Category: Blog Entries

In this blog post, we are continuing our discussion of the different types of sex addiction treatment. So far, we have discussed Inpatient Rehabilitation and Intensive Outpatient (IOP) as different levels of care for sex addiction. (To read these posts check out Part 1 and Part 2). Now, in Part 3, we will cover outpatient therapy.

This is the least stringent level of care for sex addiction. This is a more typical format of therapy where an individual attends therapy sessions approximately once a week, and are also part of an ongoing therapy support group. For sex addiction, a structured, task centered approach is often used to guide the individual and/or group therapy process.

Additionally, individuals are encouraged to engage in several 12-step meetings per week that specifically pertain to sex addiction. Active participation in 12-step programming looks like regular attendance at meetings, having a sponsor, working on step assignments, and supporting other members of the 12-step community.

Appropriate candidates for outpatient therapy include a variety of individuals. It often includes individuals whose sexual behaviors are problematic and causing emotional distress, but are not significantly impairing their daily life functioning. Outpatient therapy is also appropriate for individuals who have completed either an inpatient or intensive outpatient level of care. Ideally, individuals engaged in outpatient therapy are able to maintain personal safety and some level of sobriety during their ongoing therapy process.

A person appropriate for outpatient therapy should be in a place where they are willing and able to take strong ownership over their recovery process. This means that they are intrinsically motivated to attend therapy and incorporate recovery into their every day life. Outside of these scheduled appointments and meetings, individuals pursuing outpatient therapy are often working on recovery assignments and reading recovery material on their own.

In early stages of outpatient therapy, a person may attend individual therapy weekly, and then less frequently (say biweekly or monthly) over time. Sometimes, they may transition into couples or family therapy after being engaged in their individual therapy process for awhile. It is ideal for individuals to stay engaged in an outpatient group therapy process throughout, as it is the most effective format for treating sex addiction. It also provides individuals with supportive relationships and accountability that is critical for sustained sobriety

In this blog post, we continue our series on the different levels of care for sex addiction. In Part 1, we discussed the highest level of care for sex addiction – Inpatient Rehabilitation. Next, we will discuss the level of care that is a step down from inpatient/residential, and is referred to as Intensive Outpatient (IOP) therapy.

Intensive Outpatient (IOP) therapy comes in a couple of different formats. Many inpatient treatment programs are familiar with formalized IOP programs, and may make a recommendation for an individual to transition into that level of care following the completion of inpatient treatment. A formal IOP program includes daily group therapy and weekly individual therapy. When individuals are not in therapy, they are often required to volunteer or work part time while rigorously attending 12 step meetings. Additionally, they may be required to live in sober living housing affiliated with the IOP program. Sober living houses are places where everyone there is committed to working a recovery program, and they generally have guidelines for being able to reside in the house such as staying sober, attending 12 step meetings, and being in by a certain time in the evenings. Sober houses provide an opportunity for an individual to continue to be supported in their sobriety, but with less supervision than in an inpatient setting.

 

Options for formal IOP programs for sex addiction are limited, therefore, many outpatient treatment centers have developed a model that is a bit less formal, but still provides the level of support that an IOP program would. In this setting, a person might be involved in more than one individual therapy appointment per week, and multiple support groups (a combination of group therapy and 12 step). They may also be pursuing some sort of trauma therapy, such as EMDR, and have regular appointments with a psychiatrist to manage any medication regiment. In this case, rather than living in a sober living house, the individual may reside in their home local to the outpatient center.

 

The main difference between Intensive Outpatient (IOP) and Inpatient Rehabilitation is that the individuals do not reside at the treatment center, so they do not have 24-hour therapeutic and medical care. They typically reside in their own living space, and may even maintain part or full time employment. Because many recovering addicts struggle with transition, the IOP option can provide a nice transition for integrating recovery into daily living.

Appropriate candidates for IOP may include the following:

• Individuals who have completed inpatient treatment and need more time to transition back into their daily life.
• Individuals who are struggling to maintain sobriety in their        outpatient level of care, and need some additional structure    and support.
• Someone experiencing chronic relapse in their recovery.

The examples listed above are simply suggestions. It is always best to speak to your current provider, or schedule an assessment with a Certified Sex Addiction Therapist (CSAT) to determine what course is best for you.

People often ask the question about whether or not sex addiction really exists. Along with that, they also often ask what sex addiction rehab looks like, and how long it takes to recover. Because many people are familiar with rehab for chemical addictions such as alcohol and drugs, they often do not understand what that would look like for a process addiction, like sex addiction. So, this is the first of a four-part blog series written to clarify what sex addiction treatment looks like. The series will discuss the different levels of care available to those that struggle with sex addiction, what each level entails, how to know if it’s a good fit, and additional considerations.

 

We will begin by talking about the highest level of care for sex addiction. This is inpatient/residential treatment. When people say that they went to “sex addiction rehab”, they are generally referring to an inpatient or residential treatment program.

For starters, this usually means that they were admitted to a behavioral healthcare unit. These programs vary in length anywhere from 30 to 90 days. Individuals admitted to these programs live at the program residence during this time, so lodging and meals are provided as part of this type of treatment. Additionally, visitors and contact with the outside world is often limited for the duration of their treatment. This is due to the rigorous nature of the program where individuals are involved in therapy programming anywhere from 8-10 hours per day. During the course of their treatment, they usually receive a full medical and psychiatric work up, individual therapy, group therapy, and perhaps other alternative therapies like acupuncture, Tai Chi, Yoga, Equine therapy, or other recreational therapies.

This level of care is a good fit for individuals who are experiencing difficulty functioning in their daily life as a result of their sex addiction. For example, if an individual is experiencing ongoing suicidal ideation, then they are likely served best in an inpatient facility.

If you scrolled past this post and thought, “oh, we really don’t have that problem in our area”, then this post is for you. Recently, local news featured a story exposing the significant drug problem, particularly related to the deadly drug Heroin, in some very affluent areas in metro Atlanta. As is often the case with these types of news specials and documentaries, the special was eye opening and left many viewers wondering what they could do to help. This blog post features a few suggestions as to what you, yes you, can do to promote change as it relates to addiction and other mental health issues in your community.

1.            Acknowledge that there is a problem, even in your neighborhood. Addiction is not a disease that just affects certain people. The research and evidence consistently shows that individuals from a number of socioeconomic backgrounds are impacted by addiction. By acknowledging that there is a problem that exists and avoiding judgment among your own circles of friends, families, and coworkers you can promote change.

2.            Support mental health care -There are a number of ways to support mental health care, but one of the number one ways to do this is by normalizing the process. Many individuals avoid getting the help they need because of the stigma around mental health care. If you have ever walked into a therapist’s office yourself, then you can probably relate. Since many young adults are the ones struggling with addiction, you can imagine how difficult this can be. Make it part of your everyday conversation to speak positively towards mental health. Mental health care is just as important as any other aspect of health care. In many cases, it could be preventative care for addiction. When this process is normalized as part of good self care it allows for more people to get the help that they need.

3.            Ask for help – Just about all of us can benefit from mental health care at some point in our lives. It is just good self care, and has a major impact on many physical ailments as well. When you have received your own mental health care, then it is easier to have empathy for others about what it is like to go through that process. In the case of addiction, families often look for help for the addict first. This is often difficult as sometimes the addict is not ready for help yet. Either way, it is absolutely vital for the parents and/or partners of those struggling with addiction to get the help and support they deserve. Living with someone who is in active addiction is extremely taxing. It can often tear a family apart due to the significant emotional distress felt by all. Family therapy is just as vital as support for the addict, and it may very well encourage the addict to get some help of their own when they see their friends and family members doing so.

You would be hard pressed to find someone who addiction has not touched their life in some way, shape, or form. The way that we promote social change is by being part of the change rather than standing back and waiting for someone else to do it. This means taking an introspective look into how you can be a change agent. Addiction is a manifestation of a systemic issue on multiple levels. Each one of us is part of multiple systems (e.g. family, community, school, church, government, etc…). If we work towards changing our selves for the better, then it ultimately impacts the systems we are a part of. When a number of people do this, the change is evident!

 

Probably one of the most common things I hear people say in regards to addiction is, “I just don’t understand why they do it.” This is typically coming from the family member or friend who cannot seem to wrap their head around why someone would continue to engage in such harmful and self-destructive behavior.  From a non-addict perspective, asking this question makes a lot of sense. The answer, however, is multi-layered and multi-faceted. There is rarely one thing that answers the question as to why individuals continue to engage in addictive behavior.

In fact, we find that in working with those struggling with addiction there are often a combination of factors that lead them to try coping with their problems or emotions with addictive substances or processes. In order to help answer the question of “Why do they do it??”, here are a couple of common reasons why people engage in addictive behavior.

 

    Trauma/Intense Emotions = Temporary Relief– Most individuals engaging in addictive behaviors know that the behavior is destructive, however, they continue because of the short term temporary relief that they experience when they are using. Often whatever they are experiencing (either internally or externally) is so overwhelming that the short period of relief feels more worth it than the destruction it may cause. For example, if an individual is a victim of sexual abuse and becomes overwhelmed with pain every time they think of the abuse, so much so that it may even physically hurt, then they may look for anything that will give them some relief – even if it’s just short term. Of course, this thinking process is distorted, but when someone is actively engaged in their addiction, the rational thinking part of their brain (the prefrontal cortex) is not operating at its fullest. Instead, the emotional part of their brain (the limbic system) is firing and saying, “I just want to feel better now”, so the drugs or acting out behavior provide that short term relief.

 

     Lack of other coping skills – Another common reason why individuals continue to engage in their addiction is because they may not have developed more sophisticated ways of dealing with difficult life experiences or intense emotions. This is especially true for the adolescent who started using at an early age, and has perhaps always learned to turn to a substance or process  (e.g. video games, technology) when they feel uncomfortable. This is true for many adults as well. It comes from what was modeled for them in their life about how to deal with overwhelm. Many individuals struggling with addiction have said to me in session, “I don’t’ know what else to do”. This may sound like an excuse, and sometimes it can be, but from a brain science standpoint it makes perfect sense. In the moment of overwhelm (e.g. extreme anxiety or fear), they resort to what their brain is most familiar with (even if they have learned other things). For example, someone may know that they are supposed to breath, journal, and meditate when they are feeling overwhelmed, but in the moment that their emotional (limbic) brain is firing, the only thing that they can think to do is use or act out – because that is what is most familiar. All in all, if someone has learned to respond (cope) by engaging in addictive processes, then it takes time for new paths (such as breathing, meditating, etc…) to become their default. This is why you may see addicts engaging in the same negative behaviors over and over again despite the fact that they “know better”.  Although our brain patterns can change, it takes time.

 

Individuals impacted by the addiction of a friend or family member are always searching for an answer. It’s human nature to question why and want to have an answer to explain such seemingly irrational behavior. The truth is, however, that many individuals struggling with addiction engage in this irrational behavior because they lack their own self worth. Their feelings of worthlessness often leave them not caring whether they continue to hurt themselves, and thus others around them, as well. It’s often not until they get sober that they can begin to understand the why themselves. Perhaps the best thing that friends and family can do to help the addict get closer to the understanding of why is remind them of how worthy they are, and let them know that they deserve a better life. 

 

 

In the fast moving world of digital technology, parents are frantically searching for the latest information and how to keep their children safe online. Trying to keep up with all the latest trends can feel like a maze, and leave parents feeling dizzy.  In their dizziness, they may tend to go to extreme measures trying to do away with technology or lack concrete boundaries – just hoping for the best. While the tendency to resort to either of these options is tempting, we have compiled a list of our most commonly asked questions to help parents find a moderate answer to the challenges of technology with their teen or pre-teen. We hope these questions and answers help guide parents towards designing limits for technology that are appropriate for their unique families.

How do I protect my children when they are outside the home (e.g. someone else’s house)?

•       Let your kids know the expectations up front and remind them when they leave home. •       Inform the other parents of your wishes and ask for their support •       Have a rule that devices do not go to other families’ homes •       Be prepared to follow through with consequences if the rules are not followed.

 How do I set boundaries with my kids that aren’t punitive?

•       There is no perfect answer to this question because kids are often very resistant to boundaries. •       Know that kids will most often be resistant to boundaries, but despite this actually operate better with them in place. •       Know your rationale behind the boundary, and explain this to the kids (but also don’t feel like you have to). •       Remind yourself that your brain is more developed than theirs, and you do know what is best for them. The decision making part of their brain (the prefrontal cortex) is not developed yet. Parents are there to help with that.

What do I do when my kid is angry and resentful regarding the technology rules?

•       Validate their feelings:      “I understand that you’re angry that we have these rules, because it seems like everyone else is allowed to do _______.” •       Use current events and news as teaching opportunities for why the family rules/guidelines are in place •       Get support from other parents – because it can be hard to reinforce what you know is right when they’re upset.

 How do I address with them what is appropriate for adults regarding technology and what is appropriate for kids?

•       The best rule of thumb is modeling. Kids learn more from what they see you do than from what you say. •       Remember, though, that the adult brain is more developed and better able to make decisions regarding technology. •       Mirror to them that part of growing up and becoming an adult is being allowed more privileges – and also more responsibility.

What’s the best way to approach my kids when talking about technology?

•       Use every day experiences – on TV, movies, and radio as teaching opportunities •       Make it a conversation versus a lecture. For example, ask them what they think, and if appropriate, allow them to have input. •       Find every opportunity you can to praise them for the ways in which they behave responsibly with technology. •       Keep asking questions even when they act like they don’t care or don’t want to talk. Hint: Open-ended questions help foster more dialogue.

 What do I do if I find inappropriate content on my child’s device(s)?

•       First of all, gather yourself and avoid “freaking out” •       Tell your child that you have found it. Model a trustworthy relationship where people are honest with each other even when it is difficult. •       This is where having set a precedence that you are always monitoring their activity becomes helpful because, then they do not feel as though you have gone behind their back. •       Explain why this is inappropriate (even if you think they know – repetition is important for their developing brain) •       Delete the content •       Determine if there are other controls that need to be in place to prevent this in the future. •       Notify other parents if their children are involved. •       Commonly asked questions

Where do I go for support?

•       Depending on the nature of the content, you may need to contact the police (e.g. online predator, adult/minor, etc…) •       If inappropriate behavior continues (2 or more times), then you may consider seeking a therapist to have your child evaluated.   Note: The staff at Relatoinship Recovery Center are well versed in their ability to address this with children and the entire family. •       Online resources – Oddly enough their are a lot of online resources provided for free for parents and teachers to help navigate through these kinds of things.

What is normal in regards to technology use?

•       This is a difficult question to answer because it is ever changing and different for every child.    Here’s what some of the statistics are saying: •       Huffington Post reported that the average teens sends 3,417 texts per month (approx. 7/hour) •       It’s estimated that children ages 8 to 18 spend an average of seven hours a day behind screens. Whether you determine this is acceptable for your family or not is up to you, but it does

 What is not normal (i.e. things to be concerned about)?

•       Your child is not eating or sleeping due to excessive use of technology •       Your child is consistently irritable when they are away from technology •       Your child is not socially engaged in face to face relationships and activities.

How do I set boundaries with my kids about technology?

General Principles to Keep in Mind: •       If possible, set the boundaries in advance – rather than in the heat of the moment •       Maintain the boundary (i.e. if it is not respected, then there are consequences) •       Repeat, Repeat, Repeat – You will need to re-state the boundary over and over again, especially for teenagers. They need repetition. •       Be prepared for them to resist the boundary and not like the boundary. Know that this reaction is normal.

How do I create space for an ongoing dialogue about technology in your home?

•       In the digital age, having face-to-face conversations becomes more critical than it ever was. •       Keep in mind that it is all about connecting and building trust. Even if your kids don’t act like it, they want to connect with you. You are still the primary person they look to for answers. •       Ask meaningful questions, and keep asking. When your teenager knows that you are genuinely interested, they will open up. •       Keep current – Know that technology isn’t going anywhere, so being informed is your best bet. Also, use current events as a way to foster conversation.

When we talk about intimacy most people think about sex, but that’s only one part of intimacy. Couples who say they want to know each other better are also seeking intimacy. True intimacy is achieved when you are able to see and be seen by another. I’ve often heard it said that the phrase “into me you see” is a great way to remember the concept of intimacy. In my work as both a couples and sex addiction therapist, I have helped many couples improve their connection and move into deeper intimacy.  Many couples report wanting to feel closer; this is true for couples who are just starting out, and event those who have been in a relationship for a long time.  They want to know each other’s dreams and desires  – all of which is part of intimacy. By using a technique that helps couples focus on identifying and communicating their emotions, I guide them in becoming more in tune with each other. When couples feel as though they are seen and heard in a relationship, then they are more likely to share their hopes, dreams, and desires. Couples that are early in their relationship can often save themselves some heartache. And after years together, many couples develop a new depth of knowledge of each other. If you love your partner dearly, but often wish you were closer, then couples therapy focused on intimacy building could be the next step to take to get you there. Wouldn’t it be nice to share the desires of your heart with your life partner?

After attending a host of holiday gatherings over the past few months, I started reflecting on a pattern I noticed of a lack of attention that being paid towards young children at some of these events. What I noticed was not that children were being overtly neglected, but that there seemed to be some odd expectation that they would behave like little adults while the actual adults got on with more important and mature matters.

This observation inspired my thinking process, and thus this blog post, about reasonable expectations for children.  The old saying that “children should be seen and not heard” is long since a thing of the past, and we have plenty of research to show that quite the opposite is true in terms of promoting their healthy development.

• Children are meant to play. In this process, they are meant to explore, make messes, and be spontaneous. This means that they will jump from one thing to the next without thinking, and yes, without cleaning up. This process is critical to their development. Their brains are not developed enough to complete one task at a time, clean it up, and then neatly move on to another one. (Let’s be honest, some adults can’t even do this).

• Children are meant to be dependent. This means that they need you as their parent, or the involved adult in their life, to be available. They are dependent on you to not only provide their basic needs, but also to be their secure attachment when they are scared or hurting. They are also dependent on you to set reasonable expectations and boundaries for their age and development. Yes, they are needy, and they are supposed to be. Ignoring them in a moment of need could leave a very significant imprint on their brains about how important their needs are.

• Children need kid-friendly events. It is my personal belief that an event that hosts children (such as a family holiday gathering) should be prepared to cater to children. This is because children’s brains are not developed enough to allow them to sit calmly and quietly and engage in small talk (i.e. adult behaviors). Yes, these skills can be learned over time, but small children will still need to be provided with adult supervised engaging activities. When done appropriately to children’s needs – this is a big undertaking. It doesn’t look like just providing them something to occupy them, but also being present for it, watching them, and listening to them.

As I write this, I reflect on the immense energy it takes to carry out responsible care for children. Being the parent, relative, or other such adult in a child’s life is a huge undertaking. It is important for us to remember that they are precious, developing humans – not just little adults. It is our job to stop what we are doing and attend to them when they need it, even if it’s just gentle re-direction. Their brains are pretty new to this world, and super impressionable.

It is important that we take extra care in the way that we interact with them because the things we do and say will often be imprinted in their brains for a lifetime. So, the next time you’re at a backyard barbecue where you wish the kids would just “settle down”, take a deep breath and remember that they are children. They are just doing what they are innately designed to do.   

A common complaint among parents these days is that their kids spend too much time on technology. In fact, it’s the reason why many families call our office. Parents often notice that their child seems disengaged and less interested in other social activities, and thus prefers the tablet or video games. After arguing with their child (and sometimes even their spouse) for days and months on end, they often seek therapy out of frustration. Here are a couple of strategies we offer to help families strike a balance with technology use and family time.

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1.     Avoid discounting technology all together. Taking extreme measures like banning all technology does not help teach balance. Of course there are sometimes when restricting privileges is appropriate, but those should be on a case-by-case basis.

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2.      Recognize that kids may experience connection through technology, and instead of always complaining about it, use it as a chance to connect by expressing interest in their world.

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3.      Model appropriate use of technology. If you expect them not to use their phone at the dinner table, then it is a good idea for you not to use yours either. Kids will repeat more of what they see you do than what they hear you say.

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4.     Set clear boundaries around the use of technology ahead of time if possible. Before your child gets on the device, for example, let them know how long they have, and what is/is not okay. It is important to follow through with this as well.

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            The bottom line is that if adults are going to complain about the over use of technology in today’s youth, then WE need to be prepared to engage them. I’ve always thought that the interesting thing about the technology debate is that adults are typically the ones that put children in front of a television or tablet in the first place. Now, we want to unplug the TV, and take the tablet away, and we expect them to occupy themselves. It sends a very mixed message to them. Children do not innately know a variety of ways to occupy themselves. It is our job as adults to show them.

Don’t get me wrong, I think that a balance between technology and face-to-face social engagement is a wonderful thing. I think it creates well-rounded children who become well-rounded adults. We should be prepared, however, for what that really means. It means that we as adults have to put down our technology at times too; it means we have to stop attending to work emails, to cleaning the house, and all the other things that make life constantly busy. It means to stop doing all of those things in an effort to connect and engage in the lives of our children. To show them the other fun and entertaining things around them. Perhaps you play a new board game with them, spend some time outside together, or chat with them over a snack, to name a few things.

Just remember, the next time you want your kid to take a break from the latest technology gadget – be prepared to step in and do your part to engage them.

Marie Woods, LMFT, CSAT

 

“Wisdom is nothing more than healed pain.”

– Robert Gary Lee

The Ashley Madison data breach has caused quite the stir in our offices.  For marriages impacted by sex addiction and compulsivity, it’s a trigger which sparks pain and trauma to those already in treatment with us.  For others it is an initial awakening to the world of relationships impacted by the Internet. 

Ashley Madison is a website created by Canadian Internet Entrepreneur, and now former CEO, Noel Biderman.  The sole purpose was to create a “dating site” for married individuals to find partners to have extramarital sex or affairs.  The company’s by-line is “Life’s Short, Have an Affair”.

 

For many, until this data breach, Ashley Madison has been largely unknown.  Now given the impact to an estimated 32 million members with compromised confidentiality, this has become hot topic!!  News report accounts reveal that only 3 zip codes in the entire United States do not have users in that breached Ashley Madison data.  (There are approximately 43,000 zip codes in the USA.)

Couples have presented in our office for years with issues related to Internet pornography or extramarital sexual “acting out”.  With the Ashley Madison data breach, a wider swath of society is questioning their marital fidelity and soundness.

Relationship Recovery Center was created to help the healing in families impacted by the Internet. Dr. Patrick Carnes, author of Out of the Shadows and arguably world leader in the treatment protocol for sexual addiction, has called the internet’s impact to youth and families:  “a tsunami facing our culture”.

 

The institution of marriage rests on a bedrock foundation of trust and an expectation of fidelity.  Couples often present in our office when the vow of fidelity or the expectations regarding fidelity have been compromised.  The Internet and the recent Ashley Madison scandal have caused a re-examination of what constitutes the expectation of fidelity.  Further questions surface “Should I check to see if my spouse has signed up for the Ashley Madison website?”

 

Does your marriage need a “CDC” (Critical Digital Conversation)?

This recent scandal invites couples into the opportunity of important conversations about expectations in their marriage.  The Internet and Ashley Madison Scandal raise the question for couples to ask “What are my expectations of fidelity and infidelity?” Some have signed up for Ashley Madison out of curiosity without the intent of follow-through of a physical interaction.  Discovery of this creates an environment of distrust even if a profile was created without full use of the site’s intention.  For some, the viewing of pornography does not disturb the expectations of infidelity.  For others, pornography viewing is a breach of trust minimally, and compulsive use can be a deal-breaker for a marriage.

Our world is not static.  Our relationships are not static.  Every good marriage is a re-marriage – meaning – couples have to have the courage to face difficult conversations as they move through time.  They have the opportunity to revisit expectations of fidelity and safety in their relationships and negotiate their continued expectations of fidelity and trust.

 

In the aftermath of this recent scandal many individuals have questions:

“Should I see if my spouse has signed up for Ashley Madison?”

“What if I find out my husband / wife has signed up for Ashley Madison?”

“I have long suspected something is not right in my relationship – should I investigate if this is what my spouse has been involved with?”

 

If one is curious, we suggest one be prepared with what one will do with this information.  If you have suspected infidelity, what actions are you prepared to take if you find fidelity is compromised?  Perhaps your spouse has not been involved in Ashley Madison, but you are aware of other activity, such as pornography viewing, that creates an air of distrust.  Can you have the conversation about marital expectations?  We suggest talking these things over with a professional before confronting the situation or perhaps inviting your spouse into a protected professional environment if this seems overwhelming or scary to approach.

Professionals licensed as marriage and family therapists (LMFT’s) and Certified as Sex Addiction Therapists (CSAT’s) are uniquely qualified to help couples negotiate these difficult waters.  Relationship Recovery Center was founded with the knowledge that these difficult circumstances face our culture today.  Our clinicians are credentialed specifically in this way.  If your relationship is compromised, we are here to help.  There is a path for healing and rebuilding the boundaries that create fidelity and trust.  Read more at SexAddictTherapist.com