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Aaron Alan, MFT, CSAT Foundry Clinical Group [email protected] 310.721.1894. Marnie Breecker , MFT, CSAT, CCPS Center for Relational Healing [email protected] 310.860.9999. Facilitating a Formal Disclosure. Aaron Alan, MFT, CSAT

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Aaron Alan, MFT, CSAT Foundry Clinical Group [email protected] 310.721.1894

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Aaron alan mft csat foundry clinical group aaron foundryclinicalgroup 310 721 1894

Aaron Alan, MFT, CSAT

Foundry Clinical [email protected]

MarnieBreecker, MFT, CSAT, CCPS

Center for Relational [email protected]


Facilitating a formal disclosure

Facilitating a Formal Disclosure

Aaron Alan, MFT, CSAT

Foundry Clinical [email protected]

MarnieBreecker, MFT, CSAT, CCPS

Center for Relational [email protected]


Why a ceu on disclosure

Why a CEU on Disclosure?

  • To give therapists a common frame

  • Stress importance of working systemically

  • Purpose today is to give info on process rather than debate validity

    • (that’s a whole other conversation!)


Defining terms

Defining Terms

  • Addict: person disclosing secrets/lies

  • Partner: person receiving information

  • Discovery: when partner first learns of sexual acting out

  • Disclosure: the formal process of sharing information about secrets & lies related to sexual acting out


What is disclosure

What Is Disclosure?

  • The transfer of information from one party to another

  • NOT an amends, but is often considered a piece of the amends to a partner

  • Disclosure is done only with primary relationship

  • Is a part of healing relational trauma

  • Is highly stressful for everyone


Purpose of disclosure

Purpose of Disclosure

  • To facilitate healing of the trauma created by the secrets & lies

  • Rebuilding trust and intimacy in rx

  • (Re)establish equality in the relational dynamic

  • To give partners the truth about their relationship and the person with which they have chosen to share their life.

  • Shame reduction for the addict, surrender secrets

    • “We’re only as sick as our secrets”


Not all therapists agree

Not All Therapists Agree

  • Some clinicians advocate against Disclosure

    • Consider it harmful to rx

      • Shaming for addict

      • Traumatizing for partner

      • Creates power differential

  • Differ in methodology/protocol

  • Differ in content


Voluntary

Voluntary

  • Both clients must agree to participate

  • Either one can choose not to participate

  • Therapists should tread lightly in advocating for disclosure

    • Outcome cannot be guaranteed


The frame is key

The Frame Is Key

  • Structure/boundaries

  • Carefully planned

  • Therapist guided

  • Done in session not “over kitchen table”


Staggered disclosure

Staggered Disclosure

  • When pieces of information come out at different times (“drips & drabs”)

  • Partners often wonder when “other shoe will drop”

  • Message is “there’s always more”

  • Perpetuates trauma for partner

    • Similar to compulsively picking a wound


But s he knows everything

“But S/he Knows Everything”

  • Formal Disclosures are completed even when a partner has been “told everything” because information previously revealed can often be incomplete; however well intended

  • Don’t know what they don’t know

  • Healing/catharsis in process


When is disclosure done

When Is Disclosure Done?

  • As soon as reasonably possible

  • Addict is stabilized and is “sexually sober”

  • After partner has begun therapy and is stabilized


Contraindications

Contraindications

  • When divorce is imminent or relationship is ending*

  • Either person is not emotionally stable

  • Unaddressed psychiatric issues

  • Unaddressed CD/substance abuse

  • One of the treating therapists is NOT on board

  • Partner has no therapist and/or deficit of support

  • Partner is in acute state of trauma

  • Addict is continuing to act out / not in recovery


Preparation

Preparation


Pre disclosure

Pre-Disclosure

  • Informed consent (potential pros and cons)

  • Disclosure worksheets

  • Informing of Disclosure timeline

  • Cessation of “detective work” and disclosure-related questions

  • No sexual contact

    • From time Disclosure is scheduled through Post-Disclosure follow-up session

  • Safety planning for day of Disclosure


Informed consent

Informed Consent

  • Potential benefits

    • Rebuilding trust, intimacy

    • End of denial

    • Validation that partner is not crazy

    • Partner receiving the information to make decisions about future

    • Establishing equality

    • Shame reduction for addict


Informed consent1

Informed Consent

  • Potential drawbacks

    • Increased conflict in relationship

    • Intrusive thoughts for partner & other trauma sx /retraumatization

    • Anger/rage from partner

    • Misuse of disclosure in a legal proceeding

    • Destructive compensatory bx (addictions, compulsions)

    • Emotional dysregulation for both people


Immediately disclosed info

Immediately Disclosed Info

  • Imminent risk of harm or actual harm

    • e.g., safety, legal problems

  • Sexually transmitted infections and other related health issues

  • Imminent risk to reputation and/or social status

  • Imminent risk or actual harm to household/family

  • Imminent financial impact on household/family


Consultation

Consultation

  • Confer with all members of treatment team

    • Therapist for partner/addict

    • Couples therapist (if applicable)

    • Psychiatrist (if applicable)

    • Group therapist (if applicable)


Partner s preparation

Partner’s Preparation

  • Managing of expectations

    • Setting realistic expectations

  • Psychoeducation about sex addiction

  • Disclosure is voluntary

  • Informed Consent given

  • Exploration of information already known

  • Exploration what information partner wishes to receive and NOT receive


Partner s preparation cont d

Partner’s Preparation (cont’d)

  • Boundary setting (no detective work, no questions, stopping sexual contact with addict, etc.)

  • Self-care planning for before, during & after

  • Partners can request certain items/information deleted or withheld from the Disclosure, if they so choose

  • Use worksheets


Addict s preparation

Addict’s Preparation

  • Education about denial and purpose of Disclosure

  • Help in presenting information with ownership and responsibility-taking

  • Understanding importance of empathy for partner

  • Disclosure is voluntary

  • Informed Consent given


Addict s preparation cont d

Addict’s Preparation (cont’d)

  • Education and prep for Disclosure process, format and structure

  • Boundary setting (no sex with partner, etc.)

  • Incorporate partner’s personal parameters into Disclosure

  • Self-care planning for before, during & after


Disclosure vs 9 th step

Disclosure vs. 9th Step

  • “Made direct amends to such people wherever possible, except when to do so would injure them or others.”

  • Disclosure is part of treatment

    • Treatment addresses the relationship/system

  • Amends is part of recovery

    • Recovery addresses the individual

  • Pain vs. Injury

    • Pain is experienced when informed

    • Injury occurred when acting out occurred


Disclosure vs 9 th step1

Disclosure vs. 9th Step

  • Like resetting a broken bone – yes, it’s painful!

  • Disclosure = information transfer

    • Accounting of the damage

    • Necessary for a complete amends to be made

      • Otherwise, partner cannot fully understand what apology is for

  • Amends = repairing the damage

  • Information vs. taking responsibility and accountability


Content of disclosure

Content of Disclosure

  • Sobriety Date

  • List of general addictive behaviors

  • List of specific addictive behaviors, including:

    • Time frames of acting out (dates and/or events)

    • Frequency/duration of acting out

    • Places/locations of acting out that are relevant

    • Money spent on acting out

    • Behaviors that have involved another person/people


Content of disclosure cont d

Content of Disclosure (cont’d)

  • Exact # of sexual partners (or best estimate if exact number is incalculable)

  • Identity of any acting-out partner that your partner may personally know

  • Identity of any friends/family members who may already be aware of this problem


Content of disclosure cont d1

Content of Disclosure (cont’d)

  • Information starting from start of relationship

    • In some cases, partners may prefer to receive information spanning the addict’s adult life, which can be helpful to contextualize and depersonalize the addictive behaviors. In these cases, info preceding the relationship is general rather than specific.

  • Any specific lies told in service of the addiction are clarified and the truth is given


Structure of disclosure session

Structure of Disclosure Session


Therapist preamble

Therapist Preamble

  • What today looks like

  • The purpose of Disclosure

    • To have a clean slate

    • To stop staggered Disclosure (drips & drabs)

  • There may be info revealed that contradicts what addict previously swore was the truth

    • Sometimes addicts hold on to info (not to be duplicitous), but after Discovery addicts gave answer that they feel locked into or truth was soft-pedaled

    • This is opportunity to come clean about that


Therapist preamble cont d

Therapist Preamble (cont’d)

  • It’s OK to have feelings about hearing contradictory information (normalize this!)

  • Addict will read their Disclosure, giving info, no excuses, apology or rationale for behavior

  • Recommend no physical contact

  • OK to ask clarifying questions (timing, etc.)

  • If question is more in-depth, we may ask that the question be parked so it can be discussed with therapist and asked later (post-Disclosure)


Therapist preamble cont d1

Therapist Preamble (cont’d)

  • Disclosure can be read twice

  • Partner can take notes

  • Partner leads the pacing

    • “foot on gas and brake”

    • OK to pause if partner needs to leave room

  • Partner can end Disclosure at any point

  • Are you both ready?


Working systemically advocating for the partner

Working Systemically & Advocating for the Partner


Advocating for the partner

Advocating for the Partner

  • Advocating for your client with a therapist you don’t know and/or has differing opinions from you regarding Disclosure can be frustrating and extremely challenging

  • It is important to focus only on doing what is in the best interest of your client and ensuring a thorough disclosure and safe experience for both partners

  • Unfortunately, there isn’t one universal Disclosure process that is agreed upon and adopted – including within the community of sex addiction therapists


Advocating for the partner1

Advocating for the Partner

  • If the addict’s therapist is a colleague with whom you share similar views and approaches to Disclosure, your task will be much easier

  • Being on the same page regarding the structure and content of the disclosure in very important

  • When this doesn’t happen, each partner will receive conflicting information from his/her individual therapist, which can easily lead to more confusion and frustration for the couple


Advocating for the partner2

Advocating for the Partner

  • The time surrounding disclosure is typically overwhelming and emotionally excruciating and frequently causes further rupture to the relationship

  • It is the therapists’ job to work together as a team to create the safety necessary for disclosure to occur

  • Even the best intentioned therapists can succeed in splitting a couple when they engage in a power struggle over whose approach is best, as it leaves the couple arguing over whose therapist is “right” and “wrong”

  • It is our responsibility to do what we can do to help our clients heal, not exacerbate their problems


Advocating for the partner3

Advocating for the Partner

  • Having our own ideas and opinions and being reluctant to stray from that doesn’t take into account the individual needs of each client; such rigidity makes negotiation, compromise and resolution nearly impossible

  • If two therapists working with a couple differ in their opinions, there must be room for negotiation

  • Sometimes therapists get caught up in ego, pride and/or personality conflicts and can lose sight of the goal of Disclosure


Advocating for the partner4

Advocating for the Partner

  • All actions should be in service of relational healing

  • Therapists working together on a disclosure must base their decisions and planning first on the partner’s needs, then on the addict’s needs

  • It is important for therapists to manage expectations (both their own and those of their clients), as Disclosure does not necessarily mean that the couple will stay together or be successful in rebuilding intimacy and trust


Advocating for the partner5

Advocating for the Partner

  • When there are different opinions among the treating therapists, it may help to choose to work from a book such as “Disclosing Secrets”, which can ensure that both partners are being given the same information


Timeline for disclosure

Timeline for Disclosure

  • Once date is set, it’s imperative clts follow therapist recommendations (esp re boundaries)

  • Safety planning (separate cars, 24 hrs apart, etc)

  • If polygraph is incorporated, it’s usu done before Disclosure

  • Allow 2 hrs for Disclosure session

  • Partner usually has a support session immediately after Disclosure session

  • Follow-up session is usually 3-7 days after Disclosure

    • AKA “Boundaries & Consequences” session

  • Couples therapy often recommended at this point


Post disclosure boundaries

Post-Disclosure Boundaries

  • No contact for 24 hours after Disclosure

    • Allows partner to absorb info

  • Conversations only to “news, weather & sports”

  • No physical contact initiated by addict

  • No abuse (physical or verbal)

  • Copy of disclosure is in partner’s therapist file for review in session

    • Partner NEVER leaves with printed copy of Disclosure


Use of polygraph

Use of Polygraph

  • Controversial

  • Can be effective as a therapeutic tool: level of ‘willingness’ to go to any lengths for repair of relationship

  • Not “gotcha” experience (we want addict to pass)

  • Is highly shaming for person taking polygraph

  • Is highly anxiety-provoking for person waiting on results (partner)


Protocol for polygraph use

Protocol for Polygraph Use

  • Addict’s therapist gives polygrapher 2-4 questions:

    • “Is your disclosure complete and accurate to the best of your awareness/recollection?”

    • “Have you acted out sexually since your stated sobriety date?”

    • (1-2 questions generated from partner)

  • Results delivered as follows:

    • Polygrapher Addict’s therapist

    • Addict’s therapist Partner’s therapist

    • Partner’s therapist Partner


Disclosure follow up session

Disclosure Follow-up Session

  • Follow-up questions posed

  • Boundaries & consequences delivered

    • Partner uses a worksheet to assist in processing

      • “What I need to feel safe in the relationship is…”

      • “If you are unable to hold this boundary, I will take care of myself by…”

      • Cause & effect rather than punative to addict

    • Partner reads in session to the addict

    • Addict SHOULD leave with a printed copy


Mistakes commonly made

Mistakes Commonly Made

  • Giving partner a print-out of the Disclosure

  • Allowing content to include amends, excuses and rationale for behaviors/choices

  • Disclosure written as a narrative rather than simply stating the facts

  • Not editing out equivocations

    • “probably”, “maybe”, “something like…” (sounds like guessing)

    • Better to use “approximately”


Mistakes commonly made1

Mistakes Commonly Made

  • Not editing out lascivious content

    • Better to use clinical terminology

  • Failing to interrupt the asking of lascivious and/or punitive questions

    • “How large were her breasts?”

    • “How could you do this if you loved me?”

  • Including sexual template info in Disclosure

    • This is a violation against the addict


Mistakes commonly made2

Mistakes Commonly Made

  • Allowing “victim-stance” statements in Disclosure

    • “I paid for sex because you rejected me that night”

  • Not working systemically

    • Trying to manage Disclosure by self

    • Not requiring the partner work with a therapist through his process – even if it’s just temporary

  • Being too rigid about the process

  • Holding dates as more important than process / safety


Resources

Resources

  • Association of Partners of Sex Addicts Trauma Specialists (APSATS)

  • Non-profit for training/certifying therapists

  • Foundry Clinical Group

    • www.foundryclinicalgroup.com

  • The Center for Relational Healing

    • www.lacrh.com

  • “Disclosing Secrets”by Jennifer Schneider, MD


  • Facilitating a formal disclosure1

    Facilitating a Formal Disclosure

    Aaron Alan, MFT, CSAT

    Foundry Clinical [email protected]

    MarnieBreecker, MFT, CSAT, CCPS

    Center for Relational [email protected]


    Aaron alan mft csat foundry clinical group aaron foundryclinicalgroup 310 721 1894

    Aaron Alan, MFT, CSAT

    Foundry Clinical [email protected]

    MarnieBreecker, MFT, CSAT, CCPS

    Center for Relational [email protected]


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