How To Start And Sustain FSLA Group - Web
13th ANNUAL IITAP SYMPOSIUMHow to Start and Sustain aSuccessful Therapy Group forFemale Sex and Love AddictsStaci Sprout, LICSW, CSATInternational Institute of Trauma and Addiction Professionals (IIITAP)Symposium, May 5, 2018 from 4:00pm-5:30pmWhy am I interested in this topic? I am a cisgender recovered female sex and love addict who started recovery in2001. Between then through now, I have never been able to find a safe group of women torecover with in a therapeutic setting that appropriately addressed sex and love addiction.(Be the change) I earned my CSAT in 2006-2007 after being hired at a sex addiction/sex offender treatmentclinic near Seattle, WA. I started my first therapy group for FSLAs at that clinic in 2007. The materials I had seemed designed by men for men in inpatient care;needed adaptations and new materials for FSLAs in outpatient setting.* 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMMy inspirations Three pioneers whosefoundational work pavedthe way for FSLAidentification and care Marnie C. Ferree,M.A., LMFT, CSAT Kelly McDaniel LPC,NCC, CSAT Alexandra Katehakis,Ph.D., LMFTAnd many more!Publishing my memoir of sex addictionrecovery drew women to my practice Naked in Public: A Memoir ofRecovery From Sex Addiction andOther Temporary Insanitiespublished in 2015 More inquiries, more interest,request to start a group Created three levels of groupcare for female sex and loveaddicts: beginner, intermediate,and advanced More info on my website aboutmy clinical program:www.stacisprout.com 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMPresentation Outline*1. Why is group therapy important for FSLA’s?2. How are FSLA’s different from male sex addicts, females who arenot sex/love addicted, and partners of sex addicts?3. What are seven common barriers to FSLA Groups?4. FSLA attachment wounds and how that shows up for therapists5. Best group structure and clinical options6. Screening potential group members7. Why it’s worth it *For my limitations, I ask for your understanding, forgiveness and helpWhat Is “Group Psychotherapy”? “Group psychotherapy” is formally acknowledged asbeginning in 1906 by J.H. Pratt with TB patients Group therapy increased after World War II with combatveterans, demonstrating the success of peer-to-peersharing of traumatic war experiences 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMFemale Sex/Love Addicts as “Soldiers” Female sex and love addicts may relate to “a lifeexperience of neglect, subjectation and trauma”that could be described as a prolonged sexual andemotional combat zone.--adapted quote from Judith Herman, MD,Trauma and Recovery This is a population of “soldiers.” FLSA Group can be their “homecoming” and their first realfeeling that they are not alone and the war is over.Group as an Experience of Tribal “PrimarySatisfaction” Relapse Prevention"For thousands of years we were nourished by being members of acommunity, gathering around the fire, hearing the stories of the elders,feeling supported during times of loss and grief, offering gratitude,singing together, sharing meals at night and our dreams in themorning. I call these activities “primary satisfactions.” We are hardwired to want them, but few of us receive them.In their absence we turn to secondary satisfactions: rank, privilege,wealth, status — or, on the shadow side, addictions. The problem withthese secondary satisfactions is that we can never get enough ofthem. We always want more. But once we find our primarysatisfactions, we don’t want much else."--Francis Weller, MFT 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMWhat Distinguishes a FSLA Group from aMen’s SA Group?PER a LITERATURE REVIEW (McKeague, 2014): More childhood trauma and damage from ruptures andattachment failures More frequent, more severe childhood sexual abuse than men More likely to have PTSD Shame is compounded by negative cultural messages* Acting out behaviors are more often relationally motivated Trifecta: Childhood trauma, depression, and substance abuse More likely to engage in “kinky” behaviors (BDSM, legalexhibitionism) than menThe Fully Fired Female Brain!PER MY EXPERIENCE: More initial reactivity/tumult, yet once safety is established and intimacyskills are practiced: deeper bonding, vulnerability, and pro-attachmentbehaviors both inside and outside group than my men’s groups were ableto achieve Harvard psychiatrist Dr. Louanne Brizendine’s capacity theory on TheFemale Brain validates this experience – great summary in book LesbianLove Addiction by Lauren D. Costine, PhD Confounding factors – more experience/research needed 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMBarriers to Successful FLSA Groups1. Not enough FSLA clients to get a critical mass for group2. Do not have good clinical materials to offer a group3. Not enough time to create/sustain a group4. Women in different stages of their recovery don’t mixwell5. Not sure what structure to use for group6. Challenging population to treat7. Want a female CSAT to run the groupNo Critical Mass: Should you combineFSLA’s with women who are not SLA’s?Per the Women’s Sexuality Survey (Corley & Delmonico, 2011), compared tonon-FLSA’s, FSLA’s report More Shame More feelings of degradation Higher levels of powerlessness More compromised values from acting out Greater problems with life/responsibilities FSLA’s who self-report of more cybersex behavior correlated with moresevere Depression Withdrawal Use of abusive pornography/fantasies to feel aroused 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMDo What Works!Setting the Group Culture: The wisdomof the indigenous culturesIn many indigenous cultures, it is the job ofthe community to impress upon theindividual that they are somebody worthy ofwelcome. We’ve completely turned thataround in our culture where it’s up to me toprove to the community.--Francis Weller 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMGroup room as comforting ritual space Tissue Tea/Coffee Lighting Colors Seating Blankets – 1 per group member! Stuffed animal(s) Temperature Quiet and privateQuestions? 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMFSLA Attachment Woundsand Impact on TherapyGroup DevelopmentWounds from Mom: “Mother Hunger” andImpact on Therapy GroupsPioneering work by Kelly McDaniel on FSLAs (2009 – 2011): Research study of 60 women, 30 identified as sex addicts, 30 identified aslove addicts. The majority of female sex addicts reported NO attachmentto their mothers (25/30), and were more avoidant. The female love addicts reported some attachment – anxious/insecure –with their mothers. These insecurity/avoidance/ambivalence dynamics will most likely play outwith the therapist, and it takes energy and support to stay calm, caring andkeep appropriate boundaries. 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMWounds from Dad: Sexualized Gaze,Energy, and Sexually Abusive Touch Distorted attachment by fathers play a key role in the development of sexaddiction (Ferree, 2010; McDaniel, 2008; NCSAC, 2002; Opitz et al, 2009) Emotional Incest/Surrogate Spouse/Other Woman Dynamics Covert Incest/Attractions Contact Sexual Abuse “Exposure to pornography was a stronger predictorof hypersexual behavior than sexual abuse as achild” Childhood porn exposure IS sexual abuse Other forms of sexual exploitation Extreme Abuse 101, You TubeDistortions and Lies ofFamily/Culture Lead toLies to Self 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMTHE Female SexAddict LIE:I define myselfthroughindependence; Idon’t need anyone, Iam confident, I amsexy. Other womenare competition. Hurtdoesn’t hurt.THE Female LoveAddict LIE:I want and needromantic attentionfrom a man/womanto feel good. Womenfriends aren’timportant to me. Theirattention doesn’tmatter. 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMWhat Insecure Attachment Looks Likein Therapy Groups Late to group Cancelling appointments, lastminute Ghosting: no show to group withoutexplanation (‘til later) Calling frequently outside of grouptime, needing lots of extra time, butwon’t schedule 1:1 Not replying for long periods Maintaining tension in relationship Apologizing, but not changingbehavior – no true repairDealing with a Challenging Population:Screening for Readiness Identity as an addict or person with a problem and hope for a solution Has defined “sobriety” and has support to work on it Evaluate the BIG 4: Safety (Depression/Self-Harm/Suicidality) Alcohol/Drug Addiction Eating Disorders Attachment Reactivity in Group (BPD) 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMEarly FSLA Recovery and DBT“We offer DBT groups for women and as itturns out the entire group will often be FSLA.So, we only use clinicians for those groupsthat are trained to work with this clientele.”--Answer from 2018 Survey About Female Sex and LoveAddiction (FSLA) GroupsShould you offer sliding scale fees foryour FSLA therapy group?YES, with conditionsNO, not worth it You can afford it Use a reasonable fee soyou don’t have to slide You have clear policy fairlyapplied You use a written contract It’s temporary You rule out financialdisorder prior to grant No quibbling over unfairtreatment Set fee based on whatmarket will bear; lowerthan men’s groups 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMWhat is the best clinical CONTENT* of aFSLA group?“[Women] tend to focus on the relationship and not thetreatment tasks; find ways to use the relationship toincrease motivation to change through secureattachment to you as therapist.”--Women’s Sexuality Survey (Corley & Delmonico, 2011)However: Your ultimate goal is to facilitate intimacybetween group members; you will constantly work to usherthe strongest bonds between group members, not with youand each group member or the group and you.What is the best group clinicalSTRUCTURE?How far along in recovery aremembers?Match level of structure with needs ofmembersPhase 1:NEWCOMERS/IN RELAPSETIME LIMITED (3 – 6 months)SOBRIETY FOCUSED! Higher structure,more tasks, psycho-ed, regularaccountability structure. Contracts re:expectations.Phase 2:GROWING STABILITY/SOBRIETYLONGER TIMESPAN OR OPEN-ENDEDDecrease structure. More conflict(talking boundaries) and practice withintimacy skill-building. Formal tasks ofrecovery (reconciliation).Phase 3:LONG TERM SOBRIETYOPEN-ENDEDMore group self-determination,creative, MORE FLEXIBLE 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMIndividuation through community“So it is the intense engaging with others thatactually does the work of individuation. And thisisn’t such a solitary thing as it’s made out to be.There is a tribe in South Africa, says, ‘I am becausewe are.’ I become myself in the container ofintimacy, in the container of relationship, not in mysolitude.“--Francis Weller 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMWhy go through the challenge ofgetting a group going?“I really am loving it!!!!!! It's the best part of my week. The mostbeautiful thing has been watching the community growbetween the women. They have taken great steps in trust, andbeing there for each other in healthy ways!”--Susan Ward-Moynihan, LMHC, CSAT 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUM 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMMore How-To’s and resources available atwww.stacisprout.com, including: List of books every FSLA clinicianshould read, including me List of ten memoirs written by sexand love addicts or with relatedthemes How to reach FSLA’s and attractthem to your practice How FSLA’s can get more supportoutside group, even with littleavailable locally A copy of group rules for you toadapt Three phases of clinical materialsand structureMore In Depth Instructions about FSLA Groups andMore in Making Advances: A ComprehensiveGuide for Treating Female Sex and Love AddictsChapter 5:Best Practices for GroupTherapybyDeborah Corley, MarnieFeree, Linda Hudson, AlexKatehakis, Jill Vermeire,Sonnee Weedn 2018 IITAP, LLD (All content reprinted with permission of the presenter)
13th ANNUAL IITAP SYMPOSIUMPlease sign up on my mailing list (oremail me) to: A) Receive acopy of the“Women’s PCI”aka the PersonalCare Index B) Join the FSLAClinicalNetworkingGroup 2018 IITAP, LLD (All content reprinted with permission of the presenter)
Emotional Incest/Surrogate Spouse/Other Woman Dynamics Covert Incest/Attractions Contact Sexual Abuse “Exposure to pornography was a stronger predictor of hypersexual behavior than sexual abuse as a child” Childhood porn exposure IS sexual abuse Other forms of sexual
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