Traditionally, men with a history of problematic sexual behaviors would be treated within the scope of the Sexual Addiction Model. Subsequently, partners of sexual addicts would be treated with the Co-Sex Addiction Model, which is similar to Co-Dependency. But is this the most appropriate and helpful model to use in these situations? What about when abuse is involved and the partner is a trauma survivor?

This is a controversial topic lately, as many professionals have opinions all on sides of this issue. Dr. Omar Minwalla, a clinical sexologist and founder of The Institute for Sexual Health, explains, ” I decided to create a support group for partners and in working with partners directly I started to notice a lot of trauma symptoms. So, I started to do research on partner symptoms, through qualitative research and gathering written narratives. I was really overwhelmed by the descriptions in my research, which consistently appeared to describe symptoms of trauma and I noticed that many of the symptoms appeared similar to rape trauma syndrome and symptoms of sexual trauma. I started to consider that maybe partners were actually trauma survivors rather than codependents, and I presented this idea at a national sex addiction conference for professionals.”

The Sex Addiction Model Does Not Address Abuse

Dr. Minwalla describes the impacts of that initial presentation among the field of sex addiction professionals, “There was a strong show of support and a lot of emotional resonance from women and some of the female therapists or some of the younger professionals, and then definitely from partners themselves who would come up to me after I talked and really share how much they felt validated.”

But he goes to say, “At the same time, there was also a strong push back and rejection of my work by many male therapists and sex addicts themselves and those professionals that maybe had been using a co-sex addiction model for many years. This reaction, this controversy, and just the intensity of all the different reactions really peaked my interest and kind of pulled me in more and made me more curious as to what this was all about and why was it so controversial.”

What Are The Problems With Co-Sex Addiction Models?

So what are the problems with the traditional sex addiction models? Dr. Minwalla clarifies these points:

  • “The first major problem is that it’s actually a form of diagnostic mislabeling. It’s taking someone who’s been abused and has trauma symptoms and mischaracterizing it as codependency and as a disease called co-sex addiction. Remember: lying outright or by omission, deflecting and diverting, finding fault with the relationship or the partner, anger, intimidation, or threats are all cover-up behaviors utilized to maintain a secret sexual life and abusive to partners.”
  • “The second major problem with that besides just a diagnostic mislabeling is that it actually blames a victim of abuse which ends up being harmful.”

A more accurate and scientific understanding is that partners and spouses are actually victims of lies, deception, and psychological manipulation which does constitute a form of emotional and psychological abuse and that their reactions are actually symptoms of trauma rather than codependency or co-sex addiction. from a trauma perspective someone who does really understand abuse, any abused person will attempt to try and stop the abuse and will attempt to try and protect themselves. So, to view the attempt to control the abuser or to protect against harm as being a problem, particularly to characterize that as a disease, is a real mischaracterization of just basic human instincts and norms.

Trauma Symptoms Are Not The Same As Co-Dependency

Anne, founder of Betrayal Trauma Recovery, explains her experience with the some within the professional community, “I’m getting a lot of push back for saying that pornography use and infidelity are abusive to wives. Many people can agree that partners experienced trauma. Naturally the implication is, If you can agree that they experienced trauma then why is it so hard for you to wrap your head around the fact that they’re a victim of abuse?”

Minwalla expounds, “Through my work it became more and more clear to me, and I became more confident that the idea of viewing the partner or spouse of the sex addict as someone whose experienced trauma was right on and that the idea of codependency was at least inadequate if not really missing the mark. So, I continued to do workshops and then I actually decided to practice using a trauma model.”

This led to Minwalla founding the Institute for Sexual Health in 2009, where he continued to use a trauma model applied in practice. He shares the results he began to observe, “That work implementing the trauma model really seemed to resonate with partners. It also seemed to really help couples and it seemed to be much more effective than the codependency model.”

Co-Dependency Is Victim Blaming

He goes on to state, “This led to a real confidence in that view and I started challenging the traditional model and articulating how just simply using the idea of codependency was actually a form of victim blaming and was often re-injuring partners and confusing them and re-traumatizing them, and that it was clinically contraindicated. There were a lot of problems with not seeing trauma and taking someone who has been abused and has trauma symptoms and then only viewing them as a codependent, which often really doesn’t fit at all.”

Still, trends do seem be starting to become more apparent within the professional community. Specifically, Minwall states, “In the sex addiction field where people are actually recognizing trauma and there are therapists that have moved away from the co-sex addiction model and do use the trauma model for partners.”

Minwalla adds, “I see a serious problem when people who have suffered abuse and are experiencing trauma are told that they actually have a progressive illness and are convinced that it is their illness that is causing their symptoms, rather than the abuse that is causing their symptoms.”

Here at Betrayal Trauma Recovery, we encourage every woman to find peace and safety. Consider joining Betrayal Trauma Recovery Group, which is a great way to find hope and healing. We have multiple sessions per day in multiple time zones. We would love to see you there and help support you. Also, Individual Sessions are available with any one of our amazing coaches, which can also be so helpful in moving forward past trauma.


Full Transcript:

Anne: Welcome to Betrayal Trauma Recovery, this is Anne.

All of you were so excited about the podcast that we did with Dr. Omar Minwalla that I wanted to invite him back as soon as possible to talk more about how pornography addiction and women in relationships with men who use pornography or men who act out with prostitutes, and other compulsive sexual ways is abuse. We were so happy to have him on. If you didn’t hear that, I really encourage you to go back and listen to that podcast.

Dr. Minwalla is a licensed psychologist and clinical sexologist and he offers highly specialized psychological services. I really encourage you to go to his website which is theinsituteforsexualhealth.com to learn more about him and his services.

But, today we’re going to be talking about the codependency model and 12-step. Should women who have been traumatized by their husband’s sexual compulsive behaviors be in 12-step. So, we’re going to start with that.

Why Co-Sex Addiction Models Are Harmful

Dr. Minwalla:  First of all, let’s take a step back and look at the term codependency because the co-sex addiction model really comes from the codependency model, which is typically used in 12-step addiction programs.

According to Melody Beattie, who actually wrote a book called Codependent No More- How to Stop Controlling Others and Start Caring for Yourself (she wrote that around 1987), she writes that the word codependency probably developed in the chemical dependency scene in Minnesota (probably around the late 1970’s). It was originally a term used to describe some of the symptoms that people would have who were closely related or in a relationship with someone with a chemical dependency problem.

The basic idea was that codependence were people whose lies had become unmanageable as a result of living in a committed relationship with, for example, an alcoholic. Wives of alcoholics back then actually developed a 12-step program for themselves to help with this that they called Al-Anon. Melody Beattie herself admits that it’s a challenging term to define exactly. She writes in her book that codependency has a fuzzy definition because it’s a grey fuzzy condition.It’s a challenging term. I think a lot of people have different definitions. It’s also become a popularized term in our culture so people just kind of use it in various ways. It’s kind of confusing for everybody.

According to her, her definition is: A codependent person is one who has let another person’s behavior affect him or her and who is obsessed with controlling that person’s behavior. Codependency is defined as a process addiction. An addiction to certain mood-altering behaviors such as a tendency to behave in an overly passive or excessively caretaking ways that negatively impact one’s relationship and quality of life. A lot of people argue that codependency is a disease and describe it as a chronic progressive illness, and that codependents want and need sick people to be happy in an unhealthy way.

The Co-Dependency Model Is Not Appropriate For Abuse

Then what happened is the concept and idea of sex addiction emerged in the 1980’s. The sex addiction field and sex addiction professionals actually applied the concept of codependency to people in relationships with sex addicts and called this co-sex addiction. So, from this view, a partner’s symptoms, reactions, and behaviors are seen as part of her own disease called co-sex addiction. For example, Stefanie Carnes has a definition of co-sex addiction in her book Mending a Shattered Heart, which was published around 2008. There she describes a co-sex addict as someone who is married to or in a significant relationship with a sex addict and demonstrates a common set of behavioral characteristics. These characteristics include denial, preoccupation, enabling, rescuing, taking excessive responsibility, emotional turmoil, efforts to control, compromise of self, anger, and sexual issues. Then she goes on to write: Like sex addiction, co-sex addiction can range in severity. Some individuals will find they experience a few of these characteristics and for others they may demonstrate the vast majority of them and may also find they cause severe disruption in their life.

So, to summarize: the co-sex addiction model really suggests that the intimate partner or spouse of a sex addict has her own disease. Her disease is diagnosed by her attempts to control or affect the sex addiction. So, control becomes like a huge diagnostic criteria, and the co-sex addict also has these other codependent characteristics. Then treatment for her involves teaching and helping her to stop her attempts to control or affect the sex addiction and to recognize these attempts as part of her illness. Her attempts to control or affect the sex addiction actually become acting out behaviors or slips, and recovery is focused on helping her develop a spiritual relationship with a higher power and managing any of these attempts to control or affect the sex addict or the sex addiction.

Within the traditional sex addiction model, the idea is that there is a sex addict and a co-sex addict, they both have an addiction, they both require a 12-step program, they have both contributed to the problem, and often a partner has traditionally been assumed to have co-sex addictions simply by being in a relationship with a sex addict. If she does not accept this, it’s actually seen as being in denial.  

Traditional Sex Addiction Models Do Not Consider Abuse

So, that’s kind of a description of the traditional model and approach, and even today there are still treatment centers and practitioners that endorse this view of the partner. There has been some evolution and some movement away from that in the last probably 10 years, but I still find that a lot of partners describe and talk about experiencing this kind of approach and model and it’s still fairly out there, you know.

Anne: Yeah. The two most common 12-step programs are COSA (Co-sex addict) and ES-Anon, which is the victim program, or in this case what they would describe as enabler program for a companion to SAA which is sexaholics anonymous for people who aren’t familiar with that.

You just describing that is like WHOA! The question I’m going to ask you seems pretty obvious, like anyone would come to challenging this, but how did you come to challenging the co-sex addiction model and advocating for the trauma model to understand and treat wives of sex addicts?

Dr. Minwalla:  I’m trained as a clinical sexologist which means that I actually specialize in human sexuality and treating sexual disorders. At the University of Minnesota Medical School, I was actually trained with the compulsive sexual behavior model and my training actually didn’t believe or endorse in sex addiction at all, which is very different from many treatment professionals in the sex addiction field who often come from an addiction background. Maybe having experience in chemical dependency first or have their own personal or professional background with recovery including 12-step programming etc.

Betrayal Is Abuse Not Addiction

So, as a sexologist I came to the work from a bit of a different angle. More from a sexual health background versus an addiction background. However, early in my career I ended up taking a position as the clinical director of a sex addiction clinic, which utilized a very traditional sex addiction model so even though that wasn’t my background or even my training as a sexologist, I actually found myself really immersed and learning a lot about the Carnes Model and the sex addiction model and people in recovery using 12-steps to support their treatment.

When I was at that clinic the dominant model was co-sex addiction for viewing the partner or codependency and there weren’t any real services at the clinic that I was working at. So, I decided to create a support group for partners and in working with partners directly I started to notice a lot of trauma symptoms. So, I started to do research on partner symptoms and specifically as a sexologist I was interested in how their sexuality was impacted. I began doing qualitative research and gathering written narratives. I was really overwhelmed by the descriptions in my research, which consistently appeared to describe symptoms of trauma and I noticed that many of the symptoms appeared similar to rape trauma syndrome and symptoms of sexual trauma.

I started to consider that maybe partners were actually trauma survivors rather than codependents, and I presented this idea at a national sex addiction conference for professionals. The response was very interesting because there was a strong show of support and a lot of emotional resonance from women and some of the female therapists or some of the younger professionals, and then definitely from partners themselves who would come up to me after I talked and really share how much they felt validated and some of them were very emotional.

Co-Sex Addiction Can Enable Further Abuse

At the same time there was also a strong push back and rejection of my work by many male therapists and sex addicts themselves and those professionals that maybe had been using a co-sex addiction model for many years. This reaction, this controversy, and just the intensity of all the different reactions really peaked my interest and kind of pulled me in more and made me more curious as to what this was all about and why was it so controversial.

Probably a year later one of the therapists, a psychologist named Silvia Jason, who was at the conference invited me to conduct a workshop with partners and present my research. So, we actually started doing workshops for partners and really presenting the idea of trauma.

Through my work it became more and more clear to me and I became more confident that the idea of viewing the partner or spouse of the sex addict as someone whose experienced trauma was right on and that the idea of codependency was at least inadequate if not really missing the mark. So, I continued to do workshops and then I actually decided to practice using a trauma model. So, I founded the Institute for Sexual Health in 2009, and continued to use a trauma model and apply that and actually see what the results were. I found that that work really seemed to resonate with partners. It also seemed to really help couples and it seemed to be much more effective than the codependency model.

Co-Dependent Treatment Is Not Safe For Partners

That led to a real confidence in that view and I started challenging the traditional model and articulating how just simply using the idea of codependency was actually a form of victim blaming and was often reinjuring partners and confusing them and retraumatizing them, and that it was clinically contraindicated. There were a lot of problems with not seeing trauma and taking someone who has been abused and has trauma symptoms and then only viewing them as a codependent, which often really doesn’t fit and often doesn’t really even make sense to me.

Anne: Yeah, I’m getting a lot of push back for saying that pornography use and infidelity are abusive to wives, like a lot of pushback. For some reason now everybody is like: yeah, they experienced trauma, right. And I’m like okay, well if you can agree that they experienced trauma then why is it so hard for you to wrap your head around the fact that they’re a victim of abuse?

We talked about this on our last podcast. What caused the trauma? Well abuse caused the trauma and they’re a victim of abuse, and that’s why they’re having this trauma. It seems pretty logical so it’s very interesting to me that there is still so much pushback against it.

Abuse Causes Trauma And This Must Be Treated First

Dr. Minwalla:  Yeah, like we talked in the last podcast, I think people are still very uncomfortable with the term abuse, even professionals. I think we’re much more comfortable with physical abuse, but when it comes to psychological and emotional abuse we are undereducated, don’t really see it clearly.

Specifically, in the sex addiction field where people are actually recognizing trauma and there are therapists that have moved away from the co-sex addiction model and do use the trauma model for partners. I think still there is a tendency to view the trauma as coming from finding out about the secret sexual life, which definitely does cause a lot of PTSD.

Discovery, disclosure will often cause huge amount of trauma symptoms. I think some professionals are focused more on that injury and that event and that experience as causing trauma. I don’t know if we’ve really expanded beyond that and really recognized that all the patterns of lying and deception and blaming and gaslighting also cause trauma symptoms. I think that’s where the field needs to go and over time I think that will be more clearly understood. Even among trauma professionals in the sex addiction field the focus right now tends to be on discovery and disclosure as being traumatic and kind of a very simple, reductionistic view at this point.

Trauma Goes Beyond Disclosure With Sexual Betrayal

Anne: Yeah, totally.

Let’s outline the problems with the codependency model or the co-sex addiction model.

Dr. Minwalla:  The first major problem is that it’s actually a form of diagnostic mislabeling. It’s taking someone who’s been abused and has trauma symptoms and mischaracterizing it as codependency and as a disease called co-sex addiction.

The second major problem with that besides just a diagnostic mislabeling is that it actually blames a victim of abuse which ends up being harmful. The sex addiction field, like I said, borrowed from Al-Anon the concept of codependency and has misinterpreted the reactions and symptoms that partners present with as signs of codependency or characteristics of codependency.

Emotional And Psychological Abuse Leads To Trauma

A more accurate and scientific understanding is that partners and spouses are actually victims of lies, deception, and psychological manipulation which does constitute a form of emotional and psychological abuse and that their reactions are actually symptoms of trauma rather than codependency or co-sex addiction.

Anne: The main label of control that codependency labels them with, like: you’ve got a control issue, you need to stop trying to control him. What else would someone who is being abused be trying to do besides stop being abused, right. Can you talk about that for a minute?

Dr. Minwalla:  Yeah, so I think that’s really important because from a trauma perspective someone who does really understand abuse, any abused person will attempt to try and stop the abuse and will attempt to try and protect themselves. So, to view the attempt to control the abuser or to protect against harm as being a problem, particularly to characterize that as a disease, is a real mischaracterization of just basic human instincts and norms.

Trauma Survivors May Exhibit Preoccupation

So, I find that particularly problematic because it really makes common sense to me that if you’re being abused you’re going to become preoccupied with that. You’re going to try to protect yourself. You’re going to be hypervigilant about the abuser and any potential forms of reinjury or being violated again or harmed again. That’s all kind of typical in terms of symptoms of people who are being abused. The idea that any attempt to try and control or influence or protect yourself being a disease or a problem just doesn’t make since.

So, maybe we can talk a little bit about some of the so-called characteristics or symptoms of co-sex addiction and then I can maybe give you my take on how they’re actually better understood as trauma symptoms or symptoms of someone who’s being abused.  For example, one of the symptoms of supposedly co-sex addiction is preoccupation. Preoccupation is actually a normal reaction to abuse. Abused people will become preoccupied with the abuse and the abuser. This is often understood as hypervigilance and it’s actually a form of self-protection.

For example, if someone started to steal from your online bank account and you noticed a lot of money being taken, it would be normal to begin to be preoccupied with your bank account and you might end up checking it may times a day. You might also be thinking about it more often then you normally would, and all of that would be considered hypervigilance and a reaction to the violation of having money being stolen from you. So, preoccupation is really normal when there is abuse happening or there is a potential for reinjury or a threat, and reexperiencing trauma is a well-established symptom of PTSD and hypervigilance is a really well-established symptom of trauma as well.

Betrayal, Lies, And Deception Are Abuse

Another example is enabling. There is a lot of assumptions that partners of sex addicts are somehow enablers and maybe that’s something that came directly from Al-Anon and partners or wives of people are using drugs or alcohol, but for sex addiction it’s mostly something that’s been deceptively compartmentalized and hidden. Most partners had no idea that there was a secret sexual reality and their partners have manipulated, lied, hidden it, covered up, and really kept that compartmentalized. The idea that a partner would enable her husband to go see prostitutes or have affairs just doesn’t really fit at all with my clinical experience and what partners actually present with. It just doesn’t seem like it’s really based in reality.

Anne: I think another fundamental issue here is that women want to save their families. They don’t want to break their families up. They’re trying to do everything they can to have their family and their home be a safe place for them and their children. So, their behaviors wouldn’t necessarily be enabling of him, they would be an effort to keep their marriage or family or home safe.

Dr. Minwalla:  One of the symptoms of co-sex addiction is emotional turmoil. I think that’s a classic symptom of abuse and trauma. I mean, we all know that emotional dysregulation is a symptom of trauma and this may include anger, depression, grief, intense fear or anxiety. These are all normal emotional reactions to the types of violations that partners experience. So, a spouse whose husband has been cheating on her for years, and for example may not have used protection and then had sex with her and maybe even gave her a sexual transmitted disease, would definitely present with emotional turmoil including all different kinds of emotions and reactions. So, to label her emotional reactions as a disease and as a sign of her being codependent or mentally abnormal somehow is, I think, highly problematic and really defies basic common sense.

Co-Dependency Models Are Frequently Thought Of As Undisputed

Anne: Yeah. One woman, I think her husband went in and then the clergy called her in. She was very numb, and she was calm, and she didn’t scream or yell or anything like that, and he said: wow, you are reacting so well to this. So many women overreact or so many women don’t do “the right thing”. So, she was kind of feeling proud of herself, like: oh, I dealt with this the right way. I was strong, and I was logical.

I just thought this whole thing is so crazy right now. She is getting praise for facing her abuser in a logical, calm way and she is sort of being held accountable for how she reacts to it. There is some type of expectation for how the victim should react. This is crazy to me.

Dr. Minwalla:  Really any reaction is often seen as somehow pathological with the codependent model. I think you’re right, and even that I would say every victim of trauma or abuse is going to react differently. That might even include being frozen or suppressing the trauma for a while and going into a highly administrative mode out of survival. To interrupt her reactions as somehow better than the next partner or even to suggest that she’s somehow reacting in an appropriate way versus an inappropriate way. It could be that she is really traumatized and is actually frozen or in a highly traumatized state and is functioning just administratively and suppressing a lot of deeper reactions.

Co-Dependency Models Can Hurt An Abused Partner

Anne: Yeah, I was going to say I’m not saying that the way she reacted was wrong. But just to get praise for reacting “the appropriate way” and then telling her all these other women don’t act appropriately is just one example of how society in general doesn’t understand abuse nor do they understand what a woman goes through. A better thing for him to say would have been: I can see that this is how you’re reacting, and you can react any way that you choose. Victims react in a variety of ways and I just want you to know that I am here for you and that I support you.

That would have been a better response rather than put her above other victims who get angry. The other thing is, that sort of implies to her if you do hit that phase of anger or if you do hit that phase of uncontrollable crying that that’s inappropriate. It implies to her that this numb, sort of administrative way of functioning is the right way and if at some point in your healing process that you have any other type of emotion that that’s going to be a bad thing.

Dr. Minwalla:  If we even go back to Melody Beattie’s definition, I mean she’s actually saying a codependent person is one who has let another person’s behavior affect him or her. Just the idea that you have any reaction and that you allow someone to affect you is seen as a problem.

Anne: Which is crazy. Otherwise, abuse would be fine, right. It’s fine if you abuse someone because if they get hurt then it’s their problem.

Dr. Minwalla:  Yes, this is just not normal.

Traditional Sex Addiction Models Are Problematic

Anne: One of the things that our community really wanted to know was your thoughts on COSA, which is a 12-step program for partners of sex addicts or your thoughts on ES-Anon, but before I ask you what you’re thoughts are I need to be transparent, and say that I myself have attended a 12-step meeting with SA Lifeline that I absolutely love. It has really helped me with my relationship with God. I want to get that out there first and say: for me, it has been the number 1 way for me to reconnect with God in a way that I was missing before. I’m not necessarily anit-12step per say, as I work the 12-steps my relationship with God improves, but I definitely am anti-victim blaming.

Dr. Minwalla:  First, I appreciate you sharing that, and then what I would say is: when traumatized people can be supported by others who share and can resonate with their pain, it can often be helpful and healing. So, I absolutely recognize the value of group support for abused and traumatized persons. A lot of my work with partners has been in a group context and so I’ve seen the power of being able to be with other people who are experiencing the same type of wounding and to be able to kind of hold your experience and your pain, which I think can be very powerful.

Co-Sex Addiction Tends To Blame The Partner

I do want to start by saying that, and I also want to say that I appreciate that COSA and ES-Anon have at the very least attempted to support and have provided a space that’s intended to help people who are impacted or in a relationship with a sex addict or have been impacted by sex addiction somehow. I appreciate the human factors that exist in those spaces and I definitely honor any help and the help that has come to those who have been suffering. I never want to discount or negate the human support and any positive experiences that people have had.

That said, I feel that both COSA and ES-Anon have the same problems as the co-sex addiction model, which it basically is a program for co-sex addiction model. So, I believe that that paradigm itself and the ideas that are sometimes promoted by COSA and ES-Anon are still forms of diagnostic mislabeling and victim blaming and that they can reinjure and retraumatize partners and spouses.

It Is Harmful To Place Blame On An Abuse Victim

If you go to the ES-Anon website, it says as ES-Anon members we are seeking recovery from our own progressive illness. If you go to the COSA website, it also says we attempt to control, loosing regard for our own well-being in the process. Whether we choose to call it sexual codependency or co-sex addiction, our problem is a serious and progressive disease as harmful to us as sexual addiction is to the sex addict.

So, I see a serious problem when people who have suffered abuse and are experiencing trauma are told that they actually have a progressive illness and are convinced that it is their illness that is causing their symptoms, rather than the abuse that is causing their symptoms.

Anne: Yeah, I couldn’t agree more. So, even though I really do enjoy and have found great benefit from my SA Lifeline meeting, there have been times where women say they’re “staying on their side of the street” while also describing the abusive behaviors that they are subjected to, and thinking that if they just work on their side of street that somehow magically something eventually will stop the abuse. It doesn’t seem very logical actually (chuckling), and I’m thinking: you’ve got to get off the street. You need to get to safety. You can’t just say to yourself: well, I know that he’s abusive and these behaviors are hurting me, but I’m going to choose to not let them hurt me, but I’m not going to remove myself from them.

Co-Dependency Is Not Helpful For Trauma Survivors

Dr. Minwalla:  Yeah, I mean that goes back to what we were just talking about. That somehow the goal is to not be affected by abuse. I think that emancipating yourself from abuse is healthy and actually having reactions and responding is really normal and human. To pathologize any reaction and to somehow make the goal to not have reactions just doesn’t make sense at all. So, that’s really one of the key problems with these programs is that, if I was a partner I would feel very confused and very disoriented by all of that. Which is unfortunate because a lot of partners are so vulnerable and they’re so desperate for help so that when they go to institutions such as a 12-step recovery program or a treatment program, they’re very susceptible and vulnerable to being indoctrinated into some of these ideas.

Anne: Yeah.

For me, if people ask me: well, you go to a 12-step group sometimes, you know, how do you feel about it? My answer is: if I work the steps with the only intention of becoming closer to God or my higher power, not as I have some illness or not that I had some part to play in his addiction or whatever. If I work it like that, I feel very comfortable and I get a lot of benefit out of it. But, I have actually gone through my book, my 12-step manual, and crossed out parts (chuckling) and written what I feel is the right thing and written different words where I feel like: wait a minute, with step 4 you’re trying to find your character defects, right. For me I was like: okay, I know there are some things that are keeping me from my relationship with God, rather than saying: okay, I know there’s some things that are enabling my abuser, and as I have switched it to that I’ve found great benefit from it. But I do see women in 12-step just basically spinning their wheels because it’s in relationship to their abuser or as a way to stop the abuse, or something like that, rather than as their own personal journey of just: I would like to improve my relationship with God or I would like to be more clear on who I am, or something like that.

Abuse Is Never The Fault Of Anyone But The Abuser

I don’t know if that makes sense to you? I actually want to know your true opinion, so if you differ then please say it right now on the air. If you think no victim should never go to a 12-step. Do you think that? Or are you thinking if they use it appropriately it could be helpful?

Dr. Minwalla:  Well, I definitely wouldn’t say no victim of abuse or trauma should go, because like I said, there’s a lot of human factors by just being around people who are supportive and have gone through the same experience. So, that alone can really help people and I know there is partners that have been helped by that. There are partners who have the wherewithal and are able to kind of weed through some of the parts that don’t make sense to them or pushback on certain ideas to find what’s useful in the program and then leave the rest behind kind of thing.

Trauma Survivors May Seem Control Oriented

You know, I don’t think it’s a black and white issue. I also think sometimes there are partners who even just in terms of being so hypervigilant and having some ideas of focusing on yourself and trying to find comfort there instead of simply looking to the addict for reassurance all the time. Some of those types of ideas even though they can be problematic, and there’s still symptoms of trauma like hypervigilance and things like that. Maybe there can even be some relief just by some of the concepts there, but again it’s sad that victims of abuse and trauma have to do all of this gymnastics, or sorting out of the program, and that’s it’s just not a clean place for them to get support without having to navigate so carefully in potentially dangerous territory.

Anne: Maybe I should write my own 12-step manual for women who are victims that want to get closer to God, but you will not be blamed in any way for any of the (laughing), obviously right. I don’t know, but I have just found that it was so helpful to me and I’m grateful for some of the concepts I learned and not all of them, right, like I said I did sort of did rewrite my own book. Also, I think it also depends on the group. Like, the group that I had was very what I would call progressive and liberated, so we all just like: we don’t like this line, so we all crossed that out together, you know things like that. So, I think that was probably helpful but other people are finding it to be extremely traumatizing, so I think it’s just good to have a discussion about that. Especially when women just need support sometimes in any way they can find it, they’re so desperate for it.

Problems With Co-Sex Addiction Models Are Vast

Dr. Minwalla:  I know that some of those programs like the COSA, if you go to their website they have a list of bottom line behaviors, which I guess are kind of like acting out behaviors or they describe bottom line behaviors or things that the co-sex addict does to medicate uncomfortable feelings, and then on their list they have things like: sometimes feeling crazy and having a hard time separating the truth from lies when talking to the sex addict. I just step back and look that and think: well, the problem is that they’re being lied to and gaslighted and manipulated and of course the natural outcome of that is that a person might feel confused and have a hard time separating the truth. So, to have that so clearly listed as a bottom line behavior and a problem that the victim has, just seems really confusing to me. Like, I don’t even get how that’s logical.

Anne: Those concepts to me just make me kind of gag. That’s not cool. That’s never cool. It’s just another form of victim blaming. I hope I don’t sound like I’m hedging, like: I have found use in 12-step, but I also think it’s really really bad at the same time. I’m saying both of things at the same time.

Dr. Minwalla:  Well, I appreciate it because I think that’s true. I think, like I said, I think there’s probably redeeming and helpful things going on there and just to even have a space that’s supposed to be providing support for victims seems helpful, and I think I’ve heard from a lot of partners that there are helpful aspects to it. So, I do think it’s confusing and there is a duality to it, you know, so your experience makes sense to me.

Anne: Yeah. Okay, so lets talk about going beyond the sex addiction model. What are some of your other concerns in terms of the treatment of partners by the psychological field in general?

Sexual Addiction Models Do Not Address Abuse

Dr. Minwalla:  Alright, you know we have talked a lot about specifically the sex addiction field and the co-sex addiction model, but just breaking out of that for a second and just looking at the psychological and treatment field at large. One problem that’s pretty common is there’s often a view of the partner or spouse that’s in a relationship with a sex addict or where there’s sexual acting out, there’s often a view that it takes two to tango type of mentality. While it always makes sense that two people in a relationship obviously participate in it and create the dynamic that exists. It does not mean that a partner or spouse in any way invited or contributed to the decisions of the other person. Particularly when those choices to create a secret sexual life are managed with ongoing deception and a lack of integrity and a violation of human rights. The behaviors that keep that secret sexual life intact include: patterns of lying or psychological manipulation, gaslighting, deflection, withdrawal, coverups, hiding, and blaming. All of those behaviors, it does not take two people to engage in that behavior. It only takes one person to choose to engage in that behavior.

You know, a lot of therapists, when they’re presented with a relationship where there is acting out, just assume well there must be something wrong with the relationship. There must be something about the relationship that caused the acting out. I think this is an implissed way of still blaming the victim and blaming the relationship rather than solidly having the person who is sexually acting out, lying, gaslighting and all of that, really own their behaviors as theirs and that that was their decision. So, that lack of clarity still exits a lot in couple’s therapy, and in just outside of the sex addiction field that assumption is still made. I often tell people that I have a lot of clients who’ve been sexually acting out for years and have been in many relationships where they have always cheated and have always sexually acted out. That problem is really theirs, and if you have someone whose been cheating their whole life and any relationship they’ve been in they’ve been doing that, that’s just kind of illustrates how the problem really isn’t the relationship or the partner, it’s actually a problem that they have.

Trauma Involves Symptoms That Can Mimic Co-Dependency

Anne: Uh huh. My community is all women who either suspect or know about their husband’s porn use or their husband’s infidelity. I’m very very concerned with women who don’t know about the infidelity and they don’t know about the porn use and their like: oh, somethings wrong in our marriage, lets go to couple’s therapy. So, they show up in couple therapy, the therapist nor the wife know about the porn use, it’s not disclosed, it’s not a part of the discussion. Then it’s like forever a couple’s problem or a communication problem and they would never be able to get to the bottom of it. They would never in that scenario, identify the relationship is an abusive relationship.

At this point in the podcast we had some technical difficulties and we had to end the interview. So, I want to thank Dr. Minwalla for coming on, and let you know that he and I are planning on another podcast to discuss that scenario that I just talked about where a wife decides: hey, we need to go couple therapy because things aren’t right and she’s not aware of the lies, the gaslighting, and the manipulation.

Abuse From Betrayal Is Traumatizing

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