When does a family need therapy?
Constant fights, distance, a crisis or a big transition. Here’s how to know when a family or couple could use therapy, and what research says about results.
Family or couples therapy can help when the same conflicts keep repeating, communication has broken down, a crisis hits (infidelity, illness, a loss) or a child is struggling. Research shows couple therapy helps most couples, and in a large five-year trial about half the couples who went through it were still significantly better years later. The earlier you start, the better the chances.
- Couple therapy produces meaningful improvement for most couples in studies.
- Couples typically wait years before seeking help — earlier is better.
- Evidence-based approaches include Emotionally Focused, Integrative Behavioral and Gottman Method therapy.
Every family goes through rough patches. But sometimes the same arguments loop for years, people stop talking, or a crisis knocks everyone off balance. That’s when an outside, trained perspective can make a real difference.
Signs it might be time
- The same conflict repeats and nothing changes.
- You avoid each other or feel like roommates.
- There’s been a betrayal: an affair, hidden debt, broken trust.
- A child is struggling — anxiety, behavior problems, school refusal — and it’s affecting everyone.
- A major transition: a new baby, a blended family, a move, a deployment, a serious diagnosis, a death.
- Someone in the family is using alcohol or drugs in a way that worries you.
Does it work?
Jay Lebow and colleagues reviewed decades of research on couple therapy 1. Evidence-based couple therapy helps most couples — roughly 70% show meaningful improvement in clinical trials. The best-supported approaches include Emotionally Focused Therapy, Integrative Behavioral Couple Therapy and behavioral couple therapy.
In one of the largest trials, Andrew Christensen and colleagues followed 134 seriously distressed couples for five years after therapy 2. About half were significantly better five years on. Some couples separated — and for some of them, a clear, calmer decision was a good outcome too.
How to find a good therapist
- Look for a Licensed Marriage and Family Therapist (LMFT) or a psychologist trained in couples work.
- Ask: “Which approach do you use? What does the research say about it?”
- The fit matters. It’s okay to try a different therapist after a few sessions.
- Directories like Psychology Today or the American Association for Marriage and Family Therapy can help you search by location and insurance.
More in our guide How to find a therapist.
One important exception
If there’s violence or coercive control in the relationship, couples therapy is usually not recommended — it can put the person being abused at greater risk. Start with the National Domestic Violence Hotline at 1-800-799-7233.
Frequently asked questions
What if my partner won’t go?
You can start on your own. Individual therapy can change how you respond, which often shifts the whole family dynamic.
Will insurance cover family therapy?
Many plans cover it when there’s a diagnosed condition, sometimes under a family psychotherapy code. Call your insurer, or look for sliding-scale clinics and community mental health centers.
Sources
- Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145–168. doi:10.1111/j.1752-0606.2011.00249.x
- Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225–235. doi:10.1037/a0018132
Evidence-based · Human-centered · Practical — how we write and fact-check our articles.
This article is for educational purposes and does not replace advice from a licensed professional. We cite original research and update articles when new evidence appears. Spotted an error? Let us know — see our editorial policy.
If you or someone you love is in crisis, call or text 988 (Suicide & Crisis Lifeline). Veterans: dial 988, then press 1.
