Risk Factors and Context

Life crises: Illness and disability

Extreme external circumstances can act as catalysts for infidelity.

A frequent clinical scenario is the onset of serious illness or disability in one spouse.

The stress of caregiving, changing roles, and altered body image may lead the healthy partner to seek escape or validation outside the relationship.

Cases have been documented where, following a cancer diagnosis and processes such as a mastectomy, the patient's partner initiates an affair justifying it on the grounds of temporary inability to have sex or rejection of the other's new physical reality.

Similarly, accidents resulting in physical disabilities (such as the loss of a limb) can generate a crisis where the caregiver, overwhelmed by guilt or avoidance of the trauma, seeks comfort or a "normal life" in the arms of a third party.

These situations require extremely sensitive therapeutic management to address the underlying guilt and grief.

Forced or child-bonded marriages.

Another high-risk context is union based on external obligation rather than mutual desire.

Couples that were formed or kept together for religious reasons, social pressure or "for the sake of the children" are breeding grounds for betrayal.

When the basis of the relationship is duty rather than emotional satisfaction, infidelity emerges as an escape route for unmet emotional and sexual needs.

If one partner feels that he or she is sacrificing his or her happiness just to keep the family structure intact, he or she may rationalize the affair as a deserved "compensation" for his or her sacrifice.

In therapy, it is crucial to dismantle the belief that maintaining an unhappy marriage facade is healthy for the children by exploring how inauthenticity and hidden tension (including infidelity) affect the family system.

The dilemma of secrecy in therapy

A major ethical and technical challenge is when the therapist discovers that the affair continues to be active while the couple is in treatment.

The clinical question is: Can couples therapy be done if there is ongoing and secret infidelity? The general answer is that reparative work is impossible as long as the cheating persists, since the emotional energy is divided and the reality of the relationship is falsified. The therapist must handle this information with caution.

It is not his or her role to tell on the patient ("your partner is cheating on you"), but to confront the cheater privately about the unfeasibility of making progress in therapy under these conditions.

Pressure should be exerted for the affair to end or fo