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How 'Couples Therapy' Brings the Reality of Therapy to TV

couple in therapy
October 15, 2019

By Debbie Koenig

If you’ve ever wished you could be a fly on the wall of a therapist’s office, Couples Therapy on Showtime has you covered. The docu-series takes you into four couples’ sessions with Orna Guralnik, PsyD, a therapist and psychoanalyst in New York City. But rather than feeling like you’re eavesdropping, you may find yourself rooting for the couples and viewing your own relationship through their discoveries.

WebMD spoke with Dr. Guralnik about the experience of making the series, why she thinks the show is so powerful, and what it’s like to be the therapist during treatment.

Our interview has been edited for clarity and length.

WebMD: The show feels so intimate—we’re really in therapy with these couples. How did you ensure it felt authentic?

Dr. Guralnik: A few different things combined into this magic. One was the design of the set, the office, the way they embedded the cameras. Where we conducted the treatments was in an office where you had no awareness of the cameras, even though it was a 360-degree fishbowl. You could focus on the work and it felt like no one else was in the room. It was easy to indulge in the illusion. And for me, knowing that the whole production team was deeply behind me in the mission of the project, it allowed for a deep concentration, a focus on what we were there to do. It became kind of a deep meditative space.

WebMD: How is couples therapy different from individual therapy?

Dr. Guralnik: Therapy work in general is very intense, and couples therapy is doubly intense. With individual therapy a lot of the work is talking about things that happen outside the office. Some of it is in what we call the transference, within the relationship with the therapist, but a lot is about outside. On the other hand in couples therapy, even when they’re talking about things that happened outside, they’re also living it inside the office. That’s a very different quality. Couples can be disagreeing, they can be fighting, they can be loving, and it’s all in real time in the office. It has more a quality of action therapy rather than reflection. You move back and forth between action and reflection.

WebMD: Why do couples get into therapy? Are they always at a crisis point?

Dr. Guralnik: Not all couples are in therapy because they’ve reached a crisis. That’s a common reason—they feel like they’re repeating things over and over, they don’t know how to get out of their own groove or habit. But some come in, for example, when they make a deep commitment to each other and they’re worried about messing it up. They come in for preventive help. And some couples realize that, especially because of the intensity in which people live nowadays, they need a place to take a break and reflect on what’s going on with them—to create a reflective space. Those couples sometimes stay in treatment for a long time.  

For the show, we limited the couples to 20 sessions. In a treatment when it’s time limited, there’s a condensation of the work. The treatment has a kind of death sentence built in—you’ve got to get it in before the treatment ends. That gives it a dynamic, it pushes for certain resolution. But typically, there’s no one way. Some couples I see just for a few sessions, to air out a certain thing, and some do short term work. They leave, and they come back later. Others I see for a long time.

WebMD: How typical were the couples on the show, or is there no such thing as typical?

Dr. Guralnik: There is no such thing—but they were typical. The issues they came in with are the typical ones couples deal with. The people in the series are a good sample of day in, day out issues that most people can identify with.

WebMD: You approach the couples neutrally and don’t take sides, but do you have opinions during the sessions?

Dr. Guralnik: The concept of neutrality is a profound one in psychoanalytic theory and training, a core tenet of what it means to be a psychoanalyst. In theory and in the series, we talk about maintaining the same distance between all parts of the psyche. You don't side with one part of the psyche, you try to stay connected with all parts. And the same thing holds true with couples. You’re treating the couple, the unit, not the individuals. If you side with one person, you’re missing the point that your patient is the couple.

When two people are in conflict, on a deep level you know they’re each expressing one aspect of the whole unit. Both are relevant and the unit cannot function without both. If one side is arguing for more constant connection, the other side arguing for more freedom, these are both needs the couple has. Everyone has those needs. We’re always struggling between the wish for safety versus the wish for freedom. If you’re siding with one, you’re abandoning the other.

WebMD: How do you know what each couple needs?

Dr. Guralnik: You listen. They tell you. I come to each couple in a way tabula rasa—I need them to imprint upon me who they are and what they need. I need to listen to it in their language. Being an analyst, what you’re trained to do is a process of listening, and listening well. If I come to a couple with a prefabricated idea of what they need, I’m not doing analytical work. There are very few principles that I impose on couples. The rest, I listen, and I work with what they’re giving me.

I tend to at least feel like I know what to do. It’s not always true, and it’s not always right—I can be wrong in my approach. And I often have to correct myself. But I do have situations where I'm up against a certain dynamic where I cannot make an impact, either because the couple is too entrenched, or because what I'm doing is just not working for them. I’ve worked with couples where there’s something too addictive about their fighting. I couldn’t convince them to let go of the thrill of the fight. For some people either because of early trauma or other issues, they can’t let go. And then I’m helpless.

But that's rare. I mean, most people that come into treatment, they are coming from a place of wanting to get better, wanting to heal, wanting to love, wanting to recognize each other. They just don't know how.

WebMD: We also see you with your clinical advisor, an interesting look behind the scenes. Why was it important to include that?

Dr. Guralnik: I wanted people watching to be able to identify with everyone. Not only with the patients or participants, but also with the point of view of the therapist, so they can think like therapists. I wanted to bring people into the mindset you need to develop as an analytically oriented therapist, so they can figure out a way to do that work for themselves. There’s a lot of mystique around therapists, and I wanted to demystify what it means, what actually goes into what you see in a session.

WebMD: What surprised you about the process of making the show?

Dr. Guralnik: Many things. The fact that we could do it at all surprised me. It was kind of an experiment; we didn’t know if it would work. If I could work in front of cameras, if the patients could. Whether we could do the work and have it feel authentic, or if it would feel artificial. That was the first surprise, that we could totally do the work, that it felt very real.

The other thing that surprised me was how intensely and how quickly the work unfolded. I think the fact that it was documented added a certain treatment-on-steroids feeling to everything. Everyone felt we’ve got to do it now, now’s our chance to get something real done. I didn’t anticipate that it would feel that way. The connection I had with the directors and the editors, even the camera people, was pretty profound. There was a sense that we’re doing this thing together, this thing that really matters.

WebMD: Towards the end, you and your advisor talk about what it’s like for patients after therapy ends, that you’ll be just another thing that happened in their lives. But one couple stopped coming before the end of the series—what’s it like for you when a couple leaves therapy?

Dr. Guralnik: It’s an odd thing about this profession. You get very deeply engaged with people, their stories, who they are. You form deep connections with people for the purpose of them leaving, not needing you. With good treatment you should leave with the feeling almost as if nothing happened. You go back to your life and the treatment recedes into the background—that’s a sign you’re doing a good job. I think about people once they’ve left, I wonder what’s happening with them, but it’s also none of my business. I need to let them go. If you’ve done a good job, they really go. There’s a certain melancholic thread woven through it.

WebMD: What do you hope viewers will get out of the show? Can it help people figure out their own relationships?

Dr. Guralnik: What I’m really hoping for, not only speaking for myself but for the whole team, is that viewers will get a good antidote to the political vibe we’re all living in. We’re living in a time where we’re so baited to polarize, to refuse to understand other people’s points of view. I’m hoping the show will stand for compassion, for having curiosity about otherness, for being open to understanding that we’re all human. We can understand each other even though we might seem very different. That’s my real hope. I think the show in a subtle way is political, almost radical. The whole message of the show is, don’t buy into your own othering narrative. Listen, be curious about the other. Approach the other with an interest in their truth.

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