Archives for Treatment
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.
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 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.
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.
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.
In the world of science denial, the attempt to deny the existence of sex and porn addiction occupies a special place. Although a large and growing body of science demonstrates the reality of porn and sex addiction, the barrage of assaults continues in the form of weaponized research and ideological demonization. Even among many who accept the reality of behavioral addictions generally, such as food, shopping, exercise and gambling, the idea of sex and porn addiction is seen as a bridge too far. What are the motivations for such powerful reactions?
Many people manage to get free of their addictions or mature out of them on their own, but other people require help. And for those who require help, psychotherapy alone is often insufficient. On the most basic level, it is simply not possible to conduct a counseling session with a person who is using drugs as a primary coping mechanism. This includes those who rely heavily on sexual acting out, pornography, gambling and other behavioral addictions as ways to escape. Therapy can help people grow, gain self-efficacy and adopt healthier coping mechanisms through insight, awareness and working through old pain. But if you have ever tried to counsel someone who is actively using a drug you were probably humbled by the realization that you have nothing to offer that even comes close to their drug's awesome power to relieve pain and relieve it now.
As with any addiction, the denial of sex addiction is a powerful obstacle to recovery. Sex addiction recovery has been described as a grief process. When we let go of an addictive drug or behavior we are letting go of a coping skill that has served us well in the past. This is a major loss. The addiction is like an old friend, often one we have relied on our whole life to deal with stress and escape negative feelings.
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.