Couples Therapy

In couples therapy, both partners sit down together with a trained professional and discuss the issues that have become difficult in their relationship. The professional does not take sides. She listens to both sides, identifies recurring patterns, and helps get stalled conversations back on track.

Couples therapy is usually led by psychological psychotherapists, couples and family therapists, or counselors specializing in marriage, family, and life counseling who have completed several years of additional training. All parties involved are bound by confidentiality.

When a child has a mental health condition, the relationship often comes under strain. Arguments over the right way to respond, a lack of time together, and constant worry take their toll. This is exactly where couples therapy comes in: it creates a safe space where both partners can start talking again.

A common reason is that the child’s illness completely dominates their daily lives. Many couples find that they talk almost exclusively about appointments, symptoms, and worries, and hardly ever about their relationship as a couple.

• Communication breaks down: accusations, silence, or the feeling that they’re talking past each other.
• Different approaches to the diagnosis: One parent pushes for action, while the other holds back or has doubts. See the article “Disagreement Over the Diagnosis” for more on this.
• Exhaustion and withdrawal: When closeness, intimacy, and shared joy disappear—see “Exhausted Partnership.”
• Blame: The argument centers on who neglected something or made a mistake.

Couples therapy is a good option as long as both partners are fundamentally committed to working on the relationship. It can also help when a couple wants to calmly figure out how to move forward.

The process usually begins with an orientation or initial consultation. During this session, both parties discuss with the therapist what the focus will be, whether there is a good rapport, and what goals are realistic. This is followed by several sessions—typically one-on-one—each lasting about 50 to 90 minutes, spaced one to three weeks apart.

The counselor asks questions, provides feedback, and suggests small exercises—such as practicing fair arguments or expressing clear wishes. Many counselors use systemic therapy, which views the entire family as a connected whole, while others employ behavioral therapy methods. Sometimes there are individual sessions with just one partner.

The number of sessions needed depends on the issue at hand. Focused couples counseling often requires only a few sessions, while more in-depth support takes longer.

These terms are often used interchangeably in everyday conversation, but they refer to different services.

Couples counseling is offered by church-based and social service organizations such as Caritas, Diakonie, and pro familia. It is aimed at couples facing difficult life situations and focuses on communication, conflicts, and relationship issues. It is often shorter in duration and is usually free or available for a small fee.

Psychotherapy in the narrower sense treats a recognized mental health condition in an individual, such as depression or an anxiety disorder. It is based on the four main therapeutic approaches: behavioral therapy, systemic therapy, depth psychology-based psychotherapy, and analytical psychotherapy.

Couples therapy falls somewhere in between. It does not treat an individual but focuses on the relationship. This distinction is important for the cost considerations discussed in the next section.

Pure couples therapy is generally not covered by statutory health insurance. The reason lies in how it’s classified: The insurance covers treatment when a person has a recognized medical condition, but not for work on a relationship. At private practices, the cost is usually between 80 and 200 euros per session, which the couple pays out of pocket.

There is one important exception. If one partner has been diagnosed with a mental health condition, their individual psychotherapy may be covered by insurance. The other partner may be included in individual sessions as part of this treatment.

Affordable and often free options are available through counseling centers: Caritas’s couples counseling is generally free of charge; pro familia operates on a sliding-scale fee structure based on income; and Diakonie offers marriage and life counseling. Therapists and counseling centers near your home can also be found through specialized online portals.

Rückenwind It provides coaching support to parents and is not a substitute for couples therapy or psychotherapy. Only a child and adolescent psychiatrist or a medical or psychotherapeutic specialist can determine whether a child has a mental health condition.