When one partner won’t go to couples therapy, the conversation tends to default to emotional explanations almost immediately: fear, stubbornness, avoidance. A 2022 study by Hubbard and colleagues, published in the Journal of Marital and Family Therapy, offers a more structured account, sorting resistance into six distinct categories rather than treating it as one undifferentiated wall.
The categories are cost, logistics, treatment modality, trustworthiness, relational factors, and clarity of the therapeutic process itself. Each one turns out to carry very different weight, and very different solutions.
Cost Still Wins, By a Wide Margin
Fifty-five percent of potential clients cite cost as their primary barrier, which tracks with the real financial picture: in-person couples therapy in the U.S. typically runs $150 to $300 per session, and a full 12-to-25-session course of treatment can total $1,800 to $7,500 out of pocket. Most insurance plans don’t cover it directly, since relationship distress isn’t classified as a diagnosable condition under the DSM-5.
Thirty percent of couples cite lack of insurance coverage specifically as a barrier separate from raw cost, underscoring how much of the “reluctance” conversation is actually a financial-access conversation wearing emotional clothing.
Partner Resistance Is Its Own Named Category
What’s notable is that the study doesn’t fold partner resistance into some broader emotional-barriers bucket. It’s counted on its own: 38% of respondents specifically worry it would be difficult to convince their partner to attend, making it the second most-cited barrier after cost.
Stigma, tracked separately again, splits sharply by gender: 38% of men report stigma as a barrier compared with 26% of women, consistent with broader research showing men are roughly 10 to 20 percent less likely than women to seek mental health support of any kind.
The Barriers That Get Overlooked
Logistics, cited by 36% of respondents, covers scheduling conflicts, childcare, and the basic difficulty of coordinating two adult calendars around a recurring weekly commitment. It’s unglamorous, but it’s concrete, and unlike stigma, it’s a barrier that a flexible scheduling option or telehealth session can often solve outright.
Fear of judgment, the smallest category at 15%, covers something different again: worry about how a therapist specifically, not a partner or a broader social circle, will react to disclosures about infidelity or conflict patterns. That the study separates this from general stigma suggests it’s a distinct, addressable concern rather than a symptom of the same underlying reluctance.
Taken together, the six-category framework reframes what often gets treated as a single emotional standoff. A couple stuck on whether to go to therapy may actually be negotiating two or three separate, more solvable problems, cost, scheduling, and one partner’s stigma, layered on top of each other and mistaken for a single, immovable refusal.