The first night of Couples Therapy explodes with an intense fight between rapper DMX and his estranged wife Tashera. Things are no better between Angelina from MTV's Jersey Shore and her boyfriend celebrity chef Chris Nirschel, who argue in the middle of the night and well into the morning. Dr. Jenn and Dr. Mike are able to calm the couples down and accomplish some meaningful therapy in a group session, and that afternoon a new couple arrives that adds an interesting dynamic to the group. Later, after an intense and emotional therapy session, DMX refuses to attend a mandatory group session, and lashes out at Dr. Jenn and the camera crews.

Tashera struggles to keep DMX from quitting Couples Therapy as he continues to rebel against the strict rules of the facility. Linda Hogan's trust in Charley is put to the test when she reads his Facebook page. Kasey finds a text message on Vienna's cell phone from another guy she's been dating, which sets off an emotional group session, and ultimately leads Kasey to a heartbreaking personal breakthrough, but Vienna's reaction to Kasey's breakthrough threatens to destroy their fragile relationship once and for all.

There's a saying in relationship therapy that things often get worse before they get better, and that's exactly what happens for the couples as they approach the half way point in Couples Therapy. A war between Chris and Angelina erupts once again, this time because of Chris's sexual frustration and an alleged hidden cell phone Angelina has smuggled onto the facility. We learn just how much Reichen and Rodiney have both hurt one another when they finally begin to open up about their painful past, and just when it seems as though Vienna and Kasey are making healthy progress, their relationship unravels, and this time, it may not be repairable.

At this stage in Couples Therapy, Dr. Jenn and her staff start to look closer at the underlying causes of the couples' relationship issues, which often stem from childhood trauma. In an emotional group session, Angelina opens up about her tumultuous childhood and her trust issues with men, Reichen talks about being bullied in grade school for being gay, and DMX shares a horrific story of abuse that has clearly shaped the way he treats women to this day. Angelina's trust issues are tested when Chris receives a questionable card from his manager, and DMX struggles with the idea of facing his estranged mother after Dr. Jenn recommends they reunite and attempt to reconcile.

DMX has a heartbreaking reunion with his estranged mother and confronts her about abandoning him when he was a boy. Chris's manager Nicole flies in from New York to address Angelina's allegations that she's in love with Chris, and a trip to an engagement ring store stirs up some romantic feelings in Vienna, but her feelings are not for Kasey.

Linda Hogan meets with Dr. Jenn to discuss her future with Charley, and the fact that her mother does not support their relationship. Dr. Jenn helps Vienna process her feelings for her ex boyfriend Lee, and they decide that the best course of action is to be honest with Kasey, and to meet with Lee to find out where he stands. Kasey does not take it well, and things take a turn for the worse when Lee arrives.

As Couples Therapy comes to an end, Dr. Jenn and her staff do their best to help the couples resolve their relationship issues once and for all. Vienna has an emotional reunion with her ex boyfriend Lee that forces Dr. Jenn to make a drastic decision. Linda confronts her mother Gail over her lack of support for Charley, and Tashera asks Dr. Jenn for help finding closure with DMX. The couples have an emotional final group session, and that evening one of them pops a very important question.