It is the objective of this paper to bring together clinical findings of a study examining the use of emotionally focused therapy for couples (EFT) with couples where one partner had experienced childhood sexual abuse (CSA) and the empirical literature on the relationship between CSA and adult couple functioning. A specific focus was placed on the potential role of mentalizing in furthering our understanding of the challenges that CSA survivors face in their couple relationships and in couple therapy. These clinical findings are suggestive of the possibility that it may be through the mechanism of impairment to mentalizing capacity that CSA survivors develop and maintain distress in intimate relationships and that it is these deficits that may help us understand the challenges CSA survivors face in the process of couple therapy. Clinical vignettes and transcripts were utilised to illustrate this hypothesis.