has been over-functioning for years often feels real relief when someone finally says plainly what they've been living with.

A shared language for what goes wrong

Real names five losing strategies — needing to be right, controlling your partner, unbridled self-expression, retaliation and withdrawal — the moves people reach for at an impasse that never get them what they want. Once both of you can name them, you can catch one in the middle of a fight instead of a week later in my office.

Skills, taught directly

RLT is unapologetically educational. You learn to raise a complaint as a request about the future rather than a verdict on your partner's character, and to answer an upset partner by finding the part you can agree with before you defend yourself — what Real calls learning to “scan for agreement.” Those are learnable skills, and they are what lets the change outlast the sessions. I wrote more about why I built my practice on this approach in Why I practise Relational Life Therapy.

Is there evidence that RLT works?

Less than there is for some other models, and you should know that. Emotionally Focused Therapy and behavioural couple therapy have decades of randomized trials behind them; RLT does not yet. Real's Relational Life Foundation was set up in part to fund the research that would let RLT be recognised as an evidence-based treatment.

What RLT does is aim squarely at the places where the research says couples therapy breaks down — passive therapists, insight without skills, and gains that fade once sessions end. Where it fits, I also draw on Emotionally Focused Therapy, the Gottman Method and Internal Family Systems. I think you should expect any couples therapist to tell you plainly what their method rests on.

How to tell whether your couples therapy is working

Whether you work with me or with someone else, a few questions will tell you a lot within the first four or five sessions:

• Has the therapist said something to each of you that was hard to hear — and did it land as help rather than an attack?
• Can you each name your own part of the pattern, not just your partner's?
• Have you been taught something specific to do differently, and have you tried it at home?
• Are your fights getting shorter, or is repair coming sooner?
• Can the therapist tell you what their plan is?

If the answer to most of those is still no after a couple of months, say so in the session, or try a different therapist. If you're in Greater Victoria or anywhere in British Columbia, a free 15-minute consultation is an easy way to find out whether couples therapy with me is the right fit.

One exception to everything above: if either of you is afraid of the other, or there has been violence, joint couples therapy is usually not the place to start. Speak with a counsellor on your own first. If you are in danger, call 9-1-1; the Vancouver Island Crisis Line is open around the clock at 1-888-494-3888.

Couples therapy that works looks less like two people taking turns being heard and more like two people learning, with help, to stop doing the things that hurt each other. That part can be taught.