There is now a substantial body of research that compares same sex and other sex relationships. Key differences emerge from this data that have ramifications for working with same sex couples. For example, having two men in a relationship has led to clinical speculation that gay men are less likely to have satisfying relationships because they are often sexually open. For women, having two women has led to the idea that their relationships are often fused. The research is examined around these issues and other issues that are relevant for same sex couples. Evidence is offered that contradicts much of the common sense thinking that has prevailed around therapy with same sex couples. The paper develops a number of guidelines for working with same sex couples based on the review of the literature. These guidelines may be challenging for couple therapists who often offer a heterosexual perspective for couple work.