Most couples do not arrive because of the argument they had last week. They arrive because of the argument they have had, in different costumes, for eleven years.
That is the useful thing about couples therapy: it is not a negotiation, and nobody is there to rule on who was right. It is a way of seeing the pattern that the two of you keep producing together, which neither of you can see clearly from inside it.
What couples come with
The same argument on a loop. Different subject each time, money, the in-laws, the washing up, and an identical shape underneath. One pursues, one withdraws; one raises the temperature, one goes quiet; both end up lonely.
Infidelity. Discovered, confessed, or suspected and never named. The early work is rarely about the affair itself. It is about whether the relationship can survive the conversation.
Loss of intimacy. Not only sexual, though often that too. The slow drift into being competent co-managers of a household and nothing else.
A transition that landed differently for each of you. A baby, a relocation, a redundancy, a diagnosis, a parent dying, children leaving. One of you has adapted and the other has not, and neither of you has said so.
Neurodiversity in the relationship. Where one or both partners are autistic or have ADHD, much of what gets read as not caring is a difference in how attention, sensory load and emotional processing actually work. Naming that correctly changes the argument entirely.
Deciding whether to stay. A legitimate reason to come, and one that therapy should not quietly steer.
Couples therapy online
Online couples work is not a lesser version of the room. For a good number of couples it is the only version that happens at all, and for some it is better.
Two people, one screen or two. If you are in the same home you can sit together at one screen. If you are not, you each join separately. That second option has no in-person equivalent, and it is why online has opened couples therapy to people who previously could not access it.
Couples who live apart. One partner posted abroad, one working away during the week, one who has relocated ahead of the other, a relationship conducted across two countries while an immigration process grinds on. These couples are among the ones most in need of the work and least able to sit in a consulting room together. Online is not a compromise for them. It is the enabling condition.
Couples abroad. For expatriate couples, the difficulty is rarely only the relationship. It is the relationship inside an unfamiliar country, often with one partner’s career intact and the other’s suspended, inside a community small enough that a local therapist may also be a neighbour or a colleague’s spouse. Therapy while living abroad covers the practicalities, registration, time zones, insurance, confidentiality when your world is small.
Does it actually work on screen? The evidence, what changes when you are on video rather than in a room, and where it falls short: online couples therapy.
What to sort out first. Agree which time zone the appointment is anchored to, so the same person is not always taking the 11pm session. Make sure each of you has somewhere private; a session where one partner is speaking carefully because someone might walk in is not a session. And if you are joining from one screen, sit where you can both be seen, a great deal of what matters in couples work is what happens between two people while one of them is talking.
How the work actually goes
The first session is a conversation with three people in it, in which each of you says what has brought you and what you would want to be different. It is not an assessment, and there is nothing to prepare.
After that, sessions are usually weekly and fifty minutes. Some couples work for a few months on something specific. Others stay longer because what surfaced turned out to be larger than the presenting problem. That is discussed rather than assumed.
Individual sessions alongside the couples work are sometimes useful and sometimes actively unhelpful, depending on what they would be for. It is raised openly rather than arranged quietly.
Who you would see
Couples work at this practice is offered by Adam Smith, an existential and integrative psychotherapist working with individuals and couples on communication, infidelity, identity, neurodiversity and life transitions, under Dr Jacquet’s clinical supervision. He holds trainee registration with the UKCP, which is stated here rather than left for you to find. Sessions with him are in English.
Where this is the wrong answer
Couples therapy is not the right response to everything, and saying so at the first contact is more useful than discovering it three months in.
Where there is domestic abuse, physical, sexual, coercive or financial, joint sessions can be unsafe, because one person cannot speak freely and may be held to account afterwards for what they said. That needs a specialist service, not this one.
Where one partner is in active addiction, that usually has to be addressed first or alongside; couples work tends to stall around a problem that is not being named. See addiction counselling.
Where one of you has already decided to leave and wants therapy to deliver the news, that is not couples therapy. It is sometimes worth one honest session to say so out loud.
And where one person is attending to satisfy the other, the work rarely goes anywhere. It is better to say that at the start.
Where sessions happen
In person at Harley Street W1 and Fitzrovia, Central London, with evening appointments, and online by secure video anywhere. Couples outside the UK, see therapy while living abroad.
Also available in Colchester, and online for couples in Dubai, Singapore, Hong Kong, Geneva, Luxembourg and Lisbon.
Further reading: what couples therapy can and cannot do.
Starting
Write to the practice. Say briefly what has brought you and whether you are both intending to come. The first reply will tell you whether this is the right place.
Common questions
Does couples therapy actually work?
It works when both people are willing to look at their own part in the pattern, and it does not when one person has come to have the other corrected. That is the single best predictor, more than how bad things currently are. Couples arrive in serious difficulty and do well; couples arrive in mild difficulty and go nowhere. What changes things is two people prepared to be uncomfortable in the same room.
Can couples therapy be done online?
Yes, and for many couples it is the only workable option. Sessions are by secure video and the work is the same. Two people in the same room can join from one screen; two people in different cities or countries can join from separate ones, which is a genuine advantage over in-person work rather than a compromise. What matters more than the format is that each person has a private space and an uninterrupted hour.
We live in different countries. Can you still see us?
Yes. Couples separated by work, relocation or immigration are a substantial part of this practice's online work, and each partner joins from wherever they are. It is worth agreeing in advance which time zone the appointment is fixed to, so the same person is not always taking the late session.
What if only one of us wants to come?
That is worth saying at the outset rather than discovering in the first session. Sometimes the honest step is individual therapy for the person who wants it, and sometimes a single joint conversation clarifies whether there is anything both people want to work on. Couples therapy with one willing participant and one attending under protest rarely helps and often makes things worse.
Do you work with infidelity?
Yes, and it is one of the most common reasons couples come. The early work is usually not about the affair itself but about whether the relationship can hold the conversation at all. Both outcomes are legitimate: some couples rebuild, some separate with more understanding than they would otherwise have had, and the work does not assume which it should be.
Who would we see?
Couples work at this practice is offered by Adam Smith, an existential and integrative psychotherapist who works with individuals and couples on communication, infidelity, identity, neurodiversity and life transitions, under Dr Jacquet's clinical supervision. He holds trainee registration with the UK Council for Psychotherapy, which is stated plainly rather than left for you to discover. Sessions with him are in English.
Where are sessions held?
In person in central London, at Harley Street W1 and Fitzrovia W1T, and online by secure video anywhere. Evening appointments are available, which matters when two people have to be free at once.