Couples & Relationship Distress

Not a mental disorder; V/Z codes in DSM-5-TR

Communication breakdown, conflict patterns, emotional disconnection, infidelity, and attachment injuries. EFT, Gottman Method, and IBCT have strongest evidence. Relationship distress is a major driver of individual mental health problems.

Prevalence: ~40-50% of marriages end in divorce; relationship distress extremely common

16 Therapeutic Approaches

Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.

● Guideline-Recommended (2)

EFT for Couples

Sue Johnson · 1988

Effect: d = 0.87

~70-73% recovery from marital distress

APA Div 12: Strong Research Support for couples distress

Cognitive-Behavioral

Christensen / Jacobson · 1998

Effect: d = 0.59

~65-70% significant improvement

VA: adopted for nationwide dissemination

◐ RCT-Supported (11)

Emotion-Focused Therapy

Leslie Greenberg · 1990

Feminist Therapy

Various (Lerman, Brown, Worell, Enns) · 1970

John & Julie Gottman · 1999

Effect: d = 0.50

~50-65% significant improvement

de Shazer / Insoo Kim Berg · 1985

Strategic Family Therapy

Jay Haley / Cloe Madanes · 1973

Structural Family Therapy

Salvador Minuchin · 1974

Discernment Counseling

William Doherty · 2011

Harville Hendrix · 1988

Jaakko Seikkula · 1995

Pluralistic Therapy

Mick Cooper / John McLeod · 2011

Existential-Humanistic

Process Group Therapy

Irvin Yalom · 1970

○ Emerging / Limited Evidence (3)

Adlerian Therapy

Alfred Adler · 1912

Eastern-Influenced

Ishin Yoshimoto · 1940

Transactional Analysis

Eric Berne · 1958

Related Clinical Vignettes

Eating Disorder

Ava, 22, college senior

First-Episode Psychosis

Aiden, 21, college junior

Couples in Distress

James (42) & Priya (39), married 8 years, two children

Child Trauma & Behavioral Problems

Marcus, 8, referred by school

Adolescent Identity & Family Conflict

Zoe, 16, high school junior

Late-Diagnosed Autism & Burnout

Sasha, 35, data analyst, they/them