S1 E7: Dr. Stefanie Carnes on Furthering Her Father’s Legacy

Meadows Senior Fellow Dr. Stefanie Carnes joins host David Condos to reveal how growing up as the daughter of sex addiction treatment pioneer Patrick Carnes inspired her to reach the women who are often left out of the conversation around intimacy issues.

Click here to listen to part two of our conversation with Stefanie Carnes.

Podcast Transcript

Stefanie Carnes: Hi. I’m Dr. Stefanie Carnes. I’m a clinical sexologist and certified sex addiction therapist. I’m the clinical architect for Willow House, our intimacy disorders program for women at The Meadows. I also do a little bit of work with Gentle Path which is our sexual addiction unit. I’m the president of the International Institute for Trauma and Addiction Professionals where we train therapists on how to work with addictions and trauma, and an author of numerous books and speak a lot at conferences and whatnot.

David Condos: Yes, absolutely. Thank you so much for being with us, Stefanie.

Stefanie: Thanks for having me.

David: Let’s launch right into your story, your background, how you got started in this work. I know you have a special kind of unique story because of your father. Just tell us about that journey.

Stefanie: I do. I have obviously a very famous father in the field. Initially, when I got into the field of psychology I thought, “I think I better do something different.” I actually went and I worked in medical family therapy and worked with people with brain injuries and spinal cord injuries. I didn’t really want to work in the area of addiction. He continued to prod at me and tap me on the shoulder and ask me to do research projects with him and come to this training with him. Eventually, I got more and more curious over time. At one point in my life, I was ready for a change.

I got recruited to be the director at a treatment center alongside him. We worked together for six years side by side. it ended up being really fun. Now, I’ve been working in the addiction field for 20 years. It’s incredibly rewarding work. I am so glad I made that turn and started working in addictions with him. Working alongside with him has been an incredible joy of my professional career.

David: That’s cool. I think it’s interesting. When you think about growing up, your father Patrick Carnes is a pioneer in this space, specifically with sex addiction and especially at the time and even now, but especially at the time that was a not popular, exciting thing that people want to talk about. What was that like?

Stefanie: It wasn’t. It’s been very controversial. There were times when he had situations where when he was first trying to talk about sex addiction where he would have– Like I remember one time, he was at a hospital and the whole medical staff walked out on him. He would go on major TV shows like Oprah and Donahue and that type of thing. Donahue came in and said to him- he was in the backroom and he said, “You hear all those people laughing? That’s my staff. They think this is a joke.” He said, “I’m going to come out there and I’m going to help you. We’re going to make sure people understand that this is the real thing.”

There’s so many times when he faced obstacles in trying to get the word out that this is a legitimate disorder. Even at one point in time, he got a death threat. There were times when he was at conferences where things got very combative and he was ridiculed and things like that. As a daughter watching your father go through all of that, it’s an interesting perspective to have. Probably one of the reasons why I initially shied away from him.

David: I would say I would imagine that as a daughter or as a child growing up with that, it’d be like, “Okay, I want to get as far away from this as possible,” but it ended up drawing you in and motivating you to feel that this is important work.

Stefanie: Yes, eventually. Also, I have sex addiction in my family so seeing people get into personal recovery, it’s a very powerful motivator. I actually ended up also having some of my own experiences with sex addiction in my primary relationship. Out of that process, I ended up writing a couple of books for partners of sex addicts. I come to this from both a personal standpoint and a professional standpoint. Part of the reason why I’m so motivated to help people get compassionate treatment is because I’ve lived through some of that. It becomes very meaningful when it’s on a personal level.

David: Yes, absolutely. That sounds like a unique perspective for turning around and helping others.

Stefanie: Yes, it has been.

David: Like you said, you are the architect of the program here at Willow House for The Meadows. What drew you to that role? What drew you to building this program specifically for women?

Stefanie: Well, unfortunately, there’s a lot of misunderstanding about sex, love, and intimacy disorders. Many people think of it as a man’s problem, naturally because most of the publicity around it is men getting in recovery. There hasn’t been a lot of people out there being open and talking about it from women’s perspective. This is absolutely a problem for women and at much higher rates than people ever thought it was.

There was a large-scale epidemiological study that was conducted just this past summer that looked at a nationally representative sample, which is like all different ethnic groups and orientations and socioeconomic status and found that people, about 10% of men and about 7% of women struggle with how to control sexual behavior, which is much higher than the rates that they previously thought. It was previously estimated at 4.5%.

David: Especially to see women and men, the numbers so close.

Stefanie: Right, so close, right. It’s not that far away. What that means is that we’re not talking about it for women and women aren’t getting the resources that they need. There’s only one other treatment program for women with intimacy disorders in the country other than ours. There’s a huge deficit in terms of treatment resources for women. A lot of the books and materials are geared towards men. We need to start having a national conversation about this being also women’s problem and starting to destigmatize it for women so that they feel like they can come forward and get help when they’re struggling.

David: You say there’s only one other program specializing this in the country. With that lack of any resources or any ways to see what other people are doing successfully, how did you go about building a program? Where did you start when you’re really at the front end of this?

Stefanie: Pat developed a treatment protocol that is very successful for sex addiction. It’s called the 30-Task Model. It’s been used for years, very tried and true and very commonly used for men. We have taken some of that and we use it with our women but we do modify the way that we use it to be a little bit different for women. Women respond a little bit differently to the different interventions so we keep things a little bit more interactive. With the 30-Task Model, it’s very regimented and our male addicts really respond well to that.

For example, Pat has assignments for the first 190 days of treatment. There’s very specific things that you do on each day with assignments and journal assignments. It’s very, very structured. What we’ve found is men really respond well to that. They like the structure, they like to check off the boxes and make sure that that’s all, that they’re following the whole protocol.

David: They know what to do.

Stefanie: They know exactly what to do. The women don’t respond quite as well to that. They respond to more experiential work, a lot of more emotional processing. We use the tasks but we use them in a more fluid manner with women. In addition to the task, we use a lot of other different approaches and interventions as part of that. Both programs get extensive trauma work because our clients, unfortunately, come in with very, very high rates of trauma so they get somatic experiencing. We use PS work, post-induction work, EMDR, art therapy, psychodrama, mindfulness.

There’s not a lot of outcome research in sex addiction and intimacy disorders in terms of what’s effective, but all the ones that have been demonstrated to be effective, we’re using.

David: Another thing that you’re involved with in addition to the Willow House is IITAP. That’s the International Institute for Trauma and Addiction Professionals. Tell us about that organization and what’s the mission.

Stefanie: Originally, it’s interesting because it was a certification program that was housed within the Meadows originally. Pat started a certification for therapists that wanted to learn more about treating sex addiction. It got very big and started taking off and eventually, that was moved outside of The Meadows. He started it and then eventually, during his third marriage, his wife became terminally ill and died of cancer. At that point in time, I was ready for a change. I came and started running the organization. I’ve been running that ever since, about 11 years ago or somewhere around there.

David: I know as we’re diving into this part of the conversation, you say there’s the CSATs, but then there’s also other people who don’t have that specific training and may still be called sex therapist. Can you help define that distinction between that?

Stefanie: Sure. That’s also a little bit more complicated than it might sound. We do different programs within IITAP and not all of them are sexology-related. For example, we have like a Certified Multiple Addiction Therapist, we teach people how to work with financial disorders and eating disorders and chemical dependency and that type of thing as well and also programs on treating trauma and whatnot. We do have a sex therapy training but originally, when we designed IITAP, the goal was very narrow and focused in terms of working with people with sex addiction. We used to just recommend that if somebody had a sex therapy problem, that they refer out to a sex therapist.

A sex therapist or a clinical sexologist specialize in things like sexual dysfunctions or medical issues around sexuality, STDs, things like paraphilias and and fetishes. That’s the realm of the typical sexology, those types of issues, just sexual health.

David: Things that are related but not specifically addiction.

Stefanie: Right, not specifically addiction. Our training was initially just addiction-focused and things like sexual dysfunctions or fetishes, we’d say you can refer out to those. Now, we do have a little training in sex therapy but there are other organizations that are in the field of sexual health that focus specifically on sex therapy. For me, I’m a clinical sexologist and a CSAT which is two very different types of training. Then to make it more complicated, you also have sex offender specialists. There’s different specialties within the field of sexual health.

David: A lot of facets.

Stefanie: Yes, a lot of facets, right.

David: I know you’re also involved hands-on in the training, right?

Stefanie: Yes. I teach the family component of the training. I’m a marriage and family therapist and doing family therapy has always been a passion of mine. Of course, I have a heart for partners and kids. Basically, what we go over in that section is the partners’ experience and betrayal, trauma, and how to help partners heal from the pain and the devastation that is caused by sex addiction. I do a lot of training on the disclosure process which is a very sticky part of treatment. Basically, that’s when an addict gets into recovery, they need to get honest with the people in their lives. Partners have a lot of questions about what’s been going on.

We try to share that information with the partners in a way that’s as least traumatic as possible and really attending to their needs, knowing that this is going to be very difficult information for them to digest. I train therapists how to do that, and then I also train on working with kids. What to tell the children, how to approach it from a family perspective and couples therapy.

David: We’ll dive into that even deeper in the next part of this conversation. Just to wrap up this first part, I know you mentioned earlier, there are a lot of misconceptions, misunderstandings in our culture and the general public about this topic about sex addiction. What would be one thing you wish the general public understood better about this?

Stefanie: Unfortunately, there’s a lot of misinformation in the media that goes out to the general public about sex addiction. You’ll see things like sex addiction isn’t real. It’s not a real disorder. It’s not in the DSM. Part of that is there’s been a lot of controversy in terms of getting it into the DSM because of lots of different concerns. People concerned about it being used in court cases to get offenders off the hook or over-pathologizing erotic minorities or pathologizing people’s sexuality in general, which is they’re all very important concerns. It’s been more difficult getting that diagnosis and because of the controversy surrounding some of that.

Now, the World Health Organization, just this past summer, did decide to put it in the ICD-11 which is the International Classification of Diseases, which is the diagnostic manual physicians use. They put compulsive sexual behavior disorder in which has been a huge step forward for us in terms of legitimizing the condition. One of the problems when people say that this isn’t a real disorder, is that the people that are suffering out there feel more stigmatized to feel like they can’t, that they’re weird, or that something must be wrong with them when they’re experiencing something that’s actually very common.

As we talked about the rates earlier, this is much more common than people think but people aren’t talking about it. As a culture, we have to get better at destigmatizing this as an illness, an actual condition that is treatable, because it is treatable and people get better. The message that we keep on hearing in the media is very unfortunate for the general public at large. I would just want to get the message out there that this is a real condition, it is treatable and recovery is possible.

David: Dr. Stefanie Carnes is a Senior Fellow with The Meadows and also serves as the clinical architect for the Willow House in Wickenburg, Arizona. You can find out more about Stefanie’s team and what that program offers at willowhouseforwomen.com.

To check out more episodes of this podcast and find all kinds of other resources and tools for Meadows Behavioral Healthcare, visit beyondtheorypodcast.com. Finally, thank you for listening. I hope you’ll join us again next time for another episode of Beyond Theory.