1. Partner Sexuality Survey Dr. Stefanie Carnes, LMFT, CSAT-S AAMFT Approved Supervisor

2. Agenda Introduction/ History of the tool Administration Overview of scales Statistics/ Research Findings Clinical Use/ Interpretations Other Interventions

3. Introduction Survey development inspired by qualitative study conducted by Omar Minwalla – published in Chapter 6 of Mending A Shattered Heart Conclusions of study: Partners sexuality was wounded by the addicts acting out Symptoms similar to sexual trauma victims Quantitative instrument developed from this theory for easy clinical assessment

4. PSS development Original version developed in 2007 Researchers at USM factor analyzed – original version had 10 scales Items added, more data collected, re-factor analyzed Over 20,000 people have taken survey Version 2 developed

5. Administration – 4 routes Internet based Administration: Self-administration Token administration Paper Versions: Facing Heartbreak – Chapter 7 Paper version

6. www.recoveryzone.com

9. Paper versions See Handouts

10. Overview of scales Relational Sexual Difficulties Sex Addiction Sexual Aversion Sexual Shame Body Image Issues Risk of Abuse or Injury Desire for Retribution Sexual Secrets Obligatory Sex Broken Trust Fear of Health Consequences

11. Subscale One: Relational Sexual Difficulties α =.937 Place scale items here I no longer share my feelings with the addict. I dont want the addict to touch me. I no longer share my sexual desires with the addict. After learning about the sexual acting out I cant imagine being sexual with the addict again. I feel so emotionally distant from the addict that it is hard to be physically close. I no longer feel aroused when physically close to the addict.

12. Subscale One: Relational Sexual Difficulties (RSD) Place scale items here I now find the addict repulsive. I feel so angry with the addict that I can't imagine being sexual with him or her. I have lost respect for the addict. I dont like to be naked in front of the addict. I have difficulty getting aroused when being sexual with the addict. I often make excuses to avoid sex, for example, Im too tired. I doubt that I will ever be able to forgive the addict. I have difficulty achieving orgasm when being sexual with the addict.

13. Subscale description: RSD This subscale indicates the presence of sexual dysfunction in your relationship. This can include decreased feelings of sexual desire, and disruption in sexual functioning. This scale could also be impacted by biological issues or other psychological issues, such as sexual trauma history. I find it difficult to trust him, even on un(sex)related issues. … disgusted with thought of being touched.

14. Subscale Two: Sexual Addiction (SA) α =.862 My own sexual behaviors have been out of control. I am concerned that I, too, am a sex addict. I am preoccupied with my own sexual acting out. I have sought treatment for my own sexually compulsive behaviors. I have hurt others because of my own sexual acting out. I am ashamed of my sexual behaviors. When I have sex I feel depressed afterwards.

15. Subscale Description: SA Elevations on this subscale indicate that you may also be struggling with symptoms of sexual addiction, such as experiencing feelings of being out of control, being preoccupied, and having consequences for your sexual behaviors. I experience sexually compulsive behavior.

16. Subscale Three: Sexual Aversion (SAv) α =. 827 I experience low sexual desire. I do not feel sexual desire for anyone now. I often lose interest during sex. I no longer masturbate. I have completely shut down sexually. I experience pain with intercourse.

17. Subscale Description: SAv High scores on the sexual aversion subscale indicate a decrease in sexual desire, a general decrease in libido. This could be impacted by biological issues, as well as other psychological issues, such as sexual trauma history. I have not had sex for 3 years

18. Subscale Four: Sexual Shame (SSh) α =.844 I must not be a good lover, since the addict went outside of the relationship. I feel as though I am not worthy of fidelity. There is something wrong with me sexually. I am sure I was at least partly to blame for the addict's sexual acting out. I feel like the addict is the only one who would want to be sexual with me.

19. Subscale Description: SSh Elevations on this subscale indicate feelings of over- responsibility for the addicts sexual behavior, including self-blame, self-criticism, and feelings of inadequacy. Began to internalize and took the blame for his inability to have a physical relationship with a woman. Thought it was something wrong with me.

20. Subscale Five: Body Image Issues (BII) α =.888 I wish that I could change my body. I compare my body to others and feel inferior. I feel insecure about my body. I wonder how I compare sexually to other women/ men.

21. Subscale Description: BII Elevations on this subscale indicate feelings of insecurity about your body, such as feelings of inferiority when being compared with others, and a desire to change your body. Stress, anxiety, distrust, low self esteem, emotional grief and marital problems/fights

22. Subscale Six: Risk for Abuse or Injury (RAI) α =.782 The addict has hurt me physically during sex. The addict has forced me to have sex. I feel ashamed of some of the sexual behaviors I have participated in with the addict. I am afraid that the addict might hurt me physically or emotionally if I refuse sex. I don't feel safe with the addict anymore. I have engaged in sadistic sexual acts with the addict.

23. Subscale Description: RAI Elevations on this subscale indicate profound feelings of fear from the addicts behavior toward you. This may include physical and sexual abuse. High scores in this category should be a priority over all other scales. Physical safety must be established before moving forward with other areas of recovery. Im to stay because of the things he makes me do, but hes threatened me if I try to leave.

24. Subscale Seven: Desire for Retribution (DR) α =.796 I have thoughts of retaliating against the addict. I cannot get past wanting revenge, or payback for how the addict hurt me. I feel like the addict should be punished. I want to engage in sex acts that shame, degrade or humiliate the addict.

25. Subscale Description: DR Elevations on this subscale indicate profound feelings of anger and resentment and a possible desire to retaliate in reaction to the addicts behavior. This may include anger that manifests in your sexual relationship. I hate her. I hope she gets gonorrhea.

26. Subscale Eight: Sexual Secrets (SSc) α =.526 I feel so angry with the addict that I can't imagine being sexual with him or her. I have sexual secrets that if discovered would deeply hurt the addict. I, too, have been unfaithful in this relationship. I don't have a right to be angry because of my own sexual acting out.

27. Subscale Description: SSc High scores on this subscale indicate that you may have secrets about your own sexual past that the addicted partner does not know about currently. There is shame over past sexual behaviors. Given my past, I dont have room to be mad, but I am

28. Subscale Nine: Obligatory Sex (OS) α =. 822 If the addict is going to abstain from sexually acting out, then I feel obligated to be sexual with him or her. I feel as though I owe it to the addict to be sexual with him/her. The addict is in treatment so I feel like I have to forgive and have sex with him or her.

29. Subscale Description: OS High scores on this subscale indicate that you may be experiencing feelings that you owe it to the addict to be sexual with him or her. Hes been in treatment for a year and were trying to hold it together, but I hate having sex with him now. I feel cheap and dirty. Will this ever go away?

30. Subscale Ten: Broken Trust (BT) α =.762 I have been profoundly traumatized by this addiction. I will never be able to trust anyone again. I will never again be able to feel as sexually comfortable as I did before learning of the addiction. The trust in our relationship is destroyed.

31. Subscale Description: BT Elevations on this subscale indicate that the sexual acting out of the addict has profoundly interrupted the feelings of closeness and connection in your relationship and may indicate feelings of ambivalence about even being involved in this relationship. Ive been diagnosed with PTSD …recreation-it's difficult to go anywhere or do anything that used to be fun cuz now I see sex everywhere.

32. Subscale Eleven: Fear of Health Consequences (FHC) α =.883 I am afraid of catching a disease from the addict. I cant trust that the addict is a safe sexual partner.

33. Subscale Description: FHC Elevations on this subscale may indicate a lack of feelings of safety in your relationship. This may include feelings of physical or sexual safety as well as fears about catching sexually transmitted diseases. I keep getting tested for STDs even though the past ones have been negative.

34. Descriptive Statistics

35. Descriptive Statistics cont..

36. Descriptive Statistics (cont.)

43. Correlations of note... o Relational Sexual Difficulties with Sexual Aversion (.67), Broken Trust (.60), and Risk for Abuse or Injury (.40) o Sex Addiction with Sexual Secrets (.58) o Sexual Aversion with Broken Trust (.40) o Sexual Shame with Body Image Issues (.54) and Obligatory Sex (.42) o Desire for Retribution with Broken Trust (.41)

44. Correlation Matrix Relational Sexual Difficulties Sex Addiction Sexual Aversion Sexual Shame Body Image Issues Risk for Abuse or Injury Desire for Retribution Sexual Secrets Obligatory Sex Broken Trust Fear of Health Consequences Relational Sexual Difficulties 1.008.666 **.183 **.172 **.404 **.362 **.034 **.044 **.597 **.337 ** Sex Addiction.0081.042 **.282 **.144 **.387 **.259 **.579 **.206 **.001.052 ** Sexual Aversion.666 **.042 ** 1.312 **.247 **.343 **.165 ** -.002.232 **.403 **.138 ** Sexual Shame.183 **.282 **.312 ** 1.544 **.235 **.256 **.198 **.424 **.281 **.078 ** Body Image Issues.172 **.144 **.247 **.544 ** 1.131 **.226 **.061 **.333 **.327 **.080 ** Risk for Abuse or Injury.404 **.387 **.343 **.235 **.131 ** 1.372 **.294 **.230 **.252 **.277 ** Desire for Retribution.362 **.259 **.165 **.256 **.226 **.372 ** 1.278 **.154 **.406 **.310 ** Sexual Secrets.034 **.579 ** -.002.198 **.061 **.294 **.278 ** 1.152 ** -.027 *.024 * Obligatory Sex.044 **.206 **.232 **.424 **.333 **.230 **.154 **.152 ** 1.134 ** -.016 Broken Trust.597 **.001.403 **.281 **.327 **.252 **.406 ** -.027 *.134 ** 1.401 ** Fear of Health Consequences.337 **.052 **.138 **.078 **.080 **.277 **.310 **.024 * -.016.401 ** 1 **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).

45. Analysis o Only subjects with complete data for the Partner Sexuality Survey were retained (n=8,667) o Multiple Regression was used with the demographics as independent variables (predictors) and each scale score as the dependent variable (criterion). o Because the sample is so large, there would be a lot of statistical significance, though not practical significance. o Significance level for independent variables set to p<.001 o Only examined regression models where the variability explained in the scale score (R-square) was above 10%

46. Relational Sexual Difficulties R Square = 16.9% Unstandardized Coefficients (b) Standardized Coefficients (β) 2. Are you still in a relationship with the addict?-.569-.218 7. Did it seem like the only thing your partner could think about was sex?.297.155 3. How long have you been involved in this relationship?.043.122 9. Did the addict ever hide his or her sexual behavior from you?.360.091 18. Public Embarrassment.147.076

47. Sex Addiction R Square = 11.9% Unstandardized Coefficients (b) Standardized Coefficients (β) 3. How long have you been involved in this relationship? -.043-.148 20. Sexual Abuse as a Child.194.106 20. Sexual Abuse as an Adult.202.086 20. Emotional Abuse as a Child.127.078 9. Did the addict ever hide his or her sexual behavior from you? -.245-.075

48. Risk for Abuse or Injury R Square = 26.9% Unstandardized Coefficients (b) Standardized Coefficients (β) 7. Did it seem like the only thing your partner could think about was sex?.359.207 12. Sado-masochistic Behavior.494.144 2. Are you still in a relationship with the addict?-.289-.123 20. Sexual Abuse as an Adult.310.120 20. Emotional Abuse as an Adult.172.095

49. Broken Trust R Square = 20.2% Unstandardized Coefficients (b) Standardized Coefficients (β) 9. Did the addict ever hide his or her sexual behavior from you?.733.202 18. Health Consequences.220.122 3. How long have you been involved in this relationship?.033.103 7. Did it seem like the only thing your partner could think about was sex?.145.083 8. Did the sexual behavior cause disturbance in your relationship?.359.082

50. Fear of Health Consequences R Square = 33.0% Unstandardized Coefficients (b) Standardized Coefficients (β) 12. Affairs.614.235 2. Are you still in a relationship with the addict?-.506-.142 12. Prostitution.416.126 12. Anonymous Sexual Encounters.301.098 12. One-Night Stands.262.089