Summary This paper argues for the value of an adult developmental perspective in work with lesbian couples. Focusing on midlife, case examples illustrate issues and situations that create strength and satisfaction, as well as those that create stress and disappointment. Key themes include expansiveness and generativity, differentiation, awareness of past and future, reorganizing priorities, finitude, caregiving stress, infidelity, midlife crisis, self-growth, and the different impact of homophobia on three cohorts of midlife lesbians. Implications for therapeutic intervention are described, with particular emphasis on case formulation and treatment planning that explicitly provides couples with an understanding of the sociohistorical and adult developmental context in which their difficulties arise.