1. Understanding Spousal Betrayal and Narcissism/Addiction as Survival
Robert Weiss LCSW, CSAT-S
Director of Sexual Disorder Programs:
Elements Behavioral Health
Promises, The Ranch & The Sexual Recovery Institute (SRI
Note: This presentation will demonstrate methods utilized to access online sexual experiences. Explicit images will not be shown, however please carefully consider if learning such information might prove harmful to your personal health or recovery.

2. Working with Betrayed Spouses
Meditation. Become present. Imagine someone very important who is not here today, maybe your most important adult -husband, wife, parent, friend. Imagine where they might be right now - where they usually are right now -at work, childcare at home. Picture them there. How does that make you feel? What are they doing? Now imagine receiving a call or text to tell you that there is a problem, that this person didn’t show up where they were supposed to be today. No one knows where they are and in fact they have been missing for a while now, but no one wanted to tell you. How would you feel? (Name feelings) What would you do (name actions) Now imagine yourself trying to find out what happened to them. Would you stay here or leave immediately. Imagine your first reactions. Now you have left here to look for them. See yourself first calling and then perhaps visiting those who might know where they are but no one seems to be able to help. No one knows where they are. From some you get conflicting answers, others tell you to stop looking, that it’s natural for this person to take some time to themselves now and then, that you’re making too big a deal out of this. Others who you know MUST have seen your loved one - deny having seen them or make up events that don’t seem to fit What do you do? How do you feel? Perhaps you find a few clues as to where they have gone-imagine yourself finding some clues at their work or at home. Perhaps in a desk drawer you find a credit card receipt, a cell phone bill or on the computer you see something in the online history - how does that feel? What do you do once you find out some information, but not enough? Would you look further? How would you feel?

3. Diagnose this client
Acts out in angry, vengeful, acts superficially supportive of treatment while actually undermining it.
Often shifts from idealizing her spouse, therapist and treatment - to devaluing and dismissing them. Can be demanding and boundary-less.
Expresses feeling “out of control.” Engages in compulsive behaviors such as ‘detective work’ and stalking in order to somehow gain a sense of control.
Often seems to be on a mood ‘roller coaster’, it can hard to tell what mood will predominate, why and when.
Mistrustful, suspicious, at times can rage and be verbally abusive. Can ‘act out’ by overeating, spending and other compulsive behaviors.
Inconsistent and uncommitted to looking at her part or her issues - tends to externalize and blame.

4. Which one is he/she? It might take a while before you know ...
An Axis II Diagnosis -Borderline.
“Extremely codependent”. Someone who lost his/her ‘fragile self’ to him.
A client who suffering from a profound life-trauma and grief reaction without meaningful support or direction.
A client (similar to folle a deux) who has been living with a crazy person so long- they have become ‘crazy’ themselves.
It might take a while before you know ...

5. How has he failed her?
His affair and hiding the truth has produced direct consequences for her and their child
He doesn’t get honest- she has to drag the truth out of him.
His immediate need to be understood and forgiven is his priority - this is not empathic

6. How Active Sex Addicts Treat Spouses
In order to tolerate their own ambiguity and lies they devalue and diminish their partners.
They externalize and blame their unmet needs on the spouse. - thereby feeling entitled to act out.
They deny their spouses reality - leaving the spouse doubting themselves
When caught, they’re terrified of abandonment - and will use seduction, ‘regret’, lies, blame or manipulation to try to keep the relationship.
Their needs, wants and desires often come before relationship and family
The don’t understand what broken trust means as they think of it in limited terms.

7. Recovery boundary problems: Addicts
Expecting understanding, forgiveness and sometimes sex- right away (90 days or less)
Expecting the spouse to be more understanding, less angry and hurt
Expecting the spouse to ‘get over it’ -intolerance of their feelings and moods
Expecting validation from the spouse for doing basic recovery-work.
Demanding forgiveness/sex in exchange for disclosure, information and/or ‘good behavior’
Continuing to lie, keep secrets, act out etc.

8. The emotional state of a betrayed spouse
The spouses are experiencing a form of trauma
Everything about the past, present and future are in question
Afraid of further loss and abandonment
Ashamed, self hating, self doubting
Anxious - easily triggered to previous levels of trauma
Emotionally unpredictable and feel out-of-control
Worried about the future -parenting, finances, separation
Some have intrusive thoughts and images (PTSD)

9. We call this the emotional roller-coaster - think PTSD
Average time till this ride slows?
= 9 to18 months if ...

10. Recovery boundary problems - Spouses
Expecting the Addict to be 100% emotionally available to meet my needs now (because he/she owes me).
Expecting all of the addicts’ prior emotional issues (distancing, crabbiness, narcissism ) to go away right away
Not allowing the addict to have a learning curve for better communication, emotional availability, empathy etc.
Questioning erections, inner thoughts, looks and fantasy
Dismissing addict’s needs for solitude, reflection, healthy self care (meetings, therapy groups etc)
Physical or Verbal abuse - this is unacceptable
Worried that somehow they can ‘trigger the addict into acting out
Abdicating their own responsibility for relationship healing & growth, thereby holding the addict solely responsible for the relationship 

11. What are the clinical needs of this spouse?
Direction regarding self-care, health issues, talking to family etc.
Education about addiction, disclosure, family dynamics, support.
Holding and Validation of her reality and her feelings
Disclosure and clarity regarding their unknown history
Social support by professionals (peers and family where useful)
Structure toward moving forward
Hope

12. Relationship recovery steps for the addict
A committed recovery plan fully shared with the spouse
Telling the truth and telling it faster (48-hour rule)!
Staying in touch and not leaving spouses outside the loop of your commitments, schedule, feelings
Being transparent and non-defensive
Being unafraid of the truth
Having disclosure in treatment where appropriate (let’s briefly discuss disclosure ...)

13. What helps spouses feel safe?
Being respected regarding sex and intimacy
Being ‘allowed’ to be angry, hurt and emotional
Consistency in commitments and agreements
No relationship decisions/pressure for six months
No sexual pressure
Hearing the truth as clearly and quickly as possible
Receiving disclosure -if they wish it and it is appropriate to the situation

14. At the heart of the spouses’ concerns
How do I know if this is all there is to know? (Disclosure)
How will I know if he/she acts out again? (Honesty as a priority -slips will happen).
How is trust re-established? (Consistent, reliable behaviors over time)
“Broken trust is like a broken plate, you can glue it back together and make it functional, but the cracks always remain”

15. In order to get “out of the doghouse” you first have to get in it
In order to get “out of the doghouse” you first have to get in it! And this ain’t it.

16. How is couple trust regained?
Trust is restored over time through ...
Reliable and consistent actions. Love is Behavior!
Fearless truth-telling - even when facing disapproval
Keeping commitment to recovery steps
Acting as a full adult contributing family member
Patience, empathy & understanding of the spouses anger and hurt
Healthy boundaries and self-care

17. Addiction and Detachment as Emotional Survival
Narcissism,
Addiction and Detachment as Emotional Survival

18. The Problem Fmr. President Bill Clinton Fmr. Governor Elliot Spitzer
Fmr. Governor Mark Spencer
Fmr. Congressman Christopher Lee
Fmr. Congressman Larry Craig
Fmr. Sports Hero Tiger Woods
Fmr. Chief Dominique Strauss-Kahn
Fmr. Governor Arnold Schwarzenegger
Fmr. Congressman Anthony Weiner

19. Why do such smart, powerful men make such stupid, self-destructive sexual decisions?
The intellect and the emotions run on different tracks- think about being hungry when busy.
People under intense pressure with high stress and poor self-care can “end up” being lead around by their emotions. No matter how high their intellect - the emotions always win.
Some individuals seek positions of status and power in the hope that the role will bolster a preexisting internal sense of inadequacy. Without help, they will not resolve nor soothe this emptiness by high status or success, but it will remains an unfulfilled part of them.
They end-up feeling like victims of their own stressful lives and therefore entitled to act out - In their minds, they deserve it.

20. “It is thus impossible for this person to cut the tragic link between admiration and love. In his compulsion to repeat he seeks insatiably for admiration, of which he never gets enough, because admiration is not the same thing as love. It is only a substitute gratification for the primary needs for respect, understanding and being taken seriously”
Alice Miller: The Drama of the Gifted Child

21. Sexual Addiction Cycle
Ritual
Acting Out
Shortest part
Fantasy
CONTROL
RELEASE
SHAME
Could Be Any Addiction Cycle
Despair
Numbing
Shame/Blame/Guilt
Any strong emotions generate and stimulate our dependency needs
Fossum/Mason/Carnes/Weiss et al.

22. Feelings Inform Needs Sadness Joy Anger Nurturing / Understanding
Mirroring
Echoing / Support
Stories - to point out need for others

23. What are the Survival Needs of Infants?
Food and Water = Nutrition
Dry and Warm = Shelter
Holding, Mirroring and Stimulation = Love

24. What happens to the infant if any one of these three are missing?
Talk about ww2 cribs
Absent Food = Death
Absent Shelter = Death
Absent Love = Death (failure to thrive)

25. So how long would any of us survive today without ...
- Food/Nutrition
- Shelter
- Love
We Need “Love” to Survive Throughout the life-cycle

26. Learned shame prevents us from fully experiencing adult intimacy and love
Shame is a feeling of being defective brought about through early attachment deficits, unresolved character disorders and trauma.
Shame is learned as essential dependency needs are denied or subverted and the child turns upon themselves as the source of their own pain.
Shame is reinforced by secretive behavior and acting out - drugs, sex, spending etc.

27. How does the self become shamed?
Primary Narcissism
Talk about child and oatmeal

28. My Needs are the Problem . . .
So Who is the Problem?
Not Mom
Not Dad
My Needs are the Problem . . .
The Self is Shamed :(

29. Attachment and Addiction
Early attachment disturbances appear to be a key root cause of both narcissism and sexual addiction. Compulsivity and obsession offer some relief from the pain, rage and fear of the disrupted, empty self in those who never learned how to find comfort in healthy relatedness. The compensating compulsive behaviors eventually take on a life of their own.

30. Intensely stimulating activities suppress and distract from unmet dependency needs (love)
Addictions (substance and behavioral)
Intense Self Focus, Self Blame, Suicidality (shame)
Pathological Care-taking /Co-dependency
Thrill Seeking / High Risk Activities
Dissociation / Fantasy
Rage / Abuse
Passivity / Helplessness and/or Drama
Seduction and Objectification

31. Art Therapy Flowers Story
What does your addict have to say about the need for relationships and intimacy?
“I hate myself for being so needy”
“I hate my neediness”
“I hate my addict”
My needs are SHAMED and the connection between my emotions (call to action) and dependency needs is broken, but I still have quiet my needs because they are shouting in me. Acting out appears as a logical, useful sane solution to this dilemma.
Art Therapy Flowers Story

32. Maladaptive or Survival Based Coping Skills Provide
Self soothing
Calm
Distraction
Stimulation In the absence of, fear of or limited experience with, healthier, more integrated relational means of self stability like intimacy & the ability to down-regulate under stress (self-soothe)
From looking out of windows to looking at porn

33. In Summary ... This guides treatment
Addicts don’t learn about their emotions
Addicts don’t know what they need or how to get their emotional needs met, they just want any uncomfortable feelings to go away!
Addicts learn to disavow their needfulness
Most addicts would rather eat dirt than ask for help (acknowledge need)
This guides treatment

34. At-A-Boy!

35. “The child who is used emotionally by their parent has the chance to develop his intellectual capacities undisturbed, but not the world of his emotions and this will have far-reaching consequences for his well-being.”
Alice Miller: The Drama of the Gifted Child

36. Treatment

37. Elements Behavioral Health Sexual Addiction Assessment & Treatment Options
The Sexual Recovery Institute (SRI) - Los Angeles- 2-weeks of Outpatient Intensive Treatment (IOP) - Structured, manualized programming. Clients reside in men’s recovery residence - Cost $7,950 plus housing.
Also provide Psycho-sexual and Fitness for Duty Assessment, approx. $6,500
The Ranch in Tennessee - 35 Days of Residential Sexual Addiction Treatment with Extensive Trauma and Family Component - cost $24,500 inclusive
Promises Malibu or West Los Angeles- Primary CD Treatment with a focus where needed on Sexual Disorders and access to SRI clinicians or full IOP where needed.

38. Treatment vs. Therapy
Behavioral problems REQUIRE behavioral forms of intervention and treatment
Structured steps and tasks
Problem behaviors have to be contained FIRST before psycho-dynamic therapy and trauma work begins in earnest
The attachment maladaptations are the slow work of long-term therapy, living honestly and 12-step involvement (2-3 years)
Discuss that the therapeutic relationship is formed by the therapist acknowledging and confronting the defenses and adaptations that no longer work.

39. Elements Behavioral Health Assessment & Treatment Options -
The Sexual Recovery Institute (SRI) - Los Angeles- 2- weeks of Outpatient Intensive Treatment (IOP) - Structured, manualized programming. Clients stay at a men’s recovery residence - cost $7,950 plus housing.
Also provide Psycho-sexual and Fitness for Duty Assessment, approx. $6,500
The Ranch in Tennessee - 35 Days of Residential Sexual Addiction Treatment with Extensive Trauma and Family Component - cost $24,500 inclusive
Promises Malibu or West Los Angeles- Primary CD Treatment with a focus where needed on Sexual Disorders and access to SRI clinicians or full IOP where needed.

40. Initial Sexual Addiction Treatment
Is Cognitive Behavioral
In Outpatient- we don’t delve deeply into trauma or transference until 90-days sober at minimum
In Residential - we can delve into deeper issues sooner and more directly - but still stay focused on the primary goal - establishing sobriety and relapse prevention

41. Regarding Treatment The six required treatment steps when working with Sex Addicts
Do a thorough psycho-sexual history/assessment
Identify the treatment goals of the client and then align a sexual sobriety contract with those goals.
Hold clients accountable to all their agreements!
Confront denial and teach relapse prevention
Spouse, job & family crisis resolution
Refer to long-term 12-step, therapy or faith-based group support

42. What is Sexual Sobriety?
A mutually agreed upon clear, written and signed, behavioral contract based on client goals.
Sobriety plans don’t change without prior discussion.
Similar to how we handle eating disorders

43. Sexual Sobriety Contract
List of Behaviors I Want to Stop A B C D E F
List of Behaviors I Want to Add A B C D E F

44. 12-step Groups for Sexual Addicts and Partners
Sex Addict Support
SAA SA
SCA
SLAA-Women
SRA
Partner Support
S-Anon
Alanon
COSA
CODA
RCA - Couples

45. Sexual Addiction Information
The Sexual Recovery Institute
The Ranch
IITAP - International Institute for Trauma, and Addiction Professionals
SASH - The Society for the Advancement of Sexual Health
Esummits

46. Understanding Spousal Betrayal and Narcissism/Addiction as Survival
Robert Weiss LCSW, CSAT-S
Director of Sexual Disorder Programs:
Elements Behavioral Health
Promises, The Ranch & The Sexual Recovery Institute (SRI
Note: This presentation will demonstrate methods utilized to access online sexual experiences. Explicit images will not be shown, however please carefully consider if learning such information might prove harmful to your personal health or recovery.