What the Research Really Shows About Couples in Distress: A Research-Based Guide for Couples Thinking About Therapy

 If you and your partner have been going through a rough patch—fighting more than usual, feeling disconnected, or having the same argument over and over—you might be hoping things will smooth out on their own. A lot of couples think that way. With enough time, enough love, and enough patience, maybe it will get better.

But what does the research actually say? Decades of studies on couples who are struggling show a clear pattern: relationship problems rarely go away without some kind of help. That’s not meant to be discouraging—it’s meant to be useful information. Knowing what the research shows can help you make a real decision about whether couples therapy might be right for you.

Left Alone, Most Relationship Problems Get Worse

One of the biggest findings in relationship research is that unhappy couples who don’t get help tend to stay unhappy—or get worse. Notarius and Buongiorno (1992) followed couples in distress for four years without any treatment and found that fewer than one in five got meaningfully better on their own. The rest either stayed stuck or saw things get harder over time.

Part of why this happens is that relationship problems feed on themselves. Gottman (1994) found that by the time most couples first go to therapy, they’ve already been dealing with serious problems for an average of six years. Over that time, small negative habits—like snapping at each other, shutting down, or assuming the worst—become deeply ingrained. The longer those patterns go on, the harder they are to change.

Bradbury and Fincham (1990) found something similar when they studied how unhappy couples explain each other’s behavior. When relationships are struggling, partners tend to interpret even neutral things in a negative light—“He did that on purpose,” or “She never thinks about me.” Over time, that kind of thinking becomes automatic, and it’s not something most couples can just think their way out of without support.

What Can Happen When Couples Don’t Get Help

Several long-term studies have followed couples who stayed in distress without seeking treatment. The findings are worth knowing about.

Gottman and Levenson (1992) identified four specific communication patterns—criticism, contempt, defensiveness, and shutting down—that reliably predict whether a relationship will eventually end. Couples who showed these patterns and didn’t get help had significantly higher rates of separation and divorce.

Relationship problems don’t just hurt the relationship—they can affect your health, too. Beach, Sandeen, and O’Leary (1990) found strong connections between relationship distress and depression, especially in women. In other words, if the relationship isn’t doing well, it’s very hard for either partner to be doing well individually. Research by Kiecolt-Glaser and colleagues (1993) also found that ongoing conflict in a relationship can affect the immune system and raise stress hormones in the body. The emotional and physical are deeply connected.

If you have kids at home, this research matters for them too. Cummings and Davies (1994) reviewed a large body of evidence showing that ongoing conflict between parents is one of the biggest risk factors for children’s emotional and behavioral problems. Addressing relationship struggles isn’t just about you as a couple—it’s also one of the most meaningful things you can do for your children.

Couples Therapy Works—Here’s What the Research Shows

The good news: couples therapy has strong research support, and it helps a lot of people.

How Effective Is It Overall?

Hahlweg and Markman (1988) reviewed multiple studies on behavioral couples therapy and found that about two-thirds of couples who went through treatment got significantly better—compared to couples who didn’t get help. A large review by Shadish and Baldwin (2003), which looked at 30 carefully designed studies, found similar results: couples who received therapy did substantially better than those who didn’t, across a range of different problems and approaches.

Emotionally Focused Therapy

One of the most well-researched approaches is called Emotionally Focused Therapy, or EFT. It was developed by Johnson and Greenberg (1985) and is based on the science of emotional bonding between partners. A review of EFT studies by Johnson, Hunsley, Greenberg, and Schindler (1999) found that between 70 and 73 percent of couples who went through EFT moved from being distressed to no longer being distressed—and that up to 90 percent showed meaningful improvement. Those are strong results by any measure.

Do the Gains Last?

One fair question is whether therapy gains hold up after treatment ends. Snyder, Wills, and Grady-Fletcher (1991) followed couples for four years after they finished therapy and found that the improvements largely held. That’s a meaningful contrast to what happens in untreated distressed couples, who tend to get worse over those same time periods. Follow-up data from EFT studies showed the same pattern—couples often kept improving on their own after therapy ended, applying what they had learned.

Why So Many Couples Wait—And Why It Matters

Research shows that couples wait an average of six years after problems become serious before reaching out for help (Doss, Atkins, & Christensen, 2003). That’s a long time. And the longer you wait, the deeper the patterns get—and the harder they are to change. Earlier treatment is linked to better results and shorter treatment overall (Christensen & Heavey, 1999).

There are lots of reasons couples put it off. Some feel like they should be able to handle it themselves. Some worry about what other people will think. Some aren’t sure things are bad enough to justify getting help, or they have concerns about cost. These are all understandable feelings. But each year of waiting tends to be a year of the relationship moving further in the wrong direction.

It’s also worth knowing that couples don’t have to be “on the same page” about the relationship to benefit from therapy. Some couples come to therapy hoping to rebuild. Others are trying to figure out whether to stay. Therapy can help with both. And even when couples ultimately decide to separate, therapy can help them do it in a way that is less painful—especially when children are involved.

What to Expect from Couples Therapy

Couples therapy isn’t a quick fix, and both partners need to be willing to engage with the process. Most couples start to see meaningful progress within 12 to 20 sessions, though that varies depending on what you’re dealing with (Jacobson & Addis, 1993). Sessions usually focus on improving how you communicate, understanding each other’s emotional needs, breaking out of negative cycles, and learning how to handle conflict in a healthier way.

Finding the right therapist matters. You should feel like your therapist understands both of you and isn’t taking sides. It’s completely reasonable to ask a therapist about their training, the approach they use, and their experience with the kinds of issues you’re facing. Approaches like EFT, Behavioral Couples Therapy (BCT), and Integrative Behavioral Couples Therapy (IBCT) have the most research support.

The Bottom Line

The research is clear: couples dealing with significant relationship problems rarely get better on their own. Time alone doesn’t fix entrenched patterns—it usually makes them harder to change. But couples therapy does work, and for many couples it leads to real, lasting improvement.

Asking for help isn’t giving up on your relationship—it’s taking it seriously enough to do something about it. And according to the research, doing something sooner gives you the best chance at the outcome you’re hoping for.

References

Beach, S. R. H., Sandeen, E. E., & O’Leary, K. D. (1990). Depression in marriage: A model for etiology and treatment. Guilford Press.

Bradbury, T. N., & Fincham, F. D. (1990). Attributions in marriage: Review and critique. Psychological Bulletin, 107(1), 3–33. https://doi.org/10.1037/0033-2909.107.1.3

Christensen, A., & Heavey, C. L. (1999). Interventions for couples. Annual Review of Psychology, 50(1), 165–190. https://doi.org/10.1146/annurev.psych.50.1.165

Cummings, E. M., & Davies, P. T. (1994). Children and marital conflict: The impact of family dispute and resolution. Guilford Press.

Doss, B. D., Atkins, D. C., & Christensen, A. (2003). Who’s dragging their feet? Husbands and wives seeking marital therapy. Journal of Marital and Family Therapy, 29(2), 165–177. https://doi.org/10.1111/j.1752-0606.2003.tb01198.x

Gottman, J. M. (1994). What predicts divorce? The relationship between marital processes and marital outcomes. Lawrence Erlbaum Associates.

Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality and Social Psychology, 63(2), 221–233. https://doi.org/10.1037/0022-3514.63.2.221

Hahlweg, K., & Markman, H. J. (1988). Effectiveness of behavioral marital therapy: Empirical status of behavioral techniques in preventing and alleviating marital distress. Journal of Consulting and Clinical Psychology, 56(3), 440–447. https://doi.org/10.1037/0022-006X.56.3.440

Jacobson, N. S., & Addis, M. E. (1993). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61(1), 85–93. https://doi.org/10.1037/0022-006X.61.1.85

Johnson, S. M., & Greenberg, L. S. (1985). Emotionally focused couples therapy: An outcome study. Journal of Marital and Family Therapy, 11(3), 313–317. https://doi.org/10.1111/j.1752-0606.1985.tb00624.x

Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67–79. https://doi.org/10.1093/clipsy.6.1.67

Kiecolt-Glaser, J. K., Malarkey, W. B., Chee, M., Newton, T., Cacioppo, J. T., Mao, H. Y., & Glaser, R. (1993). Negative behavior during marital conflict is associated with immunological down-regulation. Psychosomatic Medicine, 55(5), 395–409. https://doi.org/10.1097/00006842-199309000-00001

Notarius, C. I., & Buongiorno, J. (1992, November). Wait time until professional treatment in marital therapy. Paper presented at the Annual Meeting of the Association for Advancement of Behavior Therapy, Boston, MA.

Shadish, W. R., & Baldwin, S. A. (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

Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4-year follow-up study. Journal of Consulting and Clinical Psychology, 59(1), 138–141. https://doi.org/10.1037/0022-006X.59.1.138

For more information about couples therapy, please reach out to me at 919-307-9017. I will have openings after July 2026.