One of our biggest decisions can be the person we choose to spend most of our time with. One of our greatest pleasures can be our relationship with our chosen partner. Couple relationships can be formed in many different ways, by marriage, civil partnership, choosing to live together or simply deciding to be ‘in a relationship’. Couple relationships can be formed in many different ways, different gender partners (female/male), same gender partners (male/male or female/female), and partnerships were gender is in transition (perhaps through a so-called ‘sex-change’). Furthermore, beyond what might be termed ‘traditional relationships’ are what might be termed ‘non-traditional relationships’ such as polyamory, BDSM lifestyles and so on.

From time to time most couple relationships go through difficult patches. Sometimes it might be appropriate to seek professional help as a couple. Often the consequences of couple break-up can be very serious with far-reaching consequences for all concerned.

A recent review of the scientific literature (Friedlander, et al., 2011) showed that couples therapy can be effective and one of the contributors to effective outcome can be the relationship the couple have with their therapist, for example feeling safe and comfortable with the counsellor, feeling understood and accepted and so on.

Dr Tony Weston’s BACP award winning research into effective treatments for depression, anxiety and distress, included couples clients who were seeking help for their relationship. Often members of a couple that are experiencing distress have their own problems, as well as the relationship difficulties. It is sometimes helpful if both individual and couple problems can be addressed at the same time, leading to greater mutual understanding and support.

Mackey and colleagues (2004) looked at the factors that contributed to same-sex and heterosexual couples staying together (on average for 30 years) and concluded two predictors of satisfaction were a) containment of conflict within the relationship, and b) psychologically intimate communication within the relationship. Markman and colleagues (2010) studied 210 couple relationships and found how couples managed negative emotions within the relationship predicted levels of couple distress, i.e. more adaptive ways of handling negativity lead to less couple distress (happier couples).

Sometimes there are specific issues a couple would like help with, e.g. dealing with young children, teenagers, adult children or elderly relatives. Oftentimes the issue is the couple relationship itself, for example wanting greater intimacy and less conflict, anger management, sexual and sex-related issues, dealing with an affair, etc.

Usually Emotion-focused Couple Therapy (EFCT), an evidence-based approach to couple counselling, developed by Dr Sue Johnson, is appropriate for most couples. EFCT focuses upon adult attachment styles and is designed for short-term therapy (e.g. 12-20 sessions), sometimes couples are happy with fewer sessions and sometimes they want more sessions. The literature, and experience at this service, suggests Emotion-focused Couple Therapy can improve not only couple relationships but also can improve depression, distress and anxiety experienced by the individuals of the couple. When there has been an affair (emotional and/or sexual) the approach taken is usually to use the evidence-based treatment manual ‘Helping couples get past the affair’. The first part of this approach is designed to minimise the damage an affair can cause to the couple relationship and the individuals involved. Seeking help soon, in the case of an affair, can help improve outcomes for all concerned.

Dr Tony Weston enjoys working with couples clients you can contact him now on 01223-894896 (phone is answered 24/7) or email him at to make an initial appointment.

Following are some outcomes for clients seen at this service, to July 2022. Average age of couple clients was around forty years, range twenties to eighties. The average number of sessions was around ten. Six out of ten clients had children.

Improvements in the satisfaction that clients experience in their couple relationship (CSI 16) have been found at this service. Research to July 2022 showed for 42 clients, change from couple relationships that were on average described as ‘dissatisfied’ to ‘satisfied’ after an average of 11 sessions:

9 csi

This was a ‘large’ improvement and statistically significant at better than 99.9% confidence.

Couple relationships can be a hugely important source of emotional attachment, enhancing wellbeing. Research at this service suggests couple attachments can improve through therapy. Overall improvements in attachment anxiety, towards a more secure couple attachment were observed for 21 clients after an average of 13 sessions, to July 2022:

6 couple anx

To July 2022, improvements from emotionally avoidant couple attachments, towards more emotionally secure attachments were seen for 9 clients, after an average of 15 sessions:

5 av att

Improvements in trust within the couple relationship, a key part of a secure emotional attachment, were observed for 21 clients to July 2022, after an average of 13 sessions:

6 couple trust

Allied to issues of adult attachment style, issues of rejection sensitivity may also play a part in some difficulties experienced by some couples. Bowlby’s (1969) work on the ideal childhood resulting in a secure attachment style helps to show that individuals can develop a sensitivity to rejection from others through childhood experience and beyond. The absence of a secure attachment can give rise to fears of abandonment, neglect and rejection that can then play out in the couple relationship. There is some evidence (Bungert et al., 2015) that childhood emotional neglect may be key in the development of long-term rejection sensitivity. Rejection sensitive individuals expect, readily perceive and often overreact to rejection. Their means of processing these fearful expectations, perceptions and experiences may in turn make rejection more likely. Individuals may thus generate ‘self-fulfilling prophecies’ which harm their experiences of relationships, and the experiences of intimate others (the other person in the couple relationship). Ironically, this makes the feared scenarios more likely.

Downey and Feldman (1998) showed that rejection sensitive people in couple relationships tended to see merely ‘insensitive’ behaviour from their partners as intentional rejection. They found that couples were one or more partners were sensitive to rejection were more dissatisfied with their relationship than those couples were neither partner was rejection sensitive. The origins of the relationship dissatisfaction were found to arise from the behaviour of the relationship sensitive partner: (i) acting out jealousy with their partner, (ii) seeking to ‘protect’ oneself by reducing emotional supportiveness, and (iii) enacting hostility towards their partner. In each instance, the rejection sensitive partner acting out of fear of rejection made it more likely they would be rejected. There is evidence that rejection sensitivity can improve though counselling. Furthermore, that issues of rejection sensitivity enacted  in couple relationships can also improve, see below.

Rejection sensitivity is composed of two parts, and in the couple relationship specifically,  these are considered to be: 1) the emotional part with fearful/ anxious feelings around the partner and 2) the cognitive/ thinking part that appraises situations in the relationship as likely to lead to rejection. Rejection sensitivity is measured using the Adult Rejection Sensitivity Questionnaire (A-RSQ) which provides scenarios in the couple relationship and asks about feelings and thoughts about each scenario. Research at this service suggests that rejection sensitivity in the couple relationship can improve and the following graph shows for 29 clients to July 2022 a reduction in rejection sensitivity that is both large (ES = 1.50) and statistically significant (p < .001), after an average of 15 sessions:

9 couple rs

Research to July 2022 suggested there was a large and statistically significant improvement in the emotions experienced by couples associated with rejection sensitivity, for 30 clients after an average of 15 sessions. Clients felt less fearful of being rejected by their partner, which helped them improve their enjoyment of their relationship:

9 couple rs e

Clients who were having difficulty with thoughts (cognitions) about rejection that were contributing to their rejection sensitivity showed large and statistically significant improvement in their rejection sensitive cognitions, for 18 clients after an average of 15 sessions to July 2022:

9 couple rs c

In addition to couple dissatisfaction, sometimes individuals within the couple relationship are experiencing difficulties that can be improved through couple counselling. These difficulties can include depression, distress, anxiety and other symptoms.

Fifty-four individuals seeking help as part of couple counselling who were suffering with depression had the following outcomes after an average of nine sessions, as at July 2022:

9 couple depression

These 54 clients had on average a moderate level of Clinical Depression at the start of couple counselling. After an average of nine sessions (range 3 to 35 sessions), they were on average no longer depressed. This was a ‘large’ effect and statistically significant at better than 99.9% confidence.

Members of couples, 86 clients, who had some level of Clinical Distress had the following outcomes (as at July 2022):

9 couple distress

Eighty-six clients with Clinical Distress had on average at the start a moderate level of distress and after an average of 6 sessions (range 2-30 sessions) they were, on average, no longer distressed. This was a ‘large’ improvement and statistically significant at better than 99.9% confidence.

To July 2022, twenty-eight clients with Clinical Anxiety attending for couple counselling had the following outcomes:

9 couple anxiety

Twenty-eight clients had, on average, a moderate level of Clinical Anxiety and after an average of ten sessions (range 3 to 36 sessions) they were on average no longer suffering with Anxiety. This was a ‘large’ improvement and statistically significant at better than 99.9% confidence.

In addition to the Couple Satisfaction Index (CSI-16) data shown above, Dr Weston has also used the Quality of Dyadic Relationships questionnaire (QDR36) to measure changes in the quality of couple relationships as a consequence of couple therapy. Arriaga and Agnew (2001) found relationship commitment consisted of three components: 1) psychological attachment (feeling component), 2) long-term thoughts about the relationship (thinking/cognitive component), and 3) intention to stay in the relationship (motivational component) The QDR36 was developed to build and improve on previous measures of couple adjustment by adding questions about communication, sensuality and sexuality to questions about satisfaction and consensus (Ahlborg, et al. 2009).

Following are average changes to July 2022 in the quality of couple relationships, showing an average improvement from the quality of couple relationship typically found in those seeking couple therapy to the quality of couple relationship usually found in long-term happy relationships:

couple qdr total

These changes included improvements across all dimensions of the couple relationship; better consensus between partners, greater cohesion within the relationship, improved relationship satisfaction, more kisses and cuddles and better quality sex.

In terms of the consensus within the relationship, improvements were found towards less disagreement and more agreement across a range of issues including handling finances, major decision-making, appropriate behaviour, household tasks, work/career, time spent together and with family & friends and so on:

couple consensus

Improvements in ‘cohesion’; laughing together, having calm discussions, co-operating together and having stimulating exchanges of ideas were also seen:

couple cohesion

Improvements in satisfaction included more frequently thinking the relationship was going well, sharing greater confidences, partners taking greater responsibility within the relationship, fewer misunderstandings and less quarrels:

couple satisfaction

Improvements in ‘sensuality’ included more frequent hugs, kisses and cuddles between the partners:

couple sensuality

Improvements in sex included greater sexual desire between the couple, partners paying more attention to one another’s sexual needs, and more frequent sex according to the partners’ wishes:

couple sex

Improvements in couple relationships can also occur from individual counselling. Following is a graph showing client-reported improvements in problems with close relationships for clients seen at this counselling service (fewer problems with close relationships) to July 2022. For these 141 clients the average number of sessions was seven, range 2-43 sessions:

4 close

This naturalistic research showed on average large improvements in couple relationships during both couple and individual counselling, even if there were other co-occuring problems. There were also on average large improvements in co-occuring problems, such as clinical distress, depression and anxiety, during couples counselling.

Please note past performance is no guide to the future and there are no guarantees about outcome in therapy.

You can contact Dr Tony Weston on 01223-894896 (phone is answered by a receptionist 24/7) or email him at to make an initial appointment.


Ahlborg, T, Lilleengen, A-M, Lonnfjord, V and Petersen, C (2009). Quality of dyadic relationship in Swedish men and women living in long-term relationships and in couples in family counselling: Introduction of a new self-report measure, QDR36. Nordic Psychology, 61 (3), 23-46.

Arriaga, X B and Agnew, C (2001). Being committed: Affective, cognitive and conative components of relationship commitment. Personality and Social Psychology Bulletin, 27, 1190-1203.

Bowlby, J (1969). Attachment and Loss. London: Hogarth.

Bungert, M., Liebke, L., Thome, L., Haussler, K., Bohus, M., and Lis, S. 2015. Rejection sensitivity and symptom severity in patients with borderline personality disorder: Effects of childhood maltreatment and self-esteem. Emotion Dysregulation, 2(4), pp.1-13.

Downey, G., and Feldman, S. 1998. Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), pp.1327-43.

Friedlander, M L, Escudero, V, Heatherington, L and Diamond, G M (2011). Alliance in couple and family therapy. In J C Norcross Psychotherapy relationships that work: Evidence-based responsiveness. New York: Oxford University Press.
Mackey, R A, Diemer, M A, and O’Brien, B A (2004). Relational factors in understanding satisfaction in the lasting relationships of same-sex and heterosexual couples. Journal of Homosexuality 47 (1) 111-136.

Markman, H J, Rhoades, G K, Stanley, S M, Ragan, E P and Whitton, S W (2010). The premarital communication roots of marital distress and divorce: The first five years of marriage. Journal of Family Psychology 24 (3) 289-298.