What happens in couples therapy?

In this fictional case study, we explore what you might expect from couples therapy.

Woman and man with a therapist

Sami and Des are a couple in their late 30s. They have two young children aged five and three and have come for a consultation to think about whether couples therapy could help them. In the consultation, they describe how there is no fun or joy left in their relationship and that life seems like an endless series of chores.

Their sex life is fairly non-existent. Both say that the other one is grumpy with each other and, whilst they agree on issues around co-parenting, they don’t seem to have any time for each other. 

Both work but Des works part-time and does more of the childcare and collecting from nursery. He feels resentful that he is the one shouldering more of the domestic side of things. Sami acknowledges that Des does more than her at home but explains that her job is quite demanding and stressful and that she has to manage quite a lot on her side of things. She said she wouldn’t necessarily have chosen it to be like this. 

They also talk about some issues with their family. Sami feels Des’s family aren’t that supportive of her working full time and can make her feel excluded when they are all together. The couple have been arguing about these issues and they are worried about the impact on their children. Whenever they try to talk about them calmly, it always escalates. 


Whilst every couple we meet in therapy is unique and has their own set of circumstances that they wish to deal with, this (imaginary) couple Sami and Des give an example of some of the issues we might see in a consultation; communication issues, resentments about how things are shared out between the couple, concerns about the children, concern that the fun and sex has gone out of their relationship, difficulties with family.

The fact that they have come for therapy reflects something important – that, at some level, they want to find a space to prioritise their relationship, even if they don’t know how.

Their time with a therapist can become their space for reflecting on their situation, thinking about what’s difficult, and trying to gain a new perspective and understanding of it. The feeling of both being heard by the therapist and each other can be supportive and can help calm some of the tensions that they are feeling.

Putting puzzle pieces together

As Sami and Des continue into weekly therapy, we use the space to understand how it is that things have deteriorated between them. It becomes clear that they fell into their roles in relation to work and childcare without really discussing them with each other. We think about what gets in the way of them discussing things with each other. It becomes really helpful to them to be acknowledged by the other one about the different feelings of their roles. 

We also spend some time thinking about their own histories – their family models, and their hopes and expectations for family life. We realise what different backgrounds they both grew up in and think about the different ways things got talked about in their families. It turns out that in both families there was an expectation that you would just get on with things and you wouldn’t really talk to each other if feeling upset. Both families were quite conflict-averse. 

We think in the therapy how, in this context, it might be quite challenging for Sami and Des to have to try and talk about areas where they disagree since, in some way, they have learned through their families to keep potentially conflictual areas off the menu of discussion. They describe that coming to therapy feels a bit like building up a new muscle where they are learning how to talk to each other about difficult things. 

Two men in counselling session

In this way, couples therapy can become a safer space to talk about areas of conflict between the two individuals.

Couples counselling can offer time to consider people’s own history of relationships in their families and the expectations that they bring to their current relationship. This can help to understand why the current situation feels so challenging and can help ease some of the pressures felt. 

It can also be a huge relief to understand that some of what is being experienced is also being experienced by other couples and that it is normal. By taking the time to talk about these things and feel that they are heard, couples can feel more understood by each other which can help to reduce conflict. Research shows that conflict that is frequent, intense and unresolved is harmful to children and, therefore, by helping couples manage the conflict between them, not only does it support the parents’ mental health but also that of their children.

Our overall assessment of outcomes at Tavistock Relationships suggests that clients who come for couples therapy show “significant increases in their relationship satisfaction and distinct decreases in their psychological distress as the therapy progresses”. 

We work with couples at different stages of their relationships. Some are dealing with transitions (such as Sami and Des), where it seems the transition to parenthood has stirred up some difficulties for them. Some are dealing with a specific life event that is feeling difficult to manage within their relationship. Some people feel they don’t have a specific problem but are bored of having the same arguments and would like to deal with their disagreements better. 

It can take a bit of time to settle into the therapy and it isn’t for everyone. But, where a couple can make use of it, it can be a space that helps them feel more connected and more able to enjoy their relationship. 


In the following video, counsellors Lee Valls and Beverley Hills explain what you can expect when you walk into therapy with your partner:

You can find more information about couples counselling and find a couples therapist on our website.

Or, if you’d like to know more about Tavistock Relationships, you can book a consultation to see if couples therapy could benefit you.

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Written by Jo Harrison

Jo Harrison is a senior clinician at Tavistock Relationships and the in-house counsellor at Family Law in Partnership. To find out more about her work, visit joannaharrison.co.uk.

Written by Jo Harrison

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