Beyond a single affair: How to heal when sexual behavior is compulsive, featuring Michele Saffier
Table of Contents
What does treatment look like for a single, vs chronic affairs?
How does treatment unfold when there’s been chronic sexual behavior?
Relationship therapist Esther Perel is known for polling audiences during her talks. Perel would ask: “how many of you have been affected by the experience of infidelity in your life?” and about 80 percent of people would raise their hands.
Infidelity is not uncommon. And yet, many couples do want to reconcile after an affair has surfaced. Despite cultural condemnation towards cheating, when couples are in long-term relationships (and especially when children are involved), there is a lot of incentive to try to find a way through this major relationship upheaval.
And it’s not uncommon for me, as a couples therapist, to receive panicked inquiries from clients who want to meet ASAP because they’ve just experienced a major earthquake in their relationship and they are in a full-on crisis.
But here's what I've learned: not all infidelity is the same. A single affair requires a very different approach than discovering a pattern of chronic betrayal. And when sexual behavior has been compulsive—happening repeatedly over months or years—couples need more than traditional therapy. They need a specialized protocol.
Treating infidelity is the specialty of Michele Saffier, LMFT-S, CSAT-S, a licensed marriage and family therapist who is also a certified sex addiction therapist. Michele is a wealth of information as she has more than three decades of experience treating this population and she has also written a book with a specific protocol to help partners through this tumultuous time.
I interviewed Michele to learn what couples need to know when infidelity has been chronic, how treatment unfolds differently for compulsive sexual behavior, and why the right therapist—with specialized training and a specific protocol—makes all the difference in whether healing is possible.
How is the scope of betrayal determined?
When Michele begins working with a couple where news of an affair has surfaced, she conducts a careful assessment to understand the scope of betrayal. This is important because there is a major difference in the course of treatment for a single affair, versus a chronic history of infidelity.
“I do a four-step process, starting with a couples session, then I see each person separately, and then end with a couples session. So it’s a four-step assessment process,” says Michele.
“When it’s a single affair,” she says, “I want the couple in together and the primary treatment is couples therapy because we have to create trust, commitment, and wade through the disclosure and discovery.”
Usually within that assessment process (which typically takes about 3 weeks), Michele can get a more detailed picture, and she conducts a sex addiction assessment on the betrayer. Michele uses the SDI (sexual dependency inventory) assessment tool, as well as an ADHD screen and PTSD inventory.
“If there’s been more than one affair,” Michele shares, “if it’s been chronic, then we may be looking at compulsivity. That is a whole other layer, really many layers in terms of childhood trauma and attachment issues, and often an attachment disorder with chronic behavior.”
What does treatment look like for a single, vs chronic affairs?
So while couples therapy is appropriate when there’s been a single affair, a much more specialized approach is necessary for sexual behavior that stems from compulsivity.
“In cases of compulsivity,” Michele says, “there’s usually an anxiety-based or fearful-avoidant attachment style. So, when it’s chronic, in that fourth session I’ll tell them what I see: compulsive behavior. Instead of ‘sex addiction’ I prefer the term ‘compulsive sexual behavior.’”
Michele uses that term because it separates the behavior from the person. She says: “it helps to hold the integrity of the humanity of the person, and not to label them. I wouldn't want to be identified by my most shameful behavior.”
In that fourth assessment session, it can be a mix of fear and relief for the betrayed to find out that their partner has compulsive sexual behavior. However, it can also activate the part of the betrayed that has an obsessive need for information.
Michele explains: “So there’s this need for information (for the betrayed), and the need to hide (because of the shame for the betrayer). So, how do we help everyone? Everyone gets therapy.”
How does treatment unfold when there’s been chronic sexual behavior?
For cases of compulsive sexual behavior, Michele recommends that each individual see a therapist (ideally a CSAT – certified sex addiction therapist), in addition to meeting with a couples therapist, and each should attend a group as well.
“Everyone gets help immediately,” says Michele. “Couples therapy can be every other week, could be once a month, it’s really hard for them not to have a place to talk. And it’s mostly for boundaries, structure, containment and crisis management.”
When it comes to the role of individual therapy during this process, Michele shares: “For the betrayer, their individual therapy is traditional sex addiction treatment, which is cognitive behavioral therapy based and a very specific treatment protocol. If they are seeing a CSAT, it’s a 30-task model that’s broken down into four stages. This is a huge undertaking, and we want them to get tons of support. So in addition to individual therapy, we want to see them in group therapy, two to three 12-step meetings per week, they have a sponsor, they work the steps, there are two workbooks that we use. And they are doing homework – so there are seven things they need to do. And, it’s not a buffet. You have to do everything.”
For the betrayed, Michele developed her own seven-task model that can be found in her book, Ambushed by Betrayal: The Survival Guide for Betrayed Partners on Their Heroes' Journey to Healthy Intimacy. “Ultimately,” says Michele, “it’s self-agency and empowerment. That’s the goal. My book has a workbook component, and it’s very experiential.”
For the betrayer: “The goal is to keep them out of their feelings as much as we can. We want to keep them in their head – reading, thinking, answering questions, responding to the next exercise, talking in meetings – because intense emotion is what causes acting out.”
Are emotional affairs just as damaging?
I asked Michele about her take on emotional affairs, and she told me the story of a couple she’s currently seeing where the husband has had four emotional affairs.
“He’s never touched, kissed or done anything physical,” Michele explains. “I don’t believe he’s even looked at pornography. And his wife is just as devastated as any other wife (or partner) I’ve worked with.”
Michele says that emotional affairs can even feel more egregious because it’s not just about sex. “It was much more intimate than a one-night stand. And when there’s more than one affair, then I still want to assess for compulsive behavior.”
Why does sobriety matter so much?
“When it comes to sex and food addictions,” says Michele, “they are the most primitive forms of self-soothing. They suggest really early traumas.”
When Michele is working with a couple in this context, she has them sign a 90-day sobriety contract. She says: “We are taking sex off the table because for some betrayed partners, it’s what they use to hold onto the person. Their belief is that if I have sex with them, they won’t want to find it elsewhere – as if they can control it. We don’t want makeup sex. People have really good sex when they just discover, which is kind of crazy in a way, but it’s the fear of abandonment and the fear of not being enough. Plus, we want them to stay sober so we just want it off the table.”
That benchmark of 90 days is not arbitrary. Michele explains: “90 days sober can start rewiring the neurochemistry around addiction. The neural pathways start to prune away.”
During these 90 days, the approach for the betrayed partner is to help them regulate. Michele explains: “The betrayed has so much emotion. There will be crisis management work, down regulation, breathing, mindfulness meditation, yoga. I use psychodrama to help them release the pain and anger, and I’m an EMDR practitioner. You start with trauma work for the betrayed, and you delay trauma work with the betrayer. They have to get sober first and need ground under their feet before doing the trauma work. There’s always trauma under addiction.”
What’s the underlying relationship dynamic?
As a licensed marriage and family therapist, Michele has been trained to view relationships as systems. There’s a common dynamic that she observes in couples where there has been chronic infidelity.
“What we’ll see in these relationships is that there are conscious and unconscious fears,” says Michele. “For the partners – their overt fear is abandonment. So they freak out when they hear they’ve been cheated on. Their covert fear is intimacy.”
“For the person with the compulsive behavior, their overt fear is intimacy, and their covert fear is abandonment. It’s really an interesting dynamic.”
How do couples build a new relationship after betrayal?
“I think of it not as rebuilding," Michele shares, “but just building from scratch. Gottman talks about a relationship house, which I like. We need to build a new foundation and load bearing walls. Trust, friendship, fondness, and admiration to me are the bones of a healthy relationship.”
“You don’t want to build a house on a cracked foundation,” she says, “so there’s also grief work in that reconciliation process. I’ll do a funeral for the relationship, a burn ceremony and a whole thing. It’s not just a concept, it has to be felt. Grief is a felt experience. In order to grow, they have to be able to feel that sadness and intentionally mourn.”
Michele uses a three phase model to help couples build this new relationship: forgiveness, exoneration, and reconciliation.
“At this stage, we want to establish transparency and honesty,” says Michele. “We really can’t do reconciliation work until there’s been disclosure and healing so they can have an interest in why the other person did what they did. We help couples understand the trauma that led them to do such extremes.”
“When we can get that,” she explains, “we can get empathy from the betrayer – which doesn’t happen for a while, they need to develop it for themselves before they can have empathy for their partner.”
What are some steps to create healthy sex and intimacy?
“Sex isn’t optional; it’s part of our being, our passion, our lust for life and for other,” says Michele. “Procreation, everything. It’s just like food, we have to have a healthy relationship with it.”
“With alcohol,” Michele says, “recovery is sobriety. With sex addiction, recovery equals connection. When someone is connected to their partner, they are unlikely to act out. The conditions aren’t there, they aren’t feeling that abandonment.”
When Michele works with couples on how to have healthy sex and intimacy, she recognizes that there are moving parts that need to be in motion simultaneously. “They are doing their trauma work so they are open to intimacy, and rewriting their story. Their work with IFS (internal family systems) helps them to understand a sense of self, and we help them establish compassion so that they can connect.”
Key takeaways
Here's what you need to know if you're facing chronic infidelity or compulsive sexual behavior in your relationship:
Not all infidelity is the same. A single affair needs couples therapy. Chronic betrayal likely involves compulsive sexual behavior and requires specialized treatment with a CSAT.
The protocol is intensive—and non-negotiable. For compulsive sexual behavior: individual therapy, group therapy, 12-step meetings, sponsorship, workbooks, and a 90-day sobriety contract. It's not a buffet—you have to do all of it.
Early couples work is about containment, not connection. In the beginning, couples therapy focuses on crisis management and boundaries while each partner does their own intensive individual work.
Healing means building something new. This isn't about going back to how things were. It's about grieving the old relationship and intentionally creating a new one with healthy intimacy.
Recovery is possible—with the right support. Michele has seen couples heal after decades of betrayal. The work is hard, but if both partners commit to the protocol, there is real hope.
Michele is such a valuable resource when it comes to this very specialized work of healing from betrayal. But what surprised me during our chat was her tone of hopefulness; she has witnessed couples who have been determined to heal. Michele told me a story of a couple who had been together for 35 years, and it came to light that the husband had been cheating that entire time.
“For the first two years of treatment, they worked their butts off,” Michele shared. “They did two hours of couples therapy a week, two hours of individual therapy, and group therapy. Now it’s three years later and they are not in therapy.”
“While the husband is more reflective and pensive – there’s a lot of sadness in what he lost while acting out – they managed to really heal as a couple and preserve their family. Their daughter just got married, and they are doing great.”
About Michele
Michele Saffier, LMFT-S, CET, CSAT-S is an award-winning author, speaker, teacher, and consultant. She is nationally recognized for her pioneering work developing the theory and application of betrayal trauma treatment and her groundbreaking work on Rising Together; a comprehensive model for healing betrayal trauma with couples.
She has trained hundreds of psychotherapists to incorporate in the Internal Family Systems model, healthy sexuality, and the heroes journey philosophy in their treatment of sexually compulsive behavior and betrayal trauma. This model fosters compassion and curiosity which combats the helpless and hopeless attitudes and beliefs which entrench the mind in a negative sentiment override, making healing elusive. Her work in the last decade has focused on developing a new understanding of the internal world of the person struggling with sexually compulsive behavior and their betrayed partner. She is the award-winning author of Ambushed by Betrayal: The Survival Guide for Betrayed Partners on their Heroes’ Journey to Healthy Intimacy. She resides in the suburbs of Philadelphia with her husband, daughter, and their dachshund, Milo.
Work with Michele
Michele is accepting new clients in the office and via telehealth. She offers a 15-minute free consultation phone call, and her fee is $230. Michele supervises pre-licensed and licensed MFTs, as well as certified sex addiction candidates.
Michele’s website: www.TraumaHealingPa.com & office number: 215-552-8938
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About the author: Jaclyn Zeal is a licensed marriage and family therapist, specializing in a relational approach to individual therapy with women and mothers, as well as couples and marriage counseling.
In her work with clients, Jaclyn takes a unique approach that blends blends a family systems perspective with attachment theory, nervous system regulation & grounding practices.
Jaclyn’s mission is to support women and couples develop more embodied, trusting relationships with themselves and each other. Jaclyn has a solo private practice and is currently accepting new clients. Learn more about Jaclyn, and her FAQs and fees.
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