Author: Lindsay Eanet - 3 min read
Reviewer: Rachelle Adams, LPC, LMFT
Deciding to start couples therapy often comes with mixed emotions. Anxiety, hesitation, relief, and hope can all exist at once. For many couples, therapy isn’t about crisis or conflict. It’s about realizing something feels off and wanting to understand why.
Changes in communication, emotional closeness, or intimacy—including challenges like erectile dysfunction—are common reasons couples seek professional help. These issues don’t mean a relationship is failing. They often mean it’s time for support.
One of the most important decisions you’ll make is choosing a therapist and approach that fits both partners. Different therapy modalities focus on different aspects of connection, emotion, and communication. Understanding the basics can help you decide what may work best for you.
The Gottman Method: Structure and communication skills
The Gottman Method, developed by psychologists John and Julie Gottman, is based on decades of research on what helps couples stay emotionally connected over time.
At the center of the approach is the Sound Relationship House, a framework that emphasizes trust and commitment as the foundation of a healthy relationship. Therapy often includes structured exercises, such as weekly check-ins, that help couples talk about challenges while also reinforcing appreciation and respect.
Alexandra Luger, Psy.D., a Gottman-certified psychologist, notes that these exercises can feel unfamiliar at first, especially for couples who have fallen into patterns of avoidance.
“Sometimes one partner resists because it feels unnatural,” she said. “But slowing things down and breaking old patterns is often where change starts.”
“The Gottmans' foundational theory is something they call the 'Sound Relationship House,' where trust and commitment are the 'load-bearing walls' of the relationship.”
This approach can be especially helpful for couples struggling with communication breakdowns around sensitive topics like intimacy or ED, where structure can reduce tension and misunderstanding.
Emotionally Focused Therapy (EFT): Rebuilding emotional safety
Emotionally focused therapy, developed by psychologist Sue Johnson, is rooted in attachment theory and focuses on emotional connection and safety.
Sara Ruiz, an associate marriage and family therapist, explains that EFT helps couples understand the emotional cycles that keep them stuck.
“What creates change is accessing fears and attachment needs and creating safety in the relationship,” Ruiz said.
Rather than homework or techniques, EFT emphasizes vulnerability and emotional responsiveness. This can be particularly effective when intimacy has faded due to stress, anxiety, or performance concerns, including ED, where fear of rejection or disappointment may be driving distance.
Imago Relationship Therapy: Understanding old patterns
Imago relationship therapy, developed by Harville Hendrix and Helen LaKelly Hunt, focuses on how early life experiences influence adult relationships.
Therapist Emilio Anguiano describes imago as a model centered on creating safe, intentional conversations.
“It requires curiosity, empathy, and learning to truly hear your partner without projecting your own fears,” he said.
“The Imago method seeks to connect conflicts in adult relationships with the partners' childhood experiences.”
This approach can be helpful for couples who find themselves repeating the same conflicts or feeling triggered by seemingly small issues. For some, challenges around sex or ED activate deeper feelings of rejection or inadequacy that imago therapy helps bring into the open.
Other approaches and when they help
No single therapy model works for everyone. Other options include:
- Narrative therapy, which helps couples separate themselves from their problems
- Discernment counseling, for couples unsure whether they want to stay together
- PACT (Psychobiological Approach to Couple Therapy), which focuses on real-time emotional and physiological responses during sessions
Research suggests that the quality of the therapist-client relationship often matters more than the specific modality.
How to choose the right therapist
Regardless of approach, experts recommend asking potential therapists:
- What percentage of their practice is couples work
- What training they’ve had in relationship therapy
- How they handle conflict, emotional safety, and sensitive topics like sexual health
“You want a clinician intentionally trained in couples work,” Luger said. “Working with couples is different than working with individuals.”
Feeling safe, respected, and understood is essential. If it doesn’t feel like a good fit after a few sessions, it’s okay to explore other options.
The Takeaway
Couples therapy isn’t a sign of failure. It’s often a sign that both partners still care enough to seek clarity and connection.
Whether the trigger is communication strain, emotional distance, or changes in intimacy such as ED, therapy can help couples understand what’s happening beneath the surface and how to move forward together.
The right approach creates space for honesty, reduces blame, and helps couples rebuild trust, closeness, and confidence—one conversation at a time.
