Betrayal Trauma Recovery - BTR.ORG

Dr. Steffens: APSATS was started out of discussions between myself and other clinicians and other coaches who were talking about the extreme need to provide better care for partners, better support, because at the time there was very little available; what was available didn't seem to be meeting the needs of the majority of partners we interacted with. So a group of us got together and did a brainstorming phone call. Out of that, we decided to start our own training and certification program.

Which, by the way, was on the very last place on any list of things I wanted to do in my life; I never wanted to start a non-profit! But we did. It was formed out of a real sense of a felt need. Partners were being hurt or not being able to find appropriate treatment and so we stepped up and tried to figure out what we could do. We now have a strong board. We have a great curriculum and provide three trainings a year; we do them in a webinar format so people can stay home or once a year we do a face-to-face training.

We have trained over 150 people now. We've trained people from all over the US, Canada, the UK, Singapore, and in July we are doing a training in New Zealand. This will give us APSATS trained providers in New Zealand.

Anne: That is awesome. I love APSATS because they are people who understand it from the very beginning. I've said so many times that I went into therapists and I sat on their coach and I paid them to train them about betrayal trauma! And then it was like, "this isn't helping." So six weeks later I would try to find a new therapists rather than actually pay someone to help me--which is what I needed.

Dr. Steffens: And that's not fair. You shouldn't have to train your help provider. And sometimes in the process of this, you get harmed and hurt.

Anne: Partners of sex addicts have difficulty finding appropriate support and help for themselves. Why do you think it is so difficult to find appropriate support?

Dr. Steffens: First, there isn't a lot of knowledge about the topic in general. I teach in a counseling program and I know that when I look at the course offerings, there is very little being taught to therapists that are getting trained about sex addiction or compulsion in general, let alone talking about the impact on the family. So I think it starts there for the help providers. There isn't a lot of public education on the topic and it still tends to be one of those things people don't understand so they don't want to talk about it. So there is very little information out there.

I think the general therapist or counselor, if this problem comes into their office, maybe they have some awareness of addiction but they don't make the leap to trauma for the family member or the wife, the spouse. Also, sometimes people think they know just enough because they read one book or something so they begin to say they can help this population and end up not being helpful and sometimes hurtful. But I think overall, it is just a lack of conversation and information.Certainly a lack of training.

Anne: I've been talking to my mom about this and it seems I'm fighting two different fronts . . . society in general and its misunderstanding of the issue and also the church which has such a misunderstanding! You'd think they would be on opposite sides, and they kinda are, but at the same time, because it's so misunderstood with both populations it's difficult to be able to teach it.

The religious community sees it a certain way and they think you should heal in a certain way that, at least for me was not helpful at all; and then society in general accepts pornography or they don't accept the trauma aspect of it. I think this makes it very difficult.

Dr. Steffens: It really does. I'm really glad you brought up faith community because I, too, have found they don't talk about it, they're afraid to talk about it, or when they do, they lack adequate information and especially when the wife or spouse goes for assistance, they can get crazy advice that can really be hurtful; ie. just be more sexual, if your husband is looking at pornography you must not be doing something you are supposed to do.

Those kinds of things don't help at all. Trying to get into faith communities to educate them about this is extremely difficult. I think they have a lot of fear; they don't want to talk about it. I think also that, as we know, leadership in faith communities are struggling with this as well; so this can be a hinderance to talking about this.

Anne: Plus the fact that it's trauma and with the trauma model, we are identified as actual true victims. Not that we need to stay in victim mode, and not that we can't make choices or be empowered, but I think that for a faith community that might have many men who are struggling with this, they don't want to admit that their behavior is causing this much trauma in someone else and that they have left a trail of destruction.

They would rather have it be, "This is my part and your part is...." (You've asked me too many questions or you've done this or done that, or you didn't make dinner) One of my coaches said that her religious community told her that she needed to win him over with her 'Godly demeanor.') This type of stuff is re-traumatizing to women. 

Dr. Steffens: What you are describing is a lot of the common features in someone who is engaging in compulsive sexual behavior. They have distorted thoughts and beliefs. Those responses from faith communities sound like so much of the distorted thinking that people have when they are engaged in this compulsive behavior: It's someone else's fault; it's not really that bad; no one needs to know; no one needs to get hurt.

They minimize and rationalize and blame shift, so unfortunately, in a lot of places where there isn't adequate training or they don't want to talk about it, they do the very same level of harm that the person does who is betraying their spouse. They use the same tactics.

Anne: Absolutely. I was abused by my church leader during this time of disclosure. That has actually been more traumatizing to me than the actual betrayal because I was going to someone for help and I was being abused by proxy because he believed all of the things that my ex was saying.

Dr. Steffens: Treatment-induced trauma is a way of describing the process when this happens. In this situation we are talking about the partner of the spouse who does to someone with an expectation that the person can help them.

And then in that process they find themselves feeling harmed and sometimes the harm in that setting can feel worse than the original betrayal because the person goes, feeling betrayed and very needy and needing to tell someone and get help, and then when you are not believed or blamed or minimized, it just adds to the level of trauma.

I compare it to a child who is being sexually abused who has the courage to speak up and tell someone and when that person does not believe them or tells them they must have imagined things, or they shouldn't talk like that, the victim pulls away and is even more hurt. When I have worked with abuse survivors, the 'not being believed' they say is worse than the actual abuse. I think for partners there is a level of this that is true as well; not being heard, believed, seen, valued adds to, and in some situations, intensifies the trauma.

There is a clinician that also calls it 'institutional betrayal.' She describes it as an expectation that this place or person I am going to is there for me; and when they turn against me, they add more level or harm and trauma to the individual.

I can tell you that since I have begun doing this work, I hear it all the time. I get emails, letters, phone calls from women all over the US and other countries and they are describing the similar experience of taking the risk to tell someone and then not being heard and being harmed in the process. It really angers me because by now there is enough information out here that I would think people would know what not to do. But it still occurs.

Anne: One of the things that I see is that the addict is so good at lying and manipulating that they are believed over the victim, repeatedly, and so this is difficult to get away from. How do you get away from someone who is lying about you or manipulating the support you are trying to get? This leads me to think that it is much better to get help for yourself without dragging your husband in so that you can get a clear picture of what is happening and get solid with what you are doing.

In cases of abuse, couples counseling for example is contraindicated until two years after the last abuse episode. And yet I would tell therapists this and they would say, "Ok, let's keep doing couple's therapy." They wouldn't say that we needed to stop and he needs to get help for his abuse. It's really difficult to want to get help, to be willing to get help, to actually make the effort to get help and then to be harmed further. 

Dr. Steffens: Yes. I think a lot of times what happens because we don't have a lot of information about what sex addiction is and what treatment looks like, a lot of times the first person a spouse goes to is their clergy who is going to look at as a marriage issue or to a couple's counselor who will view it through the lens of a marriage issue as well. An addiction is not a marriage issue.

Addiction is something in the individual that affects a marriage but a lot of times people try to treat it as a couple's issue. And it's not. I think this is where a lot of partners are, just as you described, harmed, not understood, or abused within the session and the therapist doesn't catch it. I also want to talk about the word "abuse'" that you are using.

I think that therapists are trained to recognize domestic violence physical abuse but they don't have a lot of awareness of emotional, verbal, and especially psychological abuse and manipulation. So again, they are going to see this as a communication issue rather than a power issue, a control issue, or an abuse issue. They need more training on how to identify those types of abuse.

When we do our APSATS training with therapists and coaches, we spend a lot of time talking about the emotional impact, the psychological manipulation, gaslighting, controlling behaviors, intimidation...all of those things that can go hand-in-hand with active addictive behavior that really contributes to the harm and trauma that a partner experiences.

A lot of times people think the only trauma is the discovery of the secrets. That's horrific! That's traumatic! What is missed in a lot of help settings is the on-going emotional abuse that has occurred before the addiction is even found out...and it's already done tons of damage and harm to the relationship and particularly to the person who is on the receiving end of that.

Anne: And then sometimes the continued abuse from addicts that are in "recovery" who are actually not in recovery, showing recovery behaviors.

Dr. Steffens: Right. They may have stopped the acting out behavior but they haven't taken on or begun practicing healthy relational behaviors.

Anne: In some cases, I don't know if they have stopped acting out sexually at all. Sometimes they may be lying and hiding things better, just talking the talk because they have figured out what to say in order to get their wife off their back.

Dr. Steffens: I did a workshop a few years ago at a large conference that is there for the sex addiction community. I called it "When the Chaos Doesn't Stop." I wanted to do this workshop because when partners, say at six months to a year after a discovery and partners are still not getting better, and so I tried to uncover the issues that get in the way of partner recovery.

Most often it is either because there is ongoing sexual acting out that has not been uncovered yet, and/or the ongoing chronic emotional abuse, manipulation, psychological abuse, and gaslighting--the things you were describing. The recovery behavior hasn't kicked in yet. So how is a partner supposed to begin healing when the traumatizing has not stopped?

We pathologize the partner for not getting well rather than looking at what is going on in the relationship that she still doesn't feel safe. To me that is a huge place where treatment-induced trauma occurs; where the partner is blamed for her not getting better when she still is not safe in the relationship.

Anne: I see this time and time again. It's so distressing to me because the women in these situations are feeling guilty and terrible and they can't figure out why they don't feel good when the behavior they are describing to me about their husbands sounds terrible. I'm wondering why their therapist isn't picking this up! They aren't being protected? They aren't safe?

There has been a lot with the anti-pornography movement and the movement to bring pornography addiction into the light, to not shame addicts and to give them more voice and to maybe "normalize" it somewhat so they don't feel as deviant or terrible; but in this same vein, I think in some ways the "normalizing" it has made it so that maybe it's not as bad to some people.

Dr. Steffens: What isn't being addressed are the behaviors that go along with this and the behaviors that come as a result of chronic viewing of pornography or the other types of acting out that can happen with this type of addiction.

They are looking at the acting out behavior alone, not looking at how it is impacting the character; this gets in the way of that individual caring about having empathy for the people they are harming. So therapists can talk about how to control behaviors so porn isn't being used but they are not addressing how this is impacting people as human beings in relationships with others.

Anne: As people are trying to get help but they are not getting appropriate help, what are the effects of these treatment related injuries?

Dr. Steffens: One of the saddest impacts is that is gets in the way of spouses, of partners, going to get help for themselves. Who wants to get help and be told they are part of the problem, that there is something wrong in you or this wouldn't have happened to you...and then if they don't agree with this then they pull away and say they can't trust telling this to anyone because all I am doing is getting blamed for it.

And so they pull away and don't seek help again. To me, this is the greatest damage.

We know that people who do not get help, who are being traumatized or who are in chronically unsafe abusive relationships, can develop long-term mental health issues. This adds to the level of distress for the spouse. For me, this is the greatest impact. Also, there is the secondary trauma that the partner experiences.

So not only are they working through the betrayal trauma in their relationship, but now they are working through the betrayal trauma that they experienced at the hand of a clergy member or a therapist or some other health provider...such as a physician. Many people go to a physician to talk about what is going on and try to get medication or something. The physician can do something that is harmful as well.

It's the extra trauma that doesn't need to be there. The shame that comes to a partner when they are blamed for what is happening. Partners experience this anyway; it's part of the first response ("Wow. How did this happen to me? How did I not know? What did I do or not do that my husband is acting this way?) And then when a care provider shames them and blames them as well, this heaps more shame upon the partner.

Anne: It's an extended form of the abuse.

Dr. Steffens: Yes. There is a lot of gaslighting that happens to partners and it's not all within the relationship.

Anne: In your estimation, what can partners look for in treatment or what health care providers to avoid this secondary injury?

Dr. Steffens: Partners are getting a lot more wise now that there are a lot more resources available to them, much like what BTR is doing. It is phenomenal that you are offering this kind of information for spouses. Getting educated and really asking questions before you begin working with a care provider is important.

Asking what kind of model do they use in working with partners; how do you view the partner? Do you believe all partners are co-dependent? Ask the therapist or coach, "If I don't agree with you, is it okay for me to ask to do something different?" another questions is, "This isn't working for me, can we try another approach?"

If you have a therapist or coach that says the one way is how they always do it and it works, then you might want to get someone else. You want a therapist or coach who is aware of what you need and their primary focus is on getting to know you and identifying to be able to help you and allow you to be an active part of the process.

Unfortunately, I hear a lot of times that partners go to get help and they are given a program to follow...and there isn't a lot of room for individual needs and unique treatment opportunities. The therapist is looking at a "one size fits all" way of working with partners. I've never found this to work.

Anne: This is why we don't have static modules at Betrayal Trauma Recovery. We don't have static classes. All of our educational materials are free to everyone. The support calls and groups and a crisis drop-in group that we will begin soon have individual assistance from an APSATS coach. This is where the real change can begin.

Dr. Steffens: We deal with the real person who is in front of us, with their unique history, their unique now, their unique strengths, their unique personality so people can't be put in a module and expect it to work for everyone.

So, just ask questions. Ask questions about how to work with partners. What is their belief about how this happened; what is their understanding around the model of co-dependency and co-addiction verses trauma. What books have you read? What training do you have?

I'm always encouraging people to find someone who has specific training. As clinician (I'm both a clinician and a coach so I'm putting on my clinician hat), I am bound by ethical codes that say if I am declaring I am a specialist in something, I better be able to demonstrate that I have specialized training, experience, and supervision in that area.

Unfortunately, a lot of therapists say they treat something but if asked where they got specialized training, they say they have not but that they have a read a book or something like that. So ask how they got their training and who supervised them and what is the model of the training they received.

Anne: I'm excited because I am going to get APSATS trained in June!

What can wives or girlfriends expect if they attend a family week at a residential treatment center where their husband or their boyfriend might be receiving treatment?

Dr. Steffens: They can expect a variety of things...I don't claim to know what all of the various programs do. Most of them have some kind of family week program where family members, including the spouse or girlfriend, can come and get information about sex addiction as well as perhaps participate in some sessions.

It used to be very common for partners to be called to go to a week long family week and during this process go through a disclosure-type experience where the person who is being treated gives their timeline and then shares it with the spouse who comes.

The problem with this was that a lot of harm was done to the spouses in these kinds of settings because the partner didn't have a therapist who was uniquely there for them; they didn't have preparation; they usually traveled out of town and were in a hotel room. So after hearing the disclosure and going home alone or to a hotel room without adequate support, it was too much. I never recommend a partner doing a disclosure in a setting like this.

I want to encourage spouses to be aware of asking what the program is like, what they can expect, would there be a therapist for me, what kind of contact do they have with my therapist or my coach so information is shared; is there an opportunity for disclosure during the week, and if so, then I recommend to partners to opt out of this for the reasons I just gave--there is not enough support. I have too many horror stories about women who did go through this.

So ask the questions: what do you do and what if I do not want to participate in this piece of it. I also let partners knows that they do not have to go. They can offer it and be told it will really help but if the partner doesn't think it sounds safe or like it will meet a need, then "no thank you" is fine..."I am working on my own and if my husband has things to tell me, we can work it with our therapists after he is out of residential treatment.

Take initiative. Ask questions and be empowered to ask for what you need and say what you don't want.

Anne: Listening to this podcast or to this information so you know what questions you can ask. I had been with my SA spouse for 5 years before I even heard about a therapeutic disclosure or a polygraph. A friend of mine told me about it. I didn't even know it existed!

Immersing yourself in books is good and learning about it because then you will know which questions to ask the treatment center before you go. Sometimes women are at the point of not knowing what to ask or how to go about it. Having a little bit of a foundation is helpful I think.

Dr. Steffens: I think it's hard too because if someone is going into residential treatment, most people with controlled sexual behavior don't go there. If someone is there, it's pretty extreme and been going on for a long time. It's a crisis situation.

To think about flying to another city while the individual is in crisis, trying to go to a family week...to me just doesn't make a lot of sense. I wish more residential programs had a designated partner component that really met the unique needs of that partner, rather than putting them through a step-by-step program while there. They don't need programs. They need support. 

Dr. Steffens: I think the most important thing to do if you can is to not take responsibility for what someone else did or didn't do that you needed. I think like we were talking about earlier, one should not have to train their treatment provider or caregiver. So don't own it. Go and talk to someone about it.

When I'm talking to my clients, if there is prior treatment or treatment-induced trauma they have experienced like from their faith community, processing this is part of what we do, working on ways to find healing so it doesn't fester. It makes it more difficult in the healing process but it certainly is not insurmountable; it just needs to be discussed and worked on.

Anne: Do you recommend picketing? (Laughing.)

Dr. Steffens: No but if the treatment-induced trauma is severe and you talk through it with a therapist and it seems like they not only didn't understand but it that it is a clear, ethical violation. A partner certainly has every right to complain in this instance. This can be done privately by going to the therapist or clergy member and talk to them how it hurts. Don't do this right away because it's important to feel safe and empowered and strong. This may be helpful.

Sometimes there is a level of complaint to a state board if it's a licensed individual. Again, this is usually more extreme. A therapist using an antiquated model may be an extreme and filing a formal complaint in regards to it, but it is an option. I always encourage talking this through with someone to know what your options are and then do what fits for you.

Anne: For me, being stuck in the wanting to picket phase is where I said, "This has to change. This is an institutional problem that I see within the church. It needs to change. I don't know how to change it or how to start . . . "

Last night I actually spent a lot of time praying and asking God what I should do . . . I don't know how to overcome this...I don't even know if it's healthy for me in my recovery to worry about the institution as a whole or feel like the weight of it is on my shoulders . . . but because I talk to so many women about it, I think that someone needs to do something and maybe that is me. This is such a difficult thing to understand.

Dr. Steffens: It really is and going back to where we started--this is a large part about why APSATS exists. We all said, "Something needs to change. Something needs to happen." There are various ways to do this short of picketing! Going and talking, getting an education, the services you provide through your podcast and coaching are making a difference and bringing about change.

The model is changing in the sex addiction field. In large part it's because spouses and partners have become educated, they have found support, they are connected with other people that believe similar things, and the consumer in this case is changing the institution. People are speaking up--like APSATS. When we do an educational program, we are making change too.

As an organization we are looking at what else can we do. We want to promote more research and community education in different communities to help raise the topic and talk about it. There are a lot of things we can do. It is up to the individual and what makes sense to them and what is safe. This is risky stuff. If you start talking out loud in a community setting about this, because we don't talk about sex addiction, it really can feel emotionally dangerous and risky.

Anne: Dangerous in other ways too such as reputation and emotionally. It's really risky and not something that I would necessarily would like to do and I appreciate everything you have personally done to help APSATS move this forward. We owe a great debt to you actually. 

Dr. Steffens: I've experienced it as a call all my life. Anytime I have the opportunity to talk to someone about partners and spouses of sex addicts and what they need, I know I am not just speaking for me and I am not just speaking just for APSATS. I am speaking on behalf of spouses and partners everywhere that don't have a voice or don't know how to use it. Whatever opportunity I have to verbalize and stress how extreme this need is for ethical and appropriate care for partners, I'm going to do it!

Anne: Thank you, thank you, thank you! from all of us. I will be the collective voice for all of us!

Dr. Steffens: I'm not alone in doing this. We have a phenomenal group of people in the APSATS community, which is amazing!

Anne: Yes, I am very grateful to associate with the coaches I do and I also frequently talk to Dr. Jill Manning who is also very helpful.

Dr. Steffens: An APSATS therapist is someone who is clinically trained such as a professional counselor, social worker, psychologists; we have some physicians and MDs who are clinically trained and a therapist will usually be working on symptoms like anxiety, depression, the trauma symptoms and trying to resolve some of them.

A trained APSATS coach will do the coaching around calling out the strengths in the individual, helping them identify what are the barriers to what they want and need; really coaching and encouraging them by working with them to meet their goals and get past those barriers and gain resources.

There are some similarities and overlap such as building resilience. Both a coach and therapist can do some of the same things. Coaches have specialized training on how to pull on the strengths and vision for the future and get past the barriers that are there. I love it when partners can work with both.

Perhaps in the beginning when all the symptoms of trauma are intense, working with a therapist may be the place to begin and then work with a coach once the symptoms have subsided; or, I have a lot of clients where I work with them on the trauma and then I will have them meet with a coach who helps them provide more support, work on resourcing, work on recognizing gas lighting when it happens, and then taking steps to learn how to communicate and how to take care of themselves when it happens.

So they work really well together as a team. The APSATS coaches give a phenomenal job or providing support groups for partners. For a lot of therapists, we don't have time, we don't have the setting, there are barriers to partners going to face-to-face groups. Sometimes I have partners who don't want to be seen because their loved one is high profile in their community.

So a coaches group is a safer place to go. A lot of pastor's wives will go to a coach for support rather than going to a local face-to-face group. The training is the same in terms of the APSATS training. Our coaches are already trained as coaches and have demonstrated skill there. Then they are getting additional training on how to help in a trauma informed way, doing what good coaches do.

Anne: The coaches at Betrayal Trauma Recovery are in all different time zones. All of our services are provided online. The support calls can happen during your son's soccer practice and you're sitting there for an hour waiting for him. You can call in and have your support call then. The groups are all online so it can be done while your child is napping.

We are going to try to get one at 2 am because one of our coaches is in the UK so for a crisis drop-in group for women who can't sleep, this works. We are trying to provide for women for where they are and when they need it because so many are busy with children or work that one more thing in addition to the trauma is very difficult--which may be a reason why women don't get help: they are so overwhelmed with everything that they have going on.

Dr. Steffens: Absolutely. I'm always amazed when my clients who are in the throes of crisis somehow or other find their way to think clear enough to get to my office and to get back home. Knowing they can have additional support by picking up the phone or going online is great. I love that. As a coach, I love doing partner groups.

I haven't done one for awhile but when I've done it, it is amazing because we can have people from all over the country come together as the same time and support one another. 

The other difference that some therapists don't like is that there are no bounds, no state or country bounds. For therapists in the US, we are licensed by our state. So as a licensed counselor in Ohio, I can only do counseling with clients from my state. I live 30 minutes from two other states but I can't practice in those states as a therapist.

But as a coach who is coaching and not doing treatment, I can do that with anyone, anywhere.

Anne: This is the bonus of doing coaching through Betrayal Trauma Recovery...that people can do it everywhere. We've had sessions scheduled in five different countries so far and . states. It's beautiful. I think of myself as shouting out into the void of the universe: We are here. You are supported! You can come! It doesn't matter where you live, you can find us. 

Dr. Steffens: We know there are so many areas where there is no trained specialist in treating sex addiction or compulsion and certainly no partner specialists; there are many areas in our country and outside of our country where there is nothing. I mentioned that we have an APSATS trained person in Singapore now, soon to be a partner specialist...in Asia--she is the only one. I hope it doesn't stay that way but that we get more and more. Having coaches so that people can have access no matter where they are is absolutely essential.

Dr. Steffens: If they are having some real distressing symptoms, trauma related symptoms, extreme stress, trouble eating and sleeping, feeling depression, it's really important to see a mental health professional so my suggestion usually is to find someone who is trained in treating trauma and/or find someone who is trained in working with relational abuse and betrayal.

Someone who has worked in the area of domestic violence or helping people who are emotionally abused will understand what partners are experiencing. I prefer this than going to someone who understands chemical dependency because they are different...the impact on the family members and spouse are so different.

Anne: I also think an abuse specialist or domestic violence specialist is better than a marriage counselor in this particular counselor.

Dr. Steffens: I would agree, unless that counselor has specialized training in recognizing betrayal trauma and working with the couple. We have a lot of APSATS trained therapists who do really good couples work in this situation because they are aware of the dynamics.