This chapter provides an overview of major empirically-supported therapeutic approaches to alleviating relationship distress, including behavioral couple therapy and its derivatives (cognitive-behavioral couple therapy and integrative-behavioral couple therapy); emotionally-focused couple therapy; and insight-oriented couple therapy. The underlying theory and recent empirical support for each approach is described. The emerging theoretical work on common factors in couple therapy across different orientations as well as the development of a transtheoretical model are included. Also, the chapter discusses the adaptation of couple therapy beyond the treatment of general relationship distress to address specific, difficult to treat relationship problems, such as infidelity and intimate partner violence. We also review the use of couple-based interventions for treating individual problems such as psychopathology. Finally, the chapter addresses the importance of providing couple-based interventions in a manner that is sensitive and appropriate for couples of different sociodemographic characteristics such as age, race, education, and sexual orientation.