This article explores current trends in research and clinical practice regarding life‐limiting illness and couple relationships; focusing on intimacy, gender, coping strategies and congruence in perceptions. A case example is used to illustrate how systemic ideas and techniques can help couples address the challenges they face and rethink what they want and need from each other. Practitioner points In all clinical work it is important to bear witness to partners' shared and different experiences. It is also important to reflect on resonances with one's own experiences of loss and illness. Where couples are struggling, systemic techniques offer a way of increasing relational awareness, authenticity and mutuality.