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. 2024 Oct 29;64(1):e13074. doi: 10.1111/famp.13074

Prevalence and predictors of help‐seeking steps in a nationally representative Dutch sample of romantic couples

Henk Jan Conradi 1,✉, Arjen Noordhof 1, Jan H Kamphuis 1
PMCID: PMC11786145  PMID: 39472288

Abstract

Couples appear to frequently experience relationship problems, yet estimates of the prevalence and prediction of three distinct help‐seeking steps, (1) recognition of serious relationship dissatisfaction, (2) considering help, and (3) receiving relationship help, are unknown for representative population samples. This is unfortunate as such knowledge may inform policy makers in the development of strategies to motivate couples to seek help. The prevalence of these steps along with reasons for not acquiring help was studied in a representative population sample of 1014 Dutch heterosexual couples. Multilevel Actor‐Partner Interdependence Modeling (APIM) analyses estimated the extent to which static socio‐demographic factors were predictive of help‐seeking behaviors. Of all partners, 28.6% reported having ever been seriously dissatisfied with their relationship (step 1), of which 86.2% had told their partner they were dissatisfied, on average 1.5 years after onset of the dissatisfaction. Of the seriously dissatisfied partners 36.4% considered professional relationship help (step 2) and 19.5% eventually received help (step 3), on average 3.7 years after the onset of dissatisfaction. Of these, 88.5% consulted a (couple) therapist. Main reasons for not acquiring help were that “things got better” (48.8%) and “the partner did not want relationship help” (35.4%), whereas financial considerations and shame were rarely endorsed. Although serious relationship dissatisfaction was common (i.e., 40.1% of all couples consisted of at least one partner who was ever dissatified), few couples sought help and they did so rather late. Waxing and waning of dissatisfaction often guided the decision to not seek help. Women and younger partners were more proactive in help‐seeking. Marital status, having children, and education were largely unrelated to help‐seeking.

Keywords: APIM, couples, help‐seeking steps, nationally representative sample, prevalence

Associations between relationship problems and separation on the one hand and psychological and somatic problems in (ex‐)partners and their children on the other have been amply documented (e.g., Lebow et al., 2012). Although evidence‐based couple interventions are available, the scant research findings seem to indicate that proactive help‐seeking behavior is rare (e.g., Doss et al., 2009a, 2009b). This is unfortunate as relationship problems tend to become harder to treat as they become protracted (Snyder et al., 2006), fueling further development of aversive consequences (Lebow et al., 2012). More insight in the process of help‐seeking is therefore important. In the current study, we estimated the prevalence of serious relationship dissatisfaction and steps taken in the help‐seeking process in a nationally representative Dutch population sample of couples. Further, to focus policy efforts to reach more couples with relationship problems, we predicted these help‐seeking steps by socio‐demographic characteristics.

Prevalence of steps in the help‐seeking process

Few studies have reported on the proportion of couples that received couple therapy for relationship problems and results varied widely. More specifically, in a Danish general population sample (Trillingsgaard et al., 2019) 6.9% of couples reported having been in couples therapy, in an American and Canadian sample of (newly) married couples this was estimated at 14% to 19% (Doss et al., 2009a, 2009b; Johnson et al., 2002), and in another American sample of couples currently seeking help it was even 56% (Doss et al., 2003). Differences between studies are likely due to sampling differences in nationality and mean age, but likely even more important was the particular the stage of help‐seeking that characterized the respective included couples.

Doss et al. (2003) distinguished three steps in the help‐seeking process: (1a) recognition of relationship problems and (1b) telling this to the partner; (2a) considering relationship treatment and (2b) telling this to the partner; and (3) actually receiving relationship treatment. No study has estimated the prevalences of these three help‐seeking steps in a representative population sample before, but a quick review of the scant available evidence suggests the following.

Concerning the recognition of serious relationship problems (step 1a), the study by Trillingsgaard et al. (2019) found that 13.6% of the couples experienced a crisis in the previous year. Recent estimations based on taxometric analyses range from 20% in an American sample of newly married couples (Beach et al., 2005) up to 31% in a representative American community sample of couples (Whisman et al., 2008). Taken together, one out of seven to one out of three couples reported that serious relational problems occur with a potential need for relationship help. No data can speak to how many of the partners told their partner about this dissatisfaction (step 1b).

Regarding step 2a, considering treatment for relationship problems, estimates are also near absent. Only Williamson et al. (2019) reported that in a rather specific US sample of newlyweds in low‐income neighborhoods 32% of the men and 47% of the women of all couples (i.e., both dissatisfied and satisfied) considered professional relationship help. Similar to step 1b, we found no estimates in the literature regarding the percentage of partners who told their partner they considered relationship help (step 2b).

Recognition of relationship problems and consideration of professional help are thought to be important steps toward step 3, that is, actually receiving professional help (Doss et al., 2003). Studies of couples heading for divorce (i.e., clearly experiencing severe relationship problems) showed that less than one‐fourth in American and Australian samples (Albrecht et al., 1983; Wolcott, 1986) up to a third in another American sample (Johnson et al., 2002) sought counseling or therapy. Relationship problems, however, might not only be serious and harmful for partners that are about to divorce, but also for intact couples not heading for divorce. In the previously mentioned study of Williamson et al. (2019) concerning low‐income partners it was found that of those who considered professional help only about a third actually received it, whereas in their Danish population sample Trillingsgaard et al. (2019) found of the couples who reported a relational crisis, only 8.0% received couples counseling while 13.9% received individual therapy for relationship problems. Finally, two studies reported on the time lag between recognizing dissatisfaction and eventually receiving help. Doherty et al. (2021) found an average of 2.7 years in a convenience sample, whereas Jarnecke et al. (2020) found in a veteran sample a time lag of 4 to 7 years.

In sum, the available data suggests that only a minority of couples experiencing serious relationship problems eventually utilize professional relationship help and when they do problems have usually been quite enduring. However, with the exception of Trillingsgaard et al. (2019), previous studies utilized convenience rather than representative general population samples. Moreover, no studies in representative population samples have reported on the prevalence of each of the three help‐seeking steps. This paucity of evidence makes it problematic to make reliable and generalizable estimates of help‐seeking intentions and behaviors for couples. Population‐level information is crucial for practical purposes (i.e., planning service needs, etc.), for a better understanding of differences between previous studies, and, importantly, for getting a better grip on reasons for not seeking professional help. Such information can facilitate the development of strategies for increasing attendance rates of treatment and timely intervention to prevent relationship problems from hardening with all negative consequences thereof (Snyder et al., 2006). The current study contributes to this endeavor by (1) reporting prevalences of the different stages of help‐seeking intentions and behaviors in a general population sample and (2) investigating several socio‐demographic moderators of seeking help.

Socio‐demographics predictors of‐ and barriers to help‐seeking steps

The previously mentioned variance between samples in estimated help‐seeking behaviors is likely due to some important differences between these samples in terms of socio‐demographic variables (e.g., self‐reported gender, age, education, relationship status and having children) and practical (e.g., financial limitations) and psychological (e.g., shame) barriers to seeking help. To date, only very few studies have examined such moderators of transitions between the three steps. Moreover, none of these studies used a general population sample.

Concerning problem recognition (step 1), Doss et al. (2003) found that gender, education, and age were all significant predictors. Specifically, women reported relationship problems more frequently than men, higher‐educated women more than lower‐educated women, and younger men more than elder men.

With regard to considering help (step 2), Doss et al. (2003) again found women to consider help earlier than men, but no significant associations were observed for age or education. However, an older study found higher education to be associated with greater acceptance of couple therapy (O'Farrell et al., 1986). Furthermore, a psychological barrier in considering help suggested is stigma (shame) associated with considering couples therapy (Cordova et al., 2005). Finally, a practical barrier identified in considering help is not being able to afford therapy (Williamson et al., 2019).

Finally, regarding actually receiving help (step 3), Doss et al. (2003) found that women were more likely to seek help than men. This corroborates with earlier findings that men are less willing to join women in couples treatment than vice versa (Bringle & Byers, 1997; Williamson et al., 2019; Wolcott, 1986). Inconclusive results were noted for education, with some researchers reporting a lower likelihood for highly educated couples to attend treatment (McAllister et al., 2013), others reporting the opposite effect (Trillingsgaard et al., 2019), and some reporting no significant associations (Doss et al., 2003; Sullivan et al., 2004). Likewise, with respect to age, Doss et al. (2003) found older partners to be more active in seeking help, whereas McAllister et al. (2013) and Trillingsgaard et al. (2019) found the opposite. Further, having children was hypothesized to increase the likelihood of help‐seeking by Trillingsgaard et al. (2019), but no such effect appeared in their data. Finally, it has been suggested that marital status may affect help‐seeking (Stanley et al., 2006). We only found one study including marital status as a moderator. Shannon and Bartle‐Harring (2017) found in a sample presenting for relationship therapy that cohabiting couples sought help earlier in their relationship.

In sum, the majority of findings concerning socio‐demographic predictors of help‐seeking steps are based on only one study (Doss et al., 2003), while predictors that were studied by multiple studies suffered from inconclusive results. Moreover, the samples of those studies were of strongly diverging nature namely a representative population sample (Trillingsgaard et al., 2019), couples currently attending couples therapy (Doss et al., 2003), alcoholic couples (O'Farrell et al., 1986), couples at risk of distress (Cordova et al., 2005), newlywed low‐income couples (Williamson et al., 2019), divorced men and women (Wolcott, 1986), undergraduates (Bringle & Byers, 1997), a highly educated online sample (McAllister et al., 2013), and engaged couples who planned to marry (Sullivan et al., 2004). Together, no clear or generalizable conclusions are evident.

The current study

In this study, we primarily aimed at filling the knowledge gap that exists concerning the period prevalence of each of the three help‐seeking steps in a nationally representative sample of couples. Based on the scant previous literature, we formulate as general hypotheses that: (1) most couples who have ever experienced serious relationship problems do not receive professional help and (2) when they do it is after a considerable amount of time passed after initial recognition of the dissatisfaction.

As a secondary research aim, we tested the predictive value of selected socio‐demographic factors (gender, age, education, being married, and presence of children) as moderators in the transitions between the three steps. As extant research proved inconclusive in this regard, we took an exploratory approach.

METHOD

Participants and procedure

Recruitment of couples was organized by Flycatcher, a research agency originally affiliated with the University of Maastricht. We requested a representative sample (in terms of age and education) of the Dutch population from their panel of approximately 10,000 members. Subsequently, partners of the recruited members were asked to participate. All participants gave their informed consent prior to the completion of the online survey. Panel members received a financial compensation of $2.50 and partners had a chance to win 1 of 10 vouchers of $27.50 in exchange for participation. Included were partners who were 18 years or older and who reported being in a heterosexual relationship for at least 6 months (i.e., enduring relationships). The final sample consisted of 1014 couples (see flow‐chart, Appendix S1). The study was supported by the clinical board of the University of Amsterdam and covered under the ethical approval procedures of the Flycatcher panel. Data were collected between the end of 2017 and the start of 2018.

Participants were on average 52.5 years old (see Table, Appendix S1). The age distribution in our sample approximated the Dutch population of over 18 years of age (Dutch Central Bureau of Statistics & MOA Expertise Center, 2017), and was similar to a large nationally representative population sample in the United States (Mickelson et al., 1997). Not surprisingly however, our sample was somewhat skewed toward older respondents (i.e., fewer people in the category 18–24 years old, 3.0% in our sample vs. 10.9% in the general population, and more in the category 60–64 years old, 13.4% vs. 7.8%), which may have resulted from the enduring relationship inclusion criterion (of at least half a year). The level of educational attainment (low 29.5%, middle 38.2%, high 32.2%) was comparable to that of the Dutch population (low 29.6%, middle 42.6% and high 27.8%; Dutch Central Bureau of Statistics & MOA Expertise Center, 2017). Relationship duration was on average about 25 years and 80% of the couples were married. Mean relationship satisfaction was about 118 (SD = 15.7), as measured by the Dyadic Adjustment Scale, which was comparable to the mean of 114.8 for married couples reported by Mickelson et al., (1997).

Measures

All measures were self‐report questionnaires completed by both partners. The three help‐seeking steps were assessed by an adapted version of the Steps in Seeking Marital Therapy Questionnaire (SSMTQ; Doss et al., 2003). As Doss et al. examined a sample consisting of couples who all sought and found couple therapy, the SSMTQ used by them did ask to what extent each of the partners contributed to taking these steps on a continuous 8 point Likert scale. We on the contrary used the SSMTQ item content to index the respective prevalences of the different steps taken in the help‐seeking process. To this end we changed the response format to a binary yes/no. Accordingly, the responses were used on itself and not to form scales.

Two questions tapped into problem recognition “Have you ever been seriously/substantially dissatisfied with your relationship for some time?” (step 1a) and “Have you (ever) told your partner that you were dissatisfied with your relationship?” (step 1b). Two questions covered considering treatment “Have you ever thought about seeking professional help (psychologist, clergyman, coursework, etc.) for relationship problems?” (step 2a) and “Have you ever talked to your partner about seeking professional help for relationship problems?” (step 2b). Finally, one question tapped actual treatment seeking “Did you ever receive professional relationship help?” (step 3). Moreover, we added questions about the year these steps were taken, with which we established the time lags between (1) onset of the dissatisfaction and telling the partner about the dissatisfaction and (2) the onset of dissatisfaction and actually receiving help. Because of the retrospective nature of the study we opted for the less fine‐grained time unit “year” instead of, for instance, “year plus month” to obtain equally accurate information for recent and less recent help‐seeking steps taken.

Further, we added questions covering the reason(s) why partners eventually did not receive help (step 3). Partners could select from the following options (multiple answers possible): “things got better,” “felt ashamed,” “the partner did not want help,” “the insurance did not reimburse,” and “other.” Other reasons reported were: solved problem by ourselves (9.2%), causes of the relationship problems were non‐relational (2.7%), the relationship problem was not that bad (3.3%), no faith in relationship help (4.6%) and other (13.3%). Because of the low frequencies we decided to exclude these reasons from the analyses. Finally, when partners reported they had received professional help, they were asked to clarify the nature of the help, selecting from: General Practitioner, couple therapist/psychologist/psychiatrist, and other (sexologist, clergyman, psychiatric nurse, social work, couple relationship education program).

Statistical analyses

The prevalence of the three help‐seeking steps was indexed with descriptive statistics at the level of the individual partners. For the prediction of the help‐seeking steps, we applied multilevel modeling (actor–partner interdependence model framework; Cook & Kenny, 2005) with couples as the unit of analysis (level 2) and partners nested within couples (level 1). As observations within couples cannot be considered independent, we corrected for this by including a random intercept at the couple's level. We conducted linear mixed model analyses for the continuously distributed dependent variables (the time lag indices) and generalized linear mixed models for the binary dependent variables (the other dependent variables).

Models were run separately for each of the independent variables: gender, age groups (younger and older), 1 education (low and high), 2 marital status (non‐married and married), and having children with the current partner (childless and having children). When a specific dependent variable was predicted statistically significant by more than one variable we followed up with multivariate analyses in order to control for possible confounding. Because marital status and having children are predictors at the couples' level there were no partner effects to include in these models. For education, we included partner education next to actor education in the models. To avoid excessive multicollinearity, we omitted partner age from the models (actor and partner age correlated 0.93) and only included actor age. Significance level was set at p ≤ 0.05.

Missing data were restricted to the time lag variables and varied from 3.2% (time lag between onset of the dissatisfaction and telling the partner about this) to 9.7% (time lag between onset of the dissatisfaction and receiving help). Data were analyzed in SPSS Version 29.

RESULTS

Prevalence of the three help‐seeking steps

The respective prevalences of the three help‐seeking steps in this nationally representative population sample are reported in Table 1. Of all partners, 28.6% reported having been ever (period prevalence) “seriously dissatisfied” with the current relationship (step 1a) (i.e., 40.1% of all couples consisted of at least one partner who was ever dissatified). Of the ever seriously dissatisfied partners, 86.2% told their partner about this dissatisfaction (step 1b). The time lag between first onset of the serious dissatisfaction ever and telling the partner about this was on average 1.50 years (SD = 5.12).

TABLE 1.

Prevalence of serious relationship dissatisfaction and help‐seeking steps ever during the current relationship.

Step % (N)
1a

Of all partners that participated in the study …

How many were ever seriously dissatisfied?

100 (2028)

28.6 (580)
1b

Of those who were ever seriously dissatisfied …

How many told their partner about this?

100 (580)

86.2 (500)

Of those who told their partner about their dissatisfaction …

How many years after the onset of the dissatisfaction they did? M years. (SD)

100 (500)

1.50 (5.12)
2a

Of those who were ever seriously dissatisfied …

How many did consider professional help?

100 (580)

36.4 (211)
2b

Of those who were ever seriously dissatisfied and considered professional help …

How many told their partner about this?

100 (211)

92.4 (195)
3

Of those who considered professional help and told their partner about this …

How many did not receive help?

For what reason they did not receive help? (multiple answers possible)

100 (195)

42.1 (82)

100 (82)
Things got better 48.8 (40)
Felt ashamed 3.7 (3)
Partner did not want help 35.4 (29)
Insurance did not reimburse 11.0 (9)

Of those who told their partner about considering professional help …

How many did receive professional help?

100 (195)

57.9 (113)

Of those who did receive professional help …

How many years after the onset of the dissatisfaction they did? M years (SD)

100 (113)

3.65 (5.78)
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Of those partners who were ever dissatisfied 36.4% reported having considered professional help (step 2a). Moreover, almost all partners (92.4%) who considered professional help told their partner about this (step 2b).

Next, of those who ever considered professional help and told their partner about this 42.1% did not ultimately receive help (step 3). Two predominant reasons for eventually not receiving help were evident: “things got better” (48.8%), and “the partner did not want relationship help” (35.4%). The other reasons were substantially less frequently reported ranging from 3.7% (shame) to 11.0% (reimbursement). Of those partners who considered professional help 57.9% eventually received help, which equates to 19.5% of all partners who reported being seriously dissatisfied ever. They did so 3.65 years (SD = 5.78) after onset of dissatisfaction. Finally, almost 9 out of 10 professional help‐seekers (88.5%) consulted a couple therapist, whereas 13.3% (partially overlapping with the help‐seekers who attended a couple therapist) consulted (also) another professional help provider (i.e., sexologist, clergyman, psychiatric nurse, social worker, and a couple relationship education program).

In sum, of the total sample about 29% of the partners experienced serious dissatisfaction (step 1), 10% considered help (step 2), whereas 6% actually received help (step 3). From the onset of the serious dissatisfaction it took partners about 1.5 years to tell this and 3.7 years to enter therapy. Figure 1 shows a Venn diagram on scale with the percentages of partners engaged in the three help‐seeking steps.

FIGURE 1.

FIGURE 1

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Venn diagram of the three help‐seeking steps (areas are on scale).

Socio‐demographic predictors of dissatisfaction and help‐seeking steps

Associations between help‐seeking and socio‐demographic factors were estimated with multi‐level (APIM) models. Self‐reported gender yielded three significant findings. With regard to step 1, women more than men reported that they ever were seriously dissatisfied with the current relationship (32.1% vs. 25.0%; t = 3.69; p < 0.001), and they were more likely to tell their partner about their dissatisfaction (89.0% vs. 82.7%; t = 2.15; p = 0.033). Moreover, women more than men reported as reason why they did not receive help that “their partner did not want” (46.0% vs. 18.8%; t = 2.31; p = 0.023). Considering help (step 2) and actually receiving help (step 3) were not associated with gender.

No relationship was observed between age and considering help (step 2). However, univariate analyses showed that age was predictive of how much time elapsed between the help‐seeking steps. In fact, with regard to the time between onset of dissatisfaction and sharing this with their partner (step 1), three variables were significant in univariate analyses: age, being married, and having children. From the multivariate analysis including all three predictors, only age emerged as a significant predictor, indicating that younger partners took less time than older partners (M = 0.70 years SD = 2.69 vs. M = 2.37 SD = 6.76; t = −2.93; p = 0.004) to share their relationship dissatisfaction. Finally, the time between onset of dissatisfaction and actually receiving professional help (step 3) was shorter for younger partners than older partners (M = 2.40 SD = 3.37 vs. M = 5.00 SD = 7.37; t = −2.09; p = 0.040).

Educational status was not associated with problem recognition (step 1) or considering professional help (step 2). However, actors with higher educated partners were more likely than actors with lower educated partners to report that “things got better” to account for not receiving help (29.7% vs. 64.4%; t = 2.73; p = 0.008).

Marital status was not associated with either recognition of having relationship problems (step 1) or receiving help (step 3). However, significantly more married partners told their partners that they considered help (94.8% vs. 81.6%; t = 2.36; p = 0.019).

Having children was not associated with either considering help (step 2) or receiving help (step 3). However, it was observed in step 1 that slightly more childless partners told their partner that they were dissatisfied than those with children (step 1b; 90.7% vs. 84.2%; t = −2.01; p = 0.045).

DISCUSSION

The current study investigated the prevalence of three help‐seeking steps in a large representative population sample: (1) recognizing serious relationship dissatisfaction, (2) considering help, and (3) actually receiving help. Furthermore, we explored whether socio‐demographic characteristics were associated with these steps. Our findings lend support to the scarce previous findings (Doss et al., 2009a, 2009b; Trillingsgaard et al., 2019; Williamson et al., 2019) that although a substantial part of the partners experienced serious relationship dissatisfaction (about a third), few of them considered help (about a third) and even fewer of the seriously dissatisfied eventually received help (about a fifth). Moreover, by the time help was obtained, problems tended to be protracted (i.e., 3.7 years after the onset of the problems). Furthermore, gender was most predictive of help‐seeking steps. Women more often than men recognized problems and discussed these with their partners. They also more often reported that their partner did not want to seek help.

Not seeking help: Waxing and waning of problems, partner refusal and delay

Although serious relationships problems were common only few considered, sought, and eventually received help. By far the most frequently reported reason (by about halve) for eventually not receiving help, was that “things got better.” Apparently, relationship distress must not only exceed a certain level of severity (i.e., being seriously dissatisfied), but also a certain duration (i.e., things did not get better) before partners start seriously contemplating and successfully seeking and receiving professional help. Waxing of relationship stress followed by its waning clearly diminishes the need for help. Waning of relationship problems presumably instills hope that “this time things really did change,” making help unnecessary. However, structural spontaneous remission of relationships problems is not supported by research (Roddy et al., 2020).

The second most frequently reported reason, by a third, for not attending help was that the partner did not want to join professional help. This corroborates previous research (Bringle & Byers, 1997; Doss et al., 2003; Williamson et al., 2019; Wolcott, 1986). Clearly, obtaining consent between partners about seeking help poses an important hurdle to embarking on couple therapy. Interestingly, other reasons for not receiving help, including non‐reimbursement of costs or shame about help‐seeking, were endorsed quite infrequently (<10%). The low frequency by which shame was endorsed as a reason for not seeking help is notable as it is generally considered a substantial barrier to help‐seeking (e.g., Wolcott, 1986).

Almost all (nine out of ten) partners who considered seeking help told this their partner (step 2b). Stated differently, not telling the partner does not appear to be a serious obstacle in help‐seeking. However, the time lags between onset of dissatisfaction and telling the partner about this (1.5 years), as well as the onset of dissatisfaction and telling the partner one is considering and actually receiving help (3.7 years) were quite substantial. The latter time lag is comparable to the 2.7 years reported by Doherty et al. (2021) and somewhat shorter than the 4 to 7 years found by Jarnecke et al. (2020). We conclude that it can take several years from the onset of dissatisfaction to telling the partner about considering and actually receiving relationship help. Such delay is problematic as it has been well‐established that change in therapy becomes increasingly difficult with the passage of time (Snyder et al., 2006).

Socio‐demographic predictors of help‐seeking steps

In general, we found few significant associations between the socio‐demographic variables and the (timing of) the help‐seeking steps. The most robust finding concerns the effect of gender. Women more than men reported serious dissatisfaction (step 1a) and told this their partner (step 1b). These differences where relatively small, but women reported 2.5 times more frequently than men that their partners did not want to join them in therapy. Together these gender findings suggest that women more often experience and share concerns about their relationship and are more willing to seek help for improving it. This aligns with the notion that women tend to serve as the guard keepers of the emotional climate of the relationship (Croyle & Waltz, 2002; Koski & Shaver, 1997; Loscocco & Walzer, 2013). This can be interpreted as a gender stereotyped script as suggested by Knudson‐Martin and Huenergardt (2010). It may also mean that men are only less willing to seek professional help than women as they are inclined to sort things out on their own.

Younger partners more readily told their partners about their dissatisfaction and found help more quickly. More specifically, the time between experiencing dissatisfaction and telling this the partner was about a third of the time older partners took, and half between onset of dissatisfaction and actually receiving help. These age effects are consistent with previous studies (McAllister et al., 2013; Trillingsgaard et al., 2019). More research is needed to clarify the interpretation of these now robust findings. For example, the difference may be an artifact of the fact that younger people tend to have shorter relationships and accordingly less time to tell their partner about their dissatisfaction and actually receiving help. Alternatively, it can be speculated that younger people are more open in trying new experiences (Donnellan & Lucas, 2008), that younger people have higher expectations regarding happiness and/or lower tolerance for dissatisfaction, that barriers for them are lower as they have been more exposed to therapy (e.g., in the media), or that the result is (partly) due to increasing recall bias in elder couples resulting in estimations of longer time lags.

Two small effects were that fewer partners with children compared to childless partners told their partner that they were dissatisfied, and that more of the married partners compared to non‐married partners told their partners they considered help. It may be that couples with children are less willing to “rock the boat” because their stakes are higher than for childless couples, or that they are more accepting of the fact that having children is associated with more stress. The effect in married partners may be interpreted as greater relationship commitment (Stanley et al., 2006) which may contradict findings in a convenience sample by Shannon and Bartle‐Harring (2017). Finally, we found that fewer actors with higher educated partners sought help (step 3) because “things got better.” Perhaps these individuals are more resourceful in tackling problems, face different issues, or have different styles of emotional regulation (e.g., tolerating, rationalizing, denying, etc.). Clearly, all these speculations need further study.

Limitations

Several limitations warrant mentioning. First, our study of help‐seeking behavior was based on retrospective self‐report, which is subject to several biases (Gorin & Stone, 2001). However, some of these biases pertain particularly to psychological predictors, like for example conflict styles, attachment, and forgiveness, as these may be subject to change over time or due to treatment and thus critically require longitudinal designs. To avoid contamination with time or intervention, we limited our investigation to socio‐demographic predictors that are largely static in nature (as in unchanged over time, except for age). Further, we note that recall bias may increase as people grow older, which may have compromised the reliability of the time lag data. Second, apart from financial constraints we did not measure several practical barriers to help‐seeking, like lack of availability of transport, childcare, and knowledge on where to find effective therapists (c.f., Williamson et al., 2019), or waiting lists. On the other hand, we did include “other reasons” as an option and these barriers were rarely mentioned. Third, although our sample is representative in terms of age and education, our inclusion criterion that both partners had to be willing to participate (essential to the scope of our study and the subsequent APIM analyses) may have selected for relatively functional couples (Barton et al., 2020). Hence, the estimated prevalence of partners being ever seriously dissatisfied may be somewhat underestimated, whereas prevalences of couples who were (temporarily) able to recover on their own, and couples who were likely to talk about their relationship problems might be somewhat overestimated. Another limitation may be that since the year of data collection (i.e., 2017) the context of romantic relationships has undergone significant changes due to external events and societal trends such as COVID‐19 and discussions about diversity and equality, respectively. Therefore, the findings should be interpreted keeping these developments in mind. Finally, the fact that we collected data in an exclusively heterosexual sample might restrict generalizability to some extent.

Policy implications

Our findings bear several implications for policy makers. Although serious relationship dissatisfaction is common (two‐fifths of all couples had at least one partner who was ever seriously dissatisfgied) only few couples seek help and they do this relatively late. This is often attributed to shame or financial barriers (Williamson et al., 2019; Wolcott, 1986), but our study found surprisingly little support for this idea. Of note, although there may be differences in the health care system between the United States and the Netherlands explaining this finding, it is important to stress that, in general, couples interventions were not reimbursed in the Netherlands. Instead, the most important factor mentioned by the couples in refraining from help‐seeking was the waning of distress. Policy makers may inform the public that serious relationship problems are quite common, that sustainable spontaneous remission thereof is unlikely, and that postponing help‐seeking may contribute to a hardening of relationship problems. Accordingly, it seems important that policy makers communicate that there are “light” alternatives to couple therapy, such as couple relationship enhancement courses. A prime example is the EFCT‐based Hold me Tight course (Conradi et al., 2018). Another example is the Prevention and Relationship Education Program (Markman et al., 1994). Spreading this information may be particularly useful in countries like the Netherlands and Denmark (Trillingsgaard et al., 2019) where these interventions are not as well‐known to the general public compared to the United States.

Our study confirmed previous findings (Bringle & Byers, 1997; Doss et al., 2003; Williamson et al., 2019; Wolcott, 1986) that reluctance to help‐seeking is most likely in male partners. Therefore, motivating partners, in particular men, to join the other partner in seeking professional help is crucial. Again, disseminating the availability of readily accessible “light” interventions that can be positioned as courses aimed at relationship maintenance and enhancement may help more couples to find help in a more timely fashion. For example, General Practitioners may orient couples to these options, explaining and normalizing that learning fundamentals on how to talk and love goes a long way in safeguarding enduring relationship satisfaction.

Supporting information

Appendix S1.

FAMP-64-0-s001.docx (27.8KB, docx)

Conradi, H. J. , Noordhof, A. , & Kamphuis, J. H. (2025). Prevalence and predictors of help‐seeking steps in a nationally representative Dutch sample of romantic couples. Family Process, 64(1), e13074. 10.1111/famp.13074

Footnotes

1

Younger (n = 1.028) refers to 18–54 years of age, ‘older’ (n = 999) refers to 55–93 years of age.

2

Lower education (n = 1.145) refers to completing primary or vocational school, whereas higher education (n = 883) refers to completing high school, higher professional school or university.

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Supplementary Materials

Appendix S1.

FAMP-64-0-s001.docx (27.8KB, docx)

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