Here’s a dirty little secret about couples therapy: many clinicians really, really don’t like doing it. In my conversations with senior therapists, I’ve been struck by how many have intentionally reduced their couples “load” over time, or even stopped seeing intimate partners entirely. Why? Well, let’s face it, more traditional one-on-one work tends to be far more pacific. And since the therapist is addressing just one person’s story, the issues are usually easier to sort out.

By contrast, unhappy couples almost always present conflicting stories of their troubles, with one partner typically portrayed as the scoundrel and the other as the long-suffering victim. Not only can couples work be draining, but it can often challenge the therapist’s fundamental sense of competence and hope.

But however difficult couples therapy has always been, this issue of the Networker argues that lately it’s become even more demanding and complicated. Increasingly, couples are challenging mainstream culture’s fundamental rules about intimate relationships and bringing different kinds of questions into therapy.

Our lead feature in this issue explores the remarkable level of media attention couples therapist Esther Perel, author of the forthcoming book The State of Affairs, has received for articulating the range of dissatisfactions many intimate partners experience today, and daring to open up a wider cultural conversation about our notions of couplehood. Why do partners stay or stray? And what’s the therapist’s role in helping them move beyond the traditional boundaries of intimate relationships?

In “The Long Shadow of Patriarchy,” couples therapist Terry Real examines how the jaw-dropping antics of our current president have highlighted and validated unhealthy notions of masculinity that are so poisonous to relationships, showing that what many therapists assumed had been the triumph of feminism has been wildly exaggerated. In looking at this “patriarchy creep,” Real throws down the gauntlet, insisting that when therapists see disparagement and entitlement play out in the consulting room, they have the right—and even the responsibility—to be moral arbiters, as well as empathetic guides.

Then there’s perhaps the most fundamental question of all for couples therapy—does it really work? Noted couples researchers and therapists John and Julie Gottman review the research literature to show that, on average, couples therapy only nudges partners from a place of deep distress to one of moderate misery. It’s not that couples therapy doesn’t have any effect; it’s that the effect size tends to be puny. They argue that it’s high time we appreciate not just the art, but also the science, of intimate interaction. They present some promising empirical data on the therapeutic practices that are likeliest to move a couple from tight-lipped hostility, not just to marginal improvement, but to something like real happiness—and even delight.

Needless to say, this issue doesn’t try to resolve all the myriad challenges of couples work. There’s no one-size-fits-all roadmap, and probably never will be. What we’re doing is opening up a conversation about the things couples therapists rarely talk about with clients or with each other. With so much turmoil within our culture about our very notions of intimacy and the rewards of long-term commitment, it’s a conversation that we need to encourage and lead if our profession is to keep its cultural relevance.

Richard Simon


Rich Simon

Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.