For over fifty years the concept of the “internal couple”, as a composite internal object co-constructed in intimate relationships, has been fundamental to a psychoanalytic understanding of couple relationships and their contribution to family dynamics. Considerable societal change, however, necessitates review of how effectively and ethically the concept meets practitioners' and couples' current needs. Does the concept of an internal couple help psychotherapists to describe and consider all contemporary adult couples, whether same-sex or heterosexual, monogamous, or polyamorous? How does it accommodate online dating, relating via avatars, and use of pornography? Is it sufficiently inclusive of those experimenting in terms of sexual and gender identity, or in partnerships that challenge family arrangement norms? Can it usefully support thinking about families in which parents choose to parent alone, or are absent at their children's conception thanks to surrogacy, adoption, and IVF? These and other questions prompt re-examination of this central concept's nature and value.