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What Counts as Being Chosen in Couples Therapy

Dr. Emma Smith and Dr. Alivia Stehlik watch the series Couples Therapy and talk about why every presenting problem turns existential, what a sex therapist adds to the picture, and how a narrow definition of desire prolongs the very disappointment it fears.

Summary

Couples arrive in couples therapy carrying the portable version of their problem. He is not spontaneous. She will not decide about children. They have sex too rarely, or on a schedule that feels like a standing appointment at the dentist. Then, somewhere around the fourth question, the portable version turns out to be heavy, because it was never the whole of what they were carrying.

Emma and Alivia finally watched Couples Therapy, four years after clients began asking Emma whether she had seen it. Alivia, who comes to the subject as a physical therapist and has never sat in Emma’s chair, lasted roughly thirty seconds before turning to say that Emma does not get paid enough. The weight was visible even from the couch. A couples therapist is tending three things at once, each partner and the relationship between them, and the camera makes that arithmetic hard to ignore.

How does anyone carry that and still go home and make dinner? Emma’s answer is a ball. You hold it for a moment so someone can readjust their grip, then you hand it back, because the couple walked in carrying it and they have to walk out carrying it. She is also plain that the handoff is never seamless.

Starting in the middle of the fight

Couples usually start couples therapy when the pain of discussing the problem has finally dropped below the pain of avoiding it. Alivia has heard that this often happens six or seven years into an issue. Emma, going by something she read recently, puts the wait before sex therapy closer to two or three years on average, and she takes that as mildly encouraging: a couple still willing, at least in theory, to have sex with each other is probably not as far gone.

What follows is detective work. Alivia points out that as outsiders we form a verdict about who the problem is within minutes, and the verdict is sometimes right and never complete. There is always more than one thing, sometimes more than one inside a single person. In one scene a participant describes a history of serious violence, and the therapist stops her to ask whether she understands what she has just said. Emma describes the recognition crossing the woman’s face. A person can be intelligent and insightful and still not have heard herself.

The pattern Alivia names is the one existential therapists live inside. A complaint as ordinary as my partner isn’t spontaneous becomes, a few layers down, aloneness against connection. Irvin Yalom filed this under isolation: the part of you that stays out of reach even in a marriage where everyone is perfectly pleasant, and where the dishwasher gets loaded correctly. Even a question as concrete as whether to have children now or later holds identity, meaning, and fear on its lower floors.

Emma suspects this is why a series about couples therapy works at all. By her own account it should almost be boring, with no heavy-handed goal-setting and very little technique, and it is gripping anyway. She reads the therapist as psychoanalytic, an approach that shares roots with the existential one, where the goal is clarity: a shared understanding of what the relationship needs in order to become what both people want. A promise to fight less or to communicate better is a different kind of goal. Alivia’s theory is that anyone who has ever been in a relationship has had existential difficulty with a partner, whatever the surface topic.

Nobody does this alone, including the therapist

The series shows its couples therapist taking cases to a consultation group, and Emma was glad of it. Good therapists do not pretend to have all the answers. She belongs to two consultation groups, assists in a third, and receives supervision from a woman who started practicing in 1982 and still brings cases of her own. Emma’s question about that supervisor is a fair one: is there a dynamic she has not seen in forty-four years?

The ethics sit beside that humility. Emma cannot ask clients for Google reviews, which baffles the business masterminds who tell her she needs more of them and point out that doctors do it. Her field’s code is stricter because a therapist’s relationship with a client can be closer and more influential than a physician’s. In a couples therapist’s office, everything said has an effect, including what goes unsaid.

What counts as being chosen

Several couples in the series bring a sexual complaint, and Emma draws one clinical line before saying anything else: abuse is an individual problem and cannot be treated inside couples therapy. Everything that follows concerns want, desire, and inconvenience, never harm.

Desire discrepancy is the most common presenting issue she sees, and the higher-drive partner is often the man, though not always. Add a trauma history and an irony appears. When someone finally lands with a person who would never hurt them, the nervous system may finally have room to work on what happened, and the safe partner is left saying but I am the safe one. Emma’s verdict on that low bar is What a low bar.

The partner’s feelings are real. Resentment, anger, disappointment, and the sting of rejection are all valid, and most people did not sign up to be a clinical caretaker. Emma’s argument is that fixing on what is missing blocks the intimacy being craved. She teaches a reframe from I am being punished to I am pivotal, since a person who says that sex has always felt obligatory is offering evidence of deep trust, whether or not it is anyone’s favorite evidence.

Then the aperture. When physical sex is off the table, she sees people narrow what counts as being chosen to a sliver of sexual validation. She will not forbid the benchmark. She will say the disappointment lasts longer under it. A hand held, an appreciation said while looking at each other, a note: these are ways of being told you are valued as a partner and not only as a provider or a protector.

The question to leave with

The episode ends without settling any of this, which seems right. For the reader years into a partnership, some questions to take to the kitchen table:

• If the one thing you count went missing for a year, what would you have to learn to count instead, and who taught you the original list?
• What do you currently count as proof that your partner wants you?
• Has your partner ever been told what counts for you, and have you asked what counts for them?

Moments Worth Noting

They’re not leaving their ball here. I am not taking care of their ball.

You cannot treat domestic violence or intimate partner violence or any type of abuse in the context of couples therapy because abuse is an individual problem. It is not a couple’s problem.

You’re pivotal, right? You are providing a safe environment.

A lot of times what people do is they narrow their aperture to what counts down to this very, very, very narrow sliver of sexual validation.

Chapters

• 00:00 — Opening: why they finally watched
• 02:36 — What Couples Therapy is
• 03:41 — “You don’t get paid enough”
• 05:47 — The ball: how a couples therapist carries it
• 06:57 — Starting in the middle of the fight
• 09:36 — The therapist as detective
• 12:56 — Presenting problems turn existential
• 14:43 — Psychoanalytic and existential roots, and why clarity is the goal
• 16:25 — Why a slow show is a hit
• 19:51 — Why therapists need consultation
• 28:47 — Ethics, Google reviews, and closeness
• 30:29 — Errors of omission and commission
• 36:01 — Sex therapy inside the show
• 37:42 — A clear line: abuse is an individual problem
• 40:34 — The partner’s feelings
• 42:26 — From “I am being punished” to “I am pivotal”
• 43:29 — Sex, religion, and the weight of expectation
• 47:37 — The narrowing aperture
• 51:00 — Questions for the show, and closing

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The Receipts

Where things get nerdy.

• Couples Therapy (Showtime), the series Emma and Alivia watch in this episode. Its therapist, Dr. Orna Guralnik, is a psychoanalyst.
• Irvin Yalom, Existential Psychotherapy. General background on isolation as an existential given. Not discussed on air.