Dan Crockett, M.S.

, LMHC, CAP, CSAT

The New Leaf Center
Winter Park, Fla.

Introduction
Dan Crockett
Licensed Mental Health Professional
Certified Addiction Professional by the State of Florida
Certified Sex Addiction Therapist by the International
Institute for Trauma and Addiction Professionals
Founded the New Leaf Center in 1990, an agency that
specializes in treating Addictive disorders and trauma
To address issues related to effectively treating
the Spouse/Partner of a Sex Addict
The Outbreak
Its all over the news. We are inundated with celebrities,
sports figures, religious leaders, teachers, military leaders
and politicians caught in sexual scandals that often
destroy their marriages and careers.
People who have great influence over our population,
including our children.
Most, because of their own denial, will never seek
professional help.
But how many people
pay attention to the
dilemma of the Spouse?
Common Myths
Myth 1: Couples should initiate relational therapy while
active Addiction is occurring.
Myth 2: The Addict has learned from his or her mistakes
and wont do it again.
Myth 3: The Spouse has it together or is crazy.
Myth 4: There is only one Addiction taking place.
Myth 5: Treatment for couples, where there are multiple
betrayals and often at multiple levels, is the same as
treatment for couples for whom there is a single affair or
other sexual problems.
Myth 1: Couples should initiate relational
therapy while active Addiction is occurring
Addiction is a Primary Disorder.
In most cases, it takes precedence over other problems.
It needs to be evaluated/assessed and treatment
recommendations made and followed.
Spouses need assessment/evaluation to determine their needs.
Their primary need in the beginning is for safety, support, and
boundaries.
Couples are seen at this time in order to find out whats
happening.
Initial recommendations may be made to the Spouse in individual
sessions, while initial recommendations to the Addict are often
made while the Spouse is present.









Myth 2: The Addict has learned from his
or her mistakes and wont do it again
Addicts rarely succeed at overcoming Addictions by
themselves or seek help on their own.
The Spouse is often helpful in getting their Partner to
seek help and stay in counseling.
Initially, it is good for the Spouse to come to session with
the Partner so the therapist can share the outcomes of
the evaluation/testing and recommendations to both of
them at the same time.
The evaluation should be done by a qualified therapist
skilled at doing sex Addiction evaluations and therapy.

Myth 3: The Spouse has it together or is
crazy
Spouses may initially present that they are calm and collected
when in fact they are just barely holding it together.
Many:
Have shut down their feelings in order to cope
Feel overwhelmed by the information they already have
Fear for their health (STDs), children, financial stability
Fear for their standing in the community and possible legal
repercussions
Some will display intense anger or rage and make threats of
violence or to act-out sexually themselves.
Most Spouses will deny they need help and demand that their
Partner is the only one who has a problem.










Myth 4: There is only one Addiction
taking place
Most Sexual Addicts have at least 2 to 3 active Addictions.
Drug/alcohol dependency, gambling , spending, and food
Addictions are the most common.
Addicts will substitute one Addiction for another when their
primary Addiction is getting them in trouble.


Myth 5: Treatment for couples where sex
Addiction is present is the same as
treatment for couples for whom there is
an affair or other sexual problems
With Sex Addicts, there are multiple betrayals and often at
multiple levels.
Treatment is more structured.
Individual evaluation and therapy for each person is first.

It is not uncommon for one or both to go to Intensive Programs
or In-patient Therapy.
The Addict needs to admit to and start taking responsibility for
his or her Addiction through treatment and support community.
Spousal safety is primary, as are boundaries and support system.
Disclosure is highly structured to help prevent further
psychological damage to the Spouse.
First Session: Listen & Gather Data
Listen to both: What are the concerns of each?
Gather data:
Is this their first time to seek counseling?
How long has the Spouse known about the betrayals?
How did the Spouse find out?
What does each of them want to happen?
Watch out for open relationships
The Spouse is angry or upset that the Partner wasnt having safe
sex, or being honest about how many times, etc.
Both may be Sex Addicts, but they may believe one is not because
that person exhibits greater control.

First Session: Inquire About Safety
Spousal safety is primary; is there any danger?
Toward the children or to the Spouse physically
Molestation or sexual abuse of the children
STDs: Ask both to get tested just to be sure
Physical abuse or threats
From either of the couple
Are either threatening suicide or homicide?
From an outside force (jealous lover, etc.)
Does the Spouse have a safe place to live?
Food
Finances
First Session: Childrens Safety
Most Sexual Addicts have never committed a sex offense
or been involved in sex acts related to under-age
adolescents or children.
Some sex offenders and child sex offenders also are
sexual addicts.
If sex offenses are suspected toward children under the
age of 18, addressing this takes precedence over sexual
addiction.
Child safety always comes first, and the individuals
actions may need to be reported.
First Session: Initiate Testing
Ask the client with sexual problems to take the SAST.
Sexual Addiction Screening Test at Recoveryzone.com
Free online test; takes 5 minutes
Score of 6 or higher indicates sexual Addiction
Score of 6 or higher indicates sexual Addiction and further
evaluation and recommendations will be needed.
Schedule or refer for evaluation with a CSAT
Suggest that the Spouse attend the initial evaluation
session as well as the treatment recommendation session
with the Addict to make sure he or she is being truthful.

First Session: Initiate Testing
Ask the Spouse to take the Partner Sexuality Survey (PSS)
at Recoveryzone.com and bring a copy of the results to
your next session together.
If you are not qualified or skilled in sex Addiction
evaluations and treatment, refer to someone who is.
A list of CSATs (Certified Sex Addiction Therapists) can be
found on the IITAP site (International Institute for Trauma
and Addiction Professionals) at http://www.iitap.com/
CSATs are trained to work in consultation with referring
therapists.
CSAT Evaluation
Need approximately three hours to do evaluation
Best if done in a single session
Begins with brief interview with the Spouse present
Collect a psychosexual history from client, starting with
childhood
Spouse will not be present during the evaluation.
Administer the Sexual Dependency Inventory (SDI), Post
Traumatic Stress Inventory (PTSI) and other testing if needed
Schedule an appointment for them to return to hear the
recommendation
Consult with Spouses therapist regarding the
recommendation for the Partner
Keep all therapists in the loop

Second Session: Working with the Spouse
Therapist should see the Spouse alone to determine
spousal needs and present recommendations.
Spouse is often resentful at having to be in therapy.
I dont have a problem; my Addict does.
Most Spouses dont like being labeled.
Co-dependent, co-sex addict, survivor, etc.
Win them over by being helpful.
Important that the Spouse remain a part of the Partners
treatment
Spousal Safety
Spouse often experiences Partners betrayal as a trauma.
Sex Addicts betray more ways, more frequently and often
take greater risks, create more financial problems, and do
so without considering the consequences to their Spouse or
family.
The person whom the Spouse thought he or she could trust
the most turns out to be the most untrustworthy.
The Spouse becomes overwhelmed with grief and pain as
well as concerns for their physical, emotional and financial
safety.
Careers, legal problems, and community standing also can
be affected.
Trauma vs Reality
We all need reality checks to function in the world.
Most of us have safe relationships to which we turn for
reality checks.
When the person we thought we could trust the most
with our heart and soul deceives us in so many ways and
on so many levels, our ability to trust ourselves and our
current reality becomes distorted.
A traumatic reaction can occur.
:

Impact of Trauma on Memory, Stress
According to Bessel van der Kolk, considered the worlds leading expert
on stress and PTSD:
Psychological trauma is known to impact long-term memory, including
intensifying memories . . . many systems of the brain are activated to
deal with the stress, making it difficult to go back to normal and
resulting in the brains threat detection system staying hyperactive . . .
individuals will have a hard time focusing on things [because they]
continue to be hyper-aroused . . . getting stuck in trauma. It interferes
with peoples capacity to pay attention to the present, have pleasure in
the present, focus in the present and to pay attention to whats going
on right now and to pay attention to their physical body. Their body
keeps racing, the stress hormones keep getting secreted, and they
often become ill
Spouse Symptoms
Depression
Obsessive thinking and inability to focus
Constant checking of Partners clothing, where-abouts,
computers, receipts, phone calls and records, credit cards
To the point of exhaustion
Feelings of fear/terror, betrayal, hurt, mistrust, disbelief,
jealousy, self-hatred, disgust, inadequacy, shame, anger
and rage
Physical problems: sleeplessness, stomach upsets, muscle
tension, headaches, and racing heart
Hyper-sexuality or shut-down sexually
Spouse Symptoms: Grief
The idealistic relationship the Spouse thought he or she
had is shattered.
Grieving and questioning begins.
How could I not have seen this?
Is there really true love?
What do I do now?
Am I really loveable?
How will I ever heal?
Is it ever safe to trust another so completely?
Spouse Symptoms: Anger
Betrayals can lead Spouses to experience anger that
becomes unmanageable.
Constant rumination and reminders of all of the times they
stayed home alone managing the kids, worrying about
finances, and not taking good care of themselves when the
Addict lied about having to work late
Times theyve gone without love and attention while the
Addict was doing phone sex, visiting prostitutes or massage
parlors, and masturbating to virtual sex with another
person
Anger about the debt theyve incurred due to the Addicts
acting out, which has left them with few choices about
what they can do to take care of themselves and their
children financially

Spouse Symptoms: Anger
Theres an endless list of justifiable hurts, pains,
humiliations and betrayals by the Addict.
A feeling of doom I cant survive this.
Can devolve into physical attacks on the Addict, as well as
frequent verbal assaults and loss of sexual desire
Or just the opposite -- Increased sexual acting-out as a
way to get back at the Addict, or as an attempt to prevent
the sexual Addict from acting out further
Spouse Treatment: Safety First
Helping the Spouse to create a sense of safety is primary
when treating trauma.
The therapist is often the first voice of reason.
Validate the hurt, anger, confusion, and inability to trust
Give the Spouse permission to take as long as he or she
needs to heal and regain a sense of hope
Remind the Spouse to stop periodically and breathe to
reduce tension and anxiety
Have a form that offers suggestions for relaxing activities
Have forms for her or him to use in creating a personal
safety plan
Safety Plan
People who are emotionally traumatized experience the
effects of a hyper-alert brain waiting for the next threat. It
is this brain state that often leads to the partners behaviors
of snooping, prying, questioning, threatening, and
obsessing over the Addict.
Facing Heartbreak: Steps to Recovery
for Partners of Sex Addicts
Safety Plan: Avoid Staggered Disclosures
Each disclosure re-wounds the Spouse psychologically,
physically, and spiritually.
Active Addicts will only reveal what they believe their
Spouses already know.
The Sex Addicts therapist will work with the Addict to
formally present a full disclosure to the Spouse.
The Spouse has specific tasks to complete to prepare for
the disclosure.
Safety Plan: Avoid Staggered Disclosures
Disclosure generally takes at least 6 weeks to prepare for,
once the Partner begins active treatment in an outpatient
setting.
Disclosure can take place sooner, if the Partner is at an
Intensive or In-Patient program.
Both the Spouses therapist and the Addicts therapist are
present during the disclosure.
Treatment Resources
Workbook: Facing Heartbreak: Steps to Recovery for
Partners of Sex Addicts, Stephanie Carnes, Ph.D, CSAT-S,
Mari A. Lee, LMFT, CSAT, and Anthony D. Rodriguez, MSW,
CSAT,
www.Gentlepath.com
800-708-1796
Gives the Spouse specific tools and assignments to
reclaim lost sense of power
Gives the therapist specific tasks to use to help clients
rebuild and strengthen them mentally, emotionally,
physically, and spiritually
Tools
Feelings journal
Safe, supportive people
Stay focused and avoid snooping or pain shopping
Daily exercise
Yoga, deep breathing, time spent in nature
Healthy eating
Meditation, prayer, spiritual practices and readings
Pets
Comforting activities: baths, massages, walking
Setting healthy boundaries with the Addict
Tools
The Spouse needs to take some time (6-12 months)
To figure things out and determine his or her options
Determine if the Addict will admit he or she is a Sex Addict
and demonstrate commitment to consistent recovery
Gain education about addiction and its impact on family
systems
Develop a support system
Deal with the trauma thats resulted for the Spouse
Taking the time needed to heal puts the Spouse back in
control
Boundaries
Most Addicts have few boundaries regarding their
behaviors .
Put partners at risk for STDs; financial ruin; loss of job,
friends, and social standing; legal problems; and danger to
the children
Partners need to review their boundaries and redefine
those that will keep them safe from further harm.

Boundaries
Four major types
Non-negotiable boundaries
Mental and emotional
Physical and sexual
Boundaries with other people, places and things
Consequences for boundary violations should be written
in advance.
Non-Negotiable Boundaries
See a therapist for sexual addiction and follow all of the
recommendations
Discontinue all sexual acting-out
Break-off all relationships and communication with
previous sexual people, places, and things
Remove all pornography/porn sites, sex toys from the
home, work place, beach cottage, etc.
Tell the Spouse about any relapse within 72 hours
Tell the Spouse about any change in the Addicts
treatment plan within 24 hours


Non-Negotiable Boundaries
Each non-negotiable boundary has a consequence.
Violation of this boundary will mean
I will ask that you sleep in a separate area of the house.
I will ask for a separation to give me time to determine
how serious you are about recovery.
I will move in with a safe friend or relative.
I will file for divorce.
Setting and re-enforcing these boundaries lets the Addict
know the Spouse is serious.
Boundary violation(s) may result in end of the relationship.
This is key to helping the Addict hit a bottom.
Mental & Emotional Boundaries
Help preserve ones sanity and emotional stability
I want you to do any future disclosures in the presence of
a therapist.
Dont ask me to go to vacation or business places where
you have previously acted out.
If you feel triggered to act out, discuss this with me, your
sponsor, therapist, or SA group members.
I would like you to watch the children on Tuesdays and
Saturdays so I can attend group therapy and my support
group.
I want you to pay legal expenses so I can see an attorney
to find out my legal rights.
Physical & Sexual Boundaries
Protect physical and sexual health
Right now, Im choosing to sleep in a separate bed.
Im choosing to not be sexual with you until I say I am
ready to do so.
If I want a hug or for you to touch me, I will ask for you to
do so.
I want you to do a full-screen STD test now and again in 6
months - and show me the results.
I will shower and get dressed in a separate area of our
home.
Boundaries: People, Places & Things
I want to sell our seaside cottage because you acted-out
sexually there with another person.
I want you to seek other employment or transfer
elsewhere, because you acted-out with numerous co-
employees where you currently work.
I will not go to dinner at restaurants where you have
taken others with whom you have acted out.
If any information is shared with our adult children, I
want to be present and involved in what will be shared.

Boundaries
Only work if the couple works them
Each boundary in every category should be carefully
thought through and reviewed with a therapist .
Each should have a consequence if not followed or if
violated.
All consequences need to be carefully considered to
determine if they are practical and if the Spouse is willing
to or can re-enforce it.
Couples Therapy
New research on bonding and attachment suggests . . .
we are most resilient in relationships with other people.
The natural place to heal from trauma is in the arms of
someone you love.
When there is a safe other, clients can put all of their
energies and resources into protecting themselves.
We know the quality of ones intimate relationships
impacts us physiologically and emotionally.
And has a huge effect on ones personal, physical and
mental health.


Couples Therapy
Recent research has shown:
One is twice as likely to have a stroke or heart attack if
emotionally isolated.
Stress can impact the immune system.
i.e., wounds will take longer to heal.
Clinical depression is linked to the quality of ones intimate
relationship.
Resilience to stress/trauma and ones ability to cope with
stress/trauma are linked to the quality of ones most
intimate relationship.
Sue Johnson, EFT, NICAMB, 2012



Couples Therapy
Research has found Addicts need to be actively involved
in long-term therapy and support groups for a minimum
of 2-5 years.
To heal, the Spouse must be able to manage his or her
powerful emotions; and to do so, they must feel safe.
If theyre afraid of being engulfed by their emotions and are
all alone with the emotion and catastrophic expectations,
they cant tolerate dealing with them.
Couples Therapy
Therapist might see the couple for a few sessions off and
on to generate a treatment plan, however:
Sexual Addict needs to be in his or her own treatment for a
period of time to stabilize and to determine his or her
commitment to long-term recovery.
Generally 2-3 months of therapy and support group
attendance
Disclosure takes place around 6-8 weeks.
Couples Therapy
Spouse needs time to do his or her own work and
stabilize.
Spouse also needs time to prepare for the disclosure 6-8
weeks from when the couple first starts therapy.
Spouse will need a few weeks to process what came up
for him or her after disclosure.
Hurrying or forcing the Spouse to make quick decisions
only creates more stress and possibly trauma in a world
that is already chaotic.
Couples Therapy
If the Sex Addict receives the right treatment, and his or her
Spouse receives the supportive, loving care he or she needs,
many couples can discover new and purposeful meaning in
their relationship.