One night after a blowout fight with his fiancée, Josh Perez was lying in bed, typing silently on his phone.

He was searching for contacts for the producers behind “Couples Therapy,” a documentary series he and his fiancée began watching during the pandemic. The show, which follows real couples in the New York area as they undergo about five months of therapy, had become a conduit for having difficult conversations about their own relationship. Perez hoped that being selected for the show could help them even more.

Months later, Perez and his fiancée, Natasha Marks, sat on a couch inside a soundstage in the Brooklyn neighborhood of Greenpoint. Across from them, on a TV set built to look like a therapist’s office, was Orna Guralnik, the psychoanalyst and therapeutic maestro of “Couples Therapy.”

“I guess if I was to sum up why we’re here,” Marks said, searching Perez’s face as she spoke, “we just recently had a little baby boy, and our emotional and physical intimacy, for a while, has taken a tank.”

Across the show’s four seasons — the latest was recently released on Paramount Plus with Showtime — a total of 20 couples and one polyamorous trio have revealed the kind of intimacies that Marks shared for the dissection of Guralnik and, by extension, a national TV audience. Online, the show has an active fandom that probes its relationships as if trading gossip inside a friend group. The attention has left most of the show’s couples grappling with both anticipated and unexpected consequences of televised therapy.

In interviews with six couples who appeared across the first three seasons, many said the prospect of 20 free hourlong sessions with a therapist whose work they could preview on television was a main draw. Before they applied for the show, India Browne and her husband, Dale, were having trouble finding the right therapist who was also covered under their insurance. Struggling with frequent conflict and negotiating the responsibilities of a new baby, the pair was emboldened to take a chance on TV.

“We really need some help, so hey, what do we have to lose?” India recalled thinking at the time.

Some couples were enticed by the idea of working specifically with Guralnik, who, through the show, has become the most well-known couples therapist since Esther Perel. Guralnik’s empathetic, sometimes confrontational exchanges have a way of spreading widely on TikTok, and her persona has charmed a very online, pro-therapy generation.

Attracting applicants largely through social media ads, the show receives thousands of interested couples for each season, said Josh Kriegman, a showrunner who executive produces the show with Elyse Steinberg and Eli Despres. The production offers to interview each couple that applies, and then tests how some fare in filmed practice therapy sessions.

The couples receive small stipends for their involvement. The show typically follows six couples through treatment, ultimately leaving two out of the final product. (The Brownes had hoped they might be left on the cutting room floor.) Sessions are conducted with cameras concealed behind mirrored glass.

“You’re not really thinking about the production part of the show,” Perez said in a recent interview that included Marks. “You just go to therapy.”

For its subjects, the show is an exercise in extreme transparency — including about experiences of addiction, abuse and infidelity — that they describe as both exhilarating and messy, healing and anxiety-inducing.

“This therapy saved our marriage’s life,” said DeSean Dais, who appeared with his wife, Elaine, on the show’s first season. “I was done, I was ready to go. I didn’t see a way forward.”

Their breakthrough came when Guralnik connected Elaine’s history of physical abuse at the hands of a previous partner to her hard-charging need for control. “I had no idea it was affecting her in that way,” DeSean said in a recent interview.

At their home — they moved in 2019 from New York to South Florida — the couple likes to rewatch their episodes, as if reviewing their work to ensure it sticks.

Of course, success in therapy doesn’t always mean staying together. Several of the couples involved have broken up since appearing on the show, including Lauren Guilbeaux and Sam Hopwood from Season 1, which aired in 2019. The previous year, they were searching for a couples therapist when friends of Hopwood sent them the casting call for the show.

Guilbeaux’s initial reaction: “Absolutely not,” she said. As a trans woman, she was wary of TV shows she viewed as exploitative of transgender people and did not want to risk that happening to her. But after Hopwood applied, Guilbeaux began to entertain the idea of appearing on the show. One of the show’s producers, a queer woman, quickly built trust with Guilbeaux, who was also impressed by the showrunners’ previous work, which included the 2016 documentary about the downfall of the former congressman Anthony Weiner.

The televised sessions with Guilbeaux and Hopwood revolved around their disagreements over whether the couple was ready to have children. Hopwood was eager, while Guilbeaux was more hesitant. When the show was released, they were jarred by their sudden exposure, and in the years since it aired, their perspectives on the experience have diverged.

Guilbeaux felt satisfied by the production’s representation of their relationship. Viewers told her the show had opened their minds to the life experiences of trans people, a response that felt fulfilling. She was approached in public by people who said they had been struck by the similarities between Guilbeaux’s relationship dynamics and their own. “That made it all worth it,” she said.

Hopwood, who shared their account of the therapy and its aftermath in an email, said that they felt the show’s narrative had framed them as the “antagonist” to Guilbeaux’s story and that they began questioning the ethics of conducting therapy within a television show, though they emphasized that they had given consent for the process.

At first Hopwood saw the ability to watch their therapy sessions as a gift — a way to understand their own blind spots — but as time went on, they said, “I found myself frustrated that there was a slice of me frozen in time, with very little context, on a public platform.”

“In the end I didn’t feel like anything about the process actually helped my relationship,” they said in another email. “And I’m left to wonder if that’s because the ultimate goal was to entertain.”

Guilbeaux and Hopwood divorced in 2021 and are not currently on speaking terms.

Kriegman, whose parents are both therapists, said the show aimed to capture couples therapy in its natural state, without any reality-TV-style manipulation. If the viewer is truly engaging with the show, he reasons, it will challenge any temptation to judge the subjects.

Still, the producers’ commitment to making a tasteful documentary guided by therapeutic principles doesn’t necessarily mean that viewers won’t treat it like reality television.

Marks said that after their season aired in 2023, she was shaken by some of the social media commentary about her struggles with her sex drive. One faction of commenters blamed it on her being postpartum; another had a baseless theory that she had been cheating.

“I made it a practice to avoid all ‘Couples Therapy’ content for a while,” Marks said.

Even deeper anxieties, some of the couples said, have come not from revealing their private lives to strangers but to real-life family, colleagues and, in one subject’s case, current and past students.

During filming for Season 3, Josh Elson, a high school music teacher, became so worried about the exposure that he and his wife, Molly, told the producers they wanted to quit. They had just had a particularly explosive session, and it suddenly sunk in that their issues could be put out there for the world to see.

Producers met them at a coffee shop in their neighborhood and talked them out of quitting, Molly said, by emphasizing how their story could help viewers navigate their own marriages — and reminding them that they had signed a contract.

“They made us feel like they weren’t going to exploit our story,” Josh said, adding that their decision to continue the sessions was a crossroads, after which the treatment started to come into focus.

Five years in, the showrunners say that what started as a far-fetched experiment has become a well-oiled machine, complete with a sort of instruction manual to teach crew members about the show’s philosophy and how to approach its subjects. “There’s a really intense culture of respect and, really, reverence for what they’re bringing in,” Kriegman said.

Would the producers be open to going on the show themselves? Two out of three said they would.

“I don’t think I’m brave enough,” Kriegman, the holdout, replied.