Why Couples Therapy Works: What 25 Years of Research Really Shows
This blog summarizes Carr’s (2018) evidence review, published on the 25th anniversary, on couples therapy and systemic interventions, and focuses on adults experiencing relational, mental, and physical health difficulties. This work revises earlier reviews published in the Journal of Family Therapy (2000, 2009, 2014, 2019) and integrates evidence from meta-analyses, systematic reviews, and controlled trials. The goal is to determine the effectiveness of systemic interventions, whether used independently or within multifaceted treatment plans, for various issues affecting adults.
Conceptual Background
Systemic therapy is about relational dynamics, like couples or families, not just individual problems. Couple's therapy focuses on romantic pairs and their dynamics, whereas broader systemic approaches may include extended family or social networks that influence adult mental and physical health.
The review examines evidence, comparing systemic approaches to no treatment and standard psychotherapies. Adults often seek couples therapy, which is why its supporting research is crucial for clinicians and planners.
Key Evidence and Findings
1. Relationship Distress and Satisfaction
Couple therapy is clearly effective in reducing relationship distress, one of the most common reasons adults seek psychotherapy.
Relationship education programs (preventive, psychoeducational interventions) demonstrably increase relationship satisfaction and help prevent deterioration and escalation into crises or intimate partner violence.
Different models of couple therapy, including traditional, cognitive, and integrative forms, show comparable effectiveness, suggesting that common therapeutic principles and strategies may underlie successful outcomes across models.
2. Intimate Partner Violence (IPV)
For couples where situational or stress-related intimate partner violence is central, couples therapy shows greater effectiveness than routine individual or group perpetrator-focused interventions alone. Couples therapy is not recommended when IPV cases include coercive control.
This suggests systemic approaches may help couples address communication patterns, conflict escalation, and relational context that contribute to violence.
3. Psychosexual Problems
Couples sex therapy is effective for addressing psychosexual concerns.
Specifically, for issues like erectile dysfunction, combining sex therapy with medical treatment yields better results than medication alone, highlighting how relational and psychological factors interact with biological causes.
4. Anxiety and Trauma-Related Disorders
Conditions such as panic disorder, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) often involve interpersonal dynamics (e.g., family accommodation, antagonism) that maintain symptoms.
In these situations, couples therapy is just as successful as individual evidence-based treatments, especially when the behavior of family or partners directly impacts the continuation of symptoms.
Relational framing aids in managing relationship support, accommodation, and emotional control.
5. Mood Disorders
Depression: Couples therapy, either alone or combined with antidepressants, is as effective as individual therapy, targeting emotional symptoms and relationship problems that may maintain or worsen depression.
Bipolar disorder: Psychoeducational family interventions (e.g., family-focused therapy), delivered alongside mood-stabilizing medication, help delay or prevent relapse. These interventions educate couples/families about mood regulation, early warning signs, and collaborative coping strategies.
6. Substance Use and Alcohol Problems
Systemic approaches are effective in treating alcohol problems among adults.
By involving partners or families, therapy can focus on patterns of interaction and support systems that influence substance use, relapse, and recovery — potentially increasing long-term success versus individual therapy alone.
7. Severe Mental Illness and Chronic Physical Health Conditions
Schizophrenia: Systemic interventions may be more effective than individual therapy in delaying relapse. Family involvement in care planning and communication training supports coping and medication adherence.
For chronic physical illnesses, such as adjustment to long-term medical conditions, systemic approaches help couples and families manage the psychosocial impact of illness, supporting coping, adaptation, and quality of life.
Comparisons to Individual Therapy
Across multiple problem areas, the review finds:
Systemic therapy is as effective as evidence-based individual therapies for relationship, emotional, and mental health concerns.
In some areas (notably relationship distress, situational violence, and schizophrenia relapse prevention), systemic approaches show superior outcomes.
Success seems to hinge on relational factors such as communication, conflict, and support, which may not be fully addressed by individual therapy.
Practitioner Implications
Couple and systemic therapies should be recognized and offered as evidence-based options for adult psychological and relational problems.
Therapist training should include systemic frameworks given their broad applicability and effectiveness across diagnostic categories.
Integration with other treatments (e.g., medication, individual therapy) can optimize outcomes, especially for complex or chronic conditions.
Conclusion
This 25-year evidence update reaffirms that couple therapy and systemic interventions are robust, effective treatments for a wide range of adult-focused problems. They match or exceed the effectiveness of individual therapies in many areas and offer distinct advantages when relational factors are central to the problem. The review supports systemic approaches as a core part of evidence-based practice in adult mental health and relationship therapy.
Reference
Carr, A. (2018). Couple therapy, family therapy, and systemic interventions for adult-focused problems: the current evidence base: Adult-focused problems. Journal of Family Therapy, 41. https://doi.org/10.1111/1467-6427.12225