When I wrote about extra-relationship affairs years ago, I didn’t have a lot of experience treating couples who were struggling with an affair. The written work was more journalistic than clinical, but it made quite a splash in the media as sex frequently does, especially if it touches a nerve, as infidelity is bound to do. I didn’t have enough experience at the time to realize that infidelity is perhaps the most complex issue encountered by couple therapists. The work with couples when it is straightforward, without complication is hard enough, but when infidelity is added to the mix it often challenges even seasoned couples’ therapists. Some examples that have come up and challenged me:

I saw a couple for a few visits, always conjoint. At the first visit, I explained that the alliance was to the couple. Consequently, I asserted, don’t call or text and begin by saying, “Don’t tell my partner, but. . .”

Despite that admonition, one partner showed up alone for a session, contending her mate was called out of town last minute for a business crisis. She then told me she was having an affair. How do I protect the wife’s disclosure while being fair to her husband?

In another instance I was seeing a couple and the wife became aware that her husband had a mistress. At one point, his wife turned to him and stated she was going to the police about some illegal behavior on his part. Her husband responded with a counter threat. “You want to disappear?”

A couple presented with an affair by the husband. He strongly contended that the affair was over and that he had no contact with his former paramour. However, one night I saw the husband at a local bar with a woman who was not his wife; by his contact with the woman, she appeared to be more than a friend. The husband didn’t see me. I was faced with the question, what should be my next move?

A female patient whose initial complaint was relationship issues confided after three visits that the lover she had been discussing was married. She wanted to bring in her lover, stating that he really wanted to leave his wife but they needed to work out some of their differences. How do I respond to the patient and to her request?

And the complications continue. . .

Keeping the potential complications in mind, as well as basic treatment considerations, I recall having a serious case of the jitters on my first national TV program, one of the morning news shows. The focus was infidelity. A split second before we went on the air, I noticed the interviewer’s fly was open. Oddly, that calmed me down. Maybe I wasn’t the only one with the jitters.

After my interview I passed Charles Evers, the brother of the late civil rights champion Medgar Evers, in the hallway, and he whispered to me, “Your numbers are way too low.” He was referring to my estimate of the percentage of men and women in committed relationships who had affairs. He was probably right then and would still probably be right today since most people are apprehensive to admit to having been unfaithful; consequently, even as they are updated from time to time, the published figures are likely to always be an underestimate.

Now, so many years later as a psychologist specializing in treating couples and sexual issues, I have accumulated a few decades more experience. What have I learned that stands out? I’ve learned that it is wise to be prepared for the treatment traps clinicians treating affair-involved couples are likely to encounter. Further, most clinicians, including myself, don’t have all the answers; couples work is not for the beginner. When there is an affair, it requires experience with this issue as well as colleagues to confer with from time to time as needed, in addition to keeping up with the relevant research that applies to practice.

The alliance in couple therapy is to both partners, but what if one partner calls, or shows up alone and confides an affair-involvement, as has occurred to me more than once? The clinician is in a difficult position. During the next conjoint session when the other partner asks of his or her affair-involved partner, “Why is it that I was unable to reach you last Wednesday evening?” I knew and the affair-involved knew. The non- involved partner was looking for an answer that all the others in the room had but were not eager to share.

What to do? As noted, some couple therapists state at the outset, “I don’t want to hold secrets, so don’t tell them to me.” The drawback, of course, is that there may be a major factor that is undermining the relationship, and the therapist won’t be privy to it because the involved member of the couple is reluctant to bring it to the fore.

But even with that admonition what if one partner shares a secret affair? What I’ve learned is to make once again clear to the affair-involved partner that my allegiance is not to him or her alone; it is couples therapy, not individual. Consequently, the couple bond has been broken and we cannot continue unless the affair-involved partner chooses to address the issue with his or her partner. If not, how to tell the non-involved partner that we are not continuing? It’s not my problem; it is up to the affair-involved partner to explain the abrupt termination of treatment—he or she had been warned. I’ve learned not to take responsibility that is not mine and that has not been easy for me, but there are times that being too helpful is not helpful.

I’ve learned that some views of affairs are unconventional but may have credibility, at least to some. I recall sitting in a clinical meeting with about a dozen clinicians from psychiatry, social work, and psychology. A psychologist was presenting a couple’s case and stated that the affair-involved husband contended, when caught, that his affair actually saved the marriage. What? It sounded like he was claiming that an affair was a sacrifice he was making for his family. My first thought was, “No, he didn’t say that!”

However, after I got over the shock and listened carefully, I could see the point. He loved his wife, he had two children, one with special needs, but the marital relationship left him more than a little empty. Couples therapy didn’t improve his satisfaction and divorce was not an option. His wife had a hard enough time coping even with his support; divorce, he believed, would break her. The affair, he claimed, was superficial—can getting naked with someone ever be superficial? —but it provided enough satisfaction to compensate for what he sorely missed in his marriage.

Sometimes a relationship needs three to survive. It is certainly unconventional, but far from rare. Some affairs have run parallel to long-term marriages. Then there are the genetic factors we discussed earlier. We are a product of nature and nurture, but psychologists like me are steeped in the factors of nurture, to the neglect of nature. Some people, men, and women, by nature are not particularly restrained by the monogamous code; he or she will probably be more likely to step out.

We vary in predispositions. Just as some of us naturally tend toward being heavier despite having tried numerous diets, while others have less restraint and stay slender. But is this a pass to those who violate their partner’s trust?

This is not to offer an excuse for the “wanderers,” only to make the point that maintaining a monogamous relationship is more difficult for some, just as other factors are for others. If the marriage is not a close one, these affairs may be unnoticed and without major consequence. They may even have the positive effect of keeping a marriage that is satisfactory in most respects, alive and intact. If the marriage is a close one, a strain, like an undiagnosed virus is going to undermine love, and if discovered, a crisis is likely to develop even if the affair is casual.

Of course, few of those on the betrayal end of an affair will not find anything casual or of minor consequence if it is discovered—and “I’m genetically predisposed to variety” is not likely to go over well with the offended. That’s understandable; the impact is anything but casual. More likely, it is often profound shock followed by hurt and anger. It has also occurred to me, after some experience, that discovery is often not purely accidental. When a man leaves his mistress’s underwear in the trunk of his wife’s car, stupidity is one possible reason, but it is more likely a hidden wish to be discovered, hostility is also likely.

And what about the man I saw several years back who went on a vacation with his mistress and dropped his wife a postcard, signing off, “Wish you were her.” That was the rare instance where one “e” too few changed lives.

As with all things, the prognosis for repair is always more positive if the status was decent beforehand. If the relationship was a mess and then the affair is discovered, it may be beyond repair. However, if the couple is game and will follow a repair prescription faithfully, the effort can result in a stronger relationship than before the affair. That has been my experience many times. In all areas of life, strong, unwavering commitment toward a goal is a very big advantage in the chase for success.

What I haven’t learned is how to help save a relationship when one partner continues to lie in the face of a broken trust. Or how to assist a man or woman who is intent to destroy their life and the lives of their children by continuing in an affair that is like a drug and is likely to end as badly as drug abuse does. Most affairs don’t end in a new primary relationship, and those that do often teeter on the unstable trust that initiated their alignment.

What I do know about what I don’t know is why these failures bother me so much. I lost my father at age four and subsequently, my mother married and divorced twice. It was in Brooklyn, New York, during the 1950s and 1960s when the “D” word was uncommon and support and understanding unknown. I’ve experienced the impact of a broken family and after all my years of working with couples, it still breaks my heart when it occurs unnecessarily.

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Joel Block, Ph.D., ABPP

Joel Block is an award-winning psychologist–excellence in couple therapy–practicing couple and sex therapy on Long Island, New York. Board Certified in Couple therapy by the American Board of Professional Psychology, Dr. Block is a senior psychologist on the staff of the Northwell Health System and Assistant Clinical Professor (Psychology/Psychiatry) at the Hofstra Northwell School of Medicine. Dr. Block is a Fellow of the American Psychological Association (Couple and Family Psychology) and for twenty years he was the training supervisor of the Sexuality Center at the Northwell Health System. Dr. Block is the author of over 20 books on Love and Sex, his specialty.