“Oh, no,” says Terry Real, a prominent psychologist and one of a growing number of family therapists speaking out about how couples therapy feels from their chairs. “It’s so much worse.” At the dinner table, Dr. Real explains, you’re just a bystander, collateral damage. In a therapy office, he says, “You’re supposed to do something about it.”

The fact that couples therapy stresses out therapists has long been an open secret. The field, however, seems to have decided that now would be an appropriate time for its practitioners to address their feelings and vent. It started with the November/December issue of the trade magazine The Psychotherapy Networker and its cover package, “Who’s Afraid of Couples Therapy?”

“It’s widely acknowledged that couples therapy is the most challenging,” says Richard Simon, the magazine’s editor. “The stakes are high. You’re dealing with volatility. There are often secrets. We were just trying to make explicit something people who’ve done couples therapy already know: You often feel confused, at odds with a least one of your patients, out of control.”

Part of the problem is that the kind of person who tends to become a therapist — empathic, sensitive, calm, accepting — is generally not the kind of person who is a good couples therapist. “The traditional, passive uh-huh, uh-huh is useless,” Dr. Real says. “You have to like action. To manage marital combat, a therapist needs to get in there, mix it up with the client, be a ninja. This is intimidating.”

“It’s frightening to be faced with the force of two strong individuals as they are colliding,” he says.

Peter Pearson and Ellyn Bader, psychologists and founders of the Couples Institute in Palo Alto, Calif., which offers both therapy and training for therapists, describe the experience of counseling high-conflict couples in equally violent if metaphorical terms, as “like piloting a helicopter in a hurricane.”

Compounding the tender-empath-caught-in-the-crossfire problem, couples therapy, as it is practiced today — one therapist and two spouses together in a room — started in what might be seen as a convoluted way. Before the early 1960s, husbands and wives most typically sought counsel singly, not together; that counsel was provided by a clergy member, a medical doctor or a social worker, and the mode of conversation was didactic (here’s what you need to do), not therapeutic (let’s figure out why you feel so bad).

But then through the late ’60s and ’70s, divorce rates started rising and the field of marriage therapy exploded. Building off the family therapy model, in which families were treated as a whole — or as a system, the term of art — therapists started seeing most couples in pairs. This was a nice enough idea, maybe even a good one, but there was no research to support it. As a result, the practice, known as conjoint therapy, was blasted in psychology journals as “seriously lacking in empirically tested principles” and a “technique in search of a theory.” One theory the field latched onto was psychoanalysis: now married couples had problems because of neurotic interactions and individual psychopathology. (Great, right?)

Another framework came from the human potential movement. Virginia Satir, known as “the mother of family therapy,” was also the first director of training at the Esalen Institute in Big Sur, Calif., where Jack Kerouac and Joan Baez, among others, retreated to find themselves. Ms. Satir claimed that the goal of marriage therapy was “not to maintain the relationship nor to separate the pair but to help each other to take charge of himself.”

Who or what is to be saved or taken charge of remains unresolved in some couples therapy practices. Is the client one of the spouses? Both of them? The relationship? The tangle of needs and obligations can lead to problems from Session 1.

“For starters, there’s an ever-present risk of winning one spouse’s allegiance at the expense of the other spouse’s,” explains William J. Doherty, the University of Wisconsin professor of family social science, in his groundbreaking 2002 article on the topic of awkward couples counseling in the Networker, titled “Bad Couples Therapy.” “All your wonderful joining skills from individual therapy can backfire within seconds with a couple. A brilliant therapeutic observation can blow up in your face when one spouse thinks you’re a genius and the other thinks you’re clueless — or worse, allied with the enemy.”

Timing is also crucial, far more than in individual therapy, and it causes stress for therapists as well. “Let a couple interrupt each other for 15 seconds, and pretty soon you have them screaming at each other and wondering why they need you to do what they could do at home,” Professor Doherty says by phone.

Elizabeth Weil is the author of the new book “No Cheating, No Dying: I Had a Good Marriage. Then I Tried to Make It Better” (Scribner).