The Meadows Blog

Wednesday, 04 July 2012 20:00

Dr. Shelley Uram on Little Traumas

Dr. Shelley Uram on Little Traumas

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from the nature of the authentic self to the benefits of Somatic Experiencing.

In the installment titled "Little Traumas," Dr. Uram, a psychologist and senior fellow at The Meadows, discusses the small traumas that people experience throughout life. While these "covert traumas" aren't visible from the outside, they get locked in the brain and, whether accurate or not, stay lodged in its trauma areas.

"And even if you learn better 10 years later," Dr. Uram states, "they're still there, and they're still going to get triggered."

In other videos in this series, Dr. Uram shares her expertise on trauma triggers, addiction, and the effects of emotional trauma on brain development.

Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain’s survival wiring — and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.

The Meadows’ video series includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg.  To learn more about The Meadows’ innovative treatment program for trauma, addiction, and other disorders, visit www.themeadows.com or call 800-244-4949.

Sunday, 24 June 2012 20:00

Partners of the Chronically Unfaithful

BY: Bill Herring, LCSW, CSAT - Atlanta Counseling, Therapy and Coaching For Healing And Growth

NOTE: This article started out like many of the others I have written on topics related to growth and healing for both individuals and couples. However, I kept feeling the need to add more and more information just to feel like I had covered the basics, since chronic sexual betrayal can be so overwhelming to a person who is just confronting it. By the end this article had grown to about 20 pages, several times larger than any other on this site. I believe it contains a great deal of important information as well as some potentially unique perspectives, which means it may require a substantially greater amount of time and attention than is typical for my writing. It is my hope that the investment proves worthwhile for people who have been repeatedly sexually betrayed and the professionals who attempt to provide meaningful assistance to them during such a difficult time.

This article is also available in a printable .pdf version in which the bold-type highlights like these, which are helpful for website readability, have been removed. This format, which can be viewed and/or downloaded by clicking here, is easily readable with Adobe Acrobat or Adobe Reader.

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A person in a monogamous relationship who learns that his or her partner has been sexually unfaithful, especially if it has happened more than once, experiences a level of emotional devastation that just cannot be fully understood or appreciated by someone who hasn't endured the same dreadful pain. Intimate betrayal cuts to the marrow of a partner's self-esteem, trust and emotional security.

This is worth repeating: sexual infidelity is immensely damaging to a partner's sense of emotional safety and well-being, especially when it happens more than once, after forgiveness, re-commitment and reconciliation have taken place. It is as if a raw wound has slowly been restored to health, only to be cruelly torn open again.

Repeated Sexual Betrayal Turns Reality Upside-Down

The loyal partner of a chronically unfaithful person is often shocked by the degree to which deception has infiltrated the relationship. It can seem like he or she has never known the person who so tenderly and soulfully promised a lifetime of love and commitment. This is a kind of trauma that causes a person to question absolutely everything:

  • Was anything in this relationship real?
  • What about all those loving acts, thoughtful gestures, and times of deep emotional support...how can they exist alongside such terrible lies?
  • Will the relationship ever feel normal and healthy again? Will I?
  • Who can I turn to for support and understanding?
  • How could I be such a fool to not know about this until now?
  • What else don't I know?
  • Should I stay in or get out of this relationship?

A person who has weathered the ups and downs of a long relationship is likely to assume that the bonds of commitment have remained intact. Sure, there may have been troubled times, misunderstandings, disagreements, arguments, hurt feelings or even periods of outright hostility - but infidelity is a class of pain all by itself, especially when it is revealed that a partner has engaged in all kinds of sexual betrayal not once or twice but potentially dozens or hundreds of times.

Typical Symptoms Of Repeatedly Betrayed Partners

The poison that oozes from recurrent sexual betrayal contains a toxic mix of abandonment, manipulation, deception, withholding of affection and deflection of responsibility. It's therefore not surprising that a host of conflicting emotions and symptoms can infect the psyche of a person who has been repeatedly sexually deceived. These include:

  • Obsessive preoccupation, such as intrusive thoughts about what has already happened, what is currently happening and what may eventually happen;
  • Hypervigilence and paranoia that can result in a partner continually looking for evidence of ongoing infidelity such as by checking phone records, wallet contents, bank accounts, internet histories and so forth;
  • All manner of anxiety such as an upswing of fear if the partner who cheated doesn't answer the phone or is even a few minutes late coming home from some seemingly legitimate event;
  • Disturbance in eating and sleeping patterns such as sudden-night awakenings, especially in the early days, weeks and even months after discovery;
  • Difficulty concentrating due to continually unsuccessful attempts to work the math of this strange new world where so much of what was once accepted no longer makes sense;
  • Difficulty achieving sustained emotional balance to the point that moods and reactions are unpredictable and can shift suddenly and seemingly without provocation;
  • Intrusive memories and other unwanted sources of renewed shock, anger, sadness and fear;
  • Shame and embarrassmentdue to the nature of the revealed behavior;
  • A sense of inadequacy as a person, even though the sexual betrayal was a failure of the one who did the deception and not the one who was deceived;
  • Seething resentment and outright rage in response to the inherent abuse inflicted by chronically repeated betrayal.

One defining attribute shared by all the above characteristics is an almost overwhelming loss of stability, control and safety. A person experiencing such emotional upheaval has no more ability to calm these symptoms than to control an allergic reaction. Trying to get through this kind of crisis without ample support and guidance is likely to result in ongoing frustration and lead to an ultimate depletion of emotional reserves.

Essentially trustworthy people typically do not suspect that they are being deceived, and therefore evidence to the contrary may have been initially discounted. When they finally beg1n to examine events that don’t entirely make sense (such as questioning discrepancies between what they were told and what they observed) they are often subjected to scoffing and scorn by the guilty partner, and made to feel as if they were somehow the source of the relationship problem.

As a result, people who have been chronically sexually betrayed often find that their ability to trust their own judgment has been shaken, gradually eroded or outright shattered. The loss of trust in another person pales in comparison to the exhaustion and demoralization that results from the inability to feel confident in your own perceptions and judgment.

Chronic Infidelity And the Concept Of Sex Addiction

It is becoming increasingly common to consider the phrase "sex addict" when repeated sexual betrayal is discovered. (Discovery rather than disclosure is almost always the way this behavior is brought to light. Chronic betrayers rarely stop: they are stopped). Maybe the person who has been unfaithful is the first one to speak the words, generally in great despair as\ his or her world comes crashing down. This is when the betrayed partner faces one of many challenges: is this a true explanation or a convenient excuse?

Other times it is the victim of repeated infidelity who recognizes the signs of sex addiction, often after scouring the internet for help and understanding. Sometimes the phrase is hurled in accusation: "you're nothing but a sex addict!" Sometimes it is offered as a form of intervention, sometimes as a plea, sometimes as a potential lifeline to the faint possibility of salvaging the relationship. The reaction of the betrayer will be somewhere on the continuum between denial, consideration or acceptance.

I'm a firm believer that the concept of sex addiction fits many people who repeatedly engage in behavior (a) they know is wrong, (b) which will clearly result in devastating consequences upon discovery, and (c) which they have unsuccessfully tried to stop or control despite their sincere desire to do so. It is this last criterion that is the source of so much confusion and controversy. Is the alleged absence of control real or just an excuse? This is a worthwhile and vexing question, especially since attempts to stop are not evident to others until the point of discovery and can't be proven.

As I've written elsewhere, there are explanations other than sexual compulsion to explain chronic sexual betrayal, and none of them are pretty. Maybe the person somehow doesn't think this is wrong to do, hasn't fully appreciated the degree of damage this causes, has some sort of mental illness, feels entitled to act this way, or simply doesn't care. Fundamentally this means that a person who repeatedly engages in sexual deception, especially if he or she has promised to stop this behavior, is either ignorant, impaired, unethical or addicted.

Sex addiction is not a "get out of jail free" card. Ultimate responsibility for chronic infidelity remains foursquare on the one who did the deeds. The need to accept the consequences of these actions and to do whatever it takes to insure that they never happen again must be fully accepted despite whatever degree of compulsive drive might exist. The idea of addiction is not an excuse: it is an explanation that puts a lot of behaviors together in a way that can make sense and that can offer a direction toward real and lasting change.

MODELS FOR HEALING THE WOUNDS OF CHRONIC BETRAYAL

But if the perpetrator of recurrent deception is a sex addict, what word or phrase best describes his or her partner? This is an important question because the process of healing from chronic infidelity will depend to a significant extent on how the nature of the problem is perceived, and there are often profoundly different ways of looking at the same situation or event. No label or definition is going to be fully satisfying to a betrayed partner who is grappling with how to make sense of this calamity that he or she didn't cause, can't stop and can't easily escape.

Sex Addiction and The "Co-Addiction" Model

A useful analogy to consider is the impact of alcoholism and drug addiction on families. It's well-recognized that people who continually abuse mood-altering substances tend to pull those around them into a despairing storm of chaos, confusion, and deception. The Alcoholics Anonymous (A.A.) program of recovery begins with the admission that "we were powerless over alcohol and that our lives had become unmanageable". Upon reflection it is evident that this statement also rings true for an addict's family members. To confirm this, just ask anyone who has loved a chronically relapsing alcoholic if they ever felt powerful enough to get that person sober or trusting enough to believe that early sobriety would last.

This is why alcoholism is often considered to be a "family disease". Because of this systemic perspective, it's understandable that many treatment professionals encourage the partner of an addict to carefully examine his or her own reactions to the problem. The purpose of this approach is not to implicate the partner as the cause of the problem but to recognize the negative consequences an addict's behavior has on everyone who is emotionally close to that person, even before they are aware the problem exists.

So even though an abuser of drugs or alcohol is ultimately responsible for the turmoil this behavior causes all around, labels such as "co-addict" or "codependent" are often assigned to that person's partner. These terms are intended to describe some of the reactions that regularly occur as a result of the distorted reality that comes from being in a relationship with an addict. Upon reflection, however, it is clear that this kind of language can subtly implicate the partner as part of the problem.

In other words, the "co-addict/codependent" model can unintentionally impose a framework of "illness" around the very people who have been victimized. This way of looking at the problem comes close to implying that a partner of an addict somehow has a contributory role in either developing or maintaining a toxic relationship with some aspect of the addictive process. This approach inevitably blurs the line between pathology that contributes to an addiction and that which results from one. While it is true that partners have been made sick, it's important not to confuse cause and consequence. The partner isn't part of the problem, the problem is part of the partner.

Partners of people who demonstrate sexually addictive patterns of behavior have often been similarly slotted into this same model, and many resources for support and treatment reflect this framework. For example, 12-step support groups such as “S-Anon Family Groups (S-Anon) were created to help shattered partners of sex addicts regain a sense of emotional balance and combat overwhelming isolation and despair. In much the same way that Al-Anon Family Groups (Al-Anon) formed decades ago to benefit family members of alcoholics, these groups are invaluable sources for the kind of help and hope that cannot be found anywhere else.

Unfortunately, partners of addicts frequently resist or flat-out refuse to attend such support groups and some even resent the recommendation to receive individual counseling. "I'm not the one with the problem!" is a common and seemingly compelling retort. While this statement is true, it's the equivalent of a person who has been hit by a bus denying the need for assistance simply because somebody else was driving. Regardless of who is responsible for the damage that has been inflicted, a person who is injured needs help. Accepting this reality is one of the many challenges a partner must face. My recommendation: get past the label and get to the help.

Sex Addiction and The "Relational Trauma" Model

Addiction specialists are beginning to conceptualize many of the common reactions to chronic betrayal as typical symptoms of trauma. Many partners of chronically unfaithful individuals consider the evolving "trauma model" to be a more accurate description of their experience than the traditional "co-addict"perspective. In some extreme examples it is even possible to consider a diagnosis of post-traumatic stress disorder (PTSD) for some partners of multiple betrayal.

Some skeptics may doubt how a diagnosis that applies to combat veterans and disaster survivors can be applicable to relational injury. The answer is that the impact of a traumatic event is based on the experience of it, not just the event. How a situation is internally perceived can be more important than what externally took place. A person may feel either thrilled or terrified to ride a roller coaster, and a crucial determining factor is going to be whether he or she signed up for the ride! Any event that is overwhelming to a person to the point of threatening a fundamental sense of security is traumatic.

Resolution of trauma depends on a person's ability to make sense of the event and to work through basic core beliefs of safety, control, fairness, responsibility and self-worth. Difficult, wrenching emotions such as profound grief, shock, rage and fear must be carefully navigated, not just "gotten over." The trauma model offers a way to move from victim to victor in response to the abuse that has occurred.

I feel that both the co-addiction and trauma approaches have great merit as well as substantial challenges. The 12 step-based perspective can help a partner find a place of existential solace and serenity in an essentially unpredictable relationship (and world), while the trauma model provides concrete steps along the pathway to regaining a sense of empowerment and safety. On the other hand, the focus on relational detachment and personal responsibility that is so characteristic of the co-addict model can obscure the need to recognize and respond to the inherent trauma of victimization, while the trauma model's focus on empowerment over acquiescence can obscure the need to find a place of acceptance amidst the turmoil and regardless of anything or anyone else that poses a risk to emotional well-being. Ultimately, both models work toward the ultimate well-being of the chronically betrayed partner, and I believe an approach that utilizes both philosophies has the greatest value in the long run.

One of my clients who benefited from such a blended perspective put it this way:

"I've discovered parts of myself during this ordeal that I never knew existed, both good and bad. Even though I didn't create this problem in my marriage I have a responsibility to myself and to my kids to keep growing and facing myself, even during my waves of anger and sadness. I need my husband to respect me but I can't depend on him to sustain my sense of self-worth.

Words like "surrender" and "acceptance" used to drive me nuts until I came to realize that I gave away my serenity every time I needed him to act a certain way for me to be OK. This doesn't mean he can do anything he wants without consequences. But "one day at a time" I'm learning to maintain my sanity by releasing us both from false expectations.

I've also grown to be much clearer about the limits and boundaries I need to establish in all areas of my life in order to recover from the trauma of this terrible crisis in my life. I would never wish this kind of pain on anybody but I want people to know it's possible to do more than just survive. It is possible to come out of this crisis stronger, wiser, more self-aware and (even though it can be hard to believe at first) emotionally healthier than ever."

Good books are available on both approaches, although there is not yet a text that knits the best aspects of each into a cohesive blended model. The best book on the trauma model is "Your Sexually Addicted Spouse" by Barbara Steffens and Marsha Means. It clearly presents insights, strategies and steps for achieving healing from the damage that almost always occurs. There are so many books that utilize the co-addict approach that I prefer to recommend the ones that I think are best after completing a personal consultation in order to assess the unique circumstance of each individual situation.

INITIAL CHALLENGES FACING CHRONICALLY BETRAYED PARTNERS

Regardless of which model seems to best fit a person's situation, there are certain initial struggles that are almost inevitable for a partner who is facing the long road of recovery from repeated sexual betrayal.

An Inevitable Sense of Isolation

Partners of chronically unfaithful individuals usually lack sufficient sources of much-needed support and understanding. A combination of shock and shame contributes to a sense of isolation precisely at the time when access to strength and comfort is most needed. It can seem almost impossible to tell friends or family what's really been going on, especially when doing so is likely to yield some emotional reactions and advice that may be well-meaning but short-sighted. People without an adequate conception of the complexity of emotions and choices that such a terrible situation brings may recommend strategies (i.e. "I'd just leave him if I were you") which are simplistic in conception and difficult to implement. People do a poor job of accurately predicting how they would respond in a difficult situation unless they have personally gone through something similar. Another painful discovery that repeatedly betrayed partners make is how uncomfortable and ill-equipped many friends and family feel discussing such sexual matters at any appreciable depth.

Public Perception Versus Private Pain

Many betrayed partners can attest that it can be simply infuriating to know that the world at large thinks that a chronically unfaithful person is a wonderful, loving and responsible human being. The distance between such a public facade and private reality can seem like the Grand Canyon. The repeatedly betrayed partner must either somehow withstand such a distorted image or reveal the reality of the situation for all to see. There are occasions when this is exactly what happens, as the partner makes it almost a quest to insure that everybody knows the truth that lies lurking under the myth. Parents, siblings, children, co-workers, employers, neighbors..soon everyone knows the terrible things this person has done.

I don't recommend this course of action since it can backfire in a couple of regretful ways. Sometimes the partner who reveals the sordid mess for all to see can wind up being perceived as vindictive and not very stable. And in the many scenarios in which the damaged relationship heals and even grows (which often happens, even though this can be hard to imagine in the early days after repeated sexual secret-keeping has been discovered or disclosed) the couple must face the task of reintegrating their relationship into a community of watching eyes, guarded whispers and limited understanding.

Limited Choices and Difficult Decisions

Sometimes partners of chronically unfaithful individuals feel they have little choice but to accept the possibility that future deception will occur or try to believe the promise that it won't happen again. This difficult choice can be influenced by many factors, including economic reality: spouses and longtime partners who face the dissolution of their relationship often retreat back into their unhappy life together when faced with the dire financial impact this will have on both of them. Couples may also look at innocent children sleeping peacefully in the next room while the parents" tears rain down and wonder how they could ever visit such hardship among them. This commitment to bear up under such strain because there seems to be little other choice becomes another source of the partner's perceived lack of power and control over the direction the future will take.

THE ROLE OF INFORMATION IN THE JOURNEY TO HEALTH

The realization that some basic assumptions about the relationship have been false makes the search for truth a fundamental component of the healing process for a partner of a person who has engaged in multiple acts of sexual betrayal. Once trust is broken, however, it is difficult to place faith in anything that cannot be verified, and even that can be subject to great scrutiny.

Information And The Search For Truth

Often the partner decides that what is necessary to heal is to become aware of everything that took place, even in the darkest crannies of the chronic betrayer's secret life. Interrogations such as "what hotel room did you use....what did you say to each other&...how many times did this take place...tell me every website you visited" may go on and on and on, sometimes seemingly without end.

This insatiable quest for information is easy to understand. Since a basic theme that keeps emerging for sexually betrayed partners is the sense of powerlessness that comes from being emotionally tossed around like a raft in a hurricane, it makes perfect sense that the search for a semblance of control and self-direction can assume epic proportions. The old adage that "knowledge is power" holds great sway for people who have been kept in the dark for so long.

The Risk Of "Information Addiction"

It's certainly true that possessing adequate information allows for decisions to be made on the basis of fact rather than fantasy. Information can be an important antidote to a partner's unchecked imagination. But it's also generally the case that the value of ever-more-specific details quickly reaches a point of diminishing returns. Eventually it becomes evident that information is very different from insight, just as understanding is a poor substitute for acceptance.

This limit can be difficult to determine in the ongoing search for that elusive sense of regained personal power, which is why some partners can fall into an unhealthy pattern of what has been termed "information addiction". Examples of this can be seen when a partner pulls years of phone records, questions every imaginable discrepancy and wakes the betrayer up in the middle of the night to demand another piece of information. This degree of detail rarely serves healing. Information will not scratch the itch where it resides, for that wound is not in the head where the thoughts are but in the heart where the soul lives. For this reason I caution partners against demanding or searching for too many explicit details immediately, if at all.

A useful analogy to consider is the shock you would feel upon learning that you are in a relationship with a person who repeatedly shoplifts. How many incidents would it take to indicate that this is a problem for the both of you? Would it be necessary to know the brands of the items that were stolen, the location of the security guards, the names of the cashiers on duty or even the reason for the crimes? Boil it all down and all that fundamentally matters is that you're in a relationship with a chronic shoplifter. What else do you really need to know to come to grips with the essence of your dilemma?

The Dangers Of Unrestrained Disclosure

Ironically, there are times when the betraying partner unleashes a tidal wave of explicit details early into the discovery or disclosure process. This generally happens when he or she recognizes an absence of moral authority to hold back any information that the aggrieved partner might want to know. In addition, a person who has long been lost in a self-created maze of deception, isolation and shame can find great relief by finally telling the truth and bringing what has been shrouded in darkness into the light.

But a sordid avalanche of specific detail about every act of deception can pummel the betrayed partner into a state of profound shock without yielding much that is productive enough to make such pain worthwhile. Wounds rarely benefit from salt, and the negative impact of such unrestrained disclosure can last forever. As the old saying goes, a bell can never be un-rung.
I'm not saying that a hurt partner doesn't deserve to know whatever is helpful to his or her healing process, nor that chronic betrayers should try to dictate the extent of their disclosure. Often times their protests that "I don't want to hurt you any more than I already have" or "I don't think it would be helpful", or "my sponsor told me not to go into too many details" mask deep fear and shame at the prospect of taking full accountability for the consequences of their behavior.

But in my experience partners who have been grievously hurt by chronic betrayal may demand to know every possible excruciating detail precisely at the time of their most tenuous hold on emotional stability. The harshest detail at the worst time is rarely the best course. When a partner insists on getting the most potentially damaging information while in the worst state of mind to be able to handle it, it is as if the unhealthiest part of that person is screaming for information that takes every ounce of reserve and emotional balance to incorporate. This can lead to an ultimately self-destructive phenomenon has come to be known as "pain shopping".

The Elusive Search For Explanations

Another source of frustration for chronically betrayed partners who are seeking to know more about their partner's deceptive history is that people who have engaged in chronic sexual betrayal may claim extensive memory gapsfor a variety of reasons:

  • A reality that can be painful for the betrayed partner to hear is that sometimes the sheer number of illicit sexual acts makes it impossible to remember each one with clarity.
  • A truly sexually addicted individual in the midst of a sexual binge experiences a dramatic shift of persona, judgment, reasoning, values and perception. The neurochemical activation of arousal, numbing and fantasy is why sex addiction has been called three drugs in one, as I've written about elsewhere. This altered state of awareness is a form of dissociation in which parts of the self that don't fit together are compartmentalized into fragments rather than integrated into a stable sense of identity. It's not coincidental that the word integrity and integration share the same root: a lack of integration leads to a lack of integrity. In the same way that it's difficult to remember dreams once you're awake, such episodic distortion of reality impairs a person's ability to recall events, even those which occurred fairly recently.
  • Finally, the intense shame that accompanies some of these acts can make it difficult for a person who lacks strong moral character to face the facts of his or her history. It is important for a chronic betrayer to resist the desire to "put the past behind" without completely facing it, for this would be just another form of compartmentalization rather than integration. One value that derives from involvement in a 12-step recovery process is the emphasis on obtaining a "fearless and searching" acknowledgment of all that has happened in the past. This can have a powerfully positive effect on a person's ability to recall events.

Regardless of the "who, what, when, where and how" of chronic deception, the question that can seem most important to a betrayed partner is "why". However, this often proves to be the least productive line of inquiry. The reasons why people repeatedly engage in ultimately destructive behavior are often complex and subject to many unfolding layers of insight which often emerge over time. One of the goals of therapy for chronic betrayers is to delve into the psychological drivers of such behavior. But I'm also reminded of the story of the simple response the famed bank robber Willie Sutton gave when asked why he kept robbing banks: "Because that's where the money is."

The Value Of Structured Disclosure

An adequate and appropriate disclosure process may take awhile to develop. Often it is best achieved in a counselor's office in order to provide structure, containment and guidance through a process that may otherwise go off-course in a thousand ways. It can be helpful if both partners have had the chance to achieve a degree of support and stability through some measure of individual counseling.

Since this process occurs a little later in the healing process I am not going to discuss it in depth here, since this article is written more for people who are starting out on their journey and the structured disclosure process is best discussed with a therapist in order to be tailored to the specific needs of each individual situation.

Some Information Needs to Be Immediately Disclosed

Of course some pieces of the puzzle are best turned face up right away. The following categories of information need to be immediately disclosed rather than revealed in dribs and drabs over the course of weeks or months.

1. The types of deceptive behavior that took place (online chats, phone sex, IM's, anonymous sex, affairs, one-night stands, professional sex services, etc.) Partners have a right to know the various categories of illicit sexual behavior that the chronic betrayer engaged in, even when it is not necessary to know every detail of every encounter.

2. How long the behavior has been occurring. In some scenarios partners learn that chronic infidelity began at some time after the relationship began, while in other situations they are shocked to learn that this behavior has always been a shadow side of the relationship, and may have even been a part of the betrayer’s pattern of behavior well before the couple ever knew each other.

3. Whether the partner knows any of the other people involved in the sexually inappropriate behavior. Addicts may want to hide this behavior by fearing it will implicate a friend, neighbor or business associate, but this is not where the most important sense of loyalty resides. People willing to engage in sexual betrayal should know what the risks are from the very beginning, and that includes being revealed when the secret comes out.

4. Whether any laws were broken. Partners certainly need to know if any portion of the pattern of chronic betrayal has transgressed legal boundaries, regardless of whether such behaviors resulted in arrest. Examples include prostitution, public exposure, illegal voyeurism, sexualized behavior involving minors, embezzlement to pay for illicit sexual activity, and so forth.

5. Whether there has been any risk of exposure to sexually transmitted diseases. It is obviously crucial to know if any bacterial or viral infections caused by unprotected sexual activity could possibly be a concern. Betrayed partners may decide to get medically tested regardless of what they are told. Even if sexual behavior within the relationship continues, partners may insist on condom use until all fear of risk has passed.

6. The amount of any money that was spent. Not all repetitive sexual infidelity involves significant amounts of money but some patterns can be stunningly expensive. A person who has repeatedly used professional sex workers (prostitutes, strip clubs, massage parlors, etc.) can place a huge financial toll on a relationship.

What all of these categories have in common is their direct impact on the chronically betrayed partner's need to plan a course of action for the future. This goal is not substantially aided by knowing about every detail about the secret life of the sex addict (or non-addictive chronic sexual betrayer). All that is necessary is a sufficient sense of what has taken place to make important life decisions.

I want to be clear: if you ask your chronically unfaithful partner to tell you whatever information you want to know, he or she should be prepared to do so. It may turn out that the actual details are not as important as the knowledge that your partner is willing to give you whatever you feel you need to heal the wounds caused by his or her behavior. On the other hand, it's your responsibility to be cautious about what it is you are trying to find out and clear about your motivation. Both the co-addict and trauma models of healing recognize that feeling "compelled" to get extensive details is a potentially unhealthy symptom.

THE BIG QUESTION: WHAT DOES YOUR FUTURE HOLD?

Partners who are trying to decide whether or not to remain committed to the relationship throughout a potentially long and difficult recovery process inevitably want to know the chances for ultimate success. While I know just what they mean when they look into my eyes and pleadingly ask me to give it to them straight, my initial response is to explore what "success" means to them. Sometimes they stare back at me like I'm simple-minded: of course success means that the chronic betrayer won't ever do this kind of behavior again.

No one can guarantee this.

It is necessary to accept that history argues against the prospect that a chronic betrayer will remain forever faithful to a new vow of monogamy. Regardless of whether the underlying issue is a problem of addiction, ethics, ignorance or illness, the past is the most potent predictor of the future. Even though sexual fidelity is quite possible for even the most hardcore deceiver, there's no escaping the possibility that some sort of a relapse may occur at any point in the future.

As difficult as this can be to accept, perhaps the greater misfortune is to consider sexual sobriety to be the sole measure of success. True recovery is a much more encompassing concept than "staying out of trouble", for it includes the need to develop a new way of engaging life in such a way that the underlying issues that set the stage for chronic infidelity are managed in a much healthier manner.

There's an old A.A. saying that an alcoholic horse thief who stops drinking is merely a sober horse thief. This might seem harsh, but it serves as a reminder that behavior can be easier to change than the underlying personality structure that created and supported it. It is the underlying quality of character and conscience that ultimately defines a person more than the quantity of his or her outward achievement. As the saying goes, not everything that counts can be counted.

For people who accept and incorporate the addiction model into their understanding of repeated sexual betrayal, the 12-step program of recovery provides an invaluable pathway for emotional growth that is deeper than mere behavioral change. Programs such as Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA) and Sexaholics Anonymous (SA) help a person examine the underlying aspects of his or her personality and get to the heart of what it means to be an ethical, courageous, humble, self-aware and emotionally available human being.

Narrow Definitions Of Success Create Confusing Distinctions

When sexual fidelity (which12-step groups term "sexual sobriety") is narrowly defined solely by the absence of certain behaviors, it's not long before hair-splitting distinctions can seem monumental. Here are a few examples:

1. What if your chronically cheating partner never again engages in sexual behavior with another person but occasionally (or even regularly) masturbates to pornography? How about if his or her sexual fantasies include people or situations outside of the relationship?

Committed partners by definition are not sexually involved with other people. (There is an entire culture of polyamorous relationships, but that is outside the scope of this article). A person in a monogamous relationship generally wants and expects to be "enough" for his or her partner, and ongoing infidelity shakes this assurance to its core.

But is masturbation a form of cheating? Is there such a thing as solitary infidelity? Most people in healthy relationships don't consider sexual self-gratification to be a cause of concern in and of itself. It's not uncommon for people in committed relationships to occasionally pleasure themselves sexually. However, since masturbation almost always involves some degree of fantasy, easy online exposure to a virtually endless supply of pornographic imagery is inevitably going to expand the range of person's sexual imagination.

So at what point along the continuum does masturbation to pornography increase the risk of a relapse for a person who has repeatedly engaged in sexual deception? For a true porn or sex addict the likelihood is so great as to be an almost certainty. While opinions vary as to whether the act of masturbation itself can be incorporated into the healthy sexual expression of a recovered sex addict, the clear alterations of brain chemistry caused by pornography are so dramatic that there is little question that masturbating to it is risky business.

2. How about if your partner is exceedingly friendly to - and spends unaccountable time with - a person outside the relationship in a way that raises your distrust or jealousy?

Wounded partners of repeated betrayers often develop a highly refined "radar" regarding situations and relationships that have a potential for being inappropriately sexualized. It can be exceedingly difficult to fully trust the chronically unfaithful partner's interactions with other people, no matter how brief, chance, necessary or seemingly innocent they appear to be. Danger seems to lurk everywhere.

A vicious circle can ensue: the person who was unfaithful soon begins to notice the betrayed partner constantly evaluating his or her eyes, actions, emotions and interests for signs of deception and intrigue. This can quickly result in a build-up of resentment and a corresponding reluctance to reveal more than seems absolutely necessary, which contributes to the very fear and distrust that is so toxic to relational healing.

The way to break out of such mutually unsatisfying interactions varies according to each specific situation and is often best worked out in couples counseling.

3. Finally, what if your partner desires to remain sexually but reveals sexual fantasies or fetishes that you did not know about?

Some people initially engage in sexual deception at least partly to explore or satisfy a long-standing desire for more unusual or adventurous sexual practices which they have kept from their partners due to a fear of abandonment or some other outcome that is terrifying to them. This often results in a highly reinforcing cycle of "acting out" these repressed desires in a manner that can quickly reach addictive proportions.

Is the revelation that your partner has sexual interests, fantasies and/or fetishes that you did not know about better or worse than the discovery of chronic sexual deception? On the one hand you now know an extremely fragile, very fearful and intensely guarded part of your partner's true self. The process of looking this deeply into a person, no matter how it occurs or how painful it is, is a form of intimacy ("into-me-see"). On the other hand, the nature of these revelations may require you to come to terms with the previously unexamined contours of your own sexual values, interests, insecurities, limitations and misperceptions.

Some partners who find themselves in such uncharted territory angrily respond that this is nothing more than another layer of dishonesty that has no place in the relationship. But the truth is that stopping a certain behavior can be easier than ridding oneself of the deeply embedded desire that fuels it. Adopting a "no-tolerance" policy that refuses to even consider ways to accommodate these sexual desires may require your partner to repress an aspect of his or her true nature. The irony is that such a stance encourages continued deception, only this time on your terms. Wishing your partner had different sexual desires is different than pretending they don't exist, shaming them into submission or refusing to accommodate them.

The reality is that a wide variety of sexual interests, including fantasies and fetishes that you may never have discussed with anyone in an open-minded manner, are relatively common, normal occurrences in people who have never experienced any problems with fidelity. It is wise to carefully consider if one condition of sexual fidelity that you require is that your partner not express or demonstrate any interests, impulses, fantasies or behaviors that cause you discomfort. If your expectation for sexual monogamy extends to the guarantee that you will not have to address your own sexual issues, your definition of success now sets forth two goals instead of one.

These are just some of the many questions that challenge couples who are attempting to heal their relationship after repeated loss of sexual trust. For example, how is relationally-based sexual exploration incorporated into the healing process? What behaviors and activities improve or impair the integration of a couple's emotional and sexual intimacy? How are the ghosts of old sexual wounds healed? These and many other questions are often best addressed in a safe and respectful counseling environment.

The Importance of Carefully Choosing What You Want

Imagine you are presented with two alternative scenarios, and that you may choose only one. The first is to be absolutely assured that your partner will never engage in any illicit sexual behavior again, with no other changes in the quality of the relationship. This potentially makes the minimum standard for "success" nothing more than a partner who never cheats again but who remains emotionally distant and defensive, the sexual equivalent of the sober horse thief.

The second scenario is to have a partner who:

  • has undergone a deep transformation of personality,
  • is psychologically healthier,
  • is emotionally more mature,
  • is relationally present and available in good times and bad,
  • has demonstrated a lasting and meaningful growth in spirit, and
  • has engaged in many substantive acts of amends for the deceptions and betrayals that were imposed upon you.

This second scenario would seem to clearly signify a person who in all ways has shown the most sincere and sustained actions consistent with the highest definition of "recovery." Now what if he or she confesses a "slip" back into some form of behavior that had clearly been agreed upon to be off-limits?

This is an often-overlooked dilemma of choice: would you rather have a partner who never cheats in any way but who remains otherwise essentially unchanged as a human being and life partner, or one who shows appreciable growth in many important ways but who may never-the-less experience an unfortunate backslide?

Treating monogamy as the sole indicator of a successful long-term partnership may be a poor substitute for what may be a greater and more lasting goal: sincere but imperfect growth as a person of integrity, honesty, humility, empathy and courage.

Of course it's natural to want both emotional growth and permanent behavior change. And it is definitely possible to achieve both of these excellent outcomes. As in most important life goals, the most lasting solutions emerge over much time and effort. Everybody has an important role to take in the creation of this best possible result.

The Role Of The Betrayer In the Healing Process

There are specific steps that a chronically unfaithful individual can take to help heal the wounds of a deeply damaged partner, but they are much more than mere promises and apologies. This is the time to borrow some wisdom from the Alcoholics Anonymous "Big Book" that reads "...there is a long period of reconstruction ahead... a remorseful mumbling that we are sorry won't fill the bill at all." This philosophy holds true regardless of whether the addiction paradigm is accepted as the core of the problem. Words are woefully insufficient in the absence of sincere and sustained action.

A person capable of repeated deception and betrayal must be willing to assess the entire measure of his or her life to have any hope of lasting improvement. Entering into (and sticking with) professional counseling is an extremely reasonable expectation in the absence of a compelling reason to the contrary.

It is imperative to accept that healing occurs in waves, with periods of relational pain and distance alternating with times of increased hope and emotional connection. It's unreasonable to expect that a betrayed partner will be able to quickly and easily participate in a mutually satisfying intimate relationship, especially sexually (which was often never really present in the first place). A person who either directly states or obliquely suggests that his or her partner's lack of sexual desire, comfort or prowess contributed to a cycle of repeated deception is denying that this problem could have been addressed in a more ethical and ultimately effective manner. An unsatisfying sexual life does not authorize a couple to avoid or attack each other instead of addressing their mutual problem in a loving and courageous way.

I often tell a person who has been chronically unfaithful to "be the last one to trust yourself", since self-deception typically precedes a sexual relapse. It's natural to crave forgiveness, to expect things to get back to normal, and to conclude that every possible life lesson has been extracted out of all this pain. I encourage even the most devastated sex addict crying over his shattered life to not waste such a pivotal opportunity for personal transformation by simply trying to put the pieces back together. This is the time to remember that iron can only be forged under the most intense heat, when everything else has burned away.

People who truly want to stop living out a pattern of unprincipled sexual behavior are increasingly willing to concede (or at least consider) that they are sex addicts. Some do so hesitatingly, while others seize upon the concept with all the fervor of a drowning man clinging to a life preserver. For these individuals the various 12-step groups dedicated to this issue are able to provide an unprecedented source of "experience, strength and hope" (a phrase commonly heard in such meetings). Those who hesitate to attend these meetings may do so for a variety of reasons which I have addressed at length in my article "12-Step Groups: Twelve Objections and Twelve Responses."

A person who accepts the label ";sex addict" and agrees to follow the 12-step approach quickly finds truth in the saying that "it works if you work it". Regular meeting attendance is a crucial part of this process; I typically recommend a minimum of twice-weekly meetings for at least a year. It is important to develop a relationship with a "sponsor", who is an experienced group member who serves as a personal resource throughout the recovery process. A sponsor provides guidance for "working the steps", which is a systematic process for dealing with the wreckage of the past, managing the challenges in the present and living in a way that brings about a healthier future.

Betrayed partners who accept that they are now in a relationship with a "recovering sex addict" discover that this pathway to healing is a mixture of opportunity and ordeal. The very idea that a bunch of people with poor sexual boundaries are gathering together in an anonymous manner can seem inherently risky. It may take awhile to fully trust that the presence of so many extremely motivated individuals provides a safeguard of mutual support and accountability that protects against any potential exploitation or intrigue among members. People attend these meetings to save their lives, not to mess around.

A sex addict in early recovery may spend as much or even more time away from his or her partner than when the addiction was in full swing. Some individuals experience life-changing benefit from the 12-step process by attending 90 meetings in 90 days ("90 in 90"), having daily contact with their sponsor, engaging in extensive written "step work", making telephone calls to fellow members multiple times a day, participating in "service work", sponsoring others who desire their own sexual sobriety, and doing anything else to insure that their recovery was the most important goal. Some betrayed partners can have mixed feelings about the amount of time an active recovery process can involve.

Sometimes a sponsor or therapist may recommend that a newly recovering sex addict refrain from all sexual behavior for a specific period of time, perhaps 60 or 90 days. The goal of this temporary period of conscious celibacy is to disrupt the addictive cycle and allow emotions that have often been buried by unhealthy sexual behavior to rise to the surface so that they may be dealt with consciously. Although many betrayed partners have little to no interest in being sexual with the person who has hurt them, it can feel odd to have this decision made by the betrayer.

There are situations when counseling and 12-step meetings are not enough. More intensive treatment options exist that provide the type of enhanced therapeutic environment that can bring about the deepest possible healing experience. Programs range from 5-day retreats to two-week intensives to inpatient hospitalizations lasting a month or longer. The decision to pursue any of these courses of care is based on both clinical and economic considerations. I often help people look at these options during personal consultation.

Your Role In Your Own Healing Process

Regardless of what your betraying/addicted partner does or doesn’t do, you have to accomplish many tasks:

  • to develop and maintain a strong support system;
  • to establish some sense of emotional safety, including the creation of appropriate boundaries;
  • to practice good mental, emotional and physical self-care;
  • to recognize and respond appropriately to the many cognitive distortions and negative self- talk that inevitably occur;
  • to navigate the numerous stages of loss and grief;
  • to discover and nurture a sense of personal resiliency and empowerment;
  • to find a sense of hope, regardless of what the future brings, and many other difficult tasks.

These are your tasks, no matter what your partner does or does not do. Just as the betrayer is responsible for his or her growth, you must be responsible for your own. No wonder full healing (when it occurs) is not measured in days or weeks but more often in months or even years.

The Importance Of Finding The Right Professional Help

Chronic infidelity is best addressed with experienced professional guidance in order to deal with all of the difficult and confusing issues that arise for each individual as well as for the relationship. This is not the time to "go solo". Even if the investment of time, money and energy is substantial, the benefit can be well worth it. Attempting to avoid professional assistance in the healing process can cause emotional and relational damage to linger for much longer than necessary, decreasing your ability to be happy, healthy and productive.

Unfortunately many therapists do not adequately assess for the possibility of sexual addiction as the root cause of multiple affairs and other forms of repetitive deceptive sexual practices in relationships. Some will either subtly discount or directly challenge the notion that sexual compulsivity is even a valid concept worthy of careful exploration. In a similar manner, many sex therapists tend to be reluctant to consider that inappropriate forms of sexual desire can represent an addictive drive, even in the face of obvious damage caused by chronic infidelity. I consider those colleagues who continue to resist the concept of sexual addiction are revealing themselves to be either dogmatic or ill-informed.

Because of these concerns I recommend that anyone seeking a therapist's help should find out (a) how that professional views the concept of sexual addiction, (b) what specific training that person has received on the topic, and (c) how often the therapist assesses the presence of sex addition in cases involving repeated betrayal. If the answer is "almost always" or "hardly ever" then this person may lack the degree of objectivity this kind of situation requires. Every situation must be based on its own merits.

Summary

It's obvious that repeated sexual betrayal causes damage to a relationship that often cannot be overcome. However, I have seen many situations in which couples have been transformed as the result of the hard work each person is willing and able to put forth over the long haul. The topics covered above are just a few of the many considerations that will accompany the discovery of chronic infidelity in a long-term relationship. I cannot over-emphasize the importance of gathering together a trusted and informed network of support and guidance. As the saying goes, you alone can do this, but you can't do this alone.

I hope this article is helpful to your quest for healing, understanding, guidance and hope.

Nearly four-hundred years ago, St. Francis de Sales wrote the following pearl of wisdom for those in recovery today: "Have patience with all things, but chiefly have patience with yourself. Do not lose courage in considering your own imperfections". As the fog of trauma, addiction, and emotional challenges begins to lift, one thing becomes clear: our imperfections! Even when we muster the courage to consider these imperfections, it can be disheartening to realize that some of our imperfections are terribly persistent, requiring repeated doses of courage and "an ocean of patience"(another quote by St. Francis de Sales).

On the pathway of recovery, it can be hard to see our own progress – especially when we keep running into the same old character defects. It's like courageously cutting a path through a dense thicket while hiking, only to reencounter the same thicket hours later, with the path already overgrown. In those discouraging moments, it can feel like the recovery path has circled back on itself, leaving us stuck on a ring, destined to repeatedly stumble on our imperfections. Our previously-mustered courage can get pushed aside by anger, frustration, resentment, doubt, and shame. As for that ocean of patience; forget about it - sometimes we are lucky to find a puddle of patience!

Over the years I have come to understand that this process of reencountering our imperfections is perhaps better illustrated by an image of a spring, rather than a flat ring.  While the recovery process does involve circling back to our personal thickets of imperfection, these repeated rings of experience are linked together like a spring, where each revolution actually takes us to an elevated place.  This upward progression can be gradual at times and difficult to perceive within ourselves, especially when we are in the middle of the thicket!  Ironically, our progress may be more apparent to others around us and can be the very foundation of a living amends to those we love.

Recovery from trauma and addiction requires courage to face our imperfections and patience as we face them again and again.  We may never completely rise above our imperfections, but each time we reencounter them on the spring of recovery, we find ourselves in a slightly elevated place.  This gradual shift in perspective allows us to get a better view of our imperfections, altering how we see ourselves and others.  In time, we may even begin to see the process of reencountering our imperfections as a natural part of the recovery path and as an opportunity for growth and healing.

In recognition of June as PTSD Awareness Month, The Meadows trauma and addiction treatment center in Wickenburg, Arizona, is offering discounted in-patient services through June 30, 2012.

Post-Traumatic Stress Disorder (PTSD) often is associated with soldiers or police officers involved in life-threatening situations, but the disorder can be triggered by any overwhelming experience. Chances for developing it are greatest if the incident is extreme, long-lasting, or repeated over time.

Jerry Boriskin, Ph.D., a Meadows' Senior Fellow and a Senior Psychologist for the Northern California Veterans Health Care System, recently visited The Meadows Wickenburg campus to conduct a PTSD workshop for patients. According to Dr. Boriskin, PTSD never fully goes away but there are many tools to learn to live with it "and once you understand how it operates, the mystification and its almost demonic power can be tamed."

Dr. Boriskin, who has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years, explained that in order to heal from PTSD, the individual needs to deal with the three S's - sleep, safety, and sobriety. What is needed, he said, is an environment that contains the addictive disorder while at the same time begins work on the post-traumatic stress disorder. He said that some systems, such as private sector, outpatient, residential, VA and non-VA, treat PTSD in a bifurcated process, which can delay healing.

"What is unique about The Meadows" program is the intent to do both at the same time; emphasizing first the sobriety and the detox, working on a recovery model that fits the individual's needs, yet at the same time beginning to look at what PTSD is about," said Dr. Boriskin. "That is an invaluable duality and simultaneity that permits more rapid progress."

To learn more about how The Meadows can help you or your loved one with PTSD or to take advantage of our limited time inpatient discount offer, contact an intake coordinator at (866) 856-1279 or visit http://www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

The Meadows is sponsoring a free lecture in Dallas, Texas on Tuesday, June 19 presented by Katrena Hart, LPC, on the topic of how to create health in romantic relationships called "The 5 Pillars of Real Love." It will be held at the Unity Church of Dallas Sanctuary from 7:00 to 8:30pm and no registration is required.

"We are always quick to define unhealthy relationships but do not spend enough time describing how to create a healthy relationship," said Hart.

Hart is a Licensed Professional Counselor (LPC) in private practice in Allen, Texas. She is a Certified Bioenergetic Therapist (CBT), and serves on the board for the Dallas Society of Bioenergetic Analysis. She is trained in Eye Movement Desensitization and Reprocessing, EMDR. She is a Certified Psychodramatist (CP), and is a trained mediator. She is a Trainer Educater Practitioner (TEP) of Psycochodrama allowing her to give hours of psychodrama training towards certification by the American Board of Examiners of Psychodrama. Hart is an expert in the treatment of domestic violence issues with teens and adults. She also has expertise in treating chemical dependency and behavioral issues with teens and adults. In addition, she has experience in treating depression, phobias, anxiety, and dissociative disorders with all ages

The Meadows sponsors free lectures in various cities throughout the country. Speakers include local therapists familiar with The Meadows' model. Lectures are free and open to the public. Attendees can earn 1.5 Continuing Education Credits. For more information, contact Betty Ewing Dicken at 972.612.7443 or bdicken@themeadows.com.

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

By:  Brad J Kammer, MA, MFT, SEP

After Hurricane Katrina devastated the Gulf Coast, I had the great fortune to travel down to the area as part of a trauma outreach team, training local crisis workers on how to use the basic principles of Somatic Experiencing (SE) to help them manage the trauma that was now overwhelming the remaining residents. I had been following the news reports post-­‐Katrina, and vividly remembered the horror stories of looting and violence, particularly those coming out of the New Orleans Superdome - like stories out of Lord of the Flies - with reports of gang attacks, rapes and murder. Having worked in refugee camps on the Thai-Burma border amidst civil war, I understood how trauma could so immediately overwhelm people and communities that they would turn against each other in violence. But what I also understood was that in our most overwhelming crises, people also come together for protection, safety and healing. It happened in those first few days after 9/11 in New York City and elsewhere, and as I traveled down to the Gulf Coast region, I imagined that despite all the news reports to the contrary, it must have happened there too.

What I found when I arrived was almost exactly opposite of those news reports I had been following. All over southern Louisiana, individuals, families and communities had come together to support one another. I heard countless stories of strangers helping strangers, taking families into their homes, and other acts of selfless giving. The most startling story I heard, however, had to do with the New Orleans Superdome. I was talking with a woman who had been on the clean-­‐up crew after the last few hundred refugees were evacuated from the Superdome, expecting her to share horrifying images of what she observed. Instead, she shared with me the image of folding chairs placed in circles, all throughout the Superdome, stating that folks had come together to share stories, food, laughter and comfort.

In my years of teaching about stress and trauma, I have found that nearly everyone is familiar with the "fight and flight" survival response. However, very few people are aware of the "tend and befriend" survival response. In Somatic Experiencing, we turn to animals in the wild to understand how despite constant predator-­‐prey dynamics, wild animals are able to manage life-­‐threatening experiences and not develop the symptoms of post-­‐traumatic and other chronic stress disorders. We have carefully studied how wild animals are able to recover from high stress states by completing their fight/flight responses and thereby discharging the high arousal associated with threatening experiences. We have also understood the nature of the freeze response, which comes on-­‐line when we cannot successfully fight or flee from a life threat, and how in humans, going into freeze predicts the onset of developing PTSD and other chronic stress disorders. In Somatic Experiencing, we have developed strategies and tools to help individuals move out of freeze and restore the feeling of being in control, balanced, and capable of meeting further life challenges.

But what about this tend and befriend response? What is this all about? And how does this relate to recovering from trauma? If we look back to the wild animals, we see that there are numerous examples of herds of animals that when threatened or attacked, form protective circles. I've watched videos of zebras, elephants, sheep, and other animal species who on initial response to threat, do not immediately fight or flee, but come together as bands - and if we look closely enough, we see this beyond just mammalian herd behavior, we see this with flocking of birds, shoaling of fish, and the swarming behavior of insects.

Now let's look back to the Katrina refugees, huddled in shock, terror and confusion, locked in the Superdome with thousands of other shocked, terrified and confused refugees. These individuals were in a life-­‐threatening situation, and their very survival was at stake. It is true that there were instances of violence, most likely instigated by erratic attempts at fight or flight, but we cannot overlook the majority of individuals who bonded together with others for safety and comfort. In many ways we can see this in the various social institutions we've created as well, from national armies to gangs to families - we join together with others to protect and secure safety.

When threatened, our first biological response is to orient to the danger. Our senses are heightened and we will scan the environment for the source of threat. Maybe this has happened to you late at night while you're sleeping. You hear a noise downstairs and immediately startle, sitting up, and using your senses (ears, eyes, possibly even smell) to locate the source of the noise. I live in the country and see this happen frequently with deer. I'm walking on a trail and observe a deer some 30 yards ahead, standing still, but with probing eyes and shifting ears, attempting to evaluate if I am a source of threat. If I continue to walk closer, they will immediately run away (flight).

However, part of this orientation - often overlooked due to the rapid firing of these instinctive survival responses - is an orientation to the herd. Before the deer run away, they are also orienting to the other deer. And before you get out of bed to check the noise downstairs, you might wake up your sleeping partner to check in with them. If others are there for us, we will come together in numbers to better assure protection and safety. And if not, we will move rapidly into fight, flight or freeze responses. These are not well thought-­‐out plans, these are instinctual, biological and genetic programs that are activated in the face of danger and threat. As humans, we are programmed to connect and collaborate for survival: this is the tend and befriend survival response.

Over the past 20 years, thanks to the emergence of incredible brain imaging technology, we can now map the brain and body like never before. These studies show us that the regulators of our minds and bodies are embedded in relationships. This goes beyond the realm of mere survival into the realms of understanding illness, health, and resilience. Research suggests that in terms of health and healing, social support is more powerful than anything besides genetics. And when there is an absence of appropriate social interactions, when individuals retreat into social and/or emotional isolation, substitutions are made in the form of such things as food, alcohol, drugs, sex, TV, computer and video games. Meanwhile, chronic stress builds in the nervous system which leads to a host of symptoms and chronic disorders. There is plenty of information showing us that isolation and lack of social engagement can make us sick. And yet, we live in a world where we retreat more and more, creating alternate realities and identities on digital screens, whispering messages of loves through text taps, and flirting with emoticons. Contrary to what we may believe, these forms of engagement are not bringing us closer together nor are they triggering the hard-­‐wired mechanisms in our brain and bodies that are required for supporting health and well-­‐being.

Some years ago, oxytocin, the "love" chemical, was discovered in the brain. Scientists observed that this chemical was released in both mothers and their babies during labor and birth, and during bonding between parents and their children. This chemical is released to support the loving feelings necessary for healthy bonding and attachment. As we have learned through studying bonding, the mother's presence and loving attention helps to regulate the newborn's not yet fully-­‐developed nervous system. Studies have shown that when there is an absence or oxytocin release, bonding suffers and proper infant development is threatened. For the baby, then, along with food, water and oxygen, the ability to feel connected assures their very survival.

But interestingly, oxytocin also shows up in the human body during times of close social connection including romantic encounters, trusted friendships, and even the comforting pat on the back or rewarding high-­‐five. Being a big basketball fan, I enjoyed reading a research study on the National Basketball Association (NBA) a few years back which compared the performance of a team with the number of times during a game players on that team use supportive touch with one another - anything from a handshake to a chest bump to a bear hug. This study demonstrated that there is a strong correlation between successful teams and the frequency of contact, with the Boston Celtics and LA Lakers, the two teams that met in the 2008 NBA Finals, being the two "touchiest" teams.

As scientists continued to research this neurochemical, they realized that not only does oxytocin coordinate social behavior with bonding, healthy development, and improved performance, but it also supports physical health. It acts to lower the neurochemicals associated with stress and anxiety, is analgesic (blocks pain), and anti-­‐inflammatory (aids in healing). Maybe this accounts for why children run to their parents when they fall off their bicycles and scrape their knees - maybe their mother's embrace actually triggers pain-­‐reducing, healing mechanisms in the skin. Maybe this is why being with friends and family during tragedy can help us stay balanced and sane. Maybe this is why all the Katrina refugees joined together in circles at the Superdome.

Many ancient cultural and religious rituals serve this very function. For example, in the Jewish tradition, close family and friends come together to mourn a loved one's death for seven days following their passing. This practice of "sitting shiva" allows for grieving family members to be supported by their community as they manage the intense emotions associated with the loss of a loved one, possibly inoculating them against the effects of depression and illness reactions. More recently, social, self-­‐help and therapeutic groups have served a similar function in our modern society. An informative research study from Stanford University was done with 50 women diagnosed with metastatic breast cancer. They followed two groups of women - one consisted of women who joined cancer support groups and the other were women who did not join any support groups. The results demonstrated that the women who joined a support group lived twice as long as the women who did not join a support group. Not only that, those women who joined a support group also reported a higher quality of living, including 50% less pain than those not in a support group.

When working with individuals dealing with trauma, many are so engaged in managing the energy of their basic survival - which can be observed in such behaviors as conflict, avoidance and isolation, and such emotional states as rage, anxiety and depression - that their ability to be present and available for meaningful relationships suffers. This means that the most primary survival response - tend and befriend - goes off-­‐line, leaving individuals vulnerable to further effects of trauma and chronic stress disorders.

When working with Somatic Experiencing, we are focused on the unresolved dysregulation of the brain and nervous system, those neuro-­‐circuits which became dysregulated through our incomplete responses to danger and threat. In other words, a life experience overwhelmed our capacity to cope, leaving our brain and bodies disorganized and unbalanced. For example, what if upon waking in the middle of the night to that noise downstairs, you register that a hurricane had hit your home. You survive the environmental assault on your home, but your body might have not returned to the balance you experienced before this event. Now every time you hear a loud noise, you startle, or maybe you've even lost your ability to fall asleep and sleep restfully throughout the night. Unbeknownst to you, your body might be frozen in that past experience, still stuck in an incomplete fight/flight state, thereby creating a dysregulated nervous system.

Understanding the avenues of resolving the fight, flight and freeze states is essential in effective trauma treatment, but I remind my students to be on the lookout for the disrupted tend and befriend states as well. My work centers around supporting people in social engagement. I recognize that without social connection - when tend and befriend are off-­‐line we miss out on the healing process this behavior promotes. Part of this healing is to return to the feeling of one's sense of self before a traumatic experience disrupted one's life. To many cultures, the loss of connection with others equates to the loss of one's self.

A memory comes to mind of sitting around a refugee camp in Asia with my Burmese friends, eating good food, laughing at our poor language skills, and singing along to the guitar playing Burmese freedom songs. I was moved by the moment and by

their inspiring resiliency. I was curious as to what techniques or rituals they had in their culture to help them deal with the unrelenting trauma of social oppression. So I asked my friends what helped them deal with the brutal trauma they were experiencing. They looked at me puzzled, and finally Ko Yee Zaw, a dear friend, said "this". Right in front of my eyes, between us there that evening, safety was being established and healing promoted. Despite the very best efforts from international organizations and providers to equip the Burmese people with the technical, medical and educational support they needed to survive, my friends recognized the inherent support they already had with them - social connection.

What I've learned since is that safety translates to biology, meaning that if we trigger states of well-­‐being through personal connection, we can promote both psychological and physical health. Amidst unspeakable acts of human and environmental destruction, what I discovered in the refugee camps of Southeast Asia and the parishes of southern Louisiana was that relationships might just be the best medicine.

Brad J Kammer, MA, MFT, SEP is a Psychotherapist, Somatic Experiencing Practitioner and Assistant Trainer, and has been involved in bringing SE to various communities and cultures. Brad lives and works in Ukiah, California, but also has a private practice in San Francisco. Brad is an adjunct psychology instructor at Mendocino College and National University. To contact Brad or learn more about his work and teaching: www.body-­mindtherapy.com.

The Meadows will offer a Love Addiction/Love Avoidance Workshop the week of June 18 from 8:30am to 4:30pm Monday through Friday at The Meadows' campus. This workshop is based on Pia Mellody's groundbreaking work on the compulsive behaviors of love addicts and love avoidants.

During the workshop the characteristic of the love addict and love avoidant are explored. Love addicts experience abandonment and neglect in childhood, causing them to assign too much time, attention and value to another person, while neglecting to care for or value themselves. Focus on the partner is obsessive, and fear of abandonment drives the obsession. Love addicts can be addicted to anyone: lover, spouse, friend, parent or child. By comparison, the love avoidant was smothered or enmeshed in childhood, for example, a parent who was domineering or used the child as a confidante or surrogate spouse.

"Love addicts create fantasies and they live in fantasy rather than reality. They make up a fantasy about who the other person is and have unrealistic expectations about what it means to be relational," said Gail Yaw, Director of Workshops at The Meadows and a Licensed Clinical Social Worker. "The love avoidant's fear is "if I let you get close, you'll take me over."

Attending a Meadows' workshop offers an individual many benefits. A workshop can be a cost-effective alternative when long-term treatment is not an option. Individuals who cannot be away from their work or families for an extended period of time can attend a workshop and work on sensitive issues in a five-day concentrated format. This allows individuals to jump start their personal recovery by gaining insight into patterns and practicing new relational skills within a safe environment.

For more information about The Meadows' Love Addiction/Love Avoidance Workshop and other workshops offered by The Meadows, please contact Heidi Dike-Kingston at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

The Meadows and The Refuge are hosting a free one-day trauma workshop for clinicians on June 8, 2012, in Delray Beach, Florida from 8:00am to 3:30pm.

This workshop will focus on both attachment and addiction; exploring how the lack of healthy attachment in childhood can lead to a variety of mental, emotional, social, and physical health problems in adulthood, effecting resiliency and a person's ability to function in a healthy manner. The presentation will also explore the neurobiology behind "the perfect storm" of addiction and how trauma replicates and fuels chemical dependence.

Presenters include Judy Crane, Founder and Executive Director of The Refuge; Dr. Jon Caldwell, psychiatrist at The Meadows; and Dr. Douglas Davies, neurobiologist. Titles of presentations include "The Loneliest Heart: "The Many Faces of Trauma,"" "Mindful Awareness of Attachment: "Fostering Emotion Regulation and Resiliency in Trauma Recovery,"" and "Neurobiology of Addictions and Trauma."

For more information and to register for the workshop, contact Shea Beasley at 352.512.8877. This event offers 5.5 Continuing Education Credits sponsored by The Institute for Continuing Education.
The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment. My answer is always the same - "yes". Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic. In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment. These theories of human development have also furthered our understanding of "neural plasticity" the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful. In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences. In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called "schizophrenigenic mothers"). Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the "cognitive-revolution", with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability. For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected. Findings such as these clearly showed that genetics play a role in many forms of mental illness. However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found "the suicide gene").

At the turn of the twenty-first century, genetic theories relying on simple one-to-one relations between a single gene and a psychiatric condition were supplanted by "diathesis-stress" models, which posited that genetic diatheses or "vulnerabilities" could interact with environmental stressors to produce deleterious outcomes. The most prominent study of this genre was published by Caspi et al. in 2002 and showed that the relation between childhood maltreatment and later-occurring antisocial behavior was much stronger for individuals who had the less efficient form of the MAOA gene (a gene that improves the function of nerve transmission in the brain). In other words, genetics alone didn't predict poor outcomes; it was the combination of a genetic predisposition and the stress of childhood maltreatment that led to an increase in antisocial behavior.

Although this particular gene-environment interaction has been replicated a number of times, some researchers have questioned whether the diathesis-stress model tells the whole story. In the last decade, researchers began noticing that when individuals with a genetic "vulnerability" experienced lower levels of environmental stress, they often fared better than those with individuals with the "favorable" form of the gene. For example, in the graph from the Caspi (2002) study (see above), under conditions of no childhood maltreatment, individuals with the "inefficient" form of the gene (red line) actually had lower levels of antisocial behavior than individuals with the "efficient" form of the gene (blue line). In the Caspi study, this difference wasn't statistically significant, but it raised questions about whether it could be a significant finding if studies were designed to see the phenomenon more clearly.

Jay Belsky, a professor of mine at the University of California at Davis, was one of the first to propose that particular genes (like MAOA) may confer risk or benefit, depending on the environment. Instead of thinking of certain genes as merely a liability, he argued that these genes might increase susceptibility to environmental conditions, "for better or for worse". Belsky and colleagues" theory of "Differential Susceptibility" is rooted in an evolutionary argument that, under circumstances where the future is uncertain, it makes sense to have some offspring that are less sensitive, and other offspring that are more sensitive, to environmental conditions. Like a well-diversified financial portfolio with some money in conservative, robust holdings and some money in high-risk stocks that can respond dramatically to market swings (too close to home for some of us), differential susceptibility posits that some people have a more "fixed" genetic makeup that is less vulnerable to environmental conditions, while others have a more plastic or malleable genetic makeup that is more susceptible to the environment, whether it be positive or negative.

Of course, this theory comes with the exciting possibility that reducing environmental stress (e.g., child maltreatment and relational trauma) may be particularly meaningful for individuals with genetic susceptibilities. In a study published in 2008, Bakermans-Kranenburg and her colleagues tested this hypothesis by investigating 157 families with toddlers who showed elevated levels of externalizing problems (e.g., hyperactivity, oppositional behavior, aggression, etc.) They found that their Positive Parenting and Sensitive Discipline intervention program was most effective in reducing externalizing behaviors in those children who had a version of the dopamine gene (DRD4) that has been linked to externalizing behavior and attention-deficit hyperactivity disorder. That is, children who would have traditionally been thought of as carrying a dopamine-related genetic "vulnerability" were in fact most responsive to the positive environmental changes associated with the parenting intervention program.

The results of this study, and many others like it, suggest that improving environmental conditions during childhood can drastically enhance developmental outcomes, especially for those children who are genetically susceptible to environmental influences. However, these findings might also apply to adults - especially considering recent research showing that the brain remains plastic or malleable well into adulthood. For adults with adverse life experiences who are recovering from conditions like depression, addiction, and post-traumatic stress, the genetic susceptibilities that previously contributed to their sensitivity to adverse environmental conditions may also facilitate their responsiveness to the positive changes associated with recovery treatment. In other words, by improving environmental conditions, what was once considered a vulnerability may actually become the very means for plasticity and growth.

As the Serenity Prayer suggests, it takes courage to improve our environmental conditions and there is much of our day-to-day circumstances that remains beyond our control. However, even when we cannot change our external environment, we can always alter our perspective of it. Approaching ourselves, our fellow beings, and the world with a greater measure of acceptance and compassion can literally change the subjective experience of our environment, and in many cases it can also lead to objective changes in the environment. This shift in perspective is bound to feed back into the biology of our being, perhaps most noticeably for those individuals who at one time may have been considered genetically vulnerable, but who might actually be predisposed to resiliency, especially if the right environmental conditions are established.

Dr. Shelley Uram on the Sense of Self and Nature of Children

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from family dysfunction to the benefits of Somatic Experiencing. In the installment titled "The Sense of Self and Nature of Children," the psychologist and Meadows senior fellow discusses the development of the sense of self.

Dr. Uram first describes the authentic nature of a newborn baby: existing moment to moment with no judgments, expectations of self or others, or sense of the past or future. At three months of age, infants begin to develop a sense of self; as the thinking brain matures, this sense of self grows continually more complex. As individuals progress through life, they advance through Maslow's Hierarchy of Human Needs, wherein self-knowledge and transcendence stand as the ultimate goals.


In other videos in the series, Dr. Uram shares her expertise on trauma triggers and the effects of emotional trauma on brain development, among other topics.
Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain's survival wiring - and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.
The Meadows' video series also includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg. To learn more about The Meadows' innovative treatment program for trauma and other disorders, visit www.themeadows.org or call 800-244-4949.

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