Going From Surviving To Thriving In A Relationship Where One Partner Has A History Of Sexual Abuse

Childhood sexual abuse stats in Canada are staggering. I would like to begin this blog by sharing what research tells us about this worrisome issue.

In 1999, the McCreary Adolescent Health Survey II* found that:

• 35% of girls and 16% of boys between grades 7 - 12 had been sexually and/or physically abused
• Among girls surveyed, 17-year-olds experienced the highest rate of sexual abuse at 20%

In their 2001 report on Family Violence in Canada**, The Canadian Centre for Justice Statistics found that children who are exposed to physical violence in their homes are:

• more than twice as likely to be physically aggressive as those who have not had such exposure;
• more likely to commit delinquent acts against property
• more likely to display emotional disorders and hyperactivity

University of Victoria's Sexual Assault Centre*** posts the following childhood sexual abuse statistics:

• 1 in 3 females and 1 in 6 males in Canada experience some form of sexual abuse before the age of 18.
• 80% of all child abusers are the father, foster father, stepfather or another relative or close family friend of the victim.
  
• Incestuous relationships last 7 years on average
  
• 75% of mothers are not aware of the incest in their family
  
• 60-80% of offenders in a study of imprisoned rapists had been molested as children
  
• 80% of prostitutes and juvenile delinquents, in another study, were sexually abused as children.

Most common types of abuse
In their 2001 report on Family Violence in Canada****, The Canadian Centre for Justice Statistics found that:

• 69% of substantiated physical abuse involved inappropriate punishment
• 68% of substantiated sexual abuse involved touching and fondling
• 58% of substantiated emotional maltreatment involved exposure to family violence
• 48% of substantiated cases of neglect primarily involved failure to supervise the child properly, which lead to physical harm

Abusers are commonly known to the survivor In their 2001 report on Family Violence in Canada****, The Canadian Centre for Justice Statistics found that family members, including relatives, constituted the vast majority (93%) of alleged perpetrators. Another statistical study conducted in 2001 by the Canadian Centre for Justice Statistics**** found that:

• among family assaults parents were the perpetrators in 56% of physical assaults against youths and 43% of sexual assaults against youth victims 12 to 17 years of age;
• siblings were responsible for approximately 25% of physical and 26% of sexual assaults in the family that were perpetrated against youth
• extended family members committed 8% of physical, and 28% of sexual assaults against youth

A BC snapshot In a snapshot taken on April 17, 2000****, in British Columbia, there were 689 residents in shelters: 54% were women and 46% were children.

• 82% were women escaping abusive situations
• of the women escaping abuse, 32% indicated they were also protecting their children from psychological abuse, 28% from witnessing abuse of their mother, 13% from threats, 9% from physical abuse, 5% from neglect, and 5% from sexual abuse

 Although I have shared some stats with you to raise your awareness around the prevalence of childhood abuse, I would like to explore with you how victimized individuals of childhood sexual abuse are implicated in their future adult intimate relationships. The partner with a history childhood sexual abuse (CSA) significantly can be affected in their capacity to manage intimacy.  Marital distress along with difficulties in the ongoing maintenance of the couple's relationship can become obvious. CSA often takes place in a close interpersonal relationship that has a number of similarities to traditional couple relationships. For example, in the case of incest, CSA is likely to be associated with emotional and sexual intimacy that develops gradually over time. Therefore, the context in which CSA occurs may predispose victim to experience emotional distress and confusion in subsequent adult relationships (Feinauer, 1989).

In the U.S., it is generally accepted that one-third of women have experienced some form of sexual trauma under the age of 18 years of age (Briere, 1992). These experiences include CSA, date and stranger rape, harrassment, and many other forms of victimization. The national studies for reported male CSA is approximately 10% (Finkelhor, Hotaling, Lewis, & Smith, 1990). The reason I share these stats with you is that the majority of research around this issue has been guided and based mostly on women, so it should be generalized with men cautiously. 

When we compare nonabused women to survivors of CSA, CSA are at greater risk for many negative internal experiences such as depression, anxiety, intrusive memories, rage and shame (Browne & Finkkelhor, 1986; Polusny & Follette, 1995). Women who have a history of complex trauma from CSA might engage in negative coping behaviours such as self-harm, self-mutilation, binge eating, substance abuse, suicide attempts (Briere & Runtz, 1993). When we begin to understand the impact that CSA has on the survivor, this raises awareness to the difficulties that can arise regarding the strain these behaviours might bring to a couples relationship. Research has identified (Biglan et al., 1985; Jacobson, Holtzworth-Munroe, & Schmaling, 1989) that individual disorders such as depression, anxiety, and substance-abuse can cause distress and negatively influence the intimate functioning of a couples relationship. Although the research in limited to the influence of interpersonal difficulties from trauma and couples distress, there are similar connections as in previous research mentioned. Individuals implicated by previous complex trauma commonly experience severe disruptions in social adjustment and couples relationships. A lack of 'trust' and increased fear are also features of CSA. Based on the finding mentioned, it makes perfect sense why survivors of CSA struggle to establish close relationships, maintain relationships and to build healthy attachments. 

In my next blog I will review how intimacy, avoidance and emotions operate in a relationship where one partner is a survivor of CSA.

Thanks for reading!!   

The Trauma of an Affair: Telling the Story

In my last blog, I explored the stages of restorative couples therapy after the trauma of an affair and the importance of establishing "Safety" and "Hope". Reconnecting a couple to doing the behaviours that they hope their emotions will become in the relationship is critical. Reconnecting caring behaviours, even when it feels very difficult to do, is critical at this stage. At best, some couples are only able to be 'considerate' or 'respectful' because caring is to difficult. Time, energy and caring are essential reinvestment's to restoration of the relationship. Building a process of safety and hope takes time, but it is necessary in moving forward to the next step of 'Telling the Story'.

Telling the story or recalling the story is the beginning process of healing. Before the story is told, it is sometimes helpful to have the betrayed partner write out all of their questions and then I would hold on to these questions. The betrayed might have significant difficulties accepting the story that might differ from what they know or believe to be true. As we begin the journey of piecing the story together, it needs to be co-constructed by both. Initially, the early stage of truth seeking is an adversarial process. As the therapist, it is our goal to move the truth seeking to a more neutral process of information seeking. This shift is evident toward a more empathic neutral process when the goal is focused on 'mutual understanding' rather than explicit fact finding and details. As we go through the process of telling the story, earlier lies and secrets are likely to be unearthed.

As this journey begins for the couple, the betrayed partner will often focus on where the involved partner and affair partner went, what gifts were exchanged, were they planning a future or other things together and finally, the degree of the emotional and sexual intimacy. The involved partner is usually opposed to discussing these details, so the betrayed partner needs to be able to communicate appreciation for the truth, even if it is painful, for healing to begin to occur. The therapist's role going forward is to begin discussions around the meaning of the infidelity. Exploration needs to occur regarding 'values' and 'vulnerabilities' of the involved partner in giving themselves permission to cross the boundaries and threshold to infidelity. Underlying this, it is important to understand from the involved partner "What did you like about yourself in the affair that can be brought back into the marriage" A deeper knowledge needs to be gained towards understanding the context that created the vulnerabilities for the extramarital affair. Contributors associated within the marriage, individual, cultural double standards, community, transgenerational patterns, social and occupational norms and values must all be reflected on within the disclosure in order to better understanding the individual's reasoning to engage in the affair. Also it is important to explore other contributing vulnerabilities such as underlying attitudes and beliefs along with symptoms of depression/mood disorders/narcissism/personality disorder/ and sexual disorder/impulsivity/attachment style and compulsiveness features. Exploring how power operates within the individual and their marriage and what role it played in the affair is also important. Finally, it is important for the therapist with the couple to better understand the deeper marital problems that lead to increase vulnerability without being caught in justifying the choice to become engaged in the affair.

Establishing 'Safety' & 'Hope': Struggling Through The Trauma Of The Affair

When couples come to therapy to explore whether they can restore their relationship after an affair, it is not uncommon for the betrayed partner to experience trauma features and responses. These features might include obsessive rumination about the affair, difficulty sleeping, intrusive thoughts and dreams of the lies and secrets, the moment of the disclosure or uncovering, and sexual images of the affair. These thoughts can be highly consuming for the betrayed partner. Flashbacks can also be cued through anniversary dates, music that references 'cheating', area of town, TV shows or movies. Emotional and sexual intimacy may also trigger flashbacks in the betrayed partner. Flashbacks have the potential of extending up to a year. Trauma can be characterized with having feelings of 'hypervigilance'. Hypervigilance is a term used to describe  feelings of elevated fear in response to a perceived lack of safety or trust. When the betrayed partner begins to search for more 'clues', becomes overly suspicious or jealousy, hypervigilance is evident. As you can see, there are many significant difficulties that the betrayed partner goes through as a result of the affair. Juxtaposed is the other partner who now is potentially feeling in crisis as a result of the affair being uncovered. Their crisis is best described as 'what do I need to do to fix this....to be able to save our marriage'. Often times the partner who had the extramarital relationship want the process of therapy to move at a far quicker pace than what the betrayed partner is able to manage. When it come to this type of therapy, you can not move faster than the slowest person in the room. In this case, it will be the traumatized betrayed partner.

Before, any trauma work can be started, it is critical to begin establishing 'safety' and 'hope'. Initially, safety is established by contracting with both parties to agree to attend 6-12 counselling sessions. At times, couples struggle with this especially if one person is ambivalent. In order to establish 'safety', the involved partner MUST STOP and terminate all verbal and physical contact with the affair partner. Then all unavoidable communication or interactions with the past affair partner must be 'shared' openly with the betrayed spouse. In short, a reverse must happen by which the betrayed partner is now on the inside and the affair partner clearly and evidently is placed on the outside of the relationship. The process of recovery cannot begin until the extramarital relationship is clearly terminate and no longer a threat.

In the restoration and rebuilding phase, the couple need to be encouraged to understanding that 'time' and 'energy' into the marriage are critical to reexperiencing their bond. Emotionally, it can be very difficult for a couple to feel motivated in doing things together again. I encourage couples to start doing the behaviours that they want your emotions to become in reestablishing this bond.

In the early phases of therapy, emotions cycle. Having the couple reflect on establishing 'Caring Behaviours' and behavioural expectations is important upfront in therapy despite the underlying anger, mistrust and pain. Generally I will ask couples 'what caring did you receive in the past week' from each partner. Sometimes partners are too implicated and depleted to respond to the notion of 'caring'. In this case, I try to have the couple focus on being 'considerate' and 'respect'. Partners who are hostile and angry might be remind to treat each other as appropriately and respectfully as they would treat a stranger. 

In the next blog, I will begin to share the 'telling the story of the affair' process.



 

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