I have heard this story of treatment failure from many couples who come in to see me about sex addiction. One partner was discovered to have sexually addictive behavior(s) such as porn addiction, voyeurism, hook-ups, paying for sex etc. After an initial upheaval the couple found help for the addict. The addict went into a program which may have included residential or intensive outpatient treatment, individual therapy, couple counseling, or some combination of these.
At some point the addict felt that he or she had seen the light and was able to refrain from the compulsive behavior for a period of months or years. Then seemingly out of the blue, the addict starts secretly acting out again. Often it is the same old behavior but sometimes it includes different behaviors as well. Both partners are dismayed and the trauma begins all over again. Something didn’t quite work, but what?
Many life events can present a challenge to someone’s recovery. Illness, financial stress and other crises can trigger a relapse. But if the addict and the couple are in good recovery they can usually get through a crisis without a return to sex addiction.
The problem arises when the addict’s “sobriety” was only skin deep. Treatment involves addressing many different issues and neglecting any of them is not an option. Here are some of the reasons sex addiction treatment can fail and recovery can go off the rails.
- Incomplete disclosure. Sometimes the addict in treatment “discloses” everything to the partner but holds back something from both the partner and the therapist. This can be subtle such as omitting the fact that the addict had unprotected sex with someone or failing to reveal that the affair was with a friend of the spouse. Or it can be blatant such as the failure to admit to a whole set of behavior like cybersex, gay sex or hiring escorts. Complete disclosure often comes in stages, but if the addict never tells everything he or she is perpetuating the habit of sexual secrecy. Without a commitment to honesty the addict will continue to live with the lies and shame that can ultimately lead back to acting out.
- Recovery tourism. Some addicts are recovery tourists. They follow through on a program of sex addiction treatment and even go to 12-step meetings but they do not feel engaged in a genuine way. They sometimes feel they are there to keep their partner happy or to look good in the eyes of others. But they never feel the intrinsic value of recovery for themselves. This limits how much they can really change. Recovery demands deeper change and those in good recovery experience this as truly life-changing.
- Seeing the problem as purely a relationship problem. Sometimes addicts never get the right kind of treatment to begin with. It is an easy mistake to think that sexual acting out by one partner is a symptom of something wrong in the relationship. But couple therapy alone cannot address the very powerful habit of using sex a drug any more than couple counseling can cure alcoholism. While it is true that sex addiction usually signals a problem with intimate relating, better relationship skills may not be possible until the addict addresses the addictive behavior. A trained sex addiction therapist will be able to make a plan to treat all aspects of the problem.
- Ignoring the deeper issues. On the flip side, it is possible for treatment to address the addict’s problem with using sex as a drug but never deal with the intimacy avoidance that goes along with a sexual double life. Most addicts lack true intimacy skills, the ability to be nurturing and vulnerable, to share power and to communicate their needs and feelings. Unless they gain these skills their relationships will be problematic and inauthentic. This in turn leads back to the addict reaching out for another kind of gratification elsewhere. And the intimacy avoidance can in turn relate to longstanding problems such as childhood attachment issues, abuse and trauma. These must be resolved somewhere along the line for the recovery process to be reliable.
- Misdiagnosis. This happens more than I would like. I see couples who have been to therapists for help with one partner’s sexual acting out behavior but have come away with a mistaken understanding of the problem. Often the therapist will say that the problem is due to the addict’s emotional immaturity and self-centeredness, i.e. a case of “arrested development.” Sometimes therapists do not see the compulsive nature of the behavior and address only the need for better communication and a greater understanding of the spouse or partner’s feelings. Worst perhaps is when the addict convinces the therapist that the partner is wrong and paranoid. In this case the therapist may work on getting the partner to accept what is taken as normal behavior. In cases like these the addict feels that that they have addressed the issue in therapy and have essentially been given a clean bill of health.
Reliable recovery from sex addiction demands many things; an acceptance of the problem as an addiction, the need not only to detox from that sexually compulsive activity but to follow through with the deeper work of personal growth and to learn a new way of living. Addicts who have done this have turned a corner; they are on much firmer ground in their recovery and in their lives generally.