Staff Perspective: Couples Counseling as Preventative Care - A Transitive Model
Quick question for my military couples: “How did you make it through the pandemic?” Answers range from “It brought us closer” to “We didn’t.” For me and my husband, the answer was couples counseling.
As a therapist, I wish I could say that I share this response with pride. I do say it openly—to model healthy behavior for clients, friends, family, and the public—but inside, I’ve felt a twinge of discomfort. Call it fear (of judgment), doubt (about whether it’ll work for us), or embarrassment (about exposing marital imperfections). Whatever the label, these emotions are worth examining because if I, as a mental health professional, feel them, imagine how someone with little to no exposure to therapy must feel. Those feelings create tremendous barriers to seeking help.
Yet, when I schedule a doctor’s appointment for myself or my husband, I don’t feel fear, shame, or embarrassment. In fact, I might even feel responsible, proactive—maybe even a little proud. And when it comes to preventative care!? Woo wee!! I’m nailing this adulting thing! I just know these actions are improving my health and quality of life.
So What’s the Difference?
The gap between seeking medical care and seeking couples’ therapy stems from two key factors: lack of information and stigma. Social norms tell us that needing therapy signals weakness or failure. Add in the common misconception that “it won’t make a difference,” and many people are discouraged from seeking help. But the research tells a different story. Long-term partnership with high relationship satisfaction is good for your health (Rhoades & Stanley, 2014)!
The Solution: A Logical Application of the Transitive Property
Bear with me, it’s about to get a little “mathy”. The transitive property states that if “B” leads to “C” and “A” leads to “B” then “A” leads to “C” and vice versa. I am going to apply this logic as a way to overcome the barriers above.
B Leads to C
Marital/relationship satisfaction is linked to far-reaching positive health and quality of life outcomes, such as overall better health, lower rates of disease, and lower mortality rates (Robles et. al., 2014). It is also linked to improved mental health (Downward et al., 2022) and financial communication (Saxey, et. al., 2023). Conversely, marital/relationship distress is consistently linked to mood disorders, anxiety disorders, substance use disorders, and increased physical health problems (Lebow, 2019). According to the DoD’s Annual Report on Suicide in the Military, the top psychosocial stressor associated with both suicide deaths and attempts is intimate relationship problems (Department of Defense, 2024). Additionally, the adverse impact it has on children is so noteworthy that it is now its own condition according to the DSM-5 (Bernet et.al., 2016). Thus, high relationship satisfaction (B) leads to improved physical and mental health (C).
Marital Health by the Numbers
Since we’ve established that healthy relationships lead to better health and longevity and that relationship distress leads to increased health problems and poorer outcomes, let’s take a look at marital health. In the general population, divorce rates remain between 40-50% for first marriages (U.S. Census Bureau, 2001). According to the CDC (2002), the median length of marriages that end in divorce is 7-8 years—meaning couples endure years of marital dissatisfaction and distress before ending the relationship. That is a long time to be miserable.
On top of the stressors that lead to these outcomes for civilian couples, military couples face unique stressors. Deployments, PCS moves, unpredictable schedules, limited family and social support, and high-pressure work environments put additional strain on marriages.
On average, service members marry younger and at higher rates than civilians. More than 50% of married service members do so before age 25. One of the strongest predictors of divorce is age at first marriage, which likely contributes to divorce rates in the military being higher than in the general population (Hogan & Seifert, 2010).
A Leads to B
The good news? Couples counseling works!
Research shows that 60-80% of distressed couples benefit from behavioral and emotion-focused therapies (Bradbury & Bodenmann, 2020). The average person receiving couples therapy fares better than 70-80% of individuals who don’t (Bradbury & Bodenmann, 2020). Emotionally Focused Therapy (EFT) helps 70% of couples become symptom-free by the end of treatment (Spengler, et. al., 2024)
That said, couples therapy isn’t a magic fix. Anywhere from 35-50% married couples who engage in therapy still divorce—but that’s lower than the rate for couples with similar issues who never seek help (Snyder & Balderrama-Durbin, 2020). A critical factor? Timing.
Both military and civilian couples wait anywhere from 2 and a half to 7 years after issues begin before seeking therapy (Doherty, 2021; Jarnecke, 2020). Earlier engagement could significantly improve outcomes.
Thus, couples counseling (A) leads to increased relationship satisfaction (B).
A Leads to C
What if we treated couples counseling like dental checkups? We don’t wait until we have cavities or gum disease before seeing a dentist. Regular teeth cleanings prevent major dental issues and even reduce risks for heart disease, diabetes, and other systemic conditions.
What if we applied the same approach to relationships? Preventative couples counseling—regularly scheduled, even when things are “fine”—could prevent major breakdowns and improve long-term relationship health, leading to better overall physical and mental health. Plus we are addressing stigma by normalizing and establishing preventative relationship health as a priority.
Couples Counseling as an Essential Component to Mission Readiness
Strong, satisfying marriages aren’t just good for our well-being—they’re critical to overall health and thus, mission readiness. High relationship satisfaction is linked to lower rates of disease and lower mortality rates. According to Kornblum and colleagues (2021), it’s also associated with improved mental resilience, financial stability, and success in attaining career goals —key factors for military personnel and their families. Service members undergo medical, dental, and readiness screenings before deployments, sea time, or PCS moves. These transitions are some of the most stressful events a military couple can face—so why isn’t relationship health part of the checklist?
Including couples counseling in pre-deployment training, PCS preparation, and reintegration programs could set military families up for success. Imagine how much we could improve overall health and military readiness if we routinely strengthened relationships before high-stress periods instead of waiting until things fall apart.
BOTTOM LINE: Couples counseling leads to improved physical and mental health or, A leads to C.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
Bernet, W., Wamboldt, M. Z. & Narrow, W. E. (2016). Child Affected by Parental Relationship Distress. Journal of the American Academy of Child & Adolescent Psychiatry, 55, (7), 571 - 579. https://doi.org/10.1016/j.jaac.2016.04.018
Bradbury, T. N. & Bodenmann, G. (2020). Interventions for Couples. Annual review of clinical psychology, 16 (1), 99 - 123. https://doi.org/10.1146/annurev-clinpsy-071519-020546
Centers for Disease Control and Prevention (2002). Cohabitation, marriage, divorce, and remarriage in the United States (Vital and Health Statistics Series 23, No. 22). https://www.cdc.gov/nchs/data/series/sr_23/sr23_022.pdf
Department of Defense. (2024). Annual report on suicide in the military for 2023. https://www.defense.gov/News/Releases/Release/Article/3964785/department-of-defense-releases-its-annual-report-on-suicide-in-the-military-for/.
Doherty, W.J., Harris, S.M., Hall, E.L. and Hubbard, A.K. (2021). How long do people wait before seeking couples therapy? A research note. J Marital Fam Ther, 47: 882-890. https://doi.org/10.1111/jmft.12479
Downward, P., Rasciute, S. & Kumar, H. Mental health and satisfaction with partners: a longitudinal analysis in the UK. BMC Psychol 10, 15 (2022). https://doi.org/10.1186/s40359-022-00723-w.
Hogan, P. F., & Furst Seifert, R. (2010). Marriage and the Military: Evidence That Those Who Serve Marry Earlier and Divorce Earlier. Armed Forces & Society, 36(3), 420-438. https://doi.org/10.1177/0095327X09351228
Jarnecke, A. M., Ridings, L. E., Teves, J. B., Petty, K., Bhatia, V., & Libet, J. (2020). The path to couples therapy: A descriptive analysis on a veteran sample. Couple and Family Psychology: Research and Practice, 9(2), 73–89. https://doi.org/10.1037/cfp0000135
Kornblum, A., Unger, D., and Grote, G (2021). How romantic relationships affect individual career goal attainment: A transactive goal dynamics perspective. Journal of Vocational Behavior, 125, 103523. https://doi.org/10.1016/j.jvb.2020.103523
Lebow, J. L. (2019). Divorce today. In J. L. Lebow, Treating the difficult divorce: A practical guide for psychotherapists (pp. 35–55). American Psychological Association. https://doi.org/10.1037/0000116-003
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140(1), 140–187. https://doi.org/10.1037/a0031859
Saxey, M. T., LeBaron-Black, A. B., Dew, J. P., Yorgason, J. B., James, S. L., & Holmes, E. K. (2023). Money to Marriage, or Marriage to Money? Examining the Directionality Between Financial Processes and Marital Processes Among Newlywed Couples. Journal of Social and Personal Relationships, 40(8), 2445-2465. https://doi.org/10.1177/02654075221149967
Snyder, D.K. and Balderrama-Durbin, C.M. (2020). Current Status and Challenges in Systemic Family Therapy with Couples. In The Handbook of Systemic Family Therapy (eds K.S. Wampler and A.J. Blow). https://doi.org/10.1002/9781119790945.ch1
Spengler, P. M., Lee, N. A., Wiebe, S. A., & Wittenborn, A. K. (2024). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81–99. https://doi.org/10.1037/cfp0000233
United States Census Bureau (2001). Number, Timing, and Duration of Marriages and Divorces: 2001. https://www.census.gov/library/publications/2005/demo/p70-097.html
Quick question for my military couples: “How did you make it through the pandemic?” Answers range from “It brought us closer” to “We didn’t.” For me and my husband, the answer was couples counseling.
As a therapist, I wish I could say that I share this response with pride. I do say it openly—to model healthy behavior for clients, friends, family, and the public—but inside, I’ve felt a twinge of discomfort. Call it fear (of judgment), doubt (about whether it’ll work for us), or embarrassment (about exposing marital imperfections). Whatever the label, these emotions are worth examining because if I, as a mental health professional, feel them, imagine how someone with little to no exposure to therapy must feel. Those feelings create tremendous barriers to seeking help.
Yet, when I schedule a doctor’s appointment for myself or my husband, I don’t feel fear, shame, or embarrassment. In fact, I might even feel responsible, proactive—maybe even a little proud. And when it comes to preventative care!? Woo wee!! I’m nailing this adulting thing! I just know these actions are improving my health and quality of life.
So What’s the Difference?
The gap between seeking medical care and seeking couples’ therapy stems from two key factors: lack of information and stigma. Social norms tell us that needing therapy signals weakness or failure. Add in the common misconception that “it won’t make a difference,” and many people are discouraged from seeking help. But the research tells a different story. Long-term partnership with high relationship satisfaction is good for your health (Rhoades & Stanley, 2014)!
The Solution: A Logical Application of the Transitive Property
Bear with me, it’s about to get a little “mathy”. The transitive property states that if “B” leads to “C” and “A” leads to “B” then “A” leads to “C” and vice versa. I am going to apply this logic as a way to overcome the barriers above.
B Leads to C
Marital/relationship satisfaction is linked to far-reaching positive health and quality of life outcomes, such as overall better health, lower rates of disease, and lower mortality rates (Robles et. al., 2014). It is also linked to improved mental health (Downward et al., 2022) and financial communication (Saxey, et. al., 2023). Conversely, marital/relationship distress is consistently linked to mood disorders, anxiety disorders, substance use disorders, and increased physical health problems (Lebow, 2019). According to the DoD’s Annual Report on Suicide in the Military, the top psychosocial stressor associated with both suicide deaths and attempts is intimate relationship problems (Department of Defense, 2024). Additionally, the adverse impact it has on children is so noteworthy that it is now its own condition according to the DSM-5 (Bernet et.al., 2016). Thus, high relationship satisfaction (B) leads to improved physical and mental health (C).
Marital Health by the Numbers
Since we’ve established that healthy relationships lead to better health and longevity and that relationship distress leads to increased health problems and poorer outcomes, let’s take a look at marital health. In the general population, divorce rates remain between 40-50% for first marriages (U.S. Census Bureau, 2001). According to the CDC (2002), the median length of marriages that end in divorce is 7-8 years—meaning couples endure years of marital dissatisfaction and distress before ending the relationship. That is a long time to be miserable.
On top of the stressors that lead to these outcomes for civilian couples, military couples face unique stressors. Deployments, PCS moves, unpredictable schedules, limited family and social support, and high-pressure work environments put additional strain on marriages.
On average, service members marry younger and at higher rates than civilians. More than 50% of married service members do so before age 25. One of the strongest predictors of divorce is age at first marriage, which likely contributes to divorce rates in the military being higher than in the general population (Hogan & Seifert, 2010).
A Leads to B
The good news? Couples counseling works!
Research shows that 60-80% of distressed couples benefit from behavioral and emotion-focused therapies (Bradbury & Bodenmann, 2020). The average person receiving couples therapy fares better than 70-80% of individuals who don’t (Bradbury & Bodenmann, 2020). Emotionally Focused Therapy (EFT) helps 70% of couples become symptom-free by the end of treatment (Spengler, et. al., 2024)
That said, couples therapy isn’t a magic fix. Anywhere from 35-50% married couples who engage in therapy still divorce—but that’s lower than the rate for couples with similar issues who never seek help (Snyder & Balderrama-Durbin, 2020). A critical factor? Timing.
Both military and civilian couples wait anywhere from 2 and a half to 7 years after issues begin before seeking therapy (Doherty, 2021; Jarnecke, 2020). Earlier engagement could significantly improve outcomes.
Thus, couples counseling (A) leads to increased relationship satisfaction (B).
A Leads to C
What if we treated couples counseling like dental checkups? We don’t wait until we have cavities or gum disease before seeing a dentist. Regular teeth cleanings prevent major dental issues and even reduce risks for heart disease, diabetes, and other systemic conditions.
What if we applied the same approach to relationships? Preventative couples counseling—regularly scheduled, even when things are “fine”—could prevent major breakdowns and improve long-term relationship health, leading to better overall physical and mental health. Plus we are addressing stigma by normalizing and establishing preventative relationship health as a priority.
Couples Counseling as an Essential Component to Mission Readiness
Strong, satisfying marriages aren’t just good for our well-being—they’re critical to overall health and thus, mission readiness. High relationship satisfaction is linked to lower rates of disease and lower mortality rates. According to Kornblum and colleagues (2021), it’s also associated with improved mental resilience, financial stability, and success in attaining career goals —key factors for military personnel and their families. Service members undergo medical, dental, and readiness screenings before deployments, sea time, or PCS moves. These transitions are some of the most stressful events a military couple can face—so why isn’t relationship health part of the checklist?
Including couples counseling in pre-deployment training, PCS preparation, and reintegration programs could set military families up for success. Imagine how much we could improve overall health and military readiness if we routinely strengthened relationships before high-stress periods instead of waiting until things fall apart.
BOTTOM LINE: Couples counseling leads to improved physical and mental health or, A leads to C.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
Bernet, W., Wamboldt, M. Z. & Narrow, W. E. (2016). Child Affected by Parental Relationship Distress. Journal of the American Academy of Child & Adolescent Psychiatry, 55, (7), 571 - 579. https://doi.org/10.1016/j.jaac.2016.04.018
Bradbury, T. N. & Bodenmann, G. (2020). Interventions for Couples. Annual review of clinical psychology, 16 (1), 99 - 123. https://doi.org/10.1146/annurev-clinpsy-071519-020546
Centers for Disease Control and Prevention (2002). Cohabitation, marriage, divorce, and remarriage in the United States (Vital and Health Statistics Series 23, No. 22). https://www.cdc.gov/nchs/data/series/sr_23/sr23_022.pdf
Department of Defense. (2024). Annual report on suicide in the military for 2023. https://www.defense.gov/News/Releases/Release/Article/3964785/department-of-defense-releases-its-annual-report-on-suicide-in-the-military-for/.
Doherty, W.J., Harris, S.M., Hall, E.L. and Hubbard, A.K. (2021). How long do people wait before seeking couples therapy? A research note. J Marital Fam Ther, 47: 882-890. https://doi.org/10.1111/jmft.12479
Downward, P., Rasciute, S. & Kumar, H. Mental health and satisfaction with partners: a longitudinal analysis in the UK. BMC Psychol 10, 15 (2022). https://doi.org/10.1186/s40359-022-00723-w.
Hogan, P. F., & Furst Seifert, R. (2010). Marriage and the Military: Evidence That Those Who Serve Marry Earlier and Divorce Earlier. Armed Forces & Society, 36(3), 420-438. https://doi.org/10.1177/0095327X09351228
Jarnecke, A. M., Ridings, L. E., Teves, J. B., Petty, K., Bhatia, V., & Libet, J. (2020). The path to couples therapy: A descriptive analysis on a veteran sample. Couple and Family Psychology: Research and Practice, 9(2), 73–89. https://doi.org/10.1037/cfp0000135
Kornblum, A., Unger, D., and Grote, G (2021). How romantic relationships affect individual career goal attainment: A transactive goal dynamics perspective. Journal of Vocational Behavior, 125, 103523. https://doi.org/10.1016/j.jvb.2020.103523
Lebow, J. L. (2019). Divorce today. In J. L. Lebow, Treating the difficult divorce: A practical guide for psychotherapists (pp. 35–55). American Psychological Association. https://doi.org/10.1037/0000116-003
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140(1), 140–187. https://doi.org/10.1037/a0031859
Saxey, M. T., LeBaron-Black, A. B., Dew, J. P., Yorgason, J. B., James, S. L., & Holmes, E. K. (2023). Money to Marriage, or Marriage to Money? Examining the Directionality Between Financial Processes and Marital Processes Among Newlywed Couples. Journal of Social and Personal Relationships, 40(8), 2445-2465. https://doi.org/10.1177/02654075221149967
Snyder, D.K. and Balderrama-Durbin, C.M. (2020). Current Status and Challenges in Systemic Family Therapy with Couples. In The Handbook of Systemic Family Therapy (eds K.S. Wampler and A.J. Blow). https://doi.org/10.1002/9781119790945.ch1
Spengler, P. M., Lee, N. A., Wiebe, S. A., & Wittenborn, A. K. (2024). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81–99. https://doi.org/10.1037/cfp0000233
United States Census Bureau (2001). Number, Timing, and Duration of Marriages and Divorces: 2001. https://www.census.gov/library/publications/2005/demo/p70-097.html