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Practice / Relationships & Couples
Psychiatrist & Therapist · San Francisco

Relationship therapy in San Francisco — individual and couples work that goes below the surface.

Andrew works with individuals and couples in his San Francisco office, throughout the Bay Area, and via telehealth across California. Relationships are where our deepest patterns surface — attachment wounds, communication failures, the gap between how we want to show up and how we actually do. Andrew works with individuals navigating relationship challenges and with couples seeking a clinical space to do real work together. He brings both the psychological depth to understand what's underneath the conflict and the clinical breadth to address what's feeding it.

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What It Looks Like

When something in the
relationship isn't working.

The same arguments cycling without resolution

Emotional distance or disconnection from your partner

Difficulty communicating needs without escalation or shutdown

Patterns in relationships that keep repeating across partners

A growing sense of loneliness within the relationship

Differing needs around intimacy, sex, or closeness

Grief or anxiety after a breakup or separation

Attachment anxiety — fear of abandonment or suffocation

Feeling fundamentally unseen or misunderstood by the people closest to you

Why most relationship
problems aren't about communication.

"Better communication" is the most common goal people name when they come to couples therapy. It's rarely the right diagnosis. Most relationship conflicts are driven by attachment needs that aren't being met — the deeper questions of safety, worth, and belonging that get expressed through argument, withdrawal, or pursuit. Improving communication technique without addressing those underlying dynamics produces surface change at best.

Most couples don't fight about what they fight about. The argument about the dishes or the schedule is rarely about the dishes or the schedule.

Individual and couples work.

Andrew works with individuals processing relationship experiences — navigating a difficult dynamic, understanding patterns that repeat across partners, recovering from a breakup or betrayal — and with couples who want to work directly on the relationship together. Both have significant value; the right format depends on what you're working on and what you're ready for.

The psychiatric dimension.

A significant number of relationship difficulties are shaped by clinical conditions that rarely get addressed in couples therapy: untreated ADHD creating patterns of inattention and inconsistency; anxiety producing hypervigilance and need for reassurance; depression causing withdrawal that a partner experiences as rejection; trauma responses activated in moments of conflict. When these are driving the relational patterns, therapy alone can only go so far. Andrew addresses both. This intersection is more common than most couples realize — anxiety disorders alone affect nearly one in five adults, and conditions like ADHD and depression frequently go unrecognized as drivers of relational patterns (National Institute of Mental Health).

Andrew sees patients for relationships and couples therapy in person at his Pacific Heights office — conveniently located for those coming from Presidio Heights, Cow Hollow, the Marina, and Nob Hill — and via telehealth throughout California.

The relationship you
want is worth working for.

Andrew is accepting new patients in San Francisco. The first call is complimentary — no paperwork, no commitment.

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Questions

Common questions
about relationship therapy.

Anything else — the complimentary phone call is the right place to ask.

Both. Andrew sees individuals working through relationship challenges — a breakup, a difficult dynamic, attachment patterns that keep repeating — and couples who want to work together. For couples, both partners are seen together in session, with the relationship itself as the focus.
A psychiatrist brings a different lens than a standard therapist. When one or both partners are struggling with anxiety, depression, ADHD, or trauma — and those conditions are affecting the relationship — Andrew can address the clinical dimensions directly, not just the relational patterns. This is often where couples therapy stalls when the therapist doesn't have that scope.
Evidence-based couples therapy — particularly approaches like EFT (Emotionally Focused Therapy) and the Gottman Method — has strong outcome data. The research suggests that about 70% of couples show significant improvement. The most important predictor of success isn't severity of conflict but both partners' genuine commitment to the process.
Individual therapy focused on relationship patterns is still highly valuable. Understanding your own attachment style, identifying what you bring to relational dynamics, and building new ways of communicating and connecting can produce real change — even when your partner isn't in the room.
Yes. Andrew works with couples and individuals in all relationship structures, including non-monogamous and polyamorous arrangements, LGBTQ+ relationships, and intercultural partnerships. The clinical space is explicitly non-judgmental about structure — the focus is on the health of the relationships within whatever structure you've chosen.
Clinically reviewed by Andrew Chacko, MD · April 2026