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:

1. Violent offenders
2. Fixated child offenders
3. Regressed child offenders
4. Sexually addicted offenders

I also mentioned the some of the most damaging misconceptions that most people, including many psychotherapy professionals, have about sex offenders.

1. All sex offenders are treatable.
2. No sex offenders are treatable.
3. All sex offenders are sociopaths

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 working husband who rarely returns home in time to see his wife still awake
• The wife who puts her entire emotional self into childcare, leaving nothing leftover to meet the needs of her neglected spouse
• The serial dater, consistently bouncing from one intensity-based superficial relationship to the next
• The “modern” couple, too distracted by smartphones, laptops and video to prioritize an emotional connection

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.

As reports that “Congressman Anthony Weiner heads to rehab” continue to dominate headlines (and the Twitter-sphere), I am receiving an increasing number of media calls asking to explain exactly how sex addiction treatment works.  While many believe that “Men In Power” heading to rehab is a blatant attempt to “help their image” or somehow excuse their bad behavior, I can promise you that rehab isn’t intended to serve either of those purposes.

Pre- Rehab: Crisis (in this case “Weinergate”)

The initial need for any addiction treatment – whether sex, gambling, food, drug or sex rehab – is most often born out of a crisis. For those attending sexual addiction treatment the crisis tends to be related to their profound betrayal of primary relationships, but problems can also center on health, work, legal or financial issues that have come about due to their sexual behavior problem. Sometimes a crisis is created to get someone to go into rehab and this is called an Intervention.