Couples counselling or couples therapy: what do you need, and when?

The difference does not lie in which is more demanding, but in what it is aimed at. Couples counselling works on what goes on between two people in the present. Psychotherapy treats the illness or the deeper wound of one person. If you need one and get the other, you lose months.

I offer couples counselling, not therapy. So this text will send some of you elsewhere, and that is intentional.

The difference in substance

Couples counselling looks at the movement between the two of you. Who does what when the other does what. It works in the present, is usually designed for a small number of sessions and assumes that both of you are basically able to act.

Psychotherapy treats an illness or a burden that one person carries within them. Depression, anxiety disorders, the consequences of violence, grief that does not move on. It usually takes longer, it goes back into the person’s history, and it mostly takes place with one person.

In between lies a grey area. People who offer couples therapy often work on the same dynamic as counselling does, usually over a longer period.

The comparison

	Couples counselling	Psychotherapy
Focus	the dynamic between two people	an illness or burden of one person
Who takes part	both of you	usually one person
Time focus	the present, concrete situations	also the past and how things came about
Duration	a few sessions, often four to ten	months to years
Precondition	both are able to act and want to change something	considerable suffering or a diagnosis
Costs	paid privately	with a diagnosis, usually covered by health insurance
Access	possible at short notice	often with a waiting list
What it is meant for	when you are going round in circles and both want to stay	when one person needs something a relationship cannot provide

The last row is the one that matters. There is no ranking, just two different tools.

The questions you should ask before an appointment

People with very different kinds of training work in this field, and the job titles tell you little about that. That is why it makes sense to ask beforehand. It is common practice and nobody will take offence.

• What training have you done, with whom and over what period?
• How long have you been working with couples?
• What does a session with you look like?
• Which topics do you not work on, and when do you refer people on?

The last question is the most revealing. Anyone who says yes to everything has not clarified their own limits.

For my own part: I am a couples counsellor, I have been working with couples for eight years and in that time I have accompanied around 500 couples. My training as a couples counsellor took two years, and on top of that I trained as a counsellor for individuals. I do not treat mental illnesses and I refer people on when something like that comes up. If something needs therapeutic treatment, I say so and refer people on.

When counselling is the right choice

• You have been having the same argument for months or years and cannot get out of it.
• One of you shuts down, the other can no longer get through.
• You have drifted apart and do not know where to start.
• Everything has shifted since the birth of a child.
• You both want to stay and need tools, not an interpretation.

The telltale sign: the problem lies between you, not in one of you.

When therapy is the right choice

• One of you has a diagnosis or suspects one.
• There is violence or trauma in your past.
• Someone has not been able to get out of exhaustion or heaviness for months.
• There is addictive behaviour.
• One person needs a space of their own in which the relationship is not the focus.

The telltale sign: the problem would still exist if the relationship ended tomorrow.

Both at the same time is possible and often makes sense. One person in psychotherapy and the couple in counselling are not mutually exclusive. Both sides just need to know about it.

When neither of the two is enough

There are situations in which both would be the wrong path, and I say this clearly.

In cases of violence, physical or verbal. In cases of systematic belittling. In cases of control over who you talk to, where you go or what you have access to. When you are kept away from your people.

In those situations there is no shared dynamic that two people can work on as equals. Joint sessions can even do harm here, because they demand things of the person affected that they then pay for at home.

I do not take on couples in that situation. What is needed is a service focused on protection.

The German helpline for women affected by violence (Hilfetelefon Gewalt gegen Frauen) is available around the clock, free of charge and anonymously, on 116 016, even if you just want to talk and sort things out.

The question of money

With a diagnosis, psychotherapy is usually covered by health insurance. Relationship conflicts alone are not an illness, which is why couples counselling is a private service.

What also exists, and is mentioned far too rarely: marriage and family counselling centres, run by local authorities, churches or welfare organisations. Counselling there is free or costs a small contribution, there is one in almost every larger town, and the counsellors are trained.

If money is the reason you are hesitating, that is the route I would recommend. One appointment there is much better than a year in which nothing happens.

What I would like you to take away

The question that probably brought you here is not really counselling or therapy. It is: is it bad enough for us that we are allowed to get support?

My answer to that is always the same. You go to the doctor because you have a goal, namely being healthy. Nobody asks whether it is bad enough. A relationship affects every area of your life, your sleep, your work, your children, yourself.

So why wait to invest in it until there is hardly anything left.