Gender

Sexual Harassment: Do we have “Larger Problems” to Worry About?

How important is this issue of men getting away with unwanted or humiliating sexual behavior toward women?  I would argue that it has a very long tail.  A New York Times article about the impact of the Access Hollywood tape on couples reported that many women who had been sexually assaulted earlier in life had never told their husbands or anyone else for that matter.  Never, that is, until the so-called locker room talk tape came out. Most people found the talk of uninvited sexual touching and groping to be disturbing.  What caught my attention was that many men and women saw this as a minor issue compared to the larger issues facing the world.
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General

Sex Addiction Insights From Across the Pond: UK vs. US

Sex and porn addiction treatment are alive and well in the UK.  On a recent trip, I met and talked at length with two wonderful colleagues, one in London and one in Edinburgh.  Our two countries approach  sex addiction treatment in much the same way.  But there are differences, things we can learn from one another. Obviously this is not intended as a comprehensive survey but rather as food for thought based on my own observations and questions.  It seems to me that the differences between the approach to sex addiction in the US and the UK fall into (at least) three categories.  There are professional differences, cultural differences, political differences.
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Diagnosis

Therapy-Interfering Behaviors: Crucial, Predictable, and Often Ignored

Therapists, particularly those treating sex addiction and in the addiction field generally, are familiar with therapy-interfering behaviors. Frequent lateness or failing to show up for appointments, fomenting conflict with the therapist, and many other forms of direct and indirect ways of undermining the process.  As with problem behaviors generally, these are maladaptive attempts to solve a problem. I first encountered an analysis of therapy-interfering behaviors in the work of Dr. Marsha M. Linehan.  Dr. Linehan was a pioneer in the treatment of the maladaptive behaviors that characterize borderline personality disorder such as chronic suicidality, chemical and behavioral addictions, and other self-destructive behaviors. Sex addiction therapists, no less than those treating any other maladaptive behavior, do well to make the problem of therapy-interfering behaviors a priority. Dr. Linehan proposed a hierarchy of target behaviors:
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General

Is Trump a Sex Addict?

The temptation to diagnose Donald Trump from a distance is hard to resist.  So I've been sorting through the evidence for and against #Trumpisasexaddict.  And if he's not, then what's wrong with him? I don't know where to start with Trump's sexual indicators and behaviors.  I mean, who buys a beauty pageant?  Actually he bought three of them.  It's like the bad old joke about the gay teenager's wealthy father offering to buy his son Boys Town for graduation.  But let's start with some basics.
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General

Why Isn’t Married Sex “Hot”? And Should it be?

Does married sex really need to imitate porn and sex addiction? If sex in a long-term relationship was, on average, as erotically compelling as other kinds of sexual encounters, then about half of all books, plays and movies and other forms of entertainment would never exist. And that's not even counting the various forms of X-rated cultural products. Certainly many comedians would be out of a job. You may remember Chris Rock's clever riff on this topic: "I've been married for 14 years, and in 14 years I've never had sex! I've had intercourse---sex is something you have in the back of a rented car!" So now in this age of pornified culture there are cottage industries devoted to the goal of making marital sex as erotic and irresistible as it "should" be. The trouble is that thinking sex in a committed, long-term relationship has to be erotically supercharged is utter nonsense.
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Gay-Straight

An Explosive Issue: Are Sexual Behaviors Learned?

The question is not whether our sexually addictive behavior and fantasies are learned, but rather which ones are learned, when they are learned, and which ones are carved in stone? This issue quickly can become radioactive. Talk of any changes in our patients' sexuality brings on accusations that clinicians want to alter people's sexual orientation or fit them into a particular model of sexual health. But the fact that something can be learned or unlearned is just a fact. It does not imply anything about good or bad behavior.
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General

Signs a Sex Addiction is Spiraling out of Control

Addictions tend to grow increasingly serious over time. Sex addiction is no different from other addictions in that it tends to become increasingly severe and all consuming. But sex addicts typically differ from other addicts in that they can appear more normal over a much longer period of time than say, an alcoholic or a drug addict. The damaging affects of substance abuse and other addictions such as food and gambling tend to be more obvious in that the addict shows outward signs of deterioration in health and ability to function in the world. When sex addiction is the primary or only addiction the addict may feel and seem healthy and high functioning for years. The addiction is compartmentalized and the addict can secretly indulge in whatever the addictive behavior is and then return to the "real world" apparently normal. It's all an act of course, but sex addicts can fool others and themselves for a long time. Unless you know what to look for.
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General

Why You Should Stop Calling Sex Addicts “Perpetrators”

People who have been on the receiving end of a sex addict's betrayal, manipulation, lies, and other forms of uncaring and abusive behavior experience serious emotional trauma. Lives are torn apart, children are affected, families are alienated and as if that weren't enough there are often dire health and/or financial consequences. But is any given sex addict really a perpetrator?  A psychopath?  Well, they could be.  And there is no doubt that those around the addict are victimized. Many sex addicts initially seem sociopathic, so the case for approaching all sex addicts as perpetrators is an easy one to make. The only problem is that as a strategy for making things better it's pretty much useless. And potentially harmful to all concerned.
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Diagnosis

Can Anger Kill You?

It seems to be axiomatic that going around harboring feelings of anger is hazardous to your well-being. See for example this extensive list of quotable quotations about the perils of anger and how to handle it. Americans seem to be angrier and more pessimistic than they used to be. But according to a new NBC online poll poorer, non-Hispanic white people are the angriest. They are also the most pessimistic about the prospects for getting ahead in America. The report states: "Very rich Americans earning household incomes above $150,000 were the least angry income bracket. The poorest Americans earning less than $15,000 were the most angry."
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General

“Merry Christmas, I’m a Sex Addict”! When to Tell Your Parents and Family

Although full disclosure to a partner or spouse is considered essential to recovery, telling your parents, your grown up children, your relatives or your in-laws that you are a sex addict can be a good idea or a very bad idea depending on a number of factors. Of the scores of sex addicts I have treated, each one has had a unique situation in confronting the fallout from this question. There are a myriad of possible scenarios but I will attempt a look at some of the key variables involved in this decision.
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