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Writer's pictureLaney Knowlton

Bridging the Divide Between Treatment of Problematic Sexual Behaviors (PSB), Betrayal Trauma, Relational Counseling, and Sex Therapy

When it comes to the treatment of Problematic Sexual Behaviors (PSB) and Betrayal Trauma, there is a significant divide in the mental health field. Some clinicians approach PSB from a "sex addiction" perspective, while others use a sex therapy model, often rejecting the term "sex addiction" altogether. Despite this division, there is a general consensus that problematic sexual behaviors do exist (Salas, 2019). However, the disconnect between these approaches can lead to challenges in providing comprehensive care, especially when it comes to addressing both PSB and betrayal trauma in primary relationships.


One notable gap is the separation between clinicians who treat individuals struggling with PSB and those who focus on helping people heal from betrayal. Additionally there is a division between those who treat PSB and Betrayal and those who provide traditional couples therapy and sex therapy, which often don’t address either PSB or betrayal trauma directly. What’s needed is an integrative model that bridges these different areas of treatment.


Research in related fields suggests that a holistic approach is crucial when dealing with problematic behaviors. For instance, Gray et al. (2022) found that other problematic behaviors benefit from a comprehensive treatment model, which indicates the need for a similar approach for PSB. The Connected Recovery™ model aims to fill this gap by offering a curriculum that addresses PSB, betrayal trauma, and relational repair—all through a sex-positive lens. This program offers classes and groups for individuals struggling with PSB, those healing from betrayal, and couples working on relational recovery.


At present, very few treatment options exist that integrate all three components—PSB, betrayal trauma, and relational ruptures—within one program. While there are programs that focus on treating PSB, and others that deal with betrayal trauma, it’s rare to find options that combine these elements in an outpatient setting. Adding the principles of sex therapy and maintaining a sex-positive approach helps to reduce shame and may increase the likelihood of long-term recovery.


The inclusion of relational repair is essential, especially when considering how infidelity is a leading cause of divorce. Cross-cultural studies have shown that infidelity is the most common reason for the dissolution of marriages across more than 160 societies (Fincham & May, 2017). For many couples, infidelity represents one of the most traumatic experiences they can face, with profound emotional and psychological consequences (Blunkosky-Shaikh, 2019; Carnes & O’Connor, 2016; Couch et al., 2017).


Research has demonstrated that repeated betrayals only deepen relational trauma (Carnes & O’Connor, 2016), making comprehensive treatment for both the betrayer and the betrayed crucial for healing. The Connected Recovery™ model offers a unique approach by addressing both PSB, Betrayal Trauma, relational counseling, and sex therapy within the same framework, ensuring that both partners receive the support they need. 


In summary, the Connected Recovery™ model offers a comprehensive approach that fills a critical gap in the treatment of PSB, betrayal trauma, and relational repair. By combining these elements with a sex-positive lens, the model aims to reduce shame, promote healing, and increase the likelihood of lasting recovery. This integrated approach is essential for individuals and relationships seeking to heal from the profound impact of PSB and betrayal.


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