Helping Couples Recover from Infidelity: An Integrative Approach Douglas K. Snyder Texas AM University In collab

1. Helping Couples Recover from Infidelity: An Integrative ApproachDouglas K. SnyderTexas A&M University In collaboration with:Chaplain David Scheider, US Army

2. How Prevalent Are Affairs? Lifetime occurrence: 37% men; 20% women (Laumann et al., 1994) 40% of divorced men/44% of divorced women report extramarital sexual contact during marriage 2nd leading cause of divorce for women and 3rd leading cause for men (Janus & Janus, 1993) Therapists report as 3rd most difficult issue to treat (Whisman, Dixon, & Johnson, 1997) Occurrence rates are for both sexual and emotional infidelity. Sexual infidelity alone produces rates about half that (20% men, 10% women) These findings are from the U.S. From Janus and Janus (1993): The leading causes of divorce for women are: 1. Emotional problems of partner (including incompatibility and �rejection�) (40%) 2. Extramarital affairs by their partner (22%) The leading causes of divorce for men are: 1. Emotional problems of partner (including incompatibility and �rejection�) (43%) 2. Difficulties in the sexual relationship (17%) 3. Extramarital affairs by their partner (11%) From Whisman et al (1997): Therapists rate the following as the most difficult couple issues to treat: 1. Lack of loving feelings 4. Power struggles 2. Alcoholism 5. Serious individual problems 3. Extramarital affairs. 6. Physical abuseOccurrence rates are for both sexual and emotional infidelity. Sexual infidelity alone produces rates about half that (20% men, 10% women) These findings are from the U.S. From Janus and Janus (1993): The leading causes of divorce for women are: 1. Emotional problems of partner (including incompatibility and �rejection�) (40%) 2. Extramarital affairs by their partner (22%) The leading causes of divorce for men are: 1. Emotional problems of partner (including incompatibility and �rejection�) (43%) 2. Difficulties in the sexual relationship (17%) 3. Extramarital affairs by their partner (11%) From Whisman et al (1997): Therapists rate the following as the most difficult couple issues to treat: 1. Lack of loving feelings 4. Power struggles 2. Alcoholism 5. Serious individual problems 3. Extramarital affairs. 6. Physical abuse

3. What Is An Affair? Physical non-monogamy: Occurs along a continuum of physical involvement Emotional non-monogamy: Characterized by emotional intimacy, secrecy, and sexual chemistry Betrayal: Violation of relational standard (implicit or explicit) regarding physical or emotional exclusivity Couples define �affair� by their own unique relational standards. We use the individual�s subjective appraisal of �betrayal� to define the occurrence of an affair. The �violation of standards/assumptions� is consistent with conceptual and empirical work in the area of trauma and PTSD. Important to emphasize subjective definition and reaction to an affair. Influenced strongly by cultural differences (e.g., nationality) as well as individual family history, expectations, norms of immediate peer group, and so on. These influences often contribute to whether individuals regard their partner�s affair as problematic vs. distressing vs. traumatic. Couples define �affair� by their own unique relational standards. We use the individual�s subjective appraisal of �betrayal� to define the occurrence of an affair. The �violation of standards/assumptions� is consistent with conceptual and empirical work in the area of trauma and PTSD. Important to emphasize subjective definition and reaction to an affair. Influenced strongly by cultural differences (e.g., nationality) as well as individual family history, expectations, norms of immediate peer group, and so on. These influences often contribute to whether individuals regard their partner�s affair as problematic vs. distressing vs. traumatic.

4. Three Stage Model of Recovery Stage I - Absorbing the blow Stage II - Giving meaning, establishing new assumptions Stage III - Moving forward Will discuss each of these stages in depth later in presentation. There is no �fixed� time period for these phases. But in our structured treatment program we outline a 20-25-session (6-month) intervention model. Stage I requires about 6 sessions. Stage II requires about 10 sessions. Stage III requires about 4 sessions. Will discuss each of these stages in depth later in presentation. There is no �fixed� time period for these phases. But in our structured treatment program we outline a 20-25-session (6-month) intervention model. Stage I requires about 6 sessions. Stage II requires about 10 sessions. Stage III requires about 4 sessions.

5. Characteristics of Successful Process Gaining a fuller and balanced understanding of event(s) Not remaining preoccupied with the traumatic events Giving up the right to continuously punish the person who has �wronged� you Deciding whether to maintain or terminate the relationship Success is defined not by whether or not the couple stays married (or in their relationship) -- but how they reach a decision regarding their relationship -- and the quality of their individual and relationship functioning as they move on in life. Success: Moving on and living a full and constructive life. Success is defined not by whether or not the couple stays married (or in their relationship) -- but how they reach a decision regarding their relationship -- and the quality of their individual and relationship functioning as they move on in life. Success: Moving on and living a full and constructive life.

6. PTSD Symptoms PTSD Scale (Foa, Cashman, Jaycox, & Perry, 1997). This is a self-report measure of PTSD that yields both a PTSD diagnosis according to DSM-IV criteria and a measure of PTSD symptom severity. Has high internal consistency and test-retest reliability, high diagnostic agreement with the SCID PTSD module, and good sensitivity and specificity. (Updated from PSS-SR, Foa et al. 1993, based on DSM-III-R.) (See also Falsetti, Resnick, Resnick, & Kilpatrick, 1993; the Behavior Therapist.) 17 items corresponding to DSM-IV PTSD symptoms (5 reexperiencing; 7 avoidance; 5 arousal). Frequency of each over past month rated on 4-point scale (0 = not at all; 3 = five or more times per week). (Score range from 0 to 51.) From Falsetti article: 23 = Cutoff score for diagnosing PTSD in treatment sample; and 15 = cutoff score for diagnosing PTSD in community sample. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9, 445-451. For 1997 version, Foa et al. present the following M/SDs: For nonclinic (community) samples: M = 12.5 SD = 10.5 For clinical PTSD samples: M = 33.6 SD = 10.0 (Accident, fire, natural disaster, sexual or nonsexual assault; sexual abuse, (NOTE: We used 1993 version based on combat/war zone) DSM-III-R)PTSD Scale (Foa, Cashman, Jaycox, & Perry, 1997). This is a self-report measure of PTSD that yields both a PTSD diagnosis according to DSM-IV criteria and a measure of PTSD symptom severity. Has high internal consistency and test-retest reliability, high diagnostic agreement with the SCID PTSD module, and good sensitivity and specificity. (Updated from PSS-SR, Foa et al. 1993, based on DSM-III-R.) (See also Falsetti, Resnick, Resnick, & Kilpatrick, 1993; the Behavior Therapist.) 17 items corresponding to DSM-IV PTSD symptoms (5 reexperiencing; 7 avoidance; 5 arousal). Frequency of each over past month rated on 4-point scale (0 = not at all; 3 = five or more times per week). (Score range from 0 to 51.) From Falsetti article: 23 = Cutoff score for diagnosing PTSD in treatment sample; and 15 = cutoff score for diagnosing PTSD in community sample. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9, 445-451. For 1997 version, Foa et al. present the following M/SDs: For nonclinic (community) samples: M = 12.5 SD = 10.5 For clinical PTSD samples: M = 33.6 SD = 10.0 (Accident, fire, natural disaster, sexual or nonsexual assault; sexual abuse, (NOTE: We used 1993 version based on combat/war zone) DSM-III-R)

7. Global Commitment Broderick Commitment Scale: single item rated 1-100. The BCS is a one item question that assesses the degree to which an individual feels that he or she is committed to his/her relationship. The respondent must read a description of commitment and rate him/herself on a scale from 0 to 100, with 100 being fully committed. The BCS has been shown to be highly predictive of women's response to marital therapy. Beach, S. R. H. & Broderick, J. E. (1983). Commitment: A variable in women's response to marital therapy. American Journal of Family Therapy, 11, 16-24. �Please read the following paragraph containing a definition of commitment and rate yourself on a scale from 0 to 100: The degree to which an individual is willing to stand by another even though that may mean putting aside one's own needs and desires for the sake of the other; it can mean a time of accepting the other person in spite of his or her faults or problems that make one's own life difficult; it can mean thinking less about the immediate advantages and disadvantages of the relationship and working to make the relationship last in the long run.� Husbands M (SD) Wives M (SD) For clinic couples before therapy: 77.7 (18.2) 70.2 (24.6) For clinic couples after therapy: 80.6 (18.7) 78.5 (20.4) Broderick Commitment Scale: single item rated 1-100. The BCS is a one item question that assesses the degree to which an individual feels that he or she is committed to his/her relationship. The respondent must read a description of commitment and rate him/herself on a scale from 0 to 100, with 100 being fully committed. The BCS has been shown to be highly predictive of women's response to marital therapy. Beach, S. R. H. & Broderick, J. E. (1983). Commitment: A variable in women's response to marital therapy. American Journal of Family Therapy, 11, 16-24. �Please read the following paragraph containing a definition of commitment and rate yourself on a scale from 0 to 100: The degree to which an individual is willing to stand by another even though that may mean putting aside one's own needs and desires for the sake of the other; it can mean a time of accepting the other person in spite of his or her faults or problems that make one's own life difficult; it can mean thinking less about the immediate advantages and disadvantages of the relationship and working to make the relationship last in the long run.� Husbands M (SD) Wives M (SD) For clinic couples before therapy: 77.7 (18.2) 70.2 (24.6) For clinic couples after therapy: 80.6 (18.7) 78.5 (20.4)

8. Goals of the Initial Session Establish safety and trust Demonstrate competence Expertise regarding affairs and recovery process Obtaining relevant information Prepare for future sessions Establish an atmosphere of safety: Setting limits on negative exchanges Empathic response to overt and covert distress Establish an atmosphere of trust: Identifying �relationship� as the initial client Establishing therapy ground rules - Limits to confidentiality Establish an atmosphere of competence: Modeling of appropriate communication behaviors Relevant assessment of strengths and deficits Expertise regarding affairs and recovery process Prepare for subsequent sessions: Individual sessions and conjoint formulation Overview and rationale for treatmentEstablish an atmosphere of safety: Setting limits on negative exchanges Empathic response to overt and covert distress Establish an atmosphere of trust: Identifying �relationship� as the initial client Establishing therapy ground rules - Limits to confidentiality Establish an atmosphere of competence: Modeling of appropriate communication behaviors Relevant assessment of strengths and deficits Expertise regarding affairs and recovery process Prepare for subsequent sessions: Individual sessions and conjoint formulation Overview and rationale for treatment

9. Addressing Initial Crises Contain immediate crises: Verbal or physical aggression Immediate decisions regarding boundaries Immediate self-care needs Containing negative affect and preventing further destructive exchanges is the focus of Phase I in this therapy. Obviously, not all crises can be resolved in the initial interview. What does the couple most need just to get through the next week or two? Containing negative affect and preventing further destructive exchanges is the focus of Phase I in this therapy. Obviously, not all crises can be resolved in the initial interview. What does the couple most need just to get through the next week or two?

10. Brian and Angela � Summary Brian 29, injured partner; Angela 26, participating partner Married 6 years; sons ages 3 and 1 Affair � two months� duration. Marital history and shared work history. Individual histories: Angela: Adopted, mother died age 18 Brian: Oldest of 3 siblings; college drop-out

11. Video � Initial Session Emphasis on: Current status of couple relationship Status of outside relationship Efforts to set boundaries

12. Treatment Goals for Stage I Re-establish some form of �equilibrium� for the couple and individuals Reduce emotional upset Establish behavioral routines Minimize additional damage to either individual or the couple� �damage control� Minimize hurtful behaviors between the partners Minimize either partner creating problems with the outside world Overall treatment goals: You are really trying to do two things with a variety of interventions: First, things feel very much out of control; people are in crisis, so you want to slow things down and create some sense of stability and lower the emotion level in most cases. Re-establish routines around meals, finances, child rearing, sleep. Second, you want to make certain that the couple doesn�t make things worse, further complicating things for themselves or you as their therapist- damage control. 50% of men and 30% of women report having been �happy� in their marriage prior to learning of their partner�s affair. These hurtful acts could be aimed at the partner: physical abuse; one couple where husband had never been violent in his life yet beat his wife when finding out she had had an affair Second, people might mess things up with other people, either inadvertently or on purpose - Inadvertently: telling parents what partner did and then parents have long term resentment even after couple has worked through it - One wife sent a letter to husband�s employer telling of inappropriate things he had done on the job and he was fired.Overall treatment goals: You are really trying to do two things with a variety of interventions: First, things feel very much out of control; people are in crisis, so you want to slow things down and create some sense of stability and lower the emotion level in most cases. Re-establish routines around meals, finances, child rearing, sleep. Second, you want to make certain that the couple doesn�t make things worse, further complicating things for themselves or you as their therapist- damage control. 50% of men and 30% of women report having been �happy� in their marriage prior to learning of their partner�s affair. These hurtful acts could be aimed at the partner: physical abuse; one couple where husband had never been violent in his life yet beat his wife when finding out she had had an affair Second, people might mess things up with other people, either inadvertently or on purpose - Inadvertently: telling parents what partner did and then parents have long term resentment even after couple has worked through it - One wife sent a letter to husband�s employer telling of inappropriate things he had done on the job and he was fired.

13. Discussing Impact of the Affair What assumptions have been violated about who your partner is and what to expect from your relationship? What standards for your marriage (how partners should behave) have been violated? What does the affair mean about your partner, the relationship, and you? What emotions are you experiencing, and what ideas go with those feelings? Given these thoughts and feelings, what behaviors have changed or have been disrupted? Can refer to handout: Guidelines for Sharing Emotions Discussing the impact of the affair: Why is this important: people need to get out their feelings and express what this has been like. They have likely tried this in out-of-control, unproductive manner. Teach the couple good communication skills, expressing and listening so that they can do this well. Guide the discussion by proposing questions to address and use structure to maintain roles. For injured person, goal isn�t to attack. For participating partner, goal is to understand and not defend. Must balance giving both people a chance to express. Can refer to handout: Guidelines for Sharing Emotions Discussing the impact of the affair: Why is this important: people need to get out their feelings and express what this has been like. They have likely tried this in out-of-control, unproductive manner. Teach the couple good communication skills, expressing and listening so that they can do this well. Guide the discussion by proposing questions to address and use structure to maintain roles. For injured person, goal isn�t to attack. For participating partner, goal is to understand and not defend. Must balance giving both people a chance to express.

14. Flashback Guidelines Clarify whether emotional upset is due to something currently upsetting or re-experiencing feelings from past Let your partner know what is happening (e.g., driving by the hotel triggered old feelings) Let your partner know what you need at present (e.g., being held; being left alone; talking about it) Balance how much you talk with partner about flashbacks with other ways to handle on your own Often couple is improving and individual is more stable emotionally and then something triggers emotional response that is very strong. I have given you a handout that describes in more detail. Here are the major points: Distinguish between something happening at present that is upsetting versus re-experiencing from the past based on current cue. Clarify what is happening and what you are feeling so partner isn�t confused about your rapid change in mood. Tell partner what you need at present; might vary from one occasion to the next. At times, handle on your own so this doesn�t become the focus of your relationship. Goal is not to eliminate flashbacks -- but to limit their intensity and adverse consequences for IP and the relationship. Normalize, education, reduce secondary reactions/attributions by PP. Often couple is improving and individual is more stable emotionally and then something triggers emotional response that is very strong. I have given you a handout that describes in more detail. Here are the major points: Distinguish between something happening at present that is upsetting versus re-experiencing from the past based on current cue. Clarify what is happening and what you are feeling so partner isn�t confused about your rapid change in mood. Tell partner what you need at present; might vary from one occasion to the next. At times, handle on your own so this doesn�t become the focus of your relationship. Goal is not to eliminate flashbacks -- but to limit their intensity and adverse consequences for IP and the relationship. Normalize, education, reduce secondary reactions/attributions by PP.

15. Treatment Goals for Stage II Identify factors that potentially contributed to �vulnerability� or �risk� of affair Prepare groundwork for additional change There are four primary goals of work during this second stage. First and foremost, it�s critical that both partners be helped to construct a comprehensive, shared formulation of factors that contributed to the marriage�s vulnerability or �risk� of an affair. We�re going to look at a conceptual model for risk factors in just a moment. IF this goal is achieved it may have the following benefits: 1. The injured partner may regain a sense of �predictability� in their life. If the affair remains a random inexplicable event, it could recur at any time without any warning. Predictability affords some measure of security. Also -- to retain any relationship with the participating partner -- the injured partner needs to move beyond a one-dimensional view of the participating partner as a malevolent beast with no redeeming features to a view of the PP as someone who made a terrible, hurtful decision but may still be fundamentally a good person 2. The participating partner needs to move toward an expanded explanation that includes responsibility for the decision, acknowledges their own contributing factors, but also candidly explores factors outside self including the marriage and injured partner. 3. Successful completion of Stage II prepares the way for subsequent decision to remain in the marriage or not, and how to move on either as a couple or individually. There are four primary goals of work during this second stage. First and foremost, it�s critical that both partners be helped to construct a comprehensive, shared formulation of factors that contributed to the marriage�s vulnerability or �risk� of an affair. We�re going to look at a conceptual model for risk factors in just a moment. IF this goal is achieved it may have the following benefits: 1. The injured partner may regain a sense of �predictability� in their life. If the affair remains a random inexplicable event, it could recur at any time without any warning. Predictability affords some measure of security. Also -- to retain any relationship with the participating partner -- the injured partner needs to move beyond a one-dimensional view of the participating partner as a malevolent beast with no redeeming features to a view of the PP as someone who made a terrible, hurtful decision but may still be fundamentally a good person 2. The participating partner needs to move toward an expanded explanation that includes responsibility for the decision, acknowledges their own contributing factors, but also candidly explores factors outside self including the marriage and injured partner. 3. Successful completion of Stage II prepares the way for subsequent decision to remain in the marriage or not, and how to move on either as a couple or individually.

16. Treatment Strategies for Stage II Present rationale Potential benefits and risks of doing this Examine potential factors successively Relationship factors Stressors from outside the marriage Individual susceptibilities or contributions Participating partner Injured partner Develop shared, comprehensive formulation There are three strategies or phases underlying Stage II work. We�re going to examine each of these in more detail in a moment. Basically the three strategies include: 1. Providing a rationale for this stage -- why it�s critical to being able to �move on� in any permanent or reliable way -- and also how it can be difficult. 2. Examining potential contributing factors at each phase of the affair-sequence across domains outlined in the model shown previously. It�s usually best to examine these in the order listed here -- beginning with the marriage and outside factors impacting the marriage, and then moving to individual factors starting with the participating partner. 3. The �product� achieved by Stage II work is the �shared, comprehensive formulation.� The formulation serves to answer �how could this have happened,� and also begins to answer �what would we need to do now to move on and also prevent this from happening again?� There are three strategies or phases underlying Stage II work. We�re going to examine each of these in more detail in a moment. Basically the three strategies include: 1. Providing a rationale for this stage -- why it�s critical to being able to �move on� in any permanent or reliable way -- and also how it can be difficult. 2. Examining potential contributing factors at each phase of the affair-sequence across domains outlined in the model shown previously. It�s usually best to examine these in the order listed here -- beginning with the marriage and outside factors impacting the marriage, and then moving to individual factors starting with the participating partner. 3. The �product� achieved by Stage II work is the �shared, comprehensive formulation.� The formulation serves to answer �how could this have happened,� and also begins to answer �what would we need to do now to move on and also prevent this from happening again?�

17. Rationale for Exploring Context For injured partner Restores predictability Potentially �softens� view of participating partner Contributes to appropriate self-awareness For participating partner Broadens explanations for hurtful behavior Contributes to appropriate self-awareness For couple May facilitate collaborative efforts at addressing relationship and outside factors Injured partner: 1. Needs to resolve question of �how could this happen.� Without adequate formulation and restoration of �understandable and predictable� view of partner and relationship -- safety/security, and intimacy cannot be restored. 2. If appropriate, needs to move from view of PP as �horrible monster� to view of PP as �decent person who made terrible decision that was deeply hurtful.� 3. May need to modify self-view as responsible (self-blame; inappropriate guilt) or totally lacking in responsibility. Participating partner: 1. Needs to arrive at comprehensive understanding both to minimize future risks but also regain credibility with injured partner. (Not -- �It just happened� as explanation.) 2. If appropriate, needs to move from excessively punitive self-view (harsh guilt often dissolves into defensive anger). Or may need to accept responsibility (especially concerning enduring vulnerabilities). Couple: 1. Needs to collaborate in resolving marital and outside factors.Injured partner: 1. Needs to resolve question of �how could this happen.� Without adequate formulation and restoration of �understandable and predictable� view of partner and relationship -- safety/security, and intimacy cannot be restored. 2. If appropriate, needs to move from view of PP as �horrible monster� to view of PP as �decent person who made terrible decision that was deeply hurtful.� 3. May need to modify self-view as responsible (self-blame; inappropriate guilt) or totally lacking in responsibility. Participating partner: 1. Needs to arrive at comprehensive understanding both to minimize future risks but also regain credibility with injured partner. (Not -- �It just happened� as explanation.) 2. If appropriate, needs to move from excessively punitive self-view (harsh guilt often dissolves into defensive anger). Or may need to accept responsibility (especially concerning enduring vulnerabilities). Couple: 1. Needs to collaborate in resolving marital and outside factors.