Couples & Family Therapy

Mental health is never fully individual — it lives in the context of relationships, families, and the systems we're embedded in. Couples and family therapy address the relational dimension of wellbeing, with approaches backed by decades of research and practical experience.

13 min read Reviewed July 2026 Plain-language summary

The short version

Couples and family therapy treat the relationship system, not just individuals — the 'client' is the relationship itself.
Evidence-based approaches like EFT and Gottman Method have decades of research supporting their effectiveness.
You don't need to be in crisis to benefit — many couples seek therapy for communication, life transitions, or prevention.
Family therapy is highly effective for adolescent mental health conditions and substance use.
Individual and relationship therapy can be combined; most therapists will recommend this when both are needed.

What couples and family therapy is

Couples and family therapy (sometimes called relational therapy or systemic therapy) is a form of psychotherapy in which the unit of treatment is a relationship or family system, rather than an individual. The therapist works with two or more people together — examining how they interact, communicate, understand each other, and shape one another's behavior.

This perspective draws on a core insight from family systems theory: problems that appear to belong to one person often make more sense — and change more effectively — when the surrounding relationships are part of the picture. A child's anxiety, an adult's depression, a person's substance use — all are influenced by and influence the relational world around them.

Who provides couples and family therapy?

In New Hampshire, licensed Marriage and Family Therapists (LMFTs), Licensed Clinical Social Workers (LCSWs), licensed counselors (LPCs), and psychologists can all provide couples and family therapy, depending on their training. The credential to look for is specialized training in relational modalities — not simply the license type.

Couples therapy: major approaches

Several distinct, evidence-based models guide couples therapy. Understanding the differences can help you choose the right fit.

Emotionally Focused Therapy (EFT)

Developed by Dr. Sue Johnson, EFT is grounded in attachment theory — the science of how human emotional bonds form, rupture, and repair. EFT helps partners identify the negative interaction cycles they get caught in (pursuer– withdrawer, protest–shutdown) and access the deeper attachment fears and needs underneath the conflict. The goal is to create a secure bond: a felt sense of safety in the relationship.

EFT has the most extensive evidence base in couples therapy, with studies showing 70–73% of couples recovering from distress and significant gains maintained at follow-up. It is especially effective for couples navigating trauma, infidelity, or attachment injuries.

The Gottman Method

Based on over 40 years of longitudinal research by Drs. John and Julie Gottman, the Gottman Method addresses relationship quality through a framework called the Sound Relationship House. It builds love maps (knowing each other's inner world), fondness and admiration, and the ability to turn toward rather than away in bids for connection. The model also targets the "Four Horsemen" — criticism, contempt, defensiveness, and stonewalling — which Gottman's research identifies as the most reliable predictors of relationship breakdown.

Integrative Behavioral Couples Therapy (IBCT)

IBCT blends behavior change strategies with acceptance work. It helps partners recognize that some differences are permanent and that the goal is not to change each other into someone else, but to develop genuine acceptance alongside targeted behavioral change. Research shows it is as effective as traditional behavioral couples therapy with better maintenance at follow-up.

Discernment Counseling

When one or both partners are ambivalent about whether to continue the relationship, standard couples therapy can feel premature. Discernment counseling is a brief (1–5 session) process designed specifically for this "mixed-agenda" situation — helping both partners gain clarity about whether to work on the relationship, separate, or take more time.

Family therapy: major approaches

Attachment-Based Family Therapy (ABFT)

Developed specifically for adolescents with depression and suicidal ideation, ABFT targets the ruptures in the parent–adolescent attachment bond that leave teens emotionally isolated and vulnerable. The therapist works separately with parents and teens before bringing them together to repair the relationship. It has strong evidence for reducing adolescent depression and suicidal ideation.

Structural Family Therapy

Developed by Salvador Minuchin, structural family therapy maps and reorganizes the structure of a family system — the boundaries between subsystems, the hierarchy, and the alliances and coalitions that shape how the family functions. A symptom in one member often reflects a structural imbalance in the system.

Multisystemic Therapy (MST)

An intensive, home- and community-based intervention for adolescents with serious antisocial behavior, substance use, or juvenile justice involvement. MST addresses family, peer, school, and community factors simultaneously, with high-frequency therapist contact. It has a strong evidence base for reducing out-of-home placements and recidivism.

Functional Family Therapy (FFT)

FFT is a structured, short-term model (8–30 sessions) for families of youth with behavioral problems. It progresses through engagement, motivation, behavior change, and generalization phases, with a focus on building family strengths.

Family therapy is frequently combined with individual therapy for the identified child or adolescent — especially for anxiety disorders, eating disorders, OCD, ADHD, and depression. The two modalities reinforce each other.

When to seek couples or family therapy

You don't need to be in a crisis to benefit from relational therapy. Common reasons people seek it include:

For couples

Recurring conflict that doesn't resolve and leaves both partners feeling unheard
Communication breakdown — arguments escalate, or one or both partners shut down
Recovery from infidelity or other relationship betrayals
Major life transitions: a new baby, job loss, illness, grief, retirement
Differing parenting philosophies that create conflict
Intimacy or sexual concerns
Prevention — strengthening a relationship before problems develop
Navigating a decision about whether to stay in the relationship

For families

A child or adolescent's mental health or behavioral concerns
Blended family adjustment after divorce, remarriage, or adoption
Grief and loss affecting the family system
A family member's substance use or mental illness
Parent–adolescent conflict
Family adjustment to a member's chronic illness or disability

When individual therapy comes first

In situations involving domestic violence or active, unsafe abuse, conjoint couples therapy (both partners in the same room) is contraindicated. Individual therapy for the person being harmed, and separate accountability work for the person causing harm, is the appropriate path. If domestic violence is a concern, contact the NH Coalition Against Domestic and Sexual Violence (603-224-8893 or 866-644-3574) for guidance.

What to expect in couples or family therapy

First sessions typically involve the therapist gathering a picture of the relationship history, current concerns, and what each person hopes to gain from therapy. Many therapists schedule brief individual meetings with each person early in the process.

Unlike individual therapy, the therapist is not an advocate for any one member of the system. They hold the relationship as their client, which means working to understand all perspectives — and sometimes challenging all members of the system. This can feel unfamiliar and occasionally uncomfortable.

Sessions are typically 50–60 minutes, though some models (like Gottman Method) use extended sessions. Progress is usually visible within a few months of consistent attendance, though deeper work may take longer.

Between-session work matters in relational therapy. Partners and families are usually asked to practice specific skills, try new ways of responding to each other, and notice patterns between sessions. The work in the room is most effective when it extends into daily life.

Find help in New Hampshire

Licensed marriage and family therapists, social workers, and counselors offering couples and family therapy practice throughout NH. CMHCs serve families regardless of ability to pay, and many private practices accept Medicaid and major insurance.

Couples and family therapists in New HampshireSearch Meridian's directory for licensed therapists offering relational and family therapy across all NH regions.Browse therapy and counseling providersAll NH-verified therapists and counselors in the Meridian directory, filterable by region.

References & further reading

1.Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). Brunner-Routledge.
2.Gottman, J. M., & Silver, N. (2015). The seven principles for making marriage work (revised ed.). Harmony Books.
3.Christensen, A., & Jacobson, N. S. (1998). Acceptance and change in couple therapy. Norton.
4.Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Attachment-based family therapy for depressed adolescents. American Psychological Association.
5.Minuchin, S. (1974). Families and family therapy. Harvard University Press.
6.Henggeler, S. W., & Schaeffer, C. M. (2016). Multisystemic therapy: Clinical overview, outcomes, and implementation research. Family Process, 55(3), 514–528.
7.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.

Also in the library

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This page is general education, not medical advice or a diagnosis. Mental health conditions are best assessed and treated by a qualified professional. If you or someone else is in immediate danger, call or text 988(Suicide & Crisis Lifeline) or NH Rapid Response at 833-710-6477.