S1 E8: Dr. Stefanie Carnes on the Impact of Intimacy Issues

Meadows Senior Fellow Dr. Stefanie Carnes joins host David Condos for the conclusion of their two-part conversation. In this episode, she unpacks how intimacy issues develop, how sex addiction hurts partners and families, and how everyone involved can find healing.

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

Podcast Transcript

David Condos: It’s my pleasure to welcome back Dr. Stefanie Carnes. Thank you so much for being with us.

Stefanie Carnes: Thanks for having me.

David: In the last part of the conversation it was great to hear about your story, your journey, but now I’m excited to dive in even deeper to the work you’re doing here at the Willow House at The Meadows. To start that off, specifically, you’re working with women related to sex addiction. What are some of the intimacy issues that you’re seeing people come in with?

Stefanie: Yes, women are really varied in terms of their intimacy-related issues. We have everything from infidelity to actual sex addiction, porn addiction. Today in our culture with virtual and non-relational sex, a lot of sex app use and hookups-

David: As the technology expands, then there’s new issues that you have to learn to deal with.

Stefanie: Yes, especially some of our younger people are really struggling with some of that stuff. But then we also get a lot of sexual trauma and unfortunately, a lot of rape victims and people struggling with their intimate relationships being impacted because of their sexual trauma. We get everything from prostituted women to women that have been trafficked to all sorts of different presentations. The thing that they all have in common is issues around sexuality and intimacy. It’s very nice because it’s a small unit. We only have 10 beds and so it really allows for some bonding around that. Then all of our education is geared around that.

David: I’ve heard that a lot of the women who are in that place, they don’t even like to be affiliated with the term “sex addiction.” That’s something they shy away from. Why is that?

Stefanie: Yes, I think that that’s a term that is commonly associated with males, that males struggle with sex addiction and unfortunately, people don’t recognize that it is something that the women struggle with as well. They identify more with relationship and love addiction. So they don’t readily come in adopting that label typically, but sometimes after that, they get some education and they learn about addiction, then they sometimes later come around and recognize that that is something that they’re struggling with.

David: But are those terms interchangeable or are they actually distinct pieces of the puzzle?

Stefanie: No, they’re distinct pieces of the puzzle. With sex addiction, it’s really more about the sexual behavior itself, acting out actually, orgasm and pursuing intercourse or whatever type of behavior you’re involved in. With love addiction, it really revolves around a compulsive attachment to a person, and it’s oftentimes a person in which you are not getting your needs met. Oftentimes it’s with somebody that’s somewhat avoidant. So it’s a particular relationship pattern that we look at and teach them about along the lines of Pia Mellody’s work.

With relationship addiction, what we see is women that go have multiple relationships at the same time, one after another, always having one on the back burner or serial relationships where it’s about falling in love over and over again, that kind of thing. But unfortunately, what happens in all of these is the core intimacy needs aren’t met. Whether it’s a sex addiction, the love addiction or relationship addiction, there’s still intimacy disorder at the root of that. A lot of our patients do have trauma history and come to the table with struggles with insecure attachment and don’t know how to be intimate with people and don’t know how to get their needs met in a healthy way in relationships.

David: Different people are trying to fill that same void with all these different ways.

Stefanie: Different ways, right. Then for some it’s chemicals, for some it’s shopping, for some it’s food, for some it’s sex. They’re all self-medicating.

David: You mentioned like the trauma part of this, could you describe the role that that plays? I imagine that’s like a common piece of it.

Stefanie: Yes, let me start with a caveat. For most sex and love addicts, there is a trauma history there. When you’re experiencing trauma and abuse, many of them have complex trauma, which is trauma that occurred in the context of a relationship like caregivers that were either physically, emotionally, sexually abusive, neglectful. They learned how to have relationships with people that were un-nurturing and unsafe and not getting their needs met. So for many of our clients, they internalize a lot of shame around that, that there’s must be something wrong with me. They internalize the message that I have to do this all on my own, I can’t rely on other people. I won’t get my needs met in relationships and secure attachment results from all of that.

We see clients with trauma struggling in their relationships. It’s one of the primary ways that trauma ends up manifesting as an adult. It’s unfortunate, but when you start to do the trauma work, there’s a lot of research that shows you can change your attachment style with work so that’s one of the things that we try to teach them.

David: Yes, that’s the hope part of this is that even if that’s your past, that there is hope there, it’s possible.

Stefanie: Yes, the other thing, just to back up a little bit, I said it with caveat. We are seeing younger people come in that don’t have as much trauma history and don’t have insecure attachment, but are getting online and having early exposure to graphic content online and struggling with porn addiction and apps and things like that that don’t have that trauma history. They just had very early exposure, this limitless novelty at a very young age. So some people from very nurturing backgrounds getting into trouble just because of the intensity of what is online and what’s available.

David: Yes, but I mentioned getting exposed to such at a young age is traumatic.

Stefanie: Right, that’s an argument many people make. It’s that seeing hardcore pornography at six, seven, eight years old, which is very common, unfortunately, that that is a traumatic event.

David: Another one of your focus points in this discussion is working with the couples. You’ve mentioned that, and I know you’ve even written books on the subject and the term that I’ve heard you use related to this is betrayal trauma. Could you start to unpack that for us?

Stefanie: Yes, sure. A lot of the partners, when sex addiction comes out and they start to learn about what’s going on, they’re devastated. Oftentimes they didn’t know what was going on. Many of them have symptoms of post-traumatic stress disorder, hypervigilant and have intrusive thinking about what’s everything that’s going on. They’re very triggered and anxious about the addiction and fearful for their safety. It’s very emotional for them and many of them struggle with just functioning. So one of the things that we really try to train the addicts is how to help their loved ones heal from this trauma and that there’s a lot to work on there.

David: Yes, because they’re dealing with their own trauma and then they’re having to deal with this as well with their partner.

Stefanie: Absolutely, with the traumatized partner. From a couple’s perspective, the addicts have to get honest about everything that’s been happening with their partners, which again, is more traumatic and difficult. It takes a long time to heal from all of that. A lot of people don’t realize, but usually, the healing process for couples can be anywhere from like two to five years. When you’ve had a breach and infidelity, a sexual betrayal, that really is devastating for the attachment on-

David: It takes time to build up that trust.

Stefanie: Yes, it takes a lot of time to build up that trust. So we try and help the addicts use strategies to start rebuilding trust, like being reliable, being open and honest, being trustworthy, showing up, following their treatment plans, being open about that. Being sensitive to their partner’s fears and responsive and provide reassurance. Be open about their recovery and things that they’re working on, transparency with everything and after the addict takes accountability and starts moving forward in that way, partners still have a mess of feelings about all of this and they’re hurt. So they need the opportunity to respond and share with addicts how this has been painful for them.

That’s what my new book is going to be about is that process of helping the couple work through that. It’s a process for them and it’s again, another message that doesn’t get out there very often is that couples do heal from this, couples get better from this and there is treatment that’s effective for sex addiction and betrayal trauma.

David: Yes. This doesn’t have to be the end of the line.

Stefanie: Right. Couples basically have to realize that the old relationship is not going to ever be what it was. It’s not going to ever be the same, but they’re going to develop a new relationship in recovery and recovering addicts can make great partners. They’re learning how to be intimate, they’re learning how to be open and share on a deeper level and be better partners, but this all takes time.

David: Yes, and another piece of this is actually involving the partner in the treatment process. That’s something that’s a goal right, is to get them involved. When they’ve been so hurt and betrayed, how do you go about convincing them to be a part of the treatment process?

Stefanie: Again, it’s one of the reasons why it’s so helpful to treat intimacy disorders separate from chemical dependency because the partners’ experiences are very different. What they’re wrestling with is very different than what a partner of an alcoholic is wrestling with, right. It’s a very intensive process for them.

David: I guess, what are some ways that you’ve seen that are effective in helping the partners heal? Like what are some of their breakthrough points when they’re getting involved with that?

Stefanie: One of the things that we do is an impact letter and it’s part of the reason is that it’s really important for the addict to really understand how this has impacted their partner. That in order for there to be some healing going forward, the addict has to get it and really understand that-

David: Have to come face to face with that.

Stefanie: Come face to face with that. The partners need to feel heard. It’s a wake-up call sometimes and it also gives them the opportunity to respond to their partner and let them know I do understand. Family week is the beginning of a healing journey, so they need to continue in couples therapy when they go home. You can only do so much in five days and that’s how treatment is too. We talk to- the addicts get a lot of work done in the 45 days that they’re here but it’s the beginning of their journey. The people that are successful in long-term recovery are the people that stay in long-term recovery.

David: When you’re looking at the Willow House, for example, these women, some of them are going to be moms and so you have kids involved. I imagine this is obviously very hard on the partners but it can be very hard on the kids as well. How do you see that impact children when their mom is going through this and then how do you help them understand what’s going on?

Stefanie: It really varies on a case by case basis because you have situations where the kids know nothing, they don’t know what’s going on, they have no information and they’re-

David: In the dark?

Stefanie: In the dark around everything. Then you have other situations where they know everything and they know too much.

David: Yes, more than their age.

Stefanie: More than they should. You sometimes have situations where children are going to be told information that is really not age-appropriate for them because they have to. Like let’s say there’s some public embarrassment or dad’s going to be on the six o’clock news. There’s situations sometimes where the children get a lot of information that they really don’t need to have or they need to have.

David: That in a perfect world, they shouldn’t have to deal with that.

Stefanie: In a perfect world, they shouldn’t have to. Right, exactly, and that is traumatic for them. We talk about betrayal trauma for the partners but we also have, we call it sex addiction induced trauma for the children. That can be really traumatic and kids can have all sorts of reactions to their parents’ addiction. Confusing feelings like, “Am I going to be a sex addict too? Can I be around that person? Is it safe for me to be around that person?” To anger at the parents’ loyalty, feeling like they need to protect the parents, feeling like they need to take care of everything.

David: So it’s a wide variety of reactions.

Stefanie: A huge variety of reactions, and unfortunately, there’s not a lot of support that’s been created for children. There’s very few books and resources for kids, there’s very few groups for kids. So getting them some therapy, some family therapy can be one way that they can get some healing around it.

David: How do you involve them at the Willow House? How do you involve the kids?

Stefanie: It depends. We tend to not involve younger children. If we have mature, older adolescents that we’ve deemed that it’s appropriate, then they can be involved. But at family week, with the kind of stories and things that get shared, it’s not appropriate for most children at family week. But we do recommend that they get ongoing family therapy on an ongoing basis. Now, we do get, as I mentioned, sometimes we’ll take older adolescents or adult children and we get adult children to come all the time to family week and they can also get some healing around what’s been going on by education and learning and different processes in family therapy.

David: This sounds like there’s a lot of pain. It’s a difficult thing to do but obviously, you’re passionate about it. This is your life calling so there is hope there. What’s your favorite part about getting to do this work?

Stefanie: It’s wonderful. It’s wonderful to see people get better. Like we had a patient not that long ago, who got her kids removed from the home. That was obviously a very trying experience for her. She’s been out for a year and she just got her kids back. So it’s wonderful to see those successes and to see people heal and get better and they do and it’s awesome.

David: To wrap up, what would be one resource, one book related to this that you would recommend somebody if they want to dive in further?

Stefanie: One of the books that we use as a core piece of the curriculum for our ladies at Willow House is called The Betrayal Bondby Pat.

David: That’s your father, Patrick Carnes, for everyone who might not know.

Stefanie: Yes. He has a lot of incredible books, he’s an amazing writer. But this one is really fantastic for women with intimacy disorders because it basically looks at all the ways that trauma impacts your life that you might not be aware, and how it plays into your relationships and how it may be contributing to you being in unhealthy and exploitive relationships without you really understanding some of what’s behind that. I’m a little biased. It is my dad, right? But it’s fantastic. I would recommend that book.

David: Sounds like a good place to start. Finally, what would be a piece of advice that you would like to leave listeners with? Something that’s meant a lot to you or something that you’ve seen have a meaningful impact to other people’s lives?

Stefanie: Yes, I think I would just tell people that if anybody’s out there that is listening, so many times I’ve heard stories of people that just decide to struggle in silence around this and the message that I’ve been trying to get out to people is that, “This is more common than you think and there’s more help for you than you probably imagined and success is possible.” So I would just leave them with that idea that you can put your life back together, you can restore your relationships and get back on the path.

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