Couples may experience any number of barriers to in-person couple therapy, including scheduling difficulties, childcare needs, and stigma. Providing couple treatment via telehealth can address these obstacles and improve accessibility. However, couple therapists considering the transition to telehealth may be unsure of how to alter their current treatment approach for remote delivery. Further, there are often specific concerns of how to handle safety concerns or high-conflict couples via telehealth. The goal of this paper is to provide concrete suggestions, from pre-treatment screening through treatment, for how to conduct successful couple therapy via telehealth.