Stepping It Up in Treatment

Sex addicts, like many in early addiction recovery, are often highly resistant to the idea of attending 12-step recovery meetings. Their reasons are myriad and usually without merit, though they sure can sound convincing on first listen.

Basically, it boils down to this: individuals who hang out in adult bookstores, cruise local red light districts looking for prostitutes, download hard-core pornography on work computers and masturbate in their office during business hours, post hi-definition photographs of their exposed genitalia on dating websites, and openly announce their extramarital availability on Ashley Madison (with a face photo but without a second thought) are the same folks who become very concerned about being “spotted” at one of “those” meetings.

“What if someone sees me there and thinks I’m a pervert?” they fret. Never mind the fact that these meetings usually take place in churches, school classrooms and local businesses after hours with no neon signs announcing what’s going on. Resistance to change is what it is, and even though sex addicts invite risk when acting out, they are risk averse in terms of being seen in 12-step sexual recovery meetings like SAA, SLAA, SCA, SA, and SRA.

It is therefore up to the addiction therapist, when working with a 12-step-averse client, to bring the themes, neurobiological rewiring, and experience of 12-step recovery into the treatment arena—especially in a group therapy setting. Once the sexual behavior problem has been clearly assessed and client/treatment goals and expectations aligned, sex addiction treatment is well served by the therapist initiating discussions on themes like surrender, feeling out-of-control/powerlessness, developing personal integrity, asking for help, accepting responsibility, turning it over, establishing accountability, etc., all within the framework of cognitive behavioral treatment.

This work can be achieved either as homework or within the sessions themselves—knowing that the individual’s chances of finding and maintaining sexual sobriety will increase, probably significantly, with these themes in place. And should that person later decide to attend 12-step meetings, all the better. In nearly every case, concurrently working in therapy and in a 12-step milieu provides a mutual reinforcing. After all, the social support and shame reduction that occurs in a good “S” meeting strongly mirrors therapeutic goals.

To support client/treatment goals, what follows is an adaptation of steps 4 through 9 (of the 12-steps) into therapeutic tasks specifically designed to address sexually addictive and impulsive sexual behaviors. These six steps are generally referred to as the action steps of recovery, because this is where the addict does most of the actual “work” of understanding, surrendering, and coming to terms with his or her addiction.

These actions are, in recovery parlance, a way of getting right with yourself, with your higher power, and with the world. In steps four and five, the addict deals with his or her own issues; in steps six and seven the addict deals with his or her higher power (God); and steps eight and nine help the addict begin to clean up the wreckage of his or her past interactions with the world at large. A client who diligently and honestly completes these six steps—even within a therapeutic context—is likely to be well along the path toward lasting sexual sobriety.

Adapting the Steps

STEP FOUR: Made a searching and fearless moral inventory of ourselves.
STEP FIVE:
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

All addicts need to take a good look at their side of the street. They need to find out how far off their intended path they may have traveled, and it is imperative that they understand for themselves the role they have played in their behavior choices and the outcome thereof. Sex addicts need to learn that their adult sexual behavior (even if they think no one knows about it) does have an effect on both their lives and the lives of those around them.

Regardless of early life trauma or abuse, sex addicts need to take responsibility for their behavior, accepting that they are not victims of their adult choices (even if those choices were misguided or maladaptive). The client then needs to share that information with another human being, and, in whatever way works for them, with their higher power (God). For clients with the ego-strength for this type of task, sharing that information, especially in a clinical group context, profoundly moves forward the process of behavior change and healing past shame.

Tasks Related to Steps 4 and 5

1)     Have the client write down and bring to therapy a list of people, institutions, and ideas he or she has resentments against, along with the reason (or reasons) for each resentment and an assessment of what part of the client’s life (pride, finances, self-esteem, personal relationships, sexual relationships, etc.) is affected by their anger and disappointments. Then discuss in detail with each example:

  • What the client’s part is in the formation of each resentment
  • What the client could have done differently (if anything) to avoid the event that precipitated the formation of each resentment

2)     Have the client write down and bring to therapy a complete history of his or her problematic sexual behaviors broken down by year, with as much detail as to time, date, person, sexual activity, etc. as possible without using graphic descriptions. Ask the client to list the reasons they have viewed these behaviors as acceptable within their particular life context (married, single, gay, etc.). Then discuss each behavior and rationalization, dissecting them until the client can see and understand:

  • The lies the client has been telling to himself or herself to justify problematic sexual behaviors (denial)
  • How those sexual acting out behaviors are abnormal and/or destructive to both self and others (challenge to denial)

STEP SIX: Were entirely ready to have God remove all these defects of character.
STEP SEVEN:
Humbly asked God to remove our shortcomings.

Steps six and seven are the logical progression from steps four and five. By this point in treatment, the client has a more rounded view of the extent of the behavior problem and his or her role in that problem. Once this is established, the client needs to utilize a larger context for help, support, and change than the self (sheer willpower and/or fear of escalating consequences).

This change begins as the client recognizes and accepts responsibility for the mess that his or her life has become as a direct result of addictive sexual behavior, and becomes willing to identify and work to eliminate the character flaws (arrogant, fearful, judgmental, manipulative, etc.) that have served as the psychological underpinnings of his or her addictive behaviors.

As with steps 2 and 3, it is not necessary (or even useful) to engage clients in lengthy discussions of God/religion/spirituality, as understanding God, per se, is not necessary to successfully engage in the recovery process. All the addict need acknowledge is that he or she needs and will continue to need help—which most often takes the form of other individuals (the therapist, group members, a sponsor, etc.) who are willing to aid in the client’s recovery.

Tasks Related to Steps 6 and 7

1)     Have the client write down and bring to therapy a list of “character defects,” taking particular note of the kind of misguided thinking that supported problematic patterns of sexual behavior. The client’s step 4 inventory (see above) is typically useful in identifying the client’s most glaring character flaws.

2)     Select a few of the client’s more distressing character defects, and discuss regarding each:

  • What it would be like to live without acting on that defect, and whether the client is prepared to do that
  • Interventions the client can utilize when that character defect arises to prevent him or her from going down the same old road of “feeling victimized by XX” and therefore “entitled to YY”

3)     Have the client journal about whether and how well the interventions are working, and what effect the interventions are having on his or her life.

STEP EIGHT: Made a list of all persons we had harmed and became willing to make amends to them all.
STEP NINE:
Made direct amends to such people wherever possible, except when to do so would injure them or others.

To this point, the client has been comfortably ensconced on the therapy couch. But now this individual, armed with a little bit of knowledge about what he or she has done, needs to go out into the world and make amends. Often, the client will be over-eager, ready to run out willy-nilly to “make things right” but lacking the empathy required to not hurt others.

Imagine the damage this person could do without proper guidance! It is very important to slow this client down and make sure he or she understands which amends should be made, and when and how. It is equally important that the client understand which amends should not be made, and why. In other words, it is not acceptable to unburden oneself of guilt at the expense of another human being!

Tasks Related to Steps 8 and 9

1)     Have the client write down and bring to therapy a list of interpersonal harms for which the client is responsible. This should be specific to his or her sexual acting out history, though it also can be viewed in a broader life context. Again, work done in conjunction with step 4 will be helpful. In session, review the details of each example BEFORE the client goes into the world to make amends. Under consideration are:

  • The impact of the client’s actions, how others may have felt or may still feel
  • Whether making an actual an amends should (or should not) be made, and, if so, how that can most empathetically be handled

2)     Discuss the order in which amends should be made, and assign the making of certain amends.

3)     Have the client journal about his or her emotions prior to and after making the amends.

4)     Have the client use therapy to discuss his or her shame, fear, embarrassment, and hopes for the outcome of the amends process.

The above lists are of course incomplete, as every client’s path to long-term recovery is different. However, the well-worn, trusted concepts integrated into all 12-step recovery programs are extraordinarily useful therapeutic tasks for sex addicts. Remember too that each of the 12-step sexual recovery programs has its own “Big Book” much like the AA Big Book, and all of these can be purchased online and utilized without ever having to go to a meeting.

There are also many printed 12-step guides in booklet or book formats, many of which are either specific to sexual addiction or can easily be adapted to sexual addiction. Patrick Carnes’s book, A Gentle Path through the Twelve Steps (www.gentlepath.com), is one such example. Other excellent material is available through Hazelden Publishing (www.Hazelden.org).

* This blog is the second of a three-part series. Part one, covering steps 1 through 3, can be accessed by clicking here. Part three is planned for next month.

Robert Weiss LCSW, CSAT-S is the author of three books on sexual addiction and an expert on the juxtaposition of human sexuality, intimacy, and technology. He is Founding Director of The Sexual Recovery Institute, www.sexualrecovery.com, in Los Angeles and Director of Intimacy and Sexual Disorders Services at The Ranch in Tennessee, www.recoveryranch.com, and Promises Treatment Centers in California, www.promises.com. Mr. Weiss is a clinical psychotherapist and educator. He has provided sexual addiction treatment training internationally for psychology professionals, addiction treatment centers, and the US military. A media expert for Time, Newsweek, and the New York Times, Mr. Weiss has been featured on CNN, The Today Show, Oprah, and ESPN among many others. Rob is the Sex and Intimacy blogger for Psych-Central, an online psychology site, and can also be found on Twitter at @RobWeissMSW.

 


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From Psych Central's website:
PsychCentral (June 13, 2012)

Mental Health Social (June 13, 2012)






    Last reviewed: 13 Jun 2012

APA Reference
Weiss LCSW, R. (2012). The 12 Steps as Therapeutic Tasks for Sexual Addiction Recovery (Continued): Steps 4 through 9. Psych Central. Retrieved on September 30, 2014, from http://blogs.psychcentral.com/sex/2012/06/therapeutic-tasks-for-sexual-addiction-recovery/

 

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