The myth of therapist neutrality was first exposed back in the 1970s, when feminist therapists noted how many clinicians looked the other way when women got the short end of the relationship stick. But the therapy field has been slow to deal with a broader implication: that many issues clients bring to therapists have ethical dimensions, and that clients often struggle with ethical dilemmas, or situations in which their actions have consequences for the well-being of others. I use the term ethical consultation for the intentional and skillful exploration of these ethical dilemmas in a session—as opposed to simplistic exhortations by therapists to either “do what feels right to you” or “do the right thing.”
Here, I talk specifically about ethical consultation with clients who are having secret affairs. Not the aftermath of an affair (the standard fodder for therapy literature), but good old-fashioned cheating and lying about it to a mate who assumes there’s just one couple having sex in the relationship. Of course, there are lots of clinical issues for the therapist to explore, but the ethical dimension is inescapable.
Take the case of Cheryl, who was married to her husband for 17 years and had two teenage children. About a year before our consultation, which was requested by her therapist, who felt stuck with the case, she’d begun an affair with a man she knew professionally. Now, she was paralyzed about making a decision on whether to stay in her marriage or move to another town to be with him. Her job took her out of town about once a month, when she and her lover would get together for great sex and conversation. He’d started divorce proceedings with his wife and was pressing Cheryl for a commitment to leave her marriage and be with him. As we began our conversation, she said she was experiencing a “churning dilemma.”
When I asked about her marriage, she said her husband was a good man—kind, loving, supportive—but the marriage lacked passion for her. She believed they were doing a good job of raising their children, but she’d felt emotionally empty for years. Their sexual relationship had become infrequent and unexciting, and, she said, she deserved more out of life and marriage than she felt she could get from her husband.
Fear of hurting her children was keeping her from leaving. They’d be devastated, she believed, especially if she moved away to be with her lover. After years of enduring a loving but passionless marriage, she felt that she’d come alive after being kissed by this man.
As I listened to Cheryl, I noted how supportive she said her husband was—a good guy with interests different from hers. If she’d told me her husband was violent, addicted, or chronically irresponsible, I’d have thought about her situation differently because sometimes starting an affair is a wake-up call to consider getting out of a destructive marriage. Either way, though, continuing an affair creates damage to the spouse who’s being lied to, and there’s the risk of transmitting an STD. So multiple ethical issues were at stake in my consultation: the marital commitment, the secret affair, and the potential consequences for a number of stakeholders.
I saw Cheryl as operating out of what I call a “consumer” approach to marriage—focusing on what benefits she wasn’t receiving from her husband and not on what she was failing to put into the marriage. And I believed harm would come to her children and husband if she were to end her marriage at this point. As I listened to her, I reflected on the research demonstrating that the children who experience the most harm from divorce are those whose parents have had relatively harmonious marriages, even though not especially happy or intimate.
Cheryl struck me as a caring, sensitive person, but she spoke about her desire as if it were a constitutional right, like freedom of speech, and her emotional needs as if they were biological facts, like needing vitamin C to avoid scurvy. Our culture teaches us that we’re all entitled to an exciting marriage and great sex life; if we don’t get them, we’re deprived and permitted to go elsewhere to meet our needs. What used to be seen as a weakness of the flesh has mutated into an entitlement of the psyche.
Although it lurks inside most married people in our mainstream culture, the consumer attitude doesn’t usually become apparent until we come face to face with our disappointments about our marriage and our mate. Then we start to ask ourselves, “Is this marriage meeting my needs?” and “Am I getting enough back for what I’m putting into this marriage?” In Cheryl’s case, she’d told herself for years that she’d “settled” for a second-class marriage for the sake of the kids.
During the first 20 minutes of the interview, I focused on helping Cheryl explore the implications of the affair and leaving her husband for her well-being. Using the metaphor of the affair as a vacation paradise, an exotic island where no one can actually live permanently, I tried to undermine the fantasy of a blissful new love relationship that would never encounter a decline in passion. I also presented a scenario in which she could see rebuilding her marriage as a positive option for herself instead of a sellout of her core personal needs. Because she’d eventually end up on the “mainland” anyway—in a long-term relationship, with its daily responsibilities and challenges—why not figure out how to have a satisfying marriage with her current husband? She said she liked that option but doubted it was possible.
Toward the end of this first part of our conversation, Cheryl explicitly said that she’d consciously chosen the affair and was no longer “a good girl.” I know how I’d have handled this comment in the 1970s: I’d have encouraged her to challenge the way society or religion or her own rigid conscience were defining her as no longer “good.” I’d have supported her heroic efforts to break out of the mold of following other people’s expectations for her.
Instead, I let her remark pass without comment or follow-up. Given the urgency of her decision-making and the high stakes, I moved the conversation to the realm of interpersonal ethics—how her behavior and decisions might affect others in her life—rather than focusing on her claims to authenticity and rebellion from conventional standards. Future therapy could return to the theme of her being a good or bad girl to see whether she could integrate these parts of her identity. For now, I wanted to shift her gaze outward, rather than inward.
In a pivotal part of the interview, I summarized and validated the aspect of her decision associated with her self-interest and then asked her to reflect on the consequences of her leaving.
“Okay. So, there are two parts of this,” I said. “One part is where you might have your best chance for personal happiness—to live in this new relationship so the next part of your life may give you more joy. And then the other part of the decision concerns the consequences to different people.”
“Yes, I know, I know,” she responded.
“So, let’s talk about that part of it. For example, how do you think a divorce would affect your children?”
This question represents a core part of ethical consultation: asking about how the client’s actions might affect the welfare of someone else. I’ve never had pushback from this kind of question, delivered in a plain, matter-of-fact manner. Why not ask? Nearly all clients have already been asking themselves this question, some for quite a while. How would this affect someone else? is the quintessential ethical question.
Cheryl didn’t even let me finish the question: “Oh, the consequences would be devastating,” she said. We explored her sense of those consequences, especially for her children, and I affirmed my concern as well. The next key moment in the interview followed my statement that it’s possible for couples who work at it to “have the kind of energy and passion that’s truly fulfilling—not the same as that of a new relationship but the kind of passion that, after 10 years or 15 years or 20 years, you say, ‘Wow, this is good.’”
“Yeah, see, I can’t believe that’s possible,” Cheryl replied.
“In your marriage?” I queried.
“In my marriage, right,” she said. “So, tell me more how to do that.”
At this point, I had an okay to lay out a path in which Cheryl would end the affair definitively and tell her husband that their marriage had been in grave danger and that she’d had an affair. A little later, when she challenged the idea of telling her husband about the affair, I said that I didn’t have any firm rules about this sort of thing, but that my sense was that this level of honesty would give both of them their best chance to make some major changes.
During the remainder of the interview, I tried to undermine Cheryl’s sense of fatalism that her husband couldn’t change. I challenged her passivity in the marriage and her unrealistic beliefs that, somehow, her husband should respond with grand, dramatic, romantic actions to her ambiguous, half-hearted gestures toward improving their relationship. Near the end of the session, I repeated the theme that Cheryl, at some point in her life, would have to do the hard work of maintaining an intimate marriage, even if she left her current marriage for her lover.
“So, I might as well do it in my marriage because we’ve got history in the marriage, and it would be hurting so many people for me to leave,” she responded.
“That’s for you to decide,” I said.
“That’s for me to decide, yeah,” she agreed.
“But that sure makes sense to me,” I concluded. I reaffirmed her autonomy in this important decision while gently supporting the direction in which she appeared to be leaning. I then encouraged her to work through the decision with her therapist, who’d asked me to see her for a consultation.
Cheryl ultimately ended her affair and started working on her relationship with her husband—though not without sadness about letting go of the dream of a new, permanently passionate love affair. Then an emotional crisis with one of her children helped rivet her attention back to her family. She recommitted to her marriage when she understood what was at stake: a long-term marriage, a husband who loved her, and children who depended on that marriage. In the end, she came to see that she held citizenship papers in her marriage and only a tourist visa in her affair. When I followed up with her therapist a decade later, I learned that both she and her husband had made changes, and that the marriage was doing well.
The Clinical and Ethical Complexities of Affairs
In addition to divorce decisions, affairs may be the main ethical issue that therapists encounter in the everyday practice of adult psychotherapy. There’s extensive therapy literature on how to help couples recover from an affair and lots of lay literature on how to recover from a spouse’s affair, but little on how to counsel a married (or similarly committed) person who’s in the midst of an affair or reflecting on a past affair.
It’s clear that most clients think of their affairs in ethical terms, even if therapists prefer to think about them just clinically. Even as our society has become more accepting of sexual behaviors previously disapproved of—such as nonmarried sex and same-sex relations—the level of disapproval for extramarital sex remains high. I think the reason is that, for most people, extramarital sex in the form of secret affairs is seen as a unilateral cancellation of a core part of the marital agreement: sexual fidelity. Even couples who practice polyamory have agreements about how, when, and with whom they’ll have outside sexual relations—in other words, they’re not engaging in secret cheating.
And then there’s the issue of emotional affairs. During my training, we didn’t have a clear concept of marriage-threatening relationships that were not sexual. In those more gender-separate days, we debated whether it was possible for men and women to have close friendships that didn’t move into the sexual domain. (In the “heteronormative” world I then lived in, we didn’t consider the question of nonsexual friendships for gay people.) Nowadays, there’s lay and professional awareness that married people can get into close relationships that undermine their primary relationship without being explicitly sexual. In many cases, the people involved tell themselves that it’s not cheating on their spouse. But the effect on the spouse and the marriage can be similar when the other relationship becomes emotionally more salient and rewarding than the primary relationship—or when the other person becomes a competitor with the spouse in other ways without the spouse knowing it.
In addition to entering a relationship that can threaten marital commitment, the main ethical dimension of emotional affairs comes in the form of lies and secrecy about the existence or importance of the other relationship. For example, a husband, when describing his day at work, omits the long cappuccino break with his coworker. Or a wife, when listing which colleagues are going on a business trip, leaves off the name of someone she’s particularly looking forward to spending time with. Texts arriving at home from that coworker or friend are reported as coming from a relative. For a time, the spouse is in the dark about the other relationship, and when they begin to express worries, their mate denies or minimizes. Thus, deception becomes part of the fabric of the marriage in a way that ethically compromises the spouse having the emotional affair.
Ignoring the Ethical Dimension of Affairs
It’s possible for therapists to see themselves as doing good therapy while disregarding the impact of a client’s affair on others. In the mid-1990s, there was public discussion of the secret affair of Woody Allen and Soon-Yi Previn, the 19-year-old daughter of Mia Farrow, his long-term partner—which eventually led to a divorce from Mia and a marriage to Soon-Yi. A major issue in the custody trial over the younger children was Allen’s fitness as a parent. According to a New York Times journalist who covered the proceedings, it didn’t go well for the therapists who were called as expert witnesses. When pressed by an attorney about whether they thought it was wrong for someone to have a secret sexual relationship with a spouse’s daughter, the therapist witnesses would not give an ethical opinion. In language that reminded me of witnesses during the Watergate hearings of the 1970s, they talked of “error in judgment” and “a mistake under the circumstances.” One therapist even explained the unusual sexual arrangement as a reflection of “the postmodern family.”
At that point, the exasperated judge sternly cut him off with these words: “I find it extraordinary the words that therapists use who come here, and they can say ‘bad judgment’ or ‘lack of judgment.’ But isn’t there something stronger? You went through the ‘postmodern structure of the family’ and types of relationships. We’re not at the point of sleeping with our children’s sisters. What does it mean?”
Here’s my take on this embarrassing scene. These therapists, invited to testify because they were experts, were in a bind. They likely saw ethical language and moral judgment as inconsistent with the therapist’s role. Thus, if they’d used moral/ethical language in responding to questions, they’d be acting unprofessionally. In other words, if a true therapist is value neutral, then using value-laden language about someone’s behavior means you are not a good therapist, let alone an expert one.
Several years later, I had a chance to comment publicly on the Allen case. I was doing a New York public radio interview in which the interviewer mentioned the Allen case and asked whether I had ethical qualms that I’d have addressed if I’d been Allen’s therapist. I responded that I’d have raised the issue and pressed it, even if he dismissed my concerns about the impact of his actions on his stepdaughter, his wife, and the rest of their children. The interviewer was with me all the way and said he’d be appalled if a therapist saw it as not their role to invite a client in Allen’s shoes to examine the moral dimension of his actions.
It turned out that the first caller to the radio show was also appalled—by my stance! She said she was a psychoanalyst fully committed, not to judging clients, but to helping them explore the psychological dynamics of their life choices. The interviewer took her on, asking her whether she’d remain silent about the train wreck that Allen’s behavior was risking. She replied that challenging a client about their impact on others was not her job, and that doing so was bad therapy. She then added that if Allen’s stepdaughter had been under age 18, it would have been a different matter: the therapist would’ve had a duty to report this as child abuse. I then asked whether the difference in the therapist’s stance was based solely on whether the person harmed was under or over age 18. She replied, “Yes.” For me, this is a substitute of law for ethics without understanding the moral underpinnings of the law itself.
In fairness, I can see that, absent a process for doing sensitive, skilled ethical consultation (skills not taught in the field), entering the ethical domain with clients would threaten a core mission of therapy: to help clients make meaning of their actions and live self-determined lives. If the choice feels like being silent about (nonviolent) harm to others in clients’ lives versus alienating and losing the client by judging and moralizing, it’s probably better to remain silent and hope the client comes to make ethically sound choices through the normal process of therapy. But silence has its costs. We’re all meaning-making creatures, who deal regularly with issues of right and wrong, of self-interest and responsibility to others. Psychotherapy is sapped of healing power if it ignores this ethical dimension of our clients’ lives. There’s no separating psychological well-being from the client’s experience of ethical integrity.
Strategies for Ethical Consultation about Affairs
In focusing on ethical dimensions of working with married clients (or those in a similarly committed relationship) who are currently having a secret affair, I use an approach I think of in terms of the skills of LEAP-C (listen, explore, affirm, offer perspective, and challenge).
Listen. The key here is to listen for whether the client expresses guilt or remorse for the affair in terms of their value system and the impact of the affair on the spouse and others. I’ve found that most clients spontaneously express moral concerns about their affair—for example, “I never thought I’d cheat on my wife,” or “I feel great when I’m with her and guilty when I come home.” It’s also important to hear when the client expresses no spontaneous remorse, but instead stays mired in complaints about the marriage and what it’s been like to live without sex, affection, and so forth. Because guilt is often intertwined with resentment toward the person we feel guilty about, sometimes all that comes out at first is the resentment (“Having no sex drove me to do this”), with guilt emerging only later in the conversation.
Explore. When the client spontaneously expresses guilt or remorse about the affair, you can explore the meaning and other emotions involved. Unless the client is collapsing into self-loathing (“I’m a horrible human being and don’t deserve to be married”), be willing to stay with the guilt as opposed to just noting it, normalizing it, and then immediately moving on to more comfortable therapeutic terrain. For example, “When you say you feel bad about what you’re doing to your marriage, could you say more? What effects do you see or worry about?”
The client may worry about consequences for the affair partner, and this is also grist for ethical consultation. Perhaps the affair partner is also married or expects that the affair will lead to a long-term relationship that the client doesn’t see happening. Although this is important, I recommend being careful about equating effects on the affair partner with those of a spouse who has probably built a life around an expectation of sexual fidelity.
When the client’s ethical concerns are fully part of the conversation, you can go back and forth between the meaning-making about the affair and the ethical consequences. For example, you can explore the client’s feelings of loneliness and sexual deprivation as a source of the affair, and then switch to how the client feels about the solution to that problem via an affair that ends with remorse and other potential damage. Both sides of this dilemma are real.
I never suggest that the factors that led to the affair are a full justification for the affair. I frame them as influences and risk factors (such as a midlife crisis related to job loss and plummeting self-esteem), but not as determinants. The same goes for a sexless marriage: it’s certainly a predisposing factor, but there are other ways to deal with the problem. It’s important that the therapist not accept that the client has no agency about the affair: it’s a choice among several possible choices.
If a client has not expressed regrets or concerns about the consequences of the affair for the partner, you can ask questions to elicit that concern. I sometimes start with an empathic connection and then ask, “I hear you on how unloved and frustrated you’ve been in your marriage, and that led you to have an affair. I also want to ask you whether having an affair is consistent with your values and how you see yourself.”
Affirm. In my clinical practice, clients generally have said that cheating on their spouse compromises their values, that it’s not who they are or want to be. In some cases, this sense moves them to consider ending the affair, while in other cases, it moves them toward divorce (or ending a committed relationship) because they no longer want to feel morally compromised. In either case, I affirm the client’s sense of disjuncture between how they’re living and how they believe they ought to be living: “I appreciate that you never thought you were the kind of person to go outside your marriage,” or “I’m glad that you’re thinking about how your wife is going to be affected when she finds out about your affair.”
What if a client blames the spouse so much that they express no remorse for, or even ambivalence about, their affair? I’d ask how they’d feel if the partner spouse cheated on them and see whether that could generate a deeper conversation. If nothing else, I might be able to affirm that the client was troubled enough to see me and tell me about their affair.
Perspective. Clients having affairs often need ethical perspective from their therapist, partly because affairs can be so emotionally powerful that a balanced personal perspective is hard to come by. Again, the rhythm of the ethical consultation is to go back and forth between the client’s emotions and meaning-making about the affair, including what the affair is doing for them, and the consideration of its effects on others. For the latter, here are perspective comments I often make when the client appears not to be seeing what’s involved for their spouse. The craft here is to introduce these perspectives in a low-key way, rather than an emphatic one.
–“I’ve learned that for a lot of people, the hardest part is realizing that they’ve been lied to over and over; they don’t know what’s real any longer. I imagine you can understand what that would be like.”
–“In my experience, at some point, ongoing affairs tend to come out. When that happens, your wife will be in a world of hurt that you’ll have to deal with in some way. I’m sure you’ve thought about this. I’m just putting it on the table.”
–“I do think at some point you’re going to have to make a choice about keeping your marriage or staying in your affair. There’s a saying about a man with a foot in two canoes. They can stay together for a while, but at some point, they split apart and he’s got to jump into one. I know this is hard.”
A final element of perspective-giving concerns is whether to tell the spouse about the affair. This is a complicated matter, which therapists differ on, with some believing in full disclosure of any affair, past or present, and others encouraging not sharing. I don’t have a definitive viewpoint on this matter because of the complexities of each couple’s situation, but it’s important for the therapist doing ethical consultation to have something meaningful to share with clients who seek input. Here’s my perspective on disclosure.
On one end of the continuum are affairs of the distant past. I see little usefulness in doing what one elderly client of mine did when he thought he was on his deathbed: tell his wife about an affair with a friend of hers 40 years ago. She was devastated and had trouble forgiving him after he recovered. I helped him see that although he felt a need to “confess” his transgression, it would have been better to share his secret with someone other than his wife.
On the other end of the continuum is a current affair that’s threatening the survival of the marriage because the marriage is on shaky grounds, or the affair partner could become a new mate. Knowing that the final decision is the client’s, not mine, I’m apt to support disclosure here, so that the spouse understands a key reason the marriage was on the brink and can make an informed choice about whether to work on saving the marriage. Healing will be needed, hopefully in couples therapy, but at least no more secrets will be hiding under the table.
Between those relatively clear cases, there is the murkier territory of disclosure that comes down to risks and benefits of full airing for those involved. The decision is up to the client. We offer perspective, but do not get a vote.
Challenge. Sometimes, after spending a good deal of time using the LEAP skills (and after a good therapeutic alliance is in place), I decide to move from perspective to challenge on the issue of affairs. The criteria for using ethical challenges are when the client has a big blind spot, isn’t seeing the immediate harm to someone, or is acting in a way inconsistent with their values. I recall working with a middle-aged woman, Susan, who was having a torrid affair with a man whom she described as “a dirtbag” in terms of personality, but who was sexy and told her he adored her. She told me that her husband, who tended to be jealous, was getting suspicious. She knew what she was doing was wrong but didn’t think she could reveal the affair and then keep a promise to end it. At a meaning-making level, it seemed clear that Susan craved affirmation for being lovable and sexy.
When delivering a challenge, I often begin by framing it in terms of concern for the client. In this case, “Susan, I’m worried for you right now. You’ve said that this affair is doomed because you don’t really respect the guy, and there’s a crisis coming if and when your husband finds out on his own. It feels like you’re playing with fire here.”
A similar challenge technique is to invite the client to imagine a future self, who’s looking back at the current self and the situation: “What would your future self say was the right thing to do?” Even stronger would be, “What do you want to be able to say to your children, if you and your wife divorce, about how you handled this critical moment in the life of their family?”
It’s important to end a challenge with a reaffirmation of the client’s autonomy in making their own decisions. I sometimes say it this way: “I appreciate how you’ve taken a hard look at what’s going on for you right now and that you’ve let me push you a bit. However you decide to move forward, I’ll be here for you.”
Infidelity is a quintessential ethical issue because it seriously affects the welfare of someone else. An ethically informed psychotherapy accepts the reality that once you’ve committed to being faithful to another person, your sex life and romantic life are not just your own. Working only from a perspective on the individual client’s self-interest limits the potential of psychotherapy to be a venue of healing and growth and, in a larger way, contributes to the erosion of communal bonds in society.
Once we accept the notion of the relational self that inherently involves responsibilities to others, the challenge becomes how to incorporate this perspective into everyday practice in a caring, skillful, and seamless way that clients experience as normal, helpful therapy and not some jarring switch into the territory of judgment and prescription. If this kind of integrated ethical consultation can be effective with clients having affairs, it can be useful with any client and any issue.
From The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy (pp. 73–88), by W. J. Doherty. Copyright 2022 by the American Psychological Association. Adapted with permission.
PHOTO © ISTOCK/PONYWANG
William Doherty, PhD, is professor of family social science and director of the Minnesota Couples on the Brink Project at the University of Minnesota. He’s the author of the forthcoming book, The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy.