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In this paper the Author presents one of several cases of couple therapies with couples where one partner suffered from cancer. He shows how the disease is woven into the psychodynamics of the couple and the structure of its unconscious conflicts. A life threatening disease is a challenge for any partnership. It can lead to a stronger connection between partners, but also evoke fear, envy, fury and latent conflicts. As a consequence, the therapeutic needs can be very ­different and the therapist has to be very flexible to adapt to the needs of the couple, in particular according to signs of therapeutic stabilization. The Author also gives some comments on special issues of counter-transference. Preparatory to this, he presents the unconscious love bonding as the basis of couples relations and then five guidelines to understand couples dynamics and put it into a psychoanalytic order. He differentiates: Generations transfer, familial role distribution, modes of bonding, the structural level, the adaptation view. Following these lines he can develop a diagnostic scheme which allows him to understand important psychodynamic patterns and to decide what kind or therapeutic perspective can be put into practice, to conceptualize progression and progress within the therapeutic process.