WHAT COUPLES THERAPY ON PARAMOUNT GETS RIGHT THAT MOST PEOPLE MISS
Dr. Orna Guralnik and the psychodynamic dimension hiding in plain sight
If you have watched Couples Therapy on Paramount and found yourself unexpectedly moved; not by the conflict, not by the drama, but by something quieter happening in the room; you have been watching psychodynamic work. You may not have known to call it that. Most people do not. But what Dr. Orna Guralnik does in that consulting room, season after season with couple after couple, is something that no communication framework, no workbook, and no weekend retreat can replicate; and understanding why is some of the most useful knowledge available to anyone in a long-term relationship.
Season 5 is currently streaming on Paramount+. If you have not watched it yet, the trailer is below.
The show’s own description is worth quoting here because it names something precisely: this is true documentary filmmaking that brings viewers into the authentic and visceral experience of weekly therapy with four couples. Far from reality-show caricatures. What makes it feel different from everything else on television is not the subject matter. It is the method. And the method is psychodynamic.
What Psychodynamic Actually Means
The word psychodynamic gets used loosely; sometimes as a synonym for therapy in general, sometimes as a vague gesture toward anything that involves talking about childhood. It means something more specific than that.
Psychodynamic therapy is the tradition that takes the unconscious seriously; the recognition that the forces most powerfully shaping human behavior, relationship, and emotional life are largely outside conscious awareness. It draws on Freud’s foundational insight that what we do not know about ourselves runs us; and on a century of clinical development that has refined that insight into something practically useful. Object relations, attachment theory, self psychology, relational psychoanalysis; these are all branches of the psychodynamic tradition, each offering a different lens on the same basic question: what is happening beneath the surface of what this person believes about themselves and their relationships?
In couples work, this question becomes: what is happening beneath the surface of what these two people believe is happening between them?
The answer is almost always more interesting, and more clinically significant, than the presenting complaint.
The Dance Beneath the Dance
Every couple who sits in a therapist’s office comes with a presenting problem. He does not listen. She is always critical. We fight about money, about the children, about how much time we spend with her family. These are real complaints. They describe real pain. And they are almost never what the therapy is actually about.
What the therapy is actually about is the dynamic beneath the complaints; the pattern of interaction that the complaints are expressing, and the unconscious material that the pattern is organized around. In psychodynamic couples work, the presenting problem is the entry point, not the destination. The destination is the dynamic; and understanding the dynamic requires going somewhere that communication skills and structured exercises, however well-designed, cannot reach.
This is what you are watching in Couples Therapy. When Guralnik pauses in the middle of an exchange and names something that neither person has said; when she tracks not the content of the argument but its process, the way the couple moves into and out of contact, the moment one person’s face changes before they have spoken; she is working at the level of the dynamic. She is watching the dance, not the steps.
This is the fundamental contribution of psychodynamic thinking to couples work: the recognition that the fight is rarely about what it appears to be about; and that helping couples fight more fairly, communicate more clearly, or understand each other’s attachment needs more accurately; while genuinely useful; does not address the underlying dynamic that is generating the conflict in the first place.
What the Popular Models Offer and Where They Stop
This is not a criticism of EFT or the Gottman Method. Both are evidence-based, clinically rigorous, and genuinely helpful for a significant range of couples in distress. The Gottman approach offers research-grounded frameworks for understanding relationship health; the Four Horsemen, the Sound Relationship House, the distinction between solvable and perpetual problems. EFT offers a powerful model of how attachment needs drive emotional reactivity and how couples can learn to reach for each other in ways that actually land. These are real contributions. The couples who benefit from them are not imagining the improvement.
What both models share, and where psychodynamic thinking offers something different, is an orientation toward the conscious and interpersonal rather than the unconscious and intrapsychic. The Gottman approach teaches couples to recognize and interrupt destructive patterns. EFT helps partners identify and express their underlying attachment needs. Both work at the level of what can be identified, named, and deliberately changed.
Psychodynamic couples work asks a different question: what is driving the pattern that the couple cannot interrupt even when they know they should? What is being carried into this relationship from earlier relational experience that neither person can see because it does not feel like history; it feels like the truth about this person, this relationship, this conflict?
The answer to that question cannot be addressed by better communication. It requires the kind of sustained, depth-oriented clinical attention that goes below the level of what both partners can consciously access; and a therapeutic relationship capable of holding the complexity of what surfaces when it does.
Projective Identification in the Room
One of the concepts most consistently on display in Couples Therapy; though it is never named as such on the show; is projective identification. This is the mechanism, explored in depth elsewhere in this series, by which a person not only locates their own disowned feelings in their partner but unconsciously induces their partner to carry and express those feelings.
What this looks like in practice: one partner is convinced the other is always angry, always critical, always pulling away. They treat their partner accordingly; with defensiveness, with preemptive distance, with the hypervigilant reading of every tone and expression for evidence of the expected response. Over time, the partner; responding to being perpetually treated as angry, critical, and distant; begins to actually become those things. The projection has recruited them. The dynamic confirms itself.
This is what Guralnik is tracking when she slows a couple down mid-exchange and asks about what just happened in the room. She is not asking about the content; who said what, who was right, whose memory is accurate. She is asking about the process; the shift in tone, the moment of disconnection, the small movement that reorganized the entire field between them. The dynamic is visible in real time if you know what to look for. And naming it, in the presence of both partners, is one of the few clinical interventions that can actually interrupt it; because it makes visible something that has been operating outside awareness.
The Therapeutic Relationship as the Instrument
There is something else visible in Couples Therapy that is worth naming directly: the quality of Guralnik’s presence in the room. Not her technique; her presence. The way she holds genuine curiosity without urgency. The way she can name something difficult without it feeling like a verdict. The way she stays with a couple in a moment of genuine pain without either rushing them through it or drowning in it alongside them.
This is not a personality trait. It is a clinical skill; and it is the skill that psychodynamic training is most specifically designed to develop. The capacity to be genuinely present with another person’s pain, to hold complexity without collapsing it into a formula, to offer the kind of relational experience that itself becomes the mechanism of change; this is what the therapeutic relationship is in depth work. Not the container for the technique. The instrument.
The couples on the show change not only because they learn things about themselves and each other. They change because they experience, in the presence of another person, something they have not been able to experience in the relationship itself: being genuinely seen in the difficulty, without judgment, without the other person’s defenses mobilizing in response. That experience; the corrective emotional experience that relational psychotherapy has always pointed toward; is not deliverable through a workbook or a structured exercise. It requires a real relationship with a real clinician who can hold the room.
This is what couples therapy at its best actually is. Not a course in communication. Not a conflict resolution process. A relational encounter, in the presence of a skilled third party, in which both people discover something about themselves and each other that they could not have reached alone; and in discovering it, find that the dynamic that has been running the relationship has, slightly but genuinely, begun to shift.
Why It Matters That the Show Exists
Couples Therapy does something that almost no other television has managed to do: it makes the interior of genuine therapy visible without making it sensational. The couples are not caricatures. The conflicts are not manufactured. What happens in the room is real; edited, yes, but not staged, not provoked, not resolved in ways that the actual clinical work would not support.
For couples who have wondered whether therapy could actually help them; whether what they are experiencing is workable, whether a therapist could hold what they bring without flinching; the show is one of the most honest answers available. It demonstrates, in real time, what competent depth-oriented couples work actually looks like. And what it looks like is neither as frightening nor as magical as people tend to imagine. It looks like two people, in a room, beginning to see something they could not see before.
If Season 5 is prompting the question of whether this kind of work might be useful for you and your partner; that question is worth taking seriously. The couples who benefit most from couples therapy are rarely the ones in the deepest crisis. They are the ones who come in before the patterns have become the only story either person knows how to tell.
John Kinnaird, LCSW, is a therapist in Fort Collins, Colorado, specializing in depth psychology, trauma, and EMDR. He works with individuals and couples navigating lasting change through the Stabilize / Recover / Evolve framework at Mindful Transitions Counseling. If you are considering couples therapy and would like to explore whether this work might be useful for you and your partner, a free consultation is available at mindfultransitionscounseling.com.
What It Is Like to Work With Me
