After a familiar montage of couples arguing and apologizing, laughing and crying, pushing and pulling, Dr. Orna Guralnik makes a declaration we’ve never before heard on Couples Therapy, to open the show’s new run of episodes: “I’m not the right therapist for you guys.” We don’t know whom she’s talking to or what prompted the dramatic comment. The tease sets the stage for nine new half hours that find the complex, humane documentary series—and its compelling protagonist—inching toward uncharted territory.

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Premiering April 28 on Showtime, this batch marks the back half of Couples Therapy’s third season. The show, created by acclaimed Weiner filmmakers Josh Kriegman, Elyse Steinberg, and Eli B. Despres, premiered to universal critical acclaim roughly four years ago, introducing itself as a radically intimate and realistic portrayal of actual therapy, with (very) hidden cameras, an exhaustive casting process, and an innovative studio-office design allowing Guralnik, a practicing clinical psychologist and psychoanalyst in New York, to conduct intensive, poignant sessions with a diverse range of real-life couples. Each run of episodes introduces three or four new pairs, whose stories are intertwined in the editing. 

Guralnik is our brilliant, forthright point of focus, and Couples Therapy closely traces her experiences with patients; additional context arrives via her meetings with her own clinical adviser, Dr. Virginia Goldner, and her peer group. An overarching theme tends to emerge between each group of patients’ stories—in this edition’s case, monogamy. One younger millennial queer couple begins the first session by telling Orna that the relationship will end if they do not embrace polyamory. Over weeks, married ex-Mormons negotiate opening up the relationship (or not) in the aftermath of leaving the church. Other stories center on infidelity and fading intimacy—four very different stories, with people of very different backgrounds, linked by shifting attitudes toward sex, love, and coupledom. 

“I have a very alive private practice in New York, and [monogamy] is a very hot topic on people’s minds,” Guralnik tells Vanity Fair in her first interview about the new episodes. “What are the boundaries of a relationship? It’s one option that people come up with to deal with all sorts of stressors and issues. I don’t even know what’s considered tradition anymore, but certainly 10 years ago, that would not have been a viable option for people.” 

In that sense, the longer Couples Therapy goes on, the richer a long-form nonfiction narrative it can establish—identifying evolutions in American romantic life in real time. “I think the last five years have been pretty transformative for couples,” Guralnik says. “I know our life as a country is not doing well, but still there are certain kinds of cultural changes that are infiltrating the lives of couples in a very positive way.”

Couples Therapy finds authentic suspense in its structure—a credit to its cinematic bona fides. “We really don’t know what’s going to happen,” cocreator and executive producer Kriegman says. “There’s a formless reality to the process where we’re trusting our gut, and then really excited to see what comes of it. That’s the joy of this filmmaking.”

Having now gone through several seasons, Kriegman and his team have a better sense of what they need to work: They see hundreds of couples—the estimate in our interview for how many they saw and considered for this installment alone is 400—and rather than outsource the casting, do it all in-house themselves. Once the ensemble is finalized, the producers give Guralnik the space to conduct her sessions and progress the therapy without interference, but do speak with her regularly during production. She’s not isolated from the process. 

As Kriegman puts it, “We have conversations about how the work is going, but very much through the lens of the therapy and less through the lens of the filmmaking.”

“Never in my life as a professional have I had such close scrutiny and supervision of my work as I’ve had in the last [several] years,” Guralnik says. “I did a PhD and then I did another 10 years of analytic training…. But in every [Couples Therapy] session I have people watching the session while I’m doing it, and I have then editors and directors peering over the material and trying to understand it—and talking to me about it later, both session by session and then period by period.”

This season, Couples Therapy brought on Joshua Altman, an award-winning documentary veteran (All These Sons, Minding the Gap), as a new director. He stepped into a well-oiled machine, but also imbued it with fresh perspective. “To find couples that I felt had this push and pull of genuine love for each other, and at the same time, this dynamic between them that as an audience you’re like, ‘Man, these two should split up’—those feelings are real things that all couples go through,” Altman says. “As I watched other seasons again, I was like, ‘Okay, yeah. How can we pull that out?’”

One way was through Guralnik directly. For the first time in the series, she’s confronted with a couple she believes, to some extent, she cannot work with, and agonizes over whether to terminate the treatment. The struggles between the pair resonate, initially, as a portrait of a couple in crisis. “But [Altman] was able to say, ‘Oh, no, the story here is as much Orna’s story as it is the couple's story,’” Kriegman says. “That was a really great insight that took the season to a place that we’ve never been before.” Adds Altman: “We have the benefit of watching things and rewatching things and starting to look at patterns and offering those to her—not as a way to steer her, but to bring up questions and to raise ideas. Sometimes she shuts them down, and sometimes she’s like, ‘That’s really interesting.’”

To reiterate, this is not Guralnik’s day job. While she finds the work on Couples Therapy rewarding, the differences between it and her regular practice are notable. She’s doing sessions two days a week during filming for several hours, which she calls “a very intense immersion.” It’s completely all-in. And then, within a week, all of her patients leave at the same time, as production wraps. 

“It’s really demanding, and it’s a shift from being a very private person to being a public person,” Guralnik says. “It’s hard.” She didn’t exactly understand the point of coming back season after season, either; she wondered, “Wouldn’t you want to see other therapists do the work?” Eventually, she realized she was playing a different kind of role, that of the TV star. “I learned something about the relationship audiences have with people on the screen,” she says. “They develop a kind of an attachment.”

With Guralnik as a grounding force, the show intends to spark conversations about the conflicts and challenges presented by the people who confide in her—and has done so, successfully, for several years now. The question now is how to create a kind of progression, both thematically and logistically. “Initially you’re watching someone, they just seem so different from you, someone that you wouldn’t really connect with,” Altman says. “All of a sudden when you do, I think, that’s the beauty of cinema—to be able to connect and empathize with someone who you might otherwise not.”

In this season’s exploration of monogamy, stretching the bounds of what it means to be a couple in the modern world, we see an advancement. “Myself and the creators of the show, I think we consider ourselves progressives,” Guralnik says. “We’re hoping that the impact is going to be for further inclusivity for people to understand their fellow humans better, to dispel any kind of unneeded biases or alienation or othering that humanity likes to do.” She finds that the longer Couples Therapy goes, the better they’re getting at realizing that mission—thorough therapy, conveyed with a social impact. “It feels like we're doing something that’s a real contribution,” Guralnik says. As to how long she feels she can do it? “I can’t give you a real answer because it shifts in my mind,” she says. “But I feel very committed to it.”