Kate reviews her presentation at the May 20th luncheon titled "Betrayal, Secrets and Lies: Rebuilding Trust and Healing Sex Addiction Induced Trauma."
This article describes the phenomenon of Sex Addiction-Induced Trauma (SAIT) and contrasts two different sex addiction treatment models. In particular, I focus on the merits of the trauma-informed model as opposed to the more traditional addict-centric model. I also discuss the damage that can be caused by the treatment process itself (treatment-induced trauma). For the sake of simplicity I refer to the addict as male and partner as female, and make the assumption that both parties are choosing to stay in the relationship and do the life-changing and oftentimes gut-wrenching work.
First, let me define “sex addiction”. Sex addiction is defined as any sexually-related compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and/or one’s work environment. The criteria are the same as those of other addictions: progression in the intensity of use, increased tolerance (more is required over time), repeated attempts to quit the behavior, continued use despite consequences. While it is true that sex addiction is not a current diagnosis in the DSM, the term is now commonly used in our everyday language. It is how many clients self identify when seeking treatment for their compulsive sexual behavior.
The traditional sex addiction treatment model views the addict as identified patient, and the intimate partner as co-addict and as adjunctive support to the addict’s treatment. It promotes separate recovery programs, with limited opportunity for connection and attachment repair. The partner is considered to be out of control and/or controlling, rather than adapting to life with an addict. For instance, after discovery if a partner needs information about the addict’s travel plans or his commitment to recovery, these would be considered none of her business: she is instructed to focus solely on herself.
Conversely, the trauma model is partner sensitive and trauma informed and views the relationship through the partner’s experience and needs as well as through the needs of the addict. The betrayals as well as, the multitude of lies, contribute to the trauma that most partners of sex addicts experience upon discovery. A study conducted by author and clinician Barbara Steffens, PhD, showed that 70% of partners meet criteria for complex/PTSD, presenting with symptoms such as helplessness, sleeplessness, immobility, reliving of the event, anger, hypervigilence, anxiety, nightmares, intrusive thoughts, avoidance, mood swings, panic attacks, restlessness, confusion, etc. In my practice this number is even higher. Partners present with a vast array of symptoms, but at the core there is always a shattering of reality, disbelief and profound despair.
The trauma-sensitive model acknowledges this experience of shattering as true and appropriate to the situation, and promotes empathy on the part of the addict and treatment team. Ideally both addict and partner need to focus on their individual recovery and trauma work, and the model also critically supports relational and systemic healing. Therefore, for instance, a partner is given the information she needs. This is considered reasonable and appropriate given the situation. She is validated for seeking safety, rather than being controlling. Her symptoms are acknowledged as predictable reactions to traumatic stress. Furthermore, the model validates the partner’s pain; encourages the partner to share her story in safe settings and a guided format to ease the pain as well as other trauma specific work; places the responsibility for the addiction on the sex addict, not on the partner; and supports the partner in setting clear boundaries. (Steffens page 73-74)
Omar Minwalla, PhD, brilliantly describes Sex Addiction-Induced Trauma (SAIT) in his article, “The Thirteen Dimensions of Sex Addiction-Induced Trauma”. The thirteen dimensions are highlighted below. Not all are relevant for every partner. Trauma is subjective and individuals are completely different and unique. For the complete article see Bibliography.
1.
Discovery Trauma whereby the partner “accidentally” discovers evidence of his acting out, and her pre-existing reality is shattered as she confronts his compartmentalized reality
2.
Each Disclosure is the process of being told about some aspect of the deceptive, compartmentalized reality-system (factual or not) and is a critical trauma-inducing incident, even though ultimately it is necessary for the partner to know the truth in order to grasp a cohesive narrative necessary for healing
3.
Reality-Ego fragmentation occurs as reality is shattered
4.
Psychobiological symptoms involves trauma to one’s physical body such as, hair loss, insomnia, vaginal spasms, etc.
5.
External crisis and destabilization refers to all the practical, sudden or long-term changes and the overwhelming chaos that ensues and endures as a direct result of sex addiction such as, concerns related to finances, shifts in residence, legal issues, etc.
6.
Hypervigilence and re-experiencing as described in the DSM description of PTSD
7.
Psychological trauma and the phenomenon of gaslighting refers to the intentional manipulation of partner’s reality, thoughts and feelings in order that the victim will submit her will
8.
Sexual Trauma is often similar to that of women who have been raped or otherwise sexually traumatized
9.
Gender wounds refers to how partners are often profoundly impacted at the core of their gender
10.
Relational trauma and attachment wounds means the “Us” itself is traumatized
11.
Family, communal and social wounds speaks to the far-reaching implications for other relationships, including the parent-child bond, social world, etc.
12.
Treatment-induced trauma is a clinical intervention or omission which causes harm
13.
Existential and spiritual trauma refers to a loss of faith in the goodness of life
Relational trauma involves exposure to an extreme stressor such as sexual
addiction, by which trust is desimated and the experience of the relationship as safe is diminished. The Multidimensional Partner Trauma Model (MPTM) builds on Minwalla’s SAIT model and includes focused education on the traumatic impact of the relationally offending behaviors and that of partner trauma. It serves to provide safety for the partner and relationship, and fosters internal motivation for change towards empathy. This means specifically, that the addict is taught and encouraged to participate in helping her heal by providing empathy, compassion, honesty and accountability.
Within the MPTM, the partner’s trauma must be addressed both in her individual therapy as well as, within the relationship. There is a structured process to this relational healing that usually includes a therapeutic Disclosure. A Disclosure is a voluntary transfer of information from the addict to partner detailing a thorough and honest history of all acting out behaviors including financial costs. There is a systematic process to the preparation of the Disclosure document as well, as the sharing. Although this is often an incredibly distressful process for addict and partner alike, it is crucial because most partners can not adequately heal until they know what they must heal from. Otherwise, they are haunted by unanswered questions, doubts and fears. For the addict, secrets fuel shame and shame fuels relapse. Furthermore, secrets create barriers to the re-building of trust and intimacy. There is a saying in 12-step recovery: “we are as sick as our secrets”. This is applicable to the individual as well as, the couple. I often liken the Disclosure process and sharing of secrets to one of cleaning out an infected wound. If the wound is not completely disinfected, the infection continues to cause more and deeper damage, possibly leading to amputation or death.
Once the secrets are divulged, the next step is often a polygraph exam to establish a reliable basis for honesty and the re-building of accountability and trust. A Sobriety Contract is written and shared with the partner to further promote trust. Although sobriety is his responsibility, there is transparency into his recovery process. The couple is also given guidelines for sharing about feelings and recovery at home as soon as they are ready to do so.
Treatment-induced trauma occurs when the treatment process further injures the partner by ignoring or invalidating her needs and perceptions. An example is when the therapist believes and even asserts that the addict is not lying, despite evidence and protests by the partner to the contrary. Other examples include blaming the partner, and excluding the partner from treatment by telling her, “the addict’s recovery is none of your business” and the like.
Often treatment-induced trauma is caused by clinical interventions that are fundamentally organized around the traditional co-sex addiction model, and other traditional interventions. One such intervention is sex positive therapy, based in failure to recognize or treat SAIT among partners. Many “sex positive” counselors and educators will too quickly prescribe, “date nights or sex nights”, for traumatized and sexually abused partners and couples. For a client to reach out for support and be “let down” or “hurt instead of helped” is the utmost of serious violations in human ethics and attachment relationships – to do no harm.
Sometimes referral to a specialist for the purpose of thorough assessment, consultation and/or treatment is recommended. Certified Sex Addiction Therapists are found at www.sexhelp.com. The Sex Addiction Screening Test (SAST) is also available from the same site, and can be utilized as an initial assessment. More comprehensive assessments are available and administered by a CSAT.
To demonstrate some of the complex issues inherent in working with this population, I share the following story. Robert (not his real name) and I worked together sporadically for three years on what he described as “a fascination with certain pornographic images”. He insisted repeatedly that this was the full extent of his sexual preoccupation. If I pushed too much on the subject or inquired about other accompanying activities (such as masturbation or physical contact with others) he would discontinue therapy for weeks or months, outraged at my insinuation.
One day, I received a frantic phone call from Robert, saying that his wife had discovered a text message on his phone from another woman. He was “terrified of losing everything”. With this discovery, his life began to unravel, and the next several months were horrible as they individually as well as, collectively began to face the truth of his secret life and the extent of his betrayal. Robert revealed to me his extensive history of sexual acting out before and during his marriage including numerous affairs and prostitution. He eventually prepared and read his full Disclosure to her, 18 pages in all, and was without secrets for the first time. He passed a polygraph exam, formulated and committed to a Sobriety Contract including working a 12-step recovery program. He began to learn about honesty, empathy and ultimately, how to rebuild trust and help his wife heal from the trauma of learning the extent to which he had been unfaithful. Both Robert and his wife now agree (several years later) that the recovery process required more courage and fortitude than any other life experience. However- as most addicts and partners agree- the quality of their life and current connection is richer and more intimate than they ever dreamed possible.
This story- similar to stories that I hear in my office every day- is rich with complexity. Several of the questions are discussed below.
- · How did I- an experienced therapist and specialist- not know that Robert was lying, that there was more to his story than viewing pornography? The truth is, I didn’t know (although I usually do) because addicts are really good at lying. It is a skill well-honed over decades that serves to protect, so that the learned behavior and addictive high can continue.
- · What did the addict’s comprehensive assessments indicate that I overlooked in deference to his assertions? I was reminded (once again) to trust my intuition and clinical expertise, and confirmed that addicts lie, even to their therapist. They don’t lie because they are bad people, but because there is sufficient fear and shame that prevents them from doing otherwise. It is usually consequences- or the fear thereof- that eventually force them to risk and live in the truth.
- · How does the partner of a sex addict heal a heart shattered by the very person she loves? One of the questions I am mostly frequently asked by partners after discovery is, “how did I live with this man for all this time and not know what he was doing? ”. I often respond: “because sex addicts lie, compartmentalize, deny and scapegoat in order to maintain their secret sexual- and often financial- life.” Another common question is, “how can I stay?” This is a very individual decision. I often offer the wisdom of not making any major decisions for one year. This allows for emotions to cool and clear thinking to return so the partner can make the best decision for herself and her family.
- · How is an addict “terrified of losing everything”, and yet driven to continue activities that- if discovered- will jeopardize what he holds most dear? Sex addicts often confuse intensity for intimacy, and hurt those whom they most love.
In conclusion, I would like to leave the reader with three key points:
1.
The traditional addict-centric treatment model- in and of itself- is inadequate.
2.
It is imperative that the treatment model is trauma-informed and trauma-sensitive for the sake of the partner as well as, the addict and couple-ship. Since sex addiction is fundamentally a relational trauma, the healing and recovery process must also be relational and tend to the attachment wounds.
3.
As clinicians we must be careful to not inadvertently collude with the addict at the expense of the partner’s needs, thus damaging potential for healing of the broader system.
There is great hope. Freedom from sex addiction is possible. Healing from Sex Addiction-Induced Trauma is possible. My experience with many clients supports this optimism.
Resources
The Association of Partners of Sex Addicts Trauma (APSATS)
www.apsats.org
Therapists who specialize in the treatment of partner trauma
International Institute for Trauma and Addiction Specialists
www.IITAP.com
Certified Sex Addiction Therapists (CSAT)
www.sexhelp.com
Sex Addiction Screening Test (SAST) and other resources
www.recoveryofselfcounseling.com
Website for Kate Parkinson’s practice
Bibliography
Steffens, Barbara, PhD, (2009). Your Sexually Addicted Spouse: How Partners Can Cope and Heal, New Horizon Press.
Minwalla, Omar, PhD, (2014), Thirteen Dimensions of Sex Addiction Induced Trauma Among Partners Impacted by Sex Addiction
http://theinstituteforsexualhealth.com/thirteen-dimensions-of-sex-addiction-induced-trauma-sait-among-partners-and-spouses-impacted-by-sex-addiction/
Weiss, Doug, Helping Her Heal (DVD set) available at:
http://drdougweiss.com/product/helping-her-heal/
Corley, D., Schneider, J., (2012). Surviving Disclosure: A Partner’s Guide to for Healing the Betrayal of Intimate Trust, CreateSpace Independent Publishing Platform
About the author
Kate Parkinson, MFT, CSAT, CHFP, CEMDR, is the founder of Recovery of Self Counseling and Intensives in Palo Alto. She is a licensed Marriage and Family Therapist (MFC41470), Certified Sex Addiction Therapist (CSAT), Certified Hope and Freedom Practitioner (CHFP), and is EMDR certified. Her practice is dedicated primarily to the healing of relationally traumatized couples and families devastated by sexual addiction, sexual anorexia, and other intimacy disorders.
Kate facilitates Three-Day Intensives for couples, partners of sex addicts, and both male and female sex and love addicts. Additionally, she specializes in the treatment of complex/PTSD as well as, dissociation, shame, boundary impairments and developmental immaturity. She offers extended psychotherapy sessions as well as, Three-Day Intensives focused on trauma resolution. Kate’s approach is informed by her belief in the inherent preciousness of each and every person.
