Many people manage to get free of their addictions or mature out of them on their own, but other people require help. And for those who require help, psychotherapy alone is often insufficient. On the most basic level, it is simply not possible to conduct a counseling session with a person who is using drugs as a primary coping mechanism. This includes those who rely heavily on sexual acting out, pornography, gambling and other behavioral addictions as ways to escape.
Therapy can help people grow, gain self-efficacy and adopt healthier coping mechanisms through insight, awareness and working through old pain. But if you have ever tried to counsel someone who is actively using a drug you were probably humbled by the realization that you have nothing to offer that even comes close to their drug’s awesome power to relieve pain and relieve it now.
The challenges of sex addiction treatment
Addiction treatment is designed to address the particular challenges of working with addicts. It assumes that the addict uses a drug or a mood altering behavior to medicate or escape negative emotions such as loneliness and self-hate, emotions which can be overwhelming. It further assumes that these emotions and the addictive cravings can occur at any time of day or night, not conveniently in the therapist’s office. This means the addict will require more than a weekly therapy appointment in order to “detox” and establish an initial period of abstinence.
Since addiction usually thrives on and promotes emotional distance and disconnection from other people, addicts tend to experience human interaction as inauthentic and untrustworthy. And the addict very often brings this lack of trust into the therapy relationship. He or she is primed to experience the therapy relationship as unsafe and fraudulent and may respond in a dishonest and irresponsible way.
How sex addiction treatment differs from ordinary therapy
Out-of-office experiences. In the initial phase of addiction treatment the addict requires a great deal of external support and structure. Recent research has shown that the brains of sex addicts are compromised in some of the same ways as those of drug addicts. This means that the addicted brain lacks the necessary impulse control to go it alone. The treatment practitioner will attempt to put the necessary supports in place immediately by setting up a regimen that connects the addict with other people in recovery, people who can be available 24-7. Usually this means insisting that the addict attend 12-step meetings as often as possible and that he or she reach out to others by phone and text every day to “check in”. In the Dialectical Behavior Therapy (DBT) model, which is used with clients lacking emotional and behavioral controls, therapists often work in teams and make themselves available by phone to their clients after hours. Some clients require the even greater structure and support of intensive outpatient or residential programs.
Action orientation. Sex addiction treatment tends to be manualized and task oriented. There is an emphasis on psychoeducation, reading and homework which are geared toward breaking through the denial and self delusion that accompany all addictions. The initial task work is partly to educate the addict as to what their addiction is all about and to get them in touch with the real consequences of the way they have been conducting their life. We ask them to do experiential exercises, cataloging their addiction history and spelling out the costs and consequences over time. We ask them to inventory the secrets and lies they have been keeping as part of their addictive way of life, and we ask them to construct a detailed relapse scenario to further inoculate them against the tendency to slip back into their old behaviors. These and many other tasks and exercises take up a lot of treatment time. In traditional therapy much of the time spent talking about the problems, even if it were relevant and constructive, would still not provide concrete tools necessary to get traction in addiction recovery
Confrontation. Sex addiction treatment tends to involve direct confrontation of the ways in which the addict is kidding him/herself or those around him/her. It is also incumbent upon the sex addiction therapist to directly challenge the addict who is being manipulative, deceptive or putting up a front. This includes directly pointing out ways in which the addict may be attempting to minimize, rationalize the negative effects of their behavior on those around them. It also includes direct confrontation of manipulative behavior toward the therapist or behavior designed to get a sexual “hit”.
In traditional therapy the addict may have the best of intentions, but will be likely to slip into patterns of dishonesty. The addict only has to fool only one person: the therapist. In the treatment model there is much greater pressure for honesty and accountability.
Direct intervention. Sex addicts struggle with the extreme feelings of shame and low self worth around their addiction while at the same time clinging to a belief in their “nice guy” facade. This can play out in the addict’s refusing to do some essential piece of the program such as resisting being honest with a spouse or partner. Full disclosure is often very hard for sex addicts as they want to control how others see them and they find full disclosure of their addictive behavior to their partner unthinkable . Sometimes it is only the treating therapist laying down the law, forcing the addict’s hand that breaks through this process. This does not constitute taking over for the client but it does involve “lending” the client some of your ego strength. When we demand certain things of the client we are in effect giving them a vote of confidence and guiding them to a stronger sense of self.
Radical authenticity. Since a sex addiction treatment program demands “rigorous honesty” from the client, it is not possible for the treating person to be deceptive or phony in any way. It is far more effective in these treatment situations to be open with who you really are. Saying things like “we’re not here to talk about me” or “why do you want to know that?” will tend to put unnecessary distance between client and therapist. The therapist cannot be in hiding. The more naturalistic the therapist can be the better, including sharing parts of their own story when appropriate and relevant. In addition to modeling authenticity for the client, the clinician’s own vulnerability and honesty is necessary for paving the way to a relationship of trust.
The shift from individual to group work. Not only is group therapy an essential piece of an outpatient or inpatient sex addiction treatment program, it is part of a natural progression in the addicts long term growth. Sex addiction treatment progresses away from a reliance on the therapist to a relationship of trust and connection with a group of other addicts, as well as an emphasis on the building of trust and connection with a spouse or partner. Sex addiction groups are sometimes called a “feedback groups” in that they involve crosstalk between member, which 12-step meetings do not. Ideally these groups lead to close and lasting connections outside of therapy. A willingness to identify as a recovered sex addict and the building of lasting friendships in recovery reduces shame and prevents relapse.
Sex addiction treatment is not a brief therapy modality. It is a longer term project of 3 to 5 years total. Getting sober and establishing a connection with a treating person and with a recovery community and with a significant other are the foundation for the deeper work that builds lasting recovery.