Sex and porn addiction treatment are alive and well in the UK. On a recent trip, I met and talked at length with two wonderful colleagues, one in London and one in Edinburgh. Our two countries approach sex addiction treatment in much the same way. But there are differences, things we can learn from one another.
Obviously this is not intended as a comprehensive survey but rather as food for thought based on my own observations and questions. It seems to me that the differences between the approach to sex addiction in the US and the UK fall into (at least) three categories. There are professional differences, cultural differences, political differences.
There are five certified sex addiction therapists (CSATs) in the UK. These are the therapists who have received training and certification through the US based International Institute for Trauma and Addiction Professionals (IITAP). This is the same number of CSATs as there are in New Mexico which has one thirtieth of the population! And yet judging by the frequency of articles from the UK documenting the increases in porn and sex addiction, the problem is increasingly evident in the medical, educational, professional and non-professional communities.
Mary Sharpe of the Reward Foundation in the UK is also very active in the US based Society for the Advancement of Sexual Health (SASH). She has recently put out a press release entitled “Unprecedented rates of sexual dysfunctions in young men may be related to internet porn use”. In it she outlines a number of recent studies from the UK, Europe and the US. In addition, some of the most important laboratory research by Valerie Voon and others on the neurobiology of porn addiction has come out of Cambridge University.
Yet my colleague, Mary, is not a clinician. She is a lawyer and an activist. Just so you know, she is not a religious fanatic or a flame-out feminist. She is just a person who is determined to educate people about the problems related to porn use.
So with all the media attention given to the problem of porn and sex addiction in the UK one wonders if Brits are subject to the same kind of pro-porn backlash that we experience in the US. While the media in Britain do seem to try to be “fair and balanced” in their coverage of the topic, there does not seem to be the same kind of concerted effort to undermine the mere idea of sex or porn addiction that we see in the US. And absent, it seems, is the conspiratorial thinking of those who see sex and porn addiction treatment as some con game being perpetrated in order to make money. But more about that below.
There are 65 separate regular weekly Sex Addicts Anonymous meetings in the UK. Yet the resources for sex addiction treatment are scarce in the same way that they are in the US. Mary is frequently contacted by people looking for help. She finds herself advising them as best she can with support and information.
My new friend Paula Hall is a sex addiction therapist in England. She too connects to our professional community in the US through SASH. Although Paula is well trained and experienced, she has not completed the US based CSAT training. She is however familiar with that theoretical framework and its program tools and she uses them in her work with sex addicts.
My impression from talking to her is that Paula works with sex addicts in much the same way that I and my fellow CSATs do only without the official imprimatur. She does individual therapy, offers 6-day intensive workshops and conducts 12-week therapy groups.
Paula is impressive. When I met with her she was preparing to do a training on sex addiction in Thailand and had lectured to a psychiatric clinic in Dubai. She recently posted an excellent TEDx talk entitled “We Need to Talk About Sex Addiction”.
What I learned from Paula is that one cultural difference between the US and the UK is that clients in the US are more willing to go with a highly manualized and regimented program than are the Brits. It is always tricky to stereotype groups, but this fits with my own perceptions of the British as more irreverent and more willing to question authority. Some clients, Paula reports, are put off by what they see as “cheesy” inspirational sayings and more inclined to laugh at some of the CSAT tools such as the Personal Craziness Index which are seen as simplistic.
Paula says her solution is to say things differently, to be less directive until asked. And to be fair, some US clients react against a one-size-fits-all approach. They don’t want to “drink the kool-aid”. But my impression is that although the CSAT and 12-step approaches may seem overly rigid to some, I suspect that most CSATs in the US are able to be flexible, authentic and willing to go with what works for the client.
Government attempts to regulate the porn industry in the UK have been politically rocky but more energetic than in the US (with the exception of child porn) particularly in the area of preventing underage exposure to porn. There may be a back and forth about regulation but there seems to be less denial that porn and sex addiction pose real social and medical problems. There also seems to be and less of a backlash against regulation per se vs. the US reflex of “don’t take away my freedoms!”
I could not help but wonder if the absence of the extreme polarization we find in the US might have something to do with the very centralized nature of the professional sub-specialty here. There are any number of sexual treatment modalities in the US but CSATs are a fairly tight knit group. We are all trained in largely the same way by the same people using the same books and materials. And many of us have worked with or in the same programs and facilities around the country. Those who want to question our motives may find ammunition in this very orthodoxy. There are many other factors, of course, but as I discussed above, things seem a bit looser (and more practical?) in the UK. The problem of sex addiction in the UK is seen as real, and people from different disciplines seem to be approaching it in whatever ways they can.
I came home from my visit with a greater willingness to question American hegemony in the field and hopeful about the level of cooperation in activism, research and education. In any case, the denial of sex and porn addiction is doomed. It is doomed in the same way as science denial in general is. It will be crushed by the increasing weight of scientific evidence and pushed aside by the greater practical need to address the undeniable human fallout.