Individual Versus Couple Therapy: What Format Is Best for Marital Problems

GoodTherapy | Individual Versus Couple Therapy: What Format Is Best for Marital ProblemsThe Textbook of Family and Couples Therapy describes the three “most common types of couples therapy”:

  1. Individual therapy;
  2. Conjoint couples therapy; and
  3. Combined couples therapy

In the first, a member of a couple is treated by an individual therapist, which, the textbook notes, is suitable especially for instances in which one spouse refuses to join marital therapy but a “poor choice, however, in the presence of marital disturbance and severe psychopathology…” Individual therapy for a marital problem does not give the therapist an adequately full picture of the marital interactions, nor adequate leverage to help both participants to symmetrically address their contributions to the problem. In general, because problems tend to be interactive, for one partner to make lasting changes for the better, both parties need to make changes.

In the second, “conjoint couples therapy,” both spouses are treated at the same time by a single therapist or team of co-therapists. Again, this form of treatment does not enable the therapist to see and therefore accurately diagnose the couple’s interactive patterns. Anyone can look good in individual treatment. Whole additional aspects of couples’ functioning appear once they are interacting with their partners around emotionally sensitive issues, and these are generally the issues that couples need help addressing.

The third structure for couple treatment, “combined couples therapy,” refers to the combination of conjoint sessions that both partners attend together with ongoing or occasional individual therapy sessions for one or both spouses. That is, the therapist interweaves individual and couple sessions in a design that most meets the needs of this specific couple. “The combined treatment,” the textbook explains, “has the advantage of allowing the use of fantasies in individual sessions while providing easy access to transactional and communicational patterns” in joint sessions. Conflict resolution treatment generally employs the third of these “most common types of couples therapy.”

As described more fully in a recent article in the Journal of Marriage and Family Therapy currently available on the website of the American Association of Marriage and Family Therapy, such combined treatment offers important benefits:

One professional is in a better position to recognize, define, and point out [and thereby ameliorate] the intrapsychic and interpersonal dimensions of the symptom-problem, to be aware of the two-way street effects of one process on the other, to know areas in either process that are being avoided and impulses that are being “acted out” rather than confronted. He [or she] is able to appreciate the subtleties of the resistances and transferences and to form an integrated concept of where the individual client and the marriage is and what the client and marriage is doing in each phase of help even though each process may be conducted according to the techniques of that particular modality

Conversely, when a person is in individual therapy with one professional and in marriage counseling with another, the two processes may go off in opposite directions. Also, resistances may go unnoticed, the transferences may become more split or diluted, and the continuity of the person’s emotional flow and life processes may become more compartmentalized.

For these reasons, conflict resolution treatment recommends the practice of asking people being treated to take a break from any prior individual therapists if they are going to enter into treatment with a conflict resolution therapist. At the same time, the therapist explains that s/he will be available at any time for either spouse to schedule individual sessions as they feel the need. I explain that in general if I am seeing one spouse individually, I like to keep things symmetrical and work also with the other; and at the same time if this is not possible for financial or other reasons, I can be flexible. I add finally that the individual sessions may be occasional, suggested by either one of the spouses or by me, and/or may be part of an ongoing weekly pattern of treatment. For people dealing with specific difficulties—for instance, when one spouse has a borderline personality pattern or is dealing with chronic depression—as many as three sessions a week, with one couple session and one individual session for each spouse, can be ideal, finances and time permitting.

Multiple research studies have demonstrated that individual therapy for a spouse in a distressed marriage may make a couple’s conflict worse, making divorce more likely. These concerns, and their import for practice, are explained in a chapter of the 2008 Clinical Handbook of Couple Therapy, as follows:

“Because we take a systems perspective and view the couple as the client, we have found that individual therapy may interfere with our couple work. We also tell clients that research indicates that the chance of divorce is greater if clients engage in individual therapy rather than couple therapy (Bray & Jouriles 1995). Therefore, we request that partners stop individual therapy during our couple treatment. There is a greater chance of dysfunctional triangulating when another therapist is involved” (p. 504).

Conflict resolution treatment recommends this same policy, that is, flexible inclusion of individual and couple sessions within an overall couple treatment format with one therapist handling all the treatment components. The one exception to the one therapist rule for couples is for treatment of problems that lie outside the therapist’s areas of competence. Referral for additional specialized treatments such as neuropsychological exams, medication treatment, or addiction cessation would always be appropriate, provided the couple therapist and the additional treatment professional agree on a clear division of labor between the therapists.

What is essential however with a protocol that includes both individual and couple treatment formats is explicit confidentiality procedures. Conflict resolution therapists are encouraged to explain at the outset of treatment their policies with regard to confidentiality. Will information disclosed in one spouse’s individual session become the property of the couple? If so, then is it appropriate for the therapist to share individuals’ communications to the therapist with the other spouse? I believe not. Information shared by the couple in the presence of the couple of course is bounded by confidentiality vis-a-vis anyone other than the couple. Information shared with the therapist by one spouse must remain similarly bound by confidentiality to remain with the therapist.

With these principles, one spouse who may be having an affair is able to work on how to disentangle from the affair. The individual sessions enable the straying spouse to utilize the therapist’s in order to extricate from what can be a difficult situation. This option increases the likelihood of a positive marital outcome.

At the same time, if one spouse is having an affair, the therapist has a responsibility to clarify when the affair is revealed that affairs are a violation of the marriage contract. It is ethically important for a therapist to clarify to an unfaithful spouse that continuing to conduct therapy with a secret partner on the side is not an ethical endeavor or an option. However a therapist can help a partner who is engaged in an affair to settle their internal conflict, that is, to choose either to stay in the marriage or to leave it for the new partner.

I have found that this dilemma of having to hold confidential information with regards to an affair is a situation that does occur, but rarely. In most instances, holding individual spouses’ confidential information in confidence is relatively easy and greatly benefits both spouses. They can then enjoy the gains of both individual and couple treatment, with both aspects of this integrated treatment enhancing each other.

© Copyright 2010 by Susan Heitler, PhD. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • red-devil

    April 6th, 2010 at 6:36 PM

    The combine couples therapy seems to be the most apt because it is always better to have both the partners give their inputs to the psychotherapist.This will ensure that a better treatment especially in cases of major conflict between the partners.

  • Racine

    April 7th, 2010 at 5:12 AM

    What’s the point of doing individual therapy alone when there are problems in a marriage? So you may get your own personal issues fixed but you need to have that willing partner with you in order to save the marriage. It takes two to be engaged in a marriage- how in the world could you veer solve your marital woes with only one of you in therapy? I think that it is important to add individual counseling to the treatment but that the bulk of the counseling has to be aimed at working with the couple as a unit.

  • Happy

    September 6th, 2017 at 6:59 PM

    By going as an individual you do fix yourself and in turn will help fix problems in the relationship!!

  • Richard

    March 17th, 2019 at 8:30 AM

    Not all situations indicate the same path, but I believe having each individual sorting out how they see themselves in their own minds is the best path when time is not of the essence. I am currently struggling with being the one going through individual therapy while my spouse is not. She wants to go directly to couples counseling while my current therapist thinks that it is important that both of us have the experience of individual therapy before moving into joint sessions. He also believes that it should involve three separate therapists in the process to avoid pitfalls that might arise for us as well as the therapist(s).

  • Dr. Heitler

    August 11th, 2010 at 7:44 PM

    I totally agree with both Racine and Red-Devil. If you are feeling frustrated with what is happening in your marriage, counseling is far more likely to be helpful if you both participate.

  • Ann

    October 23rd, 2015 at 10:05 AM

    Been in couples therapy for the last few months relationship seems better. But I feel my individual needs are not getting met. I would like to seek therapy for those needs individually with a therapist I have worked with before. I like therapist we have for couples therapy but feel I need more individual therapy also with the no secret policy we have it makes it hard for me to open up about my own personal “stuff” that really has nothing to do with my relationship with partner. Any suggestions please?????

  • The Team

    October 23rd, 2015 at 10:30 AM

    Dear Ann,

    If you would like to find a mental health professional who specializes in individual therapy, please feel free to return to our homepage,, and enter your zip code into the search field to find therapists in your area. You can complete an advanced search to find a particular type of therapist by clicking here:

    Once you enter your information, you’ll be directed to a list of therapists and counselors who meet your criteria. From this list you can click to view our members’ full profiles and contact the therapists themselves for more information. You are also welcome to call us for assistance finding a therapist. We are in the office Monday through Friday from 8:00 a.m. to 4:00 p.m. Pacific Time; our phone number is 888-563-2112 ext. 1.

    Kind regards,
    The Team

  • dr heitler

    November 21st, 2016 at 4:50 PM

    Your comment highlights why it’s very important that the therapist set the rules of confidentiality as follows: Any information shared with a therapist in an individual session is subject to rules of confidentiality. The client can share it with the spouse after the session or not; that’s up to the client. The therapist however can say nothing about individual session, even that they occurred never mind what was discussed, to the spouse. In other words, confidentiality is around whomever attended that particular session and was in the room when the information was shared.

  • Jade B

    October 31st, 2016 at 4:23 PM

    I was looking to know more about couples therapy. It is good to know that combined couples therapy is the combination of conjoint sessions that both partners attend together. This would be good to unify individual therapy sessions if they exist. Something to consider would be to select a local therapist to facilitate these visits.

  • Lillian S

    November 21st, 2016 at 12:13 PM

    This is some great information, and I appreciate your point that conjoint couples therapy allows the counselor to see the interaction between both people. My husband and I have been having some issues, and I want us to work through this, but I think we’ll need some help. I want to try couples counseling, and I think conjoint therapy would be the best option for us. Thanks for the great post!

  • Jackie O

    December 21st, 2016 at 1:22 PM

    Wow, this article was so interesting! What I really thought was intriguing, was what you said about how an individual seeing a counselor, while in a distressed marriage, can cause more problems. It makes sense, I had just never thought about it before. I have a good friend who is struggling in her marriage. I’ll be sure to tell her that couples marriage is the way to go.

  • dr heitler

    December 21st, 2016 at 3:43 PM

    So glad to hear that folks are finding this article helpful! Thanks for sharing!

  • Anon

    August 5th, 2018 at 10:02 AM

    Requiring a spouse to give up treatment with an individual therapist seems silly. My shrink does psychotherapy, but he also manages my medications. He’s been by doctor for 12 years – longer than i’ve K own my husband. He’s the one who thought we would benefit from couple’s therapy and that my husband would also benefit from individual therapy. He certainly doesn’t think everything is on my husband. He knows we both contribute to our issues. I’ve spent more than 1000 hours talking to him. He knows my strengths and weaknesses pretty well.

    There are also real logistical issues. Very few therapists take insurance here. Mine doesn’t, but I see him at a reduced fee, because i’ve Been his patient since he was a resident. I wouldn’t give him up, and my husband wouldn’t want me to.

  • Dr. Heitler

    August 5th, 2018 at 8:45 PM

    Is it “silly” to give my clients what I know to be the best treatment methods? I have flexed on my general principle several times. All of these times proved to be mistakes.
    In one case the Individual therapist began teaching “assertiveness training,” which resulted in the husband, who was suddenly taken aback, pushing the wife down a flight of stairs. In another case the individual therapist kept encouraging the wife to leave the marriage, when in fact the husband was a fine man with many strengths and a divorce would have been needlessly difficult for the children as well. etc.
    When I do the wife’s individual work, and then the parallel individual work with the husband, we can then look to choreograph together new responses for both to each of their vulnerable issues. A therapist who is not working with both partners has no way to coordinate their growth.
    In sum, to be ethical as a therapist, I know I need to handle both the individual and the couple treatment components. If a potential client cannot take a break from their prior therapist, I am glad to let them find a couples therapist who has different beliefs about what matters in setting up the treatment arrangement.
    The one exception is that when special services are needed (MD to give medications, an alcohol counselor, etc). Even then however, I almost always find that the additional treatment professional does harm along with the good.

  • Anon

    August 8th, 2018 at 8:38 AM

    If you have found having patients *your* patients in individual therapy with another clinician to be problematic, then by all means you should continue to avoid that. I just object to a blanket statement that continuing to work with a separate individual therapist is bound to result in failure.
    The examples you describe sound like ones of not-terribly-good individual therapy. The”assertiveness training” you describe sounds problematic and not the tool of a skilled clinician. Regardless, whatever the provocation, the husband is ultimately responsible for his actions and should not have pushed his wife down the stairs.
    In your response you did not address the issue of what you think a patient should do when the therapist is a psychiatrist or psych NP who is also prescribing medications. Get someone else to prescribe? That could be a logistical nightmare.
    “A therapist who is not working with both partners has no way to coordinate their growth.” I’m not sure that this is true. Is it not possible to coordinate with the individual therapist? If you had a patient with schizophrenia who was involved with other treaters, would you say that s/he needed to drop all of them? Or do you assume that nobody with schizophrenia would every seek couples therapy?
    I found a thoughtful article (which unfortunately I can’t find now – I believe it ) which compared different combinations of treatment. They all have strengths and weaknesses. I’m sure that there are other articles in the literature. I just feel strongly that one size does not fit all.

  • Rhianna

    September 10th, 2018 at 12:47 PM

    My husband and I have been having problems lately, but we have kids and are dead-set against getting a divorce. We’re debating on how to approach getting therapy, and I think you’re right in that getting individual therapy could make the conflict worse and increase the gap we feel between us. If we’re both willing to let go of secrets, like you mentioned, then it sounds like therapy is something we should go into together.

  • David

    October 16th, 2019 at 6:33 AM

    I am glad that you elaborated on how when couples are together in therapy it allows them to show how they act around emotionally sensitive topics with their partner which helps the therapist address the problem more clearly. Couples that experience a lot of troubles should get couples therapy and should take sessions together. This way the therapist can see the couple in action rather than hear things from different perspectives. Thank you for this helpful advice.

  • Zachary

    July 29th, 2020 at 4:52 PM

    Thanks for helping me learn more about couples therapy. My friend and his spouse have been fighting non-stop for a week now, and he’s afraid that this might eventually end their marriage. I had no idea that you can undergo a therapy where this could meet the needs or concerns of each spouse. I’ll share this with him so he’d consider visiting a couples therapist asap.

  • Zoe

    October 23rd, 2020 at 7:06 AM

    Thanks for helping me understand that individual therapy sessions for couples might actually make things worse. I’m actually considering this because the thought of divorce had already crossed my mind. Still, going as a couple to a therapist might still be beneficial to our almost-broken relationship.

  • Neal

    March 3rd, 2023 at 8:01 PM

    “By going as an individual you do fix yourself and in turn will help fix problems in the relationship!!” Unfortunately, it doesn’t normally work this way, as a therapist, I have worked with a lot of people that have come to me with this goal and it rarely helps the relationship. As the article said it’s impossible to assess the conflicts in a relationship and “fix it” when you are only working with half of it. At best it “fixes” the person attending individual counseling so they can in turn fix the relationship themselves. This would suggest that they are solely the problem which is not the point of couples counseling, it’s about imperfect people (as we all are) learning how to have healthy relationships not one fixing themself or the other to be happy together.

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