I am a Licensed Marital and Family Therapist. As such, my professional interests and training are firmly rooted in helping couples and families heal and thrive. Consequently, when I work with someone individually, the systemic impact of that individual treatment on the couple relationship is ever-present in my mind and clinical approach.

In the field of sex addiction recovery, I view effective couple therapy as essential for overcoming the devastating impact of betrayal when reconciliation is the desired path forward.

I am passionate about couple therapy because I have yet to meet a couple in solid, long-term SA recovery who has not incorporated couple therapy into their healing process. These couples, however, have taught me a great deal about what is and isn’t effective in treating recovering SA couples specifically. 

One thing I have learned is the importance of introducing couple therapy at the appropriate time to avoid unnecessary risk to the relationship. I have also learned SA couple therapy is unique and distinct from traditional couple therapy and that if these differences are not well-understood, great harm can be done, including the risk of treatment-induced trauma.  

There are several factors which influence the effectiveness of traditional couple therapy, including, but not limited to:

• The modality of couple therapy used.
• The working relationship between the couple and the therapist.
• The fit between the therapist’s areas of specialty and the issue(s) being addressed in treatment.
• The timing of couple therapy being introduced (too soon or too late).

It is this last point, the timing of couple therapy, that I wish to highlight here.

If couple therapy is not well timed, it can result in:

• Unnecessary expense and time being invested in care that could be more wisely spent at a different stage of recovery.
• Decreased focus on individual recovery goals if individual and couple therapy occur simultaneously. This is especially true for individuals who seek most of their identity from the relationship, or for individuals who have difficulty knowing what they need or want in their own right.
• Premature termination from couple therapy because “it isn’t working.”
• Increased risk of terminating the relationship because going to couple therapy “proved we have tried everything.”
• Frustration over negligible results.

As with any type of mental health or medical treatment, indications and contraindications for commencing a treatment are important to weigh for optimal outcomes.  In the field of couple therapy, indications and contraindications have been acknowledged in peer-reviewed research articles¹ and couple therapy training programs for decades. To ignore their existence is not only unwise but also unethical and even risky in certain situations.

A 2011 journal article in the Archives of Psychiatry and Psychotherapy², outlined the following indications for engaging in couple therapy:

1. Partners are mutually trying to improve the relationship.
2. Partners want to undertake therapy for mutual support or help with problem-solving.
3. Partners with negative past experiences or previous failed relationships want to prevent or solve problems in their current relationship.
4. Partners want to prevent an accumulation of difficulties and strengthen their bond.
5. Partners want to thoughtfully attempt to reach an agreement before making the final decision about separation or divorce.
6. Partners have decided to divorce but mutually want to improve their relationship with improved co-parenting prospects.

In contrast, the same peer-reviewed article summarized the contraindications for couple therapy:

1. Active risk of abuse or violence between partners (can include emotional, physical or sexual abuse).
2. Active or untreated mental illness or addiction with one (or both) partners.
3. One or both parties are engaged in infidelity and lack the motivation to give those outside relationships up for the good of the primary relationship.
4. One or both parties have undertaken the decision to separate or divorce.

In my work with partners of sex addicts, most are facing more than one of these contraindications, and it is not uncommon to encounter situations in which all of these contraindications are present. 

It is important to remember sex addiction in and of itself frequently encapsulates the relational ‘triple threat’ of addiction, abuse & affairs. In other words, the stakes are high for couples reeling from betrayal associated with sexual addiction and great care should be taken to ensure safe and effective treatment planning.

Consequently, it has been my observation and experience that a focus on individual therapy is highly recommended for sex addicts and partners during the initial assessment and stabilization phase of recovery. Research also supports this early emphasis on individual therapy. For instance, a 2017 study revealed 72% of partners cited individual therapy as the preferred or most important form of support while healing³. An initial focus on individual therapy can provide the necessary foundation upon which safety, stability, sobriety and mutuality can be formed, thereby enhancing the chances of success when and if couple therapy is pursued. 

If couple work is mutually desired early in treatment and contraindications are present, I have observed positive results when couple meetings focus on:

• Psychoeducation of one or both parties
• Treatment planning for one or both parties
• Crisis intervention for the family, children or the couple

I cannot stress enough the potential risks inherent in doing the vulnerable work of attachment-based repair with couples if the above-listed contraindications are actively present or have not been thoroughly addressed, treated and accommodated for.

Even in the well-reputed field of Emotionally Focused Therapy (EFT), which remains one of the most research-validated couple therapy approaches to date, contraindications are readily recognized and outlined in EFT training. In speaking with an international EFT trainer recently, it was confirmed to me directly that more training and understanding is needed within the EFT field about the appropriate and optimal timing of SA couples work. I wholeheartedly support such training efforts.

To help couples determine readiness for effective relational repair work, I educate clients on what I call “The Rule of 5” as a guideline in their decision making about couple therapy timing.

The Rule of 5:

SOBRIETY IS ESTABLISHED: When a sex addict accomplishes the hard work of establishing an initial level of sobriety from all forms of acting out (e.g., 90 days is a common working minimum), it sends a clear signal that he or she is: 1) choosing the relationship over the addiction, 2) breaking through denial, 3) no longer minimizing the seriousness of the issue, and 4) wanting to change. Such signals are not only incredibly validating and reassuring for a partner, but they also allow the partner to commence couple therapy in a setting that is more likely to be free of minimization, gaslighting or further betrayal.

EMPATHY IS PRESENT: Empathy is the ability to comprehend and share the feelings of another. When the addict can begin to lean into the pain his or her actions have caused and take appropriate responsibility for that pain, it provides a foundation for understanding, awareness, safety and the dismantling of narcissistic traits and objectification. Ideally, we want to ensure all blame shifting has stopped and the addict has enough tolerance of his or her own shame that he or she can begin to comprehend the impact of the betrayal from the perspective of the partner. Getting empathy ‘online’ in the addict’s brain and heart is an important step for launching effective couple’s work.

FULL DISCLOSURE HAS OCCURED: For couple therapy to be effective, it is vital both parties have a shared knowledge of the sexually addictive behaviors. When couple therapy commences with a power imbalance of secrets in place (pre-disclosure), it puts the partner at risk of experiencing betrayal in and through the couple therapy setting (“Why didn’t the therapist catch that he was withholding information about a whole category of acting out? Am I safe with a therapist who was also fooled and manipulated by my addicted spouse?” “How will this relationship work if my spouse is still lying while we are in couple therapy?”). Consequently, I highly recommend couple therapy commence after a full therapeutic disclosure and when the partner is able to trust in his or her gut that the truth is out in the open.

MENTAL ILLNESS, ADDICTION & TRAUMA ARE MANAGED: When mental illness, addictions or traumas have not been adequately diagnosed and treated, they can wreak havoc on repairing attachment bonds within a relationship. While few people would ever be ready for couple therapy if being ‘cured’ from all such issues was the standard, it is reasonable to expect that these issues be identified and be in the process of being stabilized prior to engaging in vulnerable, attachment-based couple therapy for sex addiction. I cannot count the number of partners I have met who have been in couple therapy for months or even years and it was not until a mood disorder or addiction (in one or both parties) was diagnosed and treated that things turned a corner for the better.

RECONCILIATION IS MUTUALLY DESIRED: Although it is common for SA couples to experience differences in their level of commitment to the relationship, it is helpful if the couple can share at least some degree of willingness to explore reconciliation prior to beginning couple therapy. If one party is determined to leave the relationship, then couple therapy which focuses on relational repair is likely to prove ineffective. On the other hand, differences in commitment do not negate the option to explore differences or work toward an agreed upon goal in couple therapy or meetings.

When these criteria are met, couple therapy tends to be more productive, emotionally safe, cost-effective and successful in helping couples repair or establish a healthy bond. Additionally, partners of sex addicts are more likely to be protected from treatment-induced trauma when the timing of joint work is given careful consideration. I invite couples in SA recovery and clinicians who support them to consider implementing The Rule of 5 criteria for determining readiness for couple therapy.

¹ Beavers, W. R. (1982). Indications and contraindications for couples therapy. Psychiatric Clinics of North America, 5(3), 469-478.

² Wolska, M. (2011). Marital Therapy/Couples Therapy: Indications and Contraindications. Archives of Psychiatry & Psychotherapy; September 2011, Vol. 13 Issue 3, p. 57.

³ Laaser, D., Putney, H. L., Bundick, M., Delmonico, D. L., Griffin, E. J. (2017). Posttraumatic growth in relationally betrayed women. Journal of Marital and Family Therapy.