The Trauma of Infidelity: the Assessment Phase

In order to properly understand where to begin working with a couple dealing with the trauma of an extramarital involvement, a comprehensive assessment in the early stage of therapy is critical. As the therapist, initially we need to understand if the couple is still in crisis because the affair was recently uncovered or whether the affair in an unresolved chronic issue. Establishing the commitment level of each partner early in the clinical process is necessary. For example,  the spouse having the affair may call in to the counselling service quite distraught and trying to rescue the marriage. Here, this partner demonstrates a higher level of commitment as compared to the spouse who is being 'dragged' into therapy by the betrayed partner. Some partner's call in for therapy and request individual therapy because they are ambivalent around their motivation and commitment to remain in the marriage.

After assessing commitment level for each partner, it is imperative to understand if the affair is still happening or if it is over. Couples therapy cannot begin if the affair is not terminated. Exploring how the disclosure occurred gives insight to the degree of the crisis and the extent of deception. Therapist sometimes might use several different testing tool to better assess for capacity for care, love, sex, intimacy, justification attitudes, depression, anxiety, mix-emotions and suicidality. Assessing for acute stress or PTSD features in the betrayed partner is advised.

During the assessment phase of therapy, previous affairs, repetitive patterns and behaviour need to be explored through sexual and social histories to assess out addiction versus culturally sanctioned affairs. Cybersex, online affairs and internet addictions need to considered when assessing infidelity.  During the assessment phase, understanding the courtship phase of the relationship and the evolution of the relationship over time in necessary to explore.

When couples come to therapy, the betrayed partner initially wants to know specific information on the affair such as "who," "what," "where," and especially, "when." The betrayed spouse might also focus on "why" questions. At the early stage of therapy, these type of questions are discouraged as they only lead to the couple getting stuck and raising the threshold of the couples emotions.  Encouraging honesty regarding the extent of the extramarital involvement is critical from the beginning of the therapeutic process, but in saying this, specific details of the affair need to be deferred until a later stage of treatment.

The Trauma of Infidelity: Patterns and Attitudes Regarding Infidelity

In my last blog, I explored the different types of extramarital affairs ranging from emotional to a physical nature. As a next step, I would like to briefly review the the patterns, attitudes and beliefs around infidelity. When looking at marital satisfaction as a predictor of infidelity, there is a common belief, even amongst therapists that infidelity is the result of an unhappy marriage  that is experiencing lower satisfaction. In following this line of thinking, this would suggest that meeting your partner's needs can therefore "affair-proof" your marriage. Well, to some degree this may be the case, but not completely. Although some studies have found that marital satisfaction is lower in some involved individuals, especially with women who are in the combined-type affairs, many individuals who are in an affair describe their marriages as "happy" - especially men in a primarily sexual affair. Glass and Wright (1985) reported in a non-clinical sample that 56% of the men and 34% of the women who were having extramarital affairs reported that their marriages were happy.

So, there is some research that exists suggesting that "lower" marital satisfaction is not always predictor of infidelity and that infidelity can occur within "happy" relationships. Shirley Glass, a couples researcher and specialist reports that "women were less likely than men to agree that extramarital involvement occurs in happy marriages and is not necessarily a symptom of a distressed relationship (47% vs 61%)."

When looking closer at the predictors between genders of what influences one to enter into an affair, women report specifically unmet relationship needs and men seem to be directed more towards individualistic attitudes around sex itself (Glass & Wright, 1992-Oliver & Hyde, 1993). Women's perception of a lack of love, then intimacy are identified as justification for extramarital relationships. According to Hyde & Oliver, men endorse a sexual justification for their infidelity.   

When exploring the different codes for extramarital relationships, Buss (1994) and Francis (1977) suggest that the male code is more permissive about sexual involvement, and female code is more permissive about emotional involvement. Buss and Francis also report that husbands are more jealous of their wives' sexual involvement and women are more jealous of their husbands emotional involvement. As a result of this, men are more likely to deny emotional involvement and women are more likely to deny sexual engagements.

As a final thought, addiction to sex, love and or romance can be described as a compulsive drive towards excitement that temporarily relieves feelings of emptiness. An adult who has a history of childhood or adolescent sexual abuse can struggle with a sex addiction later on in life. Love, passion and romance drives the sex addict to seek the idealism of new relationships. Also individuals who have developed and avoidant-attachment style tend to seek out "one-night" stands according to Hazan, Zeifman, & Middleton (1994). Cross-cultural studies have reveled that a clear double standard exists between men and women regarding extramarital sex. Extramarital sex is "condoned" in men and "condemned" in women according to Penn, Hernandez, and Bermudez (1997). 


In the next blog, I will move this discussion forward to explore and review who we assess and begin to work through this very complex issue.

Cheers,
Ian

After the Affair: The Trauma of Infidelity

Couples therapy is a significant part of my private practice. I thought for this blog and the next few following, I would explore with you the traumatic implication of infidelity, the stages that a couple go through after the affair is uncovered or disclosed, triggers to the affair and then the journey following to restoration.

For today's blog, I would like to provide some understanding of different types of affairs. In therapy, affairs are the third most difficult issue to treat and by far - and the second most damaging problem that couples encounter.  Research tells us that 30% of couples that engage in  counselling do so because of the crisis of an extramarital affair (Glass & Wright, 1998). In my own practice I would suggest that this statistic is fairly close. Along with this, an additional 30% of couples that are currently in counselling also disclose a past/present affair after engaging in therapeutic process (Humphrey, 1983). In one study by Glass, he reported that of 316 referred married couples, 23% of the wives and 45% of the husbands had an affair of some type.

In therapy, clinicians understand "infidelity" to include a:

• sexual secret
• romantic involvement
• emotional involvement

Infidelity of a sexual, romantic or emotional context violates the commitment to the marriage that is viewed as exclusive. Extramarital involvement is defined by Glass, S., (2002) as emcompassing a wide range of behaviours including sexual intimacies, with or without intercourse and extramarital emotional involvement.

Glass and Wright (1984) describes three types of involvement by levels of sexual and emotional involvement. The first level is described as 1) primarily sexual - any sexual intimacy that includes kissing to sexual intercourse, but lacks emotional meaning. 2) Primarily emotional - deep emotional attachment without physical intimacy and the 3) Combined type - extramarital intercourse with deep emotional attachment.

It important to separate out the differences between and "extramarital emotional attachment" and a "platonic friendship." Emotional intimacy, secrecy and sexual chemistry are the factors that differentiate between an "extramarital emotional attachment" and a "platonic friendship."

In today's modern society, affairs have moved into the virtual/online world. The internet has become a means for many emotionally attached affairs. These type of affairs are evident when the online relationship has a greater degree of intimacy than the marriage itself. Another sign would be that emails and private chat room conversations are operating in secret isolation of your spouse or partner. A final sign is that the online relationship has an arousal component to it.

Where an affair has been uncovered or disclosed, this evokes a traumatic reaction in the betrayed partner. Their world is now shattered and having to come to terms with previously held assumptions of being in a committed relationship. The trauma of a infidelity completely undoes safety within a relationship. Deception, lying, and secrecy all compromise the previously held assumptions of honesty and trustworthiness.

In my next blog, I will discuss further the patterns, attitudes and social context of infidelity.

Cheers,
Ian

Trauma and Teens

The impact that a trauma event has on a teen can be mild to significant. Often times, the trauma is misunderstood, mislabeled and even misdiagnosed for ADHD, Oppositional Defiance, Conduct, or learning issues. In today's blog, I want to briefly review trauma itself, its impact on teens, their responses and also how you can be a support. Briefly, trauma according to the DSM-IV requires that an individual experience or witness an event(s) in which they perceive a threat to their life and evoking intensive fear, helplessness, or horror.
Trauma responses are understood as Type 1 or Type 2. Type 1 trauma response results from an unexpected and discreet experience that overwhelms the individual's ability to cope with the stress, fear, threat or horror of this event leading to PTSD. Type 1 trauma responses tend to be a single occurrence. Type 2 trauma response results from an expected, but unavoidable, ongoing experience(s) that overwhelms the individual's ability to tolerate the event (childhood sexual abuse for example). This tends to lead to more chronic and complex trauma.

When a teen experiences a trauma event, this can have a significant impact on their ability to internally cope and manage their environment. They can experience many different reactions such as:

• shock and disbelief
• fear and/or anxiety
• grief, disorientation, denial
• hyper-alertness or hypervigilance
• irritability, restlessness, outbursts of anger or rage
• emotional swings -- like crying and then laughing
• worrying or ruminating -- intrusive thoughts of the trauma
• nightmares
• flashbacks -- feeling like the trauma is happening now
• feelings of helplessness, panic, feeling out of control
• increased need to control everyday experiences
• minimizing the experience
• attempts to avoid anything associated with trauma
• tendency to isolate oneself
• feelings of detachment
• concern over burdening others with problems
• emotional numbing or restricted range of feelings
• difficulty trusting and/or feelings of betrayal
• difficulty concentrating or remembering
• feelings of self-blame and/or survivor guilt
• shame
• diminished interest in everyday activities or depression
• unpleasant past memories resurfacing
• loss of a sense of order or fairness in the world; expectation of doom and fear of the future

 People are usually surprised that reactions to trauma can last from a couple of weeks to months, and in some cases, many years. Supportive family, caring adults and friends are critical to help the teen through this period. But sometimes friends, caring adults and family may push the teen to "get over it" before they're ready. It is important that they realize such responses are not helpful for the youth right now. Being with the youth, providing support, empathy, nurturing and understanding are critical to providing a feeling of safety.

According to Patti Levin (PsyD), she describes the following helpful coping strategies for trauma reactions:

• mobilize a support system n reach out and connect with others, especially those who may have shared the stressful event
• talk about the traumatic experience with empathic listeners
• cry
• hard exercise like jogging, aerobics, bicycling, walking
• relaxation exercise like yoga, stretching, massage
• humor
• prayer and/or meditation; guided Imagery relaxation; deep breathing exercise,
  progressive relaxation
• hot baths
• music and art
• maintain balanced diet and sleep cycle as much as possible
• avoid over-using stimulants like caffeine, sugar, or nicotine
• commitment to something personally meaningful and important every day
• hug those you love, pets included
• eat warm turkey, boiled onions, baked potatoes, cream-based soups n these are tryptophane activators, which help you feel tired but good (like after Thanksgiving dinner)
• organize proactive responses toward personal and community safety 
• do something socially active
• write about your experience in detail, just for yourself or to share with others

A trauma therapist can be very helpful in supporting your teen should the trauma symptoms prolong. They can assist your teen in sorting through the anxiousness and panic features they might be experiencing. Also, they will be able to assist your teen in establishing effective coping strategies and safety in order to move beyond the trauma.

Thanks for reading!!
Ian

Trauma Responses: Through the Eyes of Early Childhood (ages 5-12)

In my last blog, I reflected on the signs and features of trauma responses in children ages 1-5. I thought I would continue on with the same theme of looking at trauma responses in children ages 5-12. Although there may be some similarities, there is also some marked differences in how trauma becomes internalized and then externalized within this age group.

Children who experience a traumatic event at this age start to present with regressive behaviours. These behaviours might include increased competition with sibling for parents attention. There may be signs of separation anxiety, excessive clinging, crying and sadness or engaging in behaviours that they have previously outgrown.

Psychological responses become quite evident. These children might start to complain of headaches, itching and scratching, nausea, dizziness, difficulty sleeping, nightmare or night terror, visual or hearing problems, sweats, racing heart or tightness of the chest.

Emotionally, traumatized children between the ages of 5-12 can experience a profound sense of loss and sadness. Fear reactions becomes more evident in this group leading to several types of phobias such as social, darkness, wind and rain, being alone, and even school. Behaviourally, these children begin to withdraw from playing with friend, being with family members and overall turn inward. In some cases, aggression can increase to where the child can become increasingly irritable, hyperactive, disobedient and oppositional. School performance can drop because of the child's difficulty in being able to concentrate and focus. Along with this, the child might start to avoid going to school because they find it so overwhelming.

As you can see, trauma through the lens of a child has a significant physiological, emotional, and behavioural impact. So what can parents do to help their child? Providing positive reinforcement is critical in beginning to rebuild the safety and hope back for the child. For a short period, the emotional needs of the child are more important than school or home performance expectations. Until the child can be stabilized from the trauma, you might want to lower the bar and relax some of the performance expectations. By providing the child with meaningful attention, support and physical comfort, they can begin to feel connected to their loved ones and know that there is understanding for what they are going through. Reassurance is always helpful by letting the child know that they are going to get through this difficult time and eventually return to their previous functioning abilities. Children always feel safer with structure. Where daily structure can be provided, things become more predictable for the child. Encouraging your child to become physically active will assist their natural neurobiological system to produce the chemicals that induce "pleasurable" feelings. Activity is vital for these children. Engaging your child to speak about the trauma through verbal expression, specifically about their thoughts and feelings of the trauma event is helpful in assisting them to process their loss and share their grieving experience. Having the child re-enact the trauma through play is helpful. Then beginning to have the child explore other "truths" about the trauma that they had not considered support challenging the catastrophic thinking of the event. Allowing the child to share what has been learned for them by going through this trauma supports in building resiliency for future traumas in life and how they might handle them.

In summing up, by providing your child the opportunity of play reenactment, the use of puppets, art, sharing your own personal experiences, books, or journaling are all ways that a child can begin to feel safe to tell their trauma story. By children being able to express themselves, we truly help our kids work through these difficult times and begin to equip them now and for future traumatic events. This is how we build RESILIENCY in our kids.

Cheers
Ian

How do I help my child (age 1-5) cope with a trauma?

After a child has been exposed to a trauma, parents begin to worry about what this will mean for their child and specifically how they will react and respond. A trauma reaction in a child is usually evident soon after the trauma occurs. There are times where a child will have a delayed response to the trauma. For example, the child seemed to have been managing fine going through the trauma and then weeks or even months later, the child's behaviour changes. Typical responses to childhood trauma reaction are quite broad. I will share with you some of the behavioural responses that I look for when assessing for childhood trauma and suggestions what you can do as parents. In saying this, what I discuss in this blog is not all inclusive, but some of the areas that I look for.

Children at this age are particularly vulnerable. They can react to changes in their routine and previously secure SAFE environment. Understanding that a child at the age lacks verbal and conceptual skills to cope with stress and they are fully dependent on their family (parents) to provide them with the emotional and nurturing supports to instill safety. On another note, children can be directly implicated by how parents reacted to trauma themselves, therefore increasing or decreasing trauma reactions in the child. Children require comforting (sensory) routines, opportunities to verbally and non-verbally express themselves and lots of encouragement and reassurance.


Trauma responses in a preschooler might present with the following symptoms:

• Resumption of bedwetting
• Fear of the dark
• Fear of animals
• Fear of monsters
• Fear of strangers
• Helplessness and passivity
• Nervousness
• Irritability 
• Disobediance
• Hyperactivity
• Separation anxiety from parents
• Noticeable decrease in attention span
• Increase aggression 
• Difficulty speaking - selective mutism
• Decrease change in appetite 
• Overeating
• Vomitting
• Sleep difficulties (fear of going to sleep, fear of sleep, fear of being alone-especially at night
• Nightmares/terrors
• Repetitive talk
• Difficulty understanding what is bothering them
• Confusion in not understanding that the danger is over - living and reliving the trauma memory
• Increase sadness and difficulty coping with daily living

Providing your child with verbal reassurances and LOTS of physical comfort by holding and caressing them is critical. Verbal reassurances and physical comfort begin to provide security and decrease the sensory reactions of the child. Here are some things you can do to help your child through this process. If you have puppets in your house, these are a great means for the child to express themselves and what has happened in their life. Art is also another effective means  to allowing your child to express themselves, and their trauma experience. They can draw pictures of what they feel and what happened in their life. This can lead to a discussion that others might share their feelings and even greater, how things can change. There are several great children's book available that can also be helpful in supporting your children through a trauma experience. As a parent you can pick an age appropriate book that you can read with your child to assist them in processing their feelings. Lastly, providing more finger food and fluids are also helpful in supporting your child needs through this stressor. Remember that children can have a regressive reaction to a trauma leading to thumb sucking. Oral stimulation needs to be introduced to support the child.

Although these are a few suggestions, there are so many other ways you can creatively support your child. In the event that your child is having difficulty in managing or being able to move forward, I would strongly recommend that you see a professional. This might include your family doctor, child psychologist, play therapist, or social worker.

Keeping conversation alive in your relationship!

Keeping the "spark" alive in your relationship requires a conscious effort of both individuals. Communication is the means of keeping the spark alive. Many couples find it increasingly difficult to stay connected on an intimate communicative level. Lian Dolan states "a recent British study found that the longer couples are married, the less they have to say to each other over the course of an hour-long meal. In other words, the social scientists assigned data to one of my greatest fears: that my husband and I will become the couple in the restaurant eating together, but not saying a word to each other except, "Pass the salt."

How bad does it get? Listen to these numbers: Couples who are dating chat for 50 minutes out of the hour. Presumably, breathing, eating and imbibing take up the remaining 10 minutes. Immediately after marriage, the downward trend kicks in, with the time spent talking dropping to 40 minutes per hour. Twenty years into marriage, the average couple talks for 21 minutes of the hour; 30 years in, conversation takes up 16 minutes. And by 50 years of marital bliss, the average couple converses for three minutes in an hour! That's 150 words or less in an entire meal! I'm guessing "Are you still breathing?" takes up most of the conversation time."

Finding time each morning and night to have a conversational "huddle" with your partner is vital to staying connected, engage, and invested in your relationship. These relational "huddles" can be as much as checking in with each other to find out what did you most enjoy about your relationship today? What was dissatisfying about your relationship today? How can you be helpful to each other? In the end a relationship is a team sport where you either win together.......or lose together!!