Long Term Treatment of Partners of Sex Addicts: A Multi-Phase Approach

By Cara Tripodi

ABSTRACT: The intimate partners of sex addicts, also known as coaddicts, are often the unrecognized “difficult” persons in the spectrum of sex addiction recovery. This paper will address several components in the long term treatment of partners of sex addicts: 1) the ways coaddicts present for treatment; 2) identification of characteristic behaviors of coaddicts, and typical phases that they move through in their own recovery; 3) differences between their initial presentation and longer-term responses to the impact of sex addiction; and finally, 4) interventions that are most useful for this special population and ways to assist therapists working with sexual coaddicts. Knowledge about these factors, as well as the destructive patterns that maintain homeostasis in the relational system, will enhance professional understanding of partners of sex addicts.

INTRODUCTION
The basis of this article originates from the author’s extensive experience with sexual coaddicts. From 1992 to the present, over 100 male and females have sought individual and/or group psychotherapy. The author is the owner and director of an outpatient for-profit program for sex addicts and their partners, located in a residential section of a large metropolitan city. Some partners were actively engaged in both models of treatment, at times simultaneously or separately. The article is designed as a clinical review of work with this specific population and is not based on any specific research. Many of the coaddicts treated were female (less than ten percent were male) and primarily married with children at the start of treatment. Modalities used in treating this population were primarily, cognitive-behavioral, psychodynamic, 12-step oriented and trauma based. Art therapy, EMDR (Eye Movement Desensitization and Reprocessing) and inner-child work were additional methods used to augment the treatment. Typically, clients entered treatment for individual therapy and, at some point in their recovery, entered a group: initially, many participated in a ten-week psycho-educational group called Beginnings as they were introduced to the various aspects of the disease model. The length of treatment for most clients was usually one to five years

LITERATURE REVIEW
Much of the literature and research in the field of sex addiction and compulsivity recognizes the role that partners and families play in the addict’s life (Carnes, 1991; Corley & Schneider, 2003; Earle & Crow, 1989; Matheny, 2002; Milrad, 1999; Schneider, 1988; Weiss, 2005; Weiss & DeBusk, 1993). With this growing awareness, however, there has been a paucity of information geared specifically to sexual coaddicts. Most of the literature focuses on the identifying characteristics of the coaddicts and early responses to the problem (Schneider, 1988; Weiss, 1993). Little has been devoted to long-term treatment and the impact this treatment can have on a co-addict’s recovery from the life- altering effects of sexual addiction.

Professionals in the sex addiction field have found the literature from the codependency model useful. Here there is a proliferation of material dedicated to the identification, causes and long-term implications of this problem, and the recovery process (Beattie, 1992; Mellody, et. al., 1989). Codependency material allows partners to identify with a pattern of thinking and behavior that is more global in nature than simply the relationship to the sex addict. Partners can relate to the characteristics of codependency. It becomes a gateway to seeing early childhood patterns that they developed in reaction to a dysfunctional family system that denied the needs of the child through abuse or neglect.

Although this information is extremely useful and clearly applicable to partners of sex addicts, it has limitations. First, it does not specifically address the particular needs and nuances of this special population, and those “how to” questions that partners have upon learning of the betrayal and infidelities. Second, it fails to answer many of the concrete questions about living in a sexually addicted relationship.

Another related field of literature that has some overlap with that of sexual co-addiction is the material on infidelity. Coaddicts and the therapists who treat them may initially find relevance to the issues of adultery, affairs and other forms of infidelity, especially as it relates to the emotional impact of betrayal on the partner. It becomes increasingly clear that sex addiction affairs are uniquely different from other affairs and therefore require a framework of intervention specifically focusing on those themes related to sex addiction (Weeks et. al., 2004; Spring, 1997; Brown, 2000). A number of authors have asserted the need for a more specific typology with its own unique interventions. They assert that addiction is fueled by internal struggles on the part of the addict, and not necessarily as a reaction to external or situational stimuli similar to what is found in extramarital affairs (Weeks et. al., 2004; Brown, 2000). In fact, most professionals in the field of sexual addiction assert that this addiction would have existed with or without the partner, which is not necessarily the case in some types of affairs.

Affair literature is limiting in its focus of the relationship or the identification of characteristics of an affair partner. Sex addicts are more interested in the chase of sex and love encounters, and not necessarily in the person with whom they are involved. In addition, the role of shame in the sex addict is a key element in their cycle of acting out behaviors. It fuels a chronic negative view of the self and contributes to defensive impaired distortions that result in further pursuit of sexual exploits. Therapists who apply infidelity interventions may not understand the importance of shame in the development of the addict and may consequently see the affair as equal. This in turn places the partner in a position where her pain and needed support will become compromised. The illusion of the relationships is often combined with serious cognitive distortions. The male sex addict who enters into an “affair” with an escort and, after two years,, feels compelled to continue the relationship because he wants to help her stop using drugs. Or the sex addict who seeks out an affair with a sex partner who turns out to be threatening and intrusive, and despite the high-risk nature of the relationship, he cannot stop the pursuit of her. Additionally, sex addicts often sexualize feeling and situations as a means to alter reality and as a way to cope with life in general.

The addiction model of treatment, most specifically that dealing with the family of substance users, is extremely helpful in therapists’ understanding of addiction treatment (Brown & Lewis, 1999; Howard & Howard, 1985). This field has broadened the mental health community’s understanding of family systems work, and demonstrated the disease model and the resulting generational effects it can have on those families who do not change their unhealthy patterns of relating. The environment for the child in an alcoholic home is greatly influenced by the rigid and disengaged styles of parenting and these patterns contribute to the child’s lack of safety and low self worth (Brown & Lewis, 1999). The dynamics in both types of families are similar. Denial of reality regarding the existence of an addiction, while at the same time addiction does exist, keeps deception as an organizing principle in how the family system operates.

How co-alcoholics change, and their process of change, parallels that of sex coaddicts with a few differences. Sexual coaddicts have greater difficulty managing an illness that, for the most part, can be kept secret and is hard to uncover. Even the recovery is done in secret. There is less social support for the problem in the larger community, and in society. This, too, may be a result of social stigmas that are tied to sexual addiction vs. alcoholism. Another difference is the complete abstinence model in alcoholism recovery vs. the reintegration of health sexuality in sex addiction treatment.

A final difference is the rebuilding of sexual intimacy. Partners of sex addicts are going to personalize the sexual behavior because it touches on a violated sacred place of union that they believed would be honored. Sex touches at the most intimate part of a person’s existence, and violations of this can be damaging for many years to come. It is the secrecy, violation of trust and the self-doubts about whether to trust again, which are deep areas of conflict and change confronting coaddicts, that is less noticeable with co- alcoholics.

PRESENTATION OF THE PARTNERS FOR TREATMENT
Those Who Knew of the Behaviors
Coaddicts typically present for treatment in one of two ways; either having known of the behavior or suddenly learning of it. Each presentation has unique characteristics, problems and require specific therapeutic interventions Partners who knew of the behaviors, describe a lack of control over their own lives. They report experiencing despair, hopelessness, confusion, anger and sadness over the escalation and continuation of the sexual behaviors despite, at times, promises on the addict’s part to stop. These feelings of unmanageability prompt them to seek help. They have been employing a level of denial that has contributed to ineffective confrontations with the addict regarding the sexual behaviors. Patterns such as these can exist in these types of relationships for many years and contribute to various cognitive distortions that exist between the partners. The dysfunctional patterns also serve as a way to maintain homeostasis in the partnership even though there is a great amount of pain and mistrust.

One partner explained that she had spent the last four years agreeing to the sexual escapades of her spouse as she, too, enjoyed the activities and wanted to be “open” sexually. Typical sexual behaviors she engaged in included exhibitionism through the use of web cameras and anonymous sex with others. After the birth of their son, she suffered post partum depression and sought treatment. She began to change and realized she no longer wanted to continue the prior lifestyle with her spouse. After a year of post partum treatment, she was referred for sexual co-addiction treatment since her symptoms were more related to distress about the relationship and her failed attempts to address this effectively with him. He refused to stop his high-risk sexual activities and was demanding that she resume these previous behaviors.

Other partners who have tolerated the sexual behaviors describe a style of defense similar to putting their “head in the sand” and purposely walling off the behavior from themselves. Some authors have termed this type of presentation of the coaddict as the pre-recovery phase of treatment, which can occur from upwards of ten years (Carnes, 1991; Milrad, 1999; Weiss, 2004).

Those who knew of sexual behaviors report signs of sexual compulsive patterns throughout the courtship and commitment phase of the relationship. They would deny that the behaviors amounted to a problem and believe they could “fix” it themselves. Coaddicts report trying harder to please the addict so as to not upset him: they would try out new sexual behaviors or escapades to keep up with the addict’s interest. Others speak of internally trying to accept the addict’s interest in pornography and rationalize that “at least he isn’t going outside the marriage” only to learn later that the behaviors would escalate to escorts, affairs partners, massage parlors or other types of anonymous encounters.

Therefore when coaddicts enter treatment, it is often to work on their pain with a futility and hopelessness that they can effect change in their addict. These coaddicts often are ready to work on themselves, which can be missing initially in those partners who present having just learned about the sexual behaviors. The denial system has been shattered and the realization that they have contributed to the problem by not confronting it, makes them ready for change. When the sexual behaviors are known in the relationship, but prior to an actual diagnosis of sexual addiction, a common characteristic exhibited by the addict is the devaluing of the co-addict either through emotional belittling or chronic avoidance. One client reported her spouse always told her that it is a wife’s job to keep the husband fulfilled or this would lead to him wandering outside the relationship. She responded over the years by trying to keep him emotionally and sexually satisfied, believing that what he said was true and feeling the burden of responsibility in the marriage. She reported that she would attempt to create an atmosphere of calm at home, and often would have candlelight dinners prepared for him when he would come home from work. She would keep the children away so as not to disturb the atmosphere she was trying to set for him. Controlling the environment helped in her need to please her spouse and served as a way to avoid the loneliness she felt in the relationship.

One partner who acquiesced to daily sex with her husband found that, after 20 years when she tried to set limits, he went outside the relationship to get his regular “fix” saying later that his sexual needs were too great and that she was no longer meeting them in the way he expected. The emotional battering can become so great that once treatment is sought there is tremendous relief and freedom. For years coaddicts blamed themselves as the reason for the addict’s unhappiness. This replicates feelings of abandonment from their own upbringing which predisposes them to relationships where they doubt their truth and stay stuck in a system that continues to reinforce this belief.
How partners find themselves in these relationships where they are constantly fending off the sexual advances of their addict partners is a topic worthy of study. However, the underlying theme that permeates all of these sexual co-addictions is the lack of a developed self, which allows the co-addict to undermine and second-guess themselves and their impressions and feelings about their relationship.

Partners Who did not Know
Partners presenting in crisis not overtly knowing or suspecting the addict’s behavior, often report having had a “hunch” that something was not right in the relationship. Often, these coaddicts will report an intuitive feeling that prompted them to look for information that might shed light on their suspicions. They might suspect a lie, but will quickly defend against this in pursuit of keeping the idealized image of their spouse. They will report experiencing sexual and emotional unavailability, and have often developed coping skills that prevent them from having needs in the relationship. This pattern contributes to the intimacy problems that already exist.

Coaddicts report certain looks and behaviors, e.g. unexplained cell phone calls, unaccounted time away from the home, or money spent that support their suspicions. In one example, a partner innocently opening a folder on the computer that had an unfamiliar name, simply came upon an entire collection of photographs of her husband having sex with another woman. Another said she was in their basement, where she rarely went, and came upon an extensive collection of photographs taken by her husband. She found an expensive camera that was used to take photographs of her sister, various neighbors and strangers. The information she found represented a long pattern of activity, which she never would have discovered if she had not stumbled upon it. She and her husband had a very distant relationship: he worked long hours and preferred the company of the television when home, so she had long since stopped trying to have a relationship with him yet she stayed in the marriage.

Other partners of sex addicts also report accidentally finding information that was not intended for them to see. In one case, a sex addict inadvertently left his computer turned on to his email account and the spouse found multiple correspondences with affair partners. In another instance, a woman had been sleeping apart from her husband for many months because they “could not get along.” In her bedroom closet, she found a video camera that was pointed at her bed, revealing that her spouse had been secretly videotaping her while undressing. A final example includes a male co-addict accidentally discovering his wife and neighbor in their basement engaging in sexual behavior while he and their children were upstairs. This discovery led to further revelations of various partners over the past 10 years. Understandably, the husband experienced a myriad of emotions typical of such disclosures.

These types of discoveries force coaddicts to confront their belief system and start to recognize that there is a problem and that help is needed. The help is initially often for the addict and for the pain the addict has caused them. It often takes longer for coaddicts to recognize the role their denial played in keeping the relationship unhealthy. Typically, once treatment advances, differences between those coaddicts who knew of the sexual behaviors and those who were unaware often diminish. Both types have tolerated unacceptable levels of unavailability on the part of the addict. This pattern can manifest itself in the addict’s work habits, which take away from significant family time and are a cover for the addict’s acting out behaviors. Excuses and justifications for time away from the home because of work are common defense tactics employed by the addict. Coaddicts believe these rationales and do not challenge the truth even though they doubt what they are being told. Many partners will complain to the spouse to no effect because, on some level, they learn to quiet their needs to know the truth. They devalue themselves by believing that they are being unrealistic. In using the cycle of co-addiction by Carnes (1991), it is here that partners will become lost in two separate problems. The first is the initial crisis they are attempting to confront. The second is their response, which often backfires on them and leads them to despair. Subsequently, resolution of the presenting problem is ignored. It is this cycle, matched with the addict’s addiction cycle that will flourish and lead to destructive patterns for each spouse and the relationship as a whole.

Another way partners tolerate unacceptable behavior is through emotional, physical or sexual avoidance in the partnership. They may have low interest in sex and have rules stemming from childhood about conflict, so thereby avoid it in the partnership. Instead, they may believe that they have to be loving and supportive, while blaming themselves for any negative feelings or reactions they have toward the spouse. There is often a lack of involvement in childrearing and the partner feels alone and will have low expectations for sharing in this responsibility with the addict. In the recovery process, coaddicts realize that the compromises they allowed is where the “addiction lies” as they begin to make sense of their role in the problems that existed prior to discovery. By identifying the coaddict’s compromises, the couple begins to understand the partners’ role and moves them forward in their healing.

INITIAL GOALS OF COADDICTS UPON ENTERING TREATMENT
As discussed, partners seek professional intervention for various reasons. Overall, they want to support the addict in their desire to stop the destructive sexual behaviors. Additionally, partners are looking for validation of their own pain and for acknowledgement of the victimization they are experiencing. Partners also need information about addiction and a framework or roadmap that they can use to navigate through this difficult crisis. In addition, they seek reassurance that there is hope that addicts can heal from the devastating sexual behaviors that have governed their lives and that the partnership can be repaired. Finally, partners are seeking concrete resources that will help them in their own recovery.

Because their initial focus is often on the addict and the emotional responses including shock, sadness, anger, fear and uncertainty, therapists must be cautious not to push partners farther than they are able to go. When the emotional stress is too great, partners have difficulty processing and integrating aspects of their own personality that have played a role in the addiction. Furthermore, the parallels between the relationship and themes from their childhood are difficult for the partners to relate, since much of their emotional attention is on their feelings in the present and the discovery of the addiction.

Therapists are therefore more effective if they can focus the treatment on here and now strategies such as creating a space where partners can come and process their feelings, question their reality, and making decisions in the present to care for themselves. This form of crisis intervention creates significant pathways to healing and sets the stage to do further developmental work. Any strategies that do not address the “here and now” issues can cause the partners to feel misunderstood and for the partner to feel devalued. A comparison could be the emotional responses one would encounter upon suddenly learning of a medical crisis resulting in emergency care. The suddenness of the event, the immersion in to the medical community with the various professionals, and a language that is often foreign to the family, combined with the uncertainly of the situation, creates immediate crisis for the family member. The expectation of the family member in this time would be minimal and the focus of the treatment team would be on life-preserving interventions and on educating the family on the status of the individual. The family members’ emotional attention would be on the crisis and little else. Even after the crisis is over, whether the loved one improved or worsened, those affected would continue to react and process the events surrounding the crisis.

Early in their treatment, many coaddicts have difficulty identifying with the various labels in the recovery movement e.g., codependency, dysfunctional family, and sexual addiction. At this stage, they often will resist labels that apply to them because they hear it as blame for the addict’s behavior, thereby missing opportunities to see their role in the addiction. As stated previously, partners with knowledge of the sexual behaviors, are more apt to present in treatment focusing on their role in abetting the addictive process. They present as informed about addiction and readily apply those labels to themselves.
The emotional upheaval and crisis at this stage effects their ability to internalize how labels and themes from childhood apply to them. It is better to help coaddicts establish emotional stability initially, which will foster their self-confidence and lead to them becoming receptive to learning about the addictive system. Some partners have reported reluctance in seeking treatment for fear of being labeled and therefore possibly misunderstood by therapists. Others have had prior therapeutic experiences where their concerns were minimized, explained away by therapists, and subsequently coaddicts felt blamed for their overreacting tendencies. The sexual problems or concerns were often denied or conceptualized as a “couples” issue. In such instances, the coaddict is doubly victimized, first by the betrayals and then by the system that intends to help.

In addition, many coaddicts are too angry with the addict and will withhold their involvement as a way to express their anger, and as a reaction to the crisis. Initially this can be an appropriate response in some situations, for it can force the addict to face the problem on their own and allow the co-addict to see if the addict’s intentions are sincere. If this stance continues for longer than the first year of treatment, it can be indicative of coaddicts refusing to change and their reluctance in addressing the addiction directly.

As partners move through the initial crisis stage and begin to adjust to the addiction, they will respond with a myriad of emotions. Most coaddicts are deeply conflicted about the role they played in the addiction; therefore they are extremely sensitive to being put into a category early on. In fact, many will view their behavior as a reflection of their personality rather than as a component of an addictive relationship. Essentially, the coaddict has denied their needs and wishes in the relationship or they have argued and then felt wrong for wanting certain things from the addict (Schneider, 1988; Carnes, 1991; Weiss & DeBusk, 1993). Either way, they subjugated their needs to the addict. In doing so, they learned that their voice in the relationship was not reliable and lost themselves in the process.

What often drives partners to seek help are the ongoing struggles they encounter with the addict and their inability to set limits in the relationship. They do not understand how they tolerate the addiction by denying their needs. Through therapy, their understanding of the addiction expands into other aspects of their lives and they actively begin to move from the addict’s problem to their own.

PHASES OF RECOVERY
PHASE ONE: SHOCK, CRISIS AND INFORMATION GATHERING PHASE
This is typically the most difficult and painful part of the process for partners. Foremost is the trauma of learning about the addiction, and the resulting emotional upheaval and uncertainty that has now entered their lives. Accepting or calling this an addiction can be extremely shaming and, at the same time, welcomed because now there is name that can be applied to a set of symptoms and circumstances that had seemed previously unknown.

For some, there is extreme anxiety and fears initially centering on social, economic and familial security. Questions around sexual boundaries will arise for themselves as well as for their children. Sexually transmitted diseases are a fear and most partners will be encouraged to seek testing and will often demand it of the addict. For those partners with children, there is the worry that the children may have been exposed to the behaviors. Overall, they are concerned about the adverse effects the addiction will have on the family system as a whole. Is the addict’s behavior putting the children at risk? Some children are unwittingly involved because they may find online pornography while working on the computer. Often addicts will use the home computer as a means to view pornography. Unfortunately addicts are often not cognizant of the ramifications of their sexual behaviors since part of the disease process is to distort reality, and deny or minimize the risks involved in their behavior (Carnes, 1991; Weiss, 2005).

One partner reported that her ten-year-old daughter, while doing homework, confronted her husband and was exposed to pornographic images of unclothed teens. In another example, a partner reported that she came upon her husband’s emails to his various paramours. After asking to him to leave the family home, she told their teenage boys about the father’s behavior and learned that they had known of this behavior for the last few years. Often coaddicts are less skilled with the computer, and addicts can often have greater freedom and access without the fear of being caught. The children in these families are more educated and knowledgeable about the computer and are at greater risk of being exposed to the sexual material of the addict.

Now that computer images can be downloaded to cell phones, addicts are able to access and transport their material more easily. One partner said that it was the five-year-old daughter’s discovery of this material on her husband’s cell phone that motivated her into confronting him and seeking treatment for both of them. In another example, an eleven-year-old daughter of a co-addict intercepted a call from her father’s lover and told the mother that she thought the father was having an affair. In this case, the partner had displayed various signs over the years that the coaddicts chose to ignore in favor of the spouse’s reasoning and explanations of suspicious events, usually centering on his work schedule. This resulted in children being exposed to matters that, if confronted sooner, would have allowed the children greater protection by the mother.

During this stage of the partner’s recovery, coaddicts will begin to seek help for themselves. They enter treatment seeking information, validation and education about addiction. In treatment, this is often the “how to” for best meeting the needs of the co-addict. All of these skills are important and each should be used consistently, especially the educational piece, for it offers a foundation from which a partner can grow and learn the necessary steps involved in recovery.

At this stage in their healing, partners respond best to the directness and advice of the therapist. This is important to note since, for some therapists, this can be extremely uncomfortable and counterintuitive. However, in the treatment of sex addiction, it is imperative to give concrete guidance since much of the disease is centered in faulty or impaired thinking. This can be especially true for the partner who may have, for years, trusted the thinking of the addict more than her own thinking.

There is a tremendous amount of self-imposed and, at times, externally-imposed pressure for the co-addict to leave the partnership. Friends and family members who having learned that the spouse is a sex addict may urge the partner to leave. This can often be from those who are misinformed and uneducated about sex addiction and therefore do not believe that healing from the disease is possible. In some instances, the coaddict’s own family of origin provide an unsupportive environment. Coaddicts will attempt any way to seek emotional validation even when it is not possible. This dynamic later becomes an element of their recovery as they each explore the impact of their own childhood and its role on their intimate relationships. One partner disclosed to her brother – a recovering alcoholic- that her spouse, a sex addict, had been cheating on her. Her brother threatened to kill the addict in his shock and outrage over what he had learned. Many partners experience shame and never let their family or friends know about sex addictions. They might make reference to having had problems for which the partnership got help, but they will remain discrete about the reason. Also there are those partners who, as a means of deriving emotional support or as a way to punish the addict, will indiscriminately tell family members. These more immediate reactions can, at times, have implications for the partnership for years to come. One partner’s mother, who never liked the spouse, sent her daughter information about psychopaths. This frightened her and played into her persistent ambivalence at a time when she had made the decision to stay in the relationship.

During this time there is tremendous ambivalence toward the addict, which can be extremely painful. Partners are often looking for an escape from the intense emotions that overwhelm them. In therapy, they will question repeatedly whether they should leave the relationship as they experience a significant amount of distress in their quest to come to terms with the upheaval that has now confronted them. They often report feeling lost in their fluctuating feelings for the addict who has betrayed them, and upon whom they have relied. Therefore, it is often the worst time for partners to decide to leave the relationship; instead, making more temporary decisions while they go through this difficult phase is recommended.

Some partners have found it necessary to ask the addict to leave the home upon learning of the addiction. Others have found that asking the addict to sleep in a separate bedroom helps create stability and control in a time of extreme stress. One partner found that taking back her maiden name was part of what she needed to gain some emotional separation. Additionally, many have found it necessary to stop sexual contact with the addict for a period of time. Some of these initial changes can be beneficial and help to build some confidence in the partner’s ability to effect change in these untoward circumstances.

In the initial phase of treatment, partners are often questioning the past as a way to come to terms with the present. Many question what they may have missed, how they tolerated unacceptable behavior, and how to reconcile with the person they thought the addict was before and after the diagnosis. This is a common expression of the grief they experience over the loss of the relationship as they knew it, and they question whether they can stay in the relationship. The ambivalent feelings, although about the addict’s behaviors, are also more significantly about themselves. Without a strong sense of identity and a clear integration of beliefs and values that match actions, it is nearly impossible for these partners to have meaningful goals for themselves or their relationships.

Partners are encouraged to be active in their addict’s recovery by establishing clear expectations of their addict’s behaviors. This can be a confusing and threatening prospect for many coaddicts because most have been accustomed to deferring or quieting their wants and needs for fear of being denied, ignored or promised things that the addict cannot provide. Alternatively, many coaddicts may be able to communicate their needs for change, but often through dysfunctional means. Angry outbursts, reasoning tactics or overwhelming tears are ways they would express themselves and then became frustrated when their requests were denied or ignored. In recovery coaddicts learn to establish follow-up measures if their requests are not met. This can only be achieved once they have confronted abandonment fears that they may lose the relationship if the addict fails to meet their requests.

Coaddicts are not accustomed to setting limits and enforcing consequences, because they do not feel entitled to being heard. Thus, a goal for them is to begin to recognize their needs and to start to express them. This process begins at a time of significant upheaval in the relationship, and continues, through the expression of different needs at later phases of treatment.

Partners often need their addicts to commit to a schedule regarding their recovery. Expecting the addict to be in therapy, attend meetings and work with a sponsor are typical requests from coaddicts once they can battle their own internal struggle to not be too controlling. Further needs include more structure in the home. For example, setting time frames for work and responsibilities with the children are common. Moving the computer into a common family area is a typical request. Partners will know they are bothered by the behaviors of the addict but often struggle with their sense of worthiness in asking changes of the addict. Addicts and their partners are enmeshed in an intricate web of dependency. Therefore, it is an important juncture for coaddicts to establish a sense of emotional maturity as they differentiate within the relationship. They learn to trust their intuition better, and when evaluating the addict’s truthfulness, they begin to see the difference between the addict’s actions and their words. In one case, a partner reported that upon learning that her spouse was late to care for their child, she did not want nor care to know the reason for his lateness; she allowed herself to feel her feelings, then made other childcare arrangements without listening to his reasons. She later learned that, in fact, he had overslept and she was right to trust herself and to act on her own behalf, rather than react to his behavior. Throughout the relationship, she had tolerated his lateness and would become a victim to this behavior.

Initially in treatment, the coaddict’s sense of victimization by the addict’s sexual behaviors is strong. Having the capacity to understand the difference between a slip and a relapse can be fertile ground for partners to lose balance with themselves and with the addict. They will often over- or under- react to situations since this is unfamiliar territory for them. Coaddicts know they cannot tolerate the sexual behaviors, but reconciling how they need to respond to other violations and disappointments is extremely complicated. Having a secure and reliable system of support allows partners to process their feelings and set the stage for deciding any action or inaction need.

The sexual parameters in the relationship can go through various transformations as the partners address their reactions to the crisis. Many may initially feel this is the only area that has given them satisfaction, and for others some sense of control, so will therefore continue to engage without any sense that limits may be needed. In fact some react by feeling stronger sexual ties to the addict and will feel awakened to an arousal that they have never known before or will be reminiscent of the relationship in earlier times.

PHASE TWO: NORMALIZATION OF THE REALITY: FOCUS SHIFTS FROM THE ADDICT TO THE SELF
During this time of their recovery, partners begin to experience greater self- confidence. It is often at this phase that couples begin to confront new challenges together regarding boundary setting and intimacy. Coaddicts begin to be tested in their ability to change, because they are forced to deal with an addict who is in recovery and thus potentially more of an equal partner. Also, this is when the underlying issues stemming from their childhood can be more directly faced. Abandonment, neglect, and themes related to shame and anger are addressed. For instance, many coaddicts report being raised in alcoholic backgrounds are able to openly speak of the impact that drinking has had on their lives. Others are able to identify an absent parent or other traumatic experience(s) that led to a sense of abandonment. Consequently, coping skills developed and became fixed, especially the pattern of caring for others, at the expense of themselves. Sometimes this phase of treatment, partners will feel stronger and more able to make the necessary decisions to leave the partnership. They are able to see certain behaviors as “red flags” and confront them effectively, rather than become a victim to the behaviors. They take the information and measure it against the parameters they have established for themselves. An example of this would be a partner expressing a bottom line behavior to the addict; e.g. if the addict has one anonymous encounter, this results in immediate separation. This new behavior demonstrates that the coaddict is able to make a decision and follow through with it. During this stage, the partners are able to identify patterns of the addict and not personalize the addiction; in Phase One, they are less capable of seeing the responsibility of acting out as that belonging to the addict.

When partners decide to terminate relationships with the addicts, and children are involved, the processes of separation and divorce can introduce new traumatic experiences and the initial victimization they felt in the relationship resurfaces. The stress and subsequent legal decisions can impede the partner’s recovery if their trauma responses are high. One client, who had never had a concern about the addict’s risk to her daughter, began to feel hyper sensitive to the idea that he might harm the child sexually once separation and fighting over visitation occurred. The coaddict herself had been a victim of child abuse, and this history combined with victimization she felt in the marriage, began to cloud her perspective and complicate the divorce process. In addition, her daughter was further caught in the middle and reacted to the mother’s fears.

Phase Two is a time when partners are fully engaged in the recovery process. They are actively involved in reading the related literature about addiction and its impact on the family of origin. Reluctantly they start to identify with the concept of an “inner child” recognizing that at an earlier phase of development the younger self was neglected, abused and/or abandoned by their family. Many are resistant to this notion since it reflects experiences where they had little control and needed to fend for themselves. They are often afraid to experience the unpleasant feelings associated with having been a child, since many did not have adequate and consistent caregivers to rely upon. This forces them to confront their own isolation and loneliness, which is why they have partnered with a sex addict with whom they could focus and thereby distract themselves from their own reality.

In this phase of their recovery, many partners are attending twelve step meetings, individual and/or group psychotherapy. Peer relationships in recovery start to form as time is shared outside a meeting or group. Others find the twelve step meetings limiting for them, and will have developed a key person or two with whom they can talk freely about the changes that are occurring in their lives. Still others of religious faith may become more involved in their spiritual practices and may join committees or groups to further their involvement.

For some, the initial distress symptoms have required intervention of psychotropic medication. Many begin to confront a long-standing history of depression or anxiety that they denied, minimized and/or normalized for years. Once in treatment, they acknowledge the existence of these diagnoses and take a more active role in managing them. Feeling more in control of themselves, they can more readily question the codependency traits in their relationships.

Sexual boundaries are often more directly addressed at this stage. Many prior limits were often in reaction to a crisis, but here in Phase Two, partners take a more active role in confronting their relationships in recovery. Many will report disturbing and intrusive thoughts of the addict’s addiction while being sexual, which creates tension for them and can trigger the need to withdraw, and avoiding sexual contact until there is more safety.

PHASE THREE: ADVANCED RECOVERY ISSUES ADDRESSED
In Phase Three, coaddicts have now entered a period of further integration about the meaning of addiction in their lives, and the impact their own upbringing had on their feelings of safety and security in the world. Partners openly explore the causes and implications of being raised in environments where their needs were made unimportant.

Partners report experiencing calm and peace and a greater appreciation for the people in their lives. One partner after 5 years reported she could finally receive the good intentions and feelings her two closest peers had for her. She “knew” they cared for her, but it was only through her work on herself, especially on the themes regarding abandonment and survival strategies she used to defend against feelings, that allowed her to integrate this knowledge with her felt experience.

There is less focus now on the sexual addiction and especially the details of the addict’s behaviors. There is greater availability to other areas of the coaddict’s life and it may be at this time that they become involved with new professional or personal endeavors. One partner who had been a stay-at-home mom with only a high school degree found tremendous satisfaction when she was offered a part-time job in a local school offering foreign language classes to students. This validated her self-worth and demonstrated her ability to have a separate identity from the partnership. She continued to also become more deeply involved in her religious group, where she experienced tremendous support. After five years, she knew that she was ready to leave treatment because she found her life had taken on new meaning and that she was able to more effectively handle problems that arose. Another partner had delayed going back to school for a masters degree because she had felt preoccupied emotionally by her recovery for four years. When the opportunity presented itself again, the timing was perfect, and she felt up to the challenge.

Intimacy within the partnership is more deeply explored. Each becomes aware of the other’s role in the distancing that has existed, and are actively engaged in a process where they can try new behaviors. Workshops geared to intimacy, couples therapy and retreats help to develop intimacy between them. These are often the safe and structured types of settings in which to try out new approaches together. One couple in recovery found that their attendance at a weekly twelve step meeting for couples became something they looked forward to for the strength and support they felt from the meeting process.

The addiction has been a catalyst for change, and with recovery, coaddicts and addicts alike become more open to seeing the role their own backgrounds have played in forming and maintaining the relationship, as they knew it. There is an appreciation for what addiction has brought to their lives, and they report feeling more detached from the earlier expressions of pain with which they initially presented.

But this is also a period where many sex coaddicts to explore more deeply those areas of their past that for years they denied as problematic. For some, it is addressing the shame of being raised in an abusive environment. For others, it is the repression of child abuse memories the coaddict can only begin to acknowledge after years of therapy. For another, it is the safety of being in group psychotherapy with other coaddicts so she can face the fears about wanting a child, and yet address her resistance to having one because of being raised in an alcoholic family. For yet another, it is moving away from the addition model of treatment, discontinuing twelve step meetings and being ready to leave therapy to embrace a spiritual practice that better meets her needs and indicates advanced recovery. Ultimately, partners at this phase are more in charge of their treatment progress. They feel more directed in their treatment goals and their self-worth has increased. They experience less self-doubt about decisions and when they do are more open to seeking help and input from others.

INTERVENTION TECHNIQUES

Long-term issues in working with partners of sex addicts are both unique and challenging. Therapists have many opportunities to help partners confront and heal, and change from a complex and highly shaming pattern of behavior that impacts most facets of their lives. A myth often voiced about the coaddict is that they either hinder the addict’s recovery or are unwilling to engage in the recovery process. In fact, partners are an integral part of the addicts’ healing. Their involvement can be associated with better treatment compliance and outcome of recovery of the addict. While the clinical work can be rewarding, it requires that the therapy be flexible and, at the same time, mindful of the processes of both denial and recovery. Brown & Lewis (1999, p.9) noted “The therapist is always guided by a focus on the organizing principles of loss of control, abstinence and the long-term developmental process.” It is advisable to enlist peer support and stay informed about current treatment modalities for coaddicts. This helps in building competence and limiting the countertransference that can occur with partners of sex addicts.

Initially, it is essential that the first phase of treatment addresses and normalizes the shock and disorientation that results from the discovery of the addiction. Education will teach them about boundaries and how to establish them in their relationship where they often felt little control. Engaging the intellect, while prompting emotional insights with examples of current stressors in partners lives, can help expedite their openness to change and foster trust in the therapeutic relationship. Recommending lecture series or psychotherapy groups geared to partners’ issues is tremendously useful for them at this stage. Referral to twelve step meetings is also extremely helpful. Clear and direct guidance from the therapist is strongly encouraged since many partners are floundering in their confusion and self-doubt and look to the therapist for emotional grounding. Remember that partners have great difficulty with change and will need constant reminders of the helpful options available to them Do not be surprised if a partner is reluctant to go to a meeting; for some it can take months to attend their first one.

The degree of internal pain and possible external consequences (loss of income to the family, law enforcement involvement) for coaddicts, as a result of the addict’s behaviors, cannot be minimized. This can be an extremely uncomfortable place for therapists since they would like to support the partner in getting involved in the changes necessary for recovery to hold. Balancing the pace of the partners’ progress, and at the same time prompting change by pointing out cognitive distortions, and set–backs in their progress is a useful strategy in working with this special population. Change comes slowly; the patterns developed happened slowly. Giving reminders of the context of this developmental process helps normalize the understandable impatience partners and therapists can experience in the treatment.

During Phase One and Two of treatment, therapists can notice partners’ increased insight about their feelings and the profound self-doubt manifested through second-guessing, minimizing and/or denying their reality. They have become accustomed to trusting the addict’s views over their own. In one case a partner found that when she would question her husband’s patterns of acting out with men over the years, he would compare his inability to stop his behaviors to her compulsive overeating, thereby quieting her inquiries. She would then blame herself for the sexual and emotional problems in the relationship, thereby not confronting him or holding him accountable. In this instance the therapists reframing of the problem showed how the initial behaviors of the addict would go unaddressed and the partner in turn would take on responsibility that was not hers to take. Furthermore, themes of emotional belittling became apparent allowing the partner to further see the impact of the addiction on her psyche.

It is essential that therapists be mindful that coaddicts do not present alike. In addition to the differences in either knowing about behaviors or not, their own disposition plays a role in how they will advance in their recovery. Some can present with an Axis 1 diagnosis, e.g. anxiety, depression and PTSD (post traumatic stress disorder), but some have personality disorders that can impede the process. Finally, previous adaptive coping skills such as religion, spirituality, career satisfaction, family and peer support are integral in both ongoing assessment and treatment of the partners. Coaddicts initially may present with some of these symptoms, but it is important to differentiate traumatic reactions to the crisis versus other Axis I or II diagnosis that have been dormant and activated by the addiction. One client reports now, after three years of recovery, she can finally see that she has been depressed since being a child.

Some partners can be more challenging to treat if they demonstrate a higher level of tolerance for unacceptable behavior. Their responses to the acting-out patterns of their addicts can often present as delayed or over-reactive. These defensive styles have interfered with them knowing how to establish and enforce appropriate boundaries for themselves. This high tolerance can reflect a more pronounced traumatic and/or negating childhood, which has been ignored or denied by them until this point. The challenge is to confront the unknown of new behaviors, which is terrifying for partners.

During Phase Two, therapists will find that teaching partners to learn to regulate their responses to issues that confront them in recovery is an excellent tool in their healing. Sometimes giving them permission simply to collect data that makes them suspicious about the addict’s behaviors allows them to build skills in trusting their intuition while delaying action. This helps foster a sense of internal control of their feelings while, at the same time, teaching them it is ok to feel feelings without action, which conversely gives them time to decide what to do. Many partners during this phase will make a number of missteps as they attempt to gain emotional footing. Offering them support while guiding them in reviewing their actions helps partners develop compassion for themselves. Additionally, these are opportunities to draw parallels between historical data from their past to their current situations.

Longer-term interventions focus more on the themes from childhood that influenced the types of relationships partners seek. Helping partners see parallels in their behaviors in the relationship to the addict to coping skills as a child provides a broader understanding of how they became oriented to relationships like that of an addict. This any be a time for partners from more destructive backgrounds to move further into those old traumas and in fact may need more therapy.

SUMMARY 
The treatment of sexual coaddicts greatly enhances the outcome of the partnership in working with sex addicts who are in primary relationships. Coaddicts offer a unique perspective on the problems in the relationship, and can be a valuable resource in assessing the recovery of the addict. However, they have their own defining characteristics that necessitate clinical interventions, which are specific to this population. Having a framework to draw upon like that of the addiction model, and the three-phase approach presented here, allows therapists and coaddicts to better understand and anticipate potential roadblocks and milestones in recovery. This helps to normalize the trauma that partners experience in their recovery from the effects of sexual addiction. This article has defined those predictable tasks, and phases that coaddicts move through that are normal to their recovery process. It is vitally important that therapists treating this special population understand what is normal in the recovery process. For if not, they can unknowingly enable, interfere, stop or attempt to fix necessary changes that are part of the recovery process for coaddicts.

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