13 Crucial Times to Start Couples Therapy

In Grief & Loss, Parenting, Relationships, Sex, Therapy by Kelsey Nimmo

People wait too long to come to therapysays every expert out there. In fact, the wonderful John Gottman tells us that couples wait an average of six unhappy years before seeking professional support.

Couples therapy used to carry a huge stigma with it. All therapy did, really. But times are changing and luckily, our awareness and understanding of mental health is improving.

Did you know that our primary relationships have a tremendous impact on our health – both mental and physical? Relationships can offer an amazing sense of security, improve our confidence level, and even help us live longer.

But if our relationship is struggling, it feels like everything is a struggle. I’m sure you can relate to this. And if we’re struggling for a long time, it feels like we are perpetually fighting.

Fun fact: if our mind thinks we are always fighting, so does our body. Which means our body stays physiologically aroused. A heightened state. The modern version of watching out for lions and tigers. Our heart rate is up, our oxygen level is down. And sooner than later, we experience health consequences.

You don’t want any of that. You want happy, healthy, and loving. Always, right? But since we know conflict is normal for relationships, how do we know when to seek couples therapy?


Prevention is always better than intervention. Always. No exceptions. Some of my favorite work with couples is premarital counseling. These couples tend to have a strong foundation beneath them that hasn’t yet been eroded by differences in values, love languages, and conflict styles – to name a few.

They are motivated, positive, and much more likely to accept influence from their partner. They also tend to be more forgiving and quicker to make changes. Again, this is probably because typically these couples catch problems before they have established roots.


Regardless of your faith beliefs, postponing sex until marriage can create some really challenging dynamics within your personal and relational sexual functioning.

For some of these couples, there is a complete absence of sexual identity and awareness prior to marriage. By restricting their lens and framework of sex, they absorb only the loudest messages – which tend to be hugely misinformed.

Then even when they do allow themselves to see through their own lens of experience, a heavy blanket of guilt and shame muddles their ability to have realistic expectations for sex after marriage.

As if that wasn’t hard enough. When these couples enter into marriage, expectations change overnight. They go from a complete lack of sexuality to an expected integration of sex, affection, and intimacy for their relationship.

Unfortunately, this isn’t how our sexuality functions. Postponing our awareness of sexual arousal creates challenges in our ability to seek sexual pleasure with our spouse. Shaming our sexual identity shapes the framework in which we view expectations for ourselves and our spouse in sex.

It is not my place to advocate for or against premarital sex for you, but I certainly am advocating for informed conversations.

Lack of discussion on these topics means that you don’t have the tools and language to reach the great sex God wants for you when you’re ready for it.

Working with a sex therapist can help you untangle some of this before or after you get married so that you can move into a loving and intimate sexual relationship with your spouse when you are ready.


Pregnancy is an extremely challenging time for families. If you have a hard time getting pregnant, staying pregnant, or you lose a child, you need support while you grieve.

And then of course during pregnancy itself, literally everything is changing:

  • Personal identity
  • Free time
  • Career
  • Extended family relationships
  • Friendships
  • Finances
  • Our body and hormones
  • Appetite
  • Thoughts and emotions
  • Priorities
  • Our home
  • Sleep
  • Sex
  • Our relationship

To most successfully navigate all of these changes for yourself and your partnership, establish a relationship with a therapist as early as you can. This support is incredibly life-changing to help keep you two connected as you bring your little into the world.


Those fuzzy early postpartum days, weeks, and months are some of the hardest on relationships. Imagine that list from above of all the changes in pregnancy and then quadruple the intensity of those and add in a crying tiny human who needs your help for literally every part of survival.

I think that type of pressure is enough of an argument to seek therapy for your relationship. But if you aren’t convinced, go talk to someone to manage through any signs of postpartum depression. This one has some nasty effects on women, their partners, and their babies.

Oh, and let’s not forget to mention the impact of a traumatic or challenging birth experience on a woman and her transition into motherhood. Also the whole breast feeding thing… so really, how many more reasons do you need?


Jennifer Senior wrote a terrific book talking about how the various developmental stages of our children impact us personally and effect our relationships. I recommend her book to almost every client I have who is a parent and I have never heard a disappointed review.

Parenting is the hardest job – no matter what anyone tells you. Get some support. Life gets real. Fast.


I once had a client tell me she felt ashamed that after her husband’s affair, she decided to stay. “Divorce is the new black,” she told me. She is not the only one who has expressed concern of judgment from their friends and family upon choosing to work through the grief, hurt, and anger of a betrayal.

While divorce may be the right choice for some couples (see number 12 below), many relationships have too much love between them to throw in the towel.

If you’re wanting to see if your relationship can be repaired after an affair or some other type of betrayal, find a therapist. There are better ways of healing than others when we are working with a vulnerable and fragile partnership.


I just heard the most interesting statistic the other day: only 66% of young people aged 16-22 (Generation Z) identify as “exclusively heterosexual.” This means that 34% of them have more reasons than just boredom or curiosity to pursue an open relationship.

Open and poly relationships seem to be trending right now. If you’re considering opening your relationship and exploring options outside of traditional monogamy, it is important to seek the support of a therapist with experience in these who can help you walk through the process.


Here are some common things I help couples (and individuals) with in my work as a sex therapist:

  • Vaginal pain during intercourse
  • Premature ejaculation
  • Erectile dysfunction
  • Low sexual desire
  • High sexual desire (or compulsive behavior)
  • Differing sexual desires between partners
  • Porn use
  • Sexual abuse
  • Sexual fantasies and preferences
  • Communicating about sex
  • Shame, guilt, and embarrassment surrounding sex
  • Trans-specific sexual concerns
  • Unrealistic expectations for sex
  • Poor quality or emotionally disconnected sex
  • Cultural or religious messages about sex

If any of these apply to you, some google searching can give you a few pointers but ultimately, a therapist with specific training in sexual health is the way to go.

Be aware that sex therapists do not have sex with their clients. Progress is made through a biopsychosocial educational approach. This means talking. Don’t think everyone is going to get naked.

Our sexual self functions entirely different from all other parts of us. Within the context of our relationship, we can’t trade it, pressure it, punish it, or reason with it. Any of these will likely lead to more challenges than we started with.

In sex, we need an educated and informed guide. Our sexual self holds trauma much deeper and longer than other parts of us – and sometimes our sexual self thinks some things are traumatic that we just don’t yet consciously understand.


This goes for any life transitions you or your partner may be going through. Think moving, job changes, shift changes, health conditions, death of loved ones, going back to school, having babies, becoming empty-nesters, watching grandbabies, buying or selling cars/houses, retiring, surgeries, changes in social circle, and the list goes on.

If it feels hard, ask for help. And remember that prevention is always better than intervention. Big life changes can create anxiety whether we notice it at first or not. Remember the frog that won’t jump out of water as it slowly heats up?


You know the ones. The types of fights that go in circles and you’re spinning your wheels, never getting anywhere. The ones that get heated really fast and really hot. The ones where you feel panic and/or anger because you’re convinced your partner just isn’t hearing you.

These types of conflicts are really hard. They also never seem to end – which takes us back to the negative health impacts of long-term marital stress. Our emotional stress takes a toll on our body. If you want to understand these fights better and finally get some traction, read my article about what’s going on in your body when you fight and how to self-soothe.


I see it all the time. A giant sigh, the body relaxes, and a smile flashes across. This is the look of relief when my clients hear that something they are experiencing is totally normal.

We don’t always know where to find reliable answers to our questions about our relationship – or ourselves. We also don’t know what we don’t know so sometimes we don’t know what questions to ask. If you’re curious, I put together some of our top myths about sex that can seriously hurt our expectations and experience of sex.

Oftentimes, my job is to help a couple understand what “normal” looks like, set realistic expectations, and identify/improve successful (or destructive) patterns in their partnership. If you have questions, it’s time to get some educated answers.


Many people think couples counseling is only if we are staying together but oh, how wrong this is.

Couples who are divorcing or separating sometimes need more support than those staying together – especially if there are children involved.

A therapist can help you navigate through what your split looks like so that you don’t end in animosity and aggression. It also is absolutely essential to prioritize the needs of your children through the process.


Those first 12 times cover so much of the lifespan and relationship cycle. But here’s the thing: there is no wrong time to start counseling – although there are certainly wrong therapists for you (more on this later).

Anytime that you have a gut feeling that counseling could be helpful, reach out. Prevention, not intervention. It is always more fun to be able to laugh and joke with clients doing maintenance and tune-ups than it is to have to do serious repair, surgery, or amputation for the relationship.

Oh, and if you still aren’t convinced, I’ll just throw out there that every good therapist has their own therapist – and this goes for couples work, too. Why? Because we know what works.

If you’re convinced it’s time but you aren’t sure how to decide on a therapist, I put together an in-depth how-to on finding a counselor and what to do if the one you found doesn’t seem to be fitting.

Side note, if you want to hear a fun story about how even therapists don’t always get things right in relationships, take a peak into a recent breakfast date I had with my partner – I wrote this article about how easy it is to try to win a fight in our marriage… and how unhelpful it is.

Set up a counseling appointment with Kelsey.

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