How To Be Relational

Marie Woods, LMFT, CSAT
Primary Therapist, Gentle Path at the Meadows When addressing an intimacy disorder such as sex addiction, one of the biggest struggles patients face is the ability to be relational. In fact, addressing these issues is at the very core of our program at Gentle Path at the Meadows. The answer to many of our patient questions in treatment are answered with strategies for being relational. For sex addicts, and many others as well, this concept can seem foreign, so we often use the following key points as a guideline for learning and practicing the art of being relational.

Sharing Thoughts and Feelings Appropriately

First, being relational requires sharing thoughts, feelings, needs, and wants appropriately. For many sex addicts, this is a huge hurdle. Perhaps they learned through various life experiences that their thoughts and feelings weren’t valuable, so they have learned to keep them to themselves, making it difficult for others to get to know them and form relationships with them. Others may have learned that in order for their thoughts and feelings to be heard, they had to be loud or rage, possibly causing people to avoid being in a relationship with them. One of the first steps to practicing healthy relational skills is learning how to share thoughts and feelings in an appropriate way. This includes speaking calmly, respectfully, and from the “I” position.

Letting Go of Resentment

The second step in practicing these skills is letting go of outcome and resentments when we share. It can be easy to assume that once we share our thoughts and feelings, others will listen, understand, or even agree, but this is not always the case. Often the most difficult part of sharing our thoughts and feelings is doing so without an underlying agenda to manipulate or control. It is important to remember that the point in sharing thoughts and feelings is to practice intimacy, being known. When we share, it is important to let go of how the information is received and know that we have done our part.

Negotiation

What often comes next is negotiation. If we have been brave enough to share our thoughts and feelings we may find ourselves in a conversation with others that requires negotiation. Perhaps they disagree or have a different perspective. Sometimes the discussion can simply be left at that, and other times, within a relationship for example, there might need to be a negotiation where both people feel heard and respected in the ongoing relationship. This will likely require several rounds of the first two steps followed by the next step.

Setting Boundaries

Following negotiation is the concept of setting boundaries in regards to what is and is not acceptable in the relationship moving forward. This really helps set the stage for building deeper connection with the other person after having successfully navigated through a difficult moment. Despite how hard this can be, it often helps develop trust and respect between individuals thus a framework for a healthy relationship.

Developing Balanced Relationships

The idea behind this equation is not to over simplify the concept of being relational, but rather to provide a basic framework to embark on this process. The ability to be relational is at the very core of what sex addicts struggle with. The steps above can seem terrifying, and thus sex addicts may resort to other less intimate coping skills that leave them isolated and lonely. The goal of practicing the relational skills mentioned above is to develop a balanced, equal relationship between individuals which is critical for deep rooted ongoing recovery. It is through these relationships versus withdrawal and isolation that sex addicts experience some of the most meaningful insights and healing.

Q&A with Lauren Bierman

Lauren Bierman, LPC, CSAT, recently took on the roll of developing and running Gentle Path at The Meadow’s Intensive Outpatient program for sex addicts. She is a Licensed Professional Counselor and Certified Sex Addiction Therapist who has worked with both individuals and families on issues related to substance abuse, depression, anxiety, personality disorders, intimacy disorders, and sexual addiction. We asked her to share some insights on sex addiction and explain her approach to her work at Gentle Path.

As a therapist, you have experience treating patients with a wide range of addictions and behavioral issues. Why did you eventually decide to focus on sex addiction?

As I started my journey in undergraduate and graduate programs towards becoming a counselor I knew that I wanted to work with addictions; but, I had little exposure to sex addiction at that time. When I started my clinical internship with The Meadows in 2010, I rotated from population to population trying to get a good foundation of how to treat all types of presenting issues. It was not until I did my rotation in the Sex Addiction primary group that I realized that I had a passion for treating individuals who were struggling with intimacy disorders such as Sexual Addiction and Love Addiction.

I quickly learned how rampant this addiction is in the general population and in those who seek treatment for other co-occurring disorders. I have also always had an interest in working with couples and it helped me see how much sex addiction therapy is needed in working within that dynamic.

Working with people struggling with intimacy disorders challenged me to become skilled at confronting overt and covert behaviors, working with personality issues such as narcissism, and helping people tolerate the emotional pain that can lie so deep within coupleship and families.

Over the years, working with great mentors, learning about Dr. Carnes work, and getting trained in the CSAT model just continued to grow my passion for this field and for the community of clinicians who work in it.

You are now in charge of Gentle Path’s new Intensive Outpatient Program. Why did we start this program? What can recovering addicts and their family members expect from it?

Individuals who come from an inpatient treatment center will likely always need some type of transition to help facilitate re-acclimating into the real world. Inpatient treatment is meant to create a safety bubble to help deter triggers and opportunities for acting out. We all know that unfortunately this is not the way the world works once they step off of campus. Maintaining long-term recovery can be especially challenging for sex addicts, due to the accessibility of opportunities to act out in almost any environment.

The Gentle Path Intensive Outpatient Program was built to allow for a smoother transition from treatment to day-to-day life, and to allow people to continue working on accountability and using the relapse prevention tools they learned about in treatment. The program allows them to practice healthy autonomy and to have a safety net of their support group.

Recovering addicts and family members can expect continued structure in their process groups, 12-step meetings, therapeutic activities, and peer support. On top of that, we also offer individual and couple's therapy to help the patient continue to delve deeper into their struggles. We are able to customize their treatment plan based on individual patients’ needs and help them to achieve goals that they want. The Phoenix valley has an abundant recovery community where patients can practice making connections and living in accordance with their recovery plan.

You also played an integral role in founding Gentle Path’s Family Week program. Can you tell us why family involvement is important to a sex addict’s recovery process?

The education that Family Week provides for the family system is extremely important. There is a large amount of misinformation out there about sex addiction and there are many stigmas and labels that come with it. This can keep families stuck in unhealthy shame and isolation.

Working with the partner of the addict and other family members is crucial to long-term success for the recovering addict. Sex addiction is the most "personal" addiction in that it can be so damaging to the partner's self-esteem, view of the world, and trust. And, not only does the spouse or partner suffer, but also many adult children, parents, and siblings of the addict are also negatively impacted; their experience with the addict often has affected their relationships with themselves and others.

I look at treatment through the lens of Family Systems Theory, which says you cannot treat the individual without treating the whole system and vice versa.

For example, when the addict is getting help, growing, and becoming healthier but the spouse who has not been therapeutically supported is still in the pain and anguish of the trauma, it can really hinder the addict’s recovery process and keep the couple stuck in a revolving circle of dysfunction.

By that same token, partners and family members can be light years ahead in their own recovery, but if the addict continues their inappropriate behavior they can stunt the development and healing that the family members have worked so hard to achieve.

Family can also unintentionally impact the addict’s recovery by enabling, rationalizing, or encouraging their dysfunctional behavior if they do not know a healthier way to interact with them. One of the hardest tasks in family week is for families to set healthy boundaries around the addictive behaviors.

Some family members, due to no fault of their own, have no idea how to communicate healthy boundaries or reinforce them long-term. This is such an imperative step in all addiction recovery to create the safety that all relationships need in order to be able to communicate effectively.

What is your hope for the future of sexual addiction treatment?

I have many hopes for the future of sex addiction. But, most important, is that we continue education about the disease and decrease the shame and stigma around it. As a clinician, you can't work day in and day out at an inpatient level of care and not believe that this is a debilitating brain disease that leads to extreme consequences─ for some, even death.

I hope that our therapeutic community will wrap their arms around the issue and continue to advocate for those who are suffering and those who have been impacted. There are so many individuals out there who are too afraid to ask for help in fear of being judged and labeled. Hopefully, in the future they will be able to come out of the shadows and seek treatment.

At one time, alcoholism was seen as a strictly "moral issue", but today it is seen by the medical world as a brain disease. I believe that one day people will also see sex addiction as a much more nuanced and complicated problem.