When should we seek couples counseling?

The short answer is as soon as it is first considered. It is well-known that couples generally put off coming in to see someone when they begin feeling distressed. We tend to hope that tomorrow will be better than today so it is on average 6+ years before most couples seek help. By then more hurt feelings and misunderstandings have occurred and interactive patterns set. The sooner the couple comes in, the better. This is an investment in the health of your relationship, yourselves and your children.

How many sessions will it take?

It varies from couple to couple. Some may benefit with a few sessions. These are usually the people who have a healthy foundation in their relationship and know they are committed to each other for life. Others take longer because the disconnection between them is more pronounced. Healing these relationships does take time and conscientiousness on the part of each partner for the most growth to occur. It has usually taken years to get to this point, so the healing may also take time.

I usually suggest that a couple commit themselves to attending 12 sessions, which is how long it takes to get really good at relationship dialogue.  Then re-assess and figure out if more therapy seems necessary.

How often are the sessions?

Initially. I suggest weekly sessions, for at least the first few weeks. This makes the most sense to get momentum going and also to get you quickly to a place where you can practice some skills at home. Once you have learned the basic skills, most of the work occurs outside the sessions, at home between the couple. So the more you practice, the less sessions are required. Sessions are meant to teach new skills, to create a safe climate where each person’s story can be revealed to increase understanding of the partner and self, and to experience connection.

How do we pick a couples therapist? Are all couples therapists the same?

I recommend you ‘interview’ the therapists by phone to find out if they have specialized training in doing couples’ work. If the therapist has specialized training, what is it? Also ask approximately how many couples the therapist has seen and over how many years. What is the therapist’s approach to couples therapy, and how is the session structured. You’ll also want to know what the therapist expects from the couple in the sessions and outside the session. Also ask any other specific questions you may have. This is an important decision.

What if I can’t afford it?

The therapist may have a payment plan or have times when they will lower their standard fee due to financial hardship. Check with your therapist about these possibilities. But do not let this keep you from getting at least some sessions to gain working knowledge and skills to begin to grow your relationship.

Do you take insurance for couples therapy?

Major insurance companies do not cover marital or couples therapy. They do not view marriage/couples counseling as ‘medically necessary’ which is what the insurance companies are there for.  Some couples therapists may bill insurance companies for “family therapy” when they are providing “marital” or “couples therapy”. When billed in this way, therapists can be reimbursed for an hour of service.  This may work if you or your partner have a major mental illness, and you are seeing the therapist for treatment of that mental illness.

In my practice, I see couples for 90 minute sessions. Insurance companies will not pay for this amount of time. In addition, when I see couples, I am not treating mental illness. I am teaching relationship skills. Therefore, I do not bill insurance for couples therapy.