This study explored therapists’ experiences in treating couples with substance addiction (SA) to understand and identify psychoanalytic therapeutic factors. The study was qualitative, using Interpretive Phenomenological Analysis. Four licensed psychoanalytic couple therapists were interviewed in depth about their experiences when working with SA couples. The eight major findings were:

1. The categorical reminder of the role of countertransference.

2. The complexity of SA symptoms and defenses, and underlying causes.

3. Psychodynamic couple therapy with SA couples is dynamic.

4. Generally, research participant couple therapists do not distinguish the manner in which they conceptualize couples with SA, and couples without SA.

5. The psychoanalytic, behavioral, and disease model of treatment are all interrelated when treating SA couples.

6. Psychodynamically, research participant understanding of SA couple therapeutic factors are not distinguishable from those deemed therapeutic when working with non-SA couples.

7. Psychodynamically, research participant understanding of the markers of change in SA couples is not distinguishable from those of non-SA couples.

8. Conceptualizing and treating SA through a narrow lens is restrictive.

Conclusions and recommendations based on the findings were offered.