Finding the Right Couples Counsellor
There is no doubt that find the right couples counsellor (also referred to as marriage counselling or relationship counselling) is difficult. It’s a relatively new field compared to many other areas of medicine and psychology. If you go to a doctor with an ear infection, you would expect to basically get the same treatment from almost any doctor you see. This is not the case with relationship problems. This page is to help you find the right type of therapy and the right person.
The first thing to consider when seeking a couples counsellor is the type of therapy that they use. We can divide therapists into a few categories in this regard:
The therapist uses an established therapy that was specifically designed for relationship problems and the therapy has been evaluated in several large research trials to demonstrate its effectiveness. This is the definition of an evidence-based therapy - it has two large randomised controlled trials conducted from separate research groups demonstrating it works compared to a control group. The therapist follows this therapy relatively closely but will also make some adaptations to it that comes from years of using it. The therapist will have qualifications or certifications from the organisation that oversees the therapy and its training.
The therapist uses and follows closely an evidence-based therapy as described above but is not fully qualified in using it. They may have done partial training, just a single workshop on it, or not received the supervision required to become certified in it.
The counsellor will use an established therapy that was specifically designed for relationship problems but the therapy has not been evaluated to the point of considering it an evidence-based therapy for relationship difficulties. It could be that there was only a small study or a few ill-designed studies that do not meet the criteria for a large-scale randomised controlled trial.
The therapist uses an established therapy but one that was never intended for couples counselling. The therapy has been demonstrated to work in research trials for other problems but not for relationship problems.
The therapist doesn’t use any established therapy but rather just listens to the couples’ problems and then does one of the following: a) nothing further, they just give each partner a space to talk by moderating the conversation so each can be heard; b) arbitrates or mediates and decides what is fair, who is should do what differently or who is right and who is wrong; or c) gives a few pieces of general relationship advice.
Of these options, the best is number one. The second best is option two, followed by the third. The fourth and fifth are probably about equal. We’re better starting with what we know works before considering other approaches. And finding someone who is well-trained in that evidence-based approach is ideal.
TYPES OF EVIDENCE-BASED THERAPIES FOR RELATIONSHIP PROBLEMS
In terms of what therapies fall into the first category - evidence-based approaches to relationship problems - there are two:
Emotionally Focused Therapy (sometimes referred to as Emotionally Focused Couple Therapy). See note below for details on the two versions of this therapy - Dr Sue Johnson’s and Dr Les Greenberg’s.
Behavioural Couple Therapy (there are a two of variants of this approach - Behavioural Couple Therapy and Integrative Behavioural Couple Therapy ).
While both Behavioural Couple Therapy and Emotionally Focused Therapy are evidenced-based for relationship problems, Emotionally Focused Therapy has an advantage. In the research, both have similar outcomes at the end of the therapy but the results for Behavioural Couple Therapy quickly dropped off at the 6-month follow-up and all but disappeared at the 2-year follow up while for Emotionally Focused Therapy the results actually increased at the 6-month and 2-year follow-up.
A popular couples counselling approach, Gottman Method Couples Therapy, is a type of behaviour therapy and widely known and used by therapists. However, an examination of the research on it shows there have been no large scale randomised controlled trials, which means it is not evidence-based, despite many people claiming it is (including John Gottman himself).
FINDING THE RIGHT THERAPIST
Even if someone is trained in an evidence-based approach, it does not mean they will be good. And even if they are good, it does not mean they will be able to address all relationship problems. Take Emotionally Focused Therapy for example. While evidenced-based, it was designed for general conflict problems and has not been designed for problems such as when someone has neurodivergence, a partner has fallen out of love, or where one partner drinks excessively. It is probably for this reason that it repaired approximately 70% of couples’ conflict and there was 90% improvement in the research trials. Years of clinical experience are needed to learn to work with the wide variety of complexity that occurs in the real world. Likewise, someone can do all the training and have years of experience but they may not have the natural skills needed to achieve great results.
In spite of the possibility of not getting the optimal therapist immediately, it is best to start with a therapist in the first of the five categories that was described earlier and if need be, look for a different therapist within that same category if it did not work out with the first person.
Where to find a therapist
If you choose to find someone who is certified or well-qualified in Emotionally Focused Therapy, the best place to start is the ICEEFT directory of therapists. This lists most therapists across the globe. There will also be some Emotionally Focused Therapists who are not listed and they may be listed on a national listing (e.g. Emotionally Focused Therapy and Training Australia and Brisbane Centre for EFT). A Google search can also help locate options.
If there is no one in your area, consider doing it online with someone from a major city. Online is probably about 20% less effective than in person but it is better to get a good quality therapy online than a bad one in person.
Note: Emotionally Focused Therapy was developed in the 1980s by Dr Sue Johnson while she was doing her PhD. She developed the first version in collaboration with her supervisor Dr Les Greenberg who had already developed a therapy ‘Emotion Focused Therapy’ for individuals with depression. Her contribution was to adapt it for couples. After their first joint version for couples, they parted ways and she continued to refine her own version (named Emotionally Focused Therapy or Emotionally Focused Couples Therapy) and evaluated it in dozens of randomised-controlled research trials while Dr Greenberg also refined his unique couple version (named Emotion Focused Therapy for Couples) but it did not undergo further research evaluation. Dr Greenberg’s individual version for individuals with depression continues to exist and has been evaluated as effective in randomised controlled trials. While easy to get confused, the crux is that the most evidenced-based approach for couples counselling is Dr Sue Johnson’s Emotionally Focused Therapy.