Getting help as a couple

Three jobs people confuse

• The psychologist holds a university degree and a protected title, and mainly sees individuals. Some are additionally trained in couples work, some are not — ask on the first call.
• The couples therapist sees both partners together and works on what happens between them, not on each person's history. It is a training that comes on top of a base profession.
• The relationship counsellor has a shorter training centred on listening, information and mediation, and does not do psychotherapy. Often the cheapest door, sometimes free, and the quickest to open.
• The psychiatrist is a doctor: they can prescribe, and they are the right address when depression, addiction or an anxiety disorder dominates.

An unprotected title — "relationship coach", or "couples therapist" used alone in some countries — guarantees no training at all. Asking for the base qualification and the professional registration number is not rude.

How couples therapy actually goes

• The first session is together. Each says why they are there. The practitioner listens to the interrupting as much as the content: that is where the mechanics show.
• One or two individual sessions often follow, to say what cannot be said in front of the other. What is said stays confidential, though most practitioners warn that they will not hold a lasting secret — a separation already decided, for instance, makes the rest impossible.
• The work is on repeated patterns rather than grievances. Who pursues, who withdraws, how a row escalates, what brings it down. Many couples discover they replay three scenes in all.
• The length counts in tens of sessions, not years: ten to twenty is a common order of magnitude, fortnightly.
• The ending is not necessarily staying together. A share of therapies leads to a better-conducted separation, which is not a failure, especially where there are children.

What it achieves, and when it is wrong

Structured couples therapies are among the best-evaluated psychological interventions: most couples are better off at the end, and part of that benefit still holds two years later. Two factors predict the outcome better than the method: coming early rather than after years of wear, and coming because you want to, not because the other insists.

Coverage, country by country

This is where differences are sharpest, and they do not track national wealth but how each country classifies couple difficulties: a health problem, or a life problem.

• France — Mon soutien psy covers twelve psychologist sessions a year at €50, reimbursed 60 % by the health insurance; a medical referral is no longer needed. It targets individual care, not couples therapy. Relationship counselling in an approved centre is, by contrast, free.
• Belgium — contracted first-line psychological care leaves €11 to pay per individual session, €4 on increased intervention, nothing up to 23, and needs no prescription.
• Switzerland — since 1 July 2022 psychotherapy by a recognised psychologist is covered by basic insurance, on medical prescription: about 155 francs an hour, reimbursed 90 % once the deductible is met.
• Germany — Paartherapie is not a statutory insurance benefit: couple difficulties are not treated as a disorder of illness value. Exception: if one partner has a recognised disorder, their therapy may take place with the partner present.
• Elsewhere — the general rule is that individual care is covered where a diagnosis exists, and couples therapy is not. Family associations, municipal social services and top-up insurers are the three avenues to try before full-price private practice.

How to choose, in practice

Call two or three practitioners before booking. Four questions are enough: what is your base training, do you see couples regularly, how many sessions do you envisage, and what is the fee. Someone who answers all four precisely is a good sign. The best predictor is none of the four, though: it is that both of you feel at ease after the first session. If one does not, changing practitioner beats dropping the idea.