In Couples Therapy, Dr. Orna Guralnik sits down with four couples over months of sessions.Paramount+/SHOWTIME/Supplied
Adrian Lee is a contributing columnist for The Globe and Mail.
There’s a moment on the new season of Couples Therapy, the Showtime docuseries that follows four couples over months of sessions, that speaks to how compelling, complicated – and compromised – the show can be.
In a gruelling yet gripping testimonial, Chris (the show doesn’t divulge last names) pours his heart out about the emotional, physical and sexual abuse that his mother wrought. Viewers can’t help but draw conclusions about Chris – whom they’ve known for a cumulative 15 minutes – and how he came to be on this couch with his wife, Sienna.
The therapist, Orna Guralnick, asks how he’s doing. Fine, he replies, almost flippantly, as the concealed camera focuses on him. “I think it’s because I’m telling a story. So while I was telling that, I didn’t feel hardly anything except excitement.” All he could think, he said, was along the lines of: How messed up is this?
Couples Therapy, drenched in the high production values of prestige TV, has a serious mission: to demystify therapy. Showrunners insist they studiously avoid sensationalizing and exploiting participants’ lives. And I believe them. There is evident tenderness for the couples involved, and there is a real effort to explain the therapy tool kit.
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The problem is, by simply turning on the cameras, no amount of care can prevent the therapy from being subsumed by the show of it all: a product for unruly audiences who demand ever-juicier narratives. Those are the same impulses behind even the trashiest reality TV – but that’s okay, because Couples Therapy is great reality TV. It just needs to accept that’s what it is.
I don’t mean this derogatorily. Yes, many reality TV shows are predatory, but the genre can also be a force for empathy. And of course, it’s compulsively watchable, too, and targeting dopamine centres does require a kind of artfulness. Couples Therapy does the same thing, cutting hours of footage into taut stories to be spread over nine episodes. (The fifth season was released Friday.)
A story, in any context, can order truth, create connection and take us outside ourselves. In the art and science that is couples therapy, stories are both problem and solution, unspooling tightly held narratives of “me” and “them” to build a “we” story based on understanding, not blame.
A story can also be a drug – something that can change minds, crack someone open and make us unable to look away. Reality TV makers understand this. Producers pull strings to extract maximum attention-grabbing drama; “villain edits” aren’t just part of the deal, they’re often pursued for building personal brands. Stories thus pursued can even become performances, numbing a person from feelings altogether, as they did for Chris.
With Couples Therapy, these elements are all handed over to viewers – millions of who tune in for the juicy drama, or out of the warped if human need for reassurance about their own relationships. And many will, based largely on production decisions, root for – or hate – the participants.
Last November, Boris Fishman, whose Season 4 appearance was derided by fans, wrote in The Guardian about this experience: “By including no fill-in to-camera interviews – presumably to distance Couples Therapy from the feel of a typical reality show – the filmmakers set themselves a difficult task: to scrape together a coherent story without jumping around between sessions, and despite the fact that patients hardly tell a coherent story themselves."
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On Reddit and social media, anonymous users diagnose the show’s couples with absolute confidence; Fishman wrote that his wife, Jessica, felt compelled to issue replies insisting she isn’t autistic. These outcomes are unique to Couples Therapy’s couples therapy.
Ultimately, the show cannot control its audience. But the way Couples Therapy is promoted is particularly unkind. Social-media snippets from the most emotional parts of longer sessions do a disservice to the therapeutic process and the people helping demystify it.
But of course, it can’t not be promoted; it is a show.
Ever it was thus. For An American Family, a 1973 “sociological exploration” now considered the first reality TV show, cameras followed the Louds for a year. The matriarch, Pat Loud, was shocked when the 12-part PBS series was marketed “as a lurid soap opera,” Emily Nussbaum wrote in her 2025 book Cue the Sun! “Critics were reviewing not the show but the family.”
Couples Therapy’s clinical ambitions ultimately run counter to the realities of marketing and production. Couples therapy, the practice, is a non-linear, long-term project that demands patience and, ideally, teaches expansive grace. Yet by virtue of being on our screens, these patients (that’s what they are) are put at the whims of TV’s power to wrench emotion from an audience that feels it has the right to judge.
The show raises fascinating questions. Who are these couples so desperate for help in the unaffordable United States that they choose to be recorded, at their possible worst, in exchange for free therapy? What do viewers deserve to watch? At what cost comes “mental health awareness”? Five seasons in, how much are the stories being performed to fit Couples Therapy?
The series doesn’t provide any answers. But that’s fair, because it’s not a prestige show. Nor is it really therapy. It’s reality TV, whether showrunners like it or not – and I’m not above watching it. Give me the juice.