When a relationship is stuck in endless arguments and silent treatment, couples therapy can help — waiting alone rarely does

20. When a relationship is stuck in endless arguments and silent treatment, couples therapy can help — waiting alone rarely does

Cost: Couples therapy comes at a cost. Fees are charged per session and vary by location and clinic; no exact figures are provided here. Typically, participants attend weekly sessions over a period of about eight months. The main challenge is that both partners must attend regularly and see it through to the end.

In plain terms: Couples who attend therapy together tend to report significantly higher relationship satisfaction — roughly 70% experience noticeable improvement. In contrast, couples who simply wait without any intervention show little to no change. However, these benefits tend to fade over time: after five years, about half of those who sought therapy still report clear gains, while roughly a quarter end up separated or divorced.

Benefit: A 2020 meta-analysis examined 58 studies involving 2,092 couples. After completing therapy, the average change in relationship satisfaction was g = 1.12 (95% CI: 0.92–1.31), which researchers consider a large effect size. g is an effect size measure; see the glossary for details. For couples who only waited without therapy, the same period yielded g = 0.12 (−0.04 to 0.29), indicating virtually no improvement. The greater the initial dissatisfaction, the larger the subsequent gain. Another review from 2012 reported that 70% of couples receiving therapy showed positive outcomes. One randomized trial followed 134 long‑married couples with serious conflicts; after eight months of two different behavioral therapy programs, satisfaction improved by d = 0.90 and d = 0.71 respectively. Five years later, 50.0% and 45.9% of those couples still showed clinically meaningful improvement. At the same time, 25.7% and 27.9% had separated or divorced.

Evidence grade: A (controversial)

Sources: Roddy MK, Walsh LM, Rothman K, Hatch SG, Doss BD (2020). Meta-analysis of couple therapy: effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology, 88(7), 583-596. <https://doi.org/10.1037/ccp0000514>; Lebow JL, Chambers AL, Christensen A, Johnson SM (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145-168. Christensen A, Atkins DC, Baucom B, Yi J (2010). Marital status and satisfaction five years following a Randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225-235. <https://doi.org/10.1037/a0018132>; Rathgeber M, Bürkner PC, Schiller EM, Holling H (2019). The efficacy of emotionally focused couples therapy and behavioral couples therapy: a meta-analysis. Journal of Marital and Family Therapy, 45(3), 447-463. <https://doi.org/10.1111/jmft.12336> (Disputant); Shadish WR, Baldwin SA (2003). Meta-analysis of MFT interventions. Journal of Marital and Family Therapy, 29(4), 547-570. <https://doi.org/10.1111/j.1752-0606.2003.tb01694.x> (disputing party); Karakurt G, Whiting K, van Esch C, Bolen SD, Calabrese JR (2016). Couples therapy for intimate partner violence: a systematic review and meta-analysis. Journal of Marital and Family Therapy, 42(4), 567-583. <https://doi.org/10.1111/jmft.12178>; National People's Congress Standing Committee (2018 revision). Mental Health Law (Article 23, 51). <https://flk.npc.gov.cn/detail?id=2c909fdd678bf17901678bf7448a066d> (National Laws and Regulations Database)

Notes: The main controversy concerns how long these benefits actually last. Another meta-analysis limited to randomized trials found g = 0.60 right after therapy and g = 0.44 after six months; by twelve months only one behavioral therapy approach retained any measurable effect, with g = 0.06 — essentially negligible. A broader review of 20 meta-analyses concluded that clinically meaningful improvement occurs in 40% to 50% of participants. The figures “70% improvement” and “40–50% clinically meaningful improvement” refer to different criteria and should not be directly compared. The five‑year trial lacked a control group of couples receiving no treatment, so it is unclear whether divorce rates rose or fell. The 2020 meta‑analysis included only heterosexual couples; no comparable randomized trials have been identified in China, so results should be interpreted with caution. In China, mental health regulations require that psychotherapy be delivered within medical institutions; counselors without medical qualifications may not provide psychotherapy. You can inquire at psychiatric or psychology departments of hospitals about available couples therapy programs. If seeking outside a hospital, verify the practitioner’s credentials and training. Couples experiencing domestic violence should not begin therapy together. A 2016 meta‑analysis noted that its conclusions apply only to mild‑to‑moderate conflicts where both partners occasionally engage in physical altercations; it does not cover situations dominated by controlling or severely harmful behavior. There is also concern that returning home after therapy might increase the risk of retaliation. If you have been physically abused, see Section 8, Item 43. For advice on how to talk during arguments, see Section 17; for guidance on whether to end the relationship, see Section 15. The primary beneficiaries of therapy are both you and your spouse.