Can we do couples therapy if there's violence in the relationship?

If one partner uses violence, threats or control so that the other is afraid, couples therapy is not appropriate, because speaking honestly in front of them could put you at more risk. Look after your safety first: talk to a social worker (Social Welfare Department hotline 2343 2255) or Harmony House (24-hour women's hotline 2522 0434; men's hotline 2295 1386), and in an emergency call the police (999). Responsible couples therapists assess each partner separately before starting; only in some cases where neither partner is afraid of the other do they assess carefully whether joint work could fit.

Can we work on it ourselves at home?

There is some evidence for guided self-help. In one US trial of 300 couples, an online programme of about 8 hours adapted from integrative behavioural couple therapy (with four 15-minute calls with staff) clearly improved relationship satisfaction compared with a waiting list (a medium-to-large effect). That said, it was in English and studied US opposite-sex couples. The self-guided path on this page is a reasonable start; if the loop keeps repeating, or talks keep spiralling out of control, working with a couples therapist is safer.

How do I find a couples therapist in Hong Kong?

Look for specific training in couple work, such as emotionally focused couple therapy, the Gottman Method or marriage and family therapy, and membership of a professional body. TreeholeHK offers couple and marriage counselling, and further down are the counsellors who offer couples therapy.

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Therapy approaches, explained

Couples therapy

Q: What is PREPARE/ENRICH?

PREPARE/ENRICH is a couple questionnaire assessment developed by David Olson and colleagues: each partner completes it online, then a trained facilitator talks the results through with you, looking at strengths and growth areas such as communication, conflict resolution, finances, and family and friends. It is an assessment tool, not therapy in itself. A study following 164 couples for three years found premarital scores separated divorced or separated couples from satisfied ones with roughly 80–90% accuracy; but the authors warned that this compared extreme groups, the sample was chosen by clergy, and the scores shouldn't be used to predict any individual couple's future. As for marriage and relationship education programmes, premarital ones included, a meta-analysis found small to moderate benefits for relationship quality and communication skills.

Couples therapy isn't about deciding who's right. It helps two people see the pattern they keep repeating, and the feelings and needs each brings to it, then try new ways of responding together.^[4,9]

Start with the basics Find a therapist

Maybe the real problem isn't your partner, and it isn't you either; it's a problem the two of you face together as a couple. I believe thinking this way helps a couple go the distance.

Couples therapy's answer: you can both have a point, because the trouble sits between you

Chi-keung said he'd call Ling at nine, after his work dinner, and by eleven he still hadn't. Ling's messages piled up, and the more of them he saw, the less he wanted to open any; by the time he got home they were fighting again. Have you ever fought over something small, each sure you had a point, and found yourselves further apart with every round? Each of you thinking: if only they would change, this would be fine.

1The worldview

More than the phone call: couples therapy looks at pattern, feelings and actions

When each of two people has a point and they still drift apart, the question isn't who is right. Couples therapy (also called marriage counselling or couples counselling) is two people seeing the same therapist together, and what it works on is not either one of them but the relationship between them. It isn't only for married couples; partners who are dating or living together can come too. In research it is mainly used for relationship distress: frequent conflict, distance, dissatisfaction with the relationship.^[1,2]

To make sense of that evening, most couple therapies share a starting point: difficulties are rarely caused by one partner alone, but by a loop the two keep going between them. The commonest is demand–withdraw: the more one pursues, the more the other pulls back, and the further they pull back, the harder the first pursues. Ling's messages and Chi-keung's silence are exactly that back-and-forth. Who pursues and who withdraws isn't only personality; it depends on who wants the change. When Christensen and Heavey observed 31 married couples, both husbands and wives demanded more when discussing a change they wanted, and withdrew more when discussing a change their partner wanted.

If Ling and Chi-keung walked into a therapy room, what would a course look like?

Now you know how it sees a person and how it works. The next questions: what is it actually like, does it work, and what is it not for?

Most couples therapy assesses first (the first three steps below) and then starts the work (the last two); the number of sessions depends on the difficulty and the model. In the large integrative behavioural trial, couples could have up to 26 sessions; when the US Department of Veterans Affairs rolled out integrative behavioural couple therapy, couples averaged about 10; NICE suggests 15 to 20 sessions of behavioural couples therapy for depression.^[4,16,22]

1A joint first sessionTogether you talk about why you've come, the history of the relationship and how each of you sees the difficulty now.
2Individual sessionsEach of you meets the therapist alone, a chance to say things that are hard to say in front of your partner, including whether you are afraid of them or face violence or control. The therapist uses this to judge whether joint work is safe and suitable.

Couples therapy videos

Episodes are in Cantonese.

A self-guided path for couples

Not ready to see a couples therapist? Start with these five steps; you can do them on your own.

Courses

No dates are open for this approach right now. All our latest courses and events are on the events page.

Therapists who practise Couples therapy

TreeholeHK's counsellors and clinical psychologists use Couples therapy to fit what you need, alongside other approaches.

Looking at the loop from other sides: neighbouring approaches

Couples therapy borrows from these approaches and they from it; start here to go deeper into any of them.

Built from long-term observation of couples: the four most damaging ways of communicating (the Four Horsemen) and their antidotes, turning toward bids, repair. Trials of the therapy itself are still few.^[2]
Greenberg's EFT for individuals shares roots with the emotionally focused couple therapy above: emotions as signals of what we need.^[7]
Sees a problem as a loop in how a family interacts, not one person's fault; couples therapy's loop thinking comes from the same tradition.

Other therapy approaches

FAQ

Is couples therapy the same as marriage counselling?

In Hong Kong the names mostly mean the same thing: two people seeing one therapist together to work on the relationship between them. It isn't only for married couples; dating or cohabiting partners are welcome too. What differs is the model the therapist uses, such as emotionally focused, integrative behavioural or Gottman couple therapy.

Which kind of couples therapy works best?

None clearly wins yet. The 2026 systematic review rated seven models as having modest support; compared head to head they mostly did equally well, and the occasional short-term edge tended to fade at follow-up. So beyond the model, the therapist's training and experience, and whether you both trust them, matter just as much.^[2,17]

What is PREPARE/ENRICH?

Want someone alongside you?

You can do the exercises on your own. When you're stuck, a trained therapist can take you further.

2The method

Where you come in sets the model: four main models side by side

Faced with that opening loop, the models come in at different places; couples therapy isn't one school. A 2026 systematic review applied the criteria the American Psychological Association has long used to 40 studies. It rated seven models (behavioural, cognitive-behavioural, emotionally focused, Gottman, integrative behavioural, insight-oriented and strategic couple therapy) as having modest support; none reached strong support. These four are among the most widely known and taught. The tag under each card shows which of the three layers above it mainly works on.^[2]

EFTEmotionally focused couple therapyDeveloped by Sue Johnson and Leslie Greenberg and built on attachment theory (the idea that in close relationships we need to be sure the other will be there and respond): first de-escalate the loop, then help partners voice the fears and needs beneath it and rebuild a secure bond.PatternFeelings
IBCTIntegrative behavioural couple therapyDeveloped by Neil Jacobson and Andrew Christensen: where differences won't change, build acceptance first; where they can, use behavioural skills to change them.PatternFeelingsActions
CBCTBehavioural and cognitive-behavioural couple therapyBehavioural couple therapy (BCT) is the most researched strand: it teaches communication and problem-solving skills and increases the behaviours each partner values. The cognitive-behavioural version (CBCT) adds a look at how partners read each other.Actions
GottmanThe Gottman MethodGrew out of John Gottman's observational research on couples: strengthen friendship, manage conflict, build shared meaning.PatternActions

Back to the missed call: one evening, two readings

EFTChi-keung said he'd call Ling at nine after his work dinner. By eleven he still hadn't.

Blaming the personSeeing the loop

Feelings and reading: Ling

Blaming the person"He doesn't care about me at all."

Seeing the loop"I'm getting scared again; we might be sliding into that loop."

Actions: Ling

Blaming the personSends ten messages in a row and confronts him the moment he's in the door.

Seeing the loopSends one: "Not hearing from you, I'm a bit uneasy. Let me know when you're home?"

Actions: Chi-keung

Blaming the personFeels chased, stops looking at his phone, and goes straight to the study when he gets in.

Seeing the loopFinds it easier to reply: "Still at dinner, home by half eleven."

3The skills

Once you see the loop, how does it change? Nine skills, each working on one layer

Seeing the loop and the feelings under it is one step; changing it is the next. Inside the therapy room, the models above become specific skills. Each skill works on one of the three layers: seeing the pattern, reaching the feelings underneath, or changing actions; each says which model it comes from. In practice, many couples therapists combine them to fit the two people in front of them.

Seeing the pattern

Map the back-and-forth loop, learn to step back and look at it, and prepare for its return; both partners stand on the same side and look at it together.

Mapping your cycle
Emotionally focused couple therapy has three stages: de-escalation (stopping fights from spiralling), restructuring the interaction, and consolidation. The first stage starts by mapping the loop: working through one or two recent fights, slowly tracking what each partner did, how they read the other's move and what they felt, to draw the pursue–withdraw loop. The aim is for both to see that the enemy isn't the other person; it's the loop.^[8,9]
Hear it in a session
1. Therapist
  I'd like to go slowly back to Friday night with you both. Not to work out who was wrong, but to see how the back-and-forth between you unfolded. Is that OK?
2. Client
  Ling: Fine. He said he'd call at nine, and by eleven nothing. I sent loads of messages and he didn't answer one.
3. Therapist
  Waiting until eleven, and the phone not ringing… what was going on inside you?
4. Client
  Ling: Furious. He always does this.
5. Therapist
  Furious. Chi-keung, what about you, seeing message after message come in?
6. Client
  Chi-keung: …I just wanted to get through the dinner. The more messages came, the less I wanted to open them. When I got home she started asking straight away, so I went into the study.
7. Therapist
  Let me check I've got this: the longer Ling can't reach you, the harder she pursues; the more chased you feel, Chi-keung, the further you pull back; and the further you pull back, the harder she pursues. Does that sound like the loop you often get stuck in?
8. Client
  Ling: Yes. Nearly every fight goes like that.
9. Client
  Chi-keung: Mm.
10. Therapist
  Ling, I want to make a guess, and it may be wrong, so correct me: when the messages went unanswered, alongside the anger, might there also have been some fear? Fear that you don't matter enough to him?
11. Client
  Ling: (pause) …A bit. Actually, it's fear.
12. Therapist
  Thank you for saying that. Chi-keung, let me guess too: opening those messages, is it a bit like hearing "you've failed again", so getting out of the way feels safer?
13. Client
  Chi-keung: …You could put it like that. Whatever I do feels wrong.
14. Therapist
  So in this loop, one of you is afraid of losing the connection, and the other is afraid of disappointing again. It sounds as if your enemy isn't each other, but the loop itself.
15. Client
  Ling: I always thought he just didn't care.
16. Therapist
  You don't have to change that view today. This week, if you notice you're in the loop again, could you just say "we're in the loop again", without arguing over who started it?
17. Client
  Chi-keung: I can try that.
18. Client
  Ling: Me too. But I still want him to answer my messages.
19. Therapist
  That's a perfectly reasonable need, and we'll give it proper time next session.
Notice: This shows mapping the cycle, using the missed call from the start. The therapist asks permission and says this isn't about who's right; slows one fight down, tracks each partner's moves in turn, then names the loop and checks both agree. Along the way the therapist also models voicing the softer feeling underneath: guessing tentatively and inviting correction. Finally the loop is framed as their shared enemy, and the only task this week is to name it when it starts. Ling still wants replies: de-escalation is a beginning, and that need is for later.
Method based on^[8,9,10]
Stepping back together: the problem as "our pattern"
A core move in integrative behavioural couple therapy is unified detachment: the two step back together and describe a recent conflict step by step, as if replaying a clip, without judging who was right; sometimes give the recurring pattern a name, even with a little humour. The problem shifts from "your fault" to "something we face together". Sessions often work from something that has just happened, or is about to.^[4,5,6]
Hear it in a session
1. Therapist
  You wanted to talk about last Sunday. Shall we go through it step by step, like replaying a clip, and hold off on deciding who was right for now?
2. Client
  Mei-kei: On Saturday night I said we'd have Sunday lunch at my mum's, and he said, "Again?"
3. Client
  Wai-kit: I'd worked six days. I just wanted one day off.
4. Therapist
  And then?
5. Client
Tolerance building: preparing for the old pattern to return
Some differences won't disappear, so beyond stepping back to look, integrative behavioural couple therapy prepares you for the moment the old pattern returns. This is tolerance building, and it means thinking ahead about three things: what the old pattern will probably look like next time; what your partner's behaviour does for them, and even its upside; and how you can look after yourself so it stings less. The aim isn't to put up with harm; it's to be less sensitive to differences that do no harm.^[5,6]

Reaching the feelings underneath

Move from anger and coolness to softer feelings and needs, and let the partner hear them.

Voicing the softer feeling underneath
The therapist notices a partner's tone, pauses and body, and makes a tentative guess ("alongside the anger, might there be some fear?"), inviting them to confirm or correct it. A study that analysed a publicly available recording of ten emotionally focused sessions with one couple found that even of the guesses the therapist was surest of, about nine in ten (88.6%) were offered tentatively. Integrative behavioural couple therapy calls the move empathic joining: from "hard" emotions (anger, blame) to "soft" ones (hurt, loneliness), which the partner usually finds easier to hear.^[5,8,10]
Turning to tell your partner
In the second stage of emotionally focused couple therapy, the therapist asks one partner to turn to the other and say directly the fear or need they've just found (such as Ling's fear of not mattering, under that opening evening), then helps the other respond. The two key shifts are the withdrawing partner re-engaging and the blaming partner "softening", able to ask for what they need from a place of vulnerability. This needs enough de-escalation first; it isn't where therapy starts.^[8,9]

Changing actions

Learn new ways to talk and solve problems, do more of the small things the other values, and check how you read each other.

Speaker shares, listener paraphrases
Communication training in behavioural couple therapy: the speaker starts with "I" and describes a specific event and their own feeling (Ling, say, might put it: "I didn't hear from you tonight and I felt uneasy") rather than judging the other person; the listener first paraphrases in their own words to check they've understood, and only then gets a turn. The therapist coaches this live in the room, then the couple take it home.^[11,12]
Solving one concrete problem, step by step
Take one problem at a time: define it clearly without dragging up the past; each partner acknowledges their own part in it; brainstorm several options, pick one to try for a set time, then review. It suits concrete disagreements that can be solved, such as dividing housework or how often to see each side's family. Differences that can't be solved go back to acceptance and tolerance building, above.^[11,12]
Doing more of the small things that matter to the other
Behaviour exchange: each partner lists small things the other could do that make them feel loved and cared for, and each week deliberately does a few, without keeping score. Gottman's turning toward bids points the same way. A bid is a passing remark or sigh with which a partner reaches for connection, and turning toward is answering it. An observational study of 49 newlywed couples found that partners who answered each other more warmly day to day also showed more humour and affection in conflict, though that is only a correlation and doesn't show that one causes the other.

The dialogues are illustrative composites, not real clients; skills that stir strong emotion or touch on trauma should be done with a trained therapist.

Does it work? Helpful overall, but no model clearly wins

These methods sound sensible, but sensible isn't the same as effective. Couples therapy does seem to help with relationship distress overall, but studies compare different things, and no model clearly beats the others. Here are the general questions first (does it help, does it last, does one model win), then some special cases, with how firm the evidence is on each and what limits it.

Does it help couples who are unhappy together?
A review pooling 58 studies found treated couples gained clearly more in relationship satisfaction than couples still on a waiting list; communication and closeness improved too, the gains mostly held at follow-up, and couples who began more distressed gained more. The limits: many comparisons were with a waiting list only, and every study involved opposite-sex couples.^[1]
Does it last?
Long-term evidence is thin and mixed. In the most complete five-year follow-up, two behavioural approaches did about as well as each other: roughly half the couples had clearly improved, and about a quarter had separated or divorced. One small trial of 59 couples found 38% of behavioural couples divorced four years on against 3% with insight-oriented therapy, but that is a single trial awaiting replication.^[16,17,18]
Does one kind of couples therapy work better?
No model clearly wins. A 2026 review rated seven models as having modest support, none as strong, and when compared head to head they mostly did about as well as each other, with short-term leads usually fading by follow-up. Studies of emotionally focused couple therapy show clear improvement, but against other couple therapies its edge is smaller and less certain.^[2,15,17]
Behavioural couple therapy: most studied, possibly overrated
Behavioural couple therapy has more randomised trials (couples randomly assigned to different groups) than any other model. Pooled across 30 trials it was clearly better than no treatment, but small studies with small effects seem to be missing from the literature, so earlier estimates may be too high.^[2,19]
When one partner misuses alcohol or drugs
Pooled across 12 trials, bringing the partner in alongside individual treatment did better than individual treatment alone. At the end of treatment the gain was mainly in relationship satisfaction; the gain in reduced substance use showed more clearly at follow-up. Those studied were married or living together and seeking help for substance problems.^[21]
When one partner is depressed
A Cochrane review of 14 studies found couples therapy and individual psychotherapy eased depression about equally, with couples therapy doing more to reduce relationship distress. But no study was free of bias, and the overall evidence is low quality. The guideline from the UK's National Institute for Health and Care Excellence (NICE) says to consider behavioural couples therapy where relationship problems may be linked to the depression.^[20,22]

To be honest: couples therapy helps on average, but most trials are small and few have been independently replicated; the couples studied are mostly opposite-sex, mainly in North America with most of the rest in Iran and Europe, and these reviews say little about couples in Hong Kong. Even in the five-year follow-up above, about half the couples had not improved to a clinically significant degree. That doesn't make couples therapy useless; it means that, beyond the model, finding a therapist trained in couple work whom you both trust matters too.^[1,2,17]

References

1.Roddy, M. K., Walsh, L. M., Rothman, K., Hatch, S. G., & Doss, B. D. (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology, 88(7), 583–596. doi.org/10.1037/ccp0000514
2.Jackson, J. B., Codecá, L., Miller, R. B., Simpson, J. E., O'Leary, A. M., & Renner, S. M. (2026). Empirically supported couple therapy models for couple relationship distress: A replication and update. Journal of Marital and Family Therapy, 52(4), e70162. doi.org/10.1111/jmft.70162
3.Christensen, A., & Heavey, C. L. (1990). Gender and social structure in the demand/withdraw pattern of marital conflict. Journal of Personality and Social Psychology, 59(1), 73–81. doi.org/10.1037/0022-3514.59.1.73
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6.Barraca, J., Nieto, E., & Polanski, T. (2021). An integrative behavioral couple therapy (IBCT)-based conflict prevention program: A pre-pilot study with non-clinical couples. International Journal of Environmental Research and Public Health, 18(19), 9981. doi.org/10.3390/ijerph18199981
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16.Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72(2), 176–191. doi.org/10.1037/0022-006X.72.2.176
17.Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78(2), 225–235. doi.org/10.1037/a0018132
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19.Shadish, W. R., & Baldwin, S. A. (2005). Effects of behavioral marital therapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 73(1), 6–14. doi.org/10.1037/0022-006X.73.1.6
20.Barbato, A., & D'Avanzo, B. (2020). The findings of a Cochrane meta-analysis of couple therapy in adult depression: Implications for research and clinical practice. Family Process, 59(2), 361–375. doi.org/10.1111/famp.12540
21.Powers, M. B., Vedel, E., & Emmelkamp, P. M. G. (2008). Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis. Clinical Psychology Review, 28(6), 952–962. doi.org/10.1016/j.cpr.2008.02.002
22.National Institute for Health and Care Excellence. (2022). Depression in adults: Treatment and management (NICE guideline NG222), recommendations 1.7.1–1.7.2. nice.org.uk
23.Bograd, M., & Mederos, F. (1999). Battering and couples therapy: Universal screening and selection of treatment modality. Journal of Marital and Family Therapy, 25(3), 291–312. doi.org/10.1111/j.1752-0606.1999.tb00249.x
24.Karakurt, G., Whiting, K., van Esch, C., Bolen, S. D., & Calabrese, J. R. (2016). Couples therapy for intimate partner violence: A systematic review and meta-analysis. Journal of Marital and Family Therapy, 42(4), 567–583. doi.org/10.1111/jmft.12178
25.和諧之家 Harmony House. (n.d.). 熱線 Hotlines: 24 小時婦女求助熱線 2522 0434；MAN 男士熱線 2295 1386. harmonyhousehk.org
26.PREPARE/ENRICH. (n.d.). About Prepare/Enrich. prepare-enrich.com
27.Fowers, B. J., & Olson, D. H. (1986). Predicting marital success with PREPARE: A predictive validity study. Journal of Marital and Family Therapy, 12(4), 403–413. doi.org/10.1111/j.1752-0606.1986.tb00673.x
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29.Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285–296. doi.org/10.1037/ccp0000063