Professionals often have labeled the partners of individuals with sexual addiction as “treatment-resistant,” but a leading therapist offered a much different perspective at the National Conference on Addiction Disorders (NCAD) in Denver. “We haven't been good at establishing an alliance,” Stefanie Carnes, PhD, LMFT, told colleagues at an Aug. 19 breakout session.
Saying that spouses/partners often are more difficult to treat than the addicts themselves, the national clinical consultant for Elements Behavioral Health outlined a therapeutic process involving the “three-legged stool” of guidance from each partner's individual therapist and a couples therapist. She discussed the careful actions professionals must take before and during a disclosure process in which the addict reveals—ideally in one session—everything he/she has done in his/her addiction.
Carnes cited data showing that 70% of partners exhibit symptoms of post-traumatic stress disorder (PTSD) after the disclosure process. Even with safeguards planned in advance to protect the partner, “Two of [my patients] were hospitalized after disclosure,” Carnes said.
She added, “We really look at this as a traumatic event for partners.”
Advice for clinicians
While emphasizing that professionals should undergo specialized training before trying to manage a disclosure process with a couple affected by sex addiction, Carnes offered several pieces of general advice about how to reach out successfully to this population:
Do not pathologize partners' reactions to the betrayal in the relationship. Carnes, who is president of the International Institute of Trauma and Addiction Professionals, believes that what some would call “detective” behavior on the part of partners seeking information about the addict's behavior should be seen as “safety seeking.”
Group therapy is cutting-edge therapy for this population. Facilitated small groups are preferable, and Carnes advises to proceed slowly with partners, carefully evaluating their readiness.
Staggered disclosure of the addict's behavior to the partner can be highly damaging. “It destroys trust in the couple relationship,” Carnes said. “[The partner] thought this was everything,” and then more is revealed later. Part of this occurs because the addict has very high levels of shame during this time and is trying to do damage control with the partner.
Even a well-managed process can have unexpected results. “All disclosures are open-heart surgery,” Carnes said. “You never know how [partners] will respond.”
Carefully manage what partners need and don't need to know. Disclosure to partners empowers them and allows them to make healthy choices going forward, but it is often not productive to know all the specific details about the addict's past behaviors. However, if the behaviors result in relevant health issues for the couple, or if they involve individuals that the partner may run into, the partner needs to know, Carnes said.