What to Expect in Couples Therapy

"How are you landing here today?" This is often the first question I ask my clients when they arrive for their initial couples therapy session.

Some say excited, but most admit they’re nervous. And that’s completely normal. After all, you’re about to share the most intimate details of your relationship with someone you’ve just met—a therapist, yes, but still a stranger. A little hesitation is to be expected. My goal is to demystify the couples therapy process, making it feel a little less intimidating to schedule that first appointment. Every therapist works differently, but this is what you can expect when you begin therapy with me.

Before Your First Session: The Consultation Call

I highly recommend scheduling a free 15-minute consultation with any therapist you’re considering if they offer it—whether you found them through Google, Psychology Today, or a referral. This initial call is a chance for both you and the therapist to get a feel for each other and determine if it's a good fit—at least good enough to book a first session.

Many clients ask during these calls, “What will sessions be like?” I often explain that I use a blend of psychodynamic and experiential approaches, including Emotionally Focused Therapy (EFT), the Psychobiological Approach to Couples Therapy (PACT), and the Gottman Method. But truthfully, the best way to know what therapy will feel like is to experience that first session.

Finding the Right Therapist: It’s Okay to Walk Away

Sometimes, even after a great consultation call, you might realize the therapist isn’t the right fit. That happened to my husband and me when we sought couples therapy. The consultation was promising, but by the third session, we knew it wasn’t working for us.

And that’s okay. We even bonded over our shared disappointment.

Finding the right therapist is crucial. Yes, you might be out a couple of hundred dollars, but you’ll gain clarity on what you need—and don’t need—from therapy. Trust yourself.

What Happens in the First Few Sessions?

In the initial sessions (other than for those coming in for infidelity/betrayal - more on that in a later post), I gather a lot of information—beyond just the reason you’re coming to therapy. Some of the questions I might ask include:

• What are your strengths as a couple?

• What’s already working in your relationship?

• How can your partner better support you?

• How did you meet, and what drew you to each other?

• What were your early experiences with relationships like? Who did you turn to for comfort as a child?

• How’s your sex life?

  
  

While we talk, I’ll also be observing your dynamics:

• Do you comfort each other?

• Do you make eye contact?

• Do you check in with each other before sharing sensitive information?

• Do you place blame or work as a team?

This phase of therapy lasts about 1-3 sessions. By the end of the first session, I usually have a good sense of your dynamic and can start developing a treatment plan. I believe in a collaborative approach—your goals for therapy matter, and they may evolve over time. What’s important is that you feel comfortable enough to engage in this process together. These questions and observations may feel invasive if they were asked by a coworker or even a friend, but for the therapist, the answers provide a roadmap to understanding the couple’s psychology and dynamics. 

Who Leads the Conversation?

Beyond the initial assessment, I let couples lead the conversation. However, this can vary:

• Some couples struggle to bring up topics because they’ve spent so long avoiding difficult conversations.

• Others arrive with a laundry list of grievances they’re eager to unpack.

Either way, I follow your lead. After all, this is your therapy. Choosing what to discuss together can even help you practice teamwork and collaboration.

If you’re unsure what to bring up, that’s okay too! Part of my job is to help guide the conversation in a meaningful direction. I may ask questions or offer observations to help uncover patterns that might not be immediately obvious. Therapy is a dynamic process, and sometimes the most valuable conversations arise naturally during the session.

Getting to Work: What Therapy Actually Looks Like

Once we start addressing key issues, we roll up our sleeves and dive in. Depending on the topic, I’ll introduce psychoeducation based on research-backed strategies for healthy communication. But therapy isn’t just about learning—it’s about experiencing change in the moment.

I often encourage couples to try different ways of connecting in session. Why? Because the brain and body remember felt experiences more deeply than just reading a worksheet or getting advice. When couples experience positive interactions in therapy, it makes it easier to recreate those moments outside of session.

So, expect to be interrupted! I may pause you mid-conversation to suggest a different way of responding, helping you practice new patterns in real time. This is the work of therapy.

And yes, sometimes I assign homework. This might be a small exercise to strengthen connection between sessions, reinforcing what we work on together. These assignments aren’t meant to be busywork—they’re designed to help you integrate what you’ve learned in therapy into your everyday interactions.

Common Misconceptions About Couples Therapy

Many people have preconceived notions about couples therapy that can make them hesitant to seek help. Let’s address a few common myths:

• Therapy means our relationship is failing. In reality, couples therapy is a proactive step toward strengthening your connection, not just a last resort.

• The therapist will take sides. While a good therapist generally is there to foster understanding and empathy between partners, there are cases where taking a stance is necessary—particularly in situations involving manipulation, emotional abuse, or harmful dynamics. A skilled therapist will prioritize fairness and accountability while still creating a space for both partners to feel heard and supported.

• Therapy is only about communication. While communication is a major focus, therapy also addresses emotional connection, intimacy, trust, and personal growth within the relationship.

• We have to be in crisis to go to therapy. Not at all! Many couples use therapy as a way to maintain a healthy relationship and prevent small issues from becoming big problems.

  
  

Final Thoughts

Starting couples therapy can feel intimidating, but it’s also an opportunity for growth, connection, and deeper understanding. Whether you’re struggling with communication, trust, or just feeling disconnected, therapy provides a space to work through challenges together.

If you’re curious about couples therapy, I invite you to schedule a free consultation with me at TherapyWithErma.com. Let’s see if we’re a good fit for your journey toward a stronger relationship.