This article describes a psychoanalytic approach to understanding and treating couple relationships, developed from the pioneering work at the Tavistock Institute of Marital Studies, now called Tavistock Relationships. The approach focuses on the influence of the past on relationships, the nature of couple relationships developmentally and dynamically in the present, and the potential for the creative development of the couple in the future. It focuses on unconscious elements including shared unconscious fantasy, the wish to repeat from the past, and the wish to create something new. It explores the central role of projective identification and mutual projective systems in couples. It concludes with an illustration of a couple treatment in which repetitive ways based on unconscious gridlock and shared unconscious fantasy are reworked in the setting of the couple therapy.