Treating the Family of the Sexual Addict

The effects on children in a household in which one or both parents suffer from an addictive sexual disorder have been overlooked in much of the literature related to sexual addiction. Most children in these households are aware of some part of the sex addict’s acting-out ritual, are often asked to keep secrets for the addicted parent, or have been overtly or covertly victimized in some other way by a parent’s acting-out behaviors and the marital discord that is present. Therefore it is vital to the recovery of the patient and to the healing of the family to include work with the family system as part of the therapeutic process.

In a study of 56 patients diagnosed with an addictive or compulsive sexual disorder who were married with children, 100% cited martial discord as one of the five most powerful stimuli or triggers for wanting to act out. In the same sample, 74% stated that their children had direct knowledge of some part of their acting-out behaviors.

Common Types of Family Interactions

Three types of family interactive patterns are seen most often in families in which addictive and compulsive sexual disorders are a problem.

• Rigid, estranged or disengaged “perfect family”
• Enmeshed and angry family
• Chaotic and unnoticing or separated family

“Perfect Families”
The “perfect family” type is characterized by a high value placed on external “proof” of perfection. The prime directive in this system is to maintain an appearance of social acceptability based in actual or perceived social status and accomplishments. This necessitates rigid role structures, especially gender-bound roles.

Enmeshed Families
In enmeshed families, there are extreme forms of proximity and intensity in family interactions. Communication within these families is frequently based upon indirect patterns. For example, instead of people talking to each other, messages may be relayed from one family member to another, blocking any direct interactions. If a member crosses the family’s boundary and seeks emotional connection with someone outside the family, it is experienced as betrayal; if a member tries to set a boundary within the system, it is seen as rejection.

Chaotic Families
In the third type of family interactive style, the household is chaotic and children’s emotional needs are unnoticed. This family dynamic is marked by the complete absence of consistent structure, rules, or appropriate roles. The family appears to be in a constant state of change or transition and may be marked by multiple residential changes.

Competency-Based Models for Family Healing
(Case & O’Hanlon, 1993; Durrant and Kowalski, 1989; Walter and Peller, 1992)

• The problem is the problem, the person is not the problem
• Problems occur within the context of human interaction and are a part of life
• People experience problems as problems and usually want things to get better
• Every problem-dominated behavior includes exceptions when the problem doesn’t occur
• People are engaged in a constant process of making sense of their experience

A Structure for Doing Family Therapy

Sharing the Family Story
Narrative therapy techniques (White & Epston, 1990), such as having patients tell their story of how the addictive or compulsive sexual behaviors have influenced their life, are useful.

Creating a Context for Change
It is important to recognize that the old way of doing things was an attempt to solve things that were not working in the relationship or life.

Externalizing the Problem
Externalizing the problem takes into consideration what might be stopping things from being different and draws a distinction between unhealthy behavior and being a bad person.

Locating Exceptions
Having established how the family has become driven by their ways of viewing the family, the next stop is to identify the exceptions to their dominant story. The focus is on occasions when the family members are more functional.

Leaving the Old Ideas Behind, Practicing New Ways, and Experimenting
Many times in addiction work we hear: “Fake it until you make it.” It may be useful to change that slightly to “Practicing doing it a different way helps you make it.” If people change their behavior, the change in their attitudes about the behavior and their ability to continue to do the healthier behavior will last.

Other Tips for Working With Young Children and Teens

• Spend time joining with the child as part of the family unit
• Help the family members consider memories of abuse, neglect, or disappointment as experiences in their lives rather than as predictors of how life is always going to be
• Look for little changes
• Build on existing strengths
• Use in-session props to support discussion and metaphor
• Use the “miracle question” described by Steven de Shazer (1988): “Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? How will your husband know without your saying a word to him about it?”

How Much to Tell

Preschool and Early Elementary School Age
Usually preschool children only want to be assured that parents are not going to die or leave them.

Older Elementary School Age
These children are also concerned that the parents will end the marriage or that they have done something wrong; some have been witness to inappropriate behavior.

Middle School/High School Age
The same type of information can be shared with these children. However, depending on the level of sex education the children have received, addicts may also want to give specific information about sex addiction and their behavior as it relates to the family.