Relationship Issues

Relationship issues encompass the broad clinical domain of intimate-partner, family, and friendship relational difficulties — including communication breakdown, conflict patterns, attachment-style mismatch, intimacy concerns, and the relational consequences of individual mental-health conditions.

Overview

Relationship issues is a broad clinical specialty area covering the diverse difficulties that can emerge in intimate partner, family, friendship, and other close relationships. The category includes communication and conflict-resolution difficulties, attachment-style mismatch, sexual and intimacy concerns, life-stage transitions affecting relationships (parenthood, career changes, retirement, illness), the relational consequences of individual mental-health conditions, and the relationship-level work necessary in the wake of trauma, infidelity, or major loss.

Relationship issues are not in themselves DSM-5-TR or ICD-11 diagnoses, but the relational distress and dysfunction they involve are formally recognized in the DSM-5-TR under Other Conditions That May Be a Focus of Clinical Attention — including Relationship Distress with Spouse or Intimate Partner (Z63.0), Disruption of Family by Separation or Divorce (Z63.5), Other Specified Problems Related to Primary Support Group, and several others. These codes acknowledge that significant clinical work occurs around relationship difficulties whether or not a formal mental-health diagnosis is present.

Population data on relationship distress: approximately 25-40% of married couples in North American samples report at least moderate relationship distress in any given year; recovery rates with structured intervention are substantially higher than without. Couples therapy is one of the most-studied modalities in clinical psychology, with strong evidence for several specific approaches.

Common presentations include: chronic communication breakdown with the same arguments repeating without resolution; contempt, defensiveness, or stonewalling patterns that erode relationship quality; sexual issues including discrepancy in desire, intimacy avoidance, and post-childbirth or post-illness sexual changes; attachment-style mismatch (one partner anxious, one avoidant) producing pursue-withdraw cycles; the relational impact of one partner’s mental-health condition (depression, anxiety, ADHD, addiction, trauma history); life-stage and transition stress; family-system difficulties involving children, in-laws, or blended-family integration.

Treatment is highly effective. Evidence-based couples therapies achieve significant improvement in approximately 70-75% of couples; even a substantial subset of couples ultimately separating through couples therapy do so with less harm to themselves and any children involved.

Signs and symptoms

Recurring unresolved conflict — The same arguments cycle without resolution; conflict produces lasting distance rather than reconnection; partners no longer try to repair after fights.
Communication breakdown — Difficulty discussing important topics; conversations escalate or shut down; misunderstanding of basic intentions and needs.
Emotional distance — Loss of emotional connection; partners feel like roommates; reduced sharing of internal life, day-to-day experience, or future plans.
Sexual concerns — Significant difference in desire; chronic avoidance of sexual contact; sex feels obligatory or distressing; sexual injury or trauma not yet addressed.
Pursuer-distancer cycle — One partner consistently pursues connection or conversation while the other consistently withdraws; the pattern reinforces itself over years.
Contempt, defensiveness, or stonewalling — The Gottman "Four Horsemen" — patterns predictive of relationship dissolution if uninterrupted: criticism, contempt, defensiveness, stonewalling.
Trust ruptures — Infidelity, deception, financial concealment, or sustained unreliability has damaged trust and not been repaired.
Co-parenting difficulties — Disagreement on parenting approach, undermining of one another in front of children, scheduling and decision conflicts that recur across years.
Family-of-origin spillover — Conflict with in-laws, parents, siblings, or adult children that consistently destabilizes the primary partnership.
Major-transition relationship distress — New parenthood, blending families, retirement, illness, career changes, or empty nest produces strain that exceeds couple's adaptation capacity.

Causes and risk factors

Relationship issues develop at the intersection of individual factors, dyadic patterns, and contextual stressors:

Individual factors: attachment-style insecurity, untreated mental-health conditions (depression, anxiety, ADHD, trauma history, substance use), emotion-regulation difficulties, and family-of-origin patterns all shape relational behaviour. Personality factors (high neuroticism, low agreeableness, low conscientiousness) are predictive of relationship outcomes.

Dyadic factors: attachment-style mismatch (anxious-avoidant pairings are particularly difficult), incompatibility of fundamental values or life goals, and entrenched negative interaction patterns (criticism, contempt, defensiveness, stonewalling) all elevate risk. Relationships with high baseline conflict are associated with worse outcomes than relationships with chronic distance.

Contextual stressors: chronic financial stress, caregiving load (children, aging parents), serious illness, immigration or relocation, infertility, and major work demands all stress relationships. Cumulative stressors are particularly difficult.

Specific events: infidelity, betrayal traumas (financial deception, hidden addiction, sexual concealment), serious illness or injury, loss of a child, and major life changes can all produce acute relationship crises that may resolve well or poorly depending on the couple’s resources and engagement.

Cultural and structural factors: intercultural relationships, mixed-religion relationships, intersectional differences (race, class, sexuality), and structural pressures (housing affordability, racism, discrimination, immigration status) all shape relationship experience.

Comorbidity: relationship distress is closely linked to individual mental-health outcomes. Marital distress is one of the strongest predictors of major depressive disorder onset; depression in turn worsens relationship dynamics. Treating both individually and as a couple often produces better outcomes than either alone.

Typical treatments

Several evidence-based couples therapy modalities have substantial empirical support:

Emotionally Focused Therapy (EFT; Sue Johnson): attachment-based couples therapy with the strongest empirical support of any specific couples-therapy modality. Targets underlying attachment-related emotional cycles rather than surface communication patterns. Typical course is 8-20 sessions.

Gottman Method Couples Therapy: developed from decades of observational research on what distinguishes relationships that succeed from those that dissolve. Targets the “Four Horsemen” patterns and builds the “Sound Relationship House” (friendship, trust, conflict management, shared meaning). Typical course is 12-30+ sessions.

Integrative behavioural Couples Therapy (IBCT; Christensen & Jacobson): integrates traditional behavioural couples therapy with acceptance-based work on enduring differences. Strong evidence base. Particularly useful when couples are struggling with chronic, unsolvable differences as much as with acute conflict.

Cognitive behavioural Couples Therapy: targets cognitive distortions and behavioural patterns affecting the relationship. Substantial evidence base.

Discernment counselling (Doherty): short-term protocol (1-5 sessions) for couples in which one partner is leaning toward divorce. Designed to support informed decision-making, not to push toward reconciliation.

Affair-recovery protocols — structured 3-phase intervention (impact and stabilization, exploration of meaning, decision-making about the future). Combined with EFT or other modalities for the underlying relationship work.

Sex therapy: specialized work for sexual issues, often coordinated with general couples therapy. Approaches include Sensate Focus, cognitive behavioural approaches to sexual dysfunction, and integrative sex therapy.

Family therapy: for issues involving children, in-laws, or blended families, family-systems approaches (Bowen, structural, narrative) are appropriate.

Individual therapy in parallel — both partners benefit from individual therapy in many cases, particularly when individual mental-health conditions, trauma history, or attachment work is part of the picture.

Pharmacotherapy is not directed at relationship issues per se but is appropriate for individual conditions affecting the relationship (depression, anxiety, ADHD, substance use disorders).

When to seek help

Couples therapy is indicated when:

You and your partner are stuck in recurring conflict patterns that you cannot resolve on your own.
You feel emotionally distant, disconnected, or like roommates rather than partners.
Trust has been damaged — by infidelity, deception, sustained unreliability, or addiction.
One partner is leaning toward leaving and you want a structured way to discuss it (discernment counselling).
You are navigating a major transition (new parenthood, blending families, illness, retirement) that is straining the relationship.
Sexual or intimacy issues are persistent and not responsive to private discussion.
Co-parenting difficulties are affecting your children.
One or both partners are dealing with mental-health conditions (depression, anxiety, ADHD, addiction, trauma history) that are impacting the relationship.

If intimate partner violence is present, couples therapy is generally not recommended; individual therapy and safety planning take precedence. For domestic violence support, contact 1-866-863-0511 (Assaulted Women’s Helpline) or ShelterSafe.ca. If you are in immediate danger, contact emergency services. If suicidal thoughts are present in either partner, free 24-hour support is available at 9-8-8 (Suicide Crisis Helpline).

Frequently asked questions

When is the right time to start couples therapy?

Earlier than most couples come. Average couple in U.S. studies waits about 6 years from the onset of significant difficulties before seeking therapy; earlier intervention has substantially better outcomes. There is no need for a crisis or near-divorce — therapy is appropriate at any stage of relational difficulty.

Can couples therapy save a relationship that is already in crisis?

Often yes, particularly when both partners engage. Outcomes depend on engagement, the absence of ongoing infidelity or violence, and willingness to work on individual contributions. A subset of couples in therapy ultimately separate; most therapists support either outcome rather than treating reconciliation as the only success.

What if my partner won't come to therapy?

Individual therapy with relational focus is highly effective. Many people change relationship dynamics from one side, and many partners eventually engage when they see meaningful change. Specific approaches like Discernment counselling, Concerned-Significant-Other interventions, and individual therapy with EFT-informed work all support this scenario.

Will the therapist take sides?

Skilled couples therapists do not take sides. Each partner's experience is taken seriously and the work focuses on patterns between you rather than blame. If you experience the therapist as taking sides over multiple sessions, raising the concern openly is appropriate; sometimes a different therapist is a better fit.

How long does couples therapy take?

Typical evidence-based couples therapies take 8-30 sessions. Short-term focused work (specific issue, discernment) is shorter. Complex situations (severe trust ruptures, multiple issues, individual mental-health conditions) often take longer. Sessions are typically weekly or every other week initially, tapering as work progresses.

Should we keep doing therapy if it isn't helping?

If after 8-10 sessions there is no meaningful improvement, raise this directly with the therapist. Sometimes a different approach or therapist is needed; sometimes the work is doing more than is visible to either partner. Stagnant therapy with no plan to change is a reason to reassess.

References

Johnson, S. M. (2004). The Practice of Emotionally Focused Couple Therapy: Creating Connection (2nd ed.). Brunner-Routledge.
Gottman, J. M., & Gottman, J. S. (2017). The Natural Principles of Love. Journal of Family Theory & Review, 9(1), 7–26.
Christensen, A., Doss, B. D., & Jacobson, N. S. (2014). Reconcilable Differences (2nd ed.). Guilford Press.
Lebow, J. L., et al. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38(1), 145–168.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA.

Find the pattern behind what's been feeling hard

A few simple questions to help surface the concerns that may fit best.

Find Your Pattern

Find a Therapist by City

Browse therapy availability by city to see local and virtual options, explore services, and connect with a clinician who can serve your area.

Relationship Issues therapists in Calgary Relationship Issues therapists in Edmonton Relationship Issues therapists in Toronto Relationship Issues therapists in Vancouver

Find a Therapist by Province

Browse therapy options by province to see which clinicians are available to work with clients in your region.

Relationship Issues therapists in Alberta Relationship Issues therapists in Ontario

Trusted by Leading Psychology & Mental Health Organizations Across Canada

ShiftGrit Psychology & Counselling is professionally regulated, certified, and recognized by leading psychology and mental-health organizations across Canada. These associations reflect our commitment to ethical practice, clinical standards, and evidence-informed therapy through Identity-Level Therapy and Reconditioning.

Trusted By Alberta’s Leading Psychology & Mental Health Organizations

ShiftGrit Psychology & Counselling is professionally regulated, certified, and recognized by leading psychology and mental-health organizations across Alberta and Canada. These associations reflect our commitment to ethical practice, clinical standards, and evidence-informed therapy through Identity-Level Therapy and Reconditioning.

Regulated and affiliated across Alberta’s leading psychology, counselling, and mental-health organizations.

Regulated and affiliated across Canada’s leading psychology, counselling, and mental-health organizations.

Authored by

ShiftGrit Clinical Editorial Team

The ShiftGrit Clinical Editorial Team combines the insight of registered psychologists, provisional psychologists, and trained writers to create accessible, evidence-informed therapy resources. All content is clinically reviewed by a Registered Psychologist.