In this article the authors examine developments in thinking about couple violence and abuse. They also explore the nature and meaning of violence and abuse within couple relationships and outline the conditions for undertaking therapy with such couples. There is a particular emphasis on the social as well as attachment considerations and the psychoanalytic workings of the mind and relationships in context. The predominance of patriarchal models in cultural structuring, where gender roles strongly define modes of family and couple organisation, provides a backdrop to understanding the ways in which couples conduct their relationships, the problematic dynamics that result in violence and abuse, and the ways in which these couples may be helped. A detailed case example brings to life the kinds of problematic couple dynamics that lead to violence and abuse and the ways in which the analyst attempts to provide meaning to their experiences as a means to transform their mostly acted out violence. A discussion between the authors deepens the thinking as well as highlighting clinical considerations and practices.