Clinical Management of Sex Addiction

Patrick J. Carnes, Kenneth M. Adams, Patrick J. Carnes, Kenneth M. Adams

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781317626589
• Edition: 2
• Topic: Psychologie
• Subtopic: Psychologie clinique

Clinical Management of Sex Addiction 's newest edition updates many of the original chapters from 28 leaders in the field with new findings and treatment methods in the field of sex addiction.

With a growing awareness of sex addiction as a problem, plus the advent of cybersex compulsion, professional clinicians are being confronted with sexual compulsion with little clinical or academic preparation. This is the first book distilling the experience of the leaders in this emerging field. It additionally provides new chapters on emerging areas of interest, including partner counseling, trauma and sexual addiction, and adolescent sex addiction.

With a focus on special populations, the book creates a current and coherent reference for the therapist who faces quickly escalating new constellations of addictive sexual behavior. Readable, concise and filled with useful interventions, it is a key text for professionals new to the field and a classic reference for all clinicians who treat sex addiction.

III

Special Populations

14Children of Sex Addicts: The Forgotten Victims

Stefanie Carnes

15Cybersex Addiction: Anticipating the Tsunami

Patrick J. Carnes

16Art Therapy

Marie Wilson

17The Value of Group Psychotherapy for Sexual Addicts

Alyson Nerenberg

18Psychopharmacologic Intervention
Sex Addiction: A Psychiatrist’s Perspective on the Diagnosis, Neuroscientific Theories and Treatment

Kenneth Paul Rosenberg and Suzanne O’Connor

19Making Advances: Treating Female Sex and Love Addicts

Marnie C. Ferree

20Dysfunctional Sexual Behavior in Borderline Women: Impulsive Sexual Acting-Out or Sexual Addiction/Compulsivity?

Shannae Anderson and Mark R. Laaser

21Pastors and Sex Addiction

Mark R. Laaser and Kenneth M. Adams

22Addiction in Health-Care Providers

Richard R. Irons and Raju Hajela

23The Homeless and Sex Addiction

Ken McGill

24Treatment Concerns for Gay Male Sex Addicts (2015 Edition)

Robert Weiss

25The Sex Addicted Adolescent Client

Richard Boggs

14

Children of Sex Addicts

The Forgotten Victims

Stefanie Carnes

Sex addiction generates havoc, chaos, devastation and trauma to the family system. The disturbance of the parental subsystem can be profound, creating ripple effects that can be experienced by all members of the family from adult children, to the youngest of members, to even the unborn. While the clinical evidence of the traumatic impact of sex addiction on children is abundant, there is scant attention paid to the topic in the literature. In recent years, there have been many new studies on the impact of sex addiction on partners of sex addicts, but to date, there is only a small handful of articles in the research literature on children of sex addicts. As a result, most of what is discussed in this chapter is theoretical and based on clinical experience, as opposed to research. This chapter will focus on the many potential negative consequences that children experience as well as treatment considerations.

Destabilization of the Parental Subsystem

When sex addiction is present the parental subsystem becomes de-stabilized. As the addict becomes further entrenched in their addiction they often become withdrawn. Sex or pornography becomes the primary relationship and a triangle is formed. As the addiction progresses, this pattern of withdrawal from the primary relationship becomes further entrenched. The consequences of the addiction mount and it becomes more challenging to keep the addiction a secret. The partner typically experiences a “discovery” process during which they learn of the addict’s behavior and realize that it is an addiction. Oftentimes, the addicts will “disclose” information to the partner about their sexual behaviors. Research has shown that this discovery and disclosure process is very traumatic for partners. As a matter of fact, one study showed that 70 percent of partners actually experience symptoms of PTSD, and/or acute stress disorder (Steffens & Rennie, 2006). Trauma responses for partners include things like emotional turmoil, including potential psychiatric impairment, sleeplessness, nightmares, physiological symptoms and obsessing about the traumatic events and the addiction. Additionally, usually there is high conflict and intensity in the couple. The relational trauma caused by the addiction has a devastating impact and results in a significant attachment rupture. It is not uncommon for couples to experience a major relationship crisis with potential to cause divorce.

Unfortunately, children are often the innocent bystanders witnessing this unraveling of their parent’s relationship. Even when the addiction is kept hidden from the children, they often feel the effects of the stress and tension experienced by their parents. This can cause a multitude of confusing feelings for the child. When the children also learn of the addiction it can create inappropriate sharing of sexual information that is confusing for the child and often not developmentally appropriate for their age level. Children can experience a host of reactions and feelings that they don’t know how to handle, sometimes creating behavioral or internalizing symptoms for the child.

Sex Addiction Induced Trauma

In the literature on partners of sex addicts, Dr. Omar Minwalla suggests that partners of sex addicts experience “Sex Addiction Induced Trauma” or SAIT (Minwalla, 2011). I believe this experience is also true for children of sex addicts. The level of the trauma to the child depends on the specific factors related to the case and also the resiliency of the child. Some children will be severely wounded and demonstrate significant symptom development and others will bounce back and appear relatively unaffected. It is important to note that those that appear unaffected may be repressing feelings and reactions to protect the parents. The severity of the trauma can be influenced by a multitude of factors.

•Child Discovery – When the child discovers the addictive behavior and is put in the quandary of keeping the addict’s secret or sharing it with the partner; trauma can be elevated. This is especially true if there is parental discord as a result of the sharing as the child might interpret it as his/her fault.

•Exposure to Sexually Inappropriate Content – When the child is actually exposed to sexual content, such as pornography, or witnessing the parent with a prostitute or affair partner etc. Developmentally inappropriate sexual content can be traumatic and can cause PTSD/acute stress for children.

•High Parental Conflict – Intense fighting among the parental unit can be traumatic and troublesome for the child.

•Addict Withdrawal or Decompensation – If the addict is psychiatrically impaired, or struggling to continue to have a role in the system and be a parent it can be more traumatic.

•High Partner Trauma – It is more traumatic if the partner is decompensating and/or exhibiting psychiatric impairment.

•High Risk or Offensive Acting Out Behavior – When the child learns of sexual behavior that is deviant or offending in nature it is more traumatic for the child.

•Public Embarrassment – When people in the child’s community are aware of the parent’s sexual behavior and it causes shame for the child in their social support system it becomes more traumatic.

•Child Victim – If the child is actually experiencing sexual abuse as a result of the addictive behavior it is more traumatic. This could occur in many forms such as, molestation, and inappropriate exhibitionism or voyeurism.

It is essential to consider these factors during your assessment of a child. If you are working with an adult child of a sex addict, those clients exposed to increased trauma due to these factors could potentially have more severe long-term effects.

Loyalty

As the parental system is de-stabilized, it is not uncommon for the children to be triangulated into the conflict. They may feel that they need to choose sides or defend one of their parents. This can include enmeshment and caretaking behavior of one parent. For example, a child may see the traumatized partner as victimized and share in the partner’s anger and resentment for the addict. This is especially common if the partner shares an inappropriate amount of information with the child. The child may act out in anger against the addict for hurting the partner and may even cut off their relationship with the addict. In these types of cases it is helpful to attempt to structurally re-stabilize the triangle with a three-pronged approach:

•Ask the partner to fortify boundaries with the child and to take a non-victim role.

•Ask the child to openly and directly express their feelings to the addict (perhaps in the form of an impact letter that they read to the addict).

•Ask the addict to take complete and total accountability and responsibility, keeping a non-defensive posture and to continue to make overtures for connection with the child and demonstrate recovery behaviors.

This type of work, when done early, can prevent this triangular pattern from solidifying and becoming rigid within the system.

Alternatively, the child may feel over responsibility for the addict, or the necessity to caretake the addict. This can be especially true if the addict is decompensating or was particularly close to the child prior to the discovery of the addiction. The child may exhibit some codependent behaviors and attempt to rescue the addict. This can inhibit the child from expressing any feelings of pain or anger regarding the addiction. The child might take on a parentified role and express concerns about the addict’s recovery and sexual sobriety. In instances such as these, the child’s anxiety can be reduced by incorporating interventions that support a healthy parental hierarchy such as:

•The addict continues to make re-assuring statements about recovery and responds to any fears the child may have about the recovery process.

•The addict does not share inappropriate information with the child, such as information about triggers or struggles they are having in recovery.

•The addict maintains appropriate boundaries with the child while continuing to be emotionally supportive and available.

Consequences of Addiction

In some cases, the whole family system can experience significant consequences as a result of the addict’s behavior. As the addict begins to hit bottom, the fallout of consequences of their behavior starts to create stress in the system. For example, an addict may lose his or her job, causing the family significant financial hardship. Another major de-stabilizing factor could be if the addiction becomes public and creates embarrassment for the family due to discovery by the social network surrounding the family. This can include the church/ synagogue/ mosque etc., school, social support and extended family networks. Often this type of exposure about the addiction will necessitate a physical move or major change in support for the family. The most challenging situations for the children is when their peer network learns of the addiction (perhaps through the media) and they need to change schools or they experience bullying and teasing. This can create major resentment towards the addicted parent. There could also be physiological consequences experienced by the addict, such as HIV or throat or cervical cancer due to sexual risk taking that could also put stress on the system, causing inadvertent stress on the child.

Neglect

Unfortunately, in most cases, as an addiction unravels in a family system even the most loving parents become more self absorbed and less emotionally available to the child. Children often misinterpret this disconnection as a statement about their worth and value and about the parent’s love for them. If this becomes chronic and severe it may even constitute child neglect. When parents become unavailable emotionally it creates an attachment rupture in the bond with the child. The unfortunate consequence of this is often internalized shame. Children are very egocentric and will not be able to separate the fact that their parent’s emotional disconnection is not about them or because of them. They internalize the rejection and cognitively can make it about their value and worth. Internal cognitive scripts develop such as “I’m not lovable,” or “I’m stupid,” or “I’m worthless.” This type of programming that occurs during childhood can be a lifelong battle for the adult child of a sex addict to eradicate. When children develop this shame core, their adolescent years can be challenging as they often feel a need to run from their own pain and shame and may turn to drugs and alcohol or other forms of unhealthy negative coping behaviors.

Shame

In addition to the shame caused by neglect, adult children may internalize the sexual shame of the addict’s behavior. Due to the fact that most addicts have a lot of shame around their sexual behavior the children may absorb some of these shame-based messages about sexuality. Their experience of secrecy around sex due to the addiction may be perceived by the children that sex is not positive and healthy and rather it’s something to be ashamed of. These messages can be internalized and impact the children as adults.

Characterological Defects in a Parent

In some unfortunate circumst...