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Relationship Issues & Therapy Options

Published April 2026 · Last updated · Written and edited by Paul Paradis · Educational information – not medical or mental-health advice

What changed: Reworded link and heading text without ranking claims: “best couples therapy platforms” to “couples therapy platforms compared”; “Best Couples Therapy Platforms” to “Couples Therapy Platforms Compared”; “Best Online Therapy Platforms” to “Online Therapy Platforms Compared”. Earlier on October 30: Retitled 2 headings in plainer words: “Understanding Relationship Difficulties” to “Where relationship trouble usually starts”, “Understanding Attachment in Relationships” to “Attachment styles in adult relationships”.

Reviewed for educational clarity and safety language by Lisa Lewis, RN, BSN

Relationship problems affect every area of your life, your emotional well-being, sleep, work performance, and even physical health, and online therapy offers multiple paths toward healthier relationships. The sections below separate couples counseling, individual work, and the situations where one of those is a poor fit, including when coaching is not therapy.

A man and a woman sit at a round wooden table and talk.

Where relationship trouble usually starts

Relationships, whether romantic partnerships, family bonds, or close friendships, require ongoing attention and adaptation. Difficulties arise naturally over time due to life transitions, unresolved conflicts, communication breakdowns, or deeper incompatibilities. Understanding the nature of your relationship challenges is the first step toward addressing them effectively.

The Impact of Relationship Distress

Relationship problems affect more than just the relationship itself:

When Relationship Problems Become Patterns

Sometimes relationship difficulties reflect broader patterns that follow us from one relationship to the next. These patterns often trace back to:

Common Relationship Challenges

People seek therapy for many relationship concerns:

Types of Relationship Therapy

Couples Therapy

Both partners attend sessions together to work on their relationship. Explore online couples therapy options for a deeper look at what's available. Effective approaches include:

Individual Therapy for Relationships

Working alone with a therapist to address:

Family Therapy

Multiple family members participate to improve communication, resolve conflicts, and strengthen bonds.

Discernment Counseling

For couples where one or both partners are uncertain about staying in the relationship. Helps gain clarity before committing to couples therapy.

Evidence-Based Approaches for Couples

Research has identified several therapeutic approaches with strong evidence for improving relationship outcomes:

Emotionally Focused Therapy (EFT)

Developed by Dr. Sue Johnson, EFT is one of the most researched and effective approaches for couples. Based on attachment theory, it helps partners understand their emotional responses and the negative cycles that trap them.

Gottman Method Couples Therapy

Based on over 40 years of research by Drs. John and Julie Gottman at their "Love Lab," this approach identifies specific behaviors that predict relationship success or failure.

Cognitive Behavioral Couples Therapy (CBCT)

Applies cognitive-behavioral principles to relationship distress:

Integrative Behavioral Couple Therapy (IBCT)

Developed by Andrew Christensen and Neil Jacobson, IBCT combines behavioral change strategies with emotional acceptance:

Attachment styles in adult relationships

Attachment theory, originally developed by John Bowlby and later applied to adult relationships by researchers like Cindy Hazan and Phillip Shaver, provides a powerful lens for understanding relationship patterns.

Attachment Styles

Your attachment style, formed in early childhood relationships, influences how you relate in adult partnerships:

Secure Attachment

Anxious (Preoccupied) Attachment

Avoidant (Dismissive) Attachment

Disorganized (Fearful-Avoidant) Attachment

The Pursue-Withdraw Dynamic

One of the most common relationship patterns involves an anxious partner pursuing connection while an avoidant partner withdraws. This creates a painful cycle:

  1. One partner (often more anxiously attached) seeks connection or resolution
  2. Their attempts feel overwhelming to the other partner (often more avoidantly attached)
  3. The second partner withdraws or shuts down
  4. Withdrawal triggers more pursuit from the first partner
  5. The cycle escalates, leaving both partners feeling unheard and alone

Understanding this pattern is often the first step toward breaking it. Couples therapy, especially EFT, specifically targets these attachment-driven cycles.

Benefits of Online Relationship Therapy

Online Platforms for Relationship Therapy

Couples Therapy Platforms

Compare options on our couples therapy platforms compared guide.

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Individual Therapy (for Relationship Work)

Insurance-Based Options

Family Therapy

For broader family dynamics, see our guide on family therapy through telehealth.

What to Expect in Couples Therapy

  1. Initial assessment: Both partners share their perspectives; the therapist gathers history
  2. Individual sessions: Some therapists meet with each partner separately once
  3. Goal setting: Collaboratively identify what you want to work on
  4. Regular sessions: Typically weekly, learning skills and processing issues
  5. Homework: Practicing communication and connection between sessions
  6. Progress review: Adjusting approach based on what's working

Important: Couples therapy works best when both partners are committed to the process and willing to examine their own contributions.

When Individual Therapy Makes Sense

Consider individual therapy if:

Red Flags: When Couples Therapy Isn't Appropriate

Couples therapy may not be safe or appropriate if:

If you're experiencing domestic violence: Contact the National Domestic Violence Hotline at 1-800-799-7233 or text START to 88788. Your safety is the priority.

Self-Help Resources

Tips for Getting Started

Communication Skills for Healthier Relationships

Effective communication is foundational to relationship health. These evidence-based skills can improve connection:

Speaker-Listener Technique

A structured approach to discussing difficult topics:

Soft Start-Up

How you begin a conversation predicts how it will end. Gottman research shows that discussions that start with criticism or contempt rarely end well.

Repair Attempts

The ability to make and accept repair attempts during conflict is one of the strongest predictors of relationship success:

Time-Outs

When emotions escalate (physiological flooding), productive conversation becomes impossible. Effective time-outs:

Special Situations

Infidelity and Betrayal

Affairs and betrayals are among the most devastating relationship injuries, but many couples do recover and even develop stronger relationships afterward. Key considerations:

Mixed-Agenda Couples

When one partner wants to stay and work on the relationship while the other is uncertain or wants to leave:

Long-Distance Relationships

Online therapy is particularly well-suited for couples managing distance:

Cultural and Religious Differences

Couples from different backgrounds may face unique challenges:

LGBTQ+ Relationship Concerns

Same-sex and LGBTQ+ couples may face unique stressors:

Frequently asked questions

What types of relationship issues can online therapy help with?

Online therapy effectively addresses a wide range of relationship concerns including communication problems and conflict patterns, trust issues and infidelity recovery, intimacy and emotional connection challenges, life transitions affecting relationships (parenthood, career changes, retirement), financial stress and disagreements, codependency and unhealthy relationship patterns, family-of-origin issues affecting current relationships, attachment style difficulties, and recurring patterns across multiple relationships. Both couples therapy (working together with a partner) and individual therapy (exploring your own patterns and contributions) are available online.

Should I do couples therapy or individual therapy for relationship issues?

Both approaches can be valuable, and sometimes a combination works best. Choose couples therapy if both partners are willing to participate and work on the relationship together, you want to improve communication and interaction patterns as a couple, and neither partner has untreated individual issues that need addressing first. Choose individual therapy if your partner isn't willing to attend, you want to explore your own patterns and contributions first, you're processing past relationship trauma, you're deciding whether to stay or leave the relationship, or the relationship involves abuse (individual therapy is recommended before couples work in abuse situations).

What are the most effective therapy approaches for couples?

Several evidence-based approaches have strong research support for couples. Emotionally Focused Therapy (EFT) focuses on attachment needs and emotional bonds, helping partners understand and respond to each other's deeper emotions. The Gottman Method is based on decades of research on what makes relationships succeed, teaching skills like building love maps, turning toward bids for connection, and managing conflict constructively. Cognitive Behavioral Couples Therapy addresses thought patterns and behaviors that create relationship distress. Imago Relationship Therapy explores how childhood experiences shape adult relationship patterns. Your therapist may use one primary approach or integrate techniques from multiple modalities.

How long does couples therapy typically take to see improvement?

Most couples notice some improvement within 8-12 sessions as they learn new communication skills and begin implementing changes. However, meaningful, lasting change typically takes 3-6 months of regular weekly sessions. The timeline depends on several factors: how long problems have existed (longstanding patterns take longer to shift), the severity of issues, both partners' commitment to the process, whether individual issues also need addressing, and how consistently you practice new skills between sessions. Some couples continue periodic maintenance sessions after intensive treatment to sustain gains.

What are signs that a relationship may benefit from professional help?

Consider seeking therapy when you notice recurring conflicts that never seem to resolve, communication has broken down or become consistently negative, trust has been damaged by infidelity or dishonesty, you feel emotionally disconnected or like roommates rather than partners, intimacy (emotional or physical) has significantly declined, major life transitions are creating strain, you're questioning whether to stay in the relationship, one partner has mental health or substance use issues affecting the relationship, or you find yourselves repeating the same arguments without resolution. Early intervention often leads to better outcomes than waiting until problems become severe.

Can online couples therapy be as effective as in-person sessions?

Research increasingly supports that online couples therapy can be as effective as in-person treatment for many relationship issues. Video-based sessions allow therapists to observe nonverbal communication, facial expressions, and couple dynamics. Online therapy offers unique advantages: partners in different locations can attend together, scheduling is easier without commute time, some people feel more comfortable in their own environment, and couples can continue therapy during travel or relocation. The effectiveness depends more on the therapeutic relationship, the approach used, and both partners' engagement than on the delivery format.

What happens in a typical couples therapy session?

A first session typically includes introductions and establishing rapport, both partners sharing their perspective on what brought them to therapy, the therapist gathering relationship history, observing how you communicate with each other, and beginning to identify patterns and goals. Ongoing sessions usually involve checking in on the week, practicing communication skills with therapist guidance, exploring specific issues or conflicts, learning new techniques and perspectives, receiving homework to practice between sessions, and periodically reviewing progress toward goals. Some therapists also schedule individual sessions with each partner to address personal contributions to relationship dynamics.

When is couples therapy not recommended?

Couples therapy may not be appropriate or safe in certain situations: active domestic violence or abuse (individual therapy and safety planning should come first), one partner is actively maintaining a secret affair, active untreated substance addiction is present (addiction treatment should be addressed first), one partner has definitively decided to leave but hasn't communicated this, or there are severe individual mental health issues requiring stabilization first. A skilled therapist will assess for these contraindications and recommend appropriate resources. If domestic violence is occurring, contact the National Domestic Violence Hotline at 1-800-799-7233.

More on relationship issues and related topics

A safety note on relationship issues

Everything on this relationship issues page is general education only. It is not relationship advice, diagnosis, or treatment recommendation. Every relationship is unique, and a qualified therapist can help you understand your specific situation.

If you're in an abusive relationship, please prioritize your safety. Contact the National Domestic Violence Hotline at 1-800-799-7233 or text START to 88788.

If you are in crisis or experiencing thoughts of self-harm: Contact the 988 Suicide and Crisis Lifeline (call or text 988), text HOME to 741741 for the Crisis Text Line, call 911, or go to your nearest emergency room. This website is not a crisis service and cannot provide emergency support.

Sources

Who wrote this relationship issues guide

This relationship issues guide was written and edited by Paul Paradis, founder and editor of Telehealth Navigator, who spent more than two years working inside a forensic mental health hospital setting, and mental health also runs through his own life and family. Each guide begins with source material most readers don’t have time to read, such as APA and NIMH guidance, CMS telehealth policy, and SAMHSA program documents, all of it rewritten here in plain English with links back to each original so you can verify it yourself. Paul is not a licensed clinician, so please treat this relationship issues guide as information rather than medical advice, and see our editorial standards for the full process of how every guide is researched, reviewed, and updated.