By Joan Gold
Joan Gold As Sexual Addiction becomes more frequently recognized as a diagnostic label, sex addicts are more easily identified and referred for treatment. Addiction being a family disease, the more sex addicts referred for treatment, the more it becomes apparent that there is an entirely new group of co-addicts that urgently require attention.
The partners and spouses of sex addicts, while sharing many similarities with partners/spouses of alcoholics, gamblers, et al., have many unique characteristics that significantly impact treatment failure or success.
I came to Impulse Treatment Center (ITC) in Walnut Creek, CA in March of 2008, having worked for several years as an intern with addicts and co-addicts of the more traditional variety. The ITC treatment model involves assessing the couple (frequently the initial treatment unit), then referring the partners to their own individual treatment groups. Couples therapy is usually, although not always, delayed until individual treatment has had a chance to create change.
Over the past year, I have learned a lot about the struggles my co-addict clients must overcome in order to have their pain recognized, their needs addressed, and their path towards wholeness and healing begun.
It is important to note that while sexual addiction is by no means gender-limited, at this time it is primarily heterosexual men who present for treatment at ITC. According to Carnes, the ratio of sex addicts presenting for treatment in general is the same as alcoholism and gambling, approximately three men for every one woman. (Carnes, 2002, p.13). I look forward to a time where this treatment group becomes more widely diversified; ITC has not, to date, been able to put together a group of women sex addicts. Currently I work exclusively with women as coaddicts.
Partners/spouses of sex addicts see themselves as victims and they almost always present for treatment in crisis; sexual betrayal has either recently become known, or known in a way that allows its full significance to be felt. I see a lot of hysterical, raging and/or collapsed women in my office as I assess them for appropriateness for my groups. Many of these women are in shock. For a large percentage, this is the first time they have put their outrage/loss/betrayal into words. Sometimes they don't have the words. Most of them have no support system, or they feel their support system cannot tolerate the knowledge that "the perfect husband" isn't perfect after all.
These women may have been holding into their lonely knowledge for days, months or years. Their language is halting, gutteral; their affect tearful, their bodies rigid, their attitudes careen between vindictive and confused. Upon further exploration, rarely do their stories of "the perfect marriage until the day I found the credit card receipts/the secret email account/the police report/the VD diagnosis" hold up. "What made this marriage so otherwise perfect?" I ask them. "Where did your feelings of being loved and valued come from?"
It is tempting to keep the empathy and support going forever, easy to join these women in their almost hypnotic recounting of family tragedy and virtue betrayed. If the therapy, group or individual, is to be effective however, it is crucial that the crisis be managed, and, once stabilized, that the client be helped to transition into a role where she becomes able to take an active part in identifying her piece of the addiction puzzle.
This is different than "blaming the victim" and one of the primary reasons that group therapy is the treatment of choice for co-addiction. If I have done my psycho education around sexual addiction correctly, the women will soon understand that their partners' addiction and/or recovery is neither their fault nor their responsibility. Their husbands or boyfriends did not become sex addicts because of anything the clients did or didn't do, however the reason the client was able to sustain what she thought of as an "intimate relationship" with someone not available for real intimacy is an important point of exploration.
It is noteworthy that many of the women I see at ITC have been
with their partners for two and three decades.
It is noteworthy that many of the women I see at ITC have been with their partners for two and three decades. Others report serial relationships with sex addicts, unwittingly married two and three times to different sexually impulsive men. These are my true allies in the group process, the women whose lives demonstrate that it isn't about being victims after all. They weren't "done wrong" by "bad men" through an accidental quirk of fate. What drew them into the same relationship over and over again? What felt so familiar that it overrode any sense of something not quite right? How did these women distract themselves from their loneliness, justify the lack of attention, learn to live with the sense of themselves as forever needy and unfulfilled?
It is the hardest part of my work as a therapist to develop the understanding that whether a woman decides to leave her relationship, or stay and see what can be salvaged, this "crisis" is her opportunity to look at her own role in maintaining a system of secrets and lies. This is the most challenging initial task of therapy and once navigated and the work begun, this is the most common place of ongoing resistance.
It is helpful to have my clients read Patrick Carnes' work on sexual addiction, in which he reports that sex addicts and co-addicts come from strikingly similar backgrounds: "families that are both rigid and disengaged," with "addicted or multiply addicted family members," where "relationships that are controlling and emotionally unsatisfying create comfort in that they are familiar." (Carnes, 1992, p.145-6)
Partners/spouses of sex addicts share many of the consequences of sexual addiction -- financial, health, family, career -- but most especially they share the shame. (Carnes, 1992, p. 147).
Over and over I hear women say, "If only he were an alcoholic" or "if only he were a gambler." They would prefer their husbands be addicted to cocaine rather than to call-girls, they tell me, because what cocaine offers is clear. It is not a fantasy wife or girlfriend. "Cocaine doesn't make you wonder where you fell short."
Sex addiction impacts partners at the deepest level of self. That is why an early intervention is an invitation to the women to take a look at who they are apart from the addict. Eating disorders, drug and alcohol dependence; childhood physical, emotional and/or sexual abuse figure large in many of these women's personal histories.
Again, the psycho education piece is crucial here in helping to reduce shame and suspend judgment, allowing the clients to develop empathy, first for themselves and, eventually (if the relationship is to endure) for their partner as well.
My goal in treatment is to shift the focus of the group off the sex addict and onto the woman herself. This can be an ongoing dance; if the sex addict partner is untreated, there is the ongoing impact of his projection and denial. If in treatment, the normal ups and downs of the recovery process are a constant invitation to judgment and blame. Two points I continually stress with my clients whose partners are in treatment: (1) sexual addiction, as all addiction, is a highly relapsable disorder and (2) the recovery process is a long slow journey. How are you going to take care of yourself while he is doing his work?
Most of the women I work with have some question in mind about whether they should stay in the relationship, or leave. I help them give themselves the time to really think through their options rather than end the relationship in a reactive state.
This is all complicated by centuries of cultural bias which makes it difficult to even believe in the concept of sexual addiction as a "real" diagnosis. Medical professionals, and even some therapists who have not been educated in the sex addiction model, unwittingly perpetrate the stereotype of "This is the way men are." I have worked with a number of women who have undergone years of couples therapy in which sex addiction was never named or addressed, but rather characterized as a problem of communication or temperament; one woman, for example, found herself labeled "uptight" in objecting to her husband's use of internet porn.
On the rare occasion when a group member leaves and a new member is added, each woman is asked to retell the story of what brought her into the group. Many of the women object to the retelling. They tell me how each time they repeat their story, it's like ripping the scab off a wound they desperately want to heal. I remind them that addiction flourishes in vagueness and obfuscation. True healing will only be found in the raw, unembellished truth.
Other women, who don't object to retelling the story per se, are worried that if they keep their "bad" feelings alive this way, they will never be able to arrive at forgiveness. Like the addict, they have gotten forgiving confused with forgetting. They will have the opportunity to forgive, I tell the women, down the road somewhere should they wish to do so. The job in early treatment is not forgiveness. Betrayal and loss by an intimate partner needs to be fully felt and processed before it can be forgiven. Premature attempts at forgiving/forgetting are just another form of the addict/co-addict cycle of denial.
In addition to telling and retelling the story, early group work involves psycho education around the issues of sexual addiction, co-addiction and addictive family systems; training in mindfulness in order to be able to identify and name feelings; and identification with other group members to help reduce shame and experience real intimacy.
Middle stage group work involves increasing tolerance for feelings, and learning to let feelings inform actions. Exploration of childhood loss/trauma also begin here. I have found the loss of self that results from those early woundings is what allows the women to remain in psuedo-intimate and disrespectful relationships, believing it is all they deserve.
Late stage group work includes acknowledging the changing sense of self, exploring the power and freedom afforded by being able to set boundaries, separating "kindness" from "enabling," rethinking relationship roles and rules, and building personal resources and support systems.
For more information about the
Spouses/Partners of Sex Addicts Program at Impulse Treatment Center, please contact Joan Gold at (925) 2806700 or (510) 418-2387. For more information about ITC's treatment programs for sex addicts, go to
www.sexaddicttreatment.net
Joan Gold is an MFT Intern supervised by Don Mathews, MFT, Director of Impulse Treatment Center. She is a 2005 graduate of JFK University, with an MA in Counseling Psychology (Transpersonal Specialization). She has completed her hours towards licensure and is currently in the process of sitting for her licensing exams.
Visit Joan Gold's page on East Bay Therapist
References
Carnes, Patrick (1982) Don't Call it Love
Carnes, Patrick (2002) Clinical Management of Sexual Addiction
