Therapists, particularly those treating sex addiction and in the addiction field generally, are familiar with therapy-interfering behaviors. Frequent lateness or failing to show up for appointments, fomenting conflict with the therapist, and many other forms of direct and indirect ways of undermining the process. As with problem behaviors generally, these are maladaptive attempts to solve a problem.
I first encountered an analysis of therapy-interfering behaviors in the work of Dr. Marsha M. Linehan. Dr. Linehan was a pioneer in the treatment of the maladaptive behaviors that characterize borderline personality disorder such as chronic suicidality, chemical and behavioral addictions, and other self-destructive behaviors.
Sex addiction therapists, no less than those treating any other maladaptive behavior, do well to make the problem of therapy-interfering behaviors a priority. Dr. Linehan proposed a hierarchy of target behaviors:
- Suicidal, parasuicidal or other potentially life-threatening behaviors
- Therapy-interfering behaviors
- Maladaptive vs. life-enhancing behaviors
The idea here is that, of course, the first goal is to make sure the patient stays alive and doesn’t harm anyone else. But next, it is crucially important to address the behaviors that keep the patient from receiving help.
I believe that with sex addicts and addicts generally, the three types of therapy-interfering behaviors described by Linehan can be traced to specific kinds of childhood trauma and attachment issues. In turn, these play out in predictable ways in addiction treatment.
These are behaviors which indicate a rather superficial engagement with therapy. These include chronically missing sessions, being late, dropping out of therapy, or being in constant crisis or chaos which disrupts recovery.
Also included in this category are behaviors that make it difficult for the client to be available in sessions such as being overly tired or under the influence of drugs. These clients seem outwardly compliant but are often fixated on their significant other to the point of being unable to fully “show up” in treatment.
The attachment style of these clients seems to be basically avoidant. They likely come from a family in which they were emotionally neglected or in which they played a parental role. They seem to find it hard to focus on themselves and tend to drift off or dissociate. They are needy and lack a sense of agency in their lives. They have developed a coping style that involves seeming to be engaged while being on their own “trip.”
These are behaviors that divert from the work in treatment, such as challenging everything the therapist says, putting up a wall, refusing to respond, and even outright verbal aggression against the therapist or against other clients in groups.
Non-collaborative clients seem to have family histories that are characterized by physical or verbal abuse, overt or covert molestation, and adversarial relating. As children they become oppositional and defiant in response to feelings of being rejected, exploited, or being in constant conflict.
These clients often seem to me to feel they are different and superior. They are the do-it-yourself type who want to write their own rules. They take a very defensive posture because they run on fear. These clients take a long time to establish any feeling of connection with a therapist or with other group members. Any kind of letting go or vulnerability seems to them illogical and even life-threatening.
Non-compliant behaviors include a resistance or unwillingness to consistently complete homework or task assignments, refusing to agree on treatment goals, and feeling overwhelmed when asked to participate in exercises or practice new behaviors. These are what might be thought of as partly passive-aggressive tactics.
These clients seem to feel one-down and powerless. They come from a feeling of hopelessness about getting their needs met, and tend to neglect their lives and their self care. Family of origin issues may involve emotional deprivation, lack of nurturing, and not feeling “seen.” These clients are “touchy” and over-sensitive to slights. They don’t expect much from anyone, and are in rebellion against having anything expected of them.
As you can see, therapy-interfering behaviors are more than just an inconvenience or a side issue. They relate to the very essence and origin of the target behaviors. Since therapy is itself an intimate relationship, the conflicts arising in that relationship relate directly to the attachment injury that created the other maladaptive behaviors in the first place.
Sex addiction treatment is a sub-specialty that is highly manualized and task-oriented, and that is as it should be. But openly talking about and targeting behaviors that get in the way of this kind of treatment involves constantly weaving in the kind of process-oriented confrontation that we already have in our skill set.