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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:
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.
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.
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.
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.
Many sex addicts don't know how to date. They crave a normal relationship but do not have a realistic picture of what a good relationship might look like - or how to get there. By the same token, they may think they are dating you when what they are actually doing is using their time with you as one of their acting out behaviors. Even for non-addicts the term "dating" is ambiguous and increasingly hard to define in this age of random sexual hook-ups. But the non-addict will be capable of normal courtship while the sex addict will have underlying intimacy issues that prevent them from pursuing a dating situation in a healthy way.
Revelations in recent years as to the extent of sexual assault on campuses, in the military and in other institutional settings has lead to some changes in the idea of what constitutes "consent" to a sexual act. There is increasing recognition that simply failing to say the word "no" does not automatically imply consent in the sense of actual willingness to do the act in question. Hence the new standard that only "yes" means "yes". But does it? It is clear that children and teens who are under the legal age of consent cannot legally (or meaningfully) say "yes" to a sex act. But there are any number of other situations in which agreeing to engage in a sex act may be the product of undue pressure, unequal power, mental abuse or deception.
Reading the statistics on what kinds of pornography people are watching is a little like the proverbial can't-look-away-from-the-car-crash. It is appalling yet fascinating at the same time. It's not recommended reading for the recovering sex addict, but I'll attempt to summarize some of the more interesting bits. Pornhub.com, which is happy to say it is the number 1 porn site in the world, published this exhaustive review of worldwide porn use for 2014.
The opposite of sex addiction is not "healthy" sex. It is a common misconception that what's wrong with sex addicts is that they have "unhealthy" sexual habits and that sex addiction treatment replaces these with "healthy" sexual behaviors.
I have heard this story of treatment failure from many couples who come in to see me about sex addiction. One partner was discovered to have sexually addictive behavior(s) such as porn addiction, voyeurism, hook-ups, paying for sex etc. After an initial upheaval the couple found help for the addict. The addict went into a program which may have included residential or intensive outpatient treatment, individual therapy, couple counseling, or some combination of these. At some point the addict felt that he or she had seen the light and was able to refrain from the compulsive behavior for a period of months or years. Then seemingly out of the blue, the addict starts secretly acting out again.