Therapeutic Dilemmas in Internet Infidelity Treatment

This art icle was downloaded by: [ Universit y of Nevada Las Vegas] On: 12 March 2014, At : 10: 40 Publisher: Rout ledge I nform a Lt d Regist ered in England and Wales Regist ered Num ber: 1072954 Regist ered office: Mort im er House, 37- 41 Mort im er St reet , London W1T 3JH, UK The American Journal of Family Therapy Publicat ion det ails, including inst ruct ions f or aut hors and subscript ion inf ormat ion: ht t p: / / www. t andf online. com/ loi/ uaf t 20 Therapeutic Dilemmas in Treating Internet Infidelity Kat herine M. Hert lein a a Marriage and Family Therapy Program , Universit y of Nevada , Las Vegas, Nevada, USA Published online: 04 Mar 2011. To cite this article: Kat herine M. 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HERTLEIN Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Marriage and Family Therapy Program, University of Nevada, Las Vegas, Nevada, USA The Internet can be a problematic place for relationship development. As popular as these approaches are, none apprise the therapist of specific dilemmas critical to the outcome of treatment. The purpose of this paper is to outline the therapeutic dilemmas faced by therapists in treating Internet infidelity. It is the first article of its kind to outline the key dilemmas: (a) seven factors that increase a couple’s vulnerability to Internet infidelity, (b) self-of-the-therapist issues, and (c) divisive issues in treatment. A case example demonstrating how to address the dilemmas in a couple experiencing Internet infidelity is included. INTRODUCTION The Internet can be a problematic place for relationship development and couple interaction. Some of the issues associated with problematic Internet usage include greater degrees of uninhibited behavior, addiction, secrecy of online activities, misrepresentation of time spent online, impairment of daily duties, interference of online behavior with the relationship, and altered levels of sexual intimacy with partner (Cooper, Delmonico, & Burg, 2000a; Cooper, Delmonico, & Burg, 2000b; Underwood & Findlay, 2004). For three-quarters of Americans, it is also a place where they locate offline sex partners (Daneback, Månsson, & Ross, 2007). Some of these encounters are between two single individuals while others begin online when one or both partners are already in committed offline relationships. Cybersex relations can significantly disrupt couple functioning and, consequently, may result in separation and /or divorce (Barak & Fisher, 2002; Schneider, 2000). For Address correspondence to Katherine M. Hertlein, Marriage and Family Therapy Program, University of Nevada, Las Vegas, 4505 Maryland Pkwy., Box 453045, Las Vegas, NV 891543045. E-mail: katherine.hertlein@unlv.edu. 162 Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Internet Infidelity Treatment 163 all of these reasons, marriage and family therapists are noting an increase in cases in which technology plays a critical (and potentially detrimental) role in the couple relationship (Goldberg, Peterson, Rosen, & Sara, 2008). As the interest in couples therapy and technology has evolved, there are many published treatment frameworks for Internet infidelity. In general, marriage and family therapists treating Internet infidelity have been found to generally use solution-focused, transgenerational theories, emotionally-focused therapies (Hertlein & Piercy, 2008). Authors such as Maheu and Subotnik (2001), Atwood and Schwartz (2002), and Hertlein and Piercy (2005) have described Internet infidelity treatment from a transgenerational perspective. Gonyea’s (2004) approach also emphasizes differentiation, but also attends to boundaries, relationship secrets, and safety. Whitty and Carr (2005) discuss Internet infidelity treatment from an object-relations perspective. As popular as these approaches are, none apprise the therapist of specific dilemmas critical to the outcome of treatment. The purpose of this paper is to outline the therapeutic dilemmas faced by therapists in treating Internet infidelity. It is the first article of its kind to demonstrate how to attend to these key dilemmas in treatment, including: (a) the seven issues that increase a couple’s vulnerability to Internet infidelity, (b) self-of-the-therapist issues, and (c) divisive issues in treatment. While the scope of this paper is not to present a distinct and separate framework for treating Internet infidelity, it is built on the assumption that the reader will attend to each of these dilemmas within their personal selected theoretical framework. The dilemmas are based on research on online behavior (specifically related to sexuality) designed to shed light on motivations for usage. How a therapist conceptualizes the issues facing the couple will influence the manner in which they incorporate the issues below with their theoretical framework and the empirical evidence on Internet usage and relationships. THERAPEUTIC DILEMMAS IN INTERNET INFIDELITY TREATMENT The Seven As: Vulnerabilities for Internet-Related Intimacy Problems (IRIPs) Vulnerabilities which increase a couple’s likelihood of experiencing Internet infidelity or other Internet-related intimacy problems (IRIPs) have been presented in previous research and include: a lack of connection between partners or limited ability to discuss problems with one’s partner, resulting in searching for something else, and one’s readiness to be in an emotional relationship with someone, and the fear of being oneself. Because these may also be considered vulnerabilities in a couple’s relationship that predispose it to traditional infidelity, others have attempted to determine characteristics germane to the Internet that increase a couple’s vulnerability to IRIPs, of Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 164 K. M. Hertlein which Internet infidelity is one. Hertlein and Stevenson (2010) and Hertlein (manuscript submitted) outline several factors related to IRIPs known as the seven “As.” In general, they state that the Internet is acceptable as a communication device (King, 1999), is very accessible, affordable, and has the ability to render users anonymous (Cooper, 2000; 2002), facilitates an approximation to real-life interactions (Hertlein & Sendak, 2007; Ross & Kauth, 2002; Tikkanen & Ross, 2003), provides ambiguity in defining problematic behavior (Hertlein, 2009b), and allows people varying degrees of accommodation in terms of their real versus ideal (more specifically their “ought”) selves,1 in Higgins (1987) conceptualization of this term (Hertlein, 2009b; Hertlein & Stevenson, 2010). For couple and family therapists, these seven As are true dilemmas in treatment that must be attended to and managed effectively. Hertlein and Piercy (2008) conducted a mixed-method study with a sample of AAMFT clinical members who had seen clients where there was an Internet infidelity concern. While the participants generally believed that Internet infidelity originated, in part, by some deficit within the couple’s relationship, many of them outlined environmental strategies (i.e., moving the computer to another room) to treat the issue. In other words, therapists viewed these cases as a stemming from a process issue, but prescribed treatment focusing on content (the environmental strategies in treatment). While such strategies might be immediately effective in decreasing electronic communication with a third party, they do not address the process issues potentially contributing to the infidelity. Further, used alone, they are unrealistic in treating Internet infidelity because (a) computers and the Internet have countless functions above and beyond communicating with an affair partner, and (b) can be found anywhere and are ingrained in our daily lives. Hence, reducing the vulnerabilities related to Internet infidelity relies on attention to the qualities of the Internet itself as well as the vulnerabilities within the individual participating in the infidelity and within the primary couple’s relationship. The seven As are critical to helping a therapist to attend to both process and content. For example, accessibility may include the extent to which an individual is knowledgeable about the mechanics of a computer. One couple came to treatment because the wife was concerned about her husband online activities. What was especially problematic to her was that she has noticed that he was viewing porn online and trying to hide his activities from her. She believed that he believed he could “get away with it” since he was more knowledgeable about the computer and knew more about accessing certain areas on the computer (content). In addition to the porn viewing, then, was the issue that her partner was actively seeking ways to hide his behavior (process). Other process areas that might need to be assessed within the seven As includes unmet expectations (assumed or explicit) within the relationship, resentments, communication problems, relationship discord, and the couple’s emotional contract (Hertlein, Weeks, & Gambescia, 2008). Internet Infidelity Treatment 165 Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Self-of-the-Therapist Another dilemma is that most of the published frameworks are silent in regard to the self-of-the-therapist issues that are operating in Internet infidelity cases. Issues of sex and infidelity are inherently connected to one’s value system, for both client and therapist. Dated research investigating therapist’s comfort with sexual material in session (which is to some degree related to therapist demographics) related to how pathological they viewed the client (Hecker, Wetchler, Trepper, & Fontaine, 1995; Schover, 1981). Because the influence of such variables and value systems are not always overt, treatment models for Internet infidelity specifically need to ensure that the selfof-therapist is considered at some point in the treatment process. Weeks, Gambescia, and Jenkins (2003) wrote about countertransference reactions of the therapist in treating offline infidelity. The therapist moral beliefs and experiences play a major role in the stance taken by the therapist. This finding has also had some support in online infidelity, as researchers have discovered a therapist’s religiosity sheds the brightest light on how the social background characteristics of therapists influence their treatment. The greater extent to which therapists religiosity therapists identified, the more serious and more damaging they viewed the problem of Internet infidelity (Hertlein & Piercy, 2008). Acknowledging Divisive Issues Nelson, Piercy, and Sprenkle (2005) also conducted a Delphi study on Internet infidelity treatment. After surveying the top therapists who work with infidelity, Nelson and colleagues (2005) found little consensus among the experts on the definition of Internet infidelity treatment, and little consensus regarding treatment strategies. In part, the treatment a therapist prescribes relies on where a therapist places him/herself on certain divisive issues, including holding secrets, structure of sessions, monitoring activities, and what affair details should be shared. Similar to the seven “As” as contributing to engagement in Internet infidelity, treatment should incorporate the divisive issues as well as assessment of how other variables about the therapist or client are operating in assessment and treatment decisions in Internet infidelity cases. MANAGING THE THERAPEUTIC DILEMMAS IN TREATMENT Therapists can attend to the dilemmas discussed earlier in a variety of ways. The attention to these dilemmas is best conceptualized by the multilevel systemic framework offered by the Intersystems approach (Hertlein, Weeks, & Gambescia, 2008) and attends to the contributing factors of Internet infidelity as described by Hertlein and Stevenson (2010). 166 K. M. Hertlein Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Managing Dilemmas Arising in Assessment In addition to the assessment a therapist conducts for their traditional infidelity cases, therapists should also consider the use of key elements of assessment in Internet infidelity cases as provided within the description of the Intersystems approach as described by Hertlein, Weeks, and Gambescia (2008). This framework provides the therapist a structure to attend to five dimensions in a client’s system; individual biological, individual psychological, dyadic, family-of-origin, and sociocultural.2 This approach has been applied to a variety of sexual functioning issues such as erectile dysfunction (Weeks & Gambescia, 2000), hypoactive sexual desire disorder (Weeks & Gambescia, 2002), sexual addiction (Turner, 2009), vaginismus and dyspareunia (Meana, 2009), and infidelity (Weeks, Gambescia, & Jenkins, 2003). Attending to the dilemmas in cases with Internet infidelity occurs in two basic ways. First, the therapist attends to the factors about the individual, couple, and context toward learning about how the vulnerabilities manifested within this case. This includes asking about personality issues, individual desires, the couple relationship, and extended family issues. For example, people whose personalities dictate a strong desire for anonymity (one of the vulnerabilities that contribute to the development of an online affair) may be satiated during online interactions with others, as the extent of the information shared is controlled by the user. In practice, this can be accomplished through using individual sessions within couple treatment (Grant & Crawley, 2001). For example, one may structure the first session as one with both members of the couple, the second session as an individual session with one partner, and the third session with the other individual, and then resume with couple work (Berman, 1982). The second way to use the assessment phase for working with intimacy problems is include the multiple dimensions of infidelity (as described by Weeks, Gambescia, & Jenkins, 2003). This generally includes assessing such factors as the duration of the affair, tracking the development, and so on. As it applies to Internet infidelity, therapists also need to ask about the context in which the Internet behavior develops and is maintained. For example, to what extent is accessibility a factor? Are there times when the partner who is engaged in the online behavior is not participating in their responsibilities or making decisions to spend their time on the Internet rather than time with their partner? Assessment is, of course, an ongoing process throughout treatment. Therapists will likely revisit conclusions drawn regarding how the vulnerabilities, self-of-therapist realizations, and their stance on divisive issues plays out over the course of gaining new information within a case. There are several ways in which the therapist can include all of the relevant concepts in their treatment (see Table 1 for an example of how to integrate all levels). While not the only manner through which a therapist can proceed to Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 TABLE 1 Managing Dilemmas within Internet Infidelity Treatment Dimension Assessment Treatment Accounting for Self-of-Therapist Moving Forward ∗ The Individual Dyadic Family-of-origin Relationship History of intimacy stress/communication avoidance and/or Fear of intimacy; etc; do I handle triangulation in response to anxiety; technology intimacy issues poor communication differently than I would if the problem was offline? Resolving underlying emotions Resentment, issue of power and Connection to a family (depression, anger, resentment, control Communication skills legacy etc.) training Intimacy management Moderating effect of Communication skills Examine your personal family influences; Intimacy training characteristics and biases. developing other Telling the story of the decision BASED ON your responses to ways to be loyal to engage in behavior that questions in Table 2, how do impairs intimacy. you conceptualize each Forgiveness session individual within the What amount of type of relationship? information is helpful for the Should you meet with one or both non-involved spouse to know? partners? Should you hold a secret that one spouse tells you? Should I encourage the How will each person move How has the concept of non-involved spouse to monitor forward from this point? the connection to Accommodation partner’s activities? one’s family of origin How has the couple developed changed? ways to manage the 7As? Acceptability Anxiety management skills Accommodation Triggers Fears preventing change dilemmas within Internet infidelity treatment as described within the manuscript are italicized. Sociocultural Accessibility Anonymity Acceptability Peer group, norms, Approximation Affordability Ambiguity Ambiguity How has the couple developed ways to manage the 7 As? Accommodation 167 Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 168 K. M. Hertlein attend to all of the information, it is one example that a therapist can follow. Essentially, the trigger phase is the where the therapist learns how accessibility, anonymity, and accommodation contribute to the Internet infidelity. It is also the time where the therapist reviews his/her views on how they perceive Internet infidelity and other IRIPs. This is an important element to review over time, as a therapist’s view may change over the course of seeing couples and reading more about the topic. Within the underlying emotions and motivations stage, the therapist addresses the concept of approximation as perhaps an underlying issue. Couple therapy for Internet infidelity is characterized by the discussion around the affordability for the Internet infidelity within the context of the couple relationship as well as addressing any ambiguity regarding the definition of what it means to be unfaithful. This conversation can also continue with other IRIPs as a focus. The therapist also makes decisions on what information they believe it would be helpful for the non-involved partner to know and examines their own biases regarding how they structure the therapy. Reducing Vulnerabilities Toward Internet Infidelity Once triggers are identified, the therapist and couple work together in order to determine ways to intervene when the triggers become realized. For the betrayed partner, the management of triggers might involve working around memories and flashbacks of the discovery or their imagination of the events. Some of these may be related to a computer itself, a Smartphone if that was the device through which the infidelity was carried out, or other hardware which has Internet access. Because the Internet is so widely accessible, the betrayed partner may be triggered many times throughout a day. The therapist can help the client moderate some effects by identifying triggers, as the more specific the trigger, the fewer instances of the trigger will be experienced. For the partner using the Internet, identifying triggers for connecting with the third party as well as developing anxiety management strategies should be included. Therefore, in the treatment stage, the therapist addresses resentment and issues of power and control in the relationship which might contribute to the affair. Part of this involves working to reduce the dissonance between the ideal and real self. Attending to Self-of-Therapist Issues As aforementioned, therapists should be aware of their social background characteristics that might affect their treatment of Internet infidelity cases (Hertlein & Piercy, 2008). Specifically, there are differences in how Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Internet Infidelity Treatment 169 therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity. In some cases, the therapist’s unique insight and value system can be extremely helpful in facilitating change; other times, values can hinder the treatment process. Therapists should therefore reflect on how their own values related to treatment of these cases affects their case conceptualization, both positively and negatively. Reflection can be structured in two broad areas: reflection on the impact of infidelity in one’s personal life and relationships, and reflection of one’s attitudes regarding computers and technology. For example, one common observation in clinical work is that there is a tendency to view someone who has a relationship with someone online as being addicted to either sex/porn or the Internet (Hertlein, 2009a). This misattribution may occur for two reasons. First, one pursuing an electronic relationship with another may spend an inordinate amount of time online, or at the very least an increased amount of time online different as compared to prior to engaging in the activities. Second, as mentioned above, particular behaviors which impair the intimacy between members of a couple may be characterized by ambiguity and not necessarily agreed on by the couple. For example, one partner may define the other’s viewing of Internet porn as a problem or breach of the relationship contract in terms of fidelity, whereas other couples may view this as one partner having a sex addiction, and still even others may not define this as problematic at all. The ambiguity results in difficulty in case conceptualization and determining to what extent the behavior in question is an addiction or another issue. See Table 2 for specific sample questions attending to each of the relevant dimensions. Managing Divisive Issues Throughout Table 1, specific strategies are listed for when and how to address the divisive issues from Nelson and colleagues’ (2005) research. For example, in the phase of treatment where the therapist is working with the couple on communication skills and intimacy training, the therapist should reflect on their personal perspective about the type of information believed to be helpful for the couple (see Table 1). Another element of managing divisive issues is to work with the couple to come to some agreement on when Internet usage begins to lead to an IRIP. In some cases, the criteria by which Internet usage interferes with the couple’s relationship may change based on the state of the couple’s relationship (for example, a breakdown of trust in the couple may result in behaviors that were not considered intimacy-impairing at one time to be so). In this phase of treatment, the therapist works with the couple to develop clear goals and expectations for their relationship, with attention to the divisive issues help the couple Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 170 TABLE 2 Sample Self-of-Therapist Assessment Questions Dimension Individual Values and Feelings Related to Infidelity How did your own infidelity impact you negatively, if at all? How did it impact you positively, if at all? Values and Feelings Related to Technology How do you believe technology/Internet helps people? How do you believe technology/Internet affects people negatively? Dyadic Family-of-origin Sociocultural How did infidelity within What are your views and beliefs about infidelity your parent’s in general? relationship impact you negatively, if at all? How did it impact you positively, if at all? What was the role of the What is the role of How do you believe Internet/ technology in technology use in technology/Internet facilitates your family of origin? relationships? society? How do you believe According to society and technology/ Internet hinders cultural, what are couple relationships? expected uses? Inappropriate uses? How did your partner’s infidelity impact you negatively, if at all? How did it impact you positively, if at all? Internet Infidelity Treatment 171 establish boundaries, feel safe within the relationship, and begin to build more satisfying relationship. Downloaded by [University of Nevada Las Vegas] at 10:40 12 March 2014 Developing a Plan to Move Forward Once the therapist has a good handle on the couple’s vulnerabilities, dilemmas, and has outlined a treatment plan that addresses the dilemmas, the therapist works with the couple to consolidate their treatment as a way to highlight and punctuate the changes they have made. In this way, the couple embarks on redefining themselves in a context that is supported by technology rather than impaired by it. In some cases, the plan to move forward can incorporate the positive aspects of technology and the Internet to enhance the relationship. Some ways include having the couple send emails to each other if they have not already done so. If the couple is already sending emails to one another, the therapist works with the couple to develop ways to create emails that are romantic and build on the couple’s personal strengths. The therapist can also find was to chat with each other online and use the Internet as a medium for seeking out relationship-enhancing information (Hertlein, 2008). CONCLUSION As the Internet becomes increasingly available across settings and demographic groups, couple and family therapists will have to be knowledgeable about the pertinent issues facing these couples and develop a treatment strategy that addressing the betrayal component in other forms of infidelity as well as the aspects specific to Internet Infidelity. Acknowledging the dilemmas inherent in treating Internet infidelity forces the therapist to be more comprehensive in their assessment and treatment. The strategies outlined for managing dilemmas has enough structure to be able to serve as a basis for outlining specific and unique issues in treating internet infidelity, but is also flexible enough to allow therapists to use their personal theoretical framework. NOTES 1. In other words, one has a vision of how they want to act (their ideal self), but have thoughts and desires (their real self) which may contradict the vision of the real self. 2. 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