It’s the rare marriage that doesn’t go through rough patches now and then.

Sometimes the rough spots are so big or so prolonged that they require the help of a professional therapist to keep a marriage from collapsing. But how do couples know when to call for that help?

“Relationships can be so hard,” said Bethany Sutton, licensed marriage and family therapist with the Village Family Service Center in Grand Forks, N.D. “The reality is that marriage is difficult; you’re always working on it.”

Conflict and disagreements are to be expected, she said. “They’re inevitable.”

A plaque on her desk reads: “The first 50 years of marriage are the hardest.” It’s a reminder that couples have difficult work to do.

“You hear a lot about premarital counseling and pre-divorce counseling,” Sutton said. “But there are so many years in between. What I find, a lot, is that people come [for counseling] too late. For years and years, the problems have built up.”

She urges people to seek therapy to deal with issues that are “bugging” them and get help “to open up and have those conversations you and your partner haven’t wanted to have. The more proactive you can be the better.”

Marriage counseling is not so different from other measures people take to maintain health and keep their lives running smoothly, she said. We go to the dentist to get our teeth cleaned. We take the car in to get the oil changed. “Why not seek therapy that could prevent major problems later on?”

Taking that first step to get counseling can be “scary, terrifying and anxiety-provoking,” she said. The root of the fear is that “you feel vulnerable — there’s still a stigma to seeking mental health services,” even though it has decreased, she said.

“People think [getting counseling] means that they’re failing, that it reflects poorly on them as a wife, as a couple, as parents. But, for me, it’s not a weakness, it’s a strength.”

Usually, there’s a “last straw” that prompts the realization that the relationship is in trouble, she said.

“There’s been a recent incident, a significant fight or a moment of awareness, and both people are like, ‘Wow, this is pretty serious.’ ”

Avoiding avoidance

The most common issues that people want to focus on are communication skills and conflict resolution, Sutton said,

“Most know they have these issues,” but they haven’t talked about the underlying feelings that they may be afraid to share because of fear it will start a fight or the other person will “shut down,” she said. “My job is to create a safe place to have trust,” she said.

Instead of avoiding the conversations about feelings, Sutton encourages a deeper level of honesty — even if it brings about emotional pain. “We’re going to move toward it before it’s going to get better,” she said.

The goal is to understand how the dynamics in the relationship are perpetuating patterns that are driving couples apart.

A common pattern is “pursue/withdraw,” she said, “One person comes across as critical, and the other withdraws to avoid conflict. When the withdrawer withdraws, the pursuer gets more angry, and the withdrawer withdraws even more.”

The vicious circle can be broken. “If just one of you does something different, the pattern changes,” she said.

Idealized images of marriage that the media and culture portray — or the idea that marriage is easy — “are so dangerous because a perfect marriage doesn’t exist,” she said.

“There are days when you want to give up, and it’s OK to have those days,” she said. “Marriage takes a lot of intentional effort, constantly.”