Dissociation: A Crucial Problem for Sex Addiction Treatment
We have always known that recovery from sex addiction involved regaining integrity. By this we usually mean that practicing sex addicts typically have a secret life. They are the all-around good guy as they move about the world and they become their darker, secret self when they are acting out sexually.
Behaving according to the same set of values in all situations is usually what we mean by integrity. But for sex addicts integrity is taking on a whole other meaning.
Kenneth Adams PhD and others have begun to emphasize the importance of dissociation in understanding and treating sex addiction. Preliminary findings indicate that addressing dissociative disconnectedness is a crucial element in treating survivors of childhood sexual abuse who have sexually addictive behaviors.
Addicts whose addictive behavior represents trauma repetition are prone to feel disconnected or in a trance when acting out. They may act out sexually but not even enjoy it. But other sex addicts including those who use sex or porn to escape into fantasy or numb out negative feelings can feel they are acting without awareness or without a sense of agency. I think of this automaton-like behavior as the Manchurian Candidate effect, as in the movie about brainwahsing.
Recent neuroimaging research is beginning to document the disconnect in the brains of addicts, the lack of integration of the parts of the brain that relate to reward and motivation and the parts responsible for executive function: cognitive control, decision making and the like. A recent article entitled “Prefrontal Control and Internet Addiction” reviews the research supporting the idea that the internet itself and specific internet related behaviors can become addictions in the neuropsychological sense.
The role of dissociation in persistent relapse
I am increasingly aware of the problem of what looks like dissociation among clients who have persistent “slips”.
These addicts are sincere in their interest in recovery and are often quite able to comply with treatment. They have given up a life of secrecy and shame and are open and accountable about their behavior. They seem to be living in integrity but then oops, they slip and act out! Part of them is cut off from another part of them.
There are a number of techniques that treat addiction by acting on the brain. They address this “Pavlovian” aspect of addiction using mindfulness practice, or de-conditioning responses to specific kinds of cues, or address trauma responses directly as with EMDR.
Many practitioners, myself included, use primarily behavioral or “bottom up” kinds of treatment to increase behavioral control but also use “top down” techniques in the attempt to re-program the person’s more automatic reactions.
Treating Dissociation as compartmentalization
Addicts who dissociate need to be made aware of the fact that they are leading a double life. Not a double life in the sense of deceiving their wives or friends about their sexual compulsions, but a double life in the sense of the two dissociated parts of them. They are no longer keeping secrets from other people; now they are only keeping secrets from themselves.
- Making the introduction
Typically my patients who have frequent slips do not recognize the part of them that is relapsing or slipping into the addictive behavior. They think of themselves as the “good guy” who is fully engaged in recovery. They feel as though the “real” them doesn’t want to act out. So the task is to keep bringing the acting out part of them into their awareness as a real part of who they are. This means in effect reminding them that they have been continuing to lead a deceptive, double life through disowning a part of themselves.
- Valuing both parts of the person.
The compliant side of the addict is not the whole person. The “good” recovering part is suppressing some key strengths; denying their need to stick up for what they believe or their right to feel all their feelings, for example. And the dissociated “addict” part needs to be given its due as being the part that is demanding to have its needs met, needing and deserving to find gratification without guilt.
- Forcing the two to collide
Checking in with someone, i.e. calling a friend in recovery is designed to ground the addict in reality and possibly short circuit acting out. But I find that my dissociated addicts will be diligent about making calls at the wrong time! They will connect with reality but in a way that doesn’t infringe on their acting out.
Having a number of recovery friends call the addict at their preferred time for acting out brings reality into the potentially slippery situation.
“Contaminating” fantasies is another technique we commonly use which helps bring reality into the dissociated addict world. Talking about the acting out experience and reflecting back some of the realistic aspects or consequences of the actions, reminding the addict of how the acting out impacts his/her real life
Likewise repeatedly describing acting out behaviors and fantasies in detail in therapy groups or one-on-one helps make that part of the person real and diminishes dissociation.
- Consistent standards
Dissociative sex addicts often will often find alternative ways to act out while still believing that they are staying away from their “real” or “serious” sexual acting out. A porn addict may allow himself to view soft core “bikini” porn because it is less extreme. Another addict may avoid hook-ups and cybersex, but get lost in an unreal world on dating sites.
Insisting that the addict recognize all related behaviors as sexual acting out forces him/her to have one set of standards and apply it thus bringing the addict self more out in the open.
Although not all addicts fit this model, for those who do it will be impossible to gain a sense of control or agency regarding their behavior unless the two parts of them are brought together. Until then, no one is in control.
Hatch, L. (2014). Dissociation: A Crucial Problem for Sex Addiction Treatment. Psych Central. Retrieved on October 19, 2017, from https://blogs.psychcentral.com/sex-addiction/2014/03/dissociation-a-crucial-problem-for-sex-addiction-treatment/