Tag Archives: trauma

The Black Stallion

 

If you’ve never seen this film, do so, for it will teach you something plain about the wild or the traumatized, human or not. I saw the film when it first came out, in 1979 when I was a newly emigrated child, feeling like child actor Kelly Reno looked in this film: dumbstruck and wide-eyed, trying to adjust to a new life. It’s not clear in the story where Reno’s character, Alec, and his father are going on their story-opening sea cruise, only that the boy is lonely and quiet, the father garrulous yet preoccupied with gambling on a ship that seems less-than-family friendly. A collector, drifter (possibly a grifter), and storyteller, he gives Alec a tiny model of an exotic black horse, foreshadowing the subsequent attachment, but he is implicitly neglectful. He seems less so when a storm hits and the smallish trawler is threatened with a wreck. By this time, Alec has become enamored of the eponymous wild horse, being kept in storage on a lower deck of the ship, cruelly mistreated by its Arab owners. As the ship capsizes Alec is thrown overboard, though not before freeing the animal from its restraints. Meanwhile, his father is missing, having tried but failed to secure a lifeboat. Treading water, Alec sees the horse flailing through the waves but managing to swim, so he latches on to the severed restraint ropes and is thereafter pulled to safety.

Sometime later Alec wakes up on a deserted island beach, apparently safe but also marooned. He sees the horse at a distance, and in spurts over what may have been days, possibly weeks. The animal appears watchful but wary. If Alec approaches, the horse gallops away with impressive speed, seemingly frightened, and distrustful of humanity, naturally, if not from life experience. However, when Alec is threatened by a snake, the horse appears out of nowhere and stomps upon the serpent, killing it. Alec, determined to make a friend of the horse, persists with his approaches, offering leafy snacks and coaxing the beast towards him. Finally, in an intimate scene, the two make contact on the beach. Alec steps forward and then stops, withdraws, then approaches again. The horse, likewise coy, does the same. After a few minutes of this sequence, remarkably filmed, they inch closer and finally touch. The scene feels like an attachment drama played out. It seems fanciful to compare this dance to that which happens between me and a reluctant client, but what can I say. I am reminded.

Soon the boy is riding bare-back on the horse as it gallops across beach-kissing waves. The cinematography that captures this is iconic. Later, Alec is discovered by fisherman and ostensibly rescued, though the fishermen misunderstand about the horse. The bond between boy and animal is conveyed as the horse wades into the water, following the boat which might have left him behind, despite Alec’s beseeching protests. The scene of the horse chasing the fishing boat, determined to follow Alec, is one of the most beautiful in cinema, climaxing as it does the film’s better first half. Back home Alec is welcomed as a Robinson Crusoe-like hero (we learn his father was killed in the wreck). Black, as Alec nicknames or christens the horse, is temporarily kept near his and his mother’s rural home, but he runs away from this strange western domesticity, wild as ever. Incorrigibly so, says Henry, a retired racehorse jockey played by Mickey Rooney, who has found and caught the horse. With Henry’s help, Alec learns to tame the animal, but recalling Black’s speed on the island beach, he convinces the former jockey to train both he and Black for the racetrack. To do this, Henry and Alec must also persuade Alec’s widowed mother that their plan is worthwhile, and above all, safe. As the mother, Teri Garr plays a similar role to the one she’d played in Close Encounters two years earlier. Irritable yet sympathetic, jaded by masculine risk-taking but ultimately forced to indulge it, she is a bystander witnessing a compulsion. This comparatively predictable second half leads to a climactic match race at a professional event before thousands of spectators.

While the outcome might be foreseeable the execution of this footage is anything but. Without stirring music, and with minimal dialogue, the race finale recalls the earlier scenes on the beach while the soundtrack re-enters the silent bond between rider and horse, adding only the vivid sounds of hooves thundering against a sandy track. Black initially falters, disturbed by the racing protocols—the entrapment of the “gate”—but once in his stride, instinct and power takes over. And this is what sententious art has to say about trauma: our native selves will prevail. Over several laps Black bridges the gap between himself and his rivals. As he passes them and victoriously sprints across the line, the exultation of the crowd is finally heard, returning from a dim background. It is as if the director were finally letting them, and the viewer, share in this moment.

Check out The Black Stallion. Be reminded of something.

 

 

 

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You must not run away

 

“No one is after you! No one, I say! You all ran away–and now I know why. I sat by the lake, and there came a fly. The fly ran away in fear of the frog, who ran from the cat, who ran from the dog. The dog ran away in fear of the pig, who ran from the cow, she was so big! The cow ran away from the fox, who ran as fast as he could in fear of the man. That man heard a thump, and away he. It was just a sheep, with an old tin can.

I looked at them all, and then I could tell they all had no fear, and now all was well. They all went away. They all waved goodbye. SO…I sat by the lake and looked at the sky.”

–from A Fly Went By, by Mike McClintock

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As dark as it gets

 

“Around ten o’clock, Andrew revealed a surprise: he’d been in therapy before, as in before he’d ever called me. And not even therapy, but analysis: for two years. He left because he didn’t like what he started to feel, a parallel between his drug addiction and emerging sexual compulsion. Though tired, I perked up, sensing something coming. Andrew spoke theoretically, about chasing highs, going back to an original experience. It felt like a prefacing explanation, his talk of addiction, its bedrock principles. Then he told me about his first time, the predictable, clandestine grope with an older girl, when he was eleven, she fourteen. The dreams of that girl, and his lust for teenage girls in general had never gone away, but he wouldn’t tell me more, not while there were legal issues pending, files not yet written. With that stuff looming, I wondered why he’d tell me anything, but then, I am ever struck by the desire to be known, by someone. Andrew’s loneliness gripped my heart, even as he retreated from memory, back to theory. He had an idea about pedophilia, he said, lowering his voice. It related to that original experience, that primal desire to be a child, experience pleasure as a child—natural, he argued. Shortly thereafter, his face broke, as if the pain in his soul had just hit him: that unsolvable clash between ancient fantasy versus the demands of growth.”

— a passage from Venus Looks Down On A Prairie Vole

Several points here, will touch on just a couple for starters. In this chapter, Daniel Pierce, my troubled protagonist and therapist, has serendipitously reunited with a patient he’d A.) thought he’d lost after a bad intake session, and B.) is the man whose privacy he is being pressured to violate by a rogue former prostitute and later, lawyers. Check out my novel and you’ll find out why.

The above conversation happens in the “privacy” of a shared room in a sober living environment–both men’s retreat. What Andrew (alias Derek) reveals here he would likely not have in the structured, orthodox forum of the therapist’s office. The thoughts Andrew shares are of a kind that few, in my opinion, share unless a near-profound alliance has been established. The reference to analysis, as distinguished from therapy, implies the depth divide between models of care, and further suggests what Daniel and Andrew tacitly have in common: they both tend to leave before the going gets tough.

 

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Sexual Narcissism

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“I’m in porn.” He’d said it quickly, in a clipped voice, while looking away, like he’d wanted the words off him, shooed away. I gave him a stilled look at which he grinned teasingly, masking unease. “Well, alright. I’m getting into porn, I should say. I’ve been in one clip so far.”

“Uh-huh. What film? What’s its title?” Rick laughed again, and shook his head. I felt like an idiot, stalling with questions to conceal my blushes.

“What film? I don’t know, man. Who cares…what film? Big dicks. It’s called ‘Big dicks’. There. I just gave it a title.”

“I’m sorry. I don’t mean to—”

“Nah, it’s cool. I don’t know why I’m giving attitude, actually. I’ve got a name, if that means anything. Kane—Kane Able. How do you like it?”

“A play on…I suppose.”

“Sure.”

“That’s good,” I lied.

So I asked about plot. About the film with no name: I asked if his clip contained any plot, or acting, or even theme. Surprisingly, Rick, or Kane—was pretty sure I’d not make the shift on this one—said there was. Firefighting, he said, not surprisingly. His part, as in his role, was that of a firefighter who has entered a burning building to rescue a trapped woman, who is feebly crying out (I imagined the acting) until the hero arrives, ready to spare her. The room is very hot, about which the performers comment wittily, and then the room gets hotter, and soon they don’t care so much about the fire and…well, you get the picture.

“Any dialogue?” I asked. Rick looked at me as if I were reading from a book of stupid questions.

“I ad-libbed this one line as I came: ‘fire in the hole, baby’, I said.” This time I said nothing. “I know, don’t tell me,” Rick lamented. “Pretty dumb, huh?”

“Did she say anything, have any lines, ad lib or scripted?”

Rick shook his head, uttered a dismissive noise, like I’d asked whether the props spoke on set. I blew air through my teeth, and thought of Lira.

“That’s typical. It goes to show there just aren’t enough good roles for women these days.”

— a passage from Venus Looks Down On A Prairie Vole

An example of parody in my mischief novel: the name Kane Abel is a play on words, of course, common to porn actors. My favorite from the real world of porn? Peter North. Subtle, right? Anyway, Kane is otherwise Rick, a young man whom Daniel Pierce meets while living at a sober living house, wherein he’s in retreat from a fraught personal and professional life. Rick’s day job is in a seafood restaurant, as a chef. There he causes trouble, disturbing his boss and Daniel’s temp boss, Jimbo, by stirring unrest, harassing female staff, flirting with nubile customers, doing very little cooking, it seems, while strutting his sex like a farmyard stud. Rick likely thinks his place in the service industry has layered meaning. He’s the kind of man who feels entitled to promiscuity, who feels offended, let down by another man’s diffidence, thinking that humankind benefits from the indiscriminate sharing of seed. He’ll try to re-ignite something in Daniel, provoke a libidinal return in the grieving, wilted psychologist. That last line, Daniel’s teasing of a feminist complaint, glides over Rick’s head, not so much because of stupidity, but rather self-absorption.

The role of women. What indeed is the role of women?

**image by Philip Lawson

 

 

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Have you ever been with…?

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She rolled her head slightly, like she was lining me up in her crosshairs. “You are shitting me”, she began hotly. “I know what you’re saying, but it’s not even the same. Man, I’d like to see you walk in a prostitute’s shoes. Only then would you know how lonely and scary it can be. Tell me you know what it’s like to work knowing your life is at risk: that you could be killed, jumped at any time because you carry cash; jumped in your own home if that’s where you do business; that no one will protect you unless you pay them; that no one would even care what happens to you cuz they think you’re nothing. Tell me you know what it’s like to give up your body everyday, to men who barely think of you as human, knowing that you’re giving away that part of yourself, every night.”

I gazed upwards, studiously contemplating sky and stars, life on Venus and Mars, alien yet pure of love and hate. “Well, I don’t know about the getting killed part. But the rest I can compare with, roughly.”

“Uh-huh?” she scoffed. “So you think you relate to prostitutes. How many have you been with?”

“Wait, I never said I’d been with a prostitute. I mean—”

She laughed back. “Yeah, I bet you haven’t.”

“I haven’t,” I replied adamantly. She relented.

“Alright. I’ll believe that, I guess, but it shows you don’t know what you’re talking about.”

“Well I’ve listened to quite a few—had them as patients.”

“Uh-huh.” She sat quietly for another few moments, letting her amusement subside. Then her voice turned somber, almost reverent.

“You ever cheat on your wife?”

“No,” I said flatly. She nodded inertly. “You believe me?” I followed up.

“I guess.” I uttered a noise which she took as a rebuke. “What do you want, a medal?”

I paused upon feeling aggrieved. “Sort of,” I replied.

“What?” she asked laughing.

“I should get a medal, actually. Any man who manages to avoid temptation should get a medal.”

“Any man? How about women?”

“Okay, women too, but it’s not the same for them.”

It got better. Soon I was expounding upon all the disadvantages men feel in the realm of sex.

–a passage from Venus Looks Down On A Prairie Vole

So a character poses a question, “have you ever been with a prostitute?” In doing so, the female antagonist is half-shaming the everymale of my story, and half-challenging his social critic credentials. Because he claims to know something. Daniel Pierce, my jaded psychologist, alcoholic widower, has a few thoughts on the subject of prostitution: like the chestnut leftist argument that all occupations in the western world entail prostitution. Therefore he doesn’t wring his hands on behalf of women, especially not women like Lira, who hardly seem like victims. Objectified? As in treated as, or thought of as an object? Sure, he concedes. But so is everyone to one degree or another, he retorts. Has she been subjectified, as in abused, or discarded. Not really, she admits, though she’s had close calls, and felt a constant risk. But she’s also profited considerably from her illicit business, spared herself the financial uphill that many of her same-age peers, male and female, face in today’s world. Above all, like any natural survivor or leader, this alpha prostitute has been nobody’s waif, but rather a cool, even dominant figure in the quasi intimate transactions of her past. In those dark, clammy pairings who has been more vulnerable, more ashamed, more consistently?

Her? Daniel Pierce writes a different script

** rendering by Philip Lawson

 

 

 

 

 

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The Trauma Currency, Part Two

(Continued from part one)

Cermak’s intent was to present codependency as a legitimate focus of clinical attention, applicable to a variety of contexts. And so we have the Co-Addict Model, which draws attention to problematic behavior as a function of an underlying, pervasive disorder. While RT adherents may agree with aspects the co-addict corollary, their clinical focus downplays the pathologizing accent. Coping strategies, such as keeping busy with tasks, are instead normalized, 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 discouraged; however, these behaviors are framed 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 Your Sexually Addicted Spouse (Steffens, Means, 2009), 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 or even adult developmental material.

The framework of RT appears to contraindicate a neutral therapeutic stance, becoming partner-centric, especially upon discovery of sexual betrayals, because the proposed de-pathologizing shift only applies to partners. There’s nothing in the RT paradigm that contests the assessment of sexual addiction. Indeed, the scope of questions for the revised version of the Sex Addiction Screening Test (or SAST) has widened in recent years, to address not only changes in technology—the broader means of acting out available to sex addicts—but also the impact upon partners of sexual betrayals. Notice, for example, a question on the 1989 version of SAST, “Does your spouse ever worry or complain about your sexual behavior?” (Carnes, 1989), versus a question on the revised 2008 version: “Has your sexual behavior ever created problems for you and your family?” Notice the slant has shifted to query problems identified by the would-be addict, instead of that which is externally identified by a partner whose perspective might be denied by the would-be sex addict, or distorted by a co-addict disorder.

The RT model calls for sex addicts or acting out partners to be identified as perpetrators of trauma, and this term—“perpetrator”—seems close enough to the connotations of “offender” that observers may be surprised that APSATS hasn’t called for the inclusion of more sex addicts on public sex offender registries. In the RT model, partners are validated as victims of a relationship-specific betrayal, and thereafter supported to integrate this experience in a way facilitates a healthy re-emergence in life, comprised of self-care, fellowship with a strong support system, realistic observation of sex addict behavior, but also renewed trust in humankind. The approach suggests that observation of predisposing pathology and validation of traumatic experience are mutually exclusive goals, which may lead to facile, short-term interventions, tailor made for practitioners presenting brief, intensive programs of care. While this may be an appropriate shift in the paradigm with respect to many partners or with all partners of sex addicts in the immediate aftermath of discovery, I wonder about the pathology that will be overlooked in the service of trauma validation, especially amid follow-up treatment episodes wherein identified-patient premises collapse over time.

In cases of sexual betrayal, a therapist working with acting out and non-acting out partners functions as a container for memories and emotions that cry out for expression, or disavowal in the case of those struggling to cope with the past. This Winnicottian task dovetails with reparation efforts—a Kleinian concept before a sex addiction treatment strategy—which hinges upon individuals’ capacity for mourning. Klein (1975) wrote that grievances we harbor towards parents for the wrongs they have committed, and for having denied those wrongs, elicit feelings of hate and desire for revenge. Durham (2000) has argued that the capacity for making reparations in the internal world is the basis on which empathy for others is established. When individuals defensively split, they attach to a narrowly defined narrative: therefore (borrowing the RT Model identifiers) a victim’s anger and hatred is rigidified in the face of a perpetrator’s denial, which represents an evil system built upon a primitive intrapsychic structure. A working through of splitting, into mourning, requires the perpetrator to own his destructiveness so as to experience mourning; then, if the victim is sufficiently open to an awareness of “good enough” qualities in the perpetrator, a re-internalization of that individual as a good object might occur, which in turn enables the victim’s own work of mourning.

Whether or not labels of victim, perpetrator, addict, or codependent are necessary, harmful, or inhibitive of this process seems ambiguous. Assessment and diagnostic nomenclature informs psychiatric intervention; enables the placement of individuals in appropriate levels of care, including hospitals when necessary; generates short and long-term treatment planning goals. Informing patients of their diagnoses gives informed consent to treatment based upon an understanding of conditions that are the focus of clinical attention. At the same time therapists know the stigmatizing risk associated with assessment and diagnostic labels, particularly those whose prescriptive measures are not clearly defined, or subject to a range of treatment alternatives, despite the attempts of some who promote protocols in response to diagnoses. The advisability of informing a patient or client that he or she has a substance dependence, for example, seems predicated on particular factors well understood across professional disciplines, and by the general public: that the problem can be accurately assessed in a short time frame; that prescriptive measures can be readily understood by those potentially receiving services (such as recommendations of abstinence, or attendance at 12-step meetings); that a person may be at grave risk of illness, injury, or even death if immediate intervention does not occur.

Are these factors true with respect to sex addiction, or codependency, or personality disorders? Maybe in some cases, but of the forty five questions on the revised SAST, for example, only one pertains to behaviors that place afflicted individuals in dangerous situations. In my training I learned to refrain from using diagnostic or assessment labels when addressing clients about their problems, unless the applicable term or terms seem critical for intervention, or unless prescriptive measures based upon the nomenclature can be articulated succinctly and concretely. Otherwise, confusion and/or resistance typically follows, with clients left thinly understanding conditions, floundering to make sense of new identities imposed by expert opinion. I often experience this when clients meet with me for the first time, having been diagnosed by a previous practitioner with, say, Narcissist Personality Disorder. They’ve been given an article to read, or a DSM criteria sheet to examine. Afterwards, they exhibit disorientation, manifest with awkward attempts to describe their freshly assigned disorder. When devising a plan, they offer that they need to learn to empathize with others more. Woodenly, they report feeling instructed, and branded, but not understood.

This is often true with individuals who are told they have a sex addiction, or a codependency problem, and while many can wrap their minds around the concept of sex addiction, the assessment still bears much explanation and holding of emotion. As for codependency: from an object relations point of view, that umbrella term represents a whole multitude of dynamic relational configurations, replete with intersecting projections and introjections. So no wonder partners of sex addicts are flummoxed and invalidated by the term, regardless of what betrayals they have felt. Aren’t many or even most shocked to hear that they may have enabled another’s addiction? Won’t many be confused to hear they may have contributed to another’s disorder by an overly close, or conversely, a distant involvement? Doesn’t it jolt the senses, the unconscious, one’s entire being, to hear that one might have a sex addiction, and that an important aspect of that concept is its impact upon intimate partners? Ultimately, what seems important is to hold the idea of a complex problem, brought to light by acting out behaviors, but not reducible to those habits, necessarily. Might it not render the divide between rival models of treatment moot to consider that our clients deserve to not be hamstrung by labels, or denied what is useful in our nomenclature? Rather, they should feel held by our open minds and fuller understanding.

 

 REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

 Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

 

 

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The Trauma Currency, Part One

 

“You didn’t get here overnight,” writes Claudia Black in her 2009 book, Deceived. It’s a solemn lesson, aimed at co-addicts, partners of sex and porn addicts—women, mostly—who are raised in households impacted by addictions of various kinds. Their childhood histories are “training grounds” for adult dysfunctional relationships, wherein such individuals engage in so-called co-addict behaviors: tolerating hurtful behavior, avoiding conflict, taking care of others, accommodating. Black describes a woman named Katy, a “perfect candidate for partnering with an addict”, who becomes compulsive in busy behaviors, attending to her children, her job, avoiding seeing and feeling, the anticipated rejection and abandonment by her sex-addicted husband (Black, 2009, P.85-86).

Profiles like the one above seem conducive to interventions that draw attention to patterns of dysfunctional behavior; patterns that implicitly predate the discovery of addictive behaviors by sexually addicted partners—this is according to adherents of the co-addict model, which is based upon the Al-anon 12-step recovery program. Treatment based upon this 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. The concept of trauma has gradually merged into the lexicon of psychology since then, reaching into or underlying our understanding of several mental health disorders, including addictions.

However, some practitioners and researchers might disagree upon the premises of partners of sex addiction treatment, and therefore differ significantly in therapeutic approach. In “From Victimhood to Victorhood” (published in the March/April 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 destroyed 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. 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 and hurtful, if sometimes accurate, assert the 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), each stops short of applying the PTSD diagnosis, suggesting that many or most partners of sex addicts do not meet full criteria for the condition. A resulting controversy seems partly attributable to conflicting language in the DSM-V. Psychologist David J Ley argues that typical partners of sex addicts do not meet criteria of section C of PTSD code F43.10, “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, however repetitive these behaviors may be, and that describing them as such does disservice to those who need services relating to life threatening events. With respect to the diagnostic question, I observe that language in section E of code F43.10 indicates that “marked alterations in arousal and reactivity associated with the traumatic event(s)” do meet criteria for the diagnosis of PTSD. This includes hypervigilance, which would likely describe the partners Ley discusses in his writing. Perhaps at odds with the criteria of section C, this language of section E suggests that a more concrete understanding of “avoidance of distressing memories”, versus hypervigilance, is called for; or that alternating or interwoven patterns of avoidance and hypervigilance merit further discussion as features of partners’ clinical presentations.

Ley’s position is interesting in so far as it challenges the premise of the RT model, the sex addiction-induced trauma assertion. While the assignment of trauma to sex addiction may be debatable, it might lead us to consider what life altering events are brought on for partners by other addictions. Alcoholics and gambling addicts also engage in patterns of deception and blaming alongside their destructive behaviors, yet we do not hear of “alcoholism induced trauma” or “gambling addiction induced trauma” as it might pertain to partners or families of drinkers and gamblers. With respect to sex addiction, I’d suggest that it is not so much the presentation of PTSD-like symptoms that warrants a specialized assessment label, or the pervasiveness of deception, or even the ongoing denial of partners’ assertions that sex addicts often exhibit. Rather, I think it’s the nature of the behavior, the context of the lies and deflections—sex—that hurts so deeply. After all, what is harder for our clients to talk about than problems relating to sex? What elicits shame, triggers vulnerability, rage, more than this traditionally-cited root of psychoneurosis?

At least trauma has been codified into psychiatric nomenclature. The same can not be said of sex addiction and codependency, neither of which is delineated within the DSM-V, still. While proponents of RT and co-addict models appear to accept the existence and clinical relevance of sex addiction, or Hypersexual Disorder (as it was proposed to DSM-V committees), they differ with respect to codependency. Proposal for inclusion of a Codependent Personality Disorder was originally made by Timmen L. Cermak in 1986. The diagnostic criteria for the condition then included such statements as “continued investment of self-esteem in the ability to control oneself and others”, “assumption of responsibility for meeting others’ needs to the exclusion of one’s own”, “enmeshment in relationships with personality disordered, chemically dependent, or impulsive individuals”. Cermak’s proposal also included a category which outlined other symptoms, including “excessive reliance on denial’, and “hypervigilance”, which should sound familiar, as the language of the DSM-V criteria for PTSD appears to echo this juxtaposition of ideas/symptoms.

REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

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