Infidelity Treatment Patterns: A Practice-based Evidence Approach

Infidelity is a common presenting problem in couples therapy and can be challenging for therapists to treat. The current zeitgeist in mental health delivery systems includes a focus on developing treatment guidelines. The essence of this movement is that therapists' practice be informed by clinical research, or at the very least, be guided by the accumulated wisdom of other therapists. Practice-based evidence has been advocated as a method using a bottom-up approach of gathering data relying on the expertise of practicing clinicians to inform treatment guidelines. The goal of this paper was to distill and disseminate such aggregated wisdom related to treating infidelity into a practice-based evidence model. We reviewed the literature related to the treatment of infidelity and identified a core set of clinical recommendations that was similar across sources. The themes and patterns that emerged are divided into the following areas: goals of treatment, treatment engagement, treatment format, assessment, process and intervention, treatment adherence, and relapse prevention. We present this as a map or guide to treatment than can be individualized to a specific clinical situation, rather than as a specific, step-by-step manualized approach. We note cultural and ethical factors that may be relevant, as well discuss areas of debate and topics for future research.