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This project explored theories, concepts, themes, and experiences clinicians believed important in working with couples in later stage recovery from sex addiction (SA) and betrayal trauma (BT). The project goal was to use existing literature and findings from clinicians’ feedback to develop a structured and systemic framework and workbook for treating these couples. The project addressed the problem of a gap in research and clinical resources for working with couples at this stage of recovery. Models including biopsychosocial, Dr. Patrick Carnes’ 30 task model, and attachment, polyvagal, and Bowen family systems theories were the guiding theoretical and conceptual framework for this project. The population and sample for this project included clinicians treating couples recovering from SA and BT. Data were collected using semistructured interviews. Qualitative thematic analysis and coding were used to analyze the data. The findings of the project revealed theoretical categories, including relational/systemic, trauma informed, attachment/emotion, psychology, and cognitive and behavioral. Conceptual categories included trauma education, relational/interpersonal skills, long term recovery education, vision/growth, and healthy intimacy and sexuality. Clinicians’ experiences reflected commonalities within these categories: multiple impacts of SA/BT, the need for mutual empathy and understanding between individuals in a relationship, and a shared vision of recovery. These findings align with current research that emphasizes the importance of utilizing trauma informed, relationally focused, and systemic theories in a framework for this population. The project findings further highlight the need for models that address the couple versus the individual and move beyond the wounding. Recommendations for future practice include testing the effectiveness of the framework in clinical settings, measuring relational and/or longitudinal outcomes, and conducting with a larger and more diverse sample of clinicians or couples.