Americans Gone Wild

There seems to be a lot of media fear-mongering about online porn, citing a wide range of statistics on usage. To listen to some, you’d think that everyone and his grandmother is online 24/7 engaging in digitally driven self-pleasure. Interestingly, both the porn industry and anti-porn activists have a tendency to cite the most inflated numbers they can find to make their particular point. The sex industry does this so they can charge more for advertisements, while anti-porn types do this to point out our moral flaws and the all-pervasive nature of this supposed problem. That said, there are some relatively reliable statistics on porn usage. Recent studies show the following:

• 12 percent of all Internet websites are pornographic.
• 25 percent of all online search engine requests are related to sex. That’s about 68 million requests per day.
• 35 percent of all Internet downloads are pornographic.
• 40 million Americans are regular visitors (in their own estimation) to porn sites.
• 70 percent of men aged 18 to 24 visit a porn site at least once per month.
• The average age of first exposure to Internet porn is 11.
• The largest consumer group of Internet porn is men aged 35 to 49.
• One-third of all Internet porn users are female.
• The most popular day of the week for watching porn is Sunday.
• The most popular day of the year for watching porn is Thanksgiving.[i]

These statistics may or may not be alarming, depending on your point of view. If you are a 16-year-old boy in the throes of adolescence, this might sound just fine and Thank you Internet! But if you are the parent of that very same young man, maybe it’s not so great. And if you are a 35-year-old married father of three who’s compulsively masturbating nightly to online porn instead of sleeping, making love to your wife, or getting ready for work the next day, also not so great.

Regardless of where you stand on the issue, it is clear that digital technology has greatly increased both the anonymous accessibility and the affordability of pornography. And because of this more people than ever – of both genders and all ages – are being exposed to it, both willingly and inadvertently.

The Gender Gap

Historically, men have utilized pornography far more often than women. One 2006 study of 10,000 randomly sampled people aged 18 to 49 found that 82 percent of those surveyed had looked at pornographic magazines, 84 percent had viewed pornographic films, and 34 percent had viewed porn on the Internet.[ii] (Keep in mind, this study was conducted in 2006 – a lifetime ago in Internet years.) Unsurprisingly, the most significant variable for predicting who had used porn was gender. And the gender difference was most pronounced on the Internet, with 63 percent of the men but only 13.6 percent of women stating they had viewed porn online.

Perhaps this “gender gap” was caused by the nature of the available pornography. It is well-known that men are more visually stimulated and women are more aroused by relationships. In other words, men are more likely to be turned on by an endless, constantly changing stream of sexual body parts, and women are more likely to become aroused by the presence (or at least the perceived presence) of emotional intimacy. Knowing this, pornographers have in recent years propagated an entirely new genre of relationship-driven erotica designed to appeal to women. And the tactic is clearly working. In 2003, 14 percent of all Internet porn users were women.[iii] Only a decade later, almost one-third of all Internet porn users are female.[iv]

The most notably successful example of this new relationship-driven erotica, sometimes called “Mommy Porn,” is British writer E.L. James’ Fifty Shades of Grey (and its two sequels, Fifty Shades Darker and Fifty Shades Freed). This best-selling trilogy traces the rocky relationship of beautiful young Anastasia Steele and super-sexy but emotionally troubled billionaire Christian Grey. In many ways the Fifty Shades books fit solidly into the rather lengthy romance novel tradition of a naïve young virgin being seduced by an otherworldly bad boy, and then somehow managing to change that bad boy into a devoted husband or lover. The difference here, of course, is that in traditional romance novels the sex scenes fade to black well before the proverbial money shot, while Fifty Shades tracks the BDSM-infused action all the way to its multi-orgasmic conclusion.

Of course, Mommy Porn doesn’t do it for all women. Some females enjoy highly objectified hardcore pornography just as much as men do. These women are perfectly comfortable viewing men (or women) in terms of their body parts, and they are very clear in the idea that when they are online they are looking for purely sexual gratification and not any type of lasting intimate relationship. Studies show that the women who use pornography in this “traditionally male” way are typically younger than those who go for “relational” stories and imagery. According to one researcher, a possible explanation is that the younger generation is more accustomed to the huge quantity of visual stimuli that is now available.[v]

Porn and Kids

Nowadays kids, especially boys, are being exposed to pornography at much younger ages. As mentioned earlier, the average age of first exposure is currently 11. And accessing porn is incredibly easy. All a curious kid has to do is click a button that says “Yes, I’m 18” and he or she is in. The child doesn’t need to show a driver’s license, doesn’t even need to pay for anything since much of the porn that’s online is free. Frankly, kids don’t even need to go looking for porn to find it. The number of seemingly innocuous words that yield porn results on Internet search engines is astounding. A single innocent click and wham, there it is.

One 2008 study found that 93 percent of boys and 62 percent of girls were exposed to online pornography during adolescence. Boys were more likely to be exposed at an earlier age, to see more images, to see more extreme images, and to view pornography more often, while girls reported more involuntary exposure.[vi] Another 2008 study found that among university students aged 18 to 26 half of the males and 10 percent of the females viewed porn at least once per week.[vii] Once again, these studies were conducted before the current online porn explosion. The percentages are likely higher today.

What Does This Mean?

Frequent porn use is not without consequences. Cosmopolitan magazine recently surveyed 68 leading sex and relationship experts. 86 percent said they feel porn has had a negative effect on relationships. 63 percent said they think porn use changes men’s expectations of what sex with a real-world partner should be like, and 85 percent said they think porn has had a negative effect on women’s self-confidence – primarily because women now feel as if they now must behave like porn stars in the bedroom.[viii] More scientific surveys support the Cosmo findings. One study revealed that women whose partners look at pornography frequently (in the woman’s estimation) are less happy in their relationships than women partnered with men who either infrequently use porn or don’t use it all (to the woman’s knowledge).[ix] The same study found that a female partner’s self-esteem decreases as her male partner’s porn use increases.

And it’s not just women who are struggling. Two large-scale studies conducted in Japan – one in 2008, one in 2010 – found that in 2010 36.1 percent of males aged 16-19 had no interest in or an outright aversion to sex with another person. This figure was more than double that of the 2008 survey (17.5 percent). For males aged 20-24 the percentage increase was similar, up from 11.8 percent in 2008 to 21.5 percent in 2010.[x] Notice how this growing disinterest in real-world encounters coincides directly with the onset of the current digital pornography boom, which began in earnest in 2008. Furthermore, many young men who are otherwise in their sexual prime are experiencing sexual dysfunction, either ED (erectile dysfunction) or DE (delayed ejaculation). Simply put, the man who spends 80 or 90 percent of his sexual life masturbating to an endless, constantly changing stream of online porn is, over time, likely to find his real-life partners less and less stimulating. And sexual enhancement drugs won’t fix things because they’re designed to help sustain an erection, not to induce one. The brain and body need to become aroused of their own accord first. Without that, no dose of erection enhancing drugs will help.[xi] So, essentially, what we are now seeing in some young men is a porn-induced emotional and physical disconnect with real-world sex partners.

Okay, this is starting to sound like one of the media fear-mongering articles I dissed in the opening paragraph. And I haven’t even discussed porn addiction. And I’m not going to, either, since I’ve covered that topic rather thoroughly in a previous blog. The reality of the situation is that for most people the growing prevalence of online pornography is a bit of a yawn. For them, it’s either not of interest or it’s a pleasurable distraction turned to when something more intimate is not immediately available. In other words, it’s no big deal. So while it is true that some people are being negatively affected by online porn, most people are successfully adapting to our rapidly expanding digital universe—porn and all.

Robert Weiss LCSW, CSAT-S is the author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. He is a regular contributor to both PsychCentral.com and The Huffington Post, writing primarily about the intersection of technology with sex and intimacy. A licensed UCLA MSW graduate and a personal trainee of Dr. Patrick Carnes, Mr. Weiss founded the Sexual Recovery Institute in Los Angeles in 1995. Currently he is Senior Vice President of Clinical Development with Elements Behavioral Health. He has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

I am not privy to the facts of this investigation, nor have I ever spoken with Ariel Castro, but it seems likely that he is attempting to use sex addiction as an excuse for what he’s done. There may or may not be an element of sexual compulsion in Castro’s horrific behavior; I couldn’t say for sure without conducting a full, in-person assessment. That said, judging from the information presented in numerous media reports Ariel Castro is probably not a sex addict. Instead, he appears to be a violent sex offender.

As I wrote in a previous blog, violent sex offenders are people who commit forcible rape and “snatch and grab” child molestations. They are the least prevalent type of sexual offender, but they nonetheless garner the most media attention, and because of this the general public has a tendency to lump all sex offenders into this category even though these individuals are in fact a small minority of the overall sex offender population. Typically, violent sex offenders do not respond in positive ways to treatment if and when they receive it.

Sex addicts are an entirely different animal. They are individuals who compulsively use sexual fantasies and behaviors as a way to escape from uncomfortable emotions, life stressors, and underlying psychological conditions such as depression, anxiety, low self-esteem, attachment deficit disorders, unresolved trauma, and the like.  Yes, some sex addicts engage in offending behaviors as a part of their addictive behavior patterns, but they lack the underlying psychopathy displayed by violent offenders such as Ariel Castro. In fact, an assessment with that level of psychopathy would rule out a diagnosis of sexual addiction. Sex addicts (including sexually addicted sex offenders) usually respond positively to accurate diagnosis and proper treatment.

The unfortunate part of Ariel Castro’s “cold blooded sex addict” statement is that he is obviously looking to place blame for his actions on someone or something other than himself. It is exactly this sort of misstatement (along with the need for more tier one, peer reviewed research) that has kept sex addiction from becoming an official diagnosis in the DSM. Some clinicians actually argue that sexual addiction doesn’t exist, that it is merely an attempt by some people to “label and diagnose bad behavior.” And in Ariel Castro’s case these clinicians are probably right on target. This does not, however, mean that sexual addiction does not exist. Either way, the simple and undeniable fact is this: Using sex addiction as an excuse for sexual offending is not kosher. Sexual addiction is never an excuse for bad behavior. NEVER. Not for a violent offender like Ariel Castro, not for the garden variety sex addict whose behavior has escalated to online exhibitionism or some other relatively mundane form of nonconsensual sexual behavior.

I have argued before and I will argue it here again that an official DSM diagnosis – which is obviously not coming anytime soon – would help to clear up a lot of confusion on this matter. It would allow clinicians to clearly identify individuals struggling with compulsive, addictive, and impulsive sexual disorders, diagnose them properly, and direct them toward useful, accurately planned models of treatment. It would also help clinicians not misidentify people who are not sex addicts as being such.

I want to now repeat my earlier statement that sex addiction is never an excuse for bad behavior. A diagnosis of sexual addiction does not take off the hook the men and women whose sexual activities have caused harm to self, loved ones, family, and others. It does not now nor has it ever been intended to provide sexual offenders with an easy way out of consequences (legal or otherwise) for their nonconsensual, violating sexual activity. Sex addicts are absolutely responsible for the hurt and loss left in the wake of their sexual acting out. So even if Ariel Castro is a cold blooded sex addict (he’s probably not) as opposed to a cold blooded violent sex offender (he probably is), a diagnosis of sex addiction would NOT excuse his crimes.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. He contributes regularly to PsychCentral.com, writing primarily about sex addiction, and The Huffington Post, writing primarily about the intersection of technology with sex and intimacy. He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.

Myth vs. Reality

Most members of the general public, in part driven by our (eager to get ratings at any cost) media, tend to view all sex offenders through the same basic lens, universally labeling them as disconnected, violent, odd, sociopathic men who force themselves on unsuspecting women and children. Basically, our overall cultural belief sends a consistent message that “sex offender” = “violent rapist” or “snatch-and-grab child predator.” And while a minority of sex offenders do fit into these categories (and get the most press), the majority do not fit this media-driven stereotype. Other offenders—most, in fact—are men, women, teenagers, and sometimes even younger children who are, for the most part, excepting their sexual disorder, relatively functional human beings.

Below is a brief attempt to address some common myths about sexual offending.

• Myth: All sex offenders are dirty old men.

  Fact:  Most sex offenders report having committed their first offense by the age of sixteen. Their offending behavior often starts small and is overlooked at first, escalating over time until it becomes more noticeable (and less socially acceptable), eventually garnering the attention of law enforcement.

• Myth: Children must always watch out for strangers (snatch and grab child molesters).

  Fact: The vast majority of child sexual offenders are known to their victims. Snatch and grab offenders are actually quite rare (less than 5 percent of all child sex offenders).

• Myth: All sex offenders are monsters, horrible people with whom no sane person would ever associate.

  Fact: Most sex offenders are, except for their sexual disorder, law abiding, functional, tax-paying citizens without a prior history of illegal behavior or arrest.

• Myth: All illegal sexual behaviors meet the clinical definition of sexual offending, and vice versa.

  Fact: The clinical definition of sexual offending is nonconsensual sexual behavior. The legal definition is sometimes quite different, and it varies from state to state and nation to nation. Consider, for instance, a fully cognizant 19-old-male and a fully cognizant 17-year-old female who engage in consensual sex after dating for nearly two years. In one state this might be a crime, while in a neighboring state it might not be. And in the states where it is a crime the caliber of the offense and the potential consequences might vary significantly. Either way, from a clinical perspective this behavior is unlikely to be considered sexual offending. In other words, the clinical definition of sexual offending is objective, whereas the legal definition is subjective and based on the morality of a particular community at a particular time. Sometimes they are one and the same; other times not.

• Myth: Sex offenders are serial recidivists, and therefore we should simply lock them up and throw away the keys.

  Fact: Generally speaking, sex offenders have a less than 10 percent chance of reoffending if they receive useful treatment, and the recidivism rate is only about 17 percent even without treatment (after they are first caught).

• Myth: The majority of sexual offenders are caught, convicted, and sent to prison.

  Fact: Only a fraction of the men and women who commit sex crimes are arrested and sentenced for their offenses. And many who are arrested and sentenced receive probation rather than incarceration. Even those who serve time are usually (eventually) released on supervised parole.

• Myth: All sex offenders are male.

  Fact: Yes, the vast majority of sex offenders are male. However, females also commit sex crimes. Approximately 5 percent of convicted sexual offenders are female, but the number of unreported sexual offenses perpetrated by females likely far exceeds the number reported.

• Myth: Kids cannot commit sexual offenses.

  Fact: Adolescents are responsible for a significant number of rape and child molestation cases each year. They also engage in other sexual offending behaviors such as exhibitionism and voyeurism (both online and off).

• Myth: No sex offender is treatable.

  Fact: Most (but not all) sex offenders respond well to proper treatment. Typically, if the underlying causes of an offender’s problematic behaviors are similar to the presenting issues of addicts and alcoholics—depression, severe anxiety, attachment deficit disorders, low self-esteem, etc., the offender is likely to respond in positive ways to the same types of treatment that are effective with addicts and alcoholics. Typically, regressed (situational) child offenders and sexually addicted offenders are treatable. Think of it this way: We’ve all seen low-bottom alcoholics get sober and, over time, live exemplary lives. Most sex offenders are capable of similar behavior change.

• Myth: All sex offenders are treatable.

  Fact: Some sexual offenders are notoriously difficult to treat. Violent offenders, fixated child offenders, and offenders who are unwilling to admit what they’ve done fall into this “troublesome” category. Some are incapable of being honest. Some are inherently sociopathic. Some are simply hardwired to be sexually attracted to children. At best, these individuals can be helped to not act on their desires, but only if they desperately want to “behave” and conform to social norms. In other words, they have to be extremely willing to act in socially appropriate ways for treatment to be at all effective, and even then their ability to not reoffend is tenuous.

Unfortunately, those of us who treat the offender population know only a fraction of what we’d like to know. And sometimes it seems like every solid bit of research comes an equally solid study to refute it. So if you’re inclined toward investigation and publication, looking into the lives, motivations, and treatment of sexual offenders would be a great way to make a significant contribution to the field. That said, until more tier-one, peer reviewed research is conducted and made available it is imperative that we convey and utilize the facts as they are known to date. Even more important is that we recognize and remember that sex offenders are people—flawed and damaged human beings who are as in need of our help as any other client. It is our duty as therapists to consider them as such.

For many therapists, fulfilling this duty properly means educating themselves about how to identify sexual offending issues, finding out who in the nearby community is equipped to handle these clients, and learning when and how to make the proper reports, referrals, and interventions. For others, it means opening our intellect (and our hearts) to people who engage in socially and morally unacceptable behaviors. To paraphrase Brene Brown, PhD, LCSW, empathy and shame are on opposite ends of the same continuum. Following her logic, I believe it is the duty of each one of us to help remove the stigma and prejudice that accompanies the label of “sex offender,” especially within the clinical community. Only then can we better and more empathetically contain and treat these individuals—hopefully with the same respect and dignity we hold for all challenged human beings.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

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.

Who We Do Not Know How To Help (Today)

Violent offenders and fixated/dedicated child offenders (pedophiles and hebephiles with no sexual attraction to adults) typically do not respond well to sexual offender treatment. These individuals do not engage in their offending behaviors because of some childhood trauma, attachment deficit disorder, or similar issue. Instead, they were “born this way” and they are unlikely to change, no matter how hard a therapist tries to help them. In most cases they are either inherently sociopathic or hardwired in their sexual attraction to children. Only the most motivated—those with the least psychopathy who are also willing to also take hormonal anti-androgen drugs (which drastically reduce their sex drive)—have much chance of success. Dedicated hebephiles are more likely than dedicated pedophiles or violent offenders to respond in positive ways to treatment, but even they are not great candidates.

Generally speaking, contraindications to sex offender treatment are:

• Physical force or violence (or the threat thereof) played a role in the offense
• The sexual activity involved bizarre or ritualistic acts (such as enemas or bondage)
• The sexual offense is one aspect of numerous antisocial behaviors or a criminal lifestyle
• The sexual offense is secondary to a condition of serious mental illness or mental retardation
• The offender denies the offense occurred or that he/she committed it

The good news is violent sex offenders, fixated child offenders, and others for whom treatment is contraindicated are a minority of the overall sex offender population.

Who We Can Help (If Motivated, Insightful, and Engaged)

As mentioned above, most sexual offenders will respond in positive ways to proper treatment. This is especially true if the underlying causes of their problematic behaviors are similar to the presenting issues of alcoholics and addicts—depression, severe anxiety, low self-esteem, attachment deficit disorders, unresolved childhood or severe adult emotional trauma, etc. Typically, regressed/situational child sex offenders and sexually addicted sex offenders are the groups most amenable to treatment. As long as these individuals are willing to admit to their offense(s) and are fully assessed for concurrent addictions/mental health disorders, the right treatment can be extremely helpful.

Modalities That Don’t Work

Over the years, a wide variety of treatment approaches have been used with sexual offenders. The vast majority of these methodologies have proven to be either ineffective or only partially effective. These modalities include:

Chemotherapy

Various anti-androgenic hormones, most notably Depo-Provera, have a moderating effect on sexual aggressiveness. These hormones have been used as a way to enhance self-regulation of sexual behavior. Depo-Provera shows promise in the treatment of sexual offenders as a chemical control of antisocial sexual acting out. However, the method is only partially effective, as human sex-drive lives primarily in the mind, not the body. Thus, offenders often still want to engage in their antisocial behavior, even if they are unable to become physically aroused and carry it out.

Behavior Modification

This approach attempts to change the offender’s sexual arousal patterns by associating aversive experiences (electric shock, for instance) with deviant sexual behaviors, while at the same time rewarding and therefore encouraging more socially acceptable behaviors. Specific thoughts and behaviors associated with an individual’s particular offense are targeted in this way. This methodology has proven to be only minimally effective, and the efficacy diminishes over time. In other words, the further away the offender is from the aversive experience, the less effect the treatment will have.

Psychodynamic Psychotherapy

This traditional therapeutic approach focuses on the offender’s childhood in the hope that he or she can find the root causes of his/her offending behavior. This method appeals to many (if not most) sex offenders because typically, when entering treatment, they are looking to blame their behavior on anyone but themselves. If they can find something awful that their mother or father did to them when they were young, they’re off the hook, so to speak. They then can think about their sexual offending as “justified.” This is the least effective methodology when working with sex offenders. It has little to no clinical use with this population beyond the building of rapport.

Modalities That Do Work

As mentioned earlier, the sex offenders who respond best to treatment are the individuals who present with underlying issues similar to those of alcoholics and addicts. So perhaps it is not surprising that the most effective treatment approaches are the ones that also work well with alcoholics and addicts—cognitive behavioral therapy (CBT), social learning, group therapy, psycho-education, prescribing SSRIs (to reduce sex drive and compulsivity), etc.

Most therapists working with sex offenders rely heavily on CBT, looking closely at the thoughts, feelings, and circumstances that trigger an offender to act out, while at the same time identifying ways to short-circuit the process. In other words, offenders are taught to stop problematic sexual thoughts and behaviors by thinking about something else or by engaging in some other, healthier behavior (talking with a therapist or 12-step sponsor, going to the gym, reading a book, cleaning the house, etc.) The therapist is directive and reality-based, focusing on the here and now rather than on the exploration of childhood issues that may or may not have led to the offending activity. In other words, the therapist’s role, at least initially, is to implement a task-oriented, accountability-based methodology geared toward containment of the individual’s problematic behaviors.

Initial CBT for sex offenders can be divided into three major stages:

1. Identification of the Problem: Close questioning and observation help the clinician and patient identify the specific behaviors that make up the problematic sexual pattern.
2. Behavioral Contracting: The clinician and patient work together to define, in written terms, specific sexual behaviors that are to be eliminated. Contracts may include tasks that encourage the use of alternate coping mechanisms such as journaling, check-in phone calls, and attendance at 12-step meetings.
3. Relapse Prevention: The clinician and patient work together to identify and reduce patterns of experience and interaction that support and/or trigger offending behaviors.

Oftentimes the treatment of sex offenders presents demands that cannot be met solely within the confines of an individual therapeutic relationship. Offenders typically require external reinforcement and support if they are to implement lasting behavior change. Group therapy is especially helpful in this regard. In a facilitated group setting, offenders can see that their problem is not unique, which helps in reducing the guilt, shame, and remorse associated with their behavior. More importantly, the group format is ideal for confronting the denial used by offenders to justify their activities. Such confrontation is powerful not only for the individual being confronted, but for group members doing the confronting. In this way, everyone present is able to see how internal rationalizations facilitate and sustain sexual offending. Inpatient recovery settings, both voluntary and mandatory, can provide an even deeper level of social learning, as every aspect of the offender’s life is scrutinized by his or her peers, and vice versa. The extended 24/7 nature of inpatient treatment inevitably leads to a deeper and fuller understanding of the individual’s triggers and potential coping mechanisms.

Many sex offenders, especially sexually addicted offenders, also benefit from 12-step meetings, which provide both guided recovery and social support. Sexaholics Anonymous (SA), Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA), and Sexual Recovery Anonymous (SRA) are all nationwide programs for sex addicts. Sexually addicted offenders are welcome in most groups.

Boundaries

In all instances, effective sex offender treatment requires transparency with clients regarding the therapist’s treatment expectations, the need for collateral information which may require appropriate releases, and obligations to report certain behaviors to the authorities. It is also important to provide clear structure, rules, and boundaries for clients, including swift and clear interventions when rules and boundaries are disregarded. This is especially important when treatment is involuntary. In such settings, the clinician must exercise power over the client in a responsible fashion through:

• Appropriate confrontation
• Outreach and monitoring
• Support that anticipates the guidance clients may need
• Even-handed implementation of consequences when the conditions of treatment are not fulfilled

Expectations Regarding Treatment

The general expectation when dealing with sex offenders is that they will come to:

• Admit to all of their problem sexual behaviors
• Accept responsibility for what they have done
• View their sexual offending as both intellectually and socially inappropriate
• Recognize their sexual offending as a pathological behavior that causes harm
• Acknowledge that they must live differently, accepting new life limitations and accountability
• Become diligently honest in treatment and with their support network

Of course, every sex offender arrives in recovery with a unique background and a specific set of offending behaviors. As such, each individual needs a program of treatment tailored to his or her precise needs. That said, some combination of CBT, group therapy, social learning, and psycho-education nearly always works, as long as the client is legitimately interested in changing his or her behavior. Unfortunately, there are individuals—particularly violent offenders and dedicated child offenders—who are unlikely to respond to even the best treatment regimen. These individuals are simply not good candidates for lasting behavioral change. Happily, these folks are a small percentage of the overall sex offender population. Most offenders—particularly regressed child offenders and sexually addicted offenders—respond in more positive ways.

The Association for the Treatment of Sex Offenders  and The Safer Society Foundation provide excellent resources for therapists, offenders, victims, and families.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

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.

She writes:

I was shocked. Eventually someone admitted that – despite the landlord sending around an advance email informing tenants the potential new renter is a Certified Sex Addiction Therapist – they wish they’d further investigated what a CSAT does, because they’d have informed the landlord that my practice is incompatible with theirs. You know, I just forget. We’re on the front lines of healing such a grossly misunderstood population. And it’s not just the masses, it’s fellow clinicians with these massive prejudices and blind spots.

Jenner is absolutely right. The world is filled with sexual prejudice of all types, and even highly trained professionals are not immune to this bias. I face this fact every single day both in my educational efforts and in my practice. Honestly, even the most basic and factual of my blogs is likely to draw “friendly fire” from certain colleagues. And only a year ago I had to host a three-day staff training session at one of the addiction treatment facilities I work for, the sole purpose of which was to calm the staff’s fears about working with a sexually addicted, potentially offending population. And their concerns – their prejudices if you will – were exactly the same as what Jenner recently faced. In other words, they were convinced that the facility’s sexually addicted clients were monsters who were going to be molesting and raping all over campus. Never mind the fact that they’d been treating these same people for years as part of the chemical dependency population.

Ignorance = Fear

The good news when it comes to clinicians is proper education can help to alleviate concerns. While it is true that some people’s prejudices toward sex offenders are simply too deep to overcome, for the most part therapists are open-minded individuals who respond well to unbiased, factual information. And that is my goal with this blog – to present the facts about who sex offenders are and the risks these men and women do and don’t present.

For starters, many clinicians don’t fully understand what sexual offending is. Oftentimes therapists, like the general public, are of the opinion that there is a one-size-fits-all definition. In reality, there is a clinical definition, along with multiple legal definitions. The clinical definition of sex offending is nonconsensual sexual activity. Essentially, a person’s carnal activity is nonconsensual (offending) if one or more of the following occurs:

• The activity is forced
• The other person is incapacitated and can’t consent (drugged, drunk, passed out, etc.)
• The other person is mentally unable to consent to the activity (developmentally disabled, psychologically disturbed, etc.)
• The other person is too young to consent
• The other person has been subjected to a non-forcible sexual experience that he or she did not invite or agree to (exhibitionism, voyeurism, frotteurism, etc.)

The legal definition of sex offending is sometimes quite different, and it varies from state to state and nation to nation. Consider, for instance, a fully cognizant 19-old-male and a fully cognizant 17-year-old female who engage in consensual sex after dating for nearly two years. In one state this might be a crime, while in a neighboring state it might not be. And in the states where it is a crime the caliber of the offense and the potential consequences might vary significantly. Even more confusing is the fact that laws sometimes change. Behavior that was illegal last year might not be today, and vice versa. Either way, from a clinical perspective this behavior is unlikely to be considered sexual offending. Another interesting example is same-sex sexual activity between consenting adults. Such behavior was illegal in most of the United States until the late 20^th century, and it is still illegal in several countries. So even though consensual gay sex was (and in some places still is) by law a sex offense, it does not now nor did it ever meet the clinical standard. In other words, from a legal perspective sexual offending is subjective, based primarily on the collective moral code of a specific community at a particular time.

From the clinical perspective, sexual offending typically involves one or more of the following behaviors:

• Exhibitionism – illegal in-person, legal online
• Voyeurism – illegal in-person, legal online
• Frotteurism (rubbing against a non-consenting person for sexual gratification) – illegal
• Sexual harassment – can be either illegal or legal, depending on circumstances
• Incest – illegal
• Viewing, downloading, or creating child pornography – illegal
• Sexual activity with a minor or mentally disabled adult – illegal
• Rape – illegal
• Abuse of a professional role to obtain sex – can be either illegal or legal, depending on circumstances

Categories of Sex Offenders

Much of the clinical prejudice toward sex offenders stems from the fact that in addition to not knowing what offending is, some clinicians have very little factual information about who the perpetrators actually are. Generally speaking, sex offenders, regardless of age and/or gender, fall into one (or more) of the following four categories:

1. Violent sex offenders: Violent sex offenders are the least prevalent type of sexual offender. Nevertheless, they (along with fixated child offenders) get by far the most media attention. These are people who commit forcible rape and “snatch and grab” child molestations. They are unlikely to enter treatment outside of incarceration, and they usually do not respond positively to treatment if and when they finally receive it. Unfortunately, the public has a tendency to perceive all sexual offenders as falling into this category, even though these individuals are in fact a small minority of the overall sex offender population.
2. Fixated (dedicated) child offenders: The primary and often sole sexual orientation of fixated child offenders is toward children – either prepubescent (pedophiles) or adolescent (hebephiles). They have little to no interest in sex with adults. Approximately 10 percent of the men and women who commit sexual offenses against children fall into this category. These individuals sometimes set up their lives so they have access to and can become emotionally (and later physically) intimate with minors. Often they relate to their victim as a peer or equal, adapting their interests and behaviors to the level of their victim(s) and experiencing themselves as children. Typically their sexual interest in kids has nothing to do with childhood sexual trauma or early abuse. They were born with this orientation. Ever since they became interested in sex their thoughts were about children. Attempts to change a fixated child offender’s orientation will almost certainly be unsuccessful, no matter how hard the therapist and client try. Former Penn State football coach Jerry Sandusky is a classic example of a fixated child offender, in that he set up his life so he could have ready access to victims (founding a child-oriented charity and even adopting a son).
3. Regressed (situational) child offenders: With regressed child offenders the sexual interest in kids is not exclusive. Approximately 90 percent of child offenders fall into this category. Usually regressed child offenders are equally or even more aroused by adults than minors. Many have adult sexual and romantic relationships, though others find adult sexuality threatening and avoid it or abandon it. When these people offend against children the behavior is opportunistic, meaning they don’t set up their lives so they can have contact with and offend against minors. When under stress, the influence of substances, or both they sometimes turn to a child/teen relationship as an unhealthy way to meet their need for intimacy. Their sexual offending is nearly always driven by life stressors and/or underlying psychological issues such as depression, severe anxiety, attachment deficit disorders, low self-esteem, etc. Typically these individuals see their victims as pseudo-adults. Because of this fantasy/misperception, they may feel as if they are not actually victimizing the child with whom they are being sexual. Regressed child offenders usually respond quite well to treatment.
4. Sexually addicted sex offenders: Sexually addicted sex offenders (SASOs) comprise anywhere from 55 to 75 percent of the sex offender population. That said, not all sex addicts are sex offenders. In fact, most are not. SASOs, like other sex addicts, use sexual fantasy and ritualized sexual behavior patterns as a way to dissociate from uncomfortable thoughts and emotions, including seemingly benign feelings like boredom. In other words, their behavior is driven by life stressors and underlying psychological conditions such as anxiety, depression, low self-esteem, attachment deficit disorders, and unresolved trauma. Anecdotal evidence from clinicians working in the field indicates that most sexually addicted sex offenders don’t start out offending. Rather, their behavior escalates over time from “vanilla” activities like legal pornography, webcam sex with adults, and casual adult sexual hookups to offending behaviors like prostitution, public sex, voyeurism and exhibitionism, viewing illegal pornography, inappropriate sexual behavior with minors, etc. Typically, SASOs respond well to treatment.

The Clinical Reality

In the clinical community there are two highly destructive beliefs about sex offenders.

1. No sex offender is treatable.
2. All sex offenders are treatable.

These two opposing opinions, neither of which is accurate, have caused a great deal of confusion, the wasting of valuable resources, and harm to the offender population, the therapists who treat those men and women, and society as a whole. The simple fact is some sex offenders can be successfully treated, while others cannot. Generally speaking, violent sex offenders and fixated child offenders do not respond well to treatment, while regressed child offenders and SASOs usually benefit greatly from proper clinical intervention.

These latter individuals, the “treatable” sex offenders, are the people that I see in my practice, and that Jenner sees in hers. They present little danger in a therapeutic setting. The odds of such a client taking advantage of another vulnerable person while sitting in the waiting room of a clinic are infinitesimally small; it’s about as likely as a recovering drug addict robbing his or her therapist’s office as a way to pay for his/her next fix. It’s possible, sure, but it doesn’t happen. In other words, we have every reason to treat these individuals, and little to no reason not to.

In next week’s blog I will discuss ways to effectively (and ineffectively) treat sexual offenders.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Mr. Weiss has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

Modern technology affects virtually every aspect of human existence. For starters, the world is rapidly becoming a much smaller place. This is not to say that our planet is physically shrinking, it’s just that we can now travel from place to place more easily and affordably than ever before. And even if we’re not willing to hop into a car or onto an airplane we can still communicate almost instantly, IRL (in real time), with practically anyone, anywhere, at any time thanks to ever-evolving digital tools like computers, laptops, pads, smartphones, e-readers, and the like. Not surprisingly, this relatively recent and ever quickening onslaught of new technology has drastically changed the ways in which we view and value intimacy with our significant other, and even our ideas about what a “significant other” actually is.

Once upon a time, being in a serious relationship meant there was one person, often of the opposite gender, to whom you were physically and emotionally committed. Open relationships, casual sex, fetish sex, gay sex, and the like certainly existed, but these things were so far out of the mainstream that hardly anyone could grasp them as being healthy forms of intimacy, let along meaningful. Yes, the social liberalism movements of the 1960s and ’70s opened a lot of minds (and bedroom doors). But by the early 1980s free love more or less disappeared—banished by HIV and AIDS—as most folks scuttled like hermit crabs back into the safety of traditional, monogamous, hetero-normative partnerships.

Then we got the Internet.

With digital interconnectivity came chat rooms, dating sites, prostitution sites, and online pornography of every ilk imaginable. Suddenly fetishes, role-playing, homosexuality, bisexuality, transvestitism, prostitution, and many other sexual behaviors were out of the shadows and into the limelight—for people who were interested in those things, anyway. (And a surprising number of people were!) Nowadays, these and many other previously marginalized sexual and romantic activities are both more viable and more socially acceptable than ever—especially among young people. Prostitution is an obvious example. In today’s world, as long as the “meeting and greeting” takes place online rather than on a street corner, nobody seems too bothered by sex for pay. Exhibitionism is following a similar path. While it is still illegal and socially unacceptable to drive around in your car or hang out in public parks exhibiting your genitalia, that same behavior carried out via webcam is not only not illegal, it is commonplace and oftentimes even encouraged. (If you’re skeptical about that statement, log onto Chatroulette or any number of other video chat sites and see what happens.) So the “new” prostitute and the “new” exhibitionist are online. And why not, when they can engage in the exact same behaviors much more efficiently and with much less chance of arrest? In similar fashion, people predisposed to all sorts of other atypical sexual behaviors (some legal, some not) are finding their “place” online in ways they wouldn’t (or can’t) in the real world.

Polyamory: It’s Not Just for Mormons Anymore

One behavior that is quietly on the rise is polyamory—the experience of multiple people living, loving, and being sexual together. Young people, aware of safer sex practices and turned off by the concept of traditional marriage and divorce, are turning away from the old-school relationship models they see failing on an everyday basis—finding it easier and more realistic to meet their needs through alternative relationships. Gary, a bisexual 26-year-old, explains:

I moved in with Emma after college, even though I wasn’t sure that was what I wanted. I figured moving in was easier and more reasonable than getting married. As it turns out, we really love living together. About two years into our relationship I met Kenny at my gym, and we started up a sexual relationship. I told Emma about it. And she took it really well. Honestly, she wasn’t surprised since I’d told her on our first date that I’m bisexual. (Her response was to laugh and say, “Me too.”) What came out of my affair with Kenny was that Emma and I decided to open up our relationship. We could both be sexual outside the partnership as long as we were safe and didn’t keep what we were doing a secret. Since that time, both of us have fallen in love more than once, and a couple of times we’ve actually had another person living with us. When Megan, our daughter, was born last year we were actually a foursome—three women and myself, all of us bisexual. One of those women has moved on, so now we’re back to three, and this feels like a good arrangement.

Certainly polyamory is not without its problems. For starters, there is the complicated relationship dynamic to deal with. Occasionally either Gary or Emma has wanted to bring a third (or fourth) party into the relationship that the other did not like. A couple of times they tried it, with poor results, so now they both have to “sign off” on someone moving in, and this solution seems to work for them. They also worry that their daughter Megan might be treated differently at school and elsewhere because of the lifestyle her parents have chosen. They further worry that they will be left out of traditional parental socialization and that their family unit will be frowned upon in the community. Yet despite these and other concerns, living and loving “commune style” has come back into, if not vogue, at least sporadic acceptance.

So Should We All Just Move In Together?

The fact that today’s young people have never known a world without HIV or the Internet means they are educated about safe ways to engage in sex, and they are adept at finding people with similar interests, such as polyamory, through the use of digital technology. And it’s not just polyamory that’s on the rise. Whatever digital natives are into, they’re finding it online—everything from chubby chasers to cigar lovers to “infants” to standard BDSM enthusiasts. Because of this, they are engaging in all sorts of digital and in-person relationships, both short- and long-term. Mostly, however, they are enthusiastic about the burgeoning digital hookup culture—built on smartphone apps like Skout and Blendr—which takes the hard work (and much of the mystery) out of meeting and wooing potential partners. Get in, get off, get out, and get on with your life.

Obviously, polyamory, fetish cultures, and casual hookups are not for everyone. Nevertheless, human sexuality and relationship formation cuts a wide swath in the wilderness of life. There have always been many paths to follow, and the Internet is not inventing or presenting anything new. Instead, it is simply illuminating a few of the roads less traveled. And for reasons far too numerous to list many people, especially younger individuals, are at least temporarily checking out these potentially more scenic paths. This is neither right nor wrong. It’s just different. The short- and long-term effects of this new, tech-driven attitude toward non-traditional relationships and evolving forms intimacy are at this point unknown. It seems likely that intimacy is still intimacy, but the way we get there, and who we get there with, may well be changing with advancements in modern digital technology.

Robert Weiss LCSW, CSAT-S is the author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. He is a regular contributor to both PsychCentral.com and The Huffington Post, writing primarily about the intersection of technology with sex and intimacy. A licensed UCLA MSW graduate and a personal trainee of Dr. Patrick Carnes, Mr. Weiss founded the Sexual Recovery Institute in Los Angeles in 1995. Currently he is Senior Vice President of Clinical Development with Elements Behavioral Health. He has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

—Robert Weiss LCSW, CSAT-S

Guest post by: Jeff Schultz
www.sonorancounselingservices.com

Is there a difference between the person who carries on with one secret sexual affair after another and the person entranced by Internet pornography?

Are sexual behaviors like affairs, sex with prostitutes, and anonymous sex a greater risk of harm to an individual or a relationship, or is pornography the greater risk?

Sex and pornography addiction both wreak havoc on individuals and relationships, yet we tend not to see Internet porn as being much of a “high risk.” Somehow, it can feel less threatening than, say, sexual massage or phone sex.

But the truth is that Internet porn addiction is the most common out-of-control sexual behavior for those addicted to sex.

It’s not just “guys being guys” and it’s not “just porn.” It’s Internet Porn and it’s powerfully addictive.

In my work as a Certified Sex Addiction Counselor abuse of Internet pornography is a part of the story for nearly all of my clients, and it’s the whole story for many.

Why is it that more sex addicts “fix” with Internet pornography than with other sexual behaviors? What makes it so addictive?

Sex is Survival

Job number one for the brain is to keep us alive.

Fortunately, we have some very old brain structures that focus on this goal. These structures jump into action when they perceive survival threats and they literally take control of our thinking in order to protect our lives.

For this primitive part of the brain, killing for food, eating and drinking, and having sex always come first. Our morals and values are a far lower priority when our survival is at risk. Staying alive has to come first.

Naturally, sex is as much a survival behavior as eating and drinking since the survival of our DNA requires conception. And so, nature rewards us for having sex by making it feel good, and it rewards us even more for having sex with new partners.

Survival Odds Improve with New Sex Partners

It makes sense from a survival perspective. Sex with multiple partners increases your odds of genetic survival, so we get a bigger dose of pleasure with each novel sexual experience. More pleasure equals more motivation.

When cavemen roamed the earth, sexual opportunities were few, but important. Nature gave us enough extra pleasure to make the search for new sexual partners motivating. The system worked and our genetic heritage survived until today.

Now, however, in a couple of minutes surfing Internet porn, our ancient brains can see more novel sexual opportunities than the caveman could see in many lifetimes.

Internet Porn is Infinite Sexual Novelty

Is it a surprise that Internet porn is so addictive? Every porn image or video is a new sexual opportunity to the brain, and each one sets off a powerful surge of feel-good stuff. With Internet porn, the brain is awash with pleasure hormones.

But our primitive brains weren’t wired for this much stimulation. It’s simply too much to handle. So, our brains begin a search for balance.

Internet Porn Leads to Desensitization and Craving

The brain protects itself from these surges of pleasure hormones by putting up a kind of shield. A new balance is thus achieved in the reward system of the brain, and those powerful Internet images and videos of old lose some of their power. The brain gets back to a balance, but it also gets desensitized to sexual pleasure.

Now it takes more arousal intensity to feel the same level of pleasure as before. And it’s not just sexual pleasure that is affected. The Internet porn user can get desensitized to pleasure more generally.

He or she just stops feeling much pleasure in things that used to feel great.

Internet porn can still deliver, though. There remains a huge volume of novel content to discover. It just takes more variety or more time to feel the old “high,” or arousal.

What we see is the beginning of a powerful dependency on Internet porn that leaves normally pleasurable experiences in the dust.

Porn-Induced Impotence

Without new sexual intensity at home, real sex with a real partner fails to bring the needed arousal to keep the equipment functioning. When the equipment begins to fail, we call the problem “porn-induced impotence.”

The porn user becomes desensitized to “old” sexual experiences, which cease to be as arousing or powerful. Now it takes more intense novelty to get turned on—the kind of novelty that Internet porn can consistently deliver.

The Bottom Line

We would be wise to take a careful look as a society and culture at what we think and say about pornography—especially Internet pornography.

There are huge numbers of men and women who are now addicted to porn that never would be if it weren’t for the Internet. My sex addiction counseling practice proves this to me daily.

Internet pornography is every bit as high a risk of harm to individuals and relationships as any other addictive sexual behavior, and it’s far more prevalent.

***

Jeff Schultz, LPC, CSAT, is a sex addiction counselor and founder of Sonoran Counseling Services in Phoenix, Arizona. Read more of Jeff’s work at Sonoran Counseling Services Blog. Jeff can also be found on Google +

Doing It Until We Need Glasses (Or Not)

There are a great many statistics – not all of them obtained scientifically – regarding the frequency of sex among long-term committed/married couples. A quick Internet search will yield a surprisingly wide variation in what is thought to be a “normal” or “healthy” amount of sex for married people. So much for Internet searches. That said, the most scientifically reliable data comes from the General Social Survey, which has tracked American sexual behaviors since the early 1970s. According to the GSS, married couples of all ages have sex an average of 58 times per year. But this number lumps 29-year-old newlyweds into the same survey sample as 70-year-olds who’ve been married half a century, and I’m guessing that those in the first blush of love tend to get it on a wee bit more than couples who’ve been together for twenty-plus years with two or three kids and maybe even some grandkids to show for it. Recent GSS studies support this, finding that couples in their twenties have sex 111 times per year on average, with that frequency dropping steadily as couples age – perhaps as much as 20 percent per decade. Basically, younger married couples have sex twice per week, give or take, slowing over time to once or twice a month with the occasional extra session thrown in to acknowledge birthdays, anniversaries, and major holidays. That said, the frequency of sex varies widely depending on health, available time, and external circumstances (new kids, caring for a senior parent, etc.), not to mention each individual’s very specific sex drive.

What is a Sexless Marriage?

Typically, a sexless marriage is defined as one in which the couple has sex fewer than 10 times per year. Approximately 15 to 20 percent of longer-term married couples fall into this category. By the way, lack of sex may or may not be an issue for couples in long-term relationships. Some couples who qualify as “sexless” are perfectly happy with their sex lives thank you very much. Once or twice a year (or not at all) is just fine with them. Perhaps these people just have lower libidos, perhaps there is a medical condition that prevents sex or the enjoyment thereof, perhaps there is an unresolved psychological issue that renders sex less appealing to one or both parties. Whatever the reason, sex just isn’t as high a priority for some couples as it is for many others. So a lack of sex doesn’t necessarily mean a couple isn’t deeply in love, attached and intimate in other ways, and happy with their marriage. It just means they’re not as engaged sexually as some of their friends and neighbors.

For others, an ongoing lack of sex can be indicative of larger issues that may ultimately lead to strife and separation. Numerous studies have shown that for some couples this is indeed the case, with lower sexual frequency in marriage corresponding directly with marital instability and thoughts of leaving a partner and/or divorcing. Sometimes one person’s sexual drive simply does not match that of his or her partner. This is a frequent issue in couples therapy. Sometimes both people have a desire for sex, but one of them does not want to have it with his or her spouse for any number of reasons, such as lingering resentments, lack of relationship intimacy, and no longer finding the other person attractive. In other cases, one partner’s lack of interest in marital sex may stem from underlying psychological issues such as depression, anxiety, drug and alcohol abuse, low self-esteem, early attachment deficits, or unresolved trauma. It is not unusual for such people to turn to non-intimate sexual experiences (online porn, webcam sex, strip clubs, prostitutes, etc.) as these encounters can feel more intense yet less emotionally challenging than being sexual within a long-term committed relationship. Another reason some people lose interest in sex with a long-term partner/spouse is they’re having an affair. If they’re getting their sexual needs met on the side, there’s not much sexual interest left for the primary relationship.

Many “sexless” couples never had much sex to begin with. For others, a particular time or event – the birth of a child, an affair, physical illness or injury – slowed their sexual frequency. Sometimes people simply mature in ways that leave them feeling less sexual but still motived to seek out life-affirming, nonsexual intimacy and connection. Whatever the case, the ways in which sexual inactivity affects a couple over the long-run depend almost entirely on the specific emotional meaning the act of sex has for that particular couple, combined with each person’s specific sexual desires. If both partners are OK with less sex, so be it. But, as mentioned above, if one partner wants sex and the other doesn’t, a lack of sexual activity can evolve into problematic patterns best addressed by a well-recommended couples counselor or sex therapist.

Is Decreasing Frequency Inevitable?

Most of us know (or at least have heard about) one long-married/committed couple that is still hot for each other decades into the relationship. And good for them. For the rest of us, libido usually droops in tandem with our aging body parts. This is perfectly normal. Some of this decline in sex drive is physical in nature – diminishing testosterone levels, side-effects of blood pressure medications, etc. – and the rest of the decline is just plain old life distracting us from the joys of making love. We get stressed out at work, worry about our kids, and struggle to make this month’s mortgage payment, and because we’re so busy dealing with that stuff we push aside and/or devalue the importance of sex.

Happily, less sex does not equal less happiness and fulfillment. For most couples, especially couples that have been together for a few years, their companionship, mutual reliability, and sense of trust in one another trumps having a lot of sex. That said, if several months have passed with no sex and this lack of mutual erotic activity is troubling to one or both partners, the matter should likely be addressed with a professional present to help.

Discerning the Underlying Issues

With some couples, a little bit of effort is enough to rev the engines. For others, there may be physical, psychological, or marital issues that need to be worked out. In all cases, the initial step to take is an open dialog to determine the source of the problem. Possible causes can include:

• Physical issues: hormonal imbalance, serious illness, injury, etc.
• Stress: work, money, kids, daily chores, car repairs, community or political turmoil, etc.
• Resentment: unresolved anger directed at the other partner
• Depression, anxiety, low self-esteem, childhood trauma, attachment deficit disorders, etc.
• Substance abuse or addiction
• Decreased physical attraction to one’s partner
• Secrets, which diminish relationship trust and emotional intimacy

Once a couple has identified the problem, they can decide what to do about it. If the issue is physical – the man has trouble maintaining an erection, for instance – a trip to the doctor can do wonders. Decreased physical attraction can sometimes be resolved with a makeover and/or an improved diet coupled with a regular workout regimen, but usually decreased physical attraction has less to do with appearance and more to do with unexpressed and unresolved unhappiness in the relationship/marriage. If this is the case, couples counseling might help. Therapeutic intervention can also help with stress, resentment, psychological issues, addiction, and the keeping of secrets.

Rekindling the Flame

As mentioned above, sometimes a little bit of effort is all that’s need to revive a flagging sex life. Oftentimes with sexless (or nearly sexless) couples, sex was great in the beginning, when everything that happened was new and exciting. The emotional connection through physical intimacy was powerful as the partners got to know each other’s bodies – learning, exploring, and experimenting. Unfortunately, somewhere along the way marital sex sometimes gets a little stale. It becomes routine, and routines can be boring. The good news is that for most otherwise healthy (read: happy) couples it’s relatively easy to spark a new fire. Below are five tips to help in this regard.

1. Try something new. You’ve always had a certain fantasy but you’ve never acted on it. Now is the time to tell your spouse and ask if he or she is willing to try it. And if you’ve had a fantasy that you’ve kept secret all these years, so has your partner. Ask about it, and be willing to indulge it.
2. Switch it up. Have sex in a different room of the house, or in a hotel, or on a cruise ship. If your partner is always the initiator, you take the lead. If you are usually the initiator, ask your partner to take the lead.
3. Be romantic. Give your spouse a gift “just because.” Tell your spouse five things that you love about him/her. Plan a surprise date, and make sure it’s something he or she will enjoy. (Rather than dragging your wife to the sci-fi convention because you’re a huge fan of Star Wars, take her to the art museum to see the modern art that she loves. Instead of dragging your husband to the mall to shop for shoes, surprise him with a trip to the drag races.)
4. Understand that physical intimacy doesn’t always mean sex. Recognize that cuddling can be as intimate as actual sex. Try holding hands and looking into your spouse’s eyes and listening to him or her. Flirt, tease, and touch, knowing that when you finally do get around to actual sex, both of you will be excited and ready.
5. Schedule it. Set aside time for you, as a couple, to be both emotionally and physically intimate. Recognize that you are both busy and stressed out, and plan to take a relaxing bubble bath together or to give each other a massage as part of your sexual foreplay.

Is Marital Sex Optional?

Sex is a natural, healthy way for couples to bond emotionally. In many ways it is an important contributor to overall health and happiness. So it is probably not surprising that increased marital sex generally corresponds to increased marital satisfaction, and vice versa. That said, non-genital touch, massage, hugs, holding, and just plain talking openly and honestly are every bit as effective as sex in bringing us closer to our partners – sometimes more so. As long as both partners within a “sexless” marriage are open about their feelings and needs and mutually satisfied with the level of intimacy, the relationship can not only survive, but thrive.

Robert Weiss LCSW, CSAT-S is the author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters. He is a regular contributor to both PsychCentral.com and The Huffington Post, writing primarily about the intersection of technology with sex and intimacy. A licensed UCLA MSW graduate and a personal trainee of Dr. Patrick Carnes, Mr. Weiss founded the Sexual Recovery Institute in Los Angeles in 1995. Currently he is Senior Vice President of Clinical Development with Elements Behavioral Health. He has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among many others.

- Song lyrics by Sammy Cahn, music by Jimmy Van Heusen (Copyright Barton Music Corporation)

Mommy, What’s a Housewife?

For much of the 20^th century young women dreamed of little pink houses, white picket fences, two (or maybe more) kids, and a cute, cuddly, calendar-worthy pet. And, of course, a faithful, clean-cut, high earning husband. Or so the story goes. In other words, young women were expected to have a “steady,” get pinned, get engaged, get married, get pregnant, and become a stay-at-home mom, at which point they could experience the joys cooking, cleaning, and generally catering to the needs and whims of their busy husbands and children. Barefoot and pregnant, educated just enough to make interesting dinner conversation, yadda yadda yadda.

Try selling that to the young women of today.

By the 1970s at least a few women were openly rejecting this Father Knows Best version of womanhood, taking to the streets, burning their bras, and demanding equal rights, equal pay, and equal say. And even though much of the traditional “establishment” (including many women) mocked these feminist activists, much was accomplished and their march toward equality continues to this day. So perhaps it should not be surprising that over the course of the last half-century or so the idea of a “traditional” marriage, where the woman stays home while the husband earns a paycheck, has largely become the relic of a bygone era – at least among younger couples.

For evidence of this, one needs to look no further than recent research on young people’s attitudes toward marriage. In one study conducted by the Pew Research Center, 44 percent of Gen Y and 43 percent of Gen X said they view the concept of marriage as “archaic.”ⁱ And young people are backing up this sentiment with real world behavior. Only 26 percent of people currently in their twenties are married – whereas 68 percent of people in their twenties were married in 1960. So clearly, among young people, marriage is no longer the be-all, end-all it was thought to be a mere half-decade ago.

The REAL Marital Tradition

The supposedly “traditional” model of coupling up – two heterosexual people falling in love and marrying with the male as sole breadwinner and head of household – was popularized in the mid-20^th century by television shows like The Brady Bunch, Leave it to Beaver, and the aforementioned Father Knows Best. However, this nuclear family fantasy is actually quite far from the reality of traditional conjugal relationships. In fact, marriage throughout the ages has almost nothing in common with this “modern” conception of a legal, social, and religious bonding of a woman to a man. The truth of the matter is that for thousands of years marriage was primarily an economic (and occasionally political) contract that was negotiated and organized not by the two people involved, but by their families, communities, and churches. Essentially, back in the day it took more than one person to make a household or family business thrive, so a mate’s skills, resources, and participation as a household/business partner were valued every bit as much as that person’s personality and physical appearance. Things like love and sexual attraction did not factor into the equation. Period.

As Stephanie Coontz writes in her enlightening book, Marriage, A History:

For most of history it was inconceivable that people would choose their mates on the basis of something as fragile and irrational as love and then focus all their sexual, intimate, and altruistic desires on the resulting marriage. In fact, many historians, sociologists, and anthropologists used to think romantic love was a recent Western invention.ⁱⁱ

Thus we see that sexual attraction and romantic love as primary reasons to marry is a relatively recent invention, brought about in large part by the evolution of a meaningful middle class – which, by the way, reached its apex in the mid-20^th century when, for the first time ever, just about any regular guy could earn enough money to support an entire family. This meant that women, also for the first time ever, didn’t need to farm, clean, cook, sew, and work in the family business to keep their spouse and children fed, clothed, and adequately housed. And because of this of this, love and attraction as a reason to marry became possible. Unfortunately, the role of women in this newfangled scenario turned them into part maid, part ornament. The mantra seemed to be: as a wife, your function in life is to look pretty and keep your husband and family well-fed and happy.

Interestingly, the educated young women of today appear to be turning away from both models of marriage. They are not enthralled with the concept of being a platonic business partner, nor are they interested in being a living, breathing, house-cleaning Barbie doll. As far they’re concerned, they can bring home the bacon and they can darn well eat it, too. So why settle?

If Not “Traditional” Marriage, Then What?

For the first time in history, single young women in America are more successful, on average, than the single young men around them. They are more likely to attend college, more likely to graduate from college, and they typically make more money.ⁱⁱⁱ For the most part the young women of today are far less interested than their predecessors were in finding Mr. Right. This is because they’re a lot more motivated and encouraged then previous generations of women to immerse themselves in things like school and career. In other words, the young women of today are as every bit as likely as most guys to say to a date, “This has been nice, but please be gone when I wake up because but I have to get back to the important stuff in my life.”

Although this romantic and sexual nonchalance is an attitude one typically associates with self-centered young men, it is nowadays serving young women quite well. In fact, the burgeoning casual hookup culture, fostered in large part by smartphone apps like Blendr, Skout, Tinder, and the like, is consider by some to be a prominent contributor to the ever-increasing economic, social, and political success currently being experienced by young women. As Hanna Rosin, author of The End of Men: And the Rise of Women, recently wrote in The Atlantic:

To put it crudely, feminist progress right now largely depends on the existence of the hookup culture. And to a surprising degree, it is women – not men – who are perpetuating the culture, especially in school, cannily manipulating it to make space for their success, always keeping their own ends in mind. For college girls these days, an overly serious suitor fills the same role an accidental pregnancy did in the 19th century: a danger to be avoided at all costs, lest it get in the way of a promising future.^iv

It is interesting to note that this attitude is the exact opposite of what women were taught to want from men, college, and dating a mere generation ago, when it was typical for a young woman to be more focused on finding a man and settling down than evolving a career. Given this, it is possible that the casual sex hookup culture is in some ways the logical outcome of feminist dogma’s merger with modern technology.

The Brave New World

In today’s increasingly digital universe, social upheaval (the feminist movement) combined with technology has created a sea-change in young women’s attitudes about all sorts of things, including marriage. What the young women of today are seeking from sex, romance, and long-term relationships has transformed in ways that were almost inconceivable fifty years ago. Basically, monogamous relationships are now thought of by many educated young women in terms of what you lose rather than what you gain. For them, marriage is seen as a restriction on personal freedoms, including the freedom to do what they want, when they want, with their education, career, and sexual autonomy.

Does this mean marriage is going the way of the 8-track tape? Perhaps, but probably not. More likely we are simply witnessing the evolution of human relationships relative to economic, cultural, and technological advance. And, as is the case with all forms of evolution, the change will be good for some, bad for others. Some young women will likely go overboard with causal hookups, never finding a meaningful connection, and others may become so turned off by the lack of intimacy that they withdraw entirely. Most, however, are using and will continue to use the app-driven hookup culture as a stopgap way of meeting their “intimate” needs without sacrificing their longer-term life goals. For these women, marriage and children will come, in time, after they’ve established themselves as thriving adults – just as men have always been able to do.

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 and Director of Intimacy and Sexual Disorders Services at The Ranch and Promises Treatment Centers. He also founded the Stimulants and Sexual Disorders Program at Promises, Malibu. 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 can also be found onFacebook at facebook.com/RobWeissMSW and Twitter at @RobWeissMSW.

ⁱPew Research Center, The Decline of Marriage and Rise of New Families, http://pewresearch.org/pubs/1802/decline-marriage-rise-new-families (Dec 19, 2010).

ⁱⁱStephanie Coontz, Marriage, a History: How Love Conquered Marriage, (London : Penguin Books, 2005) 15.

ⁱⁱⁱBelinda Luscombe, Workplace Salaries: At Last, Women on Top, Time Magazine, http://www.time.com/time/business/article/0,8599,2015274,00.html (Sep 1, 2010); Paul Wiseman, Young, Single Childless Women Out-Earn Male Counterparts, USA Today, http://usatoday30.usatoday.com/money/workplace/2010-09-01-single-women_N.htm (Sep 2, 2010); and Heather Boushey, Are Young Women Earning More than Their Boyfriends?, Slate, http://www.slate.com/articles/double_x/doublex/2010/09/are_young_women_earning_more_than_their_boyfriends.html (Sep 7, 2010).

^ivHanna Rosin, “Boys on the Side,” The Atlantic, http://www.theatlantic.com/magazine/archive/2012/09/boys-on-the-side/309062/?single_page=true (Sep 2012).

Faux Intimacy?

In today’s tech-driven world, young people (digital natives) are as likely to communicate in the digital universe as they are to communicate face-to-face. In fact, more likely. A Pew Internet & American Life study conducted in 2012 found that texting is now the primary mode of daily communication between teens and their friends and family, far surpassing phone calls, face-to-face interactions, and emailing.ⁱ So in some ways it’s only natural that teens and young adults do much of their flirting online, too. A recent University of Michigan survey of 3500 young adults (ages 18 to 24) confirms this idea, finding that for this age bracket texting and sexting are simply another way of getting to know potential romantic partners and possibly advancing a relationship.ⁱⁱ

Of course, older generations (digital immigrants) sometimes worry that all of this digital rather than in-person interaction may be ruining the ability of young people to connect in meaningful ways and develop lasting intimacy. Many feel that the increasing propensity of young people to conduct their romantic affairs online is fostering a sort of “faux intimacy” among couples. Dr. Dorree Lynn, a psychologist and the author of Sex for Grownups, is a proponent of this thinking. In a recent ABC News article she laments that it’s now “easier to hop into bed than have a relationship.” She believes that digital communication inevitably creates the sort of artificial affection mentioned above, and that it does not teach people how to create or develop lasting relationships. “It’s all a function of the fast-paced world we live in, where communication skills, genuine communication skills, which means face-to-face communication, are quickly going by the wayside.”ⁱⁱⁱ

Echoing this sentiment, the popular (anonymously written) blog entitled “The Married Chick,” in response to research on the increasing propensity of women to say “I love you” via text message, states:

When I read about this study, I wasn’t surprised at all. But as a true romantic (not a hopeless one; a hopeful one!), I was saddened. Mainly because I know that digital communication is well on its way toward replacing genuine, heart-thumping, palm-sweating human love interaction. I can remember long phone calls with my high school boyfriend. I lived for nights when I’d stay up past midnight, chatting with him about everything under the sun, hanging onto his every word. My kids will probably live this experience via IMs and text messages, typed at about 200 wpm! What’s the heart-thumping, adrenaline-pumping pleasure in that? I can see setting up plans or sharing gossip via text, but saying “I love you?” It can’t possibly have the same impact when you’re reading it for the first time on your PDA (pun intended).^iv

The Real Thing?

As discussed above, older folks sometimes worry that digital technology is ruining the ability younger people to connect in meaningful ways and to create lasting relationships. However, this does not appear to actually be the case. In fact, numerous studies demonstrate that communication via social networking sites, IMs, and texts can actually propel relationships forward, speeding up the “getting to know you” process by lowering inhibitions and allowing potential partners to be more genuine with each other, more quickly. A recent survey jointly conducted by and published in Shape and Men’s Fitness magazines is but one example. Eighty percent of the women surveyed said digital communication makes it easier to stay connected. Fifty-eight percent of men said digital flirting helps to advance a relationship. The study also found that texting is now the number one method for lovers to stay in touch, with men texting their intimate partners 39 percent more often than calling, and women texting 150 percent more often.^v Other studies and surveys have produced similar findings. So it appears the ersatz intimacy feared by older generations may actually be the real thing – at least occasionally. In other words, the connections that men and women experience through digital interactions can be as real and meaningful as in-vivo flirting, particularly among young people.

Changing Perspectives

Yes, older generations typically yearn for the type of intimate interaction they best understand, one that occurs face-to-face, but digital natives are likely consider a racy text message every bit as enticing as a knowing smile from someone in the room. Thus, the efficacy of a winking emoticon versus a real-world, in-the-flesh wink is a function of the sender and receiver’s age more than anything else. The younger you are, the more likely you are to respond positively to the digital communique. Neither is right, and neither is wrong. It is true that young people now flirt in different ways than their parents and grandparents once did, but that doesn’t mean they are flirting any less effectively or that the relationships they develop are any less meaningful.

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 and Director of Intimacy and Sexual Disorders Services at The Ranch and Promises Treatment Centers. He also founded the Stimulants and Sexual Disorders Program at Promises, Malibu. 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 can also be found onFacebook at facebook.com/RobWeissMSW and Twitter at @RobWeissMSW.

ⁱ Teens, Smartphones, and Texting, Pew Internet & American Life Project, http://www.pewinternet.org/Reports/2012/Teens-and-smartphones/Summary-of-findings.aspx (May 19, 2012).

ⁱⁱ Michigan Study Says “Sexting” is the Modern-Day Way of Flirting, ClickOn Detroit, http://www.clickondetroit.com/news/news/Michigan-study-says-sexting-is-the-modern-day-way-of-flirting/-/4714498/15697310/-/8i9r2tz/-/ind (Jul 25, 2012).

ⁱⁱⁱ http://abcnews.go.com/Technology/facebook-foreplay-survey-social-media-leads-sex-faster/story?id=12767315#.UFj0iY1mRng.

^iv The Married Chick, “I Love You” in the Digital Age, MSN, http://living.msn.com/love-relationships/the-married-chick-blog-post?post=dd46c0fd-4be1-4853-a181-c831abec5f69&_blg=3 (Aug 1, 2012).

^vKi Mae Hussner, Facebook as Foreplay? Survey Says Social Media Leads to Sex Faster, ABC News, http://abcnews.go.com/Technology/facebook-foreplay-survey-social-media-leads-sex-faster/story?id=12767315#.UFj0iY1mRng (Jan 26, 2011).