BOSTON — Marriage and family difficulties account for about half of all visits to psychotherapists, and most therapists who specialize in family therapy work chiefly with couples. The therapist helps the couple work on eliminating mutual misunderstandings, unreasonable expectations, and unstated assumptions that perpetuate conflict, explains the March 2007 issue of the Harvard Mental Health Letter.

Couples Therapists

Couples therapists make little use of psychiatric diagnosis, but they do use many of the same methods employed by therapists who work with individuals: interpreting emotional conflicts and the influence of the past; assigning exercises for behavior change; challenging beliefs; offering advice and support; and teaching social skills and problem solving.

The couples therapist assumes that the unhappiness of a couple amounts to more than the sum of their individual problems and symptoms, and helps them examine their lives together and decide what changes are needed. Therapists do, however, try to help each partner understand his or her contributions to the couple's problems. The individuals are also encouraged to weigh the benefits and costs of being in the relationship.

Relationship Therapy

Most studies find that couples therapy can be helpful. However, it's unclear whether it can transform unhappy relationships into satisfactory ones, and whether the effects last. Improvement is usually maintained for six months, but often there is a relapse after a year or two. Therapists may try different treatment approaches, or they may emphasize features that all approaches have in common.

"Emotional problems arise between people as well as within them. Couples therapy addresses this fact, and therefore can help some relationships," says Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter.