CBT for Couples (Marital Therapy)


Overview of Relationship (Marital Therapy)

Cognitive Behavioral Marital therapy begins with education, from a scientific perspective, on the biological and psychological processes that underlie marital interactions, how interactions become ineffective over time and how to get them back on track. Next, the therapist and couple work together to assess how these patterns play out in  the couple’s relationship. Subsequent sessions are then used as opportunities for the couple to practice communicating about challenging topics with the therapist as coach. The therapist listens and guides the couple in  effective interaction. He helps the couple identify and examine the behaviors that are destructive to the marriage (e.g., the “four horsemen” described below), and prompts them to try out alternative, more effective ways of thinking and behaving.  There is a strong focus on monitoring for emotion “spikes” that hijack effective communication and trigger destructive expressions, and promoting emotion regulation when these occur. Finding ways to accept and manage core differences is also emphasized. Finally, shared goals are encouraged, and used as opportunities to build positive emotional experience together to sustain an effective friendship for the years to come. To learn more, continue reading:

Incompatibilities and Disagreements are Normal

From the time we are children, we are flooded with images of the storybook marriage.   Yet, these marriages rarely occur and should not be considered normal. Research shows that incompatibilities are ever-present in marriages, yet these do not necessarily lead to marital distress and divorce. Instead, healthy marriages accept these differences, and find ways to work around them – to sustain an effective connection.

 Friendship: The Backbone of a Healthy Marriage

It’s tough to sum up the evidence for what underlies a healthy marriage. However, one clear contender would be simple friendship.  Trust, common values, and, treating one another with  dignity and respect, even though the inevitable disagreements, seem to embody the elements of a healthy marriage. And marital friendships involve common goals and interests that keep the couple connected.

The Problem

 What Did Your Family Teach You About Relationships?

There is no required high school or college course on “How to Succeed in Marriage”!  What we generally know, much of how we think feel and act in a marriage, comes from observing our parents relationship, and the relationships we have with close family members and friends. What is the character of these relationships ? What effective strategies have you learned? And what bad habits have you picked up over time and honed through years of practice?

Negative Sentiment Override: The Backbone of an Unhealthy Marriage

John Gottman, one of the foremost leaders in the field of  marital therapy, has described the psychological processes that underlie the stubborn lasting power of  an unhealthy marriage:

The emotional tone of a relationship builds over months, years, and even decades. Over time, a momentum develops which may be positive,  negative or neutral in tone. This momentum arises from the automatic and habitual cognitive and behavioral responses which which underlie emotion. These responses form deep grooves in how couples process one another and interact.  A history of kept promises and well intentioned acts sustains positive expectations and a greater willingness to act positively toward your partner, which forwards the positive momentum.  Not that the couple won’t disagree, and even “fight.” But these inevitable negative interactions are the exception and are more easily forgiven and dismissed.  Psychologists call this state “positive-sentiment override.”

When negative automatic expectations and judgments occur, along with the damaging “knee-jerk” responses, and avoidance and neglect that accompany them, the result is a negative emotional tone in a relationship. Under these conditions, partners are more apt to  each others’ behaviors negatively, to snap and withdraw from one another. These destructive thoughts and behaviors sustain a negative emotional tone which further reinforces the tendency to respond destructively. This state is called “negative sentiment override.” It is the backbone of an unhealthy marriage.

The Four Horseman of the Apocalypse

John Gottman and his colleagues have shown that divorce can be predicted with 96% accuracy by identifying the presence of absence of the following four behaviors in a marriage. In marital therapy, these behaviors are pointed out, openly discussed, and alternatives are explored and practiced:

Criticism: Attacking your partner’s personality or character, usually with the intent of making someone right and someone wrong. For example:

  • Generalizations: “you always…” “you never…”“you’re the type of person who …”
  • “why are you so …”

ContemptAttacking your partner’s sense of self with the intention to insult or psychologically abuse him/her. Examples…

  • Insults and name calling: “bitch, bastard, wimp, fat, stupid, ugly, slob, lazy…”
  • Hostile humor, sarcasm or mockery
  • Body language & tone of voice: sneering, rolling your eyes, curling your upper lip

DefensivenessSeeing self as the victim, warding off a perceived attack

  • Making excuses (e.g., external circumstances beyond your control forced you to act in a certain way)
  • “It’s not my fault…”, “I didn’t…”
  • Cross-complaining: meeting your partner’s complaint, or criticism with a complaint of your own, ignoring what your partner said
  • Disagreeing and then cross-complaining “That’s not true, you’re the one who …”
  • Yes-butting: start off agreeing but end up disagreeing
  • Repeating yourself without paying attention to what the other person is saying
  • Whining “It’s not fair.”

Stonewalling: Withdrawing from the relationship as a way to avoid conflict. Partners may think they are trying to be “neutral” but stonewalling conveys disapproval, icy distance, separation, disconnection, and/or smugness

  • Stony silence
  • Avoiding eye contact
  • Monosyllabic mutterings
  • Changing the subject
  • Removing yourself physically

The Solution


Many wonderful marriages are discarded because their core value is lost in the midst of the battle.  Only after divorce, do the members look back and see the positives they have lost. If you have entered a process of marital therapy, or explicitly working on improving/saving your marriage, then you have accepted that the whole of the marriage is valuable enough to save. You have the opportunity to be clear about the positives of your marriage. You must also be objectively clear about the obstacles. Often there are incompatibilities that, with some commitment and effort, can be accepted, and accommodated, in order to save the marriage.


I recommend that you set a time period over which you will act as if your marriage is valuable and worth every ounce of your effort to improve and to save. Put off the question “should we be together” until the end of this time period.

Empathic Communication

Numerous studies show that effective communication promote relationship health. Healthy communication involves a balanced exchange of ideas, responsible expression of strong emotions, mutual empathy and acceptance. Maintaining balance and respect in communication is one of the greatest challenges to couples and each partner plays a central role. A method called reflective  listening is used.

Soft Start-up

The ability to respectfully and assertively communicate criticism and concern is key to a healthy marriage. Harsh, critical “start-ups” often set a negative tone that will be mirrored by the partner. And an opportunity for effective problem solving instead becomes a “fight.” Learning to catch yourself before giving criticism, and doing so effectively  is a key component of  healthy communication.

The Path to Friendship: Shared Goals for Mastery and Pleasure

An essential vehicle for establishing friendship in a marriage is having shared goals the partners work toward in tandem. These include practical goals, such as parenting, managing finances, running a household, managing difficult family relations. And in addition, we recommend that couples have share goals that forward the core of their marriage, for example, that forward shared pleasure and meaning, such as sexual intimacy, exercise, leisure activities, hobbies, travel, social/political causes, spiritual practice.

* Adapted from: Gottman, John & Silver, Nan (2000) The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert; Christensen, Andrew (2002) Reconcilable Differences.