The Controversy in Treating Partners of Sex Addicts
In “From Victimhood to Victorhood” (published in the May/June 2015 issue of The Therapist), Alex Katehakis writes that a “major shift has occurred in treating partners of sex addicts”. The shift she describes is towards the Relational Trauma (RT) Model, in which practitioners emphasize that partners’ relational bonds are damaged by betrayal, as precipitated by the discovery of sexual acting out — not a historical and ongoing pattern of destructive or self-defeating behavior by non-acting out partners, as implied by the so-called co-addict model, previously espoused by writers like Stephanie Carnes and Claudia Black.
In the RT approach, practitioners eschew the implication that partners contribute significantly to an addiction by an elaborate, conscious or unconscious pattern of enabling. Such suggestions are misplaced, if sometimes accurate, assert proponents of the RT Model, while their interventions are by contrast comforting and affirming, emphasizing the depth of betrayal by a perpetrating partner. The champions of this position are The Association for Partners of Sex Addicts Trauma Specialists (or APSATS). Their members, as well as those of the hegemonic Certified Sex Addiction Therapist (CSAT) network refer to “sex addiction induced trauma” as a specified subset of a PTSD-like condition.
PTSD-like because while discovery of sex addiction has been deemed a life altering event and has even been demonstrated to be a traumatic event for partners, according to numerous researchers (Bergner & Bridges, 2002; Glass, 2003; Steffens, 2006), it’s not clear that partners of sex addicts meet full criteria for the condition. Psychologist David J. Ley argues that typical partners of sex addicts do not meet criteria of section C of PTSD code F43.10 of the DSM-V, “persistent avoidance of stimuli associated with the traumatic event(s)”, by pointing out that these partners often demonstrate “obsessive, ruminating fixation on the details of their partners’ betrayals and actions”. He states that the essential features of sex addiction — sexual betrayal, infidelity, lying — do not constitute trauma for partners, and that describing them as such dilutes the concept of trauma, which undermines services relating to life threatening events. While this latter claim seems far-fetched, it’s notable that section E of code F43.10 indicates that “marked alterations in arousal and reactivity associated with the traumatic event(s)” also meets criteria for the diagnosis of PTSD. One wonders why Ley does not find his own characterization, “obsessive, ruminating fixation”, not tantamount to this DSM definition of hypervigilance.
While the assignment of trauma to partners of sex addiction may be debatable, we might consider various reasons why the trauma model has such traction with consumers of partner treatment. We might also consider what life altering events are triggered for partners by other addictions. For example, alcoholics and gambling addicts also engage in patterns of deception and blaming alongside destructive behaviors, so why not “alcoholism induced trauma” or “gambling addiction induced trauma” as it might pertain to partners or families of drinkers and gamblers, as the latter group, especially, often practices its addiction with similar levels of secrecy as sex addicts. With respect to the effects of that condition, I’d suggest that it is not so much the presentation of PTSD-like symptoms that warrants a contrived assessment label, or the repetitive deception, but rather the context of that deception, that hurts so deeply. After all, what is harder for our clients to talk about than sex? What elicits shame, vulnerability, and therefore the defenses of rage and vengefulness, more so than sexual betrayal?
Meanwhile, as the co-addict model assigns a predisposing “codependent” personality pattern to partners of sex addicts, the RT model downplays this suggestion, though its adherents do indeed recognize patterns that implicitly predate the discovery of addictive behaviors by acting out partners. They also recognize longstanding personality factors (in partners) that may inhibit treatment, but I find they do so in clandestine fashion, conflating notions of personality disorder and trauma, and subordinating the former concept to the latter, more palatable construct. Consider, for instance, the following passage from Barbara Steffens and Marsha Means’ book, Your Sexually Addicted Spouse (2009): “PTSD can last a lifetime. Long-term PTSD sufferers develop painful coping mechanisms that burden their lifestyles and become ingrained in their personalities”. Via statements like this, personality disorders, or features of personalities disorders, are concealed within an oblique observation of developmental trauma.
Treatment based upon the Al-anon model (the now renounced “co-addict” model) prescribes self-examination for partners of sex addicts: examination of and responsibility-taking for repetitively destructive or self-defeating behaviors; examination of trauma repetitions, reenactments of familial scripts with the unconscious hope of creating new drafts in later life. The idea recalls certain 12-step slogans, such as the supposedly Einsteinian definition of insanity: doing the same thing over and over again, expecting a different result. This too is a derivative notion, echoing Freud’s concept of repetition compulsion, first published in 1914 at the outset of the First World War. Since then, the concept of trauma has gradually merged into the lexicon of psychology, not so much exclusive of character pathology as co-morbid with our observations of trauma and addiction.
As far as pragmatic interventions are concerned, I find little difference between the literature representing the co-addict model versus the supposedly paradigm-shifting RT model. Coping strategies, such as keeping busy with tasks, are normalized by adherents of both approaches: they are cast as affect regulating under exceptional circumstances. Certain behaviors such as indiscriminate sharing of a sex addict’s behavior with friends or family, including children, are likewise discouraged; an RT practitioner might call such behaviors “normal”, while an author writing from the co-addict perspective calls the same behaviors “natural”. On the other hand, in the RT model, such behaviors are framed with a different accent: as products of social isolation and episodic trauma brought on by an addict’s behavior, not an underlying or even associated pathology. The notable literature that represents this position includes the Steffens and Means book, and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts (Carnes, et al., 2012): the latter, in keeping with recovery tradition, outlines a healing process in stages: a pre-discovery stage, followed by phases of crisis/decision, and repair. In the crisis/decision stage the partner asks, “how did I get here?”, and comes to realizations like, “nothing in this marriage has been real”. Note the emphasis upon present or recent past events, not family of origin, early developmental material. Meet them where they’re at. Remember that chestnut? That approach always seems effective in the context of a short-term treatment program. But in a healing process, which is implicitly long-term, the issue is not where we meet, but where do we linger?