Categories
Sex Addiction Addictions Family, Friends and Partners Seeking Help

 

For most people, sex addiction is not actually driven by sexual desire but by issues related to intimacy, the need to numb emotional pain, assert control, avoid emotional connection, balance moods or reduce anxiety. It’s a very real and rarely discussed disorder which can have a devastating impact on individuals, relationships and families.

For those of us grappling with sex addiction, it can feel like an overwhelming and unstoppable impulse, and because sex addiction is often hidden from family and friends in a shroud of shame or denial, it has the capacity to endure and escalate over time. 

“People who present for treatment because their lives are in chaos due to problematic sexual behaviours, are suffering in similar ways to an alcoholic or gambling addict who seeks treatment after a ‘rock bottom’,” says Jane O’Keeffe, Holistic Psychologist and Consultant with South Pacific Private.  

However, many people who are struggling with sex addiction do not reach out for help due to secrecy, shame, guilt and fear, which can all feel like insurmountable barriers. These feelings can be compounded if the addiction occurs alongside infidelity or confusion over sexuality and/or gender identity. 

“It is the seeking - the suspense, anticipation, obsessive search for sexual stimulation which ignites many different neural pathways, releasing a cascade of emotions that sex addicts can become addicted to prior to the acting out behaviour,” explains O’Keeffe. “Feelings of remorse, despair, shame are often experienced after acting out and so the addict returns to the preoccupation stage again to block these unpleasant feelings,” she adds. “As the addiction progresses, people will become secretive and lie to conceal the extent of their compulsive behaviour.”

Sometimes described as hypersexuality, porn addiction or sexual compulsive disorder, sex addiction – is actually very common.

Sex addiction is a process addiction, which means people are addicted to a mood-altering experience. A person alters their mood by engaging in behaviour which brings about an obsessive, trance-like state because they are in sexual fantasy,” explains O’Keeffe.

“The typologies can include compulsive consumption of porn, fantasy sex, (compulsive masturbation, intrigue, obsession), voyeurism, spending long hours at strip shows, anonymous sex, cruising behaviour, exhibitionism (eg driving a car with pants down waiting for someone to notice), compulsive paying for sex (including phone and cybersex), frotteurism (non-consensual behaviour of rubbing oneself up against an unsuspecting person), inappropriate sexual talk during a conversation, pain exchange- sex where physical pain is involved and or being humiliated (self or others), illegal behaviour and exploitative sex.”

Seeking help for sex addiction

According to O’Keeffe, it’s important to seek treatment because compulsive sexual behaviour is not healthy sexuality. “It is progressive over time, as are the emotional, financial, social, occupational and cognitive consequences that can accompany addiction,” she says. “Untreated, people can stay in the cycle of addiction for decades. Often, other substances may be involved and depression and anxiety can increase.” 

She says if a person is not emotionally available to themselves, they are not emotionally present to others, including their partners, children, friends and colleagues. “This makes it impossible to have emotional intimacy with others.”

South Pacific Private has pioneered the treatment of sex addiction in Australia. Clients are met by trained therapists who understand addiction and have lived experience. “It’s important to take a multi -faceted approach to treatment. For long-term recovery to occur, one must deal with the presenting issue (sex addiction and other co-occuring symptoms, such as depression, anxiety, or other addictions) as well as underlying issues (developmental trauma),” explains O’Keeffe. 

“Clients receive education about the cycle of sex addiction, including the learning about the neural pathways in the brain involved in the addiction,” she adds. “It is important that they identify their arousal template. To identify this, clients need to specify what their ideal fantasy would look like with the purpose of tracing back to the origins of the original arousal experience. For example, a client who only feels aroused when they are engaging in sex that causes them (or others) physical pain may trace the origins back to being a child who grew up with a violent alcoholic father.”

Partners of people with sex addiction

Those of us who have partners battling sex addiction, will understand the feelings of despair, anger, stress and betrayal. “If infidelity occurs, the breach of trust can create deep despair, a lack of safety and impact on the self esteem and sense of the value for the partner as the sex addict lies or manipulates (gaslights) their partner to enable continued compulsive acting out,” says O’Keeffe. 

As a partner of someone with sex addiction, it is perfectly normal to feel angry, fearful, upset and helpless. It’s important to take time out for self-care and seek help if you’re feeling overwhelmed.

If you’re concerned you or your partner may have a problem with sex addiction, you can schedule a free, confidential, professional phone assessment with our team on 1800 063 332.

Online Self Assessments

Learn more about key indicators of addiction, trauma and mental health conditions by taking an assessment for yourself, or on behalf of a loved-one.

Categories
Addictions Family, Friends and Partners

How Friends and family can support recovery

The family network – whether it be our biological family or chosen family of friends and mentors – is a critical part of everyone’s recovery.

We can help those in recovery by modelling healthy behaviour, providing emotional and social support, and keeping our loved ones accountable throughout their recovery journey. But when relationships are strained, communication is lost or trust has been eroded, we – the support network – can end up feeling hurt, helpless, frustrated, overwhelmed, manipulated, burnt out or isolated. 

Many addicts in recovery cite the pain associated with interpersonal relationship breakdowns as a leading trigger for relapse, says Leanne Schubert from South Pacific Private, Australia’s leading rehab centre for addiction, trauma and mental illness. “Nobody gives you a manual or teaches you at school how to help a friend, partner or relative through addiction or mental illness, so you can be forgiven for feeling like you’re flying blind sometimes,” says Schubert.

Figuring out how to best support a loved one on their journey to recovery can be a complex and difficult process, but you’re not the first person to go through the experience. As those who’ve helped loved ones through addiction and mental health issues before will tell us, sometimes we need guidance on communication and boundary setting skills, and support in our own journey of healing.

“Often the person that comes into treatment feels like they’re the problem, wrong and unworthy, but then they make shifts and attempt to return to the family system who are still there with the person prior to treatment. They are still left with the anger and hurt,” says Schubert. “This is just one of the many reasons we see it as important to involve the family in recovery.”

Those of us who are closest to a person with addiction, trauma or mental health conditions are often drawn into behaving in ways and doing things that we’re conflicted and uncomfortable about. Schubert says it’s extremely common for family members to believe that they are helping their addicted loved one, but, in reality, they are unwittingly enabling the addiction. “The family might be suppressing feelings, accepting excuses, trying to protect them and the family image, justifying their dysfunctional behaviour or lending the person money to get them out of trouble. It comes from a place of love and care, but I’ve worked with many families who haven't set boundaries and it allows the addiction to continue. They often find it challenging to set these boundaries, but it’s important to long-term recovery.”

Healing broken relationships

Our relationship to our family system is complex and in order to heal, it’s important to unravel the elements that do not serve us without laying blame or causing further damage. It’s also important to gain a greater understanding of how we grew up in our family system. “We might not have recognised when we were younger the stressors that were placed on the family system and how we adapted - did we thrive or survive? When a family system is under stress, our needs may not have been met,” says Schubert. “Or perhaps we grew up in a dysfunctional family system where the rules were - don’t talk, don’t trust, don’t feel. We may still be feeling fear or shame from this.” 

At South Pacific Private, many clients find the three-day family program to be one of the most profound and transformational experiences in their recovery process. According to Schubert, to move forward families must learn new ways of relating to each other and communicating effectively. “Here in treatment at South Pacific Private, we encourage families to be functional by sharing how they feel - without anger or casting blame. This helps build intimacy and strengthens the relationships. We want families to be supportive and the client to be successful in recovery.” 

She says approaching conversations with honesty and compassion, and being mindful of language is key. 

South Pacific Private is Australia’s only hospital to integrate a dedicated Family Program within our treatment plans. Our range of workshops and programs dedicated to families, friends and partners are designed to equip everyone with the tools and strategies necessary to set clear and effective boundaries, communicate effectively and to care for your own mental health and resolve prior trauma.

How to seek help

If you or anyone you know needs help:

Online Self Assessments

Learn more about key indicators of addiction, trauma and mental health conditions by taking an assessment for yourself, or on behalf of a loved-one.

Categories
Family, Friends and Partners Trauma

Dealing with the Trauma of Domestic Violence

The impact of domestic and family violence

Those of us who have experienced domestic violence know the life-changing impacts it can have on us and our families. These impacts can extend to depression, anxiety, post-traumatic stresssubstance abuse and addiction. We may spend significant amounts of time in denial, or engaging in self blame, so it’s important to remind ourselves: Everyone has the right to live in a safe environment without fear.

Witnessing or experiencing domestic violence is a form of complex trauma and can trigger a range of emotional and psychological responses in us. If we’re constantly feeling unsafe in our own home or around the people who are supposed to love and care for us, it can lead to many challenging and distressing thoughts and feelings.

We may feel upset, scared, angry, ashamed, anxious or powerless, or we might feel like we’re in a constant state of fight, flight or freeze. We can find ourselves unsure of reality and with twisted perceptions of ourselves. These are all very common responses.

“We often see patients who have had a personal experience of trauma or witnessed domestic violence as a child between their parental figures,” explains Alyssa Lalor, Program Director of South Pacific Private.“Children exposed to violence in the home are especially vulnerable and can experience profound impacts on their physical, psychological and emotional health and wellbeing. Research suggests that the younger the child, the more harmful the traumatic experiences can be in terms of brain development.” 

When we’re in the thick of a domestic violence relationship, it can be difficult to make good judgments and see the reality of the situation clearly, Lalor says. We may be in denial, or we may blame ourselves. “Victims of domestic violence have been systematically programmed to believe that they cannot and will not survive without the abuser,” says Lalor.

Logistical and practical challenges can also present an issue. “They may have no means to support themselves or their children, no safe place to go or be in fear of retribution by the abuser so they are literally stuck,” she says.

Long after the family violence has occurred or after the abusive relationship has ended, we may continue to encounter triggers which leave us reliving experiences and re-experiencing our trauma responses and coping mechanisms. This has the ability to affect other relationships and lead to long-term psychological difficulties. According to Lalor, this is one of the many reasons why it’s important for survivors of domestic violence to seek support to unpack these experiences with a trained clinician.

Survivors of domestic violence may struggle to regulate strong surges of emotions such as fear or shame, here at South Pacific Private we aim to help them learn how to deal with these in a healthy and affirming manner through interpersonal work in our group therapy programs, as well as within our broader therapeutic community,” Lalor says. “Our aim is to help build a victim's sense of self and personal agency and safety by harnessing and growing the belief that they are 'good enough' and worthy of love – and do not deserve to be abused and hurt.”

The signs of coercive control and domestic violence

Domestic violence occurs predominantly between intimate partners, and is often gendered, committed primarily by men against women, but also in same-sex relationships, against children, and against other vulnerable individuals. It is a repeated pattern of behaviour that may include physical acts of violence, sexual abuse, and emotional abuse in intimate or family relationships. It can happen to anyone and be inflicted by anyone, regardless of their religion, culture, sexuality, gender, age or socio-economic status. 

Domestic violence is often also closely tied to a dynamic of coercive control, which refers to a pattern of controlling behaviours that create an unequal power dynamic in a relationship. “These behaviours give the perpetrator power over their partner, making it difficult for them to leave,” says Lalor.

Whether domestic violence is present or not, indicators of coercive control should be bright red warning signs in any relationship. They include:

  • Isolating you from your support system 
  • Monitoring your activity throughout the day 
  • Denying you freedom and autonomy 
  • Gaslighting 
  • Name-calling and putting you down 
  • Limiting access to money 
  • Reinforcing traditional gender roles 
  • Turning your kids against you 
  • Controlling aspects of your health and body 
  • Making jealous accusations 
  • Regulating your sexual relationship 
  • Threatening children or pets 

Getting out of a Domestic violence relationship

Unfortunately, many people feel trapped in their situation, facing both logistical and emotional hurdles. We may fear for our safety, the safety of others or may genuinely feel as if there's no way to address the issue within the relationship, or live without our abuser outside of the relationship. 

In all cases, it’s important for victims to seek support from someone trustworthy, to build outside connections and to start taking steps toward freedom and autonomy, even if they may be small or modest at first. “Sometimes it can feel like a game of chess," Lalor says, "as they start to move pieces of their lives around without being detected to lay the groundwork for more autonomy -- the last thing we want is to set off the abuser."

For more advice, and to reach out for help in ending a domestic violence situation or to seek support for yourself or others in dealing with the trauma:

If you or anyone you know needs help:

Online Self Assessments

Learn more about key indicators of addiction, trauma and mental health conditions by taking an assessment for yourself, or on behalf of a loved-one.

Categories
Family, Friends and Partners Trauma

How to Respond When Someone Discloses Trauma

Knowing what to say

If a family member, friend or even a colleague confides in you by sharing their traumatic experience, it can be difficult to know what to say or how you should respond. 

Watching someone you care for and love struggle with trauma can be extremely difficult. It’s natural to want to take their pain away and support them through this challenging time.

Often a person who has disclosed a traumatic event, whether a recent event or a long time ago, wants to be heard,” says Di Young, senior psychotherapist at Sydney's South Pacific Private, a treatment center with rehab programs dedicated to healing trauma. “It takes courage to tell their story. They will hope that you can sit with their pain, many unfortunately can’t.” 

If this is a new experience for us, our instincts in responding may be off. We might seek to talk too much because we want to ease tension, or seek to minimise the experience as a way of avoiding our own distress and discomfort. 

Instead, Di says, we should take a moment to acknowledge the enormous trust placed in us by the person who has made the disclosure. The person sharing their trauma is often looking for validation and empathy, Di says. “They need you to listen and empathise, they need unconditional support and love."

 

Compounding Trauma: What not to say

For those of us with a natural inclination to try to fix things, holding back and just stitting with the moment can be difficult. "When someone tells you something significant about a traumatic experience, what they don’t need is advice-giving," Young says. Even if it's because we're genuinely trying to help, it can often come off as judgmental or minimisation if we offer unprompted advice like "have you tried this?" or "why don’t you do that?" 

Some of the worst responses are those which can compound shame and self-doubt, even if they're well-intentioned. Young says statements such as "you'll get over it", "it wasn't that bad" or "what's wrong with you?" can be particularly damaging. “They're not helpful for the person suffering with a significant mental illness and can actually make things worse,” Young explains.

Even if you hope to encourage an individual to seek professional support and treatment, report an incident to authorities or take another course of action, the first step should always be to listen and empathise. “Only when the person has received an open, non-judgemental response, may they be open to practical support, possible treatment avenues and professional help,” says Young.

While talking about trauma can be painful and upsetting, the support of family and friends is often. Don’t insist on talking if they don’t want to, but if they are open to speaking about their experience or feelings, make sure you're there to listen.

 

 

A wide range of experiences have the capacity to inflict long-term trauma, from sudden, life-threatening events to longer-term, ongoing traumatic experiences, such as recurring abuse or parental neglect. However, any situation that leaves us feeling overwhelmed, desperate and isolated can result in trauma.

Just as physical trauma can leave lasting scars, so too can psychological and emotional trauma. While most of us might experience negative psychological responses following traumatic events, over time we can expect them to fade and disappear. Post-Traumatic Stress Disorder and its more common variant, Complex Post-Traumatic Stress Disorder, are diagnosed when these symptoms persist or intensify for months or begin to interfere with our ability to function normally in our daily lives.

We may feel anxious, upset, numb, sad, agitated or overwhelmed. We may be filled with rage or emotionally-frozen, finding connection and expression near impossible. Often, these symptoms begin immediately or several weeks after a traumatic experience, but sometimes symptoms can take months or years to develop, which can be especially confusing and distressing. 

Take someone like Kate for example – not her real name – who has recently gone through a tough divorce and is now struggling with anxiety and depression. Growing up as the eldest child with a single mum who was an alcoholic, she always felt she had to be the perfect one, keeping it all together.

When her marriage ended, it triggered all her feelings from childhood – the shame, the sense of failure, that nagging feeling that something was wrong with her and she was responsible for it all. "More complex cases of long-running trauma like that can have a very significant impact on people's lives," young says.

Australia’s Leading Treatment Centre

Cutting-edge treatment for addiction, trauma and mental health.

Categories
Addictions Family, Friends and Partners Seeking Help

‘We Need to Talk’: Raising Addiction Treatment Options with a Loved One

A guide to raising addiction treatment

Having a friend, family member or loved one who’s struggling with addiction can be a uniquely scary, anxious and lonely experience. It’s likely a position you never expected to be in, and for which you find yourself entirely unprepared. 

Many of us will find it daunting to have a conversation broaching the subject of addiction and raising the possiblity of seeking treatment or attending rehab, commonly described as an 'intervention'. We may feel as though we’re intruding, or be fearful of an angry response. But if approached correctly, these conversations can be turning points in the addiction cycle. At the very least, they can help us set healthy boundaries and ensure we are not enabling an addiction. 

Below, experts at Sydney's South Pacific Private treatment center outline 10 tips for maximising your chances of success, and avoiding common pitfalls:

 

1) Center yourself, understand your aims

Make sure you’re clear-eyed about your aims and ensure your approach and responses play a constructive role in achieving that outcome. 

If you enter this conversation in a moment of anger, frustration or stress, things are likely to veer off course. Your loved one may shut down or shut you out before you are able to share your perspective. Similarly, if a person is heavily under the influence, you’re not going to be able to have a productive conversation, so wait for another time. 

Your aim is likely to depend on a few things, including how serious the addiction is, the type of relationship you have with them and whether or not this is the first time you’ve raised the issue:

Aims may include:

  • Letting them know you’re aware of their addiction
  • Helping them understand their behaviour or addiction is escalating
  • Helping them understand the impact of their behaviour
  • Helping them understand the need to seek professional support
  • Setting clear boundaries in your relationship
  • Helping them overcome fear and shame related to seeking support

 

2) Be prepared for a range of outcomes

To help maintain your cool and to ensure your responses are as rational, thoughtful and helpful as possible, you should take a moment to think through the range of responses you may receive. Your loved one may not be ready at all to hear what you have to say, may be gripped by denial and excuses, or might be aware of the issue and open to your support to work through it. 

Think about how you will feel if faced with an angry or distressing response, and plan a few 'go-to' phrases which can de-escalate or pause the conversation. Make sure you have a friend, therapist or healthcare professional you can confide in afterward to debrief and level-set. 

If you find yourself struggling with intense feelings of frustration, anxiety, powerlessness, you should also consider seeking support for yourself as well. One of the first things we teach in our Family Support Workshops is that to be functional support networks, we need to be supported ourselves.

Note: If you’re dependent on the individual for housing or financial support, or if you fear there may be a reasonable risk of violence, you should stop and reach out for help and support first. You might seek advice from the Australian Domestic Violence Hotline on 1800 737 732 or the Kids Helpline (which offers support for anyone under 25) on 1800 459 975. 

 

3) Plan your language, avoid accusations

Broaching a conversation about addiction can be confronting, so it’s important to think carefully about our language to avoid derailing the conversation or veering into argument. Here are some potential ways to broach the subject and keep the conversation moving:

  • “I wanted to check in because I noticed…”
  • “Have you noticed that you’re drinking / using X more than usual?”
  • “When did this start, do you think there was something that prompted it?”
  • “Do you feel like you can stop? Could you try to stop for 48 hours or a week?”
  • “Have you thought about seeking professional help or going to an Alcoholic/Narcotics Anonymous meeting?”
  • “What scares you when you think about stopping / getting clean?”

It’s important that your loved one sees that you are speaking to them in good faith and are not trying to make accusations or guilt-trip them. This risks provoking defensiveness and shutting the conversation down. A great way to frame our speech is to use “I” sentences instead of “you” sentences – to share observations rather than make accusations. 

Say: “I’ve noticed you’ve been drinking more, and I’m concerned about the way it’s impacting the family and our relationship.”
Not: “You’ve become an alcoholic and you’re destroying our family and letting the kids down.”

Say: “I feel like this is getting worse and I worry it’s only going to be harder to stop if we don’t act now.”
Not: “Your behaviour is getting impossible, you can’t function properly and it feels like you’ll never stop this.”

 

4) Engage with compassion

Remember that you’re there for a two-way conversation, not a lecture. Much of your engagement may be geared towards asking questions, listening, responding and demonstrating compassion. People in the grips of addiction can often feel intense shame, unworthiness and hopelessness, take care not to reinforce this in your responses. 

Use phrases like:

  • “I want you to know that I love you, care for you deeply, and want you to get through this.”
  • “I know that you can get through this, I know that even if you feel hopeless and don’t believe it, you can find a way out of this.”
  • “You’re strong enough to get through this, you are loved, and you are worthy of help to work toward a better future.”

 

5) Monitor your responses

As well as listening, you should also be aware of your own responses – both words and body language. Slipping into anger or raised voices isn’t going to help, and may just give your loved one an excuse to shut down. Open body language which leans in to listen and displays no judgment is ideal. Folded arms, scowling and scoffing is to be avoided.

One method of avoiding anger is by redirecting it. As frustrating as your loved one's behaviour may be, remember that you’re angry at the addiction cycle and the substance/behaviour itself, and that your anger is motivated by care for your loved one and how it is hurting them.

Be wary of the temptation to bargain, lecture, cast blame, use guilt or make threats, none of which will be productive. Setting boundaries and outlining consequences for behaviour is important, but we shouldn’t confuse this for threats against a person if they don’t take action.

 

6) Avoid reinforcing roadblocks for recovery

Most people suffering addiction will tell you that fear and shame are often key roadblocks to reaching out for help, so it’s important we don’t reinforce them.

A person may think they can never live without the addiction; they may fear the thoughts and feelings they’ve been numbing with the addiction; they may fear the unknown of a treatment center; and they may fear they will fail. A person may be ashamed of the losses they have sustained through their addiction; they may be ashamed to be labeled an addict; they may be ashamed of letting down others; and they may fear that seeking help makes the problem ‘real’.

Even if you’re frustrated, avoid venting your anger with statements like “I can’t deal with this,” “you’re pathetic,” “you’re a junkie,” “this is hopeless,” or “you’re letting everyone down.”

7) Know the difference between support and enabling 

It’s important to know the difference between supporting a person with an addiction, and supporting the addiction. Making excuses, accepting excuses, minimizing the problem or participating in the addictive behaviour are clear examples of enabling an addict. 

If you’re struggling to articulate your support, or find yourself accused of being unsupportive, try a variation of: “I support you and I support everything I love about you and I will support you seeking help to end this addiction, but I do not support you taking drugs / gambling / etc. I don’t support the impact it is having on our family / relationship / friendship.”

 

8) Have Rehab and support options ready

While a loved one may be tempted to say they can end the addiction on their own, the truth is that professional support is often necessary, especially in resolving underlying issues. Ending substance use can also trigger strong withdrawal symptoms, and a medically supervised detox may be required.

If your loved one gets to a point where they are open to seeking help, it’s important that you can outline their options immediately. Being able to make, agree and act upon a clear plan will be important.

More details about South Pacific Private can be found here, and this link outlines our three-week inpatient program. You and/or your loved one can call us any time on 1800 063 332 or contact us here.

 

9) Offer to participate in recovery

The thought of going to group therapy, a psychologist or an inpatient program alone can be intimidating, so you can offer to participate in some way in your loved one’s recovery plan. 

You might offer to drive them to an AA or NA meeting and have a meal afterward, you might offer to join them for a family or group session with a therapist or to drive them to their inpatient program.

The South Pacific Private residential inpatient program is unique because we embed a participatory family, friends and relationship program within our treatment plan – so if your loved one is admitted, you’ll likely be joining us for a few days as well. We also offer a number of other workshops and sessions for friends, partners and families.

 

10) Keep intervention expectations realistic 

While ideally you’ll at least make some progress toward your goals, you may find yourself spinning your wheels – and you should be prepared for this.

Your loved one may be overwhelmed and need time to process things, in which case you can pause the conversation and offer a breather. If they ask for a delay, it may be an excuse to avoid the issue, but may also be because they need the space to make a decision or feel backed into a corner.

If things are going nowhere, you can end the conversation by asking what options they will consider, and what action they’ll take. If you encounter outright rejection, it may be that they’re just not ready to face reality. There may be little you can do to shift this. 

It’s important for you to understand that you do not own any failure. You are not responsible for any other person’s actions or decisions. No matter how much you love someone or care about them, it’s never enough if they’re not ready for help. Be aware that when gripped by addiction we may say things which are manipulative and hurtful. No matter what happens in your conversation, you should not let the experience make you feel unloved, unworthy or hopeless. 

 

11) Make sure you have support too

Having a loved one gripped by addiction or a mental health issue can put you at risk of unhealthy behaviours as well – including codependency, addiction or anxiety. At such a stressful time, boundaries can be difficult to set, and even more difficult to hold to.

Recognizing the burden addiction can place on loved-ones, South Pacific Private offers a one-day Family Day Program. Being able to speak with professionals and those who have gone through this before can be a deeply rewarding experience. The cost is often completely covered by private health funds and direct payment is also possible. Learn more about support for families at South Pacific Private >>

 

Online Self Assessments

Learn more about key indicators of addiction, trauma and mental health conditions by taking an assessment for yourself, or on behalf of a loved-one.