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Couples Therapy for Adults Experiencing Relationship Distress: A Review of the Clinical Evidence and Guidelines

Last updated: October 17, 2014
Project Number: RC0597-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

In Canada, approximately 40% of married couples can be expected to divorce before their 30th wedding anniversary, which suggests a high prevalence of relationship distress. Relationship distress can cause psychological and physical health concerns, such as depression, anxiety and substance abuse, and it can also result from health concerns, such as terminal illness, chronic disease, mental health disorders, infidelity, and unresolved childhood trauma.

Couples therapy is a common intervention for partners experiencing relationship distress. It is based on the idea that guiding couples through their conflict as a collaborative team is more effective than working with only one member alone. During couples therapy, a counsellor helps partners identify the reasons for the distress and find ways to alleviate it so that the relationship can be improved.

Although couples therapy is widely practised, its effectiveness as an intervention to improve relationship distress is unclear. A review of the effectiveness of couples therapy, as well as of the related evidence-based guidelines regarding couples or marital therapy, will help inform treatment decisions for adults experiencing relationship distress.

A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

The literature search identified 335 citations, with 11 additional articles identified from other sources. Of these, 40 were deemed potentially relevant, and 20 publications, describing 18 studies, met the criteria for inclusion in this review ― 8 randomized controlled trials, 9 pre-post observational studies, and 1 cohort study.

Key Messages

  • For couples experiencing relationship distress, couples therapy appears to have a positive impact on relationship satisfaction.
  • It is unclear if couples therapy provides any other relationship-related or psychological health benefits.
  • No evidence-based guidelines were found.


  1. What is the clinical effectiveness of couples therapy for adults experiencing relationship distress?
  2. What are the evidence-based guidelines regarding couples or marital therapy?

Key Message

The published clinical effectiveness literature is limited due to potential for measurement and selection bias, in part due to the inability to blind patients and therapists but also due to the broad range of approaches to couples therapy, length of treatment and reasons for couples presenting to therapy. Despite these important limitations, overall results suggest that couples therapy could have a positive impact on relationship satisfaction for couples in distress. The literature is inconclusive regarding the effects of couples therapy on other relationship-related outcomes and psychological health outcomes in this population.