The agonies and the breakthroughs

This is 'reality' TV, a 'fly on the wall' series which gives the audience a sense of what it's really like to be in couple therapy: the nervousness and shame, the sudden rising fury and talking over each other, followed by painful silences. Dr Orna Guralnik also gives us a window into what it's like to struggle along their side as a therapist. How to reach that awkward client who evades, blames and tries to hide their panic about being truly seen. To him, Guralnik calls his bluff, saying, 'do you know how hard it is to really meet you?' 

New York-based couples are seen around 20 times and their stories intercut. Perhaps the key to the show's success is that the creator, Josh Kriegman, is himself the son of two psychotherapists. Kriegman wanted to find a way to convey the agonies and the breakthroughs of couple therapy he'd heard his parents describe. He came up with a set that completely concealed the crew and cameras to give the chosen couples as near a genuine experience of working with Guralnik as possible.

As psychotherapists, we each have our own version of 'the frame', and Guralnik's version might seem a bit informal to some. She tends to lean forward, cradling a cuppa.  When departing patients asks for a hug, they get one. Personally, I was charmed by her dog, who attended every session and greeted the couples with her before flopping into his bed, whilst the couples seem to benefit from his calming presence. 

However informal in style, Guralnik does not tone down her psychoanalytic stance for the camera. Couple therapy requires gumption and we are no good to our couples if we can't say the unsayable. Take Elaine, who has created a tough exterior to cope with early neglect and trauma, and now attempts to control partner DeSean's every move. Whilst sympathetic to her past suffering, Guralnik confronts her tendency to blame DeSean for her distress and suggests that it is she who 'paints her trauma' over DeSean's desire to spend some leisure time without her. It's a breakthrough moment for Elaine, who drops her armour and becomes more self-reflective in subsequent sessions. 

Whilst this is great TV, I was frustrated not to discover more about DeSean's own complicity in this 'pursuer-pursued' dynamic. Did he, perhaps, have a critical or intrusive mother and so unconsciously provokes Elaine into a hectoring role? We will never know because the answers are on Kriegman's cutting room floor. This absence of such material may reinforce a common misconception that the couple therapist's task is to find out which one of the couple is 'the culprit', rather than to unearth what is always a collusive pattern. 

Whilst Series One is unsatisfyingly vague about some of the client's backgrounds and parental relationships, Series Two has improved on this, taking more time to reveal how couple dynamics link to childhood. Series Two also shows the transition into Lockdown, and I found it cathartic to watch another therapist try to adjust to the tricky transfer to Zoom. However, both series seem to suggest that a lot can change within a relatively short phase of treatment, and I did wonder whether the couples may have felt rushed to an end result. 

Each episode contains visits to Guralnik's supervisor, and although I recognised the agony of the responsibility she describes, these meetings feel rather staged. More revealing are the scenes of the couples outside the therapy room; hugging in the street, chatting and laughing on the subway, and pottering about at home. These moments spoke to me of how couples can benefit from leaving something to be contained by their therapist. Relieved at having survived another stomach knotting session together, they may then feel more able to tolerate the eternal conundrum of being in a twosome.

Ella Bahaire is a Couple Therapist for Tavistock Relationships and in private practice.

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