Constructing the Couple: A Constructivist Framework for Creating Treatable Couple Systems

Couple therapists often encounter partners who are dysregulated, rigid, traumatized, poorly self-reflective, or difficult to reach. Clinical impasses are commonly attributed to pathology, incompatibility, or a weak alliance. This article proposes another possibility: stuckness may also reveal limits in the therapist’s construction of the couple. Drawing on predictive-processing neuroscience, social constructionism, attachment theory, and psychodynamic thought, it frames case formulation as a provisional working model, continually tested and revised in session. A brief clinical case shows how systematic reconstruction can shift a seemingly “untreatable” couple into a treatable couple and a more workable therapeutic system.