Journal
When couples therapy helps — and when it isn't the right thing
Distance, conflict, an affair, a decision to make. And the one situation where couples therapy is the wrong first step.
AI-generated illustration. Not a real office.
Couples therapy is for two people who want something to change in how they deal with each other, or who want to decide something together, and would like some help doing it. It is not a last resort, and it is not only for couples in trouble.
It also has one clear limit. This article covers when it helps, what it looks like, and the situation where it is the wrong first step.
What couples therapy looks at
The work is on the pattern between you, not on deciding who is to blame.
Most couples who come have not got one person who is the problem. They have a cycle: one raises something, the other backs away, the first pushes harder, and both end up where they started. A therapist sitting with both of you can often see the cycle more clearly than either of you can from inside it.
Some couples come to stay together and some to separate well. Both are reasons to come.
Times people come
People come at many points: a long stretch of distance, the same argument on repeat, trust that has been damaged, a decision such as a move or a child, or a loss or a new baby that has changed how the two of you are together.
Some come early, before anything has gone wrong, because they would like to talk about it well. Some come late, when one of them is close to leaving. Both are reasonable times.
You do not need to agree on what the problem is before you come. Often the first thing a session does is show how differently each person sees it.
When one of you comes alone first
Not every relationship question needs a session for two. Some people come on their own, to understand why the same thing keeps happening to them, and some start alone and bring a partner later.
Support for relationships describes both. The free call is a good place to work out which fits.
When it is the wrong first step
There is one situation where couples therapy should not be where you start: when one partner is afraid of the other. If you are afraid of what your partner might do if you disagree, or afraid to say what you think in front of them, or you feel controlled or threatened by them, a joint session is the wrong first step.
A room with both of you in it asks each person to speak openly in front of the other. For someone who is afraid, that is not safe, and what is said in the room may be carried home afterward. Safety comes first. Anything else, including couples work, comes after, and only if it is right.
If you're in danger right now, call 911. For a mental health crisis, call or text 988.
If you are not sure whether this describes you, use the free call on your own, from somewhere your partner cannot see or hear it, and say so. Think about whether the call, a message or a confirmation could be seen on a shared phone or an e-mail account you both use.
This practice has a policy for couples work: couples work here has a "no secrets" policy: if one partner tells the therapist something alone that matters to the work you are doing together, the therapist will help them bring it into the room rather than keep it. That is the practice's policy, and your therapist will go through it at the first session. That policy suits two people who can both speak freely. It is not built for a situation in which one of them cannot.
If you need help now. If you're in danger right now, call 911. For a mental health crisis, call or text 988 or chat at 988lifeline.org, 24 hours a day; veterans can call 988 and press 1. You can also text HOME to 741741. Our phone and messages are not monitored outside office hours, and this website is not an emergency service.
What a first couples session is like
Fifty minutes with both partners, married or not, any gender. Both partners come, in person or on the same video call; sessions are fifty minutes.
Rosa Quintero, Joaquín Ibarra and Nusrat Haque work with couples here, in person or by video, and you can ask for whichever you think you would both feel at ease with.
The first session is mostly listening: how each of you describes what is happening, what you have tried, and what each of you would like to be different. You do not have to agree, and you will not be asked to take sides.
This is how couples sessions are priced:
- $240 couples session, fifty minutes The same fee with every clinician, in person or by video.
- Paid at or after each session: card, cash, check, or an HSA or FSA card. One fee however you pay.
- Twenty-four hours' notice to cancel or move a session; inside that the fee is charged, except the first time in any twelve months.
- Out of network: we don't participate in any insurance plan.
- These fees apply from October 1, 2026 to September 30, 2027.
Couples therapy has the calendar and the details.
General information, not advice for you. Nothing on this website can tell you what is going on for you. A diagnosis, where one is needed, comes from a clinician who has met you — never from a page, a quiz or a booking form.
Book a free call
Book a free fifteen-minute call, or go straight to a first session if you know what you want. Nothing is paid online, and nothing on the form asks why you're coming.