Questionnaire

 Treatment Needs of Partners of Sex Addicts:
Partners’ Experiences in Treatment/Therapy

Questionnaire

As part of our Treatment Needs of Partners of Sex Addicts Seminar, we are interested in hearing your voice and want to give you the opportunity to be heard. This is a chance to have professionals hear about your experiences in treatment ‐ good or bad ‐ so that we can all learn from them and improve treatment for Partners and Spouses.

You can participate by answering the following questions:

1. Describe your experiences in therapy / treatment that have been helpful, positive, and supportive to you. Please specify whether or not the treatment provider was a sex addiction / compulsivity specialist. Describe your experience in as much detail as possible, including details on the tools or treatment that were most helpful and your feelings about it. Use as much space as necessary.

2. Describe experiences in therapy / treatment that have been unhelpful, negative, or even harmful to you. Please specify whether or not the treatment provider was a sex addiction / compulsivity specialist. Describe in as much detail as possible, including details on what happened, what was the most problematic issue for you and your feelings about it. Use as much space as necessary.

3. What is the most important message that you would like treatment professionals to know about your needs as  a  Partner of a sex addict? Use as much space as necessary.

During the Seminar we will have an Open Forum session. The purpose of the session is to provide a safe place for you to share your answers to these questions, speak freely about your experiences and ask questions of professionals. We invite you to bring this questionnaire to the session and read your answers directly, ask someone else to read them for you (anonymously), or just share them with the professionals privately.

 

This seminar is sponsored by:

Safe Passages Counseling ‐ Barbara Steffens PhD, LPCC (co‐author of Your Sexually Addicted Spouse)

Healing & Hope Psychotherapy Services ‐ Silvia Jason, LMFT, CSAT

The Institute of Sexual Health ‐ Omar Minwalla, PsyD, Clinical Director

SerenityWorks Life‐Coaching ‐ Dorit Reichental, CPCC, PCC

Treatment Needs of Partners of Sex Addicts:

Partners’ Experiences in Treatment/Therapy

Additional questions:

1. What is your sex?

______ Male

______ Female

2. What is your race / ethnicity?

______ White/Caucasian

______ Black/African‐American

______ Hispanic/Latino

______ Asian‐American

______ Other _______________________

3. How old are you?______ Years

4. What is your marital status?

______ Single

______ Married if yes ______ Years

______ Living together if yes ______ Years

______ Separated

______ Divorced

______ Widowed

5. Do you have children?

______ Yes

______ No

If YES:How Many?: ______ 

What are their ages?: ____, ____, ____, ____, ____, ___

6. What is your annual household income?

______ < $20,000

______ $20,001‐40,000

______ $40,001‐60,000

______ $60,001‐80,000

______ $80,001‐100,000

______ $100,001+

7. What is the highest level of education you completed?

______ Less than High School

______ High School Diploma or GED

______ Some College

______ College Degree

______ Graduate Degree Specify _______________

8. How long have you known about your partner’s sex addiction / compulsion?

____ Months / years

9. Is your partner currently in any kind of treatment / therapy for sexual addiction / compulsivity?

______ Yes

______ No

If YES:

For how long? ____ Months / years

Please briefly describe the treatment.

10. Are you currently in any kind of treatment / therapy?

______ Yes

______ No

If YES:

For how long? ____ Months / years

Please briefly describe the treatment.