An NYC therapist on ‘Couples Therapy,’ defensiveness and ‘The One’

"Couples Therapy" is back with a new season, featuring four real couples grappling with issues like shame and childhood trauma in weekly therapy sessions.

Though the couples are new to the show, psychoanalyst Dr. Orna Guralnik returns to help them better understand and address some of their relationship dynamics.

"As a psychoanalyst, our whole training is about reading what's underneath," Guralnik said.

"People often argue about things like finance or division of labor," she said, but "often it's about something else."

"There are often other issues that are hiding underneath those more explicit content areas," Guralnik said.

Season four of "Couples Therapy" is streaming on Paramount+ and Guralnik, who practices in New York City, spoke to WNYC’s Alison Stewart on a recent episode of “All of It.” An edited version of their conversation is below.

Alison Stewart: You use the phrase "block the exits, open up and work it out." What changes about a couple's dynamic when you literally block the exits?

Dr. Orna Guralnik: People tend to use a lot of defensive maneuvers to avoid things that cause them discomfort or shame, and it's hard for couples to deal with their issues when they keep exiting. That exiting could be towards anything: work, an affair, or just avoiding the relationship.

What do you like about couples therapy?

First of all, even in their individual work, most of what people talk about is their relationships – whether it's their romantic relationships or with their parents or employers. Relationships is the stuff of life.

What's really interesting about couples work is that you get to actually see people in action – not only the way they think about it or talk about it, but you get to see their blind spots. You get to work on it in real time with them while they're in the room with you. It can be very exciting work.

Let's talk about a couple on the show, Katherine and Nick. They both have deep-seated trauma from their childhood: hers from being overweight, his from being ridiculed because he was questioning his sexual identity. You observe in the beginning that they're both trying to protect each other, even in the session, a little bit. How does it happen that one partner's instincts about what it means to protect can actually wind up being counterproductive?

It goes back to what we started this interview with in terms of people generally trying to avoid discomfort. They avoid their own discomfort, and empathically feel their partner's discomfort, so when things get a little tricky or shaky, they often shut it down rather than go there.

Nick and Katherine came into their marriage with a lot of hesitation, shame-based protectiveness, and they were gentle with each other. In certain ways, adorably gentle with each other, but it also blocked their development as individuals and as a couple, and that's how they started their work.

I helped them both address their own shame, loosening up those operations and allowing themselves to get more curious about each other and express their care for each other in a different way, by way of wanting to learn about each other rather than protecting each other.

There's this funny moment when Nick says he gets a little upset with her about finances in the relationship. There is the issue of finances, but there's something else going on as well. How do you unpack it so that people realize the finances are one thing, but here's something else to consider?

As a psychoanalyst, our whole training is about reading what's underneath – the stuff that is not necessarily conscious or more motivated by hidden motivations. You have to respect people's defenses and nudge them a little bit beyond what they're comfortable with, yet not overwhelm them. What might be there in addition to the thing that you're fighting about?

People often argue about things like finance or division of labor, or even when people argue about sexuality, often it's about something else. There are often other issues that are hiding underneath those more explicit content areas.

Nick and Katherine come to you after attempting to work on this experience through ayahuasca. How does that enter your approach to know that a couple has tried something aside from therapy before getting to you?

Anything that helps, I'm like, "Bring it on." Many people now are trying out psychedelic medicine to bypass certain defenses and bypass their own limitations. Sometimes it's great. It really does open up a door for people to material that they didn't have access to.

The problem with just leaning on psychedelics – there are all sorts of potential problems with it – but one is that they don't always know how to use the material that comes up for them while they're doing ayahuasca or whatever journey they went through. They don't necessarily know how to use it later and incorporate it in a more consistent way in their lives.

That's why the work of integration and therapy is helpful. With Katherine and Nick, it was super helpful to start with them right after they did that journey because they were very open, and they had access to material that was hidden from them before.

We've got a text that says, "how can I encourage my partner to attend therapy with me? He's very averse to it."

It's not an unusual question. You can just ask your partner to give it a try and give them full control over whether you continue with it or not. It doesn't hurt to try something. If it doesn't work for them, it's not a good idea.

One of our listeners is asking, "how can you be objective in the relationship without appearing to be selfish?"

I'm not sure being objective is what we do in relationships. I think, in a way, we want to be very subjective, and I don't mean subjective in terms of being distorted. When we listen to ourselves, and when we listen to our partner – really listen – there's a lot of information that is available.

When you're honest with yourself, you check in with your very subjective gut feelings, and you open honest conversation with your partner about how they're feeling. Plenty of information is available to you to know if this is a relationship that is good for the two of you.

I want to ask about Rod and Alison. She's kind of yelling when she talks to him at first, and interrupting all the time. How often do you find that you have clients who aren't aware of themselves like that?

A lot. We all have blind spots about how we interact and ways in which we influence our partners without awareness of it. That's why we get stuck in all sorts of dynamics.

Alison and Rod were a wonderful example of that in the sense that it was so obvious what was going on. They were, in a way, in the beginning, clueless about it, but they were also very open-hearted and willing to go through the process and learn really fast.

They're a great example of how the way they talk to each other gets them stuck in a certain dynamic. Also, you can see how the surface of what they're talking about is concealing much deeper issues, like grief and change that they were each going through, and their bickering was getting in the way of their really being able to address those.

This text says, "what is your opinion on the idea of 'the One,' finding the one person in your life?"

I think the feeling of having found “the One” is a wonderful feeling. I don't think it's an expression of that one special person necessarily being out there. I think it's a state of mind where you're willing to assign that kind of trust and love to someone else.

What advice would you give Tara, who called with a question about talking to her husband, who can't drive because he has these panic attacks?

Panic attacks are really hard for the person going through it and for the people around them. Also, they are quite easy to address if the person is in good therapy. Her husband is, in a way, wasting very precious time not getting help.

The question is how to bring him to the door of a good therapist. I would say to him, "Look, you're suffering. I care. I'm suffering with you. Why don't we just try?"

Some combination of a good therapist – either cognitive behavioral therapist, or if there are other issues involved, a more psychoanalytically oriented therapist – and then there are medications that help with panic. Help is really easy to find when you're dealing with panic attacks. It's a very well-known issue.

Is it helpful for Tara to tell her partner how all the driving is weighing on her?

That's more of a guilt tripping approach. I would start with more compassion and care. If that doesn't work, then you can use heavier technologies in terms of influence, but I would start with compassion.

What advice would you give folks who are in relationships to help them navigate some of the things that you've seen snowball into bigger issues?

That was a little general. Can we —

Are there certain things that people in relationships should be aware of, should acknowledge before they get out of hand? Does that make more sense?

It's so general. That question is life itself.

Life unfolds, and there are a lot of issues that we face as we live with our partners. The biggest issue that people face when they're in a committed relationship is that their partner is different from them. It could be a difference in terms of what they need, what they want, it could be a difference in values, it could be just a difference in how they see the world.

I guess my biggest advice, and I'm basically writing a book about it, is: How do you really contend with difference? How do you learn to see the world through the eyes of another person?