JUNE 14, 2021
A CENTRAL PROBLEM for therapy is that it is practiced at the individual level and doesn’t neatly scale, even if it improves the lives of those close to the patient. The therapy shortage is more complicated than simple body math. Insurance, lack of insurance, medical racism and redlining, and persistent stigma have made it extremely difficult to reach those most vulnerable and most in need of care. Mental health care professionals have generated many modes to batch process patients at a greater rate than one-to-one and one-to-two, developing short-term modalities (like the dominant therapeutic paradigm of Cognitive Behavioral Therapy) and prescribing psychopharmacological drugs. And, of course, they’ve also turned to technology.
Nonetheless, the fact remains that coming to the office for treatment does not quite help your neighbor — unless it does. Couples therapists have never been content with the one-to-two condition of seeing people in treatment when the institution of marriage itself is in trouble — and it is always in trouble. It makes sense, then, that therapists would seek to scale from one marriage to marriage itself, by giving everyone mediated access to the treatment of someone and anyone.
Across its longer history, therapy, and couples therapy in particular, has walked hand in hand with the creation of multimedia empires to deliver audiences “real couples” and their problems. Couples therapists have, repeatedly, made use of public examples of a single pair to provide vicarious care. Long before the dawn of scripted reality TV, therapists achieved iconic status by providing a form of therapy indistinct from entertainment to the many on the grounds of the few.
If, following Lauren Berlant, intimacy requires a kind of witness — publicity where we might assume privacy — couples therapy does so doubly. Formerly the province of kinship, clergy, and doctors, the practice of couples therapy acquired autonomy in a disturbing way, emerging as a eugenicist tool in Nazi Germany and then in the United States, where it sought to bring and keep together the “right” mates to make a family. Perhaps the most famous couples counselor of the first half of the 20th century, Paul Popenoe, the one-time editor of the Journal of Heredity, lobbied for forced sterilizations via his Human Betterment Foundation and eventually founded the first center for couples therapy in Los Angeles in order to help secure and safeguard a future for white families. He wasn’t just content to “save” the marriages of those at his foundation or his center: he also addressed the largest group of women he could find, via the pages of Ladies’ Home Journal. His column ran for decades, and such advice columns remain incredibly popular spaces for couple adjudication (c.f., Slate’s long-running Dear Prudence).
In the late 1960s — as divorce law retreated from a standard of documented fault, and separation became easily procurable via no-fault and no-contest — divorce rates skyrocketed. In turn, many therapists set about addressing their moment’s marriage problem, albeit from a range of political positions that offered differing diagnoses. It was only in the aftermath of women’s lib that marriage therapists became an increasingly specific discipline and service, shifting from a focus on the family to the couple. It wasn’t until then that couples were even seen in the office together; previously, marriage therapists tried to get at dynamic interpersonal problems in individual therapy. As soon as the new standard of concurrent treatment was set, it mutated and scaled. Couples therapists took to the airwaves for a live-action version of the advice column, from the interactive dial-a-shrink radio call-in shows of the 1970s and ’80s to the endless daytime television shows anchored by these celebrity doctors that brought couples in to discuss their most private problems on live television.
This generation saw Dr. Ruth — a self-described “orphan of the Holocaust” — and Dr. Toni Grant — who trained through work with Vietnam War veterans and was herself a divorcée — replace the likes of Popenoe as contenders for the status of iconic marriage therapist. Despite or because of widespread social upheaval, public-facing couples counseling remained frequently conservative; Dr. Ruth may have been loudly sex positive, pro-pornography, and progressive, but Grant equally relentlessly cautioned women against taking up the politics of women’s lib and a life beyond the home, arguing that marriage was best served by a traditional family structure and a focus on domesticity.
The 1990s offered tools mostly for women to “translate” themselves into languages understandable to men (as in Men Are from Mars, Women Are from Venus or The Five Love Languages), with notable feminist exceptions (as in the psychologically driven and public-facing work of Dr. Harriet Lerner). These books continued a long self-help tradition, allowing couples to guide themselves back to health via a most distant, mediated, and self-directed therapy. While the AIDS crisis still raged in the United States, columnist Dan Savage began providing queer, sometimes radical sex and romance advice in an alt-weekly, Seattle’s The Stranger, now syndicated nationally. But lest we are tempted by a progress narrative, couples counseling, the more liberal term for caring for those in relationships, always contains marriage therapy. The 1990s were no exception, and its overt religiosity appeared in the guise of syndicated writers such as Dr. Laura Schlessinger (author of books Ten Stupid Things Women Do to Mess Up Their Lives and The Proper Care and Feeding of Husbands — enough said).
In our contemporary moment, the threat to marriage is now marriage itself. Couples therapy is now touted as both a form of self-care and care for the institution of marriage writ large. And the institution is in need of care (for those who wish to save it). From a conservative standpoint, marriage is — seemingly eternally — an institution under various external threats: low birth rates, the decay of “family values,” gay marriage, feminism, women in the workforce. Liberals — including most contemporary couples counselors in the mainstream — seem to understand the threat to marriage as internal and individual: mismatched expectations, communication breakdowns, and insufficient boundaries. The pressures we put on marriage are manifold, taking an economic institution and claiming it must meet every emotional and physical need from friendship to everlasting sexual fulfillment. In the last decade, couples counselors have started to assist partnered couples in addressing this very paradox, even if patients come to treatment to work through affairs, debate the intimacy killing effects of screen time, or recover from porn “addiction.”
Much like the practice of curing couples itself, Mimi White argues, televised couples therapy
can be seen as attempts to (re)instate the heterosexual couple as a stable social referent even as they endlessly rehearse the couple as a body constituted in unstable mobility. […] The couple is naturalized in social relations as the linchpin between public and private identity. […] Thus the couple is never strictly a personal affair.
And, we can extrapolate, couples therapy is always, on this understanding, a conservative practice tending to a conservative institution.
In the long history of couples therapy, the therapists have scaled up from their individual clients to the public at large by working either with the composite case study in the self-help and psychoanalytic traditions (bringing together several patients to illuminate something less particular and more universal) or in one-off sound bites, whether written or sonic. When therapists pioneered the use of videotaping couples therapy in the 1960s and ’70s as part of treatment, these recordings were kept confidential and private; it is only recently that the performance of therapy, its dissemination, and its real practice have combined, a turn initiated by our contemporary couples gurus. Instead of following the “tele-advising model,” as Mimi White calls it, or the self-help format of book publishing, these couples therapists have combined the practice of therapy evangelism and outreach with a well-established form of entertainment. It has been couples therapists who have sent their practice and its focus on the smallest possible group to the largest groups possible — the partnered, the nation, the world — a publicization of privacy that functions as both entertainment and, so they argue, therapeutic benefit by proxy. Where therapy is, media too shall be.
In turn, these media-savvy therapists have ensured that one doesn’t have to be in treatment to receive treatment (or at least fluent in its vocabularies and techniques). These shows promise a sampling of what it is to be in treatment for couples with a range of problems, while also necessarily giving us access to the therapist and their strategies. Despite being nonfiction, these shows also contain a performance of therapy: the door to the consulting room seems to have been voluntarily opened when in fact it’s filmed or recorded with a crew listening in. The couples are typically not extant patients, but pairs of applicants who are actively recruited and, it seems universally, given treatment for free in exchange for airing their sessions (the cost of having one’s intimate problems broadcast turns out to be equivalent to an hourly fee). Not only are couple and therapist performing for each other, then, but for the implied viewership at home. These patients intend to be overheard — otherwise they wouldn’t be there, whether because of a lack of access to a fee-based treatment or because they only want treatment if it’s the kind that happens in public.
In doing so, celebrated couples therapists have traded on the demand for their care and how dear it is to purchase — along with the prurience surrounding their intimate work. While there may be nothing more lightly unpleasant than watching a couple fight at close range, an industry has sprung up around a paradoxically remote form of that proximity which allows us to do just that. The turn to broadcasting real therapy sessions has this as its undeniable lure: while we don’t want to be trapped at a dinner party with a fighting couple, say, many do have a desire to overhear the fight next door and a voyeuristic wish to know what’s happening in the bedrooms of others. This admixture of conventional therapy and self-help entertainment breaches two forms of privacy at once while undoing the lingering stigma of being in therapy and the taboo of discussing what happens inside a marriage.
One of the most famous couples therapists publicly addressing the crisis of partnership is Dr. Esther Perel, who first broadened the reach of her practice via that stand-by form: the self-help book. Perel authored a best-selling handbook on how to cope with the stagnation many feel in long-term partnership called Mating in Captivity: Unlocking Erotic Intelligence, which both provocatively and commonsensically claims that it’s really hard to want continually and creatively what one already has — and has in excess. Lacan put this bluntly: desire is predicated on a lack; Perel understands that for most couples, there is only surplus. In one of her two New Yorker profiles, Perel argued:
The couple today is treated as the central unit of the family. And the only reason the family survives is if the couple is remotely content. Families are not held together by kids, by female oppression, by economic dependence, by legalities that prevent divorce. […] And never has this one unit of two had to fill so many expectations. Because, today, we have to give one person what an entire village used to provide.
For Perel, the contemporary couple is under serious threat as a form yet just as essential to the functioning of the family. Welcome to the double bind of marriage.
Captivity was a wry description of the institution of partnership; now, in a pandemic, it has another valence. For most couples, whatever was happening in March of last year — too much proximity and dependence, for instance — has only intensified. In 2020, Perel took a direct run at the couple conditions of the pandemic on her lauded podcast, Where Should We Begin?, which features an extended session with real couples, edited for length and confidentiality. Having those intimate moments displayed has psychical effects for both clinician and patient, as well as the users of the broadcast — the audience. Importantly, while Perel otherwise protects the identity of her patients, there is one marker of the individuals that cannot be erased or hidden no matter how well edited: the patient’s voice. By becoming otherwise less particular via the removal of names, jobs, and other identifying markers, these real couples do take on the generalization typical of composite cases. Their exact situations might be theirs alone, but Perel’s audio-only series invites listeners into a possible identification with the couple. Perel has made a career out of taking on marriages, inviting us into the space between a particular couple and the couple form itself.
Perel is not alone either in her use of public therapy or in her diagnosis of what ails the long-term partnered. Dr. Orna Guralnik has, over the last two years, emerged as a second practitioner invested in using “the real couple” as part of a psychoanalytically oriented project to help us live and love just a little bit better. Her tool: A television show called Couples Therapy. The titular premise of the show is similar to Where Should We Begin?, but with key differences. Like Perel, Guralnik sees her patients for free in exchange for their participation. The ritual of the therapeutic setting — from the greeting (“Where should we begin?” or in Guarlnik’s case, “Talk to me”) to the hour at which the session takes place — becomes the tagline and moment of theatrical anticipation. Guralnik sees several couples in treatment for the duration of a television season, in a sound stage copy of her actual working office. In turn, we too see the couples once a week — or more. Thanks to streaming and binge-watching, viewers can in fact undergo the entire course of treatment in a single weekend, fast-forwarding through couples’ particularity into their exemplarity.
While the first season focuses on three couples and their various problems with listening, connecting, and flexibility, while navigating race and gender in marriage, the second season (released this spring) more overtly looks at how the social and the psyche are intertwined. Given that Couples Therapy is nonfiction TV, it takes place in our world, where COVID-19 and the uprisings of last summer were definitive events. As Guralnik deals with the psychological histories of individuals and the resulting dynamics between partners, she also engages with her limits as a white therapist while marching for Black Lives Matter in Brooklyn, and the problems of doing therapy over Zoom both generally (the patients can ignore her more easily) and during a worldwide crisis (babies attend sessions, sirens interrupt). And of course, the double screen makes for a more static viewing experience for those at home.
As she contends with these registers of history, politics, and psyche, Guralnik visits, from time to time, with her own supervisor to help make sense of it all. This is an intimate, meta-moment, where the work of couples therapy is dissected and where the stakes of doing the job poorly are elaborated. All the ways one can spectacularly fail at this form of care are made clear. At the end of one session, Guralnik says to her supervisor, “If I’m not surprised, I’m not doing my job right.” What she means is, if there is no surprise, she is not listening to the people who can’t listen to one another. She also necessarily means that if she isn’t surprised then neither will her audience be. Guralnik isn’t just trying to save partnerships in her office, she is de facto trying to entertain and help her viewer watching at home. If we’re not surprised, then we won’t go to screen therapy. Bad TV doesn’t make for a repeat visit — but for therapy to occur it must have duration, and duration requires investment.
Exemplarity and entertainment merge to become the tool that such practitioners use in the service of scaled therapeutic benefit. In turn, this justifies the publicization and dissemination of therapy, and the abandonment of the norm of private treatment. When these forms of therapy reach their audiences (whether through subscription to premium cable channels or piracy), broadcast therapy doesn’t just serve the prurient; the first benefit lies in the publicity itself. If therapy is often sought out in secret, couples therapy is doubly so: the stigma of mental health care meets the shame of a marriage or partnership in trouble.
But that doesn’t explain why it works to scale treatment in this way — if it does. It turns out, Tolstoy wasn’t quite right: all unhappy marriages are alike enough for advice about one pair to translate to marriages generally while we listen in. This is a remediation of the long-running trick of self-help: speak to human likelihoods as core human truths. If Perel leaves her patients just underfeatured enough so that we might identify with them and thus learn from their treatments, Guralnik demonstrates how an admixture of social and psychical history is always with us all, whether a mother’s ambient anxiety revivified in COVID-19 or interracial couples contending with white supremacy inside their homes and out. This is always the trick of mediated couples therapy: similarity and surprise must be held in equipoise or thought, as the psychotherapeutic adage goes, in terms of dosage, timing, and interpretation. Nothing is strictly personal, including the individual.
Out of mass therapy follows intimacy via identification. And the identifications roam: from individual to couple, from couple to therapist, and back once more. But the therapist is the only consistent beacon for identification. We see her limits and successes across patients; we may go so far as to see her in supervision. And perhaps, we might see her outside of the consulting room, whether in a TEDx Talk or in her self-help book. Taken together, these modes of connections to the iconic couples counselor beget something like transference — the redirection and attachment of early emotions to the therapist — but only one-sided and at distance. It is a transference begotten through identification with the treatment of the exemplary patient.
Such procedures of identification subtend the iconicity of these particular therapists. Precisely because they diagnose and treat the American marriage wholesale, even if they rely on our lesser impulses to get us in the figurative door, they rely on the feedback loop of fame and care to stay relevant. These therapists have a near-cultic form of celebrity, lying somewhere between the parasocial relationship (in which audience members feel they are intimate at distance) and transference, in which the audience can feel seen and heard without ever setting foot in the office. Taken together, these three forms of outreach enfold the person following along at home.
Every generation gets the iconic couples therapist it deserves. For the current generation, it is this strange form of remotely intimate relationship that allows couples therapists to care for those not directly in their charge, model healthy (or healthier) relationships to the public, all while undoing much of the damage of previous iterations of marriage counseling and reconceiving what partnership is and can be. This makes a certain kind of sense. If we are all playing out the relationships we know deeply, internally, and early, we’re also working through older standards of what a “good” marriage makes and, in the process, letting go of received or archaic connotations and conditions attached to long-term partnership. The rules are being rewritten. Cohabitation, monogamy, and childrearing are no longer synonymous with marriage. We’ve exchanged, perhaps finally, the “good” marriage for the marriage that works. The configurations of marriage are necessarily more open than ever for the practice to survive itself. So too might couples therapy survive itself via its flexibility.
Hannah Zeavin is the author of The Distance Cure: A History of Teletherapy (MIT Press, 2021). She is a lecturer in the departments of History and English at UC Berkeley and a member of the Berkeley Center for New Media’s Executive Committee, where her research focuses on intimate histories of technology, media, and communication. Zeavin is at work on her second book, Mother’s Little Helpers: Technology in the American Family (forthcoming from MIT Press).