A diagnosis of breast cancer powerfully challenges a couple’s relationship. This article describes a research project that applied a systemic perspective to examine the ways in which couples adapt to the experience of breast cancer. Twenty couples, all 18–31 months post-diagnosis were interviewed about their communication patterns, beliefs regarding illness and health, problem-solving techniques, feelings of loss and disfigurement, and other topics related to their experience. Results suggest the process of adaptation to be complex and variable. The meaning the couple made of the experience proved critical; the meaning lent coherence and provided direction to the couple’s coping efforts. Optimal couple functioning depended on the couple’s ability to define the experience as “our problem “Couples having a more difficult adjustment lacked a mutually constructed meaning for the experience and were also struggling with an accumulation of stressors and I or illness demands. Clinical implications as well as directions for future research are discussed.