Treating sexual addiction is not for the squeamish. Sex addicts, if and when they become honest in therapy, often relate harrowing tales of abuse and acting out. Many have engaged in sexual activities that even a seasoned prostir careers, their homes, their tute would blush to hear about, and they’ve often done so with more partners than they can count. They’ve put themselves, their spouses, their sexual hookup partners, theihealth, their children, and so much more at risk—all for a quick and ultimately meaningless sexual fix. Many were either covertly or overtly sexually abused in childhood and/or adolescence, sometimes repeatedly and horrifically. They may also have a concurrent addiction, usually some form of substance abuse but occasionally another behavioral addiction or even an eating disorder (especially among women), and this too can lead the client into episodes of traumatic experience and bad behavior.
Any clinician who treats sex and porn addicts on a regular basis can tell you that our clients, both male and female, tend to be highly narcissistic – a quality that often makes for a tempestuous therapist-client relationship. Simply put, evidence from the field strongly suggests that sex and porn addicts are nearly always self-centered and self-absorbed, often to an extreme degree, not only sexually but elsewhere in their lives. Of course, it’s nice to have scientific research that backs up what we typically see in our practices, and a recent study, Narcissism & Internet Pornography Use, accepted for publication in the Journal of Sex & Marital Therapy, does exactly that.
After more than twenty years spent treating, speaking about, and writing about sexual addiction, I’ve heard all the arguments (and then some) both in favor of and against utilizing an addiction-focused model of diagnosis and treatment to identify and help individuals who self-report repetitive, problematic patterns of impulsive and/or compulsive sexual behavior. For the most part, those who believe that sexual addiction (also known as sexual compulsivity and hypersexual disorder) is simply a myth tend to offer some combination of the five challenges presented below. I thought it might be both interesting and useful to examine the validity/reality of these concerns here.
It’s no great secret that most alcoholics, drug addicts, and behavioral addicts live with deeply felt feelings of shame. In fact, shame is nearly always part of the underlying matrix of psychological conditions that can typically lead to addiction. In short, shame leads to extreme emotional discomfort and the gnawing belief that one is inherently flawed, defective, and unworthy of love. These feelings can in turn lead to depression, severe anxiety, and lifelong challenges with intimacy and relationships. And all of the above can create a powerful desire to escape and dissociate via the use of addictive substances and/or behaviors. Over time, a pattern of self-medicating life stressors and emotional discomfort in this fashion can easily escalate to full-fledged addiction, with all of the usual negative life consequences.
Are Sex Offenders Treatable?
Last week I wrote about clinician prejudice toward sexual offenders. As part of that writing I introduced the four main categories of sexual offenders:
I also mentioned the some of the most damaging misconceptions that most people, including many psychotherapy professionals, have about sex offenders.
None of these beliefs is correct. The reality is that most but not all sex offenders can benefit from proper treatment. In fact, the recidivism rate is actually quite low, provided the offender is paired with the most effective form of treatment. It’s all about good assessment and knowing who needs what and when.
Perverts and Rapists and Creeps, Oh My!
A couple of weeks ago my colleague Jenner Bishop posted an open letter on the IITAP (International Institute for Trauma and Addiction Professionals) listserv about clinician prejudice toward sex addicts and sex offenders. Jenner had just come from a “suite meeting” for an office she’d recently rented, at which she’d been bombarded with angry questions from the other therapists about how they were supposed to protect their clients from her “unsupervised” sex addicts and offenders. She had explained that she doesn’t work with violent offenders, and that the offending behaviors of her clients were typically something along the lines of hiring prostitutes and/or looking at illegal pornography – which the other therapists’ clients were probably also doing, even if the therapists weren’t aware of it – but Jenner’s fellow professionals just wouldn’t let it go.
Hardly a day goes by without the national media trotting out the problem sexual misbehavior of some politician, sports star, actor, or religious leader. Oftentimes, within a few days or weeks we hear that same person is “entering treatment” for sexual addiction. This begs the question: What is sexual addiction treatment?
Generally speaking, well-rounded sexual addiction treatment mirrors in many ways the structure and techniques that have proven highly effective in drug and alcohol addiction treatment—focusing on breaking through denial, managing the crisis or crises that drove the person to seek help, social learning, cognitive behavioral therapy, group therapy, relapse prevention, etc. Depending on the individual being treated, the work may center on the person’s immediate life circumstances in an attempt to determine (and find healthy ways to control) the various triggers to his or her sexual acting out. Other addicts, while still needing to learn how to contain their sexual behavior, may have a greater need and ability to work though various forms of past trauma and emotional reactivity—challenges that oftentimes have been lifelong concerns. For all individuals, once sexual sobriety has been established, all useful clinical methods are on the table: art therapy, traditional cognitive behavioral therapy and relapse prevention work, social learning models, equine and experiential work, EMDR, somatic therapies, the support of 12-step meetings, etc.
Guest post by: Linda Hatch PhD, CSAT, www.sexaddictionscounseling.com
Narcissism Equals Low Self-Esteem
A majority of sex addicts behave in ways that are seen by others as narcissistic. Narcissistic personality traits are often described in terms such as grandiosity, self-centeredness and over-entitlement. This suggests the narcissist has an inflated sense of self-worth. In fact the opposite is true.
Most narcissism is actually a defense system. The narcissist has acquired a façade of superiority and self-sufficiency as a defense against unconscious feelings of inadequacy and unworthiness. This defense is often bolstered by career success or being prominent in the community. This self-image is flimsy and superficial, but it is felt by the narcissist-addict to be his or her true self.
As such, this false self protects the addict from experiencing his or her vast reservoir of unhappiness and insecurity.
The Therapeutic Use of Abstinence in Relationship and Sexual Addiction Recovery
Try telling a sex addict to stop pursuing and having sex for a month or more and you may quickly find yourself pushed aside for a more enabling (and less directive) therapist, sponsor or friend. Inform a profoundly love addicted (attachment disordered or trauma survivor) woman – the one who lives to seduce – that she can’t wear provocative clothing or makeup for at least 2-3 weeks and you will quickly learn about her level of dedication to recovery and change.
Such is the initial challenge of cognitive-behavioral treatment with sex and love addicts. In truth, a period of abstinence from sexual and romantic behavior, combined with contracted and prescribed boundaries around romance/seduction/dress, can be highly useful clinical tools toward expanding a sex and love addict’s sobriety skill set. This is especially true when working with individuals who’ve spent their whole lives seeing themselves and others as objects.
Why Abstain from Sex and Romance?
Active sex and relationship addicts base their adult self-worth on whether or not they are desirable and typically think, “I have value if I can get x, y or z to desire me sexually.” As such, they objectify themselves and others completely, often viewing their lives and relationships through a lens of conquest, seduction and intensity. This can sadly make the most mundane activities, like finding oneself in an elevator with an attractive stranger or walking past a good-looking person in the grocery aisle, a sexually charged opportunity to pursue people as objects.
Chronically distant and emotionally detached partners are often on the hunt for their mirror selves – the one who will draw them in with romantic intensity and then distance themselves when things get too close. Intimacy avoidant individuals unconsciously check out when their relationship starts to feel too close, whether related to an emotional, physical or sexual connection. Examples include:
The Love Addict/Avoidance Cycle
Outwardly often an unlikely couple, the consistent (often maternal) and desperate seduction of the relationship/love addict is a forever flame for his or her opposite – the intimacy-phobic avoidant. Their emotional dance is one of endlessly circling one another, but never quite allowing themselves to connect.