Evidence-based treatment of couples began with the provision of behavioral couple therapy, emphasizing positive behavioral exchange and communication skills training to clinically distressed couples. The theoretical models of couple therapy expanded to incorporate cognitive interventions in Cognitive-Behavioral Couple Therapy, and then acceptance-based interventions in Integrative Behavioral Couple Therapy. In parallel, Emotion-Focused Couple Therapy developed with a focus on resolving attachment insecurity. Each of these approaches has evidence for their efficacy, and there is no consistent evidence of differential efficacy. In the past two decades couple treatments were adapted for couple-based treatment of individual psychopathology. There are emerging trends to extend the range of disorders for which couple interventions are applied, to address the needs of same-sex couples, to treat inter-partner violence, and to use systematic therapy progress monitoring to enhance couple therapy effectiveness. Recent work is taking a more populationbased approach to enhancing couple relationships using a stepped model of intervention, combined with a range of flexible delivery approaches (e.g., online, video-conferencing), to make couple therapy easier to access and more efficient.