Chaos in the Storm

1. Chaos in the Storm Dan Crockett, M.S., LMHC, CAP, CSAT The New Leaf Center Winter Park, Fla.

2. Introduction • Dan Crockett • Licensed Mental Health Professional • Certified Addiction Professional by the State of Florida • Certified Sex Addiction Therapist by the International Institute for Trauma and Addiction Professionals • Founded the New Leaf Center in 1990, an agency that specializes in treating Addictive disorders and trauma

3. Objective To address issues related to effectively treating the Spouse/Partner of a Sex Addict

4. The Outbreak • It’s all over the news. We are inundated with celebrities, sports figures, religious leaders, teachers, military leaders and politicians caught in sexual scandals that often destroy their marriages and careers. • People who have great influence over our population, including our children. • Most, because of their own denial, will never seek professional help.

5. But how many people pay attention to the dilemma of the Spouse?

6. Common Myths • Myth 1: Couples should initiate relational therapy while active Addiction is occurring. • Myth 2: The Addict has learned from his or her mistakes and won’t do it again. • Myth 3: The Spouse has it together or is crazy. • Myth 4: There is only one Addiction taking place. • Myth 5: Treatment for couples, where there are multiple betrayals and often at multiple levels, is the same as treatment for couples for whom there is a single affair or other sexual problems.

7. Myth 1: Couples should initiate relational therapy while active Addiction is occurring • Addiction is a “Primary Disorder.” • In most cases, it takes precedence over other problems. • It needs to be evaluated/assessed and treatment recommendations made and followed. • Spouses need assessment/evaluation to determine their needs. • Their primary need in the beginning is for safety, support, and boundaries. • Couples are seen at this time in order to find out what’s happening. • Initial recommendations may be made to the Spouse in individual sessions, while initial recommendations to the Addict are often made while the Spouse is present.

8. Myth 2: The Addict has learned from his or her mistakes and won’t do it again • Addicts rarely succeed at overcoming Addictions by themselves or seek help on their own. • The Spouse is often helpful in getting their Partner to seek help and stay in counseling. • Initially, it is good for the Spouse to come to session with the Partner so the therapist can share the outcomes of the evaluation/testing and recommendations to both of them at the same time. • The evaluation should be done by a qualified therapist skilled at doing sex Addiction evaluations and therapy.

9. Myth 3: The Spouse has it together or is crazy • Spouses may initially present that they are calm and collected when in fact they are just barely holding it together. • Many: • Have shut down their feelings in order to cope • Feel overwhelmed by the information they already have • Fear for their health (STDs), children, financial stability • Fear for their standing in the community and possible legal repercussions • Some will display intense anger or rage and make threats of violence or to act-out sexually themselves. • Most Spouses will deny they need help and demand that their Partner is the only one who has a problem.

10. Myth 4: There is only one Addiction taking place • Most Sexual Addicts have at least 2 to 3 active Addictions. • Drug/alcohol dependency, gambling , spending, and food Addictions are the most common. • Addicts will substitute one Addiction for another when their primary Addiction is getting them in trouble.

11. Myth 5: Treatment for couples where sex Addiction is present is the same as treatment for couples for whom there is an affair or other sexual problems • With Sex Addicts, there are multiple betrayals and often at multiple levels. • Treatment is more structured. • Individual evaluation and therapy for each person is first. • It is not uncommon for one or both to go to Intensive Programs or In-patient Therapy. • The Addict needs to admit to and start taking responsibility for his or her Addiction through treatment and support community. • Spousal safety is primary, as are boundaries and support system. • Disclosure is highly structured to help prevent further psychological damage to the Spouse.

12. First Session: Listen & Gather Data • Listen to both: What are the concerns of each? • Gather data: • Is this their first time to seek counseling? • How long has the Spouse known about the betrayals? • How did the Spouse find out? • What does each of them want to happen? • Watch out for open relationships • The Spouse is angry or upset that the Partner wasn’t having safe sex, or being honest about how many times, etc. • Both may be Sex Addicts, but they may believe one is not because that person exhibits greater control.

13. First Session: Inquire About Safety • Spousal safety is primary; is there any danger? • Toward the children or to the Spouse physically • Molestation or sexual abuse of the children • STDs: Ask both to get tested just to be sure • Physical abuse or threats • From either of the couple • Are either threatening suicide or homicide? • From an outside force (jealous lover, etc.) • Does the Spouse have a safe place to live? • Food • Finances

14. First Session: Children’s Safety • Most Sexual Addicts have never committed a sex offense or been involved in sex acts related to under-age adolescents or children. • Some sex offenders and child sex offenders also are sexual addicts. • If sex offenses are suspected toward children under the age of 18, addressing this takes precedence over sexual addiction. • Child safety always comes first, and the individual’s actions may need to be reported.

15. First Session: Initiate Testing • Ask the client with sexual problems to take the SAST. • Sexual Addiction Screening Test at Recoveryzone.com • Free online test; takes 5 minutes • Score of 6 or higher indicates sexual Addiction • Score of 6 or higher indicates sexual Addiction and further evaluation and recommendations will be needed. • Schedule or refer for evaluation with a CSAT • Suggest that the Spouse attend the initial evaluation session as well as the treatment recommendation session with the Addict to make sure he or she is being truthful.

16. First Session: Initiate Testing • Ask the Spouse to take the Partner Sexuality Survey (PSS) at Recoveryzone.com and bring a copy of the results to your next session together. • If you are not qualified or skilled in sex Addiction evaluations and treatment, refer to someone who is. • A list of CSATs (Certified Sex Addiction Therapists) can be found on the IITAP site (International Institute for Trauma and Addiction Professionals) at http://www.iitap.com/ • CSATs are trained to work in consultation with referring therapists.

17. CSAT Evaluation • Need approximately three hours to do evaluation • Best if done in a single session • Begins with brief interview with the Spouse present • Collect a psychosexual history from client, starting with childhood • Spouse will not be present during the evaluation. • Administer the Sexual Dependency Inventory (SDI), Post Traumatic Stress Inventory (PTSI) and other testing if needed • Schedule an appointment for them to return to hear the recommendation • Consult with Spouse’s therapist regarding the recommendation for the Partner • Keep all therapists in the loop

18. Second Session: Working with the Spouse • Therapist should see the Spouse alone to determine spousal needs and present recommendations. • Spouse is often resentful at having to be in therapy. • “I don’t have a problem; my Addict does.” • Most Spouses don’t like being labeled. • Co-dependent, co-sex addict, survivor, etc. • Win them over by being helpful. • Important that the Spouse remain a part of the Partner’s treatment

19. Spousal Safety • Spouse often experiences Partner‘s betrayal as a trauma. • Sex Addicts betray more ways, more frequently and often take greater risks, create more financial problems, and do so without considering the consequences to their Spouse or family. • The person whom the Spouse thought he or she could trust the most turns out to be the most untrustworthy. • The Spouse becomes overwhelmed with grief and pain as well as concerns for their physical, emotional and financial safety. • Careers, legal problems, and community standing also can be affected.

20. Trauma vs Reality • We all need reality checks to function in the world. • Most of us have safe relationships to which we turn for reality checks. • When the person we thought we could trust the most with our heart and soul deceives us in so many ways and on so many levels, our ability to trust ourselves and our current reality becomes distorted. • A traumatic reaction can occur.

21. :Impact of Trauma on Memory, Stress According to Bessel van der Kolk, considered the world’s leading expert on stress and PTSD: “Psychological trauma is known to impact long-term memory, including intensifying memories . . . many systems of the brain are activated to deal with the stress, making it difficult to go back to normal and resulting in the brain’s threat detection system staying hyperactive . . . individuals will have a hard time focusing on things [because they] continue to be hyper-aroused . . . getting stuck in trauma. It interferes with people’s capacity to pay attention to the present, have pleasure in the present, focus in the present and to pay attention to what’s going on right now and to pay attention to their physical body. Their body keeps racing, the stress hormones keep getting secreted, and they often become ill…”

22. Spouse Symptoms • Depression • Obsessive thinking and inability to focus • Constant checking of Partner’s clothing, where-abouts, computers, receipts, phone calls and records, credit cards • To the point of exhaustion • Feelings of fear/terror, betrayal, hurt, mistrust, disbelief, jealousy, self-hatred, disgust, inadequacy, shame, anger and rage • Physical problems: sleeplessness, stomach upsets, muscle tension, headaches, and racing heart • Hyper-sexuality or shut-down sexually

23. Spouse Symptoms: Grief • The idealistic relationship the Spouse thought he or she had is shattered. • Grieving and questioning begins. • How could I not have seen this? • Is there really true love? • What do I do now? • Am I really loveable? • How will I ever heal? • Is it ever safe to trust another so completely?

24. Spouse Symptoms: Anger • Betrayals can lead Spouses to experience anger that becomes unmanageable. • Constant rumination and reminders of all of the times they stayed home alone managing the kids, worrying about finances, and not taking good care of themselves when the Addict lied about having to work late • Times they’ve gone without love and attention while the Addict was doing phone sex, visiting prostitutes or massage parlors, and masturbating to virtual sex with another person • Anger about the debt they’ve incurred due to the Addict’s acting out, which has left them with few choices about what they can do to take care of themselves and their children financially

25. Spouse Symptoms: Anger • There’s an endless list of justifiable hurts, pains, humiliations and betrayals by the Addict. • A feeling of doom – “I can’t survive this.” • Can devolve into physical attacks on the Addict, as well as frequent verbal assaults and loss of sexual desire • Or just the opposite -- Increased sexual acting-out as a way to get back at the Addict, or as an attempt to prevent the sexual Addict from acting out further

26. Spouse Treatment: Safety First • Helping the Spouse to create a sense of safety is primary when treating trauma. • The therapist is often the first voice of reason. • Validate the hurt, anger, confusion, and inability to trust • Give the Spouse permission to take as long as he or she needs to heal and regain a sense of hope • Remind the Spouse to stop periodically and breathe to reduce tension and anxiety • Have a form that offers suggestions for relaxing activities • Have forms for her or him to use in creating a personal safety plan

27. Safety Plan “People who are emotionally traumatized experience the effects of a hyper-alert brain waiting for the next threat. It is this brain state that often leads to the partners’ behaviors of snooping, prying, questioning, threatening, and obsessing over the Addict.” Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts

28. Safety Plan: Avoid Staggered Disclosures • Each disclosure re-wounds the Spouse psychologically, physically, and spiritually. • Active Addicts will only reveal what they believe their Spouses already know. • The Sex Addict’s therapist will work with the Addict to formally present a full disclosure to the Spouse. • The Spouse has specific tasks to complete to prepare for the disclosure.

29. Safety Plan: Avoid Staggered Disclosures • Disclosure generally takes at least 6 weeks to prepare for, once the Partner begins active treatment in an outpatient setting. • Disclosure can take place sooner, if the Partner is at an Intensive or In-Patient program. • Both the Spouse’s therapist and the Addict’s therapist are present during the disclosure.

30. Treatment Resources • Workbook: Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts, Stephanie Carnes, Ph.D, CSAT-S, Mari A. Lee, LMFT, CSAT, and Anthony D. Rodriguez, MSW, CSAT, • www.Gentlepath.com 800-708-1796 • Gives the Spouse specific tools and assignments to reclaim lost sense of power • Gives the therapist specific tasks to use to help clients rebuild and strengthen them mentally, emotionally, physically, and spiritually

31. Tools • Feelings journal • Safe, supportive people • Stay focused and avoid snooping or “pain shopping” • Daily exercise • Yoga, deep breathing, time spent in nature • Healthy eating • Meditation, prayer, spiritual practices and readings • Pets • Comforting activities: baths, massages, walking • Setting healthy boundaries with the Addict

32. Tools • The Spouse needs to take some time (6-12 months) • To figure things out and determine his or her options • Determine if the Addict will admit he or she is a Sex Addict and demonstrate commitment to consistent recovery • Gain education about addiction and its impact on family systems • Develop a support system • Deal with the trauma that’s resulted for the Spouse • Taking the time needed to heal puts the Spouse back in control

33. Boundaries • Most Addicts have few boundaries regarding their behaviors . • Put partners at risk for STDs; financial ruin; loss of job, friends, and social standing; legal problems; and danger to the children • Partners need to review their boundaries and redefine those that will keep them safe from further harm.

34. Boundaries • Four major types • Non-negotiable boundaries • Mental and emotional • Physical and sexual • Boundaries with other people, places and things • Consequences for boundary violations should be written in advance.

35. Non-Negotiable Boundaries • See a therapist for sexual addiction and follow all of the recommendations • Discontinue all sexual acting-out • Break-off all relationships and communication with previous sexual people, places, and things • Remove all pornography/porn sites, sex toys from the home, work place, beach cottage, etc. • Tell the Spouse about any relapse within 72 hours • Tell the Spouse about any change in the Addict’s treatment plan within 24 hours

36. Non-Negotiable Boundaries • Each non-negotiable boundary has a consequence. “Violation of this boundary will mean…” • “I will ask that you sleep in a separate area of the house.” • “I will ask for a separation to give me time to determine how serious you are about recovery.” • “I will move in with a safe friend or relative.” • “I will file for divorce.” • Setting and re-enforcing these boundaries lets the Addict know the Spouse is serious. • Boundary violation(s) may result in end of the relationship. • This is key to helping the Addict hit a bottom.

37. Mental & Emotional Boundaries • Help preserve one’s sanity and emotional stability • “I want you to do any future disclosures in the presence of a therapist.” • “Don’t ask me to go to vacation or business places where you have previously acted out.” • “If you feel triggered to act out, discuss this with me, your sponsor, therapist, or SA group members.” • “I would like you to watch the children on Tuesdays and Saturdays so I can attend group therapy and my support group.” • “I want you to pay legal expenses so I can see an attorney to find out my legal rights.”

38. Physical & Sexual Boundaries • Protect physical and sexual health • “Right now, I’m choosing to sleep in a separate bed.” • “I’m choosing to not be sexual with you until I say I am ready to do so.” • “If I want a hug or for you to touch me, I will ask for you to do so.” • “I want you to do a full-screen STD test now and again in 6 months - and show me the results.” • “I will shower and get dressed in a separate area of our home.”

39. Boundaries: People, Places & Things • “I want to sell our seaside cottage because you acted-out sexually there with another person.” • “I want you to seek other employment or transfer elsewhere, because you acted-out with numerous co-employees where you currently work.” • “I will not go to dinner at restaurants where you have taken others with whom you have acted out.” • “If any information is shared with our adult children, I want to be present and involved in what will be shared.”

40. Boundaries • Only work if the couple works them • Each boundary in every category should be carefully thought through and reviewed with a therapist . • Each should have a consequence if not followed or if violated. • All consequences need to be carefully considered to determine if they are practical and if the Spouse is willing to or can re-enforce it.

41. Couples Therapy • New research on bonding and attachment suggests . . . we are most resilient in relationships with other people. • The natural place to heal from trauma is in the arms of someone you love. • When there is a “safe other,” clients can put all of their energies and resources into protecting themselves. • We know the quality of one’s intimate relationships impacts us physiologically and emotionally. • And has a huge effect on one’s personal, physical and mental health.

42. Couples Therapy • Recent research has shown: • One is twice as likely to have a stroke or heart attack if emotionally isolated. • Stress can impact the immune system. • i.e., wounds will take longer to heal. • Clinical depression is linked to the quality of one’s intimate relationship. • Resilience to stress/trauma and one’s ability to cope with stress/trauma are linked to the quality of one’s most intimate relationship. Sue Johnson, EFT, NICAMB, 2012

43. Couples Therapy • Research has found Addicts need to be actively involved in long-term therapy and support groups for a minimum of 2-5 years. • To heal, the Spouse must be able to manage his or her powerful emotions; and to do so, they must feel safe. • If they’re afraid of being engulfed by their emotions and are all alone with the emotion and catastrophic expectations, they can’t tolerate dealing with them.

44. Couples Therapy • Therapist might see the couple for a few sessions off and on to generate a treatment plan, however: • Sexual Addict needs to be in his or her own treatment for a period of time to stabilize and to determine his or her commitment to long-term recovery. • Generally 2-3 months of therapy and support group attendance • Disclosure takes place around 6-8 weeks.

45. Couples Therapy • Spouse needs time to do his or her own work and stabilize. • Spouse also needs time to prepare for the disclosure 6-8 weeks from when the couple first starts therapy. • Spouse will need a few weeks to process what came up for him or her after disclosure. • Hurrying or forcing the Spouse to make quick decisions only creates more stress and possibly trauma in a world that is already chaotic.

46. Couples Therapy If the Sex Addict receives the right treatment, and his or her Spouse receives the supportive, loving care he or she needs, many couples can discover new and purposeful meaning in their relationship.

47. Questions & Discussion