How Does Couples Therapy Work?
A Guide For New Yorkers From Downtown Somatic Therapy
6 min read
If you're anything like other couples living in New York, you've probably found yourselves having the same argument for what feels like the third time this month.
Maybe it started over who forgot to buy milk, but somehow it escalated into a heated discussion about feeling unheard and unappreciated. You might be the kind of couple who screams and slams doors (apologies to your neighbors) or you might be the kind of couple who silently withdraws and ices each other out. Either way, you're stuck in a dynamic that feels impossible to change, and you're wondering: Is this just how relationships are, or is there a way out?
At Downtown Somatic Therapy, we see couples asking this question every day and we absolutely believe relationships can not only improve, they can flourish.This internal struggle shows up for so many people in different ways, and maybe that’s true for you, too. Maybe this looks like feeling guilty about the food you eat, comparing your body to others, or the feeling like you have to "make up" for something after a meal. Or maybe, you use movement to calm those feelings, which ends up feeling more like punishment than care.
This idea that something is wrong with our bodies shows up for people of all genders, gender expressions, sexualities, identities, ages, backgrounds, and body types. In her work, Krausz most often supports people who identify as women or were socialized to focus on appearance, including those in their twenties, postpartum mothers, and women navigating perimenopause and menopause.
Each stage of life brings hormonal changes like shifts in weight, mood, and energy. Yet despite this being an entirely natural and healthy part of aging, our culture still tells us to stay the same in size, shape, and more. And beneath that pressure are generations of messages that shaped how women learn to see themselves: that smaller is better, that control equals safety, and that self-worth has to be earned
So how can therapy, especially somatic therapy, help you break out of this cycle?
Whether they come to our office in Tribeca, Williamsburg or Downtown Brooklyn, couples across the City deal with fairly similar challenges.
Our therapists specialize in evidence-based approaches like Emotionally-Focused Therapy (EFT) and the Psychobiological Approach to Couples Therapy (PACT), which combine cutting edge research into neuroscience and attachment theory along with a somatic perspective that recognizes that our bodies often hold the key to deeper connection.
So, assuming you and your partner are both on board, how does couples therapy work and what can you expect?
Somatic Therapy vs. Traditional Talk Therapy & CBT: A Deeper Dive
Here's what most couples don't realize, according to Avi Klein, couples therapist and practice founder at DST: “the goal of therapy isn't just to stop fighting about the dishes or whose turn it is to walk the dog. It also isn’t about one person changing to suit the other person’s needs. The real work happens when we understand that there are underlying emotional patterns driving these surface-level conflicts and work together to shift away from them”.
How do we move beyond surface level conflicts? One way is by recognizing that conflicts often originate in our attachment needs. According to attachment theory, humans have a fundamental need for connection and emotional safety. This begins in infancy and is evolutionarily adaptive for our survival. Yet we also transfer these attachment needs to our partners in adulthood.
When we don't feel that our partner is emotionally accessible, responsive, and engaged, we often use “protest behaviors” to try and improve our connection. Unfortunately, these can often backfire and lead couples to unconsciously fall into what therapists call "negative cycles."
Picture this common scenario: Sarah and Mark are a couple who recently moved in together to a shared apartment in Williamsburg. Sarah has a more anxious/preoccupied attachment style and is more likely to feel disconnected from her partner Mark. Perhaps Mark does something insensitive like getting distracted by his phone instead of listening to Sarah while she’s telling him about her day.
Instead of redirecting him in a gentle way, she might point out what he's doing wrong in a harsh way (“You’re always on your phone!”). Mark, feeling attacked, shuts down and gets quiet. Sarah interprets his withdrawal as confirmation that he doesn't care, so she escalates her criticism. Mark retreats further and both of them end up feeling hurt and disconnected.
This is the classic pursuer-withdrawer dynamic, one of the negative cycles that keeps couples trapped in conflict.
Research by renowned psychologist and couples therapist John Gottman found that couples who stayed together returned each other's bids for connection 87 percent of the time, while those who separated only did so 33 percent of the time. The difference? Learning to turn toward each other instead of away. But how do high conflict couples learn how to do that? Think of couples therapy as a form of practice.
The Somatic Approach to Couples Therapy: Why the Body Matters
What makes somatic therapy unique in the landscape of couples therapists across Manhattan and Brooklyn? It's the recognition that our emotions and past experiences are held in our bodies. It’s not enough to understand that we need to turn towards our partners - somatic therapy helps us access the emotional blocks in real time that are getting in the way.
What is Somatic Therapy? Somatic therapy recognizes that our bodies have much to say about how we actually feel. “Insight is not enough,” says Avi. “We often repeat the same problems over and over again because we have unconscious responses and feelings that we need help accessing and responding to.” When it comes to couples therapy, a somatic therapy approach recognizes that our early attachment experiences—those first relationships with our caregivers—create blueprints that are stored not just in our minds, but in our nervous systems.
When we feel threatened in our adult relationships, our autonomic nervous system (the part of our nervous system that controls our fight, flight, or freeze responses) can activate without our conscious awareness. This means that no matter how much we love our partners, incredibly powerful survival mechanisms can take over to create conflict even when we want to avoid it.
The Process in Action: Take Lisa and David, a couple in their 50’s who have lived in Cobble Hill for decades. As they begin discussing a recent argument in one of their couples therapy sessions, Lisa's shoulders tense and her breathing becomes shallow. Her body is preparing for conflict even before harsh words are spoken. David notices his jaw clenching and his impulse to look away.
A somatic approach to couples therapy helps partners like Lisa and David become aware of these physiological responses. They learn to recognize the racing heart, the clenched jaw, or the tightness in the chest that signals their nervous system is activated.
More importantly, they learn how to regulate these responses together, creating what PACT therapist Stan Tatkin calls "co-regulation."
This body awareness allows couples to slow down and create space for new, healthier responses, building the foundation for secure attachment.
Two Key Somatic Therapeutic Models: EFT and PACT in Practice
Emotionally-Focused Therapy (EFT): Understanding the Dance
EFT, developed by Dr. Sue Johnson, operates on a core principle: conflict stems from a lack of secure emotional attachment within a couple. When partners don't feel emotionally safe, they develop predictable patterns. What we often call the "pursuer/distancer" cycle.
In EFT, couples therapy works by first identifying these patterns. . Take Maria and Alex, a couple who came to Downtown Somatic Therapy’s office in Tribeca feeling stuck. Maria would express frustration about feeling alone in their relationship, but it came out as criticism: "You never help with anything!" Alex, feeling attacked, would respond with defensiveness, “Maybe I would if you didn’t nag me all the time!”, confirming Maria's fear that she didn't matter to him.
Importantly, EFT doesn’t take a top down approach to identifying this pattern. Rather than just recognizing the dynamic, EFT therapists support clients by accessing this information experientially, meaning they might experience the pattern in real time and with the support of the therapist recognize the ways in which they are both initiating familiar dance steps.
The EFT process helps couples like Maria and Alex first recognize this dance, which helps them understand that they are both contributing to it and doing it for understandable reasons. Later, they will work to access the vulnerable emotions beneath their reactive behaviors, and eventually create new, more connecting interactions by learning how to share in a more vulnerable, less defensive way.
The Psychobiological Approach to Couples Therapy (PACT): Nervous System Awareness
PACT takes the somatic approach even further by focusing specifically on how partners' nervous systems interact. Developed by Stan Tatkin, PACT recognizes that we are constantly influencing each other's emotional states, often without realizing it.
In PACT-informed couples therapy, partners learn to read each other's nervous system cues and become skilled at helping each other stay regulated. For instance, when one partner notices their loved one is becoming activated (perhaps through changes in breathing, posture, or eye contact), they learn specific techniques to help bring them back to a calm, connected state.
This engenders a more secure attachment by helping partners learn that they can trust each other and count on each other.
This approach is particularly powerful for the couples we see in Brooklyn and Manhattan who are dealing with the additional stress of busy New Yorkers. The constant stimulation of city life can keep our nervous systems on high alert, making relationship conflicts feel even more intense. Learning practices that help us soothe each other can help us feel connected even when things around us feel challenging.
The Three Phases of Couples Therapy
Understanding how couples therapy works becomes clearer when we break down the process into three distinct phases:
Step 1: Identifying the Pattern
The first step is recognition. Therapists at Downtown Somatic Therapy help couples identify and name the cycle they're caught in. Common patterns include:
Pursuer/distancer - in which one member might criticise or pursue while the other withdraws in response
Withdraw/withdraw - Most commonly seen in two conflict avoidant people who disengage rather than talk about what’s upsetting them
The "attack-attack spiral" - this is a high conflict couple where neither partner backs down.
“What all three of these couples have in common,” says Avi, “is that they don’t know how to repair.” When couples can step back and say, "Oh, we're doing that thing again," they've already begun to break free from the pattern's grip and can begin to have a new kind of relationship.
Step 2: Exploring Deeper Emotions
This is where the real magic of couples therapy happens. Therapists at DST know that beneath every criticism is often a longing and under every withdrawal is frequently a fear.
Melanie Berkowitz, another experienced couples therapist from Downtown Somatic Therapy explains: "Sometimes when a partner criticizes or attacks the other person, underneath that behavior is a core fear that their partner will not be there for them. And often this fear didn't originate in the relationship, but in an old pattern developed in childhood."
At the same time, partners who withdraw are often very sensitive to criticism and the rejection that comes with underperforming - again, based on templates set much earlier than this adult relationship.
Take, Jake, for example. One half of a newly married couple from the East Village, he often accuses his partner of "never being available.” We might discover that underneath his anger is a deep fear of abandonment rooted in early experiences.
Meanwhile, when his partner Rob withdraws during conflict, it's not because he doesn't care, but because he learned early in life that retreat was the safest way to maintain connection and avoid the pain of rejection and disappointment.
Step 3: Creating New Interactions
Armed with awareness of their patterns and understanding of their deeper emotions, couples can begin to create new interactions. Instead of Jake saying, "You're never here for me!" he might learn to say, "I'm scared I'm not important to you, and I need to know you care."
This vulnerable sharing, facilitated by the therapist, allows partners to turn toward each other with empathy rather than defensiveness. When we can share our softer emotions in a way that our partner can hear and respond to, we create the secure bond that all healthy relationships require.
Why Location Matters: In-Person Couples Therapy in Manhattan and Brooklyn
There's something uniquely powerful about in-person couples therapy, especially for New York couples dealing with the intensity of urban life. At Downtown Somatic Therapy's locations in Lower Manhattan, Williamsburg, and Downtown Brooklyn, couples have access to a safe, supportive environment where they can learn to read each other's physical responses in real-time.
When partners can see each other's body language, notice changes in breathing, and practice co-regulation techniques together in person, the learning goes much deeper.
According to Melanie, “there's an intimacy to in-person work that can't quite be replicated virtually.” At the same time, all of our therapists also serve clients online and are skilled at helping couples attune to each other across digital platforms. It might take a little extra effort, but couples therapy online can be incredibly helpful as well.
As New Yorkers ourselves, we understand the unique challenges of maintaining connection in a city that never stops moving. The constant stimulation, long work hours, and small living spaces can all impact how couples relate to each other. Our therapists are trained to help you navigate these challenges while building the skills for a lasting partnership, whether you’re a lifelong New Yorker or ready to move to the suburbs once you have kids.
Real Change: What Success Looks Like
How do you know couples therapy is working? Here's what we see with successful couples at Downtown Somatic Therapy:
They catch their patterns early: Instead of spending hours in a destructive cycle, they notice after a few minutes and can course-correct.
They turn toward instead of away: When their partner expresses a need or concern, they move closer rather than becoming defensive.
They co-regulate effectively: They've learned to help each other stay calm and connected, even during disagreements.
They repair quickly: When they do slip into old patterns, they can reconnect and repair the relationship efficiently.
Another well known nuggets from Gottman's research is what he memorably called the four horsemen: criticism, contempt, defensiveness, and stonewalling. Successful couples learn to catch these patterns and replace them with curiosity, respect, responsibility, and engagement.
Conclusion: Begin Your Journey to Reconnection
So, how does couples therapy work? It works by addressing the underlying emotional patterns that drive surface-level conflicts. It works through evidence-based models like EFT and PACT that understand both the psychology and biology of connection. And it works through a somatic approach that recognizes how our bodies hold the wisdom for deeper intimacy.
Whether you're in Manhattan, Brooklyn, or anywhere in the New York area, the therapists at Downtown Somatic Therapy are here to help you move from conflict to connection. We combine cutting-edge therapeutic approaches with the warmth and understanding that comes from being New Yorkers who truly get the unique challenges of relationship in this incredible, intense city.
Ready to break free from the patterns keeping you stuck? Schedule a consultation with a therapist at Downtown Somatic Therapy today. Your more secure, connected relationship is waiting on the other side of that first brave step through our doors.
Downtown Somatic Therapy serves couples throughout New York City with locations in Lower Manhattan, Williamsburg, and Downtown Brooklyn. We offer both in-person and virtual couples therapy using EFT, PACT, as well as other couples therapy approaches.