Disclosure of Extramarital Sexual Activities by Sexually Exploitative Professionals and Other Persons with Addictive or Compulsive Sexual Disorders

By Jennifer Schneider, Richard Irons, and M. Deborah Corley

Journal of Sex Education and Therapy 1999, 24(4): 277-287.

Abstract

One of the most stressful events for a helping professional who has been involved in sexual misconduct is disclosure about the misconduct to his or her spouse. Such disclosure usually precipitates a crisis in the relationship. Threats by the partner to leave are common, and fear of such threats may prevent disclosure. To determine whether fear of threats to leave are justified, this qualitative study investigated the outcome of such threats following disclosure of extramarital sexual behaviors by a subpopulation of persons with a compulsive sexual disorder; 24% of them were licensed health professionals, and 21% were other licensed professionals. An anonymous survey was returned by 102 such persons (89% male) and by 94 spouses or partners or former partners (94.7% female). In most cases the extramarital sexual activities had been recurrent and long-standing, although secret, so that disclosure was particularly painful to the partners. Additionally, for some respondents, the initial disclosure was in the form of a legal action and was subsequently made public. A majority (60.2%) of the partners threatened to leave at the time of disclosure. Among persons who were still married when surveyed, only one-quarter (23.4%) of those who threatened actually separated for a time period. Most respondents emphasized that honesty was the foundation for an improved relationship. Based on their experience, the majority of both sexually compulsive persons (68.3%) and partners (81.4%) recommended disclosure to other couples. Threats to leave are seen as part of a process of coping with disclosure by partners rather than a realistic outcome for most couples in this population. Threats to leave the relationship in the aftermath of affairs or extramarital sexual activities are often not carried out, even when the betrayal has been extensive. Inpatient facilities, and therapists in general, are advised to assist the betrayed partner as well as the compulsive person with the disclosure as part of a process of healing. The spouses of sexually exploitative professionals are in particular need of counseling, as they have to deal with additional issues related to their community standing, and expectation that they will support the professional publicly and hold the family together.

Despite religious and cultural precepts that forbid sexual activity outside marital relationships, such behavior has continued in most societies and is common in the United States. Forty to fifty years ago, Kinsey and associates found that one in two husbands (Kinsey et al., 1948) and one in four wives (Kinsey et al., 1953) had engaged in sex with a partner outside the marriage. During the peak of the "sexual revolution" 20 years later, the reported numbers of unfaithful women increased (Tavris & Sadd, 1975), and categories of affairs were defined on the basis of approval or disapproval and knowledge or lack of knowledge by the spouses about the affair (O'Neill & O'Neill, 1976; Rubin & Adams, 1986).

Since the 1980s, when awareness increased of the risk of acquiring sexually transmitted diseases (STDs) such as HIV disease, herpes, chlamydia, and hepatitis, many have predicted a decrease in the number of individuals participating in extramarital sexual experiences. However, in surveys published in the United States in the past two decades over 50% of men and women admitted they had engaged in marital infidelity at some time in their marriage (Glass & Wright, 1992; Hatcher, et al., 1990; Thompson, 1983).

Psychotherapy of married couples wishing to address sexual infidelity traditionally seeks to explore motives for the behaviors, and effects upon the marriage and family. In attempts to understand extramarital sexual behavior, clinicians and researchers have utilized various typologies and definitions. Pittman (1989) defines "infidelity as a breach of the trust, a betrayal of a relationship, a breaking of an agreement. . .We might define adultery as a sexual act outside the marriage, while we might define infidelity as a sexual dishonesty within the marriage" (p. 20). In his practice, Pittman found that affairs fell into four groups: (a) accidental infidelity -- unplanned sex acts that "just happened"; (b) romantic affairs -- the person truly believed he or she was "in love"; (c) marital arrangements -- efforts to maintain a distance that is required by one of the partners; and (d) philandering , which is "that habitual sexual activity that seems natural to the philanderer, and is motivated more by fear of and lust for the 'opposite sex' than by any forces within the marriage or the immediate sexual relationship" (p. 133).

Moultrup (1990) defines an extramarital affair as "a relationship between a person and someone other than his [sic] spouse that has an impact on the level of intimacy, emotional distance, and overall dynamic balance in the marriage" (p. 11). His therapy is based on the assumption that the role of an affair is to create emotional distance in the marriage, and he emphasizes that "the critical principle is to consider the possibility of unconscious emotional benefits gained by the uninvolved spouse" (p. 37). The goal of therapy is to resolve the intimacy problems in the couple relationship so that an affair will no longer be "needed." This model does not consider the possibility of "accidental" affairs nor those that arise out of individual pathology or "habit" rather than relationship difficulties.

Brown (1991) classifies affairs into: (a) conflict avoidance strategies, in which couples who cannot discuss their differences use affairs to make it clear that there are significant problems; (b) intimacy avoidance, where "it feels safer to keep things stirred up a bit" (p. 33); (c) empty nest affairs, in which the marriage feels empty; (d) out the door affairs, in which the affair gives one or both partners the impetus to leave the marriage, and (e) sexual addiction, in which people "deal with their emotional neediness by winning battles and making conquests in the hope of gaining love" (p.35).

A particularly egregious type of betrayal of the primary relationship occurs when a physician, psychotherapist, or clergyperson embarks upon a sexual relationship with a patient, client, or other person with whom he or she has a fiduciary relationship. Such relationships are expressly forbidden by their professional associations, and in at least a dozen states they are considered felony crimes. Gabbard and Lester (1995) presented a typology of sexually exploitative psychotherapists. Their disorders consisted of: (a) psychotic disorders, such as the manic phase of bipolar illness; (b) predatory psychopathy and paraphilias, a category which includes antisocial personality disorder, severe narcissism, and various paraphilias which are repeatedly acted upon, involving many victims; (c) "lovesickness," which is believing they are madly in love with the patient or client, and (d) masochistic surrender, which describes therapists who appear to pursue humiliation and victimization in their work and often in their private lives, and eventually succumb to patients' sexual entreaties despite the costs to themselves.

Another typology of sexually exploitative health care professionals was presented by Irons and Schneider (1994), who found that 55% of 137 consecutive sexually exploitative professionals assessed in a multidisciplinary inpatient program had a paraphilic or nonparaphilic addictive or compulsive sexual disorder. Smaller numbers fell into three other categories: (a) naivete, or failure in education about appropriate professional boundaries, (b) situational stress, such as marital, professional, or health problems, and (c) other Axis I or II diagnoses (DSMIV, 1994) such as bipolar illness or antisocial or narcissistic personality disorder.

All of these various typologies have some common categories, which include (a) infidelities related primarily to difficulties within the marriage such poor communication skills and fear of intimacy, or the need for an excuse to terminate the marriage; (b) "accidental" infidelities; (c) infidelity as a resolution to situational stresses not related primarily to the marriage, such as job difficulties, deaths, health problems; (d) infidelity as a behavioral manifestation of a primary personality disorder or, more rarely, psychosis, and (e) infidelity as an expression of an addictive or compulsive sexual disorder . A "true love" affair may result from several of the above categories. Of note is that the latter two categories do not arise primarily out of relationship difficulties, but rather out of the individual psychopathology of one of the partners. In many cases the partner who has not strayed outside of the marriage has her or his own pre-existing emotional difficulties, and in almost all cases the couple relationship is affected by the infidelity. However, it is erroneous to assume that every case of infidelity requires a primarily relationship-centered treatment approach.

Several authors cited believe that sexual disorders with compulsive or addictive features may be implicated when sexual infidelities recur in ritualized patterns. There is disagreement among professionals about whether compulsive sexual behavior should be viewed as an addiction (cf. Shaffer, 1994; Schneider, 1994; Schwartz & Masters, 1994). No matter what paradigm is used, we have found that the addiction model is beneficial in helping people stop unwanted compulsive sexual behavior, in treating the disorder, and in preventing relapse. The observations of this study do not depend upon the label that is applied to the description of the problems respondents associate with marital infidelity.

Key concepts for understanding addictive sexual disorders have recently been reviewed by Irons & Schneider (1998, 1997). An addictive sexual disorder is considered to be present when (a) there is loss of control over one or more sexual behaviors -- that is, when the person has been unable to stop despite attempts and promises to oneself, (b) when the behavior is continued despite significant adverse consequences, such as loss of job or marriage, exposure to disease, risk to safety, or arrest or public humiliation, and (c) when a great deal of time is spent in fantasizing or obsessing about sex or a particular sexual activity.

Some ritualized sexual activities are classified in the DSM-IV (1994) as paraphilias because they are seen as outside the boundaries of what our society considers normal sexual behaviors. These include exhibitionism, voyeurism, and frotteurism (inappropriate touching). However, any sexual activity may become compulsive and result in significant adverse consequences, including those which are normal and healthy for most people, such as masturbation and use of pornography. An analogy may be made to the consumption of alcohol, which is a pleasant and positive experience for most people but causes significant life problems for approximately 13 percent of the population (Regier et al., 1990). The key differentiating feature is not the frequency of the behavior, but rather the consequences to the person and to others. Although recovery from alcohol dependency usually requires total abstention from alcohol consumption, recovery from an addictive or compulsive sexual disorder consists not in avoiding sex altogether, but rather in learning what are healthy sexual activities for the person. An analogy can be made with compulsive overeating, in which recovery comprises learning how to eat in a healthy and non-compulsive manner and to cope with anxiety or stress in healthy ways.

When secret extramarital sexual activities intrude on a primary committed relationship, one question inevitably surfaces: should one disclose the infidelity to the partner? Some authors have asserted the need for honesty and disclosure (Pittman, 1989; Subotnik & Harris, 1994; Vaughan, 1989), and some even give advice about what and when to tell (Subotnik & Harris, 1994; Wallerstein and Blakeslee, 1989; Vaughan, 1989). In contrast, many clinicians hesitate to recommend full or even partial disclosure because of the client's fears that the uninvolved spouse may choose to leave the relationship. Many partners who have suspected the existence of extramarital sexual activities have in fact threatened to leave should their suspicions be confirmed; on the basis of such threats, both the involved spouse and the therapist may consider it too risky to disclose. The concern is exacerbated when there has been a long-standing pattern of infidelity, as typically exists when one partner has a compulsive sexual disorder.

When an addictive disorder is present, the sex therapist must recognize the special importance of the role of honesty as a component of the most widely-accepted treatment of addiction. One of the fundamental principles of the most widely used approach for addiction treatment -- that based on Alcoholics Anonymous -- is that honesty is essential for recovery. The addict is repeatedly told of the importance of being rigorously honest about his or her behavior. However, because disclosure of sexual activities will cause pain to the partner (not to mention adverse consequences to self), being honest presents a real dilemma for both the addict and the therapist. This is particularly true when not telling could do greater harm, as when the unfaithful person has exposed the partner to human immunodeficiency virus (HIV) infection, or when sexual misconduct has occurred which could result in legal charges, loss of professional license, and financial adversity for the family. These same considerations also exist when the extramarital sexual activity did not result from an addictive or compulsive disorder.

Despite the fact that infidelity is an extremely common factor motivating a couple to seek therapy, little is reported in the sex education and therapy literature about how to help couples effectively address compulsive sexual behavior. Neither has the literature adequately addressed whether disclosure is advisable and how the therapist might facilitate the process of disclosure so that it may be healing to both the couple and to the individuals involved.

Relationship issues resulting from addictive or compulsive sexual problems have long been an interest of the authors. (Schneider, 1991, Schneider & Schneider 1989, 1990a, 1990b, 1990c, 1996; Corley & Alvarez, 1996), as have relationship problems resulting from sexual exploitation by a professional member of the couple (Irons & Schneider, 1999). Because of the compulsive nature of the behaviors, there is usually an extensive history of sexual infidelities. The emphasis on honesty in the recovery process of the patient results in pressure to disclose infidelities to partners despite fears of the consequences. For this reason this group can be expected to be particularly informative for studying issues of disclosure.

When dealing with a sexually exploitative professional in treatment, when, how, and what to tell the spouse or partner are parameters that the helping professional and those providing care for him or her during intervention and rehabilitation must face. Involvement of the spouse will significantly improve the survival and healing of the marital relationship and the rehabilitation of the professional. When a compulsive or addictive disorder (drugs, sex) is a contributing cause of the exploitative professional’s behavior, “rigorous honesty” is considered important for recovery from the disorder. This qualitative study addresses the consequences of choice of timing, extent, and manner of disclosure of the extramarital sexual behavior to the partner.

Methods

Definitions:

Addict : The individual in the dyad who has engaged in compulsive sexual behaviors outside the relationship.

Disclosure : A formal or informal process in which the person with the compulsive sexual disorder tells his or her partner about all or some of the sexual behaviors in which he or she engaged in outside the marital relationship.

Partner : The individual in the dyad who has not engaged in sexual behaviors outside the marital agreement. In the case of professional sexual misconduct, partners are considered secondary victims of the behavior.

Addictive or compulsive sexual disorder : Sexual behavior which is compulsive, continues despite significant adverse consequences to the person, and is associated with obsession or preoccupation with the behavior.

Instrument:

An anonymous self-administered survey was chosen as the most appropriate research tool for gathering data about the sensitive issue of sexual behavior outside marriage. Separate surveys were constructed for addicts and partners.

The survey contained closed, multiple-choice (with a 5-point Likert-like scale), and open-ended questions. Examples of open-ended questions were those related to the meaning of disclosure to the addict and the partner, what each individual identified as helpful or unhelpful actions or advice by the therapist, and what was the outcome of the disclosure for the couple relationship. The survey took approximately 1-1.5 hours to complete. Approval for the project was obtained from the Menninger Clinic human research committee.

Ascertainment of Subjects:

A convenience sample of 17 American and Canadian therapists who treat sex addicts and their partners was asked to distribute surveys to current and former clients. Additional surveys were sent to 5 contact persons within the sex addiction recovery community for distribution to self-identified recovering sex addicts and partners. Each survey was returned to the authors in a pre-addressed envelope. In this fashion the respondents' anonymity was respected vis a vis the authors of this study.

The respondents therefore consisted primarily of persons and partners (or former partners) of persons who had been diagnosed by a professional as having an addictive or compulsive sexual disorder (Sexual Disorder NOS in the DSMIV) and a few who were self-identified as sex addicts or partners (or former partners) of sex addicts. Originally surveys were distributed to persons who were members of a couple. A subsequent mailing targeted specifically persons whose primary relationships had ended as a result of sexual compulsivity problems and who were now separated or divorced.

Half of the therapists who assisted in distribution of the surveys worked at least part time in inpatient addiction treatment facilities. Although some clients come to such centers voluntarily, many arrive as a consequence of an intervention organized by family and friends, and helping professionals are often sent by professional licensing bodies such as state medical boards. Regardless of how they got there, it is typical of addictive and compulsive disorders that the patient initially feels a great deal of resistance and denial, and develops insight only gradually. This is why the authors attempted to survey addicts and partners who were at different stages of recovery following treatment.

Results

Demographics

Approximately 500 pairs of surveys (1,000 surveys) were initially sent out by the authors. We cannot determine the actual rate of response, because not all the surveys sent to the therapists and contact persons were actually distributed by them. A total of 161 surveys were returned, yielding a return rate of well over 16.0% of those actually distributed. Of the total, 81 addicts and 80 partners responded. Of the partners in this group (“Group A”), 4 out of 78 (5%) were separated or divorced. In addition, the second mailing of 120 surveys directed to therapists working with persons who were separated or divorced, yielded 36 responses (30%), consisting of 20 addicts and 16 partners (“Group B”).

Of the entire group, half were male, and half female; 75% were currently married or in a committed long-term relationship, whereas 25% were separated or divorced. The mean age of the respondents was 43.8 years, SD 9.1, with a range of 26-70; the mean age of the addicts was 45, the partners 42.6 years. Among the addicts, 93 (91.2%) were male; among the partners, 88 (93.6%) were female. As to sexual orientation,91.7% of the respondents identified themselves as heterosexual, and 8.3% were homosexual or bisexual.

The occupations of the respondents are summarized in Table 1.

The licensed health professionals included physician, nurse, psychologist, social worker, physical therapist, and clergy. Other regulated professionals included lawyers, professors, and teachers. The great majority of respondents were employed, and most had had higher education.

Of 100 sex addicts who specified their compulsive behaviors, 91 (91%) had engaged in sexual activities with other people outside the marriage. Many had engaged in multiple behaviors including affairs with opposite or same sex persons, having sex with prostitutes, visits to massage parlors, frequenting pornographic bookstores or theaters, or engaging in sexual activities with patients or clients. Among the 9 persons whose sexual activities had not involved contact with other people, several had engaged in illegal behaviors such as voyeurism or exhibitionism. The survey did not ask specifically about sexual involvement with patients or clients in a professional setting. However, several addicts stated that their compulsive sexual behaviors did involve crossing professional boundaries.

Persons with addictive and compulsive disorders often have more than one type of addiction or compulsive behavior. Only 42% of the 102 sex addicts in this study stated they had no other addiction; 49% reported they were also recovering from addiction to alcohol, other drugs, and/or nicotine (3 persons identified nicotine as their only drug of addiction); 25% identified an eating disorder, 12% were compulsive spenders, and the remainder identified other addictions and compulsions.

Among 94 partners, 29% reported having an eating disorder and 17% were in recovery from chemical dependence (of whom 3 had nicotine as their only addictive drug).

Among the addicts, the median time in recovery from sex addiction was 3.4 years, with a range of from less than 1 month, to 16 years; 35% had less than 2 years, 33% had 2 to less than 5 years, and 32% had at least 5 years in recovery. A majority of the partners had attended self-help programs based on the Al-Anon model. Nearly all (90.8%) of the respondents saw or were seeing a professional counselor or therapist; 59.2% of the entire group had seen more than one type of professional. In other words, this population had received both professional and peer support in their recovery process.

Suspicions about extramarital sexual behaviors

Long before disclosure took place, many partners suspected correctly that affairs or other extramarital sex is going on. In our sample, over half of the partners (52.8%) were suspicious enough to confront their spouses. Most (84%) of the addicts who were confronted denied any wrongdoing.

Threats to leave before the disclosure

Before the first disclosure, 29 out of 77 partners (37.7%) in the still-married group (Group A) threatened to leave because they had some suspicions, as did 7/16 (44%) of the divorced/separated group (Group B). Among the addicts, 44.4% of group A and 60% of group B recalled receiving such threats. Understandably, this might have given pause to the offending partners about the wisdom of disclosing that these activities had actually taken place. Threats to leave where common whether or not the couple eventually stayed together.

Threats to leave after disclosure and outcomes of the threats

In group A, 47 (60.2%) of the partners reported threatening to leave after hearing the disclosure. However, of the 47 marriages where threats to leave occurred after disclosure, only 11 (23.4%) of the couples actually separated. In 34 case (72.4%) the couples stayed together throughout. Table 2 summarizes the data for 45 partners of group A who responded. It is notable that of those spouses who threatened to leave, only one quarter actually did so, only temporarily.

When the partners who did not leave despite having threatened were asked for an explanation, half (i.e. 36.2% of the 45 who had threatened to leave) stated that they stayed because one or both went to therapy and 12-step programs (those based on the Alcoholics Anonymous model) and were working actively on their recovery. Typical comments were:

An equal number of partners (36.2% of the 45 who threatened to leave) were unable to take effective action, changed their minds, or decided to "give him another chance." Some are still debating leaving:

In Group B, consisting of 16 former partners who did leave the marriage, 10, or 62.5%, threatened to leave at the time of disclosure. Compared with the 60.2% of partners from Group A who threatened to leave, there is clearly no difference. Thus, a threat to leave did not predict the eventual outcome.

Adverse consequences of the disclosure

When asked, "Did you experience any adverse consequences as a result of the disclosure?" the vast majority of both groups, as expected, said they had - - 97.3% of the addicts and 92.2% of the partners. The most common consequences for the addicts were compromise of the relationship (40.8%), followed by emotional problems and depression (25%). Among the partners, 59.4% reported emotional problems and depression, and 23.4% felt their relationship was compromised.

Of course, many of these consequences can be considered secondary to the behavior rather than to its disclosure. Other adverse consequences included damage to other relationships such as with children, parents, and friends; legal consequences such as arrests, and financial consequences such as job loss and costs of treatment.

Disclosure of sexual misconduct during inpatient treatment:  In several cases, disclosure to unsuspecting spouses was done over the telephone. The wife of one physician who had had sexual relations with several patients reported:

A dentist who had had multiple affairs and other forms of sexual acting out, had sex with a fellow patient during inpatient treatment for sex addiction. He phoned his wife and told her about this. He reported that it ended the marriage. “She was very angry. I wish I had told her in person, with the counselor present.”

Adverse experiences were also reported by partners who received disclosures of significant sexual activities during a therapy session at the inpatient facility and were then left to process the news alone and were not provided with referrals for follow-up back home:

Public disclosure : Helping professionals are often prominent in their communities. Especially in small towns, the disclosure and its aftermath are played out in the public arena. The wife of the professional may be seen as an accessory to the misconduct. A 49-year old health professional who had been married to a clergyman reported:

Partial or sequential disclosure: Our results suggested that it is tempting for an unfaithful partner to attempt “damage control” by revealing only some information initially. The adverse effects of staggered disclosure were described by several partners. One woman wrote of her feelings after her husband lost his job because of sexual misconduct:

A man who was sent to prison as a consequence of his sexual behavior disclosed to his wife only some of his activities. She wrote:

Positive outcomes of disclosure

Both addicts and partners reported significant positive aspects of disclosure. Honesty, an end to denial, and hope for the future were recurrent themes mentioned by addicts. Partners described the main positive outcomes to disclosure as clarity and validation, and hope for the future:

The responses of Group B, now separated or divorced, were similar. A career woman, now divorced, wrote:

How important is it to disclose to your partner?

The survey asked addicts and partners whether they felt at the time that disclosure was the right thing to do, and how they feel about it now. At the time, 44 (57.9% of the addicts in Group A felt it was definitely or probably the right thing to do, but significantly more, 73 (96.1%) felt that way at the time of the survey (P<0.01). Nine (11.8%) of the addicts felt at the time that it was probably or certainly wrong, compared with only 1 (1.3%) of the addicts at the time of the survey.

In contrast, despite the pain of experiencing disclosure, a large majority of partners (81.3%) felt it was a right thing, even at the time, and this proportion increased even further with the passage of time (93%), although the difference was not statistically significant. Significantly more partners than addicts (p<.01) initially believed in the rightness of disclosure, but at the time of the survey, the difference between addicts and partners was no longer significant.

Among addicts who thought it was important to disclose, the primary reasons for this belief were that it was essential for one's own recovery, that the partner deserved and needed to know, that truth was needed for the couple relationship to be healthy, and that it was important because there were health and safety considerations.

Among partners who recommended disclosure, the chief reasons were that the offending partner needs honesty to begin healing and reduce the shame and guilt felt; the partner need to know in order to assess her health risk, to be able to make informed choices about the future, and to obtain validation.

Even among those who eventually divorced, the consensus was in favor of disclosure. A woman who is now divorced stated:

When asked, "Would you recommend disclosure to other couples?" 71% of the addicts in Group A and 82.7% of the partners said definitely or probably yes. The responses for Group B were similar despite the demise of their marriages: 65% of the 20 addicts and 87.5% of the 16 partners said definitely or probably yes.

Several partners felt strongly that in cases where the offending spouse is already in treatment or in counseling and is advised to disclose, consideration should be given to providing the partner with support to handle the disclosure.

Suggestions to therapists regarding the circumstances of the disclosure are beyond the scope of this paper and will be addressed elsewhere. Disclosure is often the crisis that brings a couple to therapy, but in those cases in which the disclosure can be planned, the needs of the partner should not be forgotten. Partners of sexually compulsive persons need peer and professional support during the disclosure process.

Discussion

The choice of study subjects

This study is based on the responses of a specific population -- persons recovering from compulsive or addictive sexual disorders and their partners, about half of them licensed professionals. This population comprises only a minority of persons who engage in extramarital affairs. It is, however, a useful population for studying the outcome of disclosure. The reason is that before they experience sufficient adverse consequences to bring them to treatment, such persons are likely to have had a long history of extramarital sexual activities and of lying to their partner. Disclosure is likely to be particularly painful. The results of the study relate only to this population and may not be generalizable to all couples dealing with infidelity.

Although only 24% of the sample were licensed health professionals, another 21% were regulated professionals. Although we did not inquire about educational level, in an earlier survey of a similar group of 142 recovering sex addicts and their partners (Schneider & Schneider, 1996), 42% of the men and 23% of the women held a graduate degree, and an additional 31% of men and 36% of women had completed four years of college. The present group, as well, is likely to be highly educated. In reviewing the individual survey responses for the present study, there was no suggestion of any significant differences in responses related to specific careers, so we chose not to subdivide the sample.

Disclosure: The threat and the reality

Confrontation and denial were recurrent themes in the relationship of these couples, resulting in a pattern of dishonesty by the addict and distrust by the spouse, which subsequently made it difficult for the partner to forgive and for trust to be restored.

Disclosure of an affair or other extramarital sexual activity is often delayed because of fears of the partner's reaction, specifically, the fear that the partner will leave the relationship. Although the partners in this survey often described their reactions to the disclosure in terms of despair, devastation, and hopelessness, and although most initially considered ending the relationship, most chose to stay and to work it through.

The authors found that threats of leaving the relationship, a common expression of anger, are a frequent initial reaction by the partner to disclosure of extramarital sexual behavior: 60.3% of spouses stated they had threatened or considered leaving, and 51.3% of addicts reported that they knew of such threats or feelings by the betrayed partner. However, only one-quarter of partners actually followed through on their threats with separation. An interesting finding was that

among those partners who ultimately stayed, there was no difference in the percent who threatened to leave (60.3%) compared to the percent among those who eventually did separate or divorce (62.5%). Thus, threatening to leave after receiving a disclosure is very common and is not a predictor of the eventual end of the marriage.

Initially, adverse consequences were inevitable. Addicts whose partners had threatened to leave "if I find out you had an affair" were fearful of the loss of the relationship. Many addicts reported feeling shame and loss of self-esteem at the time of disclosure. Both members of the couple reported significant emotional consequences. Many partners were angry, as reflected in their threats to exit the marriage. However, most of those who threatened did not actually leave, either because one or both partners went into counseling or other treatment, or because the consequences of leaving appeared to outweigh those of remaining in the relationship.

Most of the partners (81.3%) felt right from the time of the initial disclosure that the disclosure had been a good thing. A smaller majority of the addicts (57.9%) felt this way at the time of disclosure, but many more (96.1%) came around to this point of view after the passage of time. The majority of both groups (71% of addicts and 82.7% of partners) recommended disclosure to other couples. Addicts favored disclosure because it represented hope for the future, an end to denial, and a chance to come clean and put an end to secret keeping. Partners recommended receiving the disclosure because it provided validation for their perceptions and suspicions, which had frequently been discounted by the addict, because it provided hope for the future, and because it often led to a shift in focus from the addict’s needs to their own. Both groups believed that honesty is an important healing characteristics, both for each of them and for the couple relationship.

Because the study subjects was not a random sample of all persons and partners of persons with addictive or compulsive sexual disorders, this study cannot assess the statistical probability that a couple will separate or divorce following disclosure of the sexual acting out. This is clearly the chief limitation of this study. However, the value of the particular study population selected is that the betrayal and lying involved was generally more egregious, longer-lasting, and involved more offenses than relationships in which disclosure of only one or two affairs was the issue. If such couples can work through the issues of restoring trust, forgiveness, and getting the marriage back on track, then other couples for whom addiction and recurrent betrayal is not present might be expected to recover with less difficulty. The experience of the couples reported here can provide valuable information for therapists who counsel all couples about disclosure.

A factor which is both a strength and limitation of this study is that the couples were sampled at varying times in the course of recovery from the betrayal and disclosure. The time period from the relationship crisis to the time of completion of the survey varied from a few weeks to many years. Many of these couples were still in the process of working through the consequences of the betrayal. The study therefore provides a cross-section of the recovery process. We do not know, for example, how many of the couples who were separated at the time of the survey will ultimately reconcile, nor how many of the couples who are together will eventually separate.

Concerns of Women Sex Addicts

Because of the small number of female sex addicts among the survey population, this study could not address the special concerns of disclosure for this group. We may hypothesize that some of these women may not disclose because of realistic fears of violence, either to themselves or their sexual partner(s). Schneider and Schneider (1990c) surveyed several husbands of recovering female sex addicts and learned that it was common for these men to fantasize harming others, and some reported destroying furniture and other objects in anger. Before a therapist recommends disclosure to any client, an assessment of the client’s subsequent safety needs to be carried out.

Implications for sexually exploitative professionals and their spouses

In any marriage, disclosure of infidelity by one person creates an immediate personal crisis for the other. As the respondents of this survey indicated, however, the partners of sexually exploitative professionals have additional factors to contend with. The professional’s misconduct is often made public, and the spouse’s reaction is closely observed -- by the professional’s patients or clients, by the congregation, or by the public. It is traditional for the wife to “stand by her man” in such situations. The professional’s wife typically plays out this scenario no matter what her inner turmoil. Later she may experience additional anger over having been “forced” to assume this role.

Another factor for professionals’ spouses is often their very real financial dependence on the professional.The professional’s lost income, the cost of psychological assessment and therapy for the misconduct, legal costs of defending against lawsuits arising from the misconduct, and the recent decisions by medical and psychological malpractice insurance carriers to exclude from malpractice coverage the cost of fighting sexual misconduct lawsuits, all may combine to create a financial crisis for the family. It is understandable that many spouses choose to defend the exploitative professional rather than leave, no matter what their feelings.

The sexually exploitative professional’s spouse is often seen by the victim(s), the media, and by the professional’s patients or clients as an extension of the perpetrator rather than as a secondary victim. Spouses of exploitative ministers have related being ostracized by their congregation because of their husbands’ behavior (Legg & Legg, 1995). At the time that the spouse most needs a support system, her community tends to cut her off and isolate her. Her only support, in fact, seems to be her husband.

Faced with the knowledge of her husband’s betrayal, compounded by isolation from the community, the souse’s fears of abandonment from childhood become reactivated at this time. To protect herself, she may view this as the time to fight for the survival of her marriage and her lifestyle by suppressing her own needs, fears, and anger, and actively supporting her husband, rather than asking for the emotional support that she so badly needs. For example, she may be too invested in protecting her husband to be willing to open up and reveal their real problems and marital difficulties, much less her own negative feelings, during family therapy sessions (Irons & Schneider, 1999).

Disclosure is usually a process rather than a one-time event (Schneider et al., 1998). Much of the time, the identified patient does not tell all at first, then comes back to reveal more. In particular, sexually exploitative professionals often initially minimize their misconduct, not only to licensing boards and assessment teams but also to their spouse. When a wife who has publicly supported her husband because she believed in his innocence eventually learns that he continued to lie to her about the allegations after they were made public, her public humiliation and sense of betrayal is compounded, and the healing is that much more difficult.

Early disclosure by the sexually exploitative professional -- and in fact by any person who has been sexually inappropriate -- and a willingness to answer the partner’s questions honestly and provide the information requested are factors that will make it more likely that the relationship will survive the crisis. A therapist can help facilitate this process.

How much to disclose to the partner was discussed in an earlier publication (Schneider et al., 1998). We concluded in that report that “what is most helpful for the restoration of the relationship is for addicts initially to disclose at least the broad outlines of all their significant compulsive sexual activities, rather than holding back some damaging material. However, because early on, the partner tends to want ‘all the details,’ we recommend that the partner discuss with a counselor or therapist what details are really important to know and what the likely effect will be on the partner.” A precaution is in order here: When a sexually exploitative professional has had a sexual relationship with a patient or client, the professional must take care to respect that person’s confidentiality to the largest extent possible during disclosure to the spouse. Information about the patient’s medical diagnosis and personal life is best left out of the disclosure, which should focus instead on the exploitative behaviors. Ideally, the patient’s identity is best kept confidential. In reality, however, if the patient has complained to the professional’s licensing body or to legal authorities, her identity is likely to be known already.

Conclusions

A helping professional who has been involved in sexual misconduct faces both personal and professional crises when the behavior comes to light. Real or potential loss of job, legal difficulties, and exposure in the community are accompanied by the need to disclose to the spouse something about what happened.

Although such disclosure is desirable because it is necessary for healing of the individual and the relationship, it usually precipitates a marital crisis. It is common for people in a committed relationship to threaten to leave should the spouse be unfaithful; fear that such threats will be carried out may prevent an unfaithful married person from disclosing the behaviors.

To determine whether fear of threats to leave are justified, the authors carried out a qualitative outcome study among persons whose extramarital sexual transgressions are usually multiple and often diverse -- those who have a compulsive sexual disorder. These persons have problematic sexual behaviors which are compulsive, are continued despite significant adverse consequences (to health, career, relationship, etc.), and which involve a great deal of the person’s time and attention. An anonymous survey was distributed through therapists and returned by 102 such persons (89% male), and by 94 spouses, partners, or former partners (94.7% female). Approximately a quarter of the respondents were no longer married. In most cases the extramarital sexual activities had been recurrent and long-standing, although secret, so that disclosure was particularly painful to the partners. Additionally, for some respondents, the initial disclosure was in the form of a legal action and was subsequently made public, a situation that had additional consequences for both the perpetrator and the spouse.

Although the respondents in the survey included a broad range of careers, a quarter (24%) of them were licensed health professionals, and 21% were other licensed professionals. The responses of the non-licensed professionals were similar to those of the professionals, so we did not separate out the two groups

A majority (60.2%) of the partners threatened to leave at the time of disclosure. Among persons who were still married when surveyed, only one-quarter (23.4%) of those who threatened actually separated for a time period. Most respondents emphasized that honesty was the foundation for an improved relationship. Based on their experience, the majority of both sexually compulsive persons (68.3%) and partners (81.4%) recommended disclosure to other couples.

Threats to leave are seen as part of a process of coping with disclosure by partners rather than a realistic outcome for most couples in this population. Threats to leave the relationship in the aftermath of affairs or extramarital sexual activities are often not carried out, even when the betrayal has been extensive. Inpatient facilities, and therapists in general, are advised to assist the betrayed partner as well as the compulsive person with the disclosure as part of a process of healing.

Sexually exploitative professionals face particular issues related to the fiduciary nature of their professional relationships and their high status in the community. Consequences of their behavior often involve the humiliation of public exposure, loss of community status, loss of career, and at times loss of freedom. The spouse is expected to publicly support the perpetrator and to keep the family together while the perpetrator is receiving treatment or even is incarcerated. Spouses of sexually exploitative professionals need recognition by treatment professionals that they too need a great deal of support and healing.

References

1. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised . Washington, DC: American Psychiatric Association.
2. Brown, E. M. (1991). Patterns of Infidelity and their Treatment . New York: Brunner-Mazel.
3. Carnes, P J. (1991). Don't all it Love . New York: Bantam.
4. Corley, M. D. & Alvarez, M. (1996). Including children and families in the treatment of individuals with compulsive and addictive sexual disorders. Sexual Addiction & Compulsivity, 3, 69-84.
5. Gabbard, G. O. (1991). Psychodynamics of sexual boundary violations. Psychiatric Annals , 21, 651-655.
6. Gabbard, G. O. & Lester, E. P. (1995). Boundaries and Boundary Violations in Psychoanalysis . New York: Basic Books. Chap 6: Sexual boundary violations.
7. Glass, S. P., & Wright, T. L. (1992). Justifications for extramarital relationships: The association between attitudes, behaviors, and gender. Journal of Sex Research , 29, 361-387.
8. Hatcher, R. A., Stewart, F., Trussell, J., Kowal, D., Guest, F.; Stewart, G. K., and Cates, W. (1990). Contraceptive technology . New York: Irvington Publishers.
9. Irons, R. & Schneider, J. (1999). The Wounded Healer: Addiction-Sensitive Approach to the Sexually Exploitative Professional . New Jersey: Jason Aronson Publishers.
10. Irons, R. & Schneider, J. (1997). "Addictive sexual disorders." In N. S.Miller, (Ed.) The Principles and Practice of Addictions in Psychiatry . pp. 441- 457. New York: W. H. Saunders.
11. Irons, R.R. & Schneider, J.P. (1994). Sexual addiction: significant factor in sexual exploitation by health-care professionals. Sexual Addiction & Compulsivity , 1, 198-214.
12. Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual Behavior in the Human Male . Philadelphia: Saunders.
13. Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual Behavior in the Human Female . Philadelphia: Saunders.
14. Legg, A. & Legg, D. (1995). “The offender’s family.” In Restoring the Soul of the Church , ed. M. Hopkins, and M. Laaser, Minneapolis, MN: Liturgical Press.
15. Moultrup, David J. (1990). Husbands, Wives & Lovers . New York: Guilford Press.
16. O’Neill G., & O’Neill, N. (1972). Open marriage: A new life style for couples . New York: M. Evans.
17. Pittman, F. (1989). Private Lies . New York: W. W. Norton Co.
18. Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S. J., Judd, L. L. & Goodwin, F. K. (1990). Co-morbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. Journal of the American Medical Association , 264, 2511-2518.
19. Rubin, A. M., & Adams, J. R. (1986). Outcomes of sexually open marriages. Journal of Sex Research , 22, 311-319.
20. Schneider, J. P., 1994. Sexual addiction: Controversy in mainstream addiction medicine, diagnosis based on the DSM-III-R, and physician case histories. Sexual Addiction & Compulsivity , 1,17-45, 1994.
21. Schneider, J. (1991). Women sex Addicts and their spouses: Recovery issues. American Journal of Preventive Psychiatry & Neurology , 3, 1-5.
22. Schneider, J.P., Corley, M. D., & Irons, R.R. (1998. Surviving disclosure of infidelity: Results of an international survey of 164 recovering sex addicts and partners. Sexual Addiction & Compulsivity , 5, 189-217.
23. Schneider, J. P. & Schneider, B. H. 1996. Couple recovery from sexual addiction/coaddiction: Results of a survey of 88 marriages. Sexual Addiction & Compulsivity , 3, 111-126.
24. Schneider, J. P. & Schneider, B. H. (1990a). Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives. Journal of Sex and Marital Therapy , 16, 230-250.
25. (1990b). Sexual problems in married couples recovering from sexual addiction and coaddiction. American Journal of Preventive Psychiatry & Neurology , 2, 16-21, 1990.
26. (1990c). Sex, Lies, and Forgiveness: Couples Speaking on Healing from Sexual Addiction . Center City, MN: Hazelden Educational Materials.
27. Schneider, J. P. & Schneider, B. H. (1989). Rebuilding the marriage during recovery from compulsive sexual behavior," Family Relations , 38:288-294.
28. Schwartz, M. F. & Masters, W.H. (1994). Integration of trauma-based, cognitive, behavioral, systemic and addiction approaches for treatment of hypersexual pair-bonding disorder. Sexual Addiction & Compulsivity , 1:57-76.
29. Shaffer, H. (1994). Considering two models of excessive sexual behaviors: Addiction and obsessive-compulsive disorder. Sexual Addiction & Compulsivity , 1, 6- 18.
30. Smedes, L. B. (1984). Forgive & Forget , New York: Pocket Books, Simon & Schuster.
31. Subotnik, R., & Harris, G. (1994). Surviving infidelity . Holbrook, MA: Adams.
32. Tavris, C., & Sadd, S. (1975). The Redbook Report on Female Sexuality . New York: Dell.
33. Thompson, A. P. (1983). Extramarital sex: A review of the research literature. Journal of Sex Research , 19, 1-22.
34. Vaughan, P. (1989). The Monogamy Myth. New York: New Market Press.
35. Wallerstein, J. S., & Blakeslee, S. (1989). Second chances . New York: Ticknor & Fields.

Jennifer P. Schneider M.D., Ph.D. is a physician specializing in internal medicine and addiction medicine at Arizona Community Physicians, 1500 N. Wilmot, Suite B-250, Tucson, AZ 85712. Richard Irons, M.D. is Director of the Addiction Program at Menninger Clinic, 5816 SW 35th St., Topeka KS 66612 ; Deborah Corley, Ph.D. is an addictionist and marriage and family therapist. She is Clinical Director of Sante Center for Healing, 914 Country Club Rd., Argyle, TX 76226.