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.
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.
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.
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.
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.
At the recent CSAT convention in February the emphasis was on partners and couples recovering from the posttraumatic stress of sex addiction. The numerous lectures covered a wide range of topics, but several things stood out to me. What follows are some snippets I gleaned which are by no means meant to address betrayal trauma as a whole or the many issues involved in disclosure, assessment and treatment. Rather they are suggestions regarding some of the relevant risk factors and healing strategies.
I chose the metaphor of fake fruit to describe the recent article by Prause and Pfaus entitled Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction. I did this not because of any phallic symbolism with bananas but because the authors present fake conclusions. Published in the online journal Sexual Medicine (04/2015; DOI: 10.1002/sm2.58) this article appears to offer a synthesis of findings from Prause's prior attempts at porn research. On closer inspection the article turns out to be lacking in any real substance.
The mother of a 15 year old boy recently reached out to one of my colleagues for advice regarding her son's seemingly out-of-control preoccupation with kinky sex and highly sadistic pornography. (This boy was described as bright, poopular and high functioning). The response among my fellow clinicians was mixed.
I am impressed with the fact that men, the same men who are reluctant to have any fears or vulnerabilities, are all but obsessed with one persistent insecurity: their sexual potency. Normal men seem to be just this side of having a body dysmorphic disorder about their penis size and experience performance anxiety that is crippling enough to make them take ED drugs when they don't need them. A recent NYTimes.com article (1/25/15) reported the data on men's Google searches which found that men make more Google searches about their penises than about any other body part, more than about their lungs, liver, feet , ears, nose, throat and brain combined.