How to Determine Which Couples You Can (and Cannot) Treat
When a struggling couple walks into your office, itâs natural to want to help. But one of the most important acts of clinical responsibility is knowing when not to take on, or continue with, a coupleâs care. At this point, we invite you, as therapists, to look beyond technique and assess whether the coupleâs needs truly fall within your scope of practiceâand if not, how to refer them safely and ethically.
It begins with a clear and honest assessment of your own readiness. Ask yourself whether youâre trained and equipped to handle the specific issues a couple brings into the room. For example, trauma is incredibly common, and if you donât have trauma-informed training, you may miss important dynamics beneath the surface. The same holds true for couples facing active substance use, personality disorders, suicidal ideation, or untreated mental illness. These are not just relational issuesâtheyâre clinical risks that require specialized expertise. As therapists, we do a service to our clients and to ourselves when we know our limits and refer accordingly.
Perhaps the clearest red line is the presence of intimate partner violence. Before beginning any couples work, we advise conducting private interviews with each partner to assess safety. If one person expresses fear, describes controlling behavior, or hints that they canât speak freely in front of their partner, therapy must pause. In these cases, joint therapy is not appropriate. This isnât a communication breakdownâitâs a safety issue. The therapistâs role is no longer neutral; itâs protective. Continuing in a âboth sidesâ approach when abuse is present not only fails to help, but it can also do active harm.
In more nuanced situations, such as affairs, addiction, or serious psychiatric symptoms, you must determine whether conjoint therapy is even viable at this stage. Has the affair been disclosed? Is the addiction active or in recovery? Is one partner overwhelmed by untreated mental illness thatâs dominating the dynamic? If so, individual treatment may need to precede (or run alongside) any couples work. Sometimes the solution isnât to reject therapy altogether, but to restructure it so that it meets the clients where they are, safely and realistically.
A therapistâs intuition is one of the most powerful tools in the room and one of the most telling clinical tools you have is your own emotional response. When you find yourself dreading sessions, feeling helpless, or confused about the truth in the room, those reactions matter. Theyâre data. They may be telling you that the therapy is no longer safe, productive, or aligned with your training.
But most importantly, referring a couple out is not a sign of failure. Itâs a mark of ethical care. It says: I see what youâre going through, and I want to make sure you get the kind of support that will truly help. Therapists should invest in building a strong referral network like trauma-informed clinicians, substance use counselors, domestic violence advocates, culturally competent providers, so that when you recognize that something is out of scope, you have somewhere trusted to send your clients.
Ultimately, knowing who you can treat and who you cannot is not just about risk management. Itâs about respect. Itâs about honoring the complexity of couplesâ lives, protecting their safety, and preserving your integrity as a clinician. Our goal isnât to rescue every relationship. Itâs to offer meaningful help to the couples weâre equipped to serve.
And sometimes, the most therapeutic act we can offer is a compassionate referral in the right direction.
In this exclusive online course, through masterful commentary, new in-session videos and detailed case studies, you'll discover how each of the Gottman 10 principles apply to successful couples work — and how you can implement these evidence-based principles in your practice to bring greater healing to your clients.
John Gottman, Ph.D., is Professor Emeritus of Psychology at the University of Washington, where he established what the media called, "The Love Lab," and conducted much of his award-winning research on couple interaction and treatment. Dr. Gottman has studied marriage, couples and parent relationships for nearly four decades. He has authored or co-authored 119 published articles as well as 44 books, including: The Seven Principles for Making Marriage Work, The Relationship Cure, Why Marriages Succeed or Fail, and How You Can Make Yours Last, Raising an Emotionally Intelligent Child: The Heart of Parenting, And Baby Makes Three and The Marriage Clinic.
World renown for his work on marital stability and divorce prediction, Dr. Gottman's research has earned him numerous national awards, including: Four five-year-long National Institute of Mental Health Research Scientist Awards; The American Association for Marriage and Family Therapy Distinguished Research Scientist Award; The American Psychological Association Division of Family Psychology Presidential Citation for Outstanding Lifetime Research Contribution; The National Council of Family Relations 1994 Burgess Award for Outstanding Career in Theory and Research.
Dr. Gottman, together with his wife, Dr. Julie Schwartz Gottman, is the co-founder of The Gottman Institute, which provides clinical training, workshops, services, and educational materials for mental health professionals, couples, and families. He is also the co-founder and Executive Director of the Relationship Research Institute which has created treatments for couples transitioning to parenthood and couples suffering from minor domestic violence.
Dr. Gottman has presented hundreds of invited keynote addresses, workshops, and scientific presentations, to avid audiences around the world including Switzerland, Italy, France, England, Israel, Turkey, South Korea, Australia, Canada, Sweden and Norway. A wonderful story-teller and expert, Dr. Gottman has also appeared on many TV shows, including Good Morning America, Today, CBS Morning News, and Oprah, and he has been written up in numerous print articles, including Newsweek, The New York Times, The Washington Post, Los Angeles Times, Ladies Home Journal, Redbook, Glamour, Woman's Day, Men's Health, People, Self, Reader's Digest, and Psychology Today.
Drs. John and Julie Gottman currently live on Orcas Island, near Seattle, Washington. They conduct weekly and intensive couples therapy sessions, provide small group retreats, teach workshops and clinical trainings and give presentations and training workshops around the world.
Speaker Disclosures:
Financial: Dr. John Gottman is the co-founder of The Gottman Institute and co-founder and Chief Scientist of Gottman, Inc., as well as the Executive Director of the Relationship Research Institute. He receives grant funding from the National Institute of Mental Health (NIMH) and the Kirlin Foundation. Dr. Gottman also receives royalties from his published works. Additionally, he receives speaking honoraria, book royalties, and recording royalties from Psychotherapy Networker and PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. John Gottman is a member of the American Association for Marriage and Family Therapy, the American Psychological Association, and the American Psychological Society National.
