Case Illustration: John (age 49) and Mary (age 52)
John
Referred by his therapist
The perfect power couple
Cyber infidelity over a six year period
A text discovered by daughter (age 19)
Together since 1984- 2 kids- son (16) and daughter (19)
History of medically managed bipolar disorder
Shame and guilt
Presented as a customer
Mary
Emotionally devastated by the lies
“I would have done anything he wanted”
History of broken trust- parents, past relationships
Bad relationship with father- went for the wrong guys
Had successful individual treatment
High degree of self-discipline and control
Shattered reality
Done in her absence and her presence!
Dire need to know “why?”
Serious doubts about chances of recovery
Why
Need to be found attractive by women
Sense of inferiority
Sex life “lacking”-cause or result?
Tends to show off
Mary
Strong need to preserve the perfect image
Shattered reality- how do I know what I think I know?
Discovered sexting on her birthday
Business and family on the line
“Why wasn’t I enough for him?”
“How can I ever be safe?”
Treatment
Treatment as a process
Recognition of his efforts
Taught importance of tolerance of her emotional process
Grieving the lost relationship- death of the perfect relationship
Loss of heaven
End of a blind faith trust
New model of trust: evidence based trust
Collaborative reassurance and a limited use of technology
Elimination of secrecy and restriction of privacy
Support and tolerance for anger and emotional dysregulation
How much to share of the gory details?
Coping with triggers
The difference that makes a difference – new behaviors
Acceptance of distance
Gradual increase of affection and growing intimacy
Dealing with triggers:
Radical change in the use of iPhone and social media
Back in bed
Great sex
Kissing
Relapse prevention/speed bumps