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Overview of the Gottman Method

Verywell / Laura Porter

What the Gottman Method Can Help With

• Effectiveness
• What to Expect

What Are the Three Main Components of Gottman Method Therapy?

What is the gottman repair checklist, things to consider.

• Getting Started

The Gottman Method is a type of couples therapy developed by Dr. John Gottman and Dr. Julie Schwartz Gottman. Interventions used in the Gottman Method are research-based and grounded in the Sound Relationship House theory, which specifies nine elements of a healthy relationship.

The Gottman Method aims "to disarm conflicting verbal communication; increase intimacy, respect, and affection; remove barriers that create a feeling of stagnancy, and create a heightened sense of empathy and understanding within the context of the relationship."

Gottman Method Background

The Gottman Method is based on decades of research. Over more than 40 years, John Gottman has performed hundreds of empirical studies with over 3,000 couples. During that time, he and his colleague Robert Levenson performed a series of longitudinal studies that found that some marriages end in divorce while others succeed due to the way couples interact.

Married couples' interactions are fairly stable over time, and approximately 69% of problems between partners are never resolved due to differences in couples' personalities.

Of course, every couple argues and has negative interactions. Still, Gottman found that it's the way couples navigate conflict and the emotions they express that will ultimately determine who stays together and who divorces.

First, couples who stay together experience at least five positive interactions for every negative interaction during conflict. In addition, couples who broke up exhibited a high level of behaviors that Gottman refers to as the "Four Horsemen of the Apocalypse," which include:

• Defensiveness
• Stonewalling , or withdrawing from interaction

Gottman's research led to his work with his wife, Julie Schwartz Gottman, which resulted in creating the Sound Relationship House theory and the interventions employed by the Gottman Method.

Gottman Method Techniques

The Sound Relationship House theory is the foundation of the Gottman Method . It uses a house as a metaphor for a secure marriage. The theory identifies seven "floors" that a couple can move through to improve their relationship, along with two "weight-bearing walls," which are essential to holding the couple together. These are as follows:

• Build love maps: This is the first floor of the Sound Relationship House and involves couples getting to know one another's inner psychological worlds.
• Share fondness and admiration: On this floor, couples learn to overtly express appreciation and respect for each other to strengthen their bond.
• Turn towards, not away: This floor involves learning to notice when one's partner is seeking attention, affection, and comfort and responding accordingly.
• The positive perspective: This floor helps partners learn to see one another positively, enabling them to see errors as matters of circumstance, not failures of the individual.
• Manage conflict: On this floor, couples learn to manage conflict through a three-step process. First, partners take each other's feelings into account. Next, partners learn to discuss their problems. Finally, when a partner starts to feel overwhelmed during conflict, they learn techniques to self-soothe to keep their cool.
• Make life dreams come true: The second to last floor centers on supporting and championing one's partner in their dreams and goals.
• Create shared meaning: The top floor mirrors the first floor in that it involves understanding an inner world, but in this case, it's the couple's inner world and entails uncovering the rituals and stories that have shared meaning for them.
• Trust and commitment: The two weight-bearing walls of the Sound Relationship House help couples work through the seven floors. Trust enables couples to believe they can rely on one another and feel like they're a team, and commitment means couples have agreed to stick together and improve their relationship.

Clearly, each floor of the Sound Relationship House represents an opportunity for couples to develop new skills that will strengthen their relationship. Gottman therapists use this theory to drive their work with couples.

Based on his research, John Gottman maintains that even though couples feel their individual relationships are unique, marital conflicts fall into just two categories: resolvable conflicts and perpetual conflicts. Since a majority of conflicts are perpetual, the Gottman Method specifically centers on helping couples work on learning to live with this kind of conflict.

Given The Gottman Method takes this as its focus, it can help with a wide array of relationship issues , from frequent arguing to infidelity and emotional distance, which may seem unique but at their core are often the result of perpetual conflicts.

The Gottman Method can even help couples who don't feel their level of conflict is problematic but are looking to understand their relationship better. The therapy is designed to help people at any stage of their relationship and regardless of race, class, or cultural identity. Research has shown it is also effective for same-sex couples.

Benefits of the Gottman Method

The Gottman Method is unique in its focus on perpetual versus resolvable conflicts. Understanding this difference is part of how this form of therapy can help couples positively change their relationship. By learning new ways to deal with perpetual conflicts, couples can replace negative conflict patterns with healthier ones.

Also, because the Gottman Method is backed by rigorous research, many of the interventions are specific. They include actionable steps that help couples leave each session understanding what to do to continue to work on their issues outside of therapy.

Moreover, learning these steps will help couples in the long term. Even after therapy, they can continue to apply these skills and techniques, preventing them from falling back into their former negative patterns.

Gottman Method Effectiveness

Studies have demonstrated that the Gottman Method is highly effective. In addition to seeing an individual therapist, the Gottman Institute also offers workshops and retreats.

A randomized clinical trial assessed couples one year after taking either a one-day and two-day workshop or after a workshop followed by nine sessions of Gottman Method couples therapy. The trial found all to be effective. Although the most effective option, which also resulted in the least relapse, was combining a two-day workshop with nine therapy sessions.

Similarly, a study on Gottman Method couples therapy found that after 10 sessions, it was an effective treatment for improving married couples' relationships, compatibility, and intimacy.

What to Expect With the Gottman Method

Couples therapy using the Gottman Method starts with an assessment, which begins with a joint session between the couple and the therapist.

The therapist speaks with each member of the couple individually. In addition, couples may complete questionnaires developed as part of the Gottman Method. Together, this will enable the therapist to form a thorough picture of the relationship that they can then use to provide feedback to the couple on the stability of their partnership and decide on the interventions that will be most valuable to the couple.

Gottman Method interventions are designed to improve three primary areas of a relationship:

• Ability to manage conflict
• Creating shared goals

As a result, in therapy, couples will learn to improve interactions to move from negative to positive and deepen emotional connection

Gottman Method therapists don't just focus on improving skills within the relationship but also use the research on which the therapy is based to educate couples about the components of healthy relationships . This gives couples increased insight into their relationship dynamics and tools for maintaining their relationship in the long term.

The repair checklist is a list of phrases that you can use during certain situations that can help you better express how you're feeling, apologize more effectively, let your partner know you appreciate them, and more.

One of the key things to consider before deciding to see a Gottman therapist is your commitment to working on your relationship. The Gottman Method can be rigorous and intense, and therapists expect couples to continue to use the skills they learn in therapy outside of sessions. As a result, those who aren't prepared to focus on improving their relationship in this way may not benefit from the Gottman Method.

In addition, the Gottman Method is not recommended for couples that suffer from physical domestic violence. While this form of therapy can help with many relationship issues, couples counseling can't change patterns of physical violence. Instead, this issue should be handled by a domestic violence specialist, a shelter, or the police.

If you or a loved one are a victim of domestic violence, contact the National Domestic Violence Hotline at 1-800-799-7233 for confidential assistance from trained advocates.

For more mental health resources, see our National Helpline Database .

How To Get Started With the Gottman Method

If couples therapy seems like too big a commitment, the Gottman Institute currently offers a two-day workshop , two-day couples retreats , webinars , and a self-paced online coaching program. Workshops and retreats can be completed in-person and online, giving couples extra flexibility. These options will get you started with the Gottman Method and may even be all you need, depending on the level of help you're seeking.

The Gottman Institute offers a directory of Gottman-certified couples therapists for those who want to do couples therapy. In addition to being licensed therapists with an MA or PhD, Gottman therapists have undergone additional training through the Gottman Institute and attained certification in this particular method of couples therapy. In addition to in-person sessions, many Gottman-trained couples therapists are also available for online sessions .

About The Gottman Method . The Gottman Institute . 2021.

Research Overview . The Gottman Institute . 2021.

Gottman JM. What Predicts Divorce? . Hillsdale, NJ: Erlbaum; 1994.

What is The Sound Relationship House? . The Gottman Institute . 2021.

Gottman JM.  The Seven Principles For Making Marriage Work . New York: Crown Publishing Group; 2002.

Garanzini S, Yee A, Gottman J et al. Results of Gottman Method Couples Therapy with Gay and Lesbian Couples .  J Marital Fam Ther . 2017;43(4):674-684. doi:10.1111/jmft.12276

The Gottman Institute.  The Empirical Basis For Gottman Method Therapy . 2013.

Davoodvandi M, Nejad SN, Farzad V. Examining the Effectiveness of Gottman Couple Therapy on Improving Marital Adjustment and Couples' Intimacy .  Iran J Psychiatry . 2018;13(2):135-141.

By Cynthia Vinney, PhD Cynthia Vinney, PhD is an expert in media psychology and a published scholar whose work has been published in peer-reviewed psychology journals.

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The Transformative Impact of Gottman’s Science-Based Couples Therapy

The evolution of couples therapy has seen a seismic shift, particularly with the advent of science-driven methodologies pioneered by Dr. John Gottman. Often deemed impossible, Gottman’s pursuit of measurable patterns in relationship dynamics challenged the very foundations of traditional therapeutic approaches. His unwavering dedication to studying observable behaviors laid the groundwork for a scientific understanding of intimate connections, revolutionizing how troubled relationships are comprehended and healed. Dr. Gottman’s journey into the quantifiable intricacies of relationships opened new doors, sparking a transformation that reshaped the landscape of couples therapy as we know it today.

Gottman’s groundbreaking discoveries

One of Gottman’s most important discoveries was that the vast majority of relationship problems (69%) were utterly unsolvable. They were related to differences in families of origin, culture, personal beliefs and values, and personality. Much of Gottman’s discoveries were counter-intuitive and contradicted the then-current seat-of-the-pants couples therapy. These “Perpetual Problems” are a universal aspect of marital intimacy, and require management and attunement rather than specific solutions.

The predictive power of Gottman’s research

Dr. Gottman’s research fascinated the press, and he came to dominate the field of couples therapy because his research was startlingly and unarguably predictive, and replicable. In fact, in seven longitudinal studies, the data held up under scrutiny. Gottman could now predict whether or not a couple would eventually divorce with an astonishing 90% or better accuracy. He was able to stone-cold quantify what many believed was utterly unquantifiable.

Gottman wanted to know:

Were there predictable patterns…that could help us understand why some couples remained loving and connected, while others sank into misery…despite having identical problems?

The “Love Lab” and breakthroughs in emotional coding

His research employed breakthroughs in emotional coding technologies, measuring incidents of Criticism, Defensiveness, Contempt, and Stonewalling (which Gottman called the “Four Horseman of the Marital Apocalypse”). Further metrics in physiology and a fresh approach to clinical interviews were also ground-breaking. Gottman and his research colleagues truly are the fathers of modern science-based couples therapy.

Gottman and his team measured everything they could. Relentlessly. Precisely. Over decades, with over 3000 couples.

In 1986, Gottman spearheaded the design and construction of an apartment laboratory at the University of Washington that was nicknamed the “Love Lab” by the press. There were mounted cameras in the common rooms, and a large two-way mirror with technicians recording and coding marital interactions. “Jiggle meters” were at the bottoms of the chairs to measure physical agitation during conversations. Blood was drawn to ascertain prevailing levels of stress hormones. If they fought, researchers knocked on the door requesting urine samples. Their urine was   tested for changes in the level of cortisol which is a hormone produced by stress . This data is then matched against the recordings of the couple’s words, behaviors, and facial expressions. Gottman and his team measured everything they could. Relentlessly. Precisely. Over decades, with over 3000 couples.

Uncovering emotional disengagement

The “Love Lab” research famously uncovered the hidden realities of marital friendship and intimacy, and how gridlocked conflict could be constructively managed, and long-standing relational rifts healed and repaired. It took Levenson & Gottman 14 years of research, but they uncovered another more subtle dysfunctional pattern; emotional disengagement. It is characterized by a lack of positive affect while in a conflictual discussion (no curiosity, humor, repair attempts, warmth, or, most important…empathy). The uncovering of this pattern completed the clinical timeline.

For the first time in the annals of social science, it was possible to predict not only the likelihood of divorce but now, most amazingly… when. Couples who had marital interactions dominated by the Four Horsemen tended to divorce an average of five and a half years after the wedding, while the newly identified emotionally disengaged couples managed to be divorced more than three times later, just over 16 years after the wedding.

For the first time… it was possible to predict not only the likelihood of divorce but now, most amazingly… when.

The Gottman Method and Sound Relationship House Theory

In 1994, Gottman began to develop with his wife, clinical psychologist Dr. Julie Schwartz-Gottman, a synthesis of decades of research culminating in their groundbreaking, Gottman Method Sound Relationship House (SRH) theory. Many of our clinicians have been deeply involved with the Institute since its start. Gottman Theory was first codified 20 years ago. The Gottman Institute, was then founded in 1996, bringing science-based clinical research and advanced certification training to couples therapists all over the world.

The Sound Relationship House theory evolved over time, incorporating findings from the Gottmans’ ongoing research and insights from other researchers in the field. The theory outlines seven levels of a healthy relationship:

• Build Love Maps
• Share Fondness and Admiration
• Turn Towards Instead of Away
• The Positive Perspective
• Manage Conflict
• Make Life Dreams Come True
• Create Shared Meaning

While the Gottmans’ research was central to the development of the Sound Relationship House, other researchers and theories also influenced its evolution. For example, the work of psychologist Robert Levenson on emotional regulation in relationships and the research of psychologist Neil Jacobson on behavioral marital therapy contributed to the Gottmans’ understanding of relationship dynamics.

Gottman training programs for therapists

The Gottman Institute’s training programs have evolved over the years to incorporate new research findings and adapt to the needs of therapists and couples. The institute offers a range of training options, including:

• Level 1: Bridging the Couple Chasm
• Level 2: Assessment, Intervention, and Co-morbidities
• Level 3: Practicum Training (Advanced)
• Certification Track for Gottman Method Couples Therapy

These training programs provide therapists with the skills and tools to assess and intervene in couple relationships using the Gottman Method, which is based on the Sound Relationship House theory. The Gottman Institute has a rigorous certification process for therapists who wish to become “Gottman Method Couples Therapists.” The process involves attending a series of training workshops, which cover the key concepts, interventions, and research behind the Gottman Method. Therapists must complete Level 1, Level 2, and Level 3 training, each of which builds upon the skills and knowledge acquired in the previous level.

In addition to the workshops, therapists must complete a minimum number of hours of individual or group consultation with a Certified Gottman Consultant, demonstrating their proficiency in applying the Gottman Method in their clinical work. They must also submit video recordings of their therapy sessions for review and feedback. Only after completing all of these requirements can a therapist be certified as a Gottman Method Couples Therapist.

It is ambitious and demanding training. The Gottman Institute wants to know that couples are in good hands with you, particularly if you’re conducting an Intensive Couples Retreat. This training is so important that CTI requires all of its therapists to have advanced training in the Gottman Method before seeing clients here.

The significance of science-based couples therapy

What does science-based couples therapy mean to the world? What does it mean to you? Science-based couples therapy is not only effective, these effects can be life-changing. The positive impact you have on those dear to you can leave an indelible mark on their lives. The science of healing intimate bonds has never been better. The following are evidence-based methods designed to heal and repair troubled marriages:

• Gottman Method Couples Therapy: Based on over 40 years of research, this approach focuses on building a strong friendship, managing conflict, and creating shared meaning. The process includes assessment, feedback, and skills-based interventions.
• Emotionally Focused Therapy (EFT): EFT focuses on identifying and changing negative interaction patterns and promoting secure attachment bonds between partners. The process involves three stages: de-escalation, restructuring interactions, and consolidation.
• Cognitive-Behavioral Therapy (CBT): CBT for couples aims to modify dysfunctional thoughts, beliefs, and behaviors that contribute to relationship distress. The process typically includes psychoeducation, communication skills training, and problem-solving strategies.
• Integrative Behavioral Couple Therapy (IBCT): IBCT combines acceptance and change strategies to help couples improve their relationship. The process involves promoting emotional acceptance, fostering positive behaviors, and addressing problem behaviors.
• Solution-Focused Couples Therapy (SFCT) is another science-based approach that has gained popularity in recent years. SFCT emphasizes a future-oriented, goal-directed approach to helping couples build satisfying relationships.

At Couples Therapy Inc. you will find that our clinicians are cross-trained an a number of these science-based couples therapy approaches, to maximize their effectiveness in helping you in an intensive format.

In conclusion, the scientific revolution in couples therapy led by Dr. John Gottman has transformed the landscape of relationship counseling. Gottman’s meticulous research, ranging from facial coding to physiological measurements, unveiled fundamental patterns governing relationship dynamics. His findings, including identifying unsolvable issues and predicting divorce outcomes, fundamentally reshaped therapeutic approaches. The establishment of the Gottman Institute and the Sound Relationship House theory stand as pillars in evidence-based couples therapy.

Despite its remarkable efficacy, the scarcity of trained therapists underscores the urgent need for wider access to science-based methods to aid troubled relationships. As we continue to explore the complexities of human connection, Gottman’s legacy serves as a beacon, illuminating the path towards healthier, more resilient relationships. The future of couples therapy lies in embracing and expanding upon the scientific foundations laid by Gottman, ensuring that the transformative power of evidence-based approaches reaches all those in need of support and guidance on their journey towards lasting love and companionship.

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Frequently Asked Questions

Common questions answered below.  More help: Gottman Support Center .

What is the Gottman Relationship Adviser?

The Adviser is an unparalleled approach to relationship wellness. Measure your relationship health with a research-based self-assessment, analyze key areas of your partnership to identify your strengths and weaknesses, then start a tailored, step-by-step digital program proven to heal and strengthen your connection. Improve your relationship on your schedule, from anywhere.

What is the Gottman Relationship Coach?

The Gottman Relationship Coach is a self-guided program based on the popular Gottman Method.  the Coach is an inspiring and educational multimedia experience created and designed by Drs. John and Julie Gottman to enhance and transform the wellbeing of relationships. Participants access research-based relationship skill-building tools in a series of interactive videos, exercises, and card decks designed to inspire healthy communication and deeper connection. 

What is the difference between the Gottman Relationship Adviser and the Coach programs?

Whereas the Gottman Relationship Coach products address specific areas of your relationship you select, the Gottman Relationship Adviser is a complete relationship wellness program. The Adviser takes the guesswork out of improving your relationship by combining assessment and solutions all in one place. Start with a checkup to find out what you can improve, then follow a personalized, step-by-step plan for your relationship.

How does the Gottman Relationship Adviser analyze and explain my relationship?

The Adviser uses the Sound Relationship House Theory, created by world-renowned psychologists Drs. John and Julie Gottman. The Sound Relationship House is a foundational concept within Gottman Method and has been used successfully with hundreds of thousands of couples all over the world to help them understand and improve their relationships.

If I have purchased the Gottman Assessment or a Coach program, can I still experience the Gottman Relationship Adviser?

Yes, customers can benefit from taking the Gottman Relationship Adviser. The Gottman Relationship Adviser will give you a full snapshot of the state of your relationship based on a detailed self-assessment, then provides recommendations for improvement. You will also get credit for your original purchase at checkout, just login before you check out.

Do I have to take the Gottman Relationship Adviser with my partner?

No, you have the option to take the Gottman Relationship Adviser with or without your partner. You can take the Gottman Relationship Adviser alone to learn about yourself and your relationship, or you can invite your partner to take the Adviser as well, even after starting your own self-assessment. After you log in and invite your partner, they can access the Relationship Adviser by registering on Gottman Connect. Once they register, they will have the option to complete the self-assessment to receive their own custom relationship results..

Will my partner and I receive separate results?

Yes, you and your partner complete your own self-assessment and receive separate results based on your unique answers.

What does the assessment portion of the Gottman Relationship Adviser measure?

The Gottman Relationship Adviser can help you gain insight into your overall relationship health, friendship and intimacy, romance, sex, and passion, how you manage conflict, your shared meaning, trust, commitment, and more.

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You can find a Gottman-trained therapist on The Gottman Referral Network . This Network of experienced clinicians are certified the Gottman Method-based relationship-building techniques  and can use your assessments and work with the Adviser or Coaches to help you get on the pathway to a healthy, long-lasting relationship more quickly.

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Studying Marriage: Gottman’s Love Lab and the Four Horsemen of Divorce

Travis Dixon May 9, 2019 Human Relationships , Love and Marriage

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John Gottman’s decades of research has uncovered four “poisonous” factors in a marriage: Criticism, Contempt, Defensiveness, Stonewalling.  Based on this same research, Gottman has devised 7 principles that can help maintain or restore a healthy marriage. 

Background 

Why do so many marriages end in divorce? In the United States, the % of marriages that end is around 50%, and the rate is similar in other Western countries. Why does this happen? How do couples go from their (presumably) happiest day of their life on their wedding day when they vow they will spend their lives together, to some point later arguing in a divorce lawyer’s office or even in court over who gets custody of the dog/child/TV? Since the 1970s, John Gottman and his colleagues have been investigating this question.

“The Love Lab”

Much of the research on the couples involved in Gottman’s research has been made through observations in what Gottman calls “The Love Lab”. This is an apartment in Seattle overlooking the ocean that is designed to be as realistic as possible, and just like a normal apartment. Couples are invited to spend a weekend in the “lab” and there are cameras situated throughout the apartment that record the couples discussions, body language and general behaviour. They also measure things like their blood pressure and heart rate, to see the physiological effects of their interactions. (For obvious reasons they don’t, however, film them in the bathroom!) At the time of the publication of his book he was studying 700 couples over 7 different studies.

The Love Lab just looks like a regular apartment (and is a regular apartment in Seattle overlooking the ocean), except it’s been equipped with cameras and other monitoring equipment.

When one such research study began in 1983, Gottman asked 85 American couples to participate in his research study where they would be observed in his specially designed “Love Lab”. They recruited by using newspaper advertisements and from 200 couples who responded to these advertisements, a smaller group of 85 couples were invited to participate. The couples were narrowed down to obtain a distribution of marital satisfaction (i.e. low – high) to get an even representation of couples.

During each observation, the couples arrived to the lab after having not seen each other for eight hours. They were asked to converse for 15 minutes on three topics: the events of their day, something good in the relationship and a current idea that was a point of conflict between the couple. While they were conversing they were being recorded by partially hidden cameras to measure physiological reactions, such as facial expressions during conversations.

After the observations were complete, researchers transcribed the data from the video tapes and observers coded the data. Most of the couples were studied again in 1987 and then observed once a year until 1997, and then there was a final observation in 2002. By the time of the final observation, 21 of the 85 had divorced (25%).

The aim of the longitudinal study was to find correlations between the couples staying together or divorcing, and the data from the observations and their physiological responses (e.g. facial expressions). One interesting result that came out of the research was what I like to call, the five-one rule. This means that the happy couples made five positive pieces of communication for everyone negative one . Interestingly, Gottman also claims that based on studies like these he can predict divorce with 91% accuracy after just observing and listening to a couple for as little as five minutes.* Gottman has a background in mathematics and statistics and so much of his research is really focused on careful quantifying and measuring of relationship interactions. 

The way he predicts divorce is for looking for signs of the presence of the “Four Horsemen of the Apocalypse”, which is an allusion to the biblical story of the end of the world. In this context, the four horsemen are four negative styles of communication that were more prevalent in the unhappy couples’ relationships than the happy ones.

Gottmans’ Four Horsemen

Criticism: Whereas a complaint is about something you’ve done, criticism is when one partner makes a negative comment about the other’s personality or character. These negative comments are often based on “always” or “never” type comments, like “you never help around the house,” or “you always think you’re right.”

Contempt : This basically means looking down on someone, feeling like you’re better than them in some way. It often takes the shape of name-calling, sneering, eye-rolling or sarcastic jokes at your partner’s expense.

Contempt. Gottman believes he can predict divorce by looking for micro-expressions of contempt and other markers of the four horsemen.

Defensiveness : Not surprisingly, when one partner is being criticized, they may resort to being defensive, which means not taking the blame and actually shifting it to someone or somewhere else. Defensiveness escalates a conflict, which is why it’s dangerous in a relationship.

Stonewalling : putting up a barrier and withdrawing from conversation; refusing to deal with problems. In unhappy couples it’s a way of actually reducing stress, but the problem is that it doesn’t aid in improving the communication between couples.

To counter these negative communication habits in unhappy marriages, Gottman devised his seven principles for making marriage work.

Gottman’s Seven Principles for Making Marriage Work (Read more here )

• Enhance your love maps
• Nurture your fondness and admiration
• Turn toward each other instead of away
• Let your partner influence you
• Solve your solvable problems
• Overcome gridlock
• Create shared meaning

Dr. John Gottman and his wife Dr. Julie Gottman. (If ever there was a marriage that was under pressure to last, it’s this one!) (Image: wikicommons)

After reading Gottman’s book I concluded that basically the key to having a healthy marriage is to consciously and conscientiously work on maintaining a strong friendship with your partner, and healthy communication habits are at the core of building and maintaining that strong friendship. I fear that some people just expect marriages to work and when they don’t they throw in the towel. Positive communication styles may come naturally for some, but for others they will take practice and effort; in order to help people develop positive communication styles and strategies, Gottman devised his principles.

You can purchase Gottman’s book here .

Critical Thinking Questions

• What does this research study demonstrate in regards to communication in maintaining relationships?
• According to Gottman, how and/or why may some relationships change or end?
• What are the ethical considerations involved in this research?
• What are the methodological strengths and limitations of this research methodology (longitudinal studies and correlational methods)?

Gottman, John Mordechai., and Nan Silver. The Seven Principles for Making Marriage Work . New York: Crown, 1999. Print.

*However, I have heard him claim in lectures that it’s 97% accuracy, so either his initial report was wrong or he’s getting better.

Travis Dixon is an IB Psychology teacher, author, workshop leader, examiner and IA moderator.

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Investigating the effect of couple-centered counseling by Gottman method on the intimacy of infertile couples referring to the infertility Ward of Fatemieh hospital, Hamadan, Iran in 2020: a quasi-experimental study

Mehrnoosh hosseinpoor.

1 Department of Midwifery and reproductive health, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

Seyedeh Zahra Masoumi

2 Department of Midwifery and reproductive health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

Farideh Kazemi

Farzaneh soltani, mohammad ahmadpanah.

3 Department of Psychiatry and clinical psychology, medicine school, Hamadan University of Medical Sciences, Hamadan, Iran

Associated Data

The data supporting the results of this study are available upon request to the corresponding author (Seyedeh Zahra Masoumi, [email protected]).

Infertility is among the most unpleasant experiences for couples struggling with it. Therefore, coping with its associated psychological burden has become a concern in many societies due to its negative impacts on couples’ lives and intimacy levels.

Lack of marital intimacy leads to unfortunate consequences such as dissatisfaction with marital relationships between spouses. Therefore, these people should be encouraged to find an effective solution to cope with infertility.

Regarding the importance of the emotional relationship between infertile couples and the success rate of infertility treatment, this study aims to determine the effect of couple-centered counseling by the Gottman method on marital intimacy of infertile couples referred to the infertility ward of Fatemieh Hospital in Hamadan.

The sample of this quasi-experimental study included 60 infertile couples in the evaluation phase of treatment with primary infertility. We collected data in a referral infertility center in Hamadan (Iran) between December 2020 and May 2021. Marital intimacy was measured using Thompson & Walker’s Marital Intimacy Questionnaire. At the beginning of the study, the intervention and control groups completed this questionnaire. The intervention group received Gottman couple-centered counseling based on GATHER principles in 8 sessions. The groups completed the questionnaires 4 weeks after the last intervention session again. If the distribution was normal, the ANCOVA test was used to evaluate the differences between the two groups. Intra-group comparisons were performed using paired t-test, and intergroup comparisons were performed using an independent t-test.

The mean score of female intimacy increased significantly after the intervention ( P  = 0.009). There was no significant difference in socio-demographic characteristics between groups ( P  < 0.05), both of which were adjusted in ANCOVA. After the intervention, the mean marital intimacy scores were significantly higher in women participating in the intervention group (from 75.6 (±10.63) to 78.86 (±7.87)). In addition, after the ANCOVA test, the difference was statistically significant ( P  = 0.009; MD: 3.74, CI: 0.95 and 6.52). The mean score of male marital intimacy increased after the intervention (from 78.93 (±10.21) to 78.9 (±9.79)), although the difference was not statistically significant ( P  = 0.54; MD: -0.58, CI: − 2.51 and 1.34).

The findings support the effective role of Gottman’s couple-centered counseling in increasing marital intimacy by raising couples’ awareness about the principles of proper relationships between them. This outcome suggests that counseling with couples, especially in critical life situations, can improve their relationship in the infertility treatment process and prevent emotional divorce and other negative impacts on their lives.

Trial registration

IRCT Registration Number IR.UMSHA.REC.1399.535, registered on 21/09/2020.

Infertility is defined as a failure in clinical pregnancy after 12 months of regular and unprotected sex and is classified into primary and secondary categories [ 1 ].

The overall infertility rate in the world is 10% [ 2 ] and 13.2% in Iran, making it a public health concern worldwide [ 3 ].

As a crisis in a couple’s marital life, infertility causes psychological problems and can negatively affect the couple’s adjustment [ 4 ] and their sexual and marital relations [ 5 ]. In this respect, women may also face problems with their marital intimacy [ 6 ].

Numerous studies have reported a significant relationship between marital intimacy and the improved quality of life and couples’ relationship [ 7 ].

Intimacy is an interactive dynamic integrative process that includes emotional, psychological, intellectual, and spiritual dimensions [ 8 ]. The high level of emotional intimacy in interpersonal relationships is among the strongest predictors of physical and mental health and mutual satisfaction [ 9 ]. Couples with a higher level of intimacy may be more capable of coping with problems and changes related to their relationship and consequently experience higher marital satisfaction [ 10 ]. Marital intimacy is a basic need in infertile women [ 11 ]. In this respect, infertility stress disrupts marital intimacy, lowers self-esteem, and reduces the frequency of sexual intercourse [ 12 ]. On the other hand, lack of marital intimacy leads to unpleasant consequences such as relationship dissatisfaction, loss of love and affection, and poor understanding in relationships between spouses [ 13 ].

Nowadays, there are various ways to increase the quality of marital life and train marital communication skills [ 14 ], one of which is counseling. Infertility counseling aims to search, understand, and solve the problems caused by infertility and its related treatment and find ways to deal with it effectively. The counseling process should consider the needs of the patient or the client [ 15 ].

Various couple therapy and family therapy approaches have been developed to minimize conflicts and communication disorders between couples and help them better deal with current problems [ 16 ]. One of these couple therapy approaches is Gottman’s counseling. Gottman’s seven principles are based on love and affection between couples to help rebuild the relationship between couples. Overall, this method is used to increase the intimacy of all couples [ 17 ].

Gottman’s method is based on observation of couple therapy, trying to help couples achieve a deep understanding of cognition, awareness, and empathy [ 18 ] and change their thoughts, perceptions, and behaviors [ 19 ]. Gottman couple therapy is primarily aimed at helping couples rebuild and strengthen friendly relationships with each other [ 17 ] and ultimately leads to their proper intimacy and interpersonal growth [ 18 ]. It also helps couples learn the differences between them and understand that they will remain forever; accordingly, they must learn to deal with them [ 20 ]. Gottman et al. found that positive affection was the best predictor of relationship stability over a 6-month period among newlyweds and, conversely, non-emotional conflict was associated with communication dissatisfaction [ 21 ]. In Gottman’s training program, teaching effective communication skills can help couples establish an efficient two-way relationship for growth and prosperity, reduce the persistence of destructive and negative feelings during marital relationships, and bring a relationship with greater intimacy and satisfaction for couples [ 22 ].

Midwives play an important role in training and counseling at various stages of women’s lives and, consequently, in the life of couples. Therefore, the training and counseling they provide to infertile couples play an important and undeniable role in the lives of these couples. The high prevalence of infertility and its negative impacts on couples’ marital intimacy provides a golden opportunity for interventions and counseling.

Soheili et al. (2020) concluded that group counseling based on Gottman couple therapy has been effective in the marital intimacy of female nurses [ 22 , 23 ]. Also, Saemi et al. (2019), using the Gottman couple therapy method and emotion-based couple therapy, showed the efficiency of marital intimacy in couples’ relationships [ 24 ].

Infertility prevention is almost a neglected issue in health systems [ 25 ], and only few countries provide legal authorization for infertility counseling and supportive care in their reproductive health policies and programs [ 26 ]. To our knowledge, the Gottman method has received limited attention in infertile couples and infertility centers of the studied country. Therefore, the present study uses this method to increase the marital intimacy of infertile couples.

Research design and participants

This research is a quasi-experimental study in two groups to investigate the effect of Gottman’s couple-centered counseling on marital intimacy in infertile couples visiting the infertility ward of Fatemiyeh Hospital, Hamadan. The study samples included 60 couples with primary infertility and one treatment failure. The inclusion criteria for couples were primary infertility with one treatment failure experience, the age range of 18–40 years, known as an infertile couple since the last 1 to 5 years, no mental illness, sexual dysfunction, or an underlying disease affecting fertility, and not receiving marital intimacy counseling in the past. Exclusion criteria were: having a history of divorce, severe marital conflict requiring counseling, stress due to serious illness or death of first-degree relatives, and pregnancy for women.

Sampling and randomization

This research was approved by the Ethics Committee of Hamadan University of Medical Sciences under the codes of IR.UMSHA.REC.1399.535 and IRCT IRCT20120215009014N368 and project NO 9909046166. All participants signed a research consent form.

Sampling was initiated after obtaining the ethical code from the ethics committee of Hamadan University of Medical Sciences. By attending the infertility ward of Fatemieh Teaching Hospital in Hamadan, the researcher extracted a list of infertile couples with one treatment failure. Then, objectives were called and introduced with the research method.

Initially, 100 couples were screened, of which 60 couples were selected. Not meeting the criteria for inclusion, immigration, and secondary infertility were the reasons for eliminating some couples.

The eligibility of the samples was assessed, and eligible couples who wished to participate in the study were invited. After obtaining informed consent from the participants, they were selected by convenience sampling. Next, they were divided into control and intervention groups based on a predetermined allocation sequence. The allocation sequence was determined using blocks with a block size of 4, and the sequence was determined before the intervention. Accordingly, the type of intervention was written in closed opaque envelopes and coded in the order of their sequence.

Each participant was given an envelope after entering the study and asked to complete a demographic information questionnaire. Thus, they were assigned to two groups using the block randomization method (Fig.  1 ).

Flowchart Selection of participants in the study. Members of both experimental and control groups completed the Walker and Thompson’s (1983) Marital Intimacy Questionnaire

Intervention

In addition to the usual infertility procedures (including medical care and nutrition counseling, ultrasound, and tests at regular intervals), the intervention group received face-to-face couple-centered counseling based on the Gottman method and GATHER (Greet, Ask, Tell, Help, Explain, and Return) principles. These procedures were eight 45-to-60-minute sessions with an interval of at least 1 week conducted at the IVF center of Fatemiyeh Hospital.

In addition to face-to-face sessions, the clients were provided with a counseling package, including Gottman counseling CDs and exercises related to each session. Also, the researcher provided couple-centered online counseling in cases of couples’ requests. On the other hand, the control group received only the routine care provided in the infertility ward. After the counseling sessions and 4 weeks after the last session, both questionnaires were completed again by the experimental and control groups, and the Gottman counseling package was provided to the control group. The training content of the counseling sessions is presented in Table  1 .

Educational content of Gottman counseling sessions based on GATHER principles

Data collection tools

Data collection tools included the demographic information questionnaire and Thompson and Walker’s Marital Intimacy Questionnaire. The Social Demographic and Midwifery Questionnaire were prepared by the authors. Ten Hamadan University of Medical Sciences faculty members confirmed this instrument’s validity. Also, the questionnaires were completed by couples separately.

Demographic information questionnaire

The demographic information questionnaire consisted of 27 items about age, education, duration and type of marriage, infertility duration and type, and life satisfaction.

Thompson and Walker’s marital intimacy questionnaire

The Marital Intimacy Questionnaire consisted of 17 items with a maximum score of 119 and a minimum score of 17, rated on a 7-point Likert scale from 1 (Never) to 7 (Always). Also, marital intimacy scores were evaluated based on the research objectives.

This questionnaire has been standardized in Iran, as its reliability coefficient was determined to be 0.96 by Nematzadeh (2020) et al. [ 27 ].

Reliability was measured by the Intraclass correction (ICC) coefficient. For this purpose, 30 couples completed the Thompson and Walker Marital Intimacy Questionnaire at a retest of 2 weeks. As a result, the ICC was calculated to be 95%, indicating the good reliability of our instrument.

Ethics approval and consent to participate

This study was based on Gottman’s principles and related guidelines. All participants were included in the study, and their informed written consent was obtained. The ethics committee of Hamadan University of Medical Sciences approved the study (ethical code: IR.UMSHA.REC.1399.535).

Statistical analysis

Data were analyzed using Stata software ver. 13. Central and dispersion indices were used to describe quantitative variables. Quantitative data were compared between the two groups in terms of demographic and contextual variables by independent t-test, and qualitative data were performed by Fisher test. ANCOVA test was used to evaluate the differences between the two groups in terms of intimacy score and couples’ marital satisfaction due to the normal distribution. In-group comparisons were performed using paired t-test and between groups with independent t-test. The significant level in all statistical tests was considered less than 0.05.

The mean age of the female participants was 31.87 (± 4.56) and 30.67 (± 4.09) years in the experimental and control groups, respectively, while the mean age of the male participants was 35.47 (± 5.57) and 36 (± 5.25) years in these groups. Also, 43.3% of women had an academic degree, and 50% had a high school diploma in the experimental and control groups. These percentages for men were 40 and 50, respectively. The mean duration of infertility in the experimental and control groups was 5.37 (± 3.38) and 7.97 (± 4.58) years, respectively. Also, the effect of the infertility period on the study results was controlled by the ANCOVA test. About 26.7% of the experimental group reported the cause of infertility as male factors, and 56.7% of the control group reported female and male factors as its cause. In addition, 50% of the experimental group and 56.7% of the control group reported a history of IVF. Participants in both groups were homogeneous in terms of all demographic variables ( p  < 0.05; Table  2 ).

Comparison of quantitative and qualitative demographic variables between the two groups

*Independent t-test, ** fisher exact test

The mean score of marital intimacy was 76.20 (13.17) in the control group and 78.86 (7.78) in the intervention group. Although the mean score of the experimental group was higher than the control, the difference was not statistically significant ( P  = 0.34) (Table ​ (Table3 3 ).

Comparison between intra-group and intra-group marital intimacy of women before and after the intervention

*Independent t-test, ** Paired t-test

By adjusting the pre-intervention scores, infertility duration, the mean score of female intimacy after intervention was significantly higher in the experimental group compared to the control group ( P  = 0.009) (Table ​ (Table4 4 ).

Comparison of marital intimacy scores of women in the control and test groups

*adjust of scores before intervention, duration of infertility ** ANCOVA test

The results of Table  5 showed that the mean score of marital intimacy in the intervention group was higher than the control group (78.9 (9.79) and 77.7 (9.42), respectively) but this difference was not statistically significant ( P  = 0.63) (Table ​ (Table5 5 ).

Comparison between intra-group and intra-group marital intimacy of men before and after the intervention

By adjusting the pre-intervention scores, infertility duration, the mean score of male intimacy in the experimental group was higher than that in the control group after the intervention, but the difference was not statistically significant ( P  = 0.54) (Table ​ (Table6 6 ).

Comparison of male marital intimacy scores in control and experimental groups

This study aimed to investigate the effect of couple-centered counseling by the Gottman method on the intimacy of infertile couples in Hamadan. The analysis results revealed a statistically significant difference between infertile women participating in the control and intervention groups. In other words, there was a significant difference between women who received training and women who had no training. Also, Gottman couple therapy has been effective in the marital intimacy of infertile women. According to the results of statistical analysis and comparison of the average intimacy scores in men in the post-intervention stage, it is inferred that Gottman-centered couple counseling has some effect on the marital intimacy of infertile men.

Infertility is an important stressor in a couple’s life as it is very difficult to accept failure in pregnancy. In this respect, many couples experience a recurring treatment without progress, and a feeling of weakness in achieving the goal (childbearing) appears in them. Although infertility is not a disease, it can cause significant emotional disturbances. This problem leaves many psychological and social complications and delays and interferes with various aspects of the couple’s performance, including sexual activity, self-confidence, and emotional communication [ 28 ]. Experience of painstaking treatments and feelings of rejection, fatigue, confusion, and despair are among the cases that infertile couples face. All of these factors can affect the couple’s emotional connection and, therefore, their success in treatment [ 29 ].

Intimacy is an important human need and a dynamic process with internal roots based on mutual trust and respect. In this regard, clinical studies have shown that the root of many marital problems is the lack of intimacy between couples. With the help of his seven principles, John Gottman describes how a marital relationship succeeds or fails. This scholar also offers ways to facilitate change in these relationships through educational, psychological, preventative, and therapeutic interventions. These solutions, called the Seven Principles of Success in Marriage, determine the extent to which couples maintain their friendship, intimacy, and passion [ 30 ]. The goal of Gottman couple therapy is primarily to help couples rebuild and strengthen friendships with each other [ 17 ] and ultimately lead to proper intimacy and interpersonal growth [ 18 ]. In addition, Gottman couple therapy helps couples learn that there are differences between them. The therapy asserts that these differences are not indelible, and couples must learn to adapt to these persistent problems [ 20 ].

Gottman considered the following seven principles to achieve the goal: designing a love plan, cultivating love and admiration, turning to each other instead of avoiding each other, accepting the spouse’s influence, solving solvable problems, overcoming permanent problems, and creating common meaning. He also used strategies such as gratitude, early marriage memories, and an emotional bank account to increase intimacy and love between couples [ 30 ], which we also relied on in the educational package videos.

The results of this study are consistent with those of Soheili et al. (2020), who showed that group counseling based on Gottman couple therapy has a positive effect on marital intimacy in female nurses [ 23 ]. Likewise, Mortazavi et al. (2020) concluded that the relationship prevention and improvement program based on the combined approach of Gottman and Glasser is effective in marital intimacy [ 28 ].

The present study’s findings are also consistent with those of Sehat et al. (2021). These researchers reported that combination therapy based on emotion and solution is effective in marital intimacy and marital adjustment and can reduce hostile, reprehensible, and domineering behaviors and communication problems, thereby improving intimacy in conflicting couples [ 31 ]. Zarei et al. (2018) examined the effectiveness of group counseling based on choice theory and Gottman’s theory on marital intimacy and marital conflicts in married women. They eventually concluded that group counseling based on Gottman’s theory significantly increases intimacy and reduces conflict [ 32 ], which is in line with our findings.

The findings of the present study are opposed to those of Besharat Ghara Maleki (2021), who reported that counseling in the method of forgiveness therapy is ineffective in the marital intimacy of couples with emotional divorce [ 33 ]. Also, these results are inconsistent with those of Arabpour (2012), who proposed the Glaser theory is ineffective in improving the intimate relationship of couples [ 34 ].

The present study showed that couple-centered counseling as an easy and low-cost method increased marital intimacy among infertile women. In fact, couple-centered counseling is a supportive and solution-based approach that aims to identify problems, suggest appropriate solutions, and ultimately encourage people to change their behavior. This approach covers all components effective in interpersonal relationships. Since couple-centered education is much more effective than educating women alone, many studies have suggested considering the role of education and counseling in future research.

Based on the study results, it can be stated that Gottman places great emphasis on love and respect to deal with the negative aspects of marriage. In the Gottman curriculum, effective communication skills training can help couples establish an effective relationship for growth and prosperity and reduce the persistence of negative and destructive feelings during the marital relationship. Infertile couples may experience more emotional distress and divorce due to the stress of not having a child. However, Gottman’s method helps increase the desire to continue the marital relationship, reduce marital incompatibility and conflict, and provide more intimacy and satisfaction for couples [ 23 ].

When women in couple-centered counseling sessions received various training along with related exercises to reach the seven Gottman principles, all of this helped them feel more intimate with their husbands. In counseling sessions, familiarity with conflict resolution and effective communication skills helped couples realize that some problems in their marital relationship may never be resolved, and they need to learn how to deal with and manage conflict. The couple realized that establishing an effective relationship with their spouse could better understand each other’s needs and wants. Accordingly, the degree of intimacy between them would increase. Also, in these sessions, couples were introduced with four incorrect communication patterns called four riders: criticism, insult and humiliation, defensiveness, and the formation of a stone wall. They received explanations about these four factors’ destructive and negative impacts on marital relationships and learned how to replace correct behavior with behavior.

Overall, Gottman’s counseling taught couples, especially infertile women, that they could more easily deal with many of their problems, such as infertility, by creating a common sense, thus increasing marital intimacy among women. Intimate relationships and better communication patterns of these couples can go through the stages of infertility treatment better than before.

Limitations and strengths

Unlike most interventional studies that focus on training women, the counseling sessions in the present study were based on couples’ relationships and Gottman’s counseling content. Another strength of our work was the preparation of Gottman’s counseling package (counseling videos and practicing the sessions) and its presentation to couples, in addition to face-to-face counseling sessions.

One limitation of our work was the absence of a psychologist in counseling sessions. We resolved this issue by referring the couples to a psychologist upon their request after the last counseling session. Another limitation was the small number of samples due to time constraints, which reduces its generalize ability to the whole community.

Furthermore, the non-cooperation of some men to participate in counseling sessions slowed down the sampling rate. Therefore, we held online counseling sessions for some of them. Besides, some others were excluded from the study due to creating problems in emotional communication.

Conclusions

The results of this study revealed that Gottman’s counseling is significantly effective in increasing marital intimacy in women and to some extent in men. It is, therefore, recommended to use it in infertility centers to increase marital intimacy because it increases the quality of life and leads to success in infertility treatments. Moreover, training counseling skills such as Gottman’s counseling to midwifery students and healthcare staff, especially midwives working in the infertility ward, will help this group benefit from the positive effect of interventions on mental health and better emotional communication between couples.

Acknowledgments

The Vice Chancellor for Research and Technology of Hamadan University of Medical Sciences, esteemed professors, staff of the infertility ward of Fatemieh Teaching Hospital, participants and other people who helped us in this study are deeply appreciated.

Abbreviations

Authors’ contributions

MH, SZM Conceptualize, design and direct the study. MH collected information. FK has analyzed the data. FS and MA participated in writing the article and all authors have read, commented, and approved the final manuscript.

This project was funded by Hamadan University of Medical Sciences. The budget was spent on sampling and conducting the study (NO,9909046166).

Availability of data and materials

Declarations.

All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of Hamadan University of Medical Sciences under code (IR.UMSHA.REC.1399.535). Written informed consent was obtained from all subjects.

Not applicable.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Mehrnoosh Hosseinpoor, Email: [email protected] .

Seyedeh Zahra Masoumi, Email: moc.liamg@1002dimarhaz .

Farideh Kazemi, Email: moc.oohay@12imezakhediraf .

Farzaneh Soltani, Email: moc.oohay@8002inatloshenazraf .

Mohammad Ahmadpanah, Email: moc.liamg@0002damha1M .

Study assesses seizure risk from stimulating thalamus

In awake mice, researchers found that even low stimulation currents could sometimes still cause electrographic seizures

The idea of electrically stimulating a brain region called the central thalamus has gained traction among researchers and clinicians because it can help arouse subjects from unconscious states induced by traumatic brain injury or anesthesia, and can boost cognition and performance in awake animals. But the method, called CT-DBS, can have a side effect: seizures. A new study by researchers at MIT and Massachusetts General Hospital (MGH) who were testing the method in awake mice, quantifies the probability of seizures at different stimulation currents and cautions that they sometimes occurred even at low levels.

“Understanding production and prevalence of this type of seizure activity is important because brain stimulation-based therapies are becoming more widely used,” said co-senior author Emery N. Brown, Edward Hood Taplin Professor of Medical Engineering and Computational Neuroscience in The Picower Institute for Learning and Memory, the Institute for Medical Engineering and Science, the Department of Brain and Cognitive Sciences and the Center for Brains Minds and Machines (CBMM) at MIT.

In the brain, the seizures associated with CT-DBS occur as “electrographic seizures” which are bursts of voltage among neurons across a broad spectrum of frequencies. Behaviorally, they manifest as “absence seizures” in which the subject appears to take on a blank stare and freezes for about 10-20 seconds.

In their study, the researchers were hoping to determine a CT-DBS stimulation current— in a clinically relevant range of under 200 microamps—below which seizures could be reliably avoided.

In search of that ideal current, they developed a protocol of starting brief bouts of CT-DBS at 1 microamp and then incrementally ramping the current up to 200 microamps until they found a threshold where an electrographic seizure occurred. Once they found that threshold, then they tested a longer bout of stimulation at the next lowest current level in hopes that an electrographic seizure wouldn’t occur. They did this for a variety of different stimulation frequencies. To their surprise, electrographic seizures still occurred 2.2 percent of the time during those longer stimulation trials (i.e. 22 times out of 996 tests) and in 10 out of 12 mice. At just 20 microamps, mice still experienced seizures in 3 out of 244 tests, a 1.2 percent rate.

“This is something that we needed to report because this was really surprising,” said co-lead author Francisco Flores, a research affiliate in The Picower Institute and CBMM, and an instructor in anesthesiology at MGH where Brown is also an anesthesiologist. Isabella Dalla Betta, a technical associate in The Picower Institute, co-led the study published in Brain Stimulation .

Stimulation frequency didn’t matter for seizure risk but the rate of electrographic seizures increased as the current level increased. For instance, it happened in 5 out of 190 tests at 50 microamps, and 2 out of 65 tests at 100 microamps. The researchers also found that when an electrographic seizure occurred, it did so more quickly at higher currents than at lower levels. Finally, they also saw that seizures happened more quickly if they stimulated the thalamus on both sides of the brain vs. just one side. Some mice exhibited behaviors similar to absence seizure, though others became hyperactive.

It is not clear why some mice experienced electrographic seizures at just 20 microamps while two mice did not experience the seizures even at 200. Flores speculated that there may be different brain states that change the predisposition to seizures amid stimulation of the thalamus. Notably, seizures are not typically observed in humans who receive CT-DBS while in a minimally conscious state after a traumatic brain injury or in animals who are under anesthesia. Flores said the next stage of the research would aim to discern what the relevant brain states may be.

In the meantime, the study authors wrote, “EEG should be closely monitored for electrographic seizures when performing CT-DBS, especially in awake subjects.”

The paper’s co-senior author is Matt Wilson, Sherman Fairchild Professor in The Picower Institute, CBMM, and the departments of Biology and Brain and Cognitive Sciences. In addition to Dalla Betta, Flores, Brown and Wilson, the study’s other authors are John Tauber, David Schreier, and Emily Stephen.

Support for the research came from The JPB Foundation, The Picower Institute for Learning and Memory, George J. Elbaum (MIT ‘59, SM ‘63, PhD ‘67), Mimi Jensen, Diane B. Greene (MIT, SM ‘78), Mendel Rosenblum, Bill Swanson, annual donors to the Anesthesia Initiative Fund; and the National Institutes of Health.

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Are you currently looking for a Certified Gottman Couples Therapist to use research-based approaches to help your relationship?

The Gottman Institute is seeking couples to participate in an international outcome study on Gottman Method Couples Therapy.

You will be able to work with a skilled, compassionate Certified Gottman Therapist either online via HIPAA compliant telehealth or in-person. Your participation in this study will not only help your relationship, it will also help us understand what couples are experiencing today in our post-COVID-19 world and what helps couples cultivate a healthier relationship in couples therapy.

Costs and Compensation for Your Participation:

Session costs:.

While all of the studies Dr. Gottman did during his tenure as a professor were funded with federal grants, funding for research on couple relationships is not currently available. Despite this, we still believe work needs to be done. As part of your participation in this study, we are asking you to pay the Certified Gottman Therapist session fee. We wish we could provide treatment to couples in our studies at no cost and pay the therapists providing these services. We simply don’t have the funds to do so.

Free Assessment:

We do provide some financial help to couples and therapists by providing all assessment questionnaires at no charge. Couples will meet with a Certified Gottman Therapist and receive access to the new Gottman Connect assessment and an interpretation of the results that your therapist will go over with you. This is an average savings of $450.

Compensation for your time:

Additionally, we  are  fortunately able to provide compensation for the time it takes to fill out the questionnaires for our study. You will be required to fill out three or four lengthy questionnaires, at the beginning of treatment, at the end of treatment, and six months later. After the final questionnaire is filled out 6 months post-treatment, as a thank you for your time, we are happy to be able to provide one of the following (whichever you prefer and choose after completing the final questionnaire):

• a $300 Visa gift card ($150 per partner)
• A Gottman Relationship Coach Bundle of your choice
• Free registration to a live Art and Science of Love couples workshop

Do you qualify for the study?

• Couples must be presenting for couples therapy
• Couples must be married or in a committed relationship
• Couples have not worked with a Certified Gottman Therapist before (Gottman training is okay; please reach out to [email protected] if you’re not sure about their level of training, I’d be happy to verify)
• Each individual must not be attending their own individual therapy or counseling. If you are, you must be willing to cease or pause services prior to starting to work with your couples therapist for the duration of your participation in the study (during active treatment and for 6 months following)

In deciding to participate in this study, you agree to the following:

• You may be paired with a Certified Gottman Therapist that is offering teletherapy.
• The availability of in-person services will depend on both what type of services therapists licensed to work in your location are offering, as well as whether you are located close enough to them to make traveling to meet in-person feasible.
• You will be randomly assigned to either:
• An immediate treatment group. For this group, you can begin treatment immediately, or as soon as you are able to book an appointment
• A 3-week waitlist group. For this group, you will be given an assessment to complete, and then will book your first session 3 weeks out.
• You agree to repeat the Gottman assessment questionnaires at 3 or 4 time points during the study (depending on your randomly-assigned treatment group). These assessments will be provided to you at no additional cost.
• These are the same questionnaires used by Gottman-trained therapists with their regular clients. As part of the study, we are asking participants to complete the questionnaires a greater number of times than you would normally fill them out, were you not participating in research.
• Every four sessions or so, you will also be sent a brief, optional survey about your experience in therapy

Do you live in a qualifying location?

We have participating therapists in the following locations.

Both in-person and telehealth options are available.

You may participate in-person with therapist if there if one available near you in one of the cities listed.

You can also opt to see a therapist online via telehealth if you live in any of the states listed (note that you must still work with a therapist who is licensed to practice within the state you live in). Telehealth may be especially convenient if you live quite a ways away from an available city, or if you live in a state for which there are no available therapists practicing in-person.

If you have more questions about the study, please contact [email protected] .

Frequently Asked Questions

Fees depend on location, depending on both the individual Certified Gottman Therapist as well as the length of sessions (e.g. longer 90-minute sessions cost more than shorter sessions). The form should provide an estimate based on your state or country as you fill out the application, and once you  apply to participate in the study , we will also inform you of a possible estimate of a range of session rates before we schedule a screening call to share more information about the study. Most therapists charge rates consistent with the average rates in their area.

Yes. Some but not all Certified Gottman Therapists offer a reduced rate for this study. We do offer this to participants who are often marginalized in couples therapy research including BIPOC, LGBTQIA+, low socioeconomic status, disabilities (visible and invisible), etc., to better represent the effectiveness of The Gottman Method for relationships that are not often represented in research.  The Gottman Method Couples Therapy has already been established as an Evidence-Based Treamtment for Same-Sex Couples . When responding to the application verification email for the study, please indicate you are interested in the reduced rate.

It depends. Some but not all Certified Gottman Therapists accept insurance. Some therapists who do not are still able to offer a Superbill that you can submit to insurance. We would recommend checking with your provider about what they do cover. When responding to the application verification email for the study, please indicate that you are interested in being connected with a therapist who takes insurance and we will do the best we can to find you one.

The reason we need you to cease individual and/or group therapy is because it would confound the results of the study. If you are seeing an individual therapist, going to family therapy, or group therapy, we would not be able to say with confidence that The Gottman Method Couples Therapy is what improved the relationship and individual wellbeing. For this reason, we ask that you not participate in any other forms of therapy if you choose to participate in this study.

You may resume those services once you complete treatment and the 6-month follow-up period has passed, which is when we send the final assessment and wrap up the study. How long treatment takes it completely up to you and your couples therapist. For clarity, this only applies to talk therapy and similar treatment with a licensed therapist. It is okay for this study to continue to see a psychiatrist for medication management throughout.

There are three parts to our answer based on the current literature regarding research on couples therapy. The current research design was approved by an Institutional Review Board. 

Part A: The cost .

Most couples therapy research studies are done in university settings in a controlled environment with the benefit of grant funding to allow the cost of therapy to be free. While there is grant funding in other countries for couples therapy, we have not received funding for this research study because there are no funds offered for couples therapy studies at this time in the United States. Not to mention, with a sample size of 120 couples, by far the largest study on couples therapy to date, that would be a very large grant. Despite this, we feel there is still more research needed. In our part to reduce cost, we do offer the assessments for free which is a $475 value. Some of our Certified Gottman Therapists offer sliding scales and insurance (see the section above). 

Part B: The Therapist

Most couples therapy studies are completed in controlled conditions such as a university setting with student therapists under a supervisor who may watch the session live (Christensen, et al., 2005). When a couple sees a therapist in their office, there is no supervisor watching every second of the session. The difference in this study is that the counselors being seen are not students but fully licensed therapists who are specifically trained to work with couples using the Gottman Method. 

The purpose of this study is to evaluate the effectiveness of Gottman Method Couples Therapy with couples seen in typical therapy offices. Previous studies on the effectiveness of couples therapy indicated that interventions need to be stronger to effectively help couples. This study requires that participating therapists be Certified Gottman Therapists. A Certified Gottman Therapist has completed three levels of training in Gottman Method couples therapy, had multiple videos of their work scrutinized by Master Trainer Gottman Therapists, and passed a video review process demonstrating that they can effectively use Gottman interventions with couples. There are currently only 411 of therapists that meet these qualifications in the world. By agreeing to participate as a therapist in this study they have agreed to follow the Gottman Method protocol by using the appropriate interventions at the appropriate time during treatment.

Part C: Efficacy Studies In University Settings Do Not Translate to Real Therapy Offices

The efficacy studies in university settings fail to reproduce similar results in a naturalistic setting such as a typical therapy office (Halford, Pepping, & Petch, 2016). Again, this has to do with supervision as well as the type of therapist being studied. 

We also know that the screening procedures of university-based outcome studies often include a population that is only 0.5 standard deviation below the mean, meaning they are slightly unhappy (Gottman & Gottman, 2018). However, many couples starting couples therapy are 2.5 standard deviations below the mean indicating high levels of distress (Gottman et al., 2020). This highlights that the university-based outcome studies don’t include the kinds of couples seen in a typical therapist office. Our data from 40,681 couples starting couples therapy indicate that over 80% of couples about to start therapy have  serious problems  with both conflict and intimacy (Gottman et al., 2020). 

Furthermore, the university based studies on the effectiveness of couples therapy screen out many couples who struggle with substance abuse, bipolar, and personality disorders (Baucom et al., 2009; Christensen et al. 2010.). Our data indicates that these struggles are the norm and we need to learn how to help couples with these challenges in a therapy office. 

Baucom, B. R., Atkins, D. C., Simpson, L. E., & Christensen, A. (2009). Prediction of response to treatment in a randomized clinical trial of couple therapy: A 2-year follow-up.  Journal of Consulting and Clinical Psychology ,  77 (1), 160–173.  https://doi.org/10.1037/a0014405

Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.  Journal of Consulting and Clinical Psychology ,  78 (2), 225–235.  https://doi.org/10.1037/a0018132

Christensen, A., Baucom, D. H., Vu, C. T.-A., & Stanton, S. (2005). Methodologically Sound, Cost-Effective Research on the Outcome of Couple Therapy.  Journal of Family Psychology ,  19 (1), 6–17.  https://doi.org/10.1037/0893-3200.19.1.6

Gottman, J., & Gottman, J. (2018).  The science of couples and family therapy: Behind the scenes at the love lab . W. W. Norton Company, Inc.

Gottman, J. M., Gottman, J. S., Cole, C., & Preciado, M. (2020). Gay, Lesbian, and Heterosexual Couples About to Begin Couples Therapy: An Online Relationship Assessment of 40,681 Couples.  Journal of Marital and Family Therapy , jmft.12395.  https://doi.org/10.1111/jmft.12395

Halford, W. K., Pepping, C. A., & Petch, J. (2016). The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness.  Journal of Marital and Family Therapy ,  42 (1), 32–44.  https://doi.org/10.1111/jmft.12120

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The Gottman Method

Reviewed by Psychology Today Staff

The Gottman Method for Healthy Relationships is a form of couples-based t herapy and education that derives from the relationship research of psychologist John Gottman. For more than 40 years, Gottman identified and tested the elements of an enduring relationship. Gottman and his wife, psychologist Julie Schwartz Gottman, created the clinical treatment framework known as the Gottman Method and launched the Gottman Institute, a center for training, research, and education.

One of the major tenets of the Gottman Method is that couples require five times more positive interactions than negative, as negative emotions, like defensiveness and contempt, hurt a relationship more than positive ones heal. As a result, the therapy focuses on developing the skills and understanding necessary for partners to maintain fondness and admiration, turn toward each other to get their needs met, and manage conflict. It also focuses on how couples can react and repair relations when they do hurt each other.

• When It's Used
• What to Expect
• How it Works
• What to Look for in a Gottman Method Couples Therapist

The Gottman Method is a broad-based treatment that serves all couples, at any age, and in any stage of a relationship.

A 12-year study conducted by Gottman found that while gay and lesbian couples have some distinct dynamics, they are comparable to heterosexual couples in many ways, and would benefit similarly from the Gottman Method.

The method can be applied to many relationship problems but may be particularly useful for couples who are:

• Stuck in chronic conflict
• Coping with infidelity
• Struggling with communication
• In a stagnant relationship or emotionally distanced
• Facing difficulties over specific issues, such as money, parenting , or sex

All Gottman Method therapy is based on a couple’s patterns of interacting, and partners learn and implement relationship-building and problem-solving skills together.

Couples begin treatment with an assessment process and an overview of what the Gottman Method is. It continues with:

• Each partner establishing a relationship with the therapist by sharing their history, their relationship philosophy , and their goals for treatment.
• Undergoing a thorough inspection of the union, including engaging in discussion of a topic on which partners disagree.
• Learning the research-derived components of healthy relationships.
• Bolstering the fondness and respect that first brought the partners together.
• Direct coaching from the therapist on interaction skills and developing trust.
• Acquiring tools for checking and maintaining relationship health beyond therapy.

The Gottman Method focuses not only on providing practical skills for managing relationships, but on delivering deeper insight into how the relationship dynamics developed.

The length of treatment depends on the severity of a couple’s challenges. Researchers have studied it using ten sessions as a benchmark, but the duration is ultimately a decision made by the couple and the therapist. In some cases, such as a couple in crisis, treatment is employed intensively over the course of two to four days.

The Gottman Method is built on decades of research and observation into how couples interact. Gottman found that negativity has a strong impact on our brains, and that, unless couples take steps to counteract instances of negativity, they grow apart emotionally. The method identifies and addresses the states of mind and behaviors shown to underlie intimacy and helps partners maintain a positive orientation to each other that can sustain them through upsetting circumstances.

The resulting treatment focuses on the nine components of a healthy relationship, what Gottman calls “The Sound Relationship House.” It includes the following:

• Build Love Maps: Assessing how well partners know each other’s inner world: their hopes, stressors, worries, and desires.
• Share Fondness and Admiration: A focus on the level of respect and tenderness that exists between the couple. Gottman calls this level “the antidote for contempt.”
• Turn Towards Instead of Away: Being aware of your partner and responding when you can sense they need something emotionally.
• The Positive Perspective: Approaching problems and repairing relationship failures with a positive attitude.
• Manage Conflict:​​ While conflict in a relationship is inevitable, and can even sometimes be beneficial, Gottman says, managing it is different from resolving it. Some problems can be fixed, but many relationship conflicts must simply be managed.
• Make Life Dreams Come True: Creating an atmosphere that encourages each person to talk honestly about their hopes, values, convictions and aspirations.
• Create Shared Meaning: Understanding important narratives, myths, and metaphors about the relationship.
• Trust: Gottman defines trust as partners knowing that each will think and act in the best interest of the other.
• Commitment: Knowing that your partner will stick with you through the rough patches and work to get through them. It involves a focus on gratitude for who your partner is and what they do in the relationship.

Although individual perspectives and wishes are addressed, all therapy sessions in the Gottman Method are conducted with both partners together, and therapists do not privilege secrets.

While many therapists are familiar with and apply principles from Gottman’s relationship research, a certified Gottman Method therapist has completed several rounds of study and training through the Gottman Institute in Seattle.

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