Cindy Feinberg is a recovery coach and addiction case manager in New York City. She and her staff are committed to helping addicts and their families move toward recovery and a better life. She coordinates on an ongoing basis referrals to treatment specialists (treatment centers, therapists, interventionists, sober companions, MDs, and the like), at the same time managing all other aspects of care appropriate for a client and the client’s family. I have been so consistently impressed with both her intervention and recovery coaching ability that I wanted to share a bit about her world with you here.
Few places call upon people to be more vulnerable, more often, than addiction and behavioral/mental health treatment settings. Complicating matters is the fact that people who enter treatment for addiction or any other highly destructive psychiatric disorder are nearly always filled with shame – feeling as if they are inherently flawed, defective, less than, and unworthy. Sharing about these feelings and the incidents that led to them is incredibly painful, and, as such, these individuals would usually rather eat dirt than talk about them. As therapists, of course, we understand that shame thrives in darkness but withers in sunlight. In other words, we know that the best way to reduce the power of shameful feelings and incidents is to have them witnessed and understood when surrounded by safe and supportive others.
Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.
- Dr. Brené Brown
Training the Trainers
In early November, forty addictions and mental health staff from Elements Behavioral Health facilities nationwide gathered at The Ranch treatment center near Nashville, Tennessee for three days of intense and rigorous professional training. Our goal was to experience and learn the new Daring Way™ shame resilience curriculum, which is based on the extensive research of Dr. Brené Brown. Among the delegation were senior therapeutic staff members from Promises Malibu, Promises Professionals Treatment Program, Promises Young Adult Program (West LA), Malibu Vista, Promises Austin (formerly known as Spirit Lodge), The Ranch, The Sexual Recovery Institute, Lucida, The Right Step, and The Recovery Place. As a result of this effort, each of therapists in attendance is now certified as a Daring Way™ Facilitator Candidate (CDW-C). In short order these clinicians will become fully certified Daring Way™ Facilitators, and the Elements family of treatment centers will wholeheartedly incorporate the Daring Way™ shame resilience curriculum into its ever-growing family of treatment programs.
Not long ago the New York Times published a rather vitriolic article titled “An Intervention for Malibu.” For the most part, the Times chose to denigrate the 35 state-licensed drug and alcohol rehab facilities located in the small, upscale seaside village just outside Los Angeles. Much of the contempt centered on the fact that media vans and crews consistently clog the Malibu streets, with shutterbugs and TV crews alike hoping to catch the likes of Lindsay Lohan or Robert Downey, Jr. stumbling into or out of yet another treatment center. Residents of the town just plain don’t like the press swarming their ultra-swanky neighborhood, and I can certainly understand that.
Mars vs. Venus – in Recovery
We have long known that there are significant differences in the ways that men and women think, act, and relate. To a large extent these differences are neurobiological in nature as male brains and female brains show significant structural differences. For starters, the brains (and heads) of boys and men are about 9 percent larger than those of girls and women. The extra brain matter in males is mainly white matter, the part of the brain that transmits signals between brain cells. At the same time, males have relatively less of the corpus callosum, a structure that allows the left and the right sides of the brain to communicate. (Generally speaking, the left brain controls logic, analytical thinking, and objectivity, whereas the right brain controls intuition, synthesis, and subjectivity.) It seems the male brain has more connections to nearby cells, but less connectivity between the two hemispheres; vice versa for females. These basic structural differences explain, at least in part, some of the readily observable differences in male and female behavior.
In sexual addiction treatment, clinicians help clients carefully self-define the sexual behaviors that do not compromise or destroy their meaningful personal values, life circumstances, and relationships. Clients then commit in a written sexual sobriety contract to only engage in sexual behaviors that are permitted within the bounds of that predetermined pact. As long as the client’s behavior remains within his or her concretely and mutually defined boundaries, that individual is sexually sober. (I have written extensively about “boundary plans” in a previous blog) But how can we help sex addicts deal in healthy ways with the people, places, and things that trigger them to act out? After all, every time they leave the treatment setting the real world awaits-with all the same temptations as ever (and, thanks to the ever-expanding Internet, probably a few new ones).
As mentioned in last week’s blog, sexual sobriety does NOT entail long-term sexual abstinence. Often, a 30 to 90 day “cooling off” period of complete abstinence from all sexual behavior, including masturbation, is recommended when an addict enters treatment—mainly to help the addict gain perspective on his or her problematic behaviors—but in no way, shape, or form is ongoing abstinence the goal.
In fact, the heavy lifting of sex addiction recovery is not this short period away from sexual behavior; it is instead the gradual (re)introduction of healthy sexuality into the addict’s life.
But if sexual sobriety doesn’t require total sexual abstinence in the way that chemical sobriety requires total abstinence from alcohol and addictive drugs, what does it require?
Generally speaking, to achieve sexual sobriety sex addicts must define—working in conjunction with a knowledgeable sex addiction therapist, a 12-step recovery sponsor, or some other sexual recovery accountability partner—the sexual behaviors that do not compromise or destroy the addict’s values (fidelity, not hurting others, etc.), life circumstances (keeping a job, not getting arrested, etc.), and relationships.
The addict then commits in a written sexual sobriety contract to only engage in sexual behavior that is permitted within the bounds of that predetermined pact. As long as the addict’s sexual behavior remains within his or her concretely defined boundaries, the individual is sexually sober. It is important that these plans be put in writing, and that they clearly define the addict’s bottom line behaviors to be eliminated.
Having spent two decades working with relationship and sexual addicts—male and female, straight and gay, younger and older—I have come to accept that people entering sex addiction recovery typically have little to no idea of what achieving “sexual sobriety” really means or entails. This confusion is in sharp contrast to nearly any alcoholic or drug addict entering treatment, who more or less already knows that he or she will have to abstain completely from alcohol and/or illicit drugs to be sober.
Unsurprisingly, the most frequently asked question by newcomers to sexual addiction treatment is: “Am I ever going to be able to have a healthy, regular sex life, or will I have to give up sex forever?” And this question is usually followed by a statement along the lines of, “If I have to give up sex permanently, then you can forget my staying in treatment.”
Fortunately, unlike sobriety for alcoholism and drug addiction, sexual sobriety is not defined by ongoing abstinence—though a short period away from sex is often recommended as a brief, early part of the healing process. Ultimately, sexual addiction treatment addresses sobriety in much the same way it is handled in the treatment of eating disorders, another area where sobriety does not mean permanently abstaining. (You can’t very well abstain from eating!)
10) Continued to take personal inventory, and when we were wrong promptly admitted it.
11) Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.
12) Having had a spiritual awakening as the result of these steps, we tried to carry this message to other sex addicts and to practice these principles in our lives.
So Much More Than Maintenance
Sex addicts, like all addicts, can be surprisingly resistant to the idea of participating in 12-step sexual recovery programs such as SA, SAA, SCA, SLAA, and SRA. Ironically, the same men and women who regularly engage in compulsive, sometimes illegal and often public sexual acts often worry they’ll be “spotted” at a 12-step sex meeting.
The fact that they’ve posted personal information and nude photos of themselves on dating websites and “friend finder” smart-phone apps, have repeatedly looked at pornography at work, or had an angry spouse tell everyone he or she knows about their sexual behavior matters not at all. The reality escapes these individuals that the only people likely to spot a sex addict at a 12-step sexual recovery meeting are other sex addicts who are dealing with the same basic set of problems, and these are the last people on earth likely to gossip about or place a value judgment on another’s sexual history.
Nevertheless, some sex addicts fight the idea of attending 12-step recovery groups, so it is up to the therapist to bring the themes, neurological rewiring, and overall experience of step-work into the treatment arena.
For many of us, digital information gathering and online interaction have become integrated into our daily routine from the first multitasking moments. We check email, tweet and text, update Facebook, and simultaneously peruse “newspapers” from all over the globe, all while draining the morning coffee. And we do all of this on faster, more sophisticated, more portable and affordable electronic devices than ever before.
This incredible array of sophisticated interconnectivity provides endless new opportunities to support our very traditional human needs for community and social interaction. Innovations like Facebook, with over 500 million users, and Twitter, with over 300 million users, offer real-time interactions with an increasingly wider and more diverse group of people.
Friends and family who may have been too distant for regular contact just a few years ago can now be intimately folded into our lives. For partners, spouses and families separated for long periods of time by work or military service, the tech-connect boom is a godsend. Couples are now able to bond long-distance in real time, share a growing child’s latest milestone, and even engage in visual intimacy via the webcams now routinely incorporated into computers and smart-phones.
Those not yet in a committed relationship can put technology to good use when home or traveling via e-dating—establishing and growing budding relationships with a decreasing focus on who lives where. We make friends, we share and grow from our experiences, we celebrate, and we commiserate—one world, a growing interactive community.
One downside of the tech-connect boom is that whenever human access to intensely pleasurable and arousing substances, like cocaine and crystal meth, previously rare treats, like refined sugar and sweets (now on sale at every gas station), or experiences, like gambling and sex, is increased, the potential for impulsivity, compulsivity, and addiction rears its ugly head.