As a Certified Sex Addiction Therapist and a board member of the Association of Partners of Sex Addicts Trauma Specialists (APSATS), I am personally and professionally offended and outraged by Dr. Ley's article denying the legitimacy of the traumatic impact on the partner or spouse of sex addicts. APSATS was founded in large part to advocate for the men and women whose lives and psyche are significantly impacted by the compulsive sexual behavior and betrayal of their partner or spouse. These individuals often present with identical symptoms of trauma experienced by rape or assault victims, survivors of natural disasters or war veterans. Contrary to Dr. Ley's remarks, this is not simply an opinion cultivated by a group of clinicians, but rather the reported and perceived experience of the partners themselves.
In his article, Dr. Ley poses the opinion that "the idea of trauma has now been extended out to seemingly cover any unpleasant experience one might encounter." He states that betrayed spouses "don’t have PTSD, they’re not showing signs of trauma, they’re just legitimately worried, sad and depressed over the course their life and relationship has taken." Every day I work with women whose lives are shattered by the discovery of their partner's sexual behavior and betrayal. To thoughtlessly imply that this is a "seemingly unpleasant experience" when these women specifically state that they feel traumatized is unprofessional and lacks the compassion and empathy that is the cornerstone of the work we do as therapists.
Dr. Lay refers in his article to the partners he has seen in his practice . This leaves me confused, as it seems unlikely that any woman who identifies as a partner of a sex addict would seek therapy from someone who is a publicly self professed disbeliever of sex addiction. It just doesn't make sense. I can only deduce that he is talking about women who have perhaps experienced infidelity. Clearly, he has not seen a partner or spouse of a sex addict who, without question, presents with the symptoms he himself lists in the article as being absent in partners. Those of us who treat partners regularly in our practices consistently see those very symptoms, making a diagnosis of PTSD clinically appropriate and substantiated. It is for this reason that we are all as passionate about our work as we are and why we have come together to form this organization.
Dr Ley asserts that "Labeling as trauma the experiences of these partners of alleged sex addicts is clinically and diagnostically ludicrous. Worse, it’s offensive and diminishing to the experiences of people who have experienced true trauma, watched people die or had their bodies forcibly violated." I am nothing less than shocked and horrified by this notion of trauma comparison, minimizing one's trauma by comparing it to another's. As a clinician, I believe that what is clinically and diagnostically ludicrous is to invalidate a client's trauma or compare it to someone else who has experienced a traumatic event. It invites the notion that trauma can be quantified and that perhaps a list could be created of legitimate trauma so that clinicians can invalidate the traumatic experiences of others. I can't think of anything more offensive to anyone who has experienced any kind of trauma. It is our job as mental health professionals to offer compassion to our clients. If they report symptoms of PTSD, it is not our job to tell them that their symptoms are not valid because their trauma doesn't qualify.
While Dr. Ley denies the existence of any research that might substantiate the use of the trauma as it relates to partners of sex addicts, he fails to provide any research to substantiate his own claims. He states "I’d like to see that research and data. I’d like to see structured diagnostic interviews that demonstrate this, and compare these results to a normative population. That would be good research, good science, and good, evidence-based practice." Had he taken the time to actually look for the research instead of making the assumption that it didn't exist, he would have found it. He also could have reached out to any of the members of APSATS to ask questions or inquire about empirical data. Had he done so, he would have learned that 69.9 % of subjects in one study met all symptomatic criteria for PTSD using two assessments- the IES-R and the PDS (Steffens,2005; Steffens & Rennie, 2006, Steffens & Means, 2009). In the PDS, subjects were asked to answer the questions in response to the discovery of the sexual addiction/behaviors of their husbands. The majority experienced severe effects in functioning across all areas of their lives.
So, let me address the specific issue of his article, which is Dr. Ley's assertion that partners of sex addicts are not traumatized and do not meet DSM criteria for PTSD. He writes "...it takes a long-running cluster of symptoms that interfere in a person’s life, and includes flashbacks, hypervigilance, changes in perspectives on life, extreme physiological reactivity, avoidance of stimuli and situations, and increased physiological arousal. Do betrayed partners have these symptoms? I doubt it." This is what is most mind boggling to me - that all of the above mentioned symptoms that he claims SHOULD BE PRESENT to warrant a PTSD diagnosis but are not ARE ALL PRESENT in partners of sex addicts. Every single one.
I shared Dr. Ley's article with one of my client's, a woman in her thirties whose husband has been in recovery from sex addiction for several years. Like the other parters who posted their reactions to his article online, my client was understandably horrified. In an email to me she wrote "The first thing that caught my attention was the bolded remark, 'Here’s a central, critical point about PTSD that APSATS missed, through ignorance or overzealousness - the experiences which create PTSD are traumatic experiences in which there was an actual risk to life and physical integrity.' When I discovered my husband's sex addiction, much like a rape victim, I immediately had to make an appointment with my physician to be tested for STD's. Most women choose to be tested again 6 months later because of the risk of HIV which may not show up for several months. My husband, somebody I chose to trust, exposed me to an actual risk to life and physical integrity. In fact, I now carry HPV and am at higher risk for cervical cancer -- a likely result of his sex addiction. If I die of cervical cancer, will that then qualify as trauma? Perhaps, Dr. Ley should be more clear."
Another client of mine learned, during the formal disclosure of her partner's sexual acting out history, that he had unprotected anal and vaginal sex over forty times in the course of their twenty-plus year relationship. Currently, that client is recovering from a radical hysterectomy (removal of the cervix, uterus and some lymph nodes) after being diagnosed with the highest risk strain of HPV which resulted in the early stages of cervical cancer. Luckily for her, the pathology came back clear, otherwise she would have needed radiation therapy. I feel extremely confident saying that this client meets all diagnostic criteria for PTSD. Dr. Ley, please explain why this is mind boggling to you. These clients are two of countless partners who have been exposed to life threatening diseases which begs the question to Dr. Ley, what is it about this that doesn't meet your criterial for "an actual risk to life and physical integrity?" I am sincerely baffled and can't understand how a highly educated and trained professional could even postulate such an ignorant and incorrect statement.
This leads me to another point that Dr. Ley makes in his article: "Research in the 1970’s found clear parallels between the experiences of soldiers and rape victims, showing that when a person undergoes a traumatic event, it can profoundly change their cognitive and psychological functioning." The former of the two clients I referenced above had this to say in response. "Finding out that somebody I chose to trust, chose to marry in fact, put me at actual risk to life and physical integrity absolutely impacted my cognitive and psychological functioning. These changes affected my relationships, my jobs, and every aspect of my life and well-being. I suffered from depression and had to seek psychiatric intervention. I had difficulty trusting anybody, even people I love and care about. I realized that my job was not sufficient to provide for my well-being and that of my young daughter and actually chose to make a major career change as a result. I lost unhealthy amounts of weight and found it difficult to take proper care of myself. I was fortunate enough to get treatment and I have been able to make positive changes as a result but to deny that this trauma impacted my cognitive or psychological functioning would be absurd."
Essentially, Dr. Ley wrote an article based only on his own opinions. All of what he posits in his article denies and invalidates the traumatic experiences of partners of sex addicts, who have already experienced this very type of denial by their addicted spouse prior to entering therapy. That kind of denial of one's reality is referred to gaslighting in the sex addiction field and is a term used to describe the actions employed by a sex addict when trying to protect his secret sexual behavior and double life. In effect, it's a way to manipulate and deny another's reality in an attempt to achieve one's own agenda. Dr. Ley, you may not believe in sex addiction, but the article you wrote clearly meant to deny the traumatic experience of the partners of sex addicts and is ironically reflective of the manipulative behavior consistently employed by sex addicts. Interesting coincidence.
~Marnie E. Breecker, MFT, CSAT
*Please use the following resources for more information about treating partners of sex addicts from a trauma perspective:
www.marniebreecker.com
http://www.partnertraumaspecialists.org
http://nationalpsychologist.com/index.php?s=minwalla.
To read Dr. Ley's article, please visit http://www.psychologytoday.
