Does Couples Counseling Really Work?

Many people hesitate to try couples counseling because they worry it might not work or that it won’t make a meaningful difference in their relationship. This skepticism is understandable—relationship issues are deeply personal, and therapy can feel like a big leap of faith. So, does couples counseling really help?

Emotionally Focused Therapy (EFT) is one of the most well-researched approaches to couples counseling. Below, we explore the research behind EFT’s effectiveness and why it is widely regarded as a gold standard in couples therapy.

1. A Review of the Research on Emotionally Focused Couples Therapy

A 2016 comprehensive review published in Family Process by Stephanie A. Wiebe and Susan M. Johnson examined decades of clinical trials and studies on EFT. Their analysis found that EFT consistently meets or exceeds criteria for being an evidence-based treatment for couples. This means EFT has strong scientific support showing it produces reliable, long term improvements in relationship satisfaction.

The review included randomized controlled trials involving couples facing a range of issues such as chronic relationship distress, communication breakdown, and attachment injuries. Results showed that EFT not only reduces distress but also promotes lasting changes by helping partners develop secure emotional attachments. This secure attachment is key to improving communication patterns and fostering empathy. Furthermore, EFT's success has been replicated across different cultural contexts and populations, demonstrating its broad applicability. (source)

2. How EFT Changes the Brain’s Response to Threat in Relationships

One groundbreaking study published in Psychosomatic Medicine in 2013 used functional magnetic resonance imaging (fMRI) to investigate the neural effects of EFT on couples. The researchers examined how the brain responds to threat cues under different social conditions, such as holding a partner’s hand versus holding a stranger’s hand or being alone.

The study found that holding the hand of a secure romantic partner significantly reduced activation in brain regions involved in threat detection, such as the hypothalamus. After EFT therapy, these neural effects were amplified, suggesting that EFT strengthens the brain’s ability to use social support as a buffer against stress. Notably, this effect depended on the quality of the relationship—couples with stronger emotional bonds showed greater neural regulation of threat. This study demonstrates how secure attachment, the main goal of EFT couples therapy, reduces the neurological effects of stress. (source)

3. The Importance of the Therapeutic Relationship in EFT

EFT’s success as a therapeutic model is deeply rooted in the quality of the therapeutic relationship. A 2014 article in Psychotherapy explored how the therapist’s empathic attunement and genuine acceptance create a safe emotional environment for clients, improving treatment outcomes.

This relationship serves as a corrective emotional experience, helping clients regulate intense feelings and explore vulnerable emotions without judgment or fear. Through these experiences, clients internalize new ways of relating to themselves and their partners and access and express core emotions, allowing them to transform negative interaction cycles into more positive ones.

This research highlights how EFT’s change process relies heavily on the therapeutic relationship—making therapy more than just a set of interventions, but a deeply relational experience that promotes lasting emotional change. (source)

Why EFT Works

Together, these studies illustrate why EFT is such a powerful approach. It moves beyond surface-level problem-solving by rebuilding the secure bonds that form the foundation of healthy relationships. EFT changes how partners experience safety and connection on a neurological level, while the therapeutic relationship provides a supportive container for deep emotional exploration and change.

For couples wondering if therapy can truly help, EFT offers hope. If you’re considering couples counseling, understanding the research behind EFT can give you confidence that investing in your relationship has the potential to create meaningful and lasting change.