Total Sex Addiction Recovery: A Guide to Therapy Dorothy Hayden

Total Sex Addiction Recovery: A Guide to Therapy
Dorothy Hayden, LCSW
Testimonials
“If You Want to Understand Sex Addiction, Read This Book!
Rob Weiss, LCSW, C-SATS
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health and
The Ranch.
"This new book by Dorothy Hayden sheds new light on sexual addiction
and its many forms of treatment. It is a comprehensive guide that adds
practical strategies and therapy tools for how to address sufferers from
sexual addiction. This book is a must-have for clinicians as it provides
effective tools on how to address individuals, couples, and groups
struggling with this condition. Overall, the blend of academic and reallife case studies throughout each chapter will help readers move in
their journey toward recovery." --Dr. Kimberly S. Young -- founder and director, the Center for Internet
Addiction Recovery and author of Tangled in the Web: Understanding
Cybersex from Fantasy to Addiction
"Great stuff! Solid information for those who are looking for real help
from this insidious issue. A comprehensive overview of sexual addiction
and treatment modalities. It's staying on MY short list of recommended
books for our clients here at Compulsion Solutions."
George N. Collins, Director
Compulsion Solutions
Author of "Breaking the Cycle: Free Yourself from Sex Addiction, Porn
Obsession, and Shame"
Co-author of "A Couple's Guide to Sexual Addiction"
Contents
Forward
Preface
Introduction
Chapter 1– What is Sex Addiction?
Chapter 2 – Relapse Prevention
Chapter 3 – Cognitive Therapy
Chapter 4 – Psychodynamic Psychotherapy
Chapter 5– Group Therapy
Chapter 6– Couples Counseling
Chapter 7-- 12-Step Programs
Chapter 8 – Hypnosis
Chapter 9 – NLP
Chapter 10 – Psychopharmacology
Chapter 11 – “Brainlock” – A Behavioral Modification Approach
Chapter 12 – From Sexual Addiction to Sexual Fulfillment
xi
Forward
Since the internet went mainstream only 20 years ago, its accessibility,
affordability and anonymity has spawned an eruption in the numbers of
people seeking clinical treatment for sexual addiction. This increased
variety of internet-based sexual content, together with the explosion of
sexual “hooking up” via smart phone apps and social media is veritably
changing the nature of human sexuality.
It is estimated that three to six percent of the general U.S. population
suffers from some form of addictive sexual behavior with self or others.
However, the current lack of a universally recognizable clinical diagnosis —
combined with a dearth of publicly funded research and ongoing cultural
shame and stigma regarding sexual disorders in general — likely prevents
many more individuals from identifying the problem and seeking help. The
numbers of people who suffer in silence from this addiction are staggering.
Available statistics are startling, indeed. According to US News and World
Report, the pornography industry takes in more than $8 billion a year,
which is more than rock and country music, and more than all Broadway
productions, theater, ballet, jazz and classical music combined.
• Every second, 28,258 internet users are viewing pornography.
• Eighty percent of our children age 15-17 have had multiple hard-core
exposures to internet porn.
•
Pornography is big business--with $10 billion to $14 billion in annual
sales. The author of an article in the New York Times Magazine,
Frank Rich, suggests that pornography is bigger than any of the
major league sports, perhaps bigger than Hollywood. Porn is "no
longer a sideshow to the mainstream...it is the mainstream," he says.
As the problem has bounded forward in the last decade, research into new
methodologies for treatment is just keeping its head above water. Although
a number of excellent books about are on the market, supply has not kept
track with peoples’ hunger for new ideas about how to escape the
stronghold of this .
“Total Sexual Addiction Recovery – A Guide to Therapy” makes a new
contribution to the field. Besides offering an overview of the nature of the
beast and information about how to achieve fulfilling sex during and after
recovery, the book offers numerous chapters about how existing therapy
methods can be used to treat . The end result is that the reader is given a
breath and depth of understanding about what a comprehensive therapy
program for sex addiction might look like.
Who better to write this particular book than Dorothy Hayden? Dorothy and
I have been aware of each other’s careers for 15 years, in the days that we
were both the singular writers about sex addiction for PsychCentral.com.
Ms. Hayden is not only trained in sex addiction, but has remained an astute
student of contemporary psychoanalysis. She’s the rare combination in a
therapist of one who has not only the concrete skills of an , but the
psychological sophistication to understand and treat all aspects of the
addict’s personality.
Put this together with her over-30 years of personal recovery in a, her
training in Hypnosis and Neuro-Linguisitic Program, Group , and you have
the exact person to write a book about the multi-dimensional aspects of .
Dorothy not only helps people to stop compulsive, destructive sexual acting
out, but she uses her analytic skills to pull the disorder out from its roots for
the fortunate who have been her clients.
Robert Weiss, LCSW, CSAT-S
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health
and The Ranch.
Preface
I
I wrote this book because I saw a need for current models of sex addiction
treatment to become more comprehensive in their approach. Existing sex
addiction therapy focuses mostly on behavioral modification skills to stop
compulsive sexual acting out. However, the high rate of people who
repeatedly return to their preferred sexual behavior despite treatment
attests to the fact that the current treatment philosophy is insufficient to
achieve satisfactory results.
If sexual acting out is the tip of the iceberg, representing a symptom of the
problem, the personality deficits that give rise to addiction are the bottom of
the iceberg. These deficits and vulnerabilities need to be addressed and
healed for there to be any significant improvement in the person’s overall
life satisfaction. And people who have overall life satisfaction tend not to
get involved with addiction.
Treatment that merely stops the sexual acting out is no treatment at all.
The symptom can clear up, but what gave rise to the addiction behavior
can remain. Sex is not the problem in sex addiction. The problem lies
much deeper. Sexual acting out is merely symptom or sign of other
conscious and unconscious troubles. Total sexual recovery is assured from
the use of different therapeutic techniques that go blow the surface to heal
the personality problems that give rise to unwanted behavior. The
comprehensive treatment suggested in this book pulls out the problem of
sexual addiction up by its roots.
This book differs from other books about treatment because it offers a look
into a number of different therapies that help individuals recover. While
some of the techniques promote abstinence from compulsive behavior,
others deal with such things as resolving childhood abuse and conflicts,
changing the thoughts and beliefs that keep the addiction in place, learning
self-soothing techniques to replace the sense of safety and soothing found
in the addictive experience, addressing the intimacy dysfunction that is
invariably concomitant with sex addiction, and changing the person’s
“arousal template” from deviant, compulsive sex to having the ability to
experience of related sex that is vital, alive, exciting and that can bring
someone to the heights of sexual ecstasy.
The book is divided into three parts. The first part offers a discussion on
the nature of addiction itself and provides a multi-dimensional look at the
phenomenon of sex addiction. “You must know the enemy before you can
do battle with it.”
The second part of the book describes different therapeutic methods that
can be used in sex addiction recovery. My hope is that familiarity with
these a number of different therapeutic techniques will give you a deeper
understanding of the compulsion and provide you with the hope that not
only can treatment work but there are a variety of ways to achieve the goal
of sexual sanity and personal fulfillment.
Finally, the third part of the book could just as well be entitled “Is There Sex
After the Revolution?” Most books about sex addiction, and most treatment
philosophies, don’t offer a replacement for sexual abstinence. Sex is such
a pivotal part of who we are and is so much fun, who wants to be
“abstinent” from it? The final chapter seeks to provide you with ideas and
techniques to achieve your full sexual potential. The pleasure of related,
connected sex will make the fleeting pleasure of addictive sex seem like
child’s play.
My true motivation for the writing the book is to deliver one predominant
message: There is hope. There is a way to go. There is an end to the
madness. What may seem hopeless is, in fact, doable. With the right
understanding of the problem and the right therapy, you can do what
legions of others have done – break free from the shackles of sex
addiction.
Acknowledgments
My first and most important acknowledgment is to the patients I have
treated over the last 15 years. Their journey has been my journey – as an
author, a psychotherapist and a person. Having had the privilege of being
included in their process of being once defeated, confused, helpless
victims of the horrific addiction to sex, I have witnessed them become
restored to the fullness of their sexuality and their humanity.
I have seen first-hand, and over-and-over again, the resiliency of the
human spirit to grow, live and love. I thank each and every one of them.
For my training in the field of sex addiction, I thank Patrick Carnes, PhD.
And Edward Ragsdale, PhD. Dr. Ken Adams has also been enormously
helpful in helping me to deepen my understanding of the multi-dimensional
aspects of addiction.
The people who have most influenced my development as a psychoanalyst
are teachers, supervisors and mentors from The Post Graduate Center for
Mental Health, The Object Relations Institute and The Training Institute for
Mental Health. Special thanks to Chuck Strozier, PhD., Pauline Pinto,
LCSW, Jean Kemble, MS, Mark Wayne, LCSW, Larry Lewis, Ph. D.,
Michael DiSimone, DSW, among others.
A book is never written alone. My ever-supportive friend and editor, Doreen
Lewis, has been instrumental in molding my writing skills and
achievements.
Lastly, to my partner, Victor, for his unending faith in me and for providing
the support that freed up the time and space for me to write this volume.
xiii
Introduction
What is Addiction?
To be at risk for addiction, two psychological conditions seem to exist
during childhood.
• First, the child has become over- reliant on sources of comfort
outside of himself to provide a feeling of being soothed, safe and
secure.
• Second, the child had difficulty making a healthy separation from
the primary parent, with later concerns that closeness and intimacy
can be dangerous.
Both of these conditions come about as a result of failure in empathy and
attunement in the parent-child relationship that leaves the child feeling
misunderstood, unsupported and potentially unloved. What develops is a
“developmental arrest”, so that the adult in later life (like a child) is
driven above all to seek pleasure and avoid the pain of living. Not
having developed a sense of confidence and rigorous self-esteem that
growing up in a nurturing environment would have provided, the person
feels inadequate and vulnerable. The demands of reality appear too
challenging and overwhelming.
This theme of using a particular relationship to objects or behaviors to
manipulate moods so that a desired emotional/ physical state occurs
that provides needed internal benefits such as pleasure, gratification,
safety, security or arousal is one definition of addiction. It provides the
addict with predictable and stable gratification, but the experience has
concomitant costs. Eventually these costs outweigh the subjective
benefits the addiction affords. Nevertheless, people continue in their
addiction, ready to pay the price extracted, as long as they perceive it as
providing the needed gratifications.
When active addiction sets in, the problems the individual experiences in
dealing with the ups and downs of living seem to be magically solved.
The addiction is the glue that holds together the different parts of a
fragile self. It reinforces a false sense of omnipotence, grandiosity and
perfection and blots out aspects of reality that are not in concert with that
perception. It anesthetizes the individual from unwanted feelings and the
uncomfortable aspects of finding and expressing the true self. It
defends against the need for intimacy or closeness, as the addict relies
only on his addiction for a sense of pseudo-intimacy.
The “hook” of the addiction that keeps him coming back for more is that
it gives people feelings and gratifying sensations that they are not able to
get in other ways. It may block out sensations of pain, uncertainty, or
discomfort. It may create powerfully distracting sensations that focus
and absorb attention. It may enable a person to forget, to feel “okay”
about, insurmountable, or even mundane, problems. It may provide
feelings of security or calm, of self-worth or accomplishment, of power
or control, of intimacy or belonging, despite the knowledge that these
experiences are fleeting and artificial.
However powerful and gratifying the addictive experience may be, there
are costs to be reckoned. Addictions make people less aware of and less
able to respond to other people, events, and activities. Ironically, the
addictive experience reinforces and exacerbates the problems the person
wanted to desperately wanted to evade in the first place. In the persons'
inner life, the addiction has significant benefits and makes things things
seem better. However, in the real world, it makes everything worse.
Jobs, marriages, friendships fall away; health deteriorates; debts
increase; opportunities disappear; the day-to-day business of ongoing
living is neglected The person becomes increasingly detached from
nourishing contacts, essential responsibilities, meaningful long-term
goals, recreation and hobbies and core values.
Even in the face of devastating consequences to his external and internal
worlds, the addict holds on tenaciously to his only source of identity,
stability, comfort and support - the drug.
Moreover, over the years, addictive behavior becomes “reinforced”, or
embedded, as an exclusive coping mechanism. Higher coping
mechanisms have not been developed through the years of using, so as
the reality consequences have been piling up, the person's ability to deal
with them has been plummeting in the personal stagnation of life in
addiction.
A developmental arrest keeps a part of the personality immature. The
result can be personality deficits that leave the potential addict without
the capacity to regulate inner feelings of distress, to delay gratification,
to exercise impulse control, to recognize and articulate feelings, or to
create meaningful attachments to others.
So for an addict, to be without the addiction would feel like personal
annihilation.
The inner world of the addict is characterized by intense feelings that are
often experienced as unbearable, overwhelming and permanent. These
feelings form the context within which the addict lives. The actions and
choices of an active addict are organized around an attempt to manage
intense feelings. No obstacle is too formidable as the addict, in an
attempt to feel "normal", succumbs to the irresistible impulse to indulge.
Unfortunately, the strength of the urge to act out on the addiction
obliterates the ability to reflect upon the potentially devastating
consequences of his actions.
Addiction is always experienced as a profound sense of alienation from
self and others, since the ability to establish meaningful inter-personal
relationships is often crippled by toxic experiences with early-life
caretakers. I quote a former client:
” I was alone and it was loneliness and it was intense. I think the only
love in life has been the drug...I just felt so alone...I was sad, so lonely,
so isolated. I knew I wasn't being me... that I could be different, but I
couldn't with people. As far as having some friends, really being close to
somebody, there wasn't anybody...I just wasn't able to keep
connections.”
An addiction may involve any strong attachment or sensation that grows
to proportions that it damages a person's life or self-hood. Addiction –
the single-minded grasping or chasing of a seemingly magic object,
behavior or involvement; the loss of control, perspective and priorities –
is not limited to drug and alcohol addictions. When a person becomes
addicted, it is not to a chemical but to a particular type of relationship
that affords a particular experience. Anything that a person finds
sufficiently consuming and that seems to remedy deficiencies in the
person's life can serve as an addiction. The addictive potential of a
substance or experience lies in the meaning it has for a person.
It is only when the pain of active addiction outweighs its diminishing
benefits that the addict holds out the white flag and asks for help so that
he can get free from his addiction.
The Problem of Sex Addiction
Addiction to sex is a complex disorder that incorporates many aspects
of your personality, bio-chemistry, sociocultural environment, family-oforigin issues, thinking/feeling processes, self-esteem, and quality of
relations with others. I see sex addiction as a prism; depending on the
angle you hold it up to, the light can make it can look completely
different.
The complexity o addiction to sex is shown by the fact that
psychologists still don't know if it's a symptom of an obsessivecompulsive disorder, an impulse-control disorder, or an addictive
disorder. The fact that it was only recently left out of the DSM-V and so
not rec distinct as a distinct disorder means that not much substantive
research has been done to understand this multidimensional condition.
We do know that sexual addiction represents an expression of the same
processes of addiction that underlie all compulsive behaviors: an
enduring, inordinately strong tendency to engage in some form of
pleasure-producing behavior to regulate unwanted emotional states that
are painful and potentially overwhelming. Also common to all
addictions, underlying the symptom of the sexual behavior are problems
with self-care and self-regulation. Achieving a sense of “selfgovernance” is part of addiction recovery treatment.
Being perpetually ensnared in the jaws of the addiction cycle with its
loss-of-control, shame and distress, together with its negative impacts
on work/relationships/finances/self-esteem, is demoralizing. Yet the
perceived benefits seem to outweigh the high cost of the behavior, as
you experience the lure of the sexual rush to be irresistible and
compelling, regardless of inevitable consequences.
Recovery from sexual addiction must address both the destructive
addictive sexual behaviors as well as the underlying addictive process.
The challenge of the therapist who offers a sex addiction treatment
program is that of presenting a variety of treatment approaches to
accommodate and treat the addict on multiple levels. The therapist needs
to have the concrete skills of an addiction counselor as well as the
clinical training and sophistication to treat underlying issues.
Treatment for sex addiction, then, is most likely to be effective when it
emerges from an integrated, comprehensive approach that brings
together different treatment methods, is individually tailored to your
personality and evolves as you progress.
This book includes a comprehensive overview of sex addiction so you
can understand the nature of the beast; a series of chapters about the
different methods of addressing recovery from sex addiction, and a final
chapter about the shifts required to have “optimal” sexual experience, or
the achievement of your sexual potential.
The goal of the book is to present a number of therapeutic strategies that
can help free you from the shackles of addiction. My hope is that each
chapter will provide more understanding and more hope that getting out
of the snake-pit of sexual compulsion is doable. Not only is it doable,
there are a variety of ways to do it.
This book will look at therapy for sex addiction from a variety of angles.
Each chapter discusses part of the overall process of total sex addiction
recovery. Chapters include:
·Overview of Sex Addiction: Understand the enemy so you can devise
strategies for victory.
·Relapse
prevention. This is the critical first step in recovery from
addiction. You will learn to free yourself from repetitive, compulsive,
shameful sexual behaviors.
·Pharmacological
(as the “water wings” of treatment) to help with
impulse control, anxiety and depression that may contribute to the
experience of strong sexual urges.
·12-Step
Groups cultivates a support system to help sex addicts and is
an opportunity to work the 12-steps as an avenue to psychological and
spiritual maturity.
·Cognitive-behavioral therapy. The Stoic Philosophers’ theories are
the foundation of CBT. The basic idea is that we don’t suffer from the
external event; we suffer from the interpretation (thoughts) about the
event. We examine a series of belief systems common to most sex
addicts to see how they are based in the past and cause suffering in the
present. Change a thought, change a destiny.
·Group
therapy. This is a vital part of treatment for addiction. Addicts
learn intimacy and work through issues of trust. A cohesive group can
supply understanding, acceptance and empathy – things that may have
been missing in your past.
·Psycho-dynamic
therapy. This is the nuts and bolts of treatment for
addiction.
·A one-on-one relationship that heals, rather than harms, can rectify the
hurt from the past by providing a different model for relating. The
therapist considers your whole personality. Unconscious conflicts, hurts,
wounds,shame, feelings of inadequacy, amongst other issues that
underlies sexual acting out become more conscious to the person who
then is able to exercise self-control through understanding and insight.
·Couples
counseling Sex addiction is usually devastating to your
partner. If the couple-hood is to remain intact, couples counseling is
essential.
·Hypnosis. Don’t be afraid of trance; you’ve been in one all your life.
·Mindfulness Meditation It’s impossible to change without awareness
of your inner process and the ability to be aware of another person.
·Brainlock: A behavioral approach to treating compulsive behavior.
·Conclusion: “From Sexual Addiction to Sexual Fulfillment”. Here’s
how to get the total sexual experience that the addiction was searching
for but missed the mark.
As a therapist who’s worked in the field of addictions for over 25 years,
it’s been my experience that an entire repertoire of treatment skills,
strategies and techniques (arrows in the quill) are necessary to match
each client’s own set of fingerprints, and his uniqueness as a human
being. Therefore, the more treatment can be directed specifically to a
particular addict and his family, the more effective it will be.
What are some of the specific goals of comprehensive therapy for sex
addiction?
• To resolve ambivalence about change
• To prepare you to prevent relapse by helping you to recognize
triggers, urges and cravings, and arm yourself with specific tools
for dealing with them
• To recognize and work through painful feelings from childhood
that remain alive in the present.
• To put issues of shame and a sense of inadequacy to bed.
• The discovery of underlying issues of all addiction including lack
of self regulation and self care as well as an inability to exercise
restraint in the face of destructive impulses;
• To recognize and change unconscious belief systems about self,
others and the world, including sexuality and intimacy;
• To implement sex therapy techniques to overcome obstacles to
intimate sexual experience;
• To trace the origins of unhealthy relationship patterns that stem
from childhood so you can recognize that what worked in the past
may be destructive in the present;
• To become educated about intimacy skills and attitudes about sex
that will help you experience “related sex” as more fulfilling than
narcissistic self-centered sex.
Chapter 1
What is sex addiction?
First, let us consider what sex addition is NOT: Sex addition is not defined
by sexual desire. Sex addiction is not defined by the type of sexual act
performed. It isn’t defined by the frequency of sexual activity.
Rather, sex addiction is defined by the addict’s continual use of sexual
urges, cravings, fantasies and behaviors to gratify non-sexual needs that
echo from the emotional deficiencies of his early life. Sex addiction is a
misuse of sex. Sex is, after all, only sex. It can't heal the wounds in your
soul.
Manifested as a compulsive cycle of preoccupation, ritualized sexual
behavior, and despair, sex addiction is an obsessive relationship to sexual
thoughts, fantasies or activities that an individual continues to engage in
despite adverse consequences. These thoughts, fantasies or activities occupy
a disproportionate amount of "psychic space" (the inner world of the addict
that isn't conscious, but is emotionally powerful enough to overrule thinking).
These thoughts result in an imbalance in the person's overall functioning in
important areas of life, such as work and marriage. Distress, shame and guilt
about the behaviors erode the addict's already fragile sense of self.
It is this fragile sense of self at core, born of a lack of attunement with early
caregivers, that seeks solidification through the perceived power and control
of sex. A sense of masculinity, which may have been enfeebled through his
psycho-sexual development, is perceived to be strengthen by the compulsive
sexual experience.
Sexual addiction is invariably a symptom of an attachment disorder which
hinders the individual in forming and maintaining intimate relationships.
Central to the disorder is the inability of the individual to adequately bond
and attach. At it’s core, addiction is a symbolic enactment of entrenched
unconscious dysfunctional relationships with self and others.
While the definition of sex addiction has similar features as that of other
addictions, sexual compulsion is set apart from other addictions in that sex
involves our innermost unconscious wishes, needs, fantasies, fears and
conflicts.
Like other addictions, it is relapse-prone.
What are the Signs/Symptoms of Sex Addiction?
While there currently is no diagnosis of sex addiction in the DSM-IV,
clinicians in the sex addiction field have developed general criteria for
diagnosing sex addiction. If an individual meets three or more of these
criteria, he/she could be considered a sex addict: Sexual addiction is often
accompanied by other addictions, such as an addiction to work or chemicals.
• The addict displays increasingly secretive behavior, deception, and
withdrawal from those closest to him;
•
Recurrent failure (pattern) to resist impulses to engage in extreme
acts of lewd sex; frequently engaging in those behaviors to a greater
extent or over a longer period of time than intended;
• Persistent desire or unsuccessful efforts to stop, reduce, or control
those behaviors;
•
Inordinate amount of time spent in obtaining sex, being sexual, or
recovering from sexual experience;
• Preoccupation with the behavior or preparatory activities;
• Frequently engaging in sexual behavior when expected to fulfill
occupational, academic, domestic, or social obligations;
• Continuation of the behavior despite knowledge of having a
persistent or recurrent social, academic, financial, psychological, or
physical problem that is caused or exacerbated by the behavior;
• Need to increase the intensity, frequency, number, or risk of
behaviors to achieve the desired effect, or diminished effect with
continued behaviors at the same level of intensity, frequency,
number, or risk ;
• Giving up or limiting social, occupational, or recreational
activities because of the behavior;
• Experience of distress, anxiety, restlessness, or violence if unable
to engage in the behavior at times relating to SRD (Sexual Rage
Disorder);
• Tolerance, as defined by either of the following:
•
a need for markedly increased amount or intensity of the behavior
to achieve the desired effect
• markedly diminished effect with continued involvement in the
behavior at the same level or intensity
• Withdrawal, as manifested by either of the following:
• characteristic psycho-physiological withdrawal syndrome of
physiologically described changes and/or psychologically
described changes upon discontinuation of the behavior
• the same (or a closely related) behavior is engaged in to relieve or
avoid withdrawal symptoms
• There is a persistent desire or unsuccessful efforts to cut down or
control the behavior;
• The behavior continues despite knowledge of having a persistent
or recurrent physical or psychological problem that is likely to
have been caused or exacerbated by the behavior;
•
Repeatedly and compulsively attempting to escape emotional or
physical discomfort by using ritualized, sexual behaviors such as
masturbation, pornography, including obsessive thoughts.
•
Some individuals try to connect with others through highly
impersonal intimate behaviors: empty affairs, frequent visits to
prostitutes, voyeurism, exhibitionism, frotteurism, cybersex,
sexual arousal to objects, situations, or individuals that are not
part of normative stimulation.
Adapted from the Society of Sexual Health literature.
The Consequences of Sexual Addiction
Loss of Important Aspects of Life
The life of a sex addict gradually becomes very small, in terms of the number
of surrounding loved ones. The freedom of self is impaired. Precious life
energies are consumed. The rapacious need for a particular type of
experience in the “erotic haze” (See Chapter II) drives the addict to spend
untold hours in the world of his addiction. With time, the compulsion begins
to strip away all that the person holds dear: close relationships, enjoyable
activities and hobbies, trust between himself and his partner, quality time
with children, having a spiritual/moral center, commitment to productive,
meaningful employment and financial security.
Depression
Profound depression (sometimes with suicidal thoughts), chronic low selfesteem, shame, self-hatred, hopelessness, despair, helplessness, intense
anxiety, loneliness, moral conflict, contradictions between ethical values and
behaviors, fear of abandonment, spiritual bankruptcy, distorted thinking,
remorse, and self-deceit are common.
Research shows that 70 to 75% of sexual addicts report having had suicidal
thoughts related to their sexual behavior patterns resulted in significant loss
of self-esteem for both partners.
Breakdown of the Family
Often, sex addicts suffer from broken and distant relationships. The American
Bar Association reported a whopping 50% of the divorces it handled in 2009
had cybersex implicated in them. Forty percent of sex addicts report severe
marital and other relationship problems, and sexual activities outside their
primary relationship. The sex addict is frequently absent (physically and/or
emotionally), resulting in a lack of parental role modeling. Pressure is placed
on the spouse to do “double duty” as partner and primary parent.
Partners of sex addicts can develop their own addictions and compulsions to
drugs, food, and spending, for example, in addition to psychosomatic
problems, depression, and other emotional difficulties. For most women, the
discovery of their husband’s sex addiction is emotionally devastating.
Physical Health Issues
Health consequences of sex addiction may include HIV infection, genital
herpes, HPV, syphilis, gonorrhea, and other sexually transmitted diseases
(STDs). Sex addicts have a highly increased risk of contracting an STD and
of passing it along to unknowing spouses or loved ones. Genital injury can
result from sexual acting out, addictive sadomasochistic sex can cause
physical damage to the body, and automobile accidents can result when the
driver’s attention strays from the road due to sexual texting, downloading
porn, or sexually cruising other drivers.
Legal Problems
Some sex addicts go to jail, lose their jobs, get sued, or have other financial
and legal consequences because of their compulsive sexual behavior.
Financial difficulties from the purchase of porn, use of prostitutes, and travel
for the purpose of sexual hook-ups and related activities can tax the addict’s
financial resources and those of his or her family, as do the expenses of legal
representation in divorce cases.
Sixty percent of sex addicts report that they have faced financial difficulties,
58% report having engaged in some form of illegal activity, and 83% of sex
addicts also had concurrent addictions such as alcoholism, marijuana or other
drug abuses, eating disorders, and compulsive gambling. Many sex addicts
also abuse alcohol and other drugs. When multiple addictions coexist,
untreated sex addiction complicates recovery from chemical dependency and
makes relapse to drug use more likely.
Serious legal consequences of sexual addiction can result if the sex addict’s
behavior escalates into sexual offenses such as voyeurism, exhibitionism, or
inappropriate touching and/or the use of child porn. Sexual harassment in the
workplace can be part of a sex addict’s repertoire, and may result in legal
difficulties.
Many addicts report that they live in a perpetual fear of exposure. For
addicts involved in illegal sexual activities (exhibitionism, voyeurism, etc.) as
well as involvement in kiddie porn, arrest, incarceration and public
humiliation or prosecution are very real possibilities.
“Sexual addicts risk everything for the call of the erotic which promises
euphoria and yet never seems to deliver in a real, consistent way and is
usually followed by remorse and shame. Is the pleasure worth the
consequences? It is when the negative consequences, which are different for
everyone, begin to outweigh these brief periods of erotic arousal that the
person seeks.”
Adapted from The Society for the Advancement of Sexual Health
Why Can’t the Addict Control his Sexual Behavior?
Most addicts would stop if they could.
It's been said that of all the addictions, sex is the most difficult to manage.
This syndrome is a complex mixture of biological, psychological, cultural,
and family-of-origin issues, the combination of which creates impulses and
urges that are virtually impossible to resist despite the fact that acting them
out produces considerable long-term negative consequences, the addict
simply cannot resist his/her impulses. Individuals who are highly disciplined,
accomplished and able to direct the force of their will in other areas of life
fall prey to sexual compulsion. More importantly, people who love and
cherish their partners can still be enslaved by these irresistible urges.
From a biological standpoint, research has shown that certain formations in
the right temporal lobe make certain individuals sexually excitable from
birth. Whether or not such an individual becomes sexually compulsive or
perverse then depends on the child's home environment.
Research has also shown that the inability to control sexual impulses is
associated with neurochemical imbalances in the nor-epinephrine, serotonin
and dopamine systems. When the addict gets a sexual “hit”, he is really
getting a dopamine “hit”. Dopamine is the endorphin systems that provides
pleasure. The more sexually intense the acting out is, the more dopamine is
sent to the brain. It is really these neurochemicals, in particular dopamine, to
which the sex addict is really addicted. After the orgasm, dopamine levels
drop precipitously and the person experiences depression, tension and
irritability. Life seems devoid of interest and non-sexual pleasure outside the
“erotic haze” so he just bides his time until he can get his next dopamine
rush.
Biological predisposition contributes and combines with psychological
factors. One of the reasons the "erotic haze" (see Chapter 2) is so compulsory
is that it is an unconscious but maladaptive way to repair earlier disturbed,
anxiety-laden relationships. It shores up an inadequate sense of self which
results from these early-life interpersonal abandonments, and abuse. The
illusory repair of traumatic childhood experiences is compelling.
This combination of biological and psychological factors results in an
"affective disorder" in the sex addict. Feelings of depression, anxiety,
boredom and emptiness are quickly alleviated by immersing oneself in an
imaginary world that provides novelty, excitement, mystery and intense
pleasure.
Sex addiction is better than Prozac. It heals, it soothes, it contains, it
provides a "safe place" free from the demands of actual performance,
and it gives an illusory sense of belonging. The sense of empowerment in
the illicit sex act rectifies "holes in the soul" and lifts the addict from
feelings of inadequacy, insufficiency, depression and emptiness into a
state of instant euphoria.
Sex addicts, as a group, are not having fun. They suffer enormously, from
the shame, self-hatred and humiliation which are the fodder in which they
live.
And yet, they are consumed by an irresistible impulse to keep returning to the
experience of intense, euphoric pleasure that they know will create suffering
for them in the long run.
It’s hard for any of us to walk away from pleasure, even when we know it is
in our best interest. For sex addicts, it’s nearly impossible. No price seems
too high for them to pay because they are driven by the mirage of a beautiful,
ephemeral ghost that continually promises but never delivers. And, yet, they
keep returning to the empty well to quench their thirst.
Forms of Sex Addiction
The pleasure of sex addiction comes in many forms. A brief sample of these
include:
1.
compulsive masturbation,
2.
internet pornography,
3. pornographic movies, literature
4. cybersex,
5.
sexual fetishes
6.
anonymous phone sex,
7.
use of prostitutes and escorts,
8. multiple extra-marital affairs,
9. regular attendance at strip clubs,
10.
multiple and anonymous sexual partners,
1. erotic e-mailing or texting,
2.
transsexual compulsion, cross-dressing, or submission to femme
dommes.
None of the above examples as a singular act defines a sex addict, however, it
is can be the frequency and reliance on these activities, as well as using
sexual behaviors to get non-sexual needs me which may constitute addiction.
Underlying Dynamics of the Sex Addict
While the sexual behaviors differ for each addict, the underlying dynamics of
the addiction are the same. There is always an inability to form a healthy,
consistent attachment to a cherished loved one. Perhaps there was a mother
who was unable to create a bond with her infant/child that provided the
attention, recognition, validation and appropriate physical contact needed.
The early environment surrounding the sex addict’s childhood was usually
shame-based. This means that The child’s self-esteem was damaged as a
result of a dysfunctional family or from traumatizing experiences with peers.
A sense of inadequacy and helplessness then colors a sex addict’s
understanding of self and the relationship with others. When they grow to
adulthood, they may use sexual behaviors to achieve a sense of adequacy,
competence, safety and power. Consequently, they feel an (illusory) sense of
admiration and recognition that was missing from their childhoods.
The Erotic Haze
Every sex addict experiences an immersion in what I have called the “Erotic
Haze.” This is a A period of time that may last 4-5 hours or longer, the
unconscious mind overpowers the conscious mind, making it impossible to
see reality or make rational decisions. The sex addict fails to account for his
own enlightened self-interest or for the feelings of others. Instead, the body
and mind are bathed the brain in pleasure-enhancing endorphins. Time stands
still.
Fantasy is the fodder of a person in the “Erotic Haze”. In many cases, sex
addicts perform some form of ritualized behavior. This usually precedes a
sexual act. For example, an addict may cruise in a car for hours looking for
just the right sex worker. He is enveloped through the “Erotic Haze” and gets
intense pleasure from the ritual. He is no longer in touch with reality.
When the sex addict is in this mental state, his needs are what matter most of
all. He feels no anxiety about responding to the needs of another. There is
no fear of closeness, vulnerability or rejection. To him, nothing feels as if it
is a compromise. All that exists is the pleasure of the sexual fulfillment. It is
the only time in a sex addict’s life that he knows perfect control over the
“other,” and this is distinctly unlike what he experienced as a child.
The “Erotic Haze” is a totally compelling state, one in which sex addicts are
completely preoccupied.
Dual Personalities
Sex addicts have a private life and a public life. Some report a “Dr.
Jekyll and Mr. Hyde” experience with either side of the personality
having different and conflicting values and goals. Secrecy and deceit are
the hallmarks of the Mr. Hyde persona. Uneasiness, shame, guilt and fear of
exposure are the constant companions of Dr. Jekyll.
The Devastating Effects
Married sex addicts often lose their spouse in the process. Children
are commonly neglected. There can be loss of a job and income from
too many late nights that interfere with optimal functioning. Being
constantly preoccupied with sex, they lose track of time; attention to
detail is sacrificed.
Friendships that are not part of their sexual experience and normal
recreational activities usually decline or may abruptly end.
When the pain outweighs the pleasure, when self-respect is totally depleted,
there may come a moment of clarity. It is then, and only then, that they are
ready to hang out the white flag and commit themselves to sex addiction
recovery.
What are the first steps to recovery?
As mentioned, The initial step is to go to a therapist to cultivate a
healing relationship in the context of interpersonal, individual
psychotherapy. The client-therapist relationship is like no other. You
were initially wounded by your relationships to others, so will you be
healed by a new model of relating. Client and therapist establish an
atmosphere of safety, responsiveness and acceptance. In such an
atmosphere, it may be possible for you to take a leap into trust and
self-disclosure. You may find yourself able to find a voice to
previously unspoken experiences and feelings. Self-disclosure in the
presence of a trusted person goes a long way towards healing the
shame and isolation that binds you.
If addiction to sexual behaviors is the tip of the iceberg, then the
personality deficits, recurring self-defeating patterns, abuse from early
life relationships with caretakers, unconscious conflicts and skewed
perceptions about self and others represent the larger, bottom of the
iceberg. I contend that recovery from addiction, freedom from
enslaving, out-of-control, humiliating sexuality cannot be achieved
unless the issues on the bottom of the iceberg are resolved, primarily
through cognitive and psycho-dynamic psychotherapy.
Chapter 2
Goal and Objectives of Sex Addiction Recovery
Fifteen years ago, people didn't even know there was such a thing as sex
addiction, never mind how to get help for it. With Patrick Carnes'
groundbreaking book Out of the Shadows: Understanding Sex Addiction,
people who suffer from self-destructive sexual acts had hope of knowing
what ailed them. Since then, the disorder has received tremendous attention
from the media and a whole new group of therapists trained to treat sex
addiction.
The field, however, is still developing. People who seek counseling for this
debilitating addiction often don't know how or where to get help from a
competent clinician. Moreover, the path to sane sexuality -- the goals and
objectives that one should strive for -- are still sometimes muddy and
confusing.
The Issues Around Sex Addiction
• Solidifies his identity
• Feels shameful
• Is illicit, stolen, or exploitative
• Compromises values
• Draws on fear for excitement
• Reenacts childhood traumas
• Disconnects one from oneself
• Creates a world of unreality and fantasy
• Is self-destructive and dangerous
• Uses conquest or power
• Serves to medicate and kill pain
• Is dishonest
• Requires a double life
• Is grim and joyless
• Demands perfection
• Mistakes intensity for intimacy
• Requires novelty - intensity always has to be more than the last "hit"
• Gives way to self-hatred, loneliness and despair.
• Has no sexual "boundaries"
• Uses false intimacy as a way to avoid relational pain
• Preoccupation and ritualizations
• Is "doing to" someone
• Is devoid of communication
• Has no limits
• Benefits one person
• Is an uncontrollable energy
• Is emotionally distant
Other Considerations that Describe the Sex Addict
• Behavior leads to increasingly negative consequences but addict
unable to control acting out
• Denies the behavior's seriousness
• Is the product of intense, unmet needs, coupled with the demand
for perfect fulfillment and control of relational pain
• Demands that life provides (an illusion of) reassurance and
predictability which gives a sense of getting self-centered
psychological relief
• Is always a narcissistic endeavor - people are seen as "needsupplying objects", not as real human beings; more interested in
getting than giving
• Is ephemeral - physical orgasm provides a welcome rush of
adrenaline, but by itself can only offer the brief illusion of
intimacy and belonging
•
Uses sex is a conquest and abates the terrifying sense of not
belonging.
• Sexual fantasy conjures up a perfect world of nourishment, love,
generosity and tenderness.
• Are trapped in the paradox of being terrified of loneliness even as
they act in ways that create further loneliness
•
In fantasy sex, have the freedom to be vulnerable and nurtured
without fear. At it's core, sexual fantasy is worship of self.
• Carry a sense of parental betrayal; parents unable to provide a
positive role model of healthy intimacy
• Have no ability to regulate their emotions from within
• Risk relationships, financial loss, job jeopardy and physical safety
• Possesses a set of irrational cognitive distortions, including
• “Sex is my most important need";
• I am basically a bad, worthless person; no one could love me as I
am;" "
• My needs are never going to be met if I depend on others;"
• "I am valuable only if I am sexualized; being sexually desired
makes me feel alive"
Patrick Carnes, Out of the Shadows: Understanding Sex Addiction
• Have deficits in the areas of social skills, interpersonal
communication,stress control, anger management and empathy for
others
• Learned in childhood that feelings are dangerous, so learned how
to mask their feelings, even from themselves.
• Sex in the “euphoric haze” becomes his exclusive coping
mechanism, preventing him from learning higher coping
mechanisms that make life more enjoyable.
The Goals of Sex Addiction Recovery:
• Diminish/eliminate shameful, compulsive sexual behaviors
• Learn to deal with urges/cravings by understanding that they are
transitory and that they are not imperatives to act out
• Know triggers and have behavioral strategies for dealing with them
• Develop a caring support system and identify individuals to contact
when relapse is about to occur and as a support for getting dependency
needs met
• Reduction of denial, justification, rationalizations, minimalization and
other distorted thoughts and beliefs
• Replace negative core beliefs about the self with healthy self-esteem
• Heal the shame that both precedes and follows sexual acting out
• Re-frame slips/relapses from a sense of failure to an opportunity for
learning new coping skills
• Develop an understanding of the unconscious internal factors driving
sexual behavior
• Attain better self-regulation (of moods, feelings, behavior) through the
gradual internalization the nurturance, containment, and structure of
various treatment modalities
• Improve capacity for interpersonal relationships
• Improve capacity to reflect on thoughts and feelings, with a resulting
increase in inner control and a decreased need to act out unwanted
mental states
•
Explore the functions the sexual activity is serving (relief from anxiety,
momentary intimacy, master feelings of powerless and helplessness
from the past, etc.) so more constructive strategies can be developed to
get needs met
• Explore how sexual compulsion is an enactment of dysfunctional
relating patterns from the past
• Develop a clear definition of healthy sexual patterns vs. shaming and
self-harming sexual activities
• Reduce marital/relationship conflicts
•
Increase understanding of need to control intimacy as a function of
long-standing early neglect and abuse.
Chapter 3
Treatment for Sex Addiction: Relapse Prevention
Overview
Relapse in sexual addiction recovery is a reality. While all addictions are
relapse prone, it is the sexual recovery community who suffer most from the
demoralization of repeated relapse. After all, we can live without ever being
around alcohol or drugs, but our sexuality is ever-present. Because ours is a
sexualized culture, triggers, cravings, urges, cues, and high-risk situations are
everywhere. The sex addict, despite his your best efforts to achieve
continuous abstinence, you may find yourself himself continually returning to
your his addiction despite the knowledge of the damage it inflicts on you him
-- disease, damage to primary relationship, social disapproval, financial loss,
and decreased self-esteem.
In times of stress, the lure of immediate gratification (the pleasure, "high",
tension reduction, relief of distress) calls you him and you he responds,
puppet-like, to the perceived inevitability of relapse. When caught in the
addiction cycle of preoccupation, fantasies, euphoria, urges, cravings and the
intense, and driving need for comfort and gratification, retreat into the
comfort of the "erotic haze" is the only coping mechanism available to you
him at the time.
The erotic haze is a dissociative state that allows the very real negative
consequences of your his behavior to recede from consciousness as the
imperious need for immediate gratification becomes your his exclusive focus.
Most sex addicts state that the sexual act itself is inconsequential. Hours
spent in the dissociative "erotic haze" meet certain non-sexual needs. It is this
euphoric self-state that the person is really addicted to.
With orgasm, the "bubble" breaks and reality sets in. Feelings of defeat,
shame, hopelessness and demoralization are common. Because your his only
way of coping with distressing feelings is sexualization, he returns to the
addiction for relief of the pain that's caused by the addiction because he
doesn't see any alternatives. He blindly goes to the source of the pain for
relief of the pain. Thus we see the vicious, never-ending cycle of active
addiction. We keep returning to the source of the suffering for relief from the
suffering which creates more suffering so we again go to the source of the
pain and so on and so on.
But there is hope. Addicts repeatedly return to their addiction because it's
what they know. The result of long-term addiction is a gradual erosion of the
ability to choose different alternatives to deal with life. An addict just
entering treatment is in a state of nil-choice
A relapse prevention program helps people who use sexual behavior
addictively
(1)
to recognize factors and situations that are associated with an
increase in acting out.
(2)
to cope effectively with sexual urges;
(3)
to recover rapidly from episodes to symptomatic behavior;
(4)
to use such "slips as opportunities to learn about how their
recovery plans can be strengthened.
You'll learn new coping skills, new options and ne
w cognitive strategies to cope with external and internal stressors. You'll
become very familiar with the warning signs of your personal relapse process
and learn that you can intervene at many points in that process with a healthy
coping mechanism. Change a thought - and you're out of the downward
spiral. Do something different from you used to do - and you're propelled out
of the erotic haze into reality. Ingrained sexual habits can be transformed into
behaviors that are under the regulation of higher, more mature mental
processes involving awareness and responsible decision-making.
You can begin to make a variety of choices that ultimately lead to the
enjoyment of pleasurable experiences that are non-sex related and have no
negative consequences. The goal of Relapse Prevention (RP) is the
restoration of the ability to choose, an increase in the client's awareness and
choice about their behavior, to develop coping skills and self-control
capacities, and to generally develop a greater sense of confidence, master, or
self-efficacy in their lives.
Working an individualized relapse prevention program is not part of
treatment per se, but maintaining a relapse prevention (RP) program is
probably the most critical element involved in staying sexually abstinent. If
the person believes that the only goal of addiction treatment is abstinence,
then little attention is paid to the perils and demands of the journey towards
the maintenance of abstinence and continued growth as a person. In the
process of recovery you'll be faced with a plethora of temptations and
stressors.
The pull of powerful old habit patterns will beckon you. Failure to anticipate
and plan for the stressors of recovery will result in immersion in the addiction
cycle.
The phases of this cycle consist of preoccupation, dissociation, entering into
the "erotic haze", ritualization and sexual acting out, followed by despair,
shame and guilt. The addict, because he has not developed ways of coping
with overwhelming emotions, sees his only option for relief from the shame
and self-loathing as the return to the beginning of the cycle. With time, the
addiction cycle may escalate, with greater intensity, more frequency, more
risk and greater loss of control.
Relapse prevention intervenes before the client enters into the addiction
cycle. While behavioral or cognitive interventions are still possible in the
preoccupation and dissociation stages, once the client enters into the "erotic
haze", it is almost impossible to stop the process.
Motivation - Values and Goals
The cultivation of meaningful, realistic goals and clarification of personal
values should precede the development a RP program. To counteract the pull
of the addiction, you need to know why you're motivated to work for
addiction recovery.
You will your own life goals and enduring values that can guide you, as the
North Star, towards restoration, recovery from addiction and the achievement
of a satisfying and meaningful life. Most sex addicts want to achieve real
connection with others and not the mere illusion of connection. They want to
build the genuine self-esteem that comes from living out one's most cherished
ideals and values and from the ability to regulate their feelings and behaviors.
They want to stop the lies, secrets and deceptions that keep them in a
perpetual state of fear, shame and self-doubt. Luckily, these goals are
attainable.
What it Takes
Working a RP programs requires three things of you.
Motivation. You need to be consistently aware of the negative consequences
of unregulated sexual behavior. Remembering the pain and suffering of being
in active addiction can be a great motivator to change. Another motivator to
staying active in dealing with addiction and working towards your life goals
that would be unachievable if you're involved in active addiction. The
process of continuously doing what you've committed to do is itself a strong
motivator. Active addiction gradually erodes your moral fiber and betrays
your essential values. Knowing what makes life meaningful to you and re-
committing to your essential values will be the motivational force and the
foundation for the work ahead.
Mindful awareness of your inner processes. Enhanced knowledge and
awareness of inner processes (see article on "Mindfulness Meditation.") is
necessary for most aspects of recovery, but more so in RP. Most of the
warning signs of relapse occur unconsciously. Mindful awareness brings
them into consciousness where they can be dealt with in adaptive ways.
Mindfulness meditation fosters a sense of detachment between addictive
behavior and your personal identity. Cultivating a "witness consciousness"
that is balanced and non-judgmental trains you to become your own mindscientist. With mindful awareness, you can see the warning signs of
relapse as they happen so you can take proper action. Through mindful
awareness and with the help of your therapist, you'll learn to think about your
thinking and observe and detach from painful emotional processes.
A willingness to learn new responses to old stimuli, an openness to new
ways of behaving and thinking and a continuing determination to practice
new skills until they become automatic is essential to making your relapse
prevention program work for you. One definition of "determination" is the
ability to stay the course regardless of thoughts and feelings. You just keep
doing the next right behavior on your addiction recovery plan, regardless of
your feelings or your perceived discomfort. Treatment of addiction means
nothing if it's not used as a springboard for taking healthy,
constructive actions to replace the addiction.
The Basics
First you figure out what thought processes, high-stress situations and
behaviors lead to the end-point of acting out. Sexual relapse is the end-point
of a relapse process that may have begun last week, last month, or last year.
You don't get "struck" acting out. Sexual enactments don't come out of the
blue. There are many, many steps that lead to being in relapse mode.
Cultivating mindful awareness of the warning signs of your particular relapse
process is essential.
As you learn new recovery skills (or healthier coping mechanisms), you'll be
able to use one of them as an intervention at various places in the addiction
cycle. When you become aware of the warning signs of relapse, you
immediately do something different than you've always done that will disrupt
the pull towards acting out.
When an addict has used immersion in the "erotic haze" as a coping
mechanism to avoid pain and deal with life stressors for an extended period,
it becomes his exclusive way of coping with life. However, the coping
mechanism is maladaptive because it leads to suffering-inducing
consequences. An RP program teaches adaptive coping skills that generate
new behavioral alternatives, new ways of thinking, new choices, new
experiences and, combined with other treatment modalities, offers a radically
different way of being in the world.
How it Works
The Ball and Chain
When I work with clients on a RP program, I use the metaphor of a
behavioral chain that has many links. The bottom of the chain is relapse.
Each link in the chain represents a relapse warning sign that you can observe
as it happens and immediately intervene with one of your newly learned
coping skills.
Even though it seems as though relapse descends upon you, a force beyond
your control that comes "out of the blue", in fact, there is a long chain of
events that lead you there. You can learn to find and control the chain of
events that represent your particular relapse process. Clients learn how to go
back in time to reconstruct all the internal and external links of the chain
(thoughts, feelings, behaviors, urges, fantasies and external events) that have
that led to relapse in their past.
Following is an example of one of a client's behavioral chain that led to
relapse:
• Two days before his relapse, he went to the gym.
• At the gym, he thought members of the staff looked at him in a strange
way.
• He interpreted their looks as judgments about himself.
• He felt both embarrassed and hopeless. He felt hopeless because it
seems that would never feel normal in any of the places he wanted to
belong
• He went directly home without doing her errands because he didn't
want to be seem by anyone.
• Lying on the couch while watching TV, he became sexually aroused
and distracted from his earlier feelings of embarrassment and
helplessness.
• He went to the computer and looked for a site with free porn pictures.
• After his orgasm, he felt ashamed that he had look at porn after he had
promised himself he wouldn't do that again.
• He felt hopeless and depressed and thought about what a loser he was.
• He thought about how no one would ever love him.
• He thought he would go crazy if he couldn't be loved and sexually
satisfied by a woman.
•
He thought he has to prove himself that he could have sex with a
woman and that he was not a loser. He thought he needed to regain his
self-control.
This client's chain brought him to a brothel where he had sex with a
prostitute. Following his experience, he felt an immediate sense of
demoralization and shame. If uninterrupted, the displeasure of the feelings of
demoralization and shame will bring him right back to the beginning of the
addiction cycle.
This is an ordinary example of how you can end up doing exactly what you
didn't want to do. When your personal behavioral chain is pulling and you
don't try to break it until it's too late, then you've gone and gotten yourself
just in the place you've been trying to avoid.
Again, the relapse didn't descend upon him as a cruel fate. It didn't just
happen. It took a few dozen steps for this client to arrive at relapse. At each
of those steps, (or links in the chain) he could have intervened with a
cognitive change or a healthy behavior to prevent the relapse.
You need to become very aware of the links in the chain, especially when
warning signs go off. The next step is to look at each link in the chain and
come up with alternatives (also called coping mechanisms) that are ways to
get out of the chain when you are caught in it. Change a thought, you've off
the chain. Do an alternative behavior, you're off the chain. These are the ways
to free yourself from becoming tangled up in the chain. An alternative is
something you do instead of your usual response in a situation. An alternative
makes it possible for you to think and behave in a different way that you did
before.
You might want to pick up a copy of "Living Sober" (AA Worldwide) that
provides plenty of ideas of alternative, pleasurable behaviors and activities.
As you look at the sample behavioral chain, you can see a series of emotions,
thoughts and actions. You're not asked to do anything about the emotions just
now. Feelings come and go. Just notice that how you feel affects how you
think and what you do at a given time. You can't directly change feelings, but
you can become aware of them and how they affect the other parts of your
life. What you can change directly is how you think about things and what
you do about them. First you look for every cognitive distortion on your
chain and come up with alternatives ways of thinking that might be more in
line with reality. Go through the chain, replacing the thoughts that led you
down the dark sexual alternatives with better alternatives (Sbraga et al.,
2000).
Next you look at the behaviors in you chain and come up with realistic
alternatives. If you find yourself in a high-risk situation, what could you have
done instead? Write out a list of alternative behaviors that will instantly get
you off the chain. Think of lots of options, particularly options that are give
non-sexual pleasure with no negative side effects. Write your new coping
mechanisms on a card and carry them with you.
Research has shown that people lapse, it is usually in response to negative
feelings and to interpersonal conflicts. These events should always to
consider high risk.
You learn how to be good at using you coping skills to stop your relapse
progression by practicing. You are creating new, positive habits for yourself.
These are habits that will take you towards your goals instead of stealing
away the best years of your life.
Managing Feeling-States
All addicts have problems with tolerating distressing inner states. Research
shows that two types of situations are especially high-risk for relapse:
Negative emotional states and situations involving an inter-personal conflict
with a closed one. People go to any length to avoid certain feelings such as
shame, fear, anger, loneliness, emptiness, depression and so on. Addicts avoid
feelings through sexual acting out. You might consider other ways you have
to not sit with feelings.
It is possible to control feelings for a bit of time, but they surface and fade
away. Handling feelings is essential in relapse prevention because how you
feel has a lot to do with sexual control problems. Sex addicts try to manage
their emotions with sex. Think for a moment how many times you have gone
out looking for sexual satisfaction when you were feeling hurt, lonely,
rejected, sad, angry, disrespected, anxious, depressed, fearful or unloved?
And, of course, sex makes you feel better - for a brief period. Unfortunately,
this strategy of managing feelings just doesn't work. If you really did a costbenefit analysis of sexual acting out, you might see that the benefit is fleeting
and the costs...well, you know what they are.
The reality is that if having all the sex you wanted could make you feel better
or create a better life for you; don't you think it would have happened by
now? The problem is that sex, despite its allure and the false promises it
offers you, cannot make you feel better in a real or lasting sense. The
authentic self is not nourished or healed through sex.
So if you can't change your feeling and they just happen, what are we to do
about painful feelings?
Here's the deal: DO ABSOLUTELY NOTHING ABOUT YOUR
FEELINGS! Feelings, if you don't try to get rid of them, come and go rather
quickly. When people try to control their emotions, the feelings don't get the
chance to dissolve as they should. They just keep coming back. FEELINGS
DON'T KILL - THEY WILL NOT ANNIALATE YOU. THEY ARE NOT
DANGEROUS. They create discomfort, and then they pass away. The
important thing is to remember that you can handle any of your feelings that
come up. You have a choice about whether or not to act out sexually and
create more suffering.
In the same way, what do you do when you're triggered, hot, horny, aroused
and amorous? The answer is the same: DO NOTHING. Sex addicts have a
false belief that they must do something about it no matter what. This is a lie.
People feel aroused all the time and don't act on the feelings. Happily married
people are sometimes attracted to other people, but they don't have affairs.
Priests and nuns feel sexual arousal but they honor their vows. Certain
engaged young people choose to postpone sex until after marriage. Somehow,
they all survive without acting on sexual urges.
Learning to tolerate sexual arousal without being sexual is a gift you give to
yourself.
Urges and cravings
Urges and cravings are physiological responses to internal or external
triggers. You experience being pulled by the wish for immediate gratification.
An RP program teaches you urge-management techniques. You are taught to
anticipate and accept these reactions as a normal part of your addiction cure.
You are taught to dies-identify with the urge and to view it dispassionately as
an alien force. I use hypnosis to set up imagery work with the client and ask
him to imagine it as a wave, watching it rise and fall as an observer and not to
be "wiped out" by it. This imagery technique is called "urge surfing" and
refers to visualizing the urge or craving as a wave that crests and then washes
on to a beach. In so doing, the client learns that rather than building until they
become overwhelming, urges and craving peak and subside rather quickly if
they are not acted on. The client further visualizes not being "swept away"
but rather can see himself riding the wave on a surf board. This imagery
fosters detachment from the urges and reinforces the temporary, fleeting
nature of these phenomena.
Lapse Management
Despite planning and precaution, many clients committed to abstinence will
experience a lapse after initial abstinence. Lapse-management techniques
strategies focus on halting the lapse to prevent an uncontrolled relapse. I
contract with the client to contact me as soon as possible after the lapse, and
to evaluate the situation for clues to the factors that triggered the lapse. The
client is instructed to leave the lapse-inducing environment and we
immediately structure the experience as a slip-up, a mistake. Furthermore, the
client is taught to re-conceptualize the episode as a single, independent event
and to see it as a mistake and not a disaster that can never be undone.
I find that clients who place the blame for the lapse on themselves and see it
as a dead-end, a treatment failure and experience shame and defeat are more
like to move into full relapse mode. Other clients who view the lapse as a
mistake that needs correcting and an opportunity to learn what needs to be
changed in their RP strategy fare better in resisting the entrance back into the
addiction cycle (Gorsky et.al., 1986).
Sexual Fantasy as a Trigger
Sexual fantasies have to do with a wish for something. For you to discuss a
sexual fantasy is to admit that you have an unfulfilled sexual wish. There can
be shame associated with having that type of longing. Getting rid of a sexual
fantasy isn't really possible. Once again, I challenge you to handle sexual
fantasies by DOING NOTHING. People often try to get rid of their sexual
fantasies or pretend they don't have them. But trying not to think about them
may give them more energy.
Fueling fantasies to give a higher level of excitement isn't the way to go
either. By "feeding" I mean to make them longer, more detailed and stronger
than they started out. People fuel fantasies to work toward an inner
"perfection." But it can take over your life. You check out of reality and
check into your fantasy. If you start holding real-life situations and people up
to the standards of your fantasies, there is no way they can measure up.
When fantasizing takes the place of reality, it's very unhealthy. Remember a
fantasy is a fantasy precisely because there are no downsides to it. There are
no costs involved. Real life does not work that way.
A fantasy can be dispelled by discussing and understanding it with your
therapist. I have also found that the fantasy life leaves a person as he matures
and is getting satisfaction from real living. The fantasies will simply fall
away.
Lifestyle Regeneration
A focus on learning to achieve and maintain a healthy, balanced life-style is
key. This is based on the principle that a healthy, balanced life-style decreases
one's vulnerability to change warning signs into new behaviors and promotes
mental and physical well-being in general. Issues addressed should include
diet, exercise, rest, recreation and the balance between work ("the shoulds")
and play ("the wants.").
Your lifestyle should be balanced with the "wants" and the "shoulds". Life
stressors need to be balanced by genuine pleasure, shared activities and just
plain old fun.
Stress Management (Relaxation Training)
Stress is the silent killer for all of us -- more so for those involved in an
addiction recovery program. Learning to deal with stress is critical. There are
a number of relaxation trainings and stress management procedures I can
draw upon to provide the client with a global increased perception of control,
thereby reducing the stress "load" that any given situation may pose. Such
procedures as progressive muscle relaxation training, recreational reading,
yoga, meditation, exercise and self-hypnosis are useful in dealing with the
hassles of daily life. Also, through engagement in stress-management
techniques, you will gain mastery over arousal states and emotions which
before were believed to be beyond personal control.
An important component of relaxation skills is that you will learn the skill of
"self-soothing" which can give an experience of being able to generate within
that which you've been seeking from without.
Skills Acquisition
Depending on each need, different clients need to be taught different skills.
These may include:
• Social Skills
• Assertiveness Training
• Communication Skills
• Relationship Skills
• Healthy Sexuality
• Dating Skills
• Positive Self-talk
• Problem-Solving
• Positive Self-talk
• Problem-Solving
Chapter 3
Cognitive Therapy
"Men are disturbed not by things that happen, but by their opinion of the
things that happen." Epictetus (c. 50 – 120)
The philosophical basis for cognitive therapy goes back to the Stoic
Philosophers who taught that it is not the external event that causes our
distress, but rather our perception or interpretation of the event that is
distressing. According to the Stoics, people are capable of considering
alternative perceptions or interpretations by changing the thoughts that
underlie emotional distress or sexual dysfunction. This ancient philosophy
can help you in your therapy for sex addiction.
Cognitive models became popular in the early 1960's. Proponents of this
school assume the client's problems occur at two levels. The first is the overt
difficulty, such as depression or sex addiction. The second involves
addressing underlying psychological mechanisms and psychological
cognitive distortions, usually involving irrational beliefs that cause the
addictive behaviors.
Cognitive-behavioral therapies conceptualize psychological problems
primarily in terms of maladaptive learning, and are oriented toward assisting
the individual to learn more adaptive patterns of thinking and acting. This
technique typically relies on interventions that are directive, practical, taskoriented and educative in nature.
It is important to understand the major premise of cognitive approaches to
treatment: the overt problem (sex addiction) originates within what cognitive
behaviorists call the client's schemata. This is a person's world view, or core
belief system. The focuses of this approach is on how the client maintains
painful, harmful, or irrational behaviors. The primary approach utilizes some
form of debate. This involves pointing out to clients the irrationality of
certain thoughts, beliefs and perceptions and the construction and rehearsing
of rational self-statements or other more functional cognitive strategies and
skills.
My focus when working with a cognitive model includes:
1.
The focus is on stopping the undesired sexual behavior. Behavioral
modification techniques (Relapse Prevention Skills) and/or
pharmacotherapy are employed to help clients overcome addiction.
2.
This is the "admission" stage and requires the patient to accept the
existence of a problem and to promise to keep no secrets from the
therapist.
3. In this stage, patients are taught stress management techniques so they
no longer need to rely on sexual behavior to alleviate their anxiety. I
recommend physical exercise, and teach a combination of breathing
techniques, progressive relaxation, meditation and hypnosis to show
clients that they do have some power over their inner states.
4. This may be the most important stage of the program. It consists of
cognitive therapy directed towards repudiating the irrational beliefs that
underlie sexual addiction through active questioning. It allows clients to
develop an awareness of beliefs. By asking questions clients develop an
insight into their thought process and how these influence their
emotions and behavior. Accordingly the client becomes aware of
inappropriate beliefs and is helped to challenge them and change their
behavior. The process involves asking questions that support or refute
the thought, asking about possible alternative explanations. Questioning
about the range of consequences of the thought and it's impact upon the
person and what would be the effects of believing the thought or of
changing their thinking.
5. 5. Patients are trained in such skills as assertiveness and problem
solving in order to facilitate adaptive social functioning.
6. 6. Focus is on resolving whatever problems the individual has had in
establishing and maintaining a primary sexual relationship.
7. 7. Learning what thought processes lead to "setting oneself up" for a
return to relapse.
8. 8. Developing a positive attitude towards healthy sex; cultivating an
appreciation for the needs of one's partners, learning pleasuring skills,
using sex therapy if there is a sexual dysfunction.
9. Generating pleasurable sober activities and relationships - building a
life worth living.
The sex addict depends on sex to meet his emotional needs which he is
unable to meet through healthy coping skills. Sex becomes a coping
mechanism for dealing with stress, shame, guilt and isolation. It is a way to
connect without risking intimacy.
However, the addiction is never satisfied because sex is unable to meet these
needs because their source is historical and the need is too great. In addition,
the needs of the true self can never be met by sexual activity.
Patrick Carnes sets out the unconscious belief systems that all sex addicts
need to refute.
• I am basically a bad, unworthy person.
• No one would love me as I am. My needs are never going to be met if I
have to rely on others.
• Sex is my most important need.
While these are the core dysfunctional beliefs, there are many more beliefs,
attitudes, or "cognitive schema" that keep the addictive cycle in place. From
my experience, some of them are:
• I am unable to tolerate boredom; sexual acting out is a good way to fill
in the time.
• If not distracted by sex, I am filled with an intolerable sense of
emptiness.
• Men are more sex-driven than women. As a man, I need to discharge
that drive, or I'll go crazy.
• My sense of self is determined by how many women are attracted to
me.
• The vicissitudes of life are either boring or unmanageable. There is no
pleasure to be had in day-to-day life except for my "secret" world.
• Sex with my partner is a mechanical, deadening process which lacks
spontaneity and excitement.
• If life does not provide excitement and high-stimulation, then I'll be
bored and depressed forever.
• When I get an urge or impulse to act out sexually, I must succumb to
that urge.
• In order for me to be a real man, I must have sex with as many women
as I can. Furthermore, as the man, I am responsible for my partner's
pleasure through intercourse. Failing at intercourse is failing as a man.
•
Engaging in cybersex is my only means of getting away from the stress
and frustration of living. Sexuality is the only trustable means of
relating to others.
• I depend on sex to meet emotional needs which I am unable to meet
through healthy coping skills.
Addiction is self-perpetuating; it feeds on itself because of ingrained core
beliefs as well as each individual's dysfunctional beliefs about sex. In order to
change the addictive cycle, one must change the belief systems that underlie
it.
Dysfunctional beliefs give rise to rationalization, minimalization and
justification. The addict, as the disease progresses, starts to see the world
through cognitive distortions designed to protect his sexual acting out. His
whole perspective becomes distorted to the point where he becomes
increasingly out-of-touch with reality.
In treatment for sex addiction, changing these beliefs is key. Changing core
beliefs is a challenge because they were imprinted at an early age and have
remained stable over time. Another reason change is difficult is that these
beliefs live in the unconscious mind. The addict lacks awareness of his selfdefeating beliefs. How can you change something you don't even know you
have? The cognitive therapist will elicit these attitudes and beliefs and
provides alternative ways of thinking and perceiving.
I sometimes use hypnosis to gain access to the subconscious mind where the
beliefs, attitudes and cognitive schemas can be brought to awareness and
disputed.
I highly recommend David Burn's book "Feeling Good". In it he lists 10
cognitive distortions and ways to dispute them. Study the cognitive
distortions so you can begin to see how they operate in your life and change
them more realistic,
Chapter 4
Psycho-dynamic Psychotherapy
In my opinion, long-term psycho-dynamic therapy is the most efficient way
to cultivate healthy personality development. The most comprehensive
treatment for addiction combines the empathy, insight and relational abilities
of a psycho-dynamic psychotherapist with the 12-step orientation and
cognitive-behavioral strategies of an addiction specialist.
What is Psycho-dynamic Psychotherapy?
The primary focus of psycho-dynamic treatment is on your internal structural
deficits rather than on your addictive symptoms. Besides compensating and
repairing deficits in the self stemming from childhood misattunements with
early caretakers, it may also be the most appropriate treatment to help you to
cope with life stressors and painful emotional states that contribute to urges
to engage in addictive sexual behavior.
The focus of this type of therapy is to enhance your self-regulation and selfcare, and to foster your capacity for meaningful interpersonal connections.
Psychotherapy serves these goals by facilitating the development of healthy
ways to regulate emotional self-states, for getting appropriate needs met in
reality, for resolving inner conflicts, and for taking care of yourself in a
spectrum of areas.
Integration of your personality is an important element of psycho-dynamic
therapy. Sex addicts live in two worlds; the "normal" world of work and love
and the "secret world" of sexual acting out. This split in the personality
results in having different value systems and goals for each part of your
personality. Psycho-dynamic treatment promotes personality integration by
bringing together under the light of consciousness the split, denied,
dissociated and repressed aspects of your mental functions. Dr. Jekyll and Mr.
Hyde finally become one.
Some General Principles of Psycho-dynamic Therapy
•
Focus is on feelings and expression of emotions. The therapist helps
you to describe and put words to feelings, including contradictory
feelings, feelings that are threatening, and feelings that you may not
initially be able to acknowledge.
• Exploration of attempts to avoid distressing thoughts and feelings.
•
Knowing, but not knowing at the same time is the result of various
defenses the person uses to remain unaware. One aspect of this type of
therapy is actively focusing and exploring these avoidances. Patient and
therapist chip away at defenses so unconscious material can be brought
to consciousness where there is a chance of changing and adapting to
reality.
• Identification of recurring themes and patterns. Self-defeating patterns
in patients' thoughts, feelings, self-concepts, relationships and life
experiences are put under a microscope.
• The past is alive in the present. Past experience, especially early familyof-origin issues, affects our relation to, and experience of the present.
The goal is not just to dwell on the past for its own sake, but rather to
help people free themselves from the bonds of past experience in order
to live more fully in the present.
• Focus on interpersonal relationships. Psycho-dynamic therapy
emphasizes your interpersonal experience. Problematic interpersonal
patterns interfere with your ability to meet your emotional needs.
• Exploration of the entirety of mental life. Your encouraged to say
whatever comes to mind. Thoughts can range over various aspects of
mental life, including desires, cravings, fears, fantasies, dreams and
daydreams. All of this is a rich source of information about how you
view yourself and others, interpret and make sense of experiences,
avoids aspects of experience, or interferes with potential capacity to
find greater enjoyment, ease and meaning in life.
The goals of this type of therapy extend beyond healing the symptom
(compulsive sex) but also foster the positive presence of inner capacities and
resources. These might include more fulfilling relationships, more effective
use of your talents and abilities, maintain a realistic sense of self esteem,
tolerate a wider array of strong feelings without acting out, have more
satisfying sexual experiences, greater understanding of yourself and others
and face life's challenges with greater freedom and flexibility. These goals are
explored through self-reflection, self-exploration and self-discovery that take
place in the context of a safe and deeply authentic relationship between the
therapist and you.
Personality Factors Common to Sex Addicts
These are the issues usually addressed in psycho-dynamic therapy.
• Sexually compulsive behavior helps you manage fluctuating affects,
self-sooth, and maintain self-esteem. Sex distracts from painful feelings
and thoughts, counteracts inner emptiness, replaces feelings of
fragmentation with an illusion of control, and temporarily bolsters self
esteem.
•
Sexual activity is a form of self-medication, used to make unbearable
feelings and self-states bearable. Addiction furnishes externally what
cannot be provided internally.
• Sexually compulsive individuals often have personalities with
narcissistic features.
• Poor capacity for self-regulation, self-efficacy and self-care
• Sex Addicts tend to have difficulties sustaining relationships and feeling
close to others.
• Problems in family-of-origin where their individuality and needs were
often ignored or punished.
•
In childhood, the true, authentic personality needed to go
"underground" to please narcissistic parents; parts of the personality
were then "split off " and are enacted through sexual activity as the
adult.
• The person affected alternates between deprivation of needs/feelings
and unrestrained indulgence. This state is marked by significant
splitting and minimal integration. (The Dr. Jekyll/Mr. Hyde Syndrome)
• Deviant sex provides a much-needed connection with another without
the "danger" of relatedness.
• Brief sexual encounters are seen as emotionally safe. They have a fixed
ending point, no strings attached and have little room for conflict.
Furthermore, anonymous partners cannot readily reject you upon the
discovery of your real or perceived flaws.
• Many sex addicts have a strong wish for control and a fear of
vulnerability. They feel internally fragile and prone to fragmentation.
• Sexual behaviors allow a feeling of control, power, triumph or
omnipotence that compensates for early-life feelings of helplessness
and powerlessness. Most likely a ritualized sexual enactment turns
trauma into triumph and is a repetition compulsion with the
unconscious aim of repairing the original childhood trauma.
Dysfunctional relationships developing out of the trauma are enacted
through sexual activity.
• The details of a sexual enactment, and the fantasies that fuel it, are
laden with symbolic meaning and are an aid in understanding the
themes of inner conflict driving the behavior.
The Fruits of Treatment
Psycho-dynamic therapy can help you to develop:
• An understanding of the internal factors driving your sexual behavior;
• Better self-regulation through internalization of your nurturance,
containment and structure of the therapeutic environment;
• Improve your capacity for interpersonal relationships and healthy
sexuality;
• Improve your capacity for working at an optimal level;
• Improve your access to creative inner resources;
• Improve your capacity to reflect on thoughts and feelings, with a
resulting increase in inner control and a decreased need to act out
unwanted mental states;
• Integration of the private and public selves: Dr. Jekyll and Mr. Hyde
become one;
• The therapist explores your sexual behaviors and fantasies in detail.
Like dreams, they have symbolic meaning and aid in understanding the
structure of your personality as a whole.
Chapter 5
Group Therapy
Why Group Therapy for Sex Addicts?
Although the behaviors of sex addicts differ, all sex addicts share certain
similarities when you “act out”. Typically, you are disconnected from your
feelings. You substitute sexual behavior for emotional intimacy, and you
have distorted and painful interpersonal relationships. The problem of
emotional alienation is compounded particularly for men who in American
culture, are rarely connected to a social group in which they can bond and
discuss feelings with others.
Group therapy is a highly effective treatment for sex addicts. In a group
environment, no one person is singled out because everyone in the group
shares the same affliction. This commonality reduces shame and denial,
limits isolation, increases socialization skills and the development of
empathy. More importantly, the group format also fosters the development of
intimacy and helps sex addicts develop the coping skills they need to meet
their emotional needs in interaction with supportive others, rather than
through sexual behaviors.
Below is a list of the processes and benefits of group therapy for sex addicts:
•
You may have come to treatment feeling extremely hopeless. By seeing
others in addiction recovery, your faith is fostered in the belief that
treatment can and will be effective.
• You feel a sense of universality which helps you realize that an you’re
not alone in your addiction and that others have experienced similar
problems. This experience tends to reduce a member's sense of
uniqueness and reinforces the fact that each person is not unique.
•
Sex addicts are often alienated from others and experience a great deal
of shame and loneliness. The group provides a safe place to practice
trusting others. You may learn to feel free to care about each other
because of this climate of trust. You begin to see that you can talk
about feelings and elicit support.
•
The therapist and group members offer effective ways to deal with life's
problems. Education about 12-step support groups, the addiction cycle,
identification of healthy relationships, re-framing the meaning of
sexuality, and relapse-prevention strategies are also imparted.
• The opportunity to help another person because you care (altruism) and
to feel useful increases self-esteem. It also challenges one's own
demoralized position. Helping other group members can mediate this
sense of worthlessness.
• Addicts learn basic interpersonal skills which help them turn to people,
instead of relying upon fantasy enactments in times of need. Group
therapy helps you to develop new ways of relating to people
• Group members serve as role models for other members through selfdisclosure and honesty. When the therapist listens attentively and
provides direct eye contact and sympathetic expressions, she promotes
a positive attitude and an understanding of the importance of what you
are saying. Through modeling the therapist, group members learn how
to help each other feel both supported and understood. When one
member shares his or her secrets, it encourages others to take risks as
well. You have the opportunity to see how others work through their
problems without returning to destructive behaviors.
• Members are able to connect with each other because a sense of
cohesiveness develops. You begin to take seriously the events that
occur. It is what makes the group really matter to its members. Because
sex addicts have been hurt so badly in childhood, prior to group
therapy, they tended to refrain from trusting others or personally
investing themselves in adult relationships. Immersion in a therapeutic
group can help heal and rectify the interpersonal wounds of childhood.
• Many group members experience catharsis. This is defined simply as
the open expression of feelings, which is extremely important for sex
addicts who have often repressed their emotions. Sex addicts fear that if
they state where they are emotionally, they will alienate others. In fact,
members of the group generally learn those emotional experiences can
promote feelings of connection with others and not a sense of isolation.
• The sex addict’s lack of structure can be a trigger to acting out. In a
group environment, however, a support structure and a quasi-family
provides support empathy, and understanding where it seemed there
once was none. Keeping your time structured through being in the
company of family, friends and recovery “buddies” helps to mediate
that trigger.
• The Group provides accountability, which is another structure that
addicts require to recover. Individuals who are accountable to others
throughout the course of their recovery are more likely to be successful
in achieving and maintaining sexual sobriety. The members of a
therapy group provide an extra level of accountability by taking an
active role in others’ continued growth and success. Lack of
accountability is often another strong trigger for the sexually addicted.
Breaking free from this odious addiction can seem an overwhelming and
impossible task. In the group experience, addicts in recovery witness first
hand what is possible from others who are like themselves. Without hope and
a sense of direction, discouragement and self defeat can quickly lead to
relapse, but when the hope of sobriety is nourished, abstinence becomes more
attainable. Profound personal and interpersonal change and growth can occur
in a cohesive group. I believe it is a critical component of the mix.
A recent survey conducted by a sex addiction treatment rehab center gave
insight about which benefits their patients found most helpful. They said
sharing feelings, a sense of belonging and learning about recovery skills were
most helpful. Interestingly, the statement, “Revealing embarrassing things
about myself and still being accepted by others,” was the single most healing
aspect of group therapy. This finding suggests that acceptance and a sense of
belonging, perhaps the very aspects of intimacy that addicts most fear, are
also the very needs they are trying to get met through compulsive sex.
Chapter 6
Couples Counseling
Cybersex is the use of electronic communications for sexual diversion and
includes email, texting, and internet porn. The American Bar Association
cites that in 2011 a whopping 50% of the divorces it handles have cybersex
implicated in the couple’s demise. The harm and emotional wreckage to the
partner (co-addict) is enormous. As a result of cybersex, a couple’s marriage
is compromised and children within the home are harmed in numerous ways.
They suffer from the abandonment of both parents: one is obsessed with sex
and the partner is obsessed with the sex addict. In many cases, the children
don’t receive the care, time and attention they need and deserve. As a
consequence, this abandonment will affect their ability to forge healthy
relationships as adults.
Below is a case example of a couple who suffered the consequences of
cybersex in their marriage. Although the article doesn’t describe the pain and
hard work this couple put into healing through relationship, it gives insight
into the problems of sex addiction. By definition, sex addiction is an intimacy
disorder, so couples work has to start with education about intimacy skills,
including honest self-disclosure, communication skills, healthy sex, having
fun and developing a joint vision of the future.
Rebuilding trust and forgiveness were key issues for the couple, Kathy and
Brad. Kathy took about a year before she could begin to trust and forgive.
She had to witness concrete actions from Brad including the commitment to
his SAA meetings and continuing treatment in individual and group
counseling. She needed to see honesty in all areas of life, dependability and
consistency in Brad’s actions. As a couple, they needed to spend more quality
time together.
Forgiveness is a key ingredient in rebuilding trust. Forgiveness is something
you do for yourself, not for the other person. Forgiveness is freedom from
resentment. Partners of sex addicts rarely forget; Kathy spoke of painful
images of betrayal running through her head like movie reels. But she did
forgive. She reported that she still remembered the events, but the pain
associated with the memory diminished over the years.
With couples therapy over time, Kathy went from seeing Brad in a onedimensional way (“The Sex Addict”, “The Betrayer”, “The Bastard”) to
seeing him as a multidimensional human being who suffered from a
debilitating compulsion. Through involvement in her recovery from coaddiction, she moved from being his adversary to his ally in recovery.
Kathy’s Point of View
“Imagine that your husband cheated on you with one woman. Now imagine
that it was with dozens of women,” said Kathy, 43, a nutritionist. “Sounds
like Tiger Woods, right? Well, Brad was the Tiger Woods of the Internet.
He’d get incredibly graphic photos of women online and then engage in
smutty sex talk with them. And he used our credit card to pay for it! I feel
betrayed on so many levels — not only was Brad unfaithful but he had lied to
me.
“This isn’t the man I fell in love with. Brad and I met at a party seven years
ago and instantly hit it off. He was handsome, funny, and interesting. And our
upbringings were similar. We both had parents who made us feel worthless.
My mother was too self-centered to pay any attention to me, and my dad was
hypercritical. The men I dated before Brad were either indifferent or
constantly put me down — treatment I was used to from my parents. Brad
was different. He and I had a comfortable, easy relationship, and after two
years we got married. We decided not to have children because our own
parental role models were so poor.
“About a year and a half into our marriage, Brad became withdrawn and
sullen. He stopped kidding around and wasn’t affectionate. Our sex life had
always been great, but suddenly he wasn’t interested. He’d spend hours
tinkering in the basement. I had no idea what was going on but hoped it was
just a temporary midlife crisis.
“One day I went down to our basement to use the computer. I hit a key and
up came a photo of a naked woman on her back with her legs spread open. I
was horrified. At first I thought it was some random pop-up ad, but then I
clicked around and found dozens of other images of women engaged in all
kinds of unbelievable sex acts. I snooped a bit more and found erotic e-mails
he’d written and even more photos. I felt as if I was married to a stranger. A
perverted stranger.
“When I confronted Brad, he said, ‘My friends and I goof around and
sometimes exchange photos. We’re just having fun.’ I wanted to believe him.
We’d had a good marriage and I couldn’t bear the thought of ending it.
“I lay in bed for three days, crying. I called in sick to work. I couldn’t talk to
my friends because I was too ashamed. Meanwhile, Brad kept insisting that I
was overreacting. ‘You’re blowing things out of proportion,’ he said.
“I worried that it was my fault, that he wasn’t attracted to me anymore. I’d
put on weight since our marriage, and even before that I didn’t have a body
like the ones those online women have. But they’re in their 20s, and I’m 43!
“I decided to try to get him interested again. I lost some weight and bought
sexy lingerie. Nothing has worked. In fact, Brad avoids me even more. We
never have sex. We barely talk, not even about what I caught him doing. It’s
like neither of us can bear to mention it. Mostly, we fight. I am so disgusted
by his porn problem that I wonder if I can ever trust him again.”
Brad’s Point of View
“I’m so ashamed of what I’ve done and how badly I’ve hurt Kathy,” said
Brad, 43, an X-ray technician. “She doesn’t even know how bad my habit
really is, or how much money I’ve spent on it. Cybersex is a sickness. I’ve
stopped since she caught me, but it’s a constant struggle to resist.
“I’ve been into porn since I was a teenager, when I’d sneak my dad’s
Playboys from his closet. He and I had a terrible relationship. The only
emotion he ever expressed was anger, and he was abusive, emotionally and
physically. My mother was a total doormat. Even on the rare occasions when
she’d object to something he did to me, he’d shoot her a dirty look and she’d
back off.
“Dating was hard for me. I never connected with anyone, and none of my
relationships lasted long. I began dabbling in cybersex about a year before I
met Kathy, after a friend told me there were lots of hot women online who’d
talk to me. So I started going on adult sites and looking at photos of naked
women. Sometimes I’d e-mail back and forth with them. Then I moved on to
the telephone. I’d meet a woman online, I’d type in my credit card
information, she’d give me her phone number and we’d talk for an hour or
two — for $12 a minute. She’d ask me what kind of panties and perfume I’d
like her to wear and what I wanted her to do to me. As she’d talk, I’d
masturbate. This happened about twice a week. Eventually I started watching
women performing sex acts on my computer via live web cams.
“Then I fell in love with Kathy. She understood me, and together we laughed,
went to movies, and had fantastic sex. I felt more comfortable with her than
with anyone I’d ever known. But after we’d been married a year or so I
started feeling out of sorts. I’d wake up anxious for no reason. Being married
felt like a burden. Basically I shut down.
“That’s when I turned to cybersex addiction again — my easy outlet, my
quick fix. Only this time I got more sucked in than ever. I’d be in the
basement four, five times a week. Sometimes I’d hear Kathy’s footsteps on
the stairs and I’d shut down the computer. Once she said, ‘You’re spending a
lot of time online — what’s going on?’ I said I was trying to sell stuff on
eBay. Cybersex became the most important thing in my life. Kathy and I
were like roommates — the kind who barely talk to each other.
“When Kathy discovered what I was up to, I tried to worm my way out of it.
But I feel horrible. I’ve been living in fantasy land, and I’m not sure I can
stop. Kathy deserves better.”
The Therapist’s Point of View
“Not all experts believe that sex addiction is real. I do, and in Brad I saw the
classic case. He could not control his sexual thoughts and impulses and felt
compelled to act on them. His porn addiction had taken over his life and he
was lying about it.
“My first goal with this couple was to air the porn issue. Before coming to
me they’d barely discussed it. Instead they fought about things like who left
the coffeemaker on. Neither had a clue how to deal with the elephant in the
room.
“In their first session Brad admitted to all that he’d been up to in the
basement while Kathy read or watched TV upstairs. ‘How could you?’ she
wanted to know. He also confessed to squandering nearly $25,000 on his
habit in the past year, which he hid by snatching the credit card bill as soon as
it arrived. Shocked and enraged at all this, Kathy sobbed for most of the hour.
“Even so, I could see the couple loved each other and wanted to save their
marriage. I explained the concept of sex addiction and urged Kathy to see
Brad as a human being with a problem, not a pervert. But her self-esteem had
been battered and she needed to feel secure. At my suggestion they moved
their computer into the family room and installed parental locks on adult
sites.
“I also felt each of them would benefit from individual counseling. During
my sessions with Brad, we explored how his compulsion stemmed from his
childhood inability to please his father. After he married Kathy, similar
anxieties surfaced: that he could never satisfy her, emotionally or sexually.
Instead of trying to understand his feelings, he escaped to into internet porn
addiction, where he didn’t have to deal with a real-world woman or please
anyone but himself. As time went on he needed more and more intensity to
get the same high.
“By always keeping in mind the devastating marital damage that would result
if he gave in to temptation, Brad was able to control his impulses. He also
joined Sex Addicts Anonymous [SAA], where he had a ‘buddy’ to call for
support.
“With Kathy, I helped her understand how her unhappy childhood had cast a
shadow on her adult life. She freely expressed both her bitterness about her
past and her rage at Brad but realized she had to move past them. I
encouraged her to pursue activities that made her happy, such as taking a
writing course. Putting her feelings on paper boosted her confidence,
enabling her to empathize with Brad and to finally grasp that his cybersex
habit had nothing to do with who she was or how she looked. This
breakthrough was key to repairing their marriage.
“After a year of individual therapy the couple resumed couples counseling.
This time we focused on what was going right in their relationship. Kathy
needed to see that Brad was committed to reforming himself through
addiction recovery, and his hard work reassured her: He never missed a
therapy session or SAA meeting, and he not only pitched in more around the
house but he also began wooing her with flowers and date nights.
“Slowly their romance blossomed again. Today Kathy and Brad are
transformed. They enjoy each others company, go on weekend trips and have
a robust sex life. Brad still gets the occasional urge for cybersex, but he
knows better than to act on it. He’s taken on a leadership role at SAA, where
he works with newcomers. ‘I counsel men who pull over to the side of the
road to watch internet porn on their laptops,’ he said. ‘I feel so lucky I was
saved — and our marriage, too.’”
Chapter 7
The Healing Power of 12-Step Groups
Introduction
An effective approach to sex addiction treatment is The 12 Steps Program,
involving group membership and participation of peers through recovery.
The program has it roots in the treatment of alcohol addiction with a spiritual
foundation. Since the program’s inception in 1936 by Alcoholics
Anonymous, the tenets of the 12 steps have been borrowed and modified,
remaining a core component of many other addiction treatment programs,
including treatment for sex addiction. The 12 Steps encompass levels of
suggested progressions of lifelong healing. Central to recovery under the
program is the notion of “people helping people” such that those farther
along in the program serve as example to those who have similar afflictions
and experiences. Personal stories by group members provide real world
inspiration to peers.
Within my practice, I recommend the 12 Program in unison with a
therapeutic approach.
How Fellowship Heals
Sex addicts need to find positive activities as substitutions for their sexual
acting out. For those who choose it, 12-step meetings does this in abundance.
The groups are comprised of many individuals who care, who have similar
stories and do not tire of hearing new ones. Because of this compassionate
support, members in the group may be able to gently confront the addict with
his maladaptive behaviors. Specifically, sex addicts begin to see that they
share in common several behavioral defenses. Defenses are the ego’s way of
protecting one’s self from anxiety and in the case of sex addicts often
include:
Denial, in which a person convinces himself that the unpleasant emotions are
nonexistent.
Rationalization, in which a person finds logical reasons to justify
undesirable behavior, and,
Magical thinking, an error in thinking in which an addict believes he can
recover without intervention, for example. It’s a form of self-protection
which prevents inflicting new wounds upon the self.
Sex addicts have in common a reduced capacity for impulse-control. In the
12 Step program, the influence of these other individuals is gradually
internalized, which means it becomes personal and part of the self-governing
structure of the self. The group itself, as a consistent, caring object also may
be internalized. Over time, the psychological wounds of growing up in a
dysfunctional family can be repaired through the acquisition of a new family
that provides the empathic soothing and caring that was missing in early
childhood.
Sex addiction groups have regularly scheduled meetings with a predictable
format, repetitive slogans and messages. The structure of meetings provide a
certain order -- a system --even ritual, which can aid the addict in the
development of healthy internalized self-governing structures.
Learning to Talk about Feelings
A mark of the addictive experience is feeling overwhelmed when faced with
intense feelings. Some addicts are unable to describe the sensations for which
language seems inadequate. A 12-step meeting offers a series of lessons that
help find language to represent the self. The basic format of the meeting is
that people gather to speak of themselves and listen to others. This provides
a powerful experience in modeling how to use language to express feelings
and experience, as well as reduce feelings of shame. In this way, what was
once felt to be unutterable is formulated into words which then defuse
overwhelming feelings.
Without influence, an addict’s central control is limited to his own way of
thinking. There is a certain type of control within the individual personality
which can have its source only outside of the personality - the moral
principles advocated by a closely knit group. A peer group can effect change
in an individual against self-centered, gratification-oriented impulses.
Instead, an involuntary feeling of belongingness and allegiance to such a
group takes hold.
The linchpin upon which the 12-step process is based is that an addict finally,
unembarrassed, acknowledges the need for participation in a caring
community. The participation in the group is understood that it exists without
ulterior motives, and which accepts the individual totally for what he is. A
sex addict cannot thrive normally as a solitary structure; instead, it is
essential that the self’s survival and value require participation in a social
structure or community. The development of a true self is always
participating with others in its realization and progress. Once this is
acknowledged, this is the beginning of the "unfreezing" of the developmental
arrest and becomes an adaptive substitute for the destructive, maladaptive
addiction.
But it is only the beginning. The passage from infantile narcissism (or,
having every whim gratified) to emotional maturity and full humanity is
ultimately accomplished by consistent immersion in working the 12 steps.
How the Steps Heal
Step 1: We admitted we were powerless over alcohol - that our lives had
become unmanageable.
The admission of powerlessness over the one's addiction is the first defeat of
infantile egoism (an immature view of self as foremost important). This is a
first step in the assumption of responsibility.
During Step 1, the sex addict adopts the conviction that he can no longer
engage in one's addiction. This becomes an inarguable truth. The denial
defense mechanism breaks down as the addict increasingly sees that to give
way to the impulse to "pick up" has far-reaching and devastating
consequences. The addict comes to terms with the essential paradox: you
have to lose to win.
The term "surrender" permeates step work. There are two facets of surrender
in the first step. The first and surely the most significant, is formation of
deep conviction that one is powerless over one's addiction. One surrenders to
the reality that he can never act on the impulse to "pick up". For example,
addicts progressing through this stage begin to view "One Day at a Time,”
comprised of small successes. This truth unfolds as recovery progresses. The
second facet is that the addict is really surrendering their sense of uniqueness.
As one admits powerlessness, one no longer expects the world to conform to
one's own egocentric beliefs. The first step is a step toward "living life on
life's terms". It is making a decision that one is no longer driven by the desire
for pleasure and is willing to be open to accepting and coping with reality.
Step 2: Came to believe that a power greater than ourselves could restore
us to sanity.
In this stage, the addict forms an openness to the possibility that a higher
power exists. Such belief propels an individual to develop boundaries. An
egoistic perception is replaced by a new reality . From a psychological
developmental perspective, immature levels of personality structure are
egoistic in nature. All things seem related to one’s self, a condition that
prevents the individual from seeing others for who they really are. Rather,
others are seen as extensions of oneself, making it impossible for the
individual to have anything but a self-centered point of view. The realization
and acceptance of some power need not be religious or even spiritual. The
power merely needs to be seen as a force greater than one's egoistic pursuits,
and this puts in motion the abandonment of a grandiose posture. One no
longer expects the world to conform to the self’s own needs and wants.
Rather, one learns to live "Life on Life's Terms".
Step 3: Made a decision to turn our will and our lives over to the care of
God as we understand Him.
This step suggests that another "surrender" be considered. Specifically, this
step requires the surrender of one's own willfulness in the decision-making
process. When left to their own devices, addicts tend to make decisions
based only on their ego-centric motives and ways of seeing the world. The
step suggests a less self-driven version of reality which leads one to consider
one's powerlessness over many of the events that occur in one's life.
Step 3 sparks a renewal of trust in living and a loosening of ego-dominated
self-sufficiency. Doing the work of this step requires an understanding and
acceptance of paradoxical thinking, meaning that the addict learns he can
achieve control by actually letting go of control. Prior to recovery, the addict
focuses intensely upon control issues (e.g., controlling use of the drug,
controlling the amount of damage caused by the using, and controlling
emotional distance to minimize vulnerability). Such focuses are held
exclusive and sway over the addict's consciousness. Step 3 encourages a
more passive mode of letting go by surrendering and allowing events to
unfold without futile attempts to control outcomes.
Step 4: Made a searching and fearless moral inventory of ourselves.
This step represents the attempt to review one's life in as a meticulous and
forthright way as possible, listing the action and choices that have caused
guilt and shame in oneself and harm to others. The process of emotional
development involves a degree of self-knowledge and self-awareness. This
step is an opportunity for the addict to see repetitive cognitions and behaviors
that inhibit this process of growth. When one sees the contribution that these
"character defects" have made in one's own misery, the process of projection
onto other people and external events for unwanted inner states is reduced.
The focus in Step 4 is on the self and not the faults of others. The addict can't
help but accept responsibility for his life, a crucial step on the movement
towards maturity.
The presence of the word "moral" needs special consideration in this stage.
When the Dr. Jeckyll/Mr. Hyde personalities of an addict (described in detail
in another article – LINK) split the person "dissociates" and, in a manner
similar to multiple personality disorder, becoming two distinctive
personalities. The addict has his "normal" life and his "secret" life. The Dr.
Jeckyll side of the personality has one set of values, goals and beliefs, and the
Mr. Hyde side has a completely different set. I understand the despair,
remorse and regret that follows an episode of acting out (When Dr. Jekyll
returns) as the realization that one has betrayed one's own values and moral
injunctions.
Step 5: Admitted to ourselves, God, and another human being the exact
nature of our wrongs.
The words "sex addict" and "secrecy" go hand in hand. The addict carries the
weight of the knowledge of what occurs in his "secret" world. If he shared
the "secret" with another person, he would, in his mind, be condemned to
hell. He believes he would be despised. A diminishing sense of self esteem
contributes to a sense of isolation and alienation. With the 5th Step, the
secret is out and this is good news. The ability to know and accept oneself in
the presence of complete disclosure to another recovering addict is very
freeing. One can let down one's defensive armor and have more of a sense of
ease with the world. The recovering person in revealing the content of their
inventory to another, defuses feelings of guilt and shame. Another
significance of this step is that the paralyzing feelings of isolation, fear, and
mistrust of others begin to crumble as the interpersonal immersion in a caring
community begins.
Step 6: Became willing to have these defects removed.
From a psychological standpoint, an attitude of "willingness" is essential to
the process of growth. It puts the person in a less egocentric stance. It also
conveys a breaking down of rigid defense mechanisms that may have worked
as a barrier of protection in the past to survive a frightening, unstable
childhood. Now, such defenses have outlived their usefulness and, in fact,
contribute negatively to the addict's here-and-now problems in living if they
continue.
Step 7: Humbly asked Him to remove these shortcomings.
Humility is a word much discussed in 12-step meetings. It is desirable to
have a modest view of one’s importance. The posture of humility allows a
person to quell excessive self-preoccupation and instead, opens him/her up to
having a sense of awe in the moment-to-moment awareness of life, nature,
God and fellow human beings. Gaining humility also suggests a turningpoint in personality development from the illusion of self-sufficiency to
having an interdependent view of relating to others, one that is reciprocal and
enriching. Step 7 is the beginning of understanding that building character
and remaining close to essential values are more important activities than
chasing the high of sex addiction. I quote from the book Twelve Steps and
Twelve Traditions (Alcoholics Anonymous Worldwide): "We never thought
of making honesty, tolerance and true love of man and God the daily basis of
living. We sought to gain a vision of humility as the avenue to true freedom
of the human spirit."
Having a humble approach along with the admission of powerlessness leads
to a softening of childish demands for immediate gratification.
Step 8: Made a list of all persons we had harmed, and became willing to
make amends to the all.
Achieving the quality of healthy interpersonal relationships is a mark of a
person's stability and ability to live comfortably with others. Here, we again
come across the word "willingness", implying a deeper insight into the self is
necessary to overcome unnecessarily carrying responsibility for repetitive,
unsatisfying personal relationships. It is only by letting go of resentment of
the (real or imagined) harm done by others and instead focusing on what can
be changed in oneself that the personality becomes less emotionally
vulnerable, less reactive, and more stable.
Step 9: Made direct amends to such people wherever possible, except
when to do so would injure them or others.
Step 9 is another deeply liberating step. After amends have been made, there
are no reasons for the addict to hide from the world for past deeds. Before
recovery, those we were harmed or whom we avoided out of shame had an
exaggerated power over us. The step implies a readiness to take the
consequences of past behavior, which is important in developing new modes
of being in the world. It is an essential step in the development of a self and
other orientation to living.
Step 10: Continued to take personal inventory and when we were wrong,
promptly admitted it.
In Step 10 the goal is the development of better coping skills in dealing with
the vicissitudes of daily living. When thrown off emotional balance by people
or new events, the process of taking a quick inventory, admitting to errors in
the now and and learning to forgive (or at least tolerate) the imperfections of
others is a sign of a stable person who has developed a new way of dealing
with reality. The practice of Step 10 releases one from the need to be right,
and instead offers a truly liberating way of operating in the world.
Step 11: Sought through prayer and meditation a conscious contact with
God as we understood him, praying only for knowledge of His will and
the power to carry it out.
Research has consistently shown the psychological and physical benefits of
prayer and meditation. The person in recovery discovers that he is not a
victim of his own mind and that he does have power over the state of his
inner life. Meditative techniques have a powerful influence in reducing the
anxiety that underlies most addictive behaviors. The individual can generate
a sense of calm, focus and direction. Psychologically, the 11th Step is a
means for even deeper insight into one's motives and needs.
Recovering people are often befuddled about "knowledge of His will". It
would seem to me that it is not God's will, or anybody's will, that the addict
return to using. It's probable that God's will includes living a life that is not
entirely self-centered or self-serving. Perhaps God's will includes living a
moral life, consistent with one's deepest values and beliefs. From a
psychological standpoint, it is a conscious contact with the higher self -- the
best part of who we, as individuals, really are.
Step 12: Having had a spiritual awakening as a result of these steps, we
tried to carry this message to alcoholics and to practice these principles
in all our affairs.
The inherently beneficial values of care for others, unconditional love, and
genuine, honest relating comprise the core of the recovery process, a process
that produces a mature personality. Successful application of this step would
seem to define the essence of emotional maturity. To reach Maturity means
having an authentic self that has been able to develop adequate coping skills;
a sense of "agency" of the self that had been lost to the addiction; the ability
to tolerate emotional pain with the knowledge that all internal states are
transitory; the development of healthy inter-personal relationships, and a
sense of purpose in living.
In summary, the addictive experience is marked by inter-personal difficulties
and problems with isolation, self-esteem, impulse control, lack of selfregulation among other symptoms. The problematic dimensions of the
addictive experience are addressed through the structure of "S" meetings.
The program, including the steps, provides cognitive strategies,
compensatory mechanisms and intra/interpersonal resources to assist the
addict in successfully negotiating the vicissitudes of human living and stay
sober for good purpose.
Chapter 8
Hypnotherapy
Is Hypnosis REALLY a Serious Treatment Modality for Sex Addiction?
The usual response to the suggestion to one of my clients that hypnotherapy
might be useful in the treatment of sexual addiction is typical of the general
public's misguided understanding of hypnotherapy:
• "I'm afraid of going into trance - I might lose control"
• "You'll find out things about me that I don't even know myself",
•
"I'm just not the type to benefit from hypnosis".
•
Hypnotic trance, however, is really nothing out of the ordinary; it is a natural
experience that occurs routinely in daily life. Daydreaming, fantasizing,
driving a car, or watching TV are all trance states.
Almost everyone can be hypnotized. The old debate about whether or not a
subject is "hypnotizable" has become moot. Hypnosis happens when a person
allows it to happen. A willingness to relax and clear the mind, focus and
imagine the things that are suggested lead to a receptive mental state which
induces a hypnotic effect.
A willingness to learn, and an attitude of receptivity coupled with practice,
enhances the hypnotic effect. Willingness is critical for you to experience
yourself in a different way that effects change.
What is Hypnosis?
Hypnosis is an inner, altered state of consciousness in which the critical,
logical, and conscious part of the mind is temporarily suspended so access to
the subconscious is available to receive suggestions for new attitudes, beliefs
and values. While you are in touch with the subconscious mind, new
psychological connections can be made.
When you can let yourself go into a goal-directed daydream, what happens is
you dissociate yourself from your surrounding environment. You become
completely engrossed in your inner reality. You are in an alternate state of
awareness. This is called hypnotic trance.
While in a trance state one is open to suggestion and free to accept positive,
healthy, constructive suggestions without the interference of thoughts,
objections, excuses and rationalizations.
How can hypnosis help recovery from sex addiction?
Hypnosis can stop the purely cognitive functions with which the person is
familiar Hypnosis engages him in new inner experiences which will produce
new attitudes about sex This leads to a lessening of the toxic core beliefs
about the self which is the foundation for the process of addiction. Trance
induction is the use of the power of the unconscious mind to re-work the
neurological wiring born of childhood experiences. It is in childhood when
unwanted, self-destructive impulses and behaviors are first form and that
continually result in adverse consequences. Trance induction allows
development of new pathways from that old wiring. Hypnosis is used to retrain your neurology to increase the ability to tolerate unpleasant
affects/feelings that are often triggers for sexual acting out.
Erotic Haze
In Chapter 2, I described “Erotic Haze”. The experience of the erotic haze is
very intense and compelling. One reason for its hold on people is that it is a
psychologically stimulated neuro-chemical state induced by the release of
several brain chemicals. These include: adrenaline, dopamine, endorphins
and serotonin, all of which are produced and increased by the body when the
sex addict engages in intense sexual fantasy, rituals, and behaviors. In truth,
maintaining the high of intensity sensations which are evoked by sexual
cruising and fantasy is more sought than the sexual act itself. Like a gambler
walking into the casino and before he even hits the slot machines, sex addicts
are high on their own neurochemistry long before actually acting out.
Besides the neuro-chemical high, what are the psychological factors that
make this particular hypnotic, erotic trance state so compelling for the sex
addict? What makes this state so irresistible that money, time, family, selfrespect and sometimes sanity are sacrificed?
A Secure, Safe Place Within Yourself
A famous psychoanalyst once coined the term "holding environment", a
normal condition which occurs when an infant and an emotionally adequate
mother form a bond that nullifies the infant's weakness and creates a sense of
being "held" in the world as the child grows to be a man.
During adulthood, the ability to draw on the earlier functions of the holding
environment helps maintain a stable sense of self. People who lacked an
emotionally adequate mother (who could not create this holding
environment) will more often find themselves feeling anxious, fragmented,
insecure, and emotionally isolated. It is these chaotic, painful emotions that
start the addict off in search of immediate gratification through sex. In the
frenzied search for a sexual encounter you may try to recreate a holding
environment that compensates for the lack of a secure sense of self and to rid
yourself of unwanted and uncomfortable feeling states. The choice of a
specific sexual behavior may be a compulsive attempt to find exactly the
right way to be held - to be soothed, to be comforted - to be re-assured.
Hypnotic techniques are effective in treating sex addicts because the sexually
compulsive state (the "erotic haze") is nothing more than a trance state in
which you feel "held" in a constructive way. You feel right at home in trance
You’ve lived most of their lives in one. Hypnotherapy enables you to
experience a valuing, ego-enhancing, resourceful trance state that may enable
you to find a way to be (symbolically) held that leads to constructive, rather
than destructive consequences. A good hypnotherapist provides messages
which inspire feelings of self-worth, self-value, plus the ability to inhibit
impulses. This allows you to tap into existing resources within so that
messages are received at a deep, unconscious level. Here lies significant
potential to effect personality change at a profound level.
Effective hypnotherapy helps the client to find parts of the self that sustain or
restore the sense of a true self so that aloneness is tolerated without the need
to sexual acting out. Through self-hypnosis you can experience a calming and
self-valuing experience that is generated from within you. You can then be
freed from the prison of the compulsion to get your needs met by external
sources that seem to always disappointment. Moreover, hypnotherapy also
affords a process of age-regression and re-framing that allows for reparation
of the original trauma of not being adequately held by an emotionally
sustaining mother.
New Attitudes towards Healthy, Related Sex
John Money, a famous sexologist, termed the phrase "Love Map" that refers
to the programming that each person has received from past experiences that
give rise to your “arousal templates”. Using hypnosis, mental models and
arousal templates can be modified so that the urge for compulsive sex is
replaced with knowledge and appreciation of related sex.
Hypnosis enriches sexuality through six important facts:
1.Cognitive control is achieved.
2.Relaxation from anxiety and stress is accomplished.
3.Consciousness of one's own "thoughts" that may be negative about related
sex can be recognized.
4.Positive imagery is used to enhance positive sex.
5.Natural physiological processes are freed to function normally.
6.The person acquires a new mental skill of self-control over his thoughts,
emotions and over his body.
Sex, as we know, starts in the mind and physical responses travel downward.
Hypnosis facilitates healthy sex by changing negative attitudes toward
sexuality, increasing communication between the couple, and exploring new
sexual techniques. Hypnosis can enhance the client's ability to focus attention
and increase sensory awareness, thereby facilitating increased arousal and
pleasure.
It seems fair to say that hypnosis, perhaps combined with sex therapy, is the
most effective way to improve the human sexual experience. The recovering
sex addict can be conditioned to want to experience and enjoy person-toperson, mutual sex that serves to bond two people who care for each other
and know each other on all levels of intimacy.
Please contact my office to discuss your personal situation and to determine
if hypnotherapy is right for you.
Chapter 9
Neuro-Linguistic Programming
NLP is an approach to doing psychotherapy that was all the rage in the 70’s
and early 80’s. It is a model of the structure of your inner, subjective
experience and how that experience influences behavior. It provides a
framework for eliciting the way you experience reality with a focus on
reorganizing that experience so you, as a human being, can optimally
function in work, love and recreation. NLP is designed to elicit information
from the subjective (inner) world, to see the limitations these experiences
impose on each individual and to direct strategies to the conscious and
unconscious processes for the purpose of facilitating change towards a
happier, more satisfying life.
How is NLP Employed in the Treatment of Sex Addiction?
Addiction, in all its forms, is a social epidemic and certainly represents an
obstacle to a life well lived. NLP’s methods, skills, and strategies (too
numerous and complex to detail) allow for the construction of a wider and
more effective repertoire of internally generated alternatives to addiction. As
is the case with any major dysfunction or illness, sex addiction, or the process
of being a sex addict, erodes the internal repertoire of choices until life
becomes determined by basically one primary factor: access to sex and to the
“erotic haze” that accompanies it. Stated in a different way, the acquisition of
a sexual “rush” determines the addict’s lifestyle and imposes severe
limitations on life experience.
NLP offers “technology” for therapists to deliberately internally “install”
various strategies and processes, allowing you the required range of choices
needed for you to move toward an addiction-free, satisfying sense of well
being in your life. It both increases your awareness of your internal
processes in measurable ways and provides specific methodologies for using
information obtained through your conscious/unconscious processes in the
manner of one who has “enlightened self-interest.” If internally no new
choices or alternatives are generated in you, you will repeat – ad nauseum –
choices and behaviors that obviously no longer work in the present, but
which at some point in time, appeared to have produced results.
One of NLP’s precepts is that all behavior makes sense in the context in
which it was originated (called “Positive Intent of Behavior versus the
Manifested Behavior”). Behavior, no matter how bizarre it may appear to be
(I think of fetishes), makes sense when it is perceived in the context of the
choices generated by the individual’s particular model of himself and the
world. Addiction is not a matter of making a wrong choice, but of not having
sufficient internal choices – thus you act on old instruction or generally
outdated information that has no bearing on the present except that the
present contains the trigger that sets the old behavior in motion.
The more entrenched the behavior is, the more likely it is to be connected to
early survival skills – the need for protection, nurturing, feeling enlivened yet
safe, or the need to explore the world as an individual separate from mother
(the sexual need for novelty and excitement). You can see that, somehow-orother, things went developmentally array in your childhood and the survivalseeking pleasure of existence was not provided in the way you needed it to be
provided. The result is that you go to sexual excitement (remember of
definition of sex addiction) to get non-sexual, emotional needs met.
I suspect that the original positive intent of your behavior was to feel safe,
valued, recognized, wanted and alive. When compared to the “Manifested
Behavior” – the addiction with all of its dreaded consequences, you can
clearly see that behavior that had an original positive intent in the past now
manifests as behavior that doesn’t satisfy your needs in a real, consistent, self
esteeming enhancing way, but rather produces most of the distressing internal
and external circumstances of your life.
One of NLP’s contributions to sexual recovery is that it allows you to access
and employ your internal resources in order to have a repertoire of feelings
and behaviors that you can refer to which can appropriately take the place of
compulsive sexuality by fulfilling some of your needs in realistic, sustaining
ways.
The NLP Strategy of Re-framing
“Re-framing” is an NLP stalwart strategy. To “re-frame” a stimulus (e.g.
sexual urges) means to change the meaning of the stimulus and thus to
change the way you behave towards the stimulus. To “re-frame” the past
means to look at it differently in light of new information and growing
maturity.
When I was in therapy, I could only bemoan growing up in the chaos of life
with two alcoholic parents. I would regale the therapist with tales of the
HORROR of it all! At some point in my development, I began to have a
series of positive memories about my parents. Although dysfunctional after
their illness took over, there were, in fact, many years of togetherness,
closeness and fun. I have also come to recognize that they were not bad
people, just people with a bad disease.
Despite it all, they managed to march to the tune of their own drummer in
terms of their lifestyle choices and engendered in me enough love of learning
to be able to write this book! So…voila! You can change the past,
depending on which frame you choose to put on it.
NLP uses a “Six-Step Re-frame” to work with a variety of unwanted
behaviors, thoughts, feelings and attitudes. In brief, these include:
Step 1: Identify the behavior to be changed.
In other words, what do you want and what stops you from getting there at
this time. You may, for instance, was to enjoy sexuality as an experience
shared with a cherish partner that leaves you feeling enlivened rather than
depleted and self-hating. What stops you from getting there? Why, your
addiction, of course.
Step 2: Establish communication with the part of you that generates the
behavior.
This is the part of you that revels in the experience of intense sexual pleasure
and can’t figure out, for the life of you, why you would ever want to stop.
You need to understand that the addict part is part of your early survival skills
and will only change if presented with additional internal alternatives to the
addiction that responds as successfully, or preferably even better to the
original needs.
Step 3: Separate the original, positive intention of the behavior from the
actually manifested addictive behavior.
Almost all of the techniques for recovery covered in this book include a
process of “dissociating” from the addiction.
Step 4: Create alternative behaviors to satisfy the intention.
Ask yourself: in what other ways might I feel safe, enlivened, protected?
How might I give vent to my leanings toward mystery, novelty and risk that
aren’t sexual? Ask the “wise man” inside you for 3-5 ways of dealing with
life other than with the use of sex or pornography.
Step 5: Check again with your “addict” part to see if he’ll accept at least
one of the new choices.
Step 6: Ecological check.
The therapist asks you to check if there are any parts of yourself that appear
to object to the preceding negotiations and, if not, if you then feels that all of
you is willing to support trying new behavior that supports the original
intention of the lustful behavior.
Summary
The Six-Step Re-frame represents some of the most significant models of
NLP, the creation and behavioral installment of an internal repertoire of
choices to deal effectively with life events, the belief that individuals have all
the resources they need to lead satisfying lives, that the therapist’s job is to
help the client in accessing thee internal resources and that all behavior, no
matter how bizarre, makes sense in the context in which it was originated. It
further demonstrates that there is a positive connotation in all dysfunctional
behavior. This connotation is the pivotal point for turning current negative
behavior around by offering an array of choices that responds more
appropriately to the original needs. Finally given the opportunity, the human
being moves toward well being which can only occur in the context of the
continual creation of new internal alternatives and choices.
Chapter 10
PSYCHOPHARMACOLOGY
Sex addiction recovery typically involves at least psychotherapy,12 step
groups(or Therapy Groups), self-help groups and medication. Medication
while not always necessary, can serve as the “water wings “ for negotiating
the changes necessary for growth .
Certain psychiatrists believe that addiction is maintained by mood-dependent
motives and that pharmacological treatment of the underlying mood disorder
can diminish the urges and cravings associated with the addiction to sex.
Medications that enhance mood/feelings regulation also enhance your ability
to control impulses.
That there are chemical changes in the brain when you enter "the erotic haze"
cannot be disputed. Sexual arousal is a stimulated neuro-chemical state,
induced by the release of adrenaline, serotonin, dopamine and endorphins
that occurs when you engage in intense sexual fantasy, rituals and behaviors.
You get high on your own neurochemistry long before you actually have sex.
In fact, you may try to stay in the "erotic haze" as long as you can, putting off
any actual sexual release. A euphoric state not dissimilar to the inner state of
an opiate user occurs.
During recovery, certain medications can help sexual addicts alleviate
compulsivity anxiety and depression. Some medications act on brain
chemicals linked to obsessive thought and behaviors and reduce the chemical
"rewards" of sexual behaviors. Which medication is best for you depends on
your overall situation and other mental health conditions or addictions you
may have.
You may have to try several medications, or a combination of medications, to
find what works best for you with the fewest side effects. Medications used
in addiction recovery treatment are often used primarily for other conditions.
They include:
·Antidepressants.
Those most commonly used to treat compulsive sexual
behavior are selective serotonin re-uptake inhibitors (SSRIs). These may
include Prozac, Paxil, Zoloft and others. SSRi's often have a side effect of a
reduction in libido and sexual functioning which is sometimes useful in
recovering from addiction.
·Mood
stabilizers. These medications are usually used to treat mania, but
research suggests that they also help addicts to reduce uncontrollable sexual
urges, in order to achieve sexual sobriety.
·Naltrexone.
This medication is generally used to treat alcoholism/ and Drug
addiction by blocking the part of your brain that experiences pleasure from
addictive behaviors.
·Anti-androgen. These medications reduce the biological effects of sex
hormones in men and help free them from addiction. Because they reduce
sexual urges, anti-androgen are often used in men whose sexual behavior is
dangerous to others, such as pedophilia.
·Luteinizing
hormone-releasing hormone (LHRH). This medication may
turn around the process of addiction and reduce obsessive sexual thoughts by
reducing the production of testosterone.
·Anti-anxiety
medications. Examples include Klonopin, Ativan, Librium,
Valium and Xanax. These medications are used to reduce serious anxiety and
aggression in emergency situations, but are generally avoided, as they may
result in abuse of the chemical.
Chapter 11
MINDFULNESS MEDITATION
Introduction
Mindfulness is a method of awareness and introspection which involves a
conscious attempt to focus attention intensely on the present moment, noting
thoughts, feelings, perception, images and sensation without judging them,
participating in them or acting on them. The contents of your mind appear
and disappear without reacting to them. You experiences on a fundamental
level that every thought, desire, urge or impulse dies a natural death if not
fueled by emotional reaction or through behavioral enactment.
What you can hope for initially is freedom from your fears and addictions to
your desires, which can be a hindrance to adhering to personal values and to
the pursuit of meaningful goals in your life.
By becoming aware of inner body sensation, you can become aware of sexual
urges before they manifest in the form of thoughts, fantasies and behaviors. It
also helps to manage strong emotions (cravings and aversions) by using
certain Buddhist-based cognitive strategies.
In my opinion, Mindfulness meditation can be used in treating sexual
addiction, since traditionally it has been used in treating cravings of all sorts.
Working a successful relapse prevention program requires enhanced
awareness (mindfulness) of stressors, cues, triggers, thought processes,
emotions and cravings and urges that precede sexual acting out. Regular
practice of meditation increases awareness of all inner processes, including
the ones that precipitate relapse.
Our perceptions are colored by emotions, desires, fears and fantasies. Sex
addicts react more to their own fantasized images project onto people than to
the people themselves. Mindfulness enables you to free your mind of all
distorting influences and to achieve a state of equanimity or neutrality of
mind.
How Mindfulness Meditation Works in Sex Addiction Recovery
The following mechanisms explain the ways in which mindfulness works:
• Anxiety reduction: Sexual addictions are mediated by anxiety
reduction, not sexual desire per se. Mindfulness meditation has been
shown to reduce anxiety scores.
• Antidepressant effect: Sexual addiction can be described as a way of
coping with depression, anesthetizing painful feelings of loneliness,
self-hatred and the dreaded sense of emptiness experienced by so many
addicts.
• Development of healthy coping skills: Addiction is a misdirected way
to cope with inner and outer stressors. Meditation facilitates better
coping mechanisms because without being in a state of high emotional
reactivity, your ability to cope with life by being present and not getting
overwhelmed or overly disturbed is enhanced.
• Affect Regulation: Intense, painful feelings (affects) that you feels are
overwhelming and intolerable are neutralized and stabilized. When you
can experience feelings as transitory and ephemeral, the resulting
effect is increased tolerance for distressing feelings and an increasing
ability to regulate your inner life.
Mindfulness meditation helps to experience sexual cravings for sensation as
the transitory phenomenon that they are and increases a sense of detachment
from these inner sensations that are at the root of acting out.
• Mindfulness neutralizes emotionally charged traumatic experiences
from the past that are stored in the unconscious mind.
•
The replacement of the altered state of consciousness involved in
immersion in the erotic haze ("bubble") with the altered state of
(higher) consciousness of meditation makes addictive behavior
unnecessary. Experience of a higher nature emerges during meditation
which brings a new sense of purpose in living. This new way of being
(the "spiritual awakening" discussed in AA) assumes a priority over the
desire to indulge in compulsive sexual behaviors.
•
Finally, when it is possible to free yourself from fears and fantasies, the
mind attains greater equanimity. You are able to self-sooth rather than
having to chase a high from an external source. The ability to exercise
free choice is enhanced with a concomitant reduction in the shame of
being out of control and in a rise in self- esteem. When engaged in an
active program of meditation, over time you gradually aligns behaviors
in a way that is consistent with your deepest values and long-term
goals. Shame and guilt are dramatically reduced. When peace is
generated from within, the frenetic, compulsive chase for sexual
gratification that never quite satisfies is finally over. This state of mind
in itself is deeply satisfying and much more enjoyable than the transient
and disillusioning excitement you gets from addictions.
Suggested Reading
Insight Meditation: A Step-by-Step Course on How to Meditate//Sharon
Salzberg
Meditation for Beginners//Jack Kornfield
Wherever You Go, There You Are//Jon Kabat-Zinn
Mindfulness in Plain English//Bhante Henepola Gunaratana
Everyday Zen: Love and Work//Charlotte J. Beck
Nothing Special: Living Zen//Charlotte J. Beck
Mindful Recovery: A Spiritual Path to Healing from Addiction//Thomas Bien,
PhD. And Beverly Bien
(Audios)
Mindfulness for Beginners//Jon-Kabat-Zinn
Guided Mindfulness Meditation//Jon-Kabat-Zinn
Mindful Solutions for Addiction and Relapse Prevention//Stephanie
Goldstein, PhD.
Guided Meditation (6 CD set) / Jack Kornfield
http://www.sextreatment.com/
Chapter 12
“Brainlock” -- a Behavioral Modification Program.
“Brainlock, a 4-Step Self-help Guide for Treating OCD” is a book written by Jeffrey
Schwartz, M.D., a physician who spent most of his career treating and doing research
on Obsessive/Compulsive (OCD) behaviors. His has developed a four-part program
self-help program that can be used for any unwanted compulsive urges, desires and
behaviors.
Let’s go through Dr. Schwartz’s four-part program. It is similar to what I’ve written about
Relapse Prevention, but the point can’s be driven home enough – that if you immediately change
your behavior when you get an urge, the changed behavior will sooner of later create new neuropathways in your brain that will re-enforce your abstinence.
Step 1. “RELABEL”
You learn to Relabel unwanted fantasies, urges and behaviors. Call them
what they are in reality: the voice of your addiction. Addiction is a biological
condition that has to do with an imbalance of certain endorphins, mainly
dopamine and serotonin. It sends false messages from your brain, and you
are to recognize them as such. You must make a conscious effort to stay
grounded in reality because you must strive to avoid being tricked into
thinking that a sexual urge or craving is based on a real need. It is not.
Your sexual urges are symptoms of obsessive-compulsive disorder, combined with an impulsecontrol disorder, both of which are medical issues. Relabeling simply means calling the
unwanted cravings and urges by their real names – the voices of your addiction.
This is war and the enemy is the addiction monster in you. When
overwhelmed by cravings, you can say to yourself “It’s not me – it’s the
addiction.” You work constantly to prevent confusing your true self with the
voice of addiction.
I’ve been in AA recovery for 33 years. When I first started going to meetings, I would
hear, from time to time, someone say “The Disease Talks to Me”. What that meant, I
had no clue. It took years of recovery before I could cultivate a sense of myself as a
whole person who heard the voice of the addiction as something that was there, but IT
WAS NOT ME. A kind of separation had occurred between my true self and my
addictive self. All these years later, the addiction still whispers in my ear from time to
time, but I get amused, I don’t listen to it, and let it go on it’s way so that I can engage
in behaviors that are either productive or enjoyable and have no negative
consequences to my self-esteem.
The Impartial Spectator
Dr. Swartz, I think, may have been trained by a Buddhist-teacher. The development of the
“Impartial Spectator” evolves through Mindfulness Meditation (see Mindfulness article).
As I wrote in my article on relapse prevention, mindfulness awareness is essential to a sexual
recovery program. Awareness requires you to consciously recognize and make a mental note of
a disturbed feeling or urge. Your goal is to observe them rather than act on them. When you
develop a relationship with “The Impartial Spectator”, you can step back and say to yourself,
“This is just my brain sending me a false message. If I change my behavior at the point of the
urge, I’ll actually be changing how your brain works.”
Once a person with a compulsive disorder learns behavior therapy and resolves to
change his response to an intrusive sexualized thought or fantasy by not performing a
pathological behavior, a willful resolve gradually kicks in because a sense of personal
empowerment starts to develop.
Think of the “Impartial Spectator” as a vehicle for distancing your real person from your
addiction. Create a safety zone between your internal self and spirit, and the unwanted
compulsive urge. Rather than respond to the urge in a mechanical, driven way, you present
yourself with alternatives. It’s good to have some alternative behaviors up your sleeve, so you’ll
be ready when the voice of the “erotic haze” calls you.
RX: Action
Learning to overcome sexual compulsion is like learning to ride a bike. Once you learn, you
don’t forget, but getting good at it takes practice. In your recovery, it’s likely that you may fall
off, but you must get back on. If you give up, you’ll never learn. And you learn by falling off!
Passivity is your enemy. Activity is your friend. Having things you really need to do –activities
much more productive and creative that the illusional, nonsensical sexual ritual – is a great
motivator.
When you are capable of seeing quite clearly the difference between healthy behavior and
compulsive behavior, you are able to bring yourself around by zeroing in on reality.
A client of mine who used this system stated: ”Before, I was overtaken by sexual fantasies, urges
and cravings. I was overwhelmed. Now I know where they are going to get me – back in the
same self-hating self I don’t want to be in. So I’m ready. I don’t listen to my addiction because I
know it’s fake. I let it go quickly and so something that’s real and authentic.
STEP TWO: RE-ATTRIBUTE
If you wonder why you never seem to be free of sexual preoccupation, one of the
answers is that research has shown that the addictive brain is related to a biochemical
imbalance in the brain. In the Re-attribute step, you learn to place a lot of the blame
squarely on your brain: The addictive brain sends you a false message. If you change
the way you react to the false message, you can make your brain work better. Your
urge to go, puppet-like into the “erotic haze” will diminish.
The pervasiveness of these fantasies or urges in not a personal weakness. It is a false
alarm caused by a short circuit in the brain. When sex addiction sends a false message
to your brain, you can’t make it go away, but you don’t have to act on it.
If you have understood so far, perhaps you can use the author’s “fifteen minute” strategy. When
you get an urge to act destructively, wait for 15 minutes. During this time you actively keep
telling yourself, “These are not real thoughts. They are faulty messages from my brain.” After
15 minutes, the urge usually goes away and you begin to see that you have a sense of control
over your addiction. You are no longer a passive victim to addiction.
At some point, when sexual fantasies and desires to act out occur you realize – You are not going
to do it. Why not? BECAUSE THE REAL YOU DOESN’T WANT TO DO IT!
STEP 3: REFOCUS
Refocus tells you what to do while are trying to overcome urges to do compulsive
behaviors. It instructs you to “work around” those nagging needs by Refocusing your
attention on some useful, constructive, enjoyable activity. The key to the Refocus step
is to do another behavior/concentrate on something else. When you do, you are
repairing the broken gearshift in your brain. Your brain starts shifting more smoothly to
other behaviors.
You have to step aside, put the erotic pull aside, and work around it by putting your mind in
another place and doing another behavior, one that is more pleasant and functional.
Once you realize that the things that call you erotically have no deep meaning, that they’re just a
false alarm, a ghost from the past, you be able to largely ignore them and go about your business.
STEP 4: REVALUE
Revalue is an outcome of having worked the first three steps. With consistent practice, you will
quickly come to realize that your obsessive thoughts and compulsive behaviors are worthless
distractions to be ignored. With this understanding you will be able to devalue the pathological
urges and fend them off until they begin to fade.
If you do not actively Revalue these thoughts and urges as false messages coming from the brain
– messages with no spiritual, productive or inter-personal value whatsoever –and, if fact, are
shame filled and demoralizing.
The more clearly you see what the symptoms of sexual compulsions really are, the more rapidly
you can dismiss them as worthless garbage that are not worth paying attention to.
It would be good to use the Four Steps for gradually increasing periods. This means telling
yourself , “It’s all right – it’s just the voice of the addiction (Relabeling; then Re-attributing it to
faulty brain chemistry; Refocusing on a constructive, enjoyable behavior instead of one that will
lead you to the road of self-hate. Finally, Revalue the meaning of those fantasies or urges. You,
in essence, devalue those silly thoughts.
Dr. Jeffrey M. Schwartz wrote an exceedingly interested book that helps people deal with OCD
symptoms. I highly recommend this book because it can be applied to all compulsions,
including the prison of sex addiction.
Sex addiction is an impulse-control disorder; it is not an OCD syndrome. Compulsive behaviors
differ from OCD in that there is intense pleasure in sexually acting out; whereby there is not
pleasure in an OCD person washing her hands repeatedly. Frankly, it makes the job a bit harder
because the dopamine rush of the “erotic haze” and the intense pleasure of acting out can seem
irresistible.
The key problem in therapy for sexual addicts is how much people with this disorder make the
excessive, problematic, out-of-control and shaming behaviors “ego-dystonic,” that is, how much
can they come to find their behavior genuinely foreign to their own notion of who they are;
different than the values, goals and meanings that they most cherish.
People who are addicted to intense sexual pleasure come to expect pleasure to be taboo,
secretive, chaotic, and both soothing and exciting. Do they miss out on the extraordinary
pleasure that can be received from living a mindful life, staying in the now, and taking pleasure
in eating a peach or cooking a meal or seeing a sunset? This, too, is pleasure.
The Buddha warned against “cravings”, especially sexual arousal. He saw these constant
longing, wanting, cravings, to be the type of “attachment” that keeps people in “samsara” (the
suffering of life). His first Noble Truth was that life is suffering. The second Noble Truth was
that people suffer because of “cravings.”
We should live life with pleasure not for pleasure. Pleasure is ephemeral. The process
of obtaining intense sexual pleasure promises what it can’t deliver.
That’s why you feel so disenchanted, let down, shamed and disappointed after you act out. You
chase idealized perfect visions that turn out to be dust in your hands.
Chapter 15
From Sexual Addiction to Sexual Fulfillment
Over the years, the people I have worked with have used various words to describe the
end result of their compulsive sexual behaviors: words like shame, anger,
depression, anxiety, disappointment, self-hatred, hopelessness and
helplessness, usually describe their subjective experience after the orgasm is over.
Never have I worked with a person who described their sexually addictive experiences
with words like, fulfillment, satisfaction, closeness, or ecstasy.
Yet these are the kinds of states that optimal related sex offers. Exciting,
healthy, hot sex, comes from being relational, that is, connecting deeply
with both yourself and your partner. We are sexual beings from the day
we're born until the day we die. Sex is fundamental to our lives and seems
to be the area of life that most deeply touches our most personal issues.
Our sexuality is a core expression of who we are. We can hide with sex, we
can hide from sex, but when we are fully ourselves sexually, we no
longer have to hide.
For the sex addict, physical pleasure is fleeting and is only a numbing source for the excruciating
emotional pain that triggered the sexual act. It’s a fallacy for anyone to think that sex addicts
gain fulfillment from the sex act.
However, sexual desire and pleasure is our birthright. After all, we were created naked and with
complementary genitals. There must have been a plan in mind.
“We can hide with sex,
we can hide from sex,
but when we are
fully ourselves sexually, we no longer have to
hide.”
Good sex is a complex concoction of openness and secrecy, balance, risk
and control, and personal satisfaction. These ingredients foster mutual
fulfillment. Good sex –the quality kind that exists between healthy,
consenting partners – requires an ability to be totally immersed in the
moment (which is difficult for most people), ever-present to the sensuality
of yourself, your partner, and attentive to life. Exciting, hot sex comes from
being relational, that is, connecting deeply with both yourself and your
partner.
Can a sex addict return to the natural expression of sex and receive its benefits?
After you achieve a period of abstinence from self-destructive sexuality, you’re able to focus on
personal growth and intimate sexual relating. (Katehakis, pg. 67) A program of comprehensive
sex addiction therapy is a gradual process of moving from the addiction “arousal template” in the
brain, to a different (healthier and ultimately more satisfying) template. It’s a process of
redefining sex, and changing the addictive imprint born from faulty understandings about
sexuality and intimacy.
Exciting, intimate, tender, ecstatic, hot sex is attainable if you’re willing to
change your focus from non-related, self-centered sex to the joy of knowing
yourself and your partner in sexual ecstasy.
Chart Your Course and Choose the Path
In order to arrive at a destination, you have to have a map of the territory and a view of
what the destination holds for you. There are two paths from which to choose with one
path heading towards a healthy life, and the other towards self destruction. Knowing
the differences between compulsive sex and wholesome, related sex serves as the
compass for the journey.
The Gratification Difference
Addictive sex is based on immediate gratification and surrender to acting on impulses. Mature
sex is a choice; one that entails focusing on the entirety of the experience, not just the immediate
gratification of orgasm.
The discussion in this book so far has focused primarily on the different
ways to cease and desist sexual behaviors that you know are eroding your
self-esteem and your relationship. In AA terms, this involves “putting the
plug in the jug” of destructive behavior so that the business of recovery can
begin. Learning to choose how to stop the destructive behaviors and to
make a conscious choice about how to channel your sexual energies is
“clearing the runway” for optimal sex to develop.
The Urgency Difference
Addictive sex is compulsive sex, while sexual celebration emerges from conscious
deliberate choice. The compulsion of addictive sex, must be disentangled, understood
and put to rest. Psychoanalyst Sigmund Freud coined the term “repetition compulsion”
and it is referred to by therapists when they talk about an addict doing the “trauma”
work. You keep doing “it” (the sex act) over and over again until you get it right. But
you never do – get it right – because “it” happened in times past and the behavior is no
longer appropriate for your adult self. Having a sexual compulsion is like dying from
thirst, but always going to an empty well to quench it.
Compulsion is a mental pressure of internal origin compelling you to think, act, or react in
accordance with specific urges and energies that do no coincide with your habitual patterns of
thought. For a person with a sexual compulsion, there is a “must have” quality to a particular
sexual experience, regardless of a partner’s wants and needs. A compulsion is an irresistible
impulse to act, regardless of the rationality of the motivation. There is a sense of being driven; it
is obligatory -- somehow destined to occur despite your better judgment. Compulsion’s home
base is the unconscious mind where hurts and traumas of past experiences reside outside of
conscious awareness.
“Sexual compulsion” is an attempt to “undo” the traumatic experiences of the past.
You were powerless to effect change as a child because you didn’t have the resources
to take care of yourself. As an adult, through a repetition compulsion, you can achieve
a sense of mastery over the sense of helplessness you experienced as a child. But
this is faulty thinking.
A case in point:
A new client came for a consultation recently. His distress was centered around compulsive
enactments of themes of sexual dominance and submission where the female is fearful and
vulnerable and he assumes the power in the play. While he didn’t report any family-of-origin
traumas, he reported that he’d always had “a touch” of autism as a child. He felt disconnected to
his peers and especially shut out from the mystifying world of girls.
When he understands that his sexual fantasies and enactments were devised for him to
take an active role in contrast to his passive experiences of being socially unwanted;
when he recognizes that his sexual desires were based on a need to feel in control in
contrast to his childhood feelings of powerlessness; when he discovers and
acknowledges his own sense of self-esteem and appropriate self mastery, my hope is
that he will be relieved of the compulsion and be free to explore equality in his
relationships with women.
In another case:
A former client had witnessed the protracted suffering and death by cancer of his
beloved mother when he was six years old. His father was not able to give him the
space to grieve the death, telling him he needed him to be the “little man” in the family.
Years later, with unresolved grief as a catalyst, he became a compulsive cross-dresser
and ruined his marriage. If he hadn’t been able to keep mother alive back when, he
would keep her alive through becoming her in his cross-dressing erotic haze. Only
when he was able to “do the grief work in therapy” was he able to lose interest in
wearing women’s clothing.
Healthy sex enhances your self-esteem and allows you to enjoy and control your sexual energies
without guilt, fear or shame.
Shame strikes deepest into the human psyche; it is a sickness within the self, a disease
of the spirit. It is the feeling of indignity, of defeat, of transgression, of inferiority and of
alienation. Shame is experienced as an inner torment. It is a wound made from the
inside, dividing us both from ourselves and from one another. Shame violates our
essential dignity as human beings.
The person feeling shame thinks, “Whether all eyes are upon me or only my own, I feel
deficient in some vital way as a human being.” The disturbance within the self produced
shame, impacts not only self-esteem, but also the development of identity and the
pursuit of intimacy. When shame captures the addictive personality, it grows like a
cancerous growth. Shame precedes and enables sexual addiction. It follows sexual
acting out. Addicts often suffer another bout of sexual acting out to alleviate the shame
of acting out! Until treatment, it is a vicious, never-ending cycle.
Children can experience shame beginning from a very early age. Dysfunctional
(non-nurturing) families that are emotionally, sexually or physically abusive serve as the
spark that heats hot-beds of shame for their off springs. Neglect that is physically or
emotionally depriving also contributes to the formation of a shame-bound personality in
a child. The family isn’t the only source of shame; problems with peer relationships at
school can also be very traumatizing.
When an afflicted child reaches adulthood, he is haunted by shame. Combine this
with the cultural messages about the “sinfulness” of sex and that a large part of the
population feels shameful about sexual needs. Indeed, many of the dynamics of sex
addiction are about managing sexual shame. Intense sexual arousal obviates sexual
shame and allows for sexual activity. Sexual addiction makes sex so desirable it
overrides shame.
Shame is an integral part of your “Addictive Prison”. In the first place, shame-bound
people do shameful sexual behaviors. So shame precedes the acting out. There is one
particular feature of every addiction which is central to understanding the addictive
process: a profound, discouraging sense of powerlessness over the addiction. The tail
increasingly comes to way to dog, engendering shame about the addiction itself. We
feel humiliated whenever we feel controlled by anything, but especially in the sexual
experience because of the shameful connotations communicated by family, church and
culture that sex is “bad”, “sinful”, “shameful”. Each time there is failure to break the
addiction and regain power over it, the sex addict feels defeated. He grows to hate
himself, disgusted by the helplessness, the lack of resolve, the lack of inner strength.
Getting treatment for shame is an essential part of recovery from addiction.
The Substitution and Escape Difference
Those who have a healthy sex life do not need substitutions or escape mechanisms in their
relationships. In contrast, the sex addict requires it.
The addiction serves as a substitute for shame-bound interpersonal needs. For example, the
alcoholic who has a relationship with his bottle has substituted something else for a human
relationship. All compulsive sexual acts are substitutes for human needs about which you feel
shame.
The addiction also functions as an escape from intense shame. Feelings of shame
encountered anew in daily life, may serve as triggers to re-experience shaming
experiences from early life. These often trigger an episode of sexually acting out, as a
way to soothe the pain of shame. However, each new addictive episode also
reproduces shame, which then activates the entire cycle, all over again.
The Truth Difference
In contrast to shame-based sex addiction, celebratory sex is open, not hidden. It involves honest
communication between lovers, not lies and duplicity. Healthy sex exalts the individual and the
couple. Sex addiction destroys both.
Right now, you maybe you have the experience of having two selves: the private self
and the public self; the solid family man and the sexual deviant; the social self and the
self that may spend six hours a day in isolation looking at pornography. I call it “The Dr.
Jeckyl and Mr. Hyde” syndrome.
Your “Secret World” is separate from your public self. The overwhelming need of your
secret self is to protect it and hide it from other parts of your life. If addictive sex requires
a double life, healthy sex enhances and celebrates who you really are, increases self
esteem, and is empowering.
“Lying and Duplicity” are Necessary to Keep Your “Secret World”, Secret!
Pivotal to all addictions is the defense mechanism of denial. It’s been said that DENIAL means
“Don’t Even Know I’m Lying”. So you lie to yourself. You lie to yourself about how out-ofcontrol you are, that you have a serious problem that requires professional treatment, that you’re
not hurting your spouse and children, that you’ve been isolated from friends and have stopped
hobbies and activities that you used to enjoy.
Shame is again the culprit. You feel that if you told the truth about your sexual experiences,
you’d be shamed, humiliated, rejected and abandoned.
Part of clearing the path to healthy sexuality means telling the truth about yourself – in a 12-step
program, to a trusted therapist or a close friend. Eventually you’ll need to have an open, honest
dialogue with your partner about your addiction.
“It is impossible to have an intimate, connected relationship with another person if you
carry a back-pack of secrets and lies.”
The Maturity Difference
Optimal sex requires a degree of psychological maturity. Perfect fulfillment of sexual potential
is never achieved. It is a lifelong pursuit of personal development. It involves the conquest of
self-centeredness, the transcendence of personal limitations, and the dauntless struggle to be fully
human and fully sexual with a cherished other. The depth of connection in related sex far
surpasses the fleeting physical pleasure of a sexually addictive behavior. Erotic, mature, intense
sex makes sex addiction look like child’s play because it requires maturity and mutual caring for
another that only an adult can bring into play.
Sex addiction is immature and narcissistic (self-centered). Like an infant, you require
immediate gratification and cannot put off gratification in the service of a long-term goal.
You may have problems in self-regulation. You cannot regulate your feelings internally.
You need a sexual activity to help you feel good. Also like infants and children, you
don’t have the ability to control your impulses. Impulse control is a mark of a healthy
personality which can reflect on impulses and urges, think them through, and make
decisions to let them pass.
With healthy sex, you have awareness and empathy for your partner’s experiences.
True eroticism arises from the particular energy created by two people who care for and
respect each other. Most therapists in the sex therapy field focus on being able to
sexually function. But “optimal” sex includes consideration of eroticism, intimacy and
personal meaning in sexual behavior. The human capacity for intimacy and attachment
gives profound emotional meaning to sexual experience. With these factors in place,
human beings are capable of profound sexual experiences.
The Scattered Mind vs. Moment-to-Moment Awareness Difference
Sustaining a healthy, balanced sex life requires mindful attention to your senses, to the
physical, emotional, intellectual and spiritual dimensions of yourself, as well as your
partner. In profound intimate sex, nothing exists beyond the immediate presence of the
two partners. Awareness of the room, or even the bed, may cease to exist as you are
embraced by the sensual, erotic sense of the NOW.
The mind is scattered when involved with addictive sex; thoughts run the gamut of
thoughts about past sexual splendor with no recall of the negative consequences
(euphoric recall) to thoughts about future sexual exploits (fantasy). However,
sumptuous sex with a cherished other requires the ability to maintain awareness of
moment-to-moment sensation. Depth of involvement in a sexual trance increases as
day-to-day reality fades, replaced by increasing concentration on the sexual reality of
the moment. At profound depths of involvement in the sensual/physical/sexual moment,
the individual becomes totally absorbed in the sexual reality and loses awareness of
extraneous events. There can be an ecstatic sense of preoccupation and
transformation in which self and other become one.
According to the wise words of Sophocles, "KNOW THYSELF" in order to know what
you want and need sexually. Then you need to have the courage and self-assurance to
communicate these desires to your partner, even in the face of possible rejection. You
are ready for intimacy and related sex only after you have achieved a core sense of
identity.
The outstanding quality of intimacy is the sense of being in touch with your
real self. When "the other" also knows and is able to express his real self,
intimacy happens. Intimacy can be defined as a close, trusting relationship
between two people who are both willing to be emotionally open and
honest with each other in spite of the risks that may be involved. Intimacy
is also the joy of being known and accepted by another who is loved. The
quest for intimacy is one of the oldest themes in Western civilization.
However, although most people chase after intense sex and intimacy, few
seem truly willing and able to find it.
Through the experience of intimacy, you may experience yourself in some new, different, and
more profound way. When I am close, I know you in your presence; when I am intimate I know
myself in your presence. Intimacy is a remarkable experience. To feel and know myself in the
presence of another is enlivening, enlightening, joyful and freeing. I can be who I am freely and
fully in the presence of another. It is the only true freedom we have as human beings.
Sexuality is both an expression of that intimacy and a bond that enhances intimacy. With this
kind of personal/sexual intimacy, your growth experience as humans is energized, enhanced, and
fueled. Intimacy is the most meaningful and courageous of human experiences. Through its
experience, it is possible for you to “grow yourself up.
Your personal well being and your ability to be intimate with another cannot survive your
dislike or disrespect of yourself. If you dislike yourself, you’ll never be comfortable with
your sexuality. If you hold a lot of self-judgment about your past sexual behaviors,
identify yourself as a whole, valuable person who has an addictive behavior.
Remember – who you are essentially is separate from your behaviors.
Sex addicts escape into the “erotic haze” which involves dissociation from true feelings; healthy
sex opens a person up to tremendous depth of feelings. In the addictive sexual state sexual
experience is an avoidance of connection with your partner and your own feelings in the present.
Addictive sex is devoid of love; in sexual recovery, sex is an expression of love. In intimate sex,
you no longer hide out through fantasizing about others or dissociating. You are fully present
with yourself and your partner, preparing for your journey into the erotic.
Good communication is crucial to healthy sex. You can greatly increase feelings of mutual
respect, emotional closeness and sexual pleasure when you and your partner know how to
communicate well with each other. Knowing how to talk openly and comfortably about sexual
wants and desires can help you address issues that come up from time to time in the normal
course of an on-going intimate/sexual relationship.
The “Inner Validating” vs. “External Validating Difference
Addictive sexuality involves the search for “reflected validation”; that is, “if she/he desires me, I
feel validated.” Healthy sex requires self-validation. You know you are sexy and desirable
because your sexuality is a God-given part of who you are. You have no need to validate your
sexuality through getting or not getting any particular response from your partner or through a
fantasy connection on the computer.
Self-validation produces an enhanced sense of self. Being “other-validated” you put your value
as a person in the hands of other people. You sculpt your behavior and attitudes on the basis of
not being rejected or judged by others. If you have a reflected sense of self, you see the result of
your actions as though through another’s eyes.
You can never have an authentic sense of self if you are “other-validated”. The
fear of being separated, rejected, abandoned or judged makes you concerned with the
response of the “other” or “others”, and so keeps you from being your real self and
ultimately prevents you from loving, since loving involves disclosing your true and
authentic self to another.
An Expanded Vision of Sexual Fulfillment
What prevents people from experiencing the upper limits of human sexual potential?
·Adherence to rigid gender-role stereotypes where sexual behaviors are dictated by cultural
gender norms.
·Viewing the goal of sexuality as intense orgasms. For some, the number of
orgasms rather than their quality is the key to sexual fulfillment. It is a misconception
that orgasm and repetitive copulation capacity is the sole determinate of sexual
satisfaction. While orgasms are undeniably erotic, orgasms and eroticism are quite
different things. The fulfillment of sexual potential involves experiencing the upper limits
of physical sensation together with the capacity for intellectual, emotional, aesthetic,
and spiritual connectivity. Intense sexuality occurs within a context of profound emotion
and meaning.
The focus on intercourse in “normal” sexuality keeps dysfunctional gender-roles
in place. In this culturally embedded view of sexuality, the man must PERFORM and
the woman must be desirable. The focus on male sexual potency creates the most
common problem in sexual relating: PERFOMANCE ANXIETY. In addition to his
concern about the size and function of his penis, the male may have shame about his
anxiety! Now, how sexy is that? The man thinks he shouldn’t be anxious and feels
shameful. The result is that he becomes more emotionally isolated from his partner and
more turned off. Sex becomes something that isolates the lovers rather than bringing
them closer together. Sexual intensity is more a function of emotional maturation than
of physiological responsiveness.
The sex addict’s pursuit of intense orgasms per se, often interferes with repeated attainment of
transcendent eroticism and intimacy. As you know, orgasm can (and often does) occur without
profound personal meaning. The capacity for intimacy and intense, hot sex is a function of
personal development, rather than on physiological functioning.
·Seeking personal validation through sexual performance, It is essential that you
detach your self-esteem from your sexual “capacities,” and gender-role behavior.
Adequacy and eroticism should be detached from sexual functioning. There are
handicapped people who transcend their disability and maintain eroticism and self-
esteem intact, even though they violate normal social expectations. Self-worth derived
from sexual performance perpetuates the continual need to perform with its attendant
anxieties.
·Lack of partner engagement. Self-centered, compulsive sexuality, in recovery, will
give way to a caring attachment to a partner. The partner is seen as the individual
person she is, rather than solely as a sex object. Sex addicts sometimes have deficits
in empathic listening and relating skills and may need to learn them to have more
satisfying relationships. In the intimate and sexual bond, you appreciate your partner’s
core potentialities, strengths and assets; as you disclose your wants and needs, you
also are accepting of the partner’s self; loving synergy is involved in partner
engagement.
·Misconceptions about the function of intimacy. I’ve worked with people who say
they want a healthy relationship. What, in fact, they are doing is desperately seeking
someone to reassure them that they are worth loving. The quest for intimacy is not
about the trials of knowing yourself and letting yourself be known; it’s about the quest
for a “reflected” or “other-validated” sense of self. These people have ego deficits in
validating and soothing themselves. Some people think they seek intimacy when what
they are doing is looking for someone to help carry the burden of a dissatisfying
relationship with themselves. When intimacy and sex are pursued to validate your selfimage and self-worth, you will never be able to really see and acknowledge someone
else. Moreover, you will never know your true, authentic self. The ability to selfdisclose and self-validate in the absence of validation from others is a disquieting and
challenging task, but it can be done. People involved in these types of “validate me!”
relationships become over-sensitive, reactive, combative, and controlling. This is not
the stuff that hot, loving sex is made of.
Does SexTakeWork?
For some people, climbing a mountain is unthinkable work; for others it is a vacation.
The sex addiction fantasy is that sexual gratification involves no effort at all. It’s like
wanting to have the benefits of running a marathon without ever actually running. Good
sex requires effort – but its effort that can result in self-transcendence and self-andother celebration. The romantic view of sex suggests that if you love your partner
(enough), and if your partner loves you (enough), desire and performance naturally
follow. Working at desiring sex is a bit tricky. Pushing yourself to desire when one is
not desirous is self-defeating. But working at the things that might effectively increase
desire for sex often requires advanced preparation.
This might include scheduling an “intimacy time” with your partner; sending the kids to
grandma’s for a few hours; disclosing your sexual dissatisfaction, demonstrating what you really
want, and struggling through one’s possible anxiety and embarrassment, It might involve losing
(or gaining) 30 pounds. It might involve keeping one’s integrity intact. Discarding the societal
pathological beliefs about sex and developing your own definition of good sex takes work.
Intense, erotic sex with a partner takes effort. However, effort in related, intense sex doesn’t feel
like work; in mediocre sex it does. Intense sex and profound intimacy take more effort than most
people want to invest. It takes a lot of personal development and work to mature enough to
tolerate intense intimacy and eroticism.
Sexuality that is like “kissing the face of God”
In health-based models of sexual potential, the upper limit of sexual desire is where one
meets the God-within.
For Plato, Eros has a transcendent manifestation when the subject seeks
to go beyond itself and form a communion with the other.
Eastern philosophy, particularly the Hindu tradition, sees physical sensual pleasure as one of
several paths to liberation and the union of the individual with the universal. Sexual relations are
considered a path to integration and expanded cosmic awareness. Eastern views celebrate sexual
pleasure as a value in its own right. Kama, “the pursuit of love and pleasure, both sensual
aesthetic”, is one of the goals of life in the Hindu tradition.
Eastern approaches to eroticism based on Tantric Yoga emphasize self-discipline in focusing
consciousness and sexual energy. Sexual potential is thought to require practice, discipline, and
understanding the interaction among spiritual, emotional, and physical dimensions. This
approach emphasizes spiritual and emotional transcendence through sex rather than orgasm.
In marked contrast, Christian-dominated Western society promotes a division between
spirit and body and is associated with original sin. In Western Christian mythology, sex
is a barrier to be overcome. Humans are urged to achieve salvation by denial of the
senses, especially the sexual impulses. Western culture and religion has failed to help
people to integrate sexuality and spirituality. Contemporary Western values inhibit the
exploration of human sexuality, rather than support it.
The role of sexuality in one’s spiritual development is evident when spirituality is conceptualized
as the integration of all aspects of the person and the actualization of one’s fullest potential.
Spiritual development divorced from religion and dogma is human development viewed from the
perspective of an ongoing integration that results from openness to the experience of selftranscendence.
From hot, erotic, related sex, you can begin to be open to spiritual energies you’ve never
experienced before because of the strong connection you’ve made both with your authentic self
and with your partner. Slowly your judgments strip away, together with your clothing, your
pride and your fears. The lovers’ experience coalesces into a swirling energy that rises and bursts
out of your head. When the boundaries of self and other are transcended in this swirl, it is
possible to achieve an experience of your incontrovertible connection to the universe.
The illusion of who you think you are, the mask of the false and social self, the need to perform
or look good, together with your ego, gradually drop. Peak experiences of self-transcendence
may occur. Shame is banished, replaced with deep serenity and contentment. Your thoughts and
your bodily tensions relax and slow down. Time stops. Consciousness expands. The experience
is similar to what the mystics describe as ecstasy.
Sexual potential comes from surrendering – that is, not trying. With a willingness to give
up control along with your egotistic preoccupations, you’re in a state of not knowing, of
just experiencing as you make a space for deep eroticism to emerge. Two dissolve into
one and a third energy, perhaps a spiritual energy, emerges. You meld into one entity
and touch the silence of the universe. (Katehakis, pg. 205).
Nothing beats it.
What does a sex addict need to learn in order to traverse the distance between sex addiction and
the achievement of full sexual potential?
As a sex addict, you need to learn:
·You cannot integrate heart and genitals. Heartless sex is mere mechanics and leaves people
feeling empty and disillusioned.
·To own your full power of sexuality with utmost respect for that power. This requires that you
be sexually assertive yet vulnerable and open.
·Take the responsibility and power associated with sex seriously.
·You may get your vanity satisfied with deviant sex, but you fear real connection.
·Impulse Control.
·Ability to listen to and adapt to the needs of your partner
·Sex that satisfies only physical needs misses out on the wonderful complexity of sex where
emotion, communication, sensuality, and relatedness are the context within which sexuality exist.
·You are torn between the mature adult you have become in other areas of life and an adolescent
sexual response that still controls your brain.
·You learned misguided ideas about sex from family and the general culture, which is sexnegative and sexist for both men and women. However, what has been learned can be unlearned
and recreated.
·A good sexual relationship is always based in authenticity.
·Growth in healthy intimacy involves naming, claiming and embracing old hurts and negative
scripts from the past and making conscious decisions to appropriately channel sexual energies
and to act with integrity.
·Cultivate the capacity for self-acceptance and willingness to embrace your wounds, mistakes
and limitations. You can’t have good sex if you don’t like yourself. Also, if you have accepted
yourself, you’ll be more comfortable with the authentic self-disclosure about your self, in
particular your sexual self, to a valued other.
·Intimate sex requires a level of self-awareness and of vulnerability which exposes you to
yourself. It may seem daunting, but the adventure of self-discovery is the only game in town.
·Optimal sex involves a gradual acceptance of one’s unique sexuality rather than being
caught in sex-negative messages from family, church, the media or the general culture.
·Cultivate the ability to listen, attend to, and have empathy for other people. It will make you a
better lover.
·Learn to tolerate being misunderstood when you have the courage to self-disclose your
authentic needs, wants, desires and fantasies.
·Growing in mature sexuality is about becoming real.
·Achieving full sexual potential involves whole body sex, not just genital sex. It includes
emotional, intellectual, social and spiritual connection and bonds which can catapult you into sex
that really packs a wallop.
·Addicts experience pseudo-intimacy – a shoddy replacement for the real things. Intense sexual
feelings substitutes for genuine intimacy.
·Compulsive sexuality, despite the intense high, causes self-rejection and alienates you from
your own experience and your own sense of self.
·Redefining sexuality is a process of self-confrontation and authentic self-disclosure in the
presence of a partner.
·Focusing only on genital performance circumvents the most powerful and most useful
aspects of sex: profound emotional intimacy.
·Sexual Potential considers eroticism, intimacy and personal meaning in sexual behavior.
(Katehakis, pg.
·At the further reaches of human sexual potential lies peak transcendental experience.
·A life filled with sexual acting out does is insufficient to trigger the process of personal growth
that can navigate the exploration of the fullness of human sexual potential.
·Optimal sex involves the dauntless struggle to be fully human with one’s partner.
·Profound personal growth in nonsexual areas is key in embracing your sexual potential.
·Sex can be so much more than a vehicle for our needs to feel good. It can be joyous and
illuminating. It can be a truly trans-formative force in our lives. Sexual intimacy can penetrate
the skins of our bodies as it penetrates the boundaries of our egos. Only then can we recognize
ourselves and our partner in the Mystery of existence itself.
In conclusion, I invite you to take up the challenge and adventure of reaching your full
sexual potential and to be and remain the erotic, celebratory, courageous, connected
and sexual being that you’re meant to be.
Suggested Reading
Hope and Recovery: A Twelve Step Guide for Healing From Compulsive Sexual
Behavior, Anonymous.
Mindful Recovery: A Spiritual Path to Healing from Addiction,
Thomas Bien, Beverly Bien.
Say Yes to Your Sexual Healing: Daily Meditations for Overcoming Sex Addiction, Leo
Booth.
Lust, Anger, Love: Understanding Sexual Addiction and the road to Healthy Intimacy,
Maureen Canning.
Mending a Shattered Heart: A Guide for Partners of Sex Addicts, Stephanie Carnes
A Gentle Path Through the Twelve Steps: The Classic Guide for All People in the
Process of Recovery, Patrick Carnes.
Out of the Shadows: Understanding Sexual Addiction, Patrick Carnes.
Don’t Call it Love: Recovery From Sexual Addiction, Patrick Carnes.
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior,
Patrick Carnes.
Breaking the Cycle: Free Yourself From Sex Addiction, Porn Obsession and Shame,
George Collins.
Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for
Addicts and Co-dependents, Ralph Earle.
Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction,
Alexandra Katehakis.
Healing the Wounds of Sexual Addiction, Mark Laaser.
The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography,
Wendy Maltz and Larry Maltz.
The Circle of Life: The Process of Sexual Recovery Workbook,
KJ Nivin.
The Sex Addiction Workbook: Proven Strategies to Help You Regain Control of Your
Life, Willian T. O’Donohue and Tamarqa Penix Sbraga.
False Intimacy: Understanding the Struggle of Sexual Addiction, Harry Schaumburg.
Sex Addicts Anonymous, Sex Addicts Anonymous Fellowship
Treating Pornography Addiction: The Essential Tools for Recovery,
Kevin Skinner.
Wired for Intimacy: How Pornography Hijacks the Male Brain, William M. Struthers.
Cruise Control: Understanding Sex Addiction in gay Men, Robert Weiss.
Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age, Robert
Weiss and Jennifer P. Schneider.
About the Author
Dorothy C. Hayden, LCSW, MBA, CAC, is a psychoanalytic psychotherapist who specializes in
chemical dependency, sex addiction, BDSM, fetishes, cross dressing and sexual perversion.
She has appeared on the British HBO show documentary “The Devil and the Flesh”, about
sexual power and celibacy, ABC’s “20/20” about the phenomenon of cybersex addiction, “The
Jenny Jones Show”, about adolescent homosexuality and “The Ricky Lake Show” about fetishes.
In addition, she has appeared on CNN’s Anderson Cooper “360” about transsexualism and is a
regular commentator on WBAI radio on the contemporary sexual scene including the polyamory
(non-monogamy) movement, dominance/submission lifestyles, and the
bondage/domination/sado/masochism (BDSM) community.
Ms. Hayden has been interviewed by such print media as The New York Post, Playgirl,
Cosmopolitan, New York Magazine and Time Out New York.
A published author, her 20+ articles have been translated into other languages and appear on
websites throughout the world. Her new e-book: “You Can Do This!! Twelve Ways to Treat Sex
Addiction and other Essays” is in press as of this writing.
Ms. Hayden graduated in 1995 from New York University with an M.S.W. and holds an M.B.A.
in marketing from Baruch College (1987). She attended advanced clinical training at the Post
Graduate Center for Mental Health, and the Object Relations Institute and the Training Institute
for Mental Health. A graduate of the Milton H. Erickson Institute for Psychotherapy and
Hypnotherapy, she uses hypnosis in working with fetishes, sexual dysfunction and sexual
enhancement. She is also certified in Neuro Linguistic Programming (NLP).
With twelve years of experience in the chemical dependency field and fifteen years as a sex
addiction therapist, she has worked in a number of the major drug and alcohol rehabs in the New
York City area and was awarded a CAC (Credentialed Alcoholism Counselor) certificate in 1994.
From 1993-1995, she was on the faculty of Mary Mount Manhattan College as an instructor in
their addictions counseling training program.
In addition, she trained with Patrick Carnes, the pioneer in the field of sex
addiction treatment who wrote the book: “Out of the Shadows:
Understanding Sexual Addiction”.
Ms. Hayden is affiliated with the Post Graduate Society for Psychoanalysis, the Association of
Sex Educators, Counselors and Therapists (ASECT) and the Society for the Advancement of
Sexual Health (SASH).
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health and The Ranch.
"This new book by Dorothy Hayden sheds new light on sexual addiction and its
many forms of treatment. It is a comprehensive guide that adds practical strategies
and therapy tools for how to address sufferers from sexual addiction. This book is a
must-have for clinicians as it provides effective tools on how to address individuals,
couples, and groups struggling with this condition. Overall, the blend of academic
and real-life case studies throughout each chapter will help readers move in their
journey toward recovery." ---Dr. Kimberly S. Young -- founder and director, the
Center for Internet Addiction Recovery and author of Tangled in the Web:
Understanding Cybersex from Fantasy to Addiction
"Great stuff! Solid information for those who are looking for real help from this insidious issue.
A comprehensive overview of sexual addiction and treatment modalities. It's staying on MY
short list of recommended books for our clients here at Compulsion Solutions."
George N. Collins, Director
Compulsion Solutions
Author of "Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession, and Shame"
Co-author of "A Couple's Guide to Sexual Addiction"
Contents
Forward
Preface
Introduction
Chapter 1– What is Sex Addiction?
Chapter 2 – Relapse Prevention
Chapter 3 – Cognitive Therapy
Chapter 4 – Psychodynamic Psychotherapy
Chapter 5– Group Therapy
Chapter 6– Couples Counseling
Chapter 7-- 12-Step Programs
Chapter 8 – Hypnosis
Chapter 9 – NLP
Chapter 10 – Psychopharmacology
Chapter 11 – “Brainlock” – A Behavioral Modification Approach
Chapter 12 – From Sexual Addiction to Sexual Fulfillment
xi
Forward
Since the internet went mainstream only 20 years ago, its accessibility,
affordability and anonymity has spawned an eruption in the numbers of
people seeking clinical treatment for sexual addiction. This increased
variety of internet-based sexual content, together with the explosion of
sexual “hooking up” via smart phone apps and social media is veritably
changing the nature of human sexuality.
It is estimated that three to six percent of the general U.S. population
suffers from some form of addictive sexual behavior with self or others.
However, the current lack of a universally recognizable clinical diagnosis —
combined with a dearth of publicly funded research and ongoing cultural
shame and stigma regarding sexual disorders in general — likely prevents
many more individuals from identifying the problem and seeking help. The
numbers of people who suffer in silence from this addiction are staggering.
Available statistics are startling, indeed. According to US News and World Report, the
pornography industry takes in more than $8 billion a year, which is more than rock and
country music, and more than all Broadway productions, theater, ballet, jazz and
classical music combined.
·Every second, 28,258 internet users are viewing pornography.
·Eighty percent of our children age 15-17 have had multiple hard-core exposures to internet
porn.
·Pornography is big business--with $10 billion to $14 billion in annual sales.
The author of an article in the New York Times Magazine, Frank Rich,
suggests that pornography is bigger than any of the major league sports,
perhaps bigger than Hollywood. Porn is "no longer a sideshow to the
mainstream...it is the mainstream," he says.
As the problem has bounded forward in the last decade, research into new methodologies for
treatment is just keeping its head above water. Although a number of excellent books about are
on the market, supply has not kept track with peoples’ hunger for new ideas about how to escape
the stronghold of this .
“Total Sexual Addiction Recovery – A Guide to Therapy” makes a new contribution to
the field. Besides offering an overview of the nature of the beast and information about
how to achieve fulfilling sex during and after recovery, the book offers numerous
chapters about how existing therapy methods can be used to treat . The end result is
that the reader is given a breath and depth of understanding about what a
comprehensive therapy program for sex addiction might look like.
Who better to write this particular book than Dorothy Hayden? Dorothy and I have been
aware of each other’s careers for 15 years, in the days that we were both the singular
writers about sex addiction for PsychCentral.com. Ms. Hayden is not only trained in sex
addiction, but has remained an astute student of contemporary psychoanalysis. She’s
the rare combination in a therapist of one who has not only the concrete skills of an , but
the psychological sophistication to understand and treat all aspects of the addict’s
personality.
Put this together with her over-30 years of personal recovery in a, her
training in Hypnosis and Neuro-Linguisitic Program, Group , and you have
the exact person to write a book about the multi-dimensional aspects of .
Dorothy not only helps people to stop compulsive, destructive sexual acting out, but she uses her
analytic skills to pull the disorder out from its roots for the fortunate who have been her clients.
Robert Weiss, LCSW, CSAT-S
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health and The Ranch.
Preface
I wrote this book because I saw a need for current models of sex addiction treatment to
become more comprehensive in their approach. Existing sex addiction therapy focuses
mostly on behavioral modification skills to stop compulsive sexual acting out. However,
the high rate of people who repeatedly return to their preferred sexual behavior despite
treatment attests to the fact that the current treatment philosophy is insufficient to
achieve satisfactory results.
If sexual acting out is the tip of the iceberg, representing a symptom of the problem, the
personality deficits that give rise to addiction are the bottom of the iceberg. These deficits and
vulnerabilities need to be addressed and healed for there to be any significant improvement in the
person’s overall life satisfaction. And people who have overall life satisfaction tend not to get
involved with addiction.
Treatment that merely stops the sexual acting out is no treatment at all. The symptom
can clear up, but what gave rise to the addiction behavior can remain. Sex is not the
problem in sex addiction. The problem lies much deeper. Sexual acting out is merely
symptom or sign of other conscious and unconscious troubles. Total sexual recovery is
assured from the use of different therapeutic techniques that go blow the surface to
heal the personality problems that give rise to unwanted behavior. The comprehensive
treatment suggested in this book pulls out the problem of sexual addiction up by its
roots.
This book differs from other books about treatment because it offers a look into a
number of different therapies that help individuals recover. While some of the
techniques promote abstinence from compulsive behavior, others deal with such things
as resolving childhood abuse and conflicts, changing the thoughts and beliefs that keep
the addiction in place, learning self-soothing techniques to replace the sense of safety
and soothing found in the addictive experience, addressing the intimacy dysfunction that
is invariably concomitant with sex addiction, and changing the person’s “arousal
template” from deviant, compulsive sex to having the ability to experience of related sex
that is vital, alive, exciting and that can bring someone to the heights of sexual ecstasy.
The book is divided into three parts. The first part offers a discussion on the nature of
addiction itself and provides a multi-dimensional look at the phenomenon of sex
addiction. “You must know the enemy before you can do battle with it.”
The second part of the book describes different therapeutic methods that
can be used in sex addiction recovery. My hope is that familiarity with
these a number of different therapeutic techniques will give you a deeper
understanding of the compulsion and provide you with the hope that not
only can treatment work but there are a variety of ways to achieve the goal
of sexual sanity and personal fulfillment.
Finally, the third part of the book could just as well be entitled “Is There Sex After the
Revolution?” Most books about sex addiction, and most treatment philosophies, don’t
offer a replacement for sexual abstinence. Sex is such a pivotal part of who we are and
is so much fun, who wants to be “abstinent” from it? The final chapter seeks to provide
you with ideas and techniques to achieve your full sexual potential. The pleasure of
related, connected sex will make the fleeting pleasure of addictive sex seem like child’s
play.
My true motivation for the writing the book is to deliver one predominant message: There is
hope. There is a way to go. There is an end to the madness. What may seem hopeless is, in fact,
doable. With the right understanding of the problem and the right therapy, you can do what
legions of others have done – break free from the shackles of sex addiction.
Acknowledgments
My first and most important acknowledgment is to the patients I have treated over the
last 15 years. Their journey has been my journey – as an author, a psychotherapist and
a person. Having had the privilege of being included in their process of being once
defeated, confused, helpless victims of the horrific addiction to sex, I have witnessed
them become restored to the fullness of their sexuality and their humanity.
I have seen first-hand, and over-and-over again, the resiliency of the human spirit to grow, live
and love. I thank each and every one of them.
For my training in the field of sex addiction, I thank Patrick Carnes, PhD. And Edward Ragsdale,
PhD. Dr. Ken Adams has also been enormously helpful in helping me to deepen my
understanding of the multi-dimensional aspects of addiction.
The people who have most influenced my development as a psychoanalyst are teachers,
supervisors and mentors from The Post Graduate Center for Mental Health, The Object Relations
Institute and The Training Institute for Mental Health. Special thanks to Chuck Strozier, PhD.,
Pauline Pinto, LCSW, Jean Kemble, MS, Mark Wayne, LCSW, Larry Lewis, Ph. D., Michael
DiSimone, DSW, among others.
A book is never written alone. My ever-supportive friend and editor, Doreen Lewis, has been
instrumental in molding my writing skills and achievements.
Lastly, to my partner, Victor, for his unending faith in me and for providing the support that freed
up the time and space for me to write this volume.
xiii
Introduction
What is Addiction?
To be at risk for addiction, two psychological conditions seem to exist during childhood.
·First, the child has become over- reliant on sources of comfort outside of himself to provide a
feeling of being soothed, safe and secure.
·Second, the child had difficulty making a healthy separation from the primary parent, with later
concerns that closeness and intimacy can be dangerous.
Both of these conditions come about as a result of failure in empathy and attunement in the
parent-child relationship that leaves the child feeling misunderstood, unsupported and potentially
unloved. What develops is a “developmental arrest”, so that the adult in later life (like a child) is
driven above all to seek pleasure and avoid the pain of living. Not having developed a sense of
confidence and rigorous self-esteem that growing up in a nurturing environment would have
provided, the person feels inadequate and vulnerable. The demands of reality appear too
challenging and overwhelming.
This theme of using a particular relationship to objects or behaviors to manipulate moods so
that a desired emotional/ physical state occurs that provides needed internal benefits such as
pleasure, gratification, safety, security or arousal is one definition of addiction. It provides the
addict with predictable and stable gratification, but the experience has concomitant costs.
Eventually these costs outweigh the subjective benefits the addiction affords. Nevertheless,
people continue in their addiction, ready to pay the price extracted, as long as they perceive it as
providing the needed gratifications.
When active addiction sets in, the problems the individual experiences in
dealing with the ups and downs of living seem to be magically solved. The
addiction is the glue that holds together the different parts of a fragile self. It
reinforces a false sense of omnipotence, grandiosity and perfection and
blots out aspects of reality that are not in concert with that perception. It
anesthetizes the individual from unwanted feelings and the uncomfortable
aspects of finding and expressing the true self. It defends against the need
for intimacy or closeness, as the addict relies only on his addiction for a
sense of pseudo-intimacy.
The “hook” of the addiction that keeps him coming back for more is that it gives people feelings
and gratifying sensations that they are not able to get in other ways. It may block out sensations
of pain, uncertainty, or discomfort. It may create powerfully distracting sensations that focus and
absorb attention. It may enable a person to forget, to feel “okay” about, insurmountable, or even
mundane, problems. It may provide feelings of security or calm, of self-worth or
accomplishment, of power or control, of intimacy or belonging, despite the knowledge that these
experiences are fleeting and artificial.
However powerful and gratifying the addictive experience may be, there are costs to be
reckoned. Addictions make people less aware of and less able to respond to other people,
events, and activities. Ironically, the addictive experience reinforces and exacerbates the
problems the person wanted to desperately wanted to evade in the first place. In the persons'
inner life, the addiction has significant benefits and makes things things seem better. However,
in the real world, it makes everything worse. Jobs, marriages, friendships fall away; health
deteriorates; debts increase; opportunities disappear; the day-to-day business of ongoing living is
neglected The person becomes increasingly detached from nourishing contacts, essential
responsibilities, meaningful long-term goals, recreation and hobbies and core values.
Even in the face of devastating consequences to his external and internal worlds, the addict holds
on tenaciously to his only source of identity, stability, comfort and support - the drug.
Moreover, over the years, addictive behavior becomes “reinforced”, or embedded, as an
exclusive coping mechanism. Higher coping mechanisms have not been developed through the
years of using, so as the reality consequences have been piling up, the person's ability to deal
with them has been plummeting in the personal stagnation of life in addiction.
A developmental arrest keeps a part of the personality immature. The result can be personality
deficits that leave the potential addict without the capacity to regulate inner feelings of distress,
to delay gratification, to exercise impulse control, to recognize and articulate feelings, or to
create meaningful attachments to others.
So for an addict, to be without the addiction would feel like personal annihilation.
The inner world of the addict is characterized by intense feelings that are often experienced as
unbearable, overwhelming and permanent. These feelings form the context within which the
addict lives. The actions and choices of an active addict are organized around an attempt to
manage intense feelings. No obstacle is too formidable as the addict, in an attempt to feel
"normal", succumbs to the irresistible impulse to indulge. Unfortunately, the strength of the urge
to act out on the addiction obliterates the ability to reflect upon the potentially devastating
consequences of his actions.
Addiction is always experienced as a profound sense of alienation from self and others, since the
ability to establish meaningful inter-personal relationships is often crippled by toxic experiences
with early-life caretakers. I quote a former client:
” I was alone and it was loneliness and it was intense. I think the only love in life has
been the drug...I just felt so alone...I was sad, so lonely, so isolated. I knew I wasn't
being me... that I could be different, but I couldn't with people. As far as having some
friends, really being close to somebody, there wasn't anybody...I just wasn't able to keep
connections.”
An addiction may involve any strong attachment or sensation that grows to proportions
that it damages a person's life or self-hood. Addiction – the single-minded grasping or
chasing of a seemingly magic object, behavior or involvement; the loss of control,
perspective and priorities – is not limited to drug and alcohol addictions. When a person
becomes addicted, it is not to a chemical but to a particular type of relationship that
affords a particular experience. Anything that a person finds sufficiently consuming and
that seems to remedy deficiencies in the person's life can serve as an addiction. The
addictive potential of a substance or experience lies in the meaning it has for a person.
It is only when the pain of active addiction outweighs its diminishing benefits that the addict
holds out the white flag and asks for help so that he can get free from his addiction.
The Problem of Sex Addiction
Addiction to sexual behavior is a complex disorder that incorporates many
aspects of your personality, bio-chemistry, sociocultural environment,
family-of-origin issues, thinking/feeling processes, self-esteem, and quality
of relations with others. I see sex addiction as a prism; depending on the
angle you hold it up to, the light can make it can look completely different.
The complexity of addiction to sex is shown by the fact that psychologists
still don't know if it's a symptom of an obsessive-compulsive disorder, an
impulse-control disorder, or an addictive disorder. The fact that it was only
recently left out of the DSM-V and so not rec distinct as a distinct disorder
means that not much substantive research has been done to understand
this multidimensional condition.
We do know that sexual addiction represents an expression of the same processes of
addiction that underlie all compulsive behaviors: an enduring, inordinately strong
tendency to engage in some form of pleasure-producing behavior to regulate unwanted
emotional states that are painful and potentially overwhelming. Also common to all
addictions, underlying the symptom of the sexual behavior are problems with self-care
and self-regulation. Achieving a sense of “self-governance” is part of addiction recovery
treatment.
Being perpetually ensnared in the jaws of the addiction cycle with its loss-of-control,
shame and distress, together with its negative impacts on
work/relationships/finances/self-esteem, is demoralizing. Yet the perceived benefits
seem to outweigh the high cost of the behavior, as you experience the lure of the sexual
rush to be irresistible and compelling, regardless of inevitable consequences.
Recovery from sexual addiction must address both the destructive addictive sexual
behaviors as well as the underlying addictive process. The challenge of the therapist
who offers a sex addiction treatment program is that of presenting a variety of treatment
approaches to accommodate and treat the addict on multiple levels. The therapist
needs to have the concrete skills of an addiction counselor as well as the clinical
training and sophistication to treat underlying issues.
Treatment for sex addiction, then, is most likely to be effective when it emerges from an
integrated, comprehensive approach that brings together different treatment methods, is
individually tailored to your personality and evolves as you progress.
This book includes a comprehensive overview of sex addiction so you can understand
the nature of the beast; a series of chapters about the different methods of addressing
recovery from sex addiction, and a final chapter about the shifts required to have
“optimal” sexual experience, or the achievement of your sexual potential.
The goal of the book is to present a number of therapeutic strategies that can help free you from
the shackles of addiction. My hope is that each chapter will provide more understanding and
more hope that getting out of the snake-pit of sexual compulsion is doable. Not only is it doable,
there are a variety of ways to do it.
This book will look at therapy for sex addiction from a variety of angles.
Each chapter discusses part of the overall process of total sex addiction
recovery. Chapters include:
·Overview of Sex Addiction: Understand the enemy so you can devise strategies for
victory.
·Relapse prevention. This is the critical first step in recovery from
addiction. You will learn to free yourself from repetitive, compulsive,
shameful sexual behaviors.
·Pharmacological (as the “water wings” of treatment) to help with
impulse control, anxiety and depression that may contribute to the
experience of strong sexual urges.
·12-Step Groups cultivates a support system to help sex addicts and is an
opportunity to work the 12-steps as an avenue to psychological and
spiritual maturity.
·Cognitive-behavioral therapy. The Stoic Philosophers’ theories are the foundation of
CBT. The basic idea is that we don’t suffer from the external event; we suffer from the
interpretation (thoughts) about the event. We examine a series of belief systems
common to most sex addicts to see how they are based in the past and cause suffering
in the present. Change a thought, change a destiny.
·Group therapy. This is a vital part of treatment for addiction. Addicts learn
intimacy and work through issues of trust. A cohesive group can supply
understanding, acceptance and empathy – things that may have been
missing in your past.
·Psycho-dynamic therapy. This is the nuts and bolts of treatment for
addiction. A one-on-one relationship that heals, rather than harms, can
rectify the hurt from the past by providing a different model for relating. The
therapist considers your whole personality. Unconscious conflicts, hurts,
wounds,shame, feelings of inadequacy, amongst other issues that
underlies sexual acting out become more conscious to the person who
then is able to exercise self-control through understanding and insight.
·Couples counseling Sex addiction is usually devastating to your
partner. If the couple-hood is to remain intact, couples counseling is
essential.
·Hypnosis. Don’t be afraid of trance; you’ve been in one all your life.
·
·Mindfulness Meditation It’s impossible to change without awareness of your inner
process and the ability to be aware of another person.
·Brainlock: A behavioral approach to treating compulsive behavior.
·Conclusion: “From Sexual Addiction to Sexual Fulfillment”. Here’s how to get the total
sexual experience that the addiction was searching for but missed the mark.
As a therapist who’s worked in the field of addictions for over 25 years, it’s been my experience
that an entire repertoire of treatment skills, strategies and techniques (arrows in the quill) are
necessary to match each client’s own set of fingerprints, and his uniqueness as a human being.
Therefore, the more treatment can be directed specifically to a particular addict and his family,
the more effective it will be.
What are some of the specific goals of comprehensive therapy for sex addiction?
·To resolve ambivalence about change
·To prepare you to prevent relapse by helping you to recognize triggers, urges and cravings, and
arm yourself with specific tools for dealing with them
·To recognize and work through painful feelings from childhood that remain alive in the present.
·To put issues of shame and a sense of inadequacy to bed.
·The discovery of underlying issues of all addiction including lack of self regulation and
self care as well as an inability to exercise restraint in the face of destructive impulses;
·To recognize and change unconscious belief systems about self, others and the world, including
sexuality and intimacy;
·To implement sex therapy techniques to overcome obstacles to intimate sexual experience;
·To trace the origins of unhealthy relationship patterns that stem from childhood so you can
recognize that what worked in the past may be destructive in the present;
·To become educated about intimacy skills and attitudes about sex that will help you experience
“related sex” as more fulfilling than narcissistic self-centered sex.
Chapter 1
What is sex addiction?
First, let us consider what sex addition is NOT: Sex addition is not defined by sexual desire. Sex
addiction is not defined by the type of sexual act performed. It isn’t defined by the frequency of sexual
activity.
Rather, sex addiction is defined by the addict’s continual use of sexual
urges, cravings, fantasies and behaviors to gratify non-sexual needs that
echo from the emotional deficiencies of his early life. Sex addiction is a
misuse of sex. Sex is, after all, only sex. It can't heal the wounds in your
soul.
Manifested as a compulsive cycle of preoccupation, ritualized sexual behavior, and despair, sex
addiction is an obsessive relationship to sexual thoughts, fantasies or activities that an individual
continues to engage in despite adverse consequences. These thoughts, fantasies or activities occupy a
disproportionate amount of "psychic space" (the inner world of the addict that isn't conscious, but is
emotionally powerful enough to overrule thinking). These thoughts result in an imbalance in the
person's overall functioning in important areas of life, such as work and marriage. Distress, shame and
guilt about the behaviors erode the addict's already fragile sense of self.
It is this fragile sense of self at core, born of a lack of attunement with early caregivers, that seeks
solidification through the perceived power and control of sex. A sense of masculinity, which may have
been enfeebled through his psycho-sexual development, is perceived to be strengthen by the
compulsive sexual experience.
Sexual addiction is invariably a symptom of an attachment disorder which hinders the individual in
forming and maintaining intimate relationships. Central to the disorder is the inability of the individual
to adequately bond and attach. At it’s core, addiction is a symbolic enactment of deeply entrenched
unconscious dysfunctional relationships with self and others.
While the definition of sex addiction has similar features as that of other
addictions, sexual compulsion is set apart from other addictions in that sex
involves our innermost unconscious wishes, needs, fantasies, fears and
conflicts.
Like other addictions, it is relapse-prone.
What are the Signs/Symptoms of Sex Addiction?
While there currently is no diagnosis of sex addiction in the DSM-IV, clinicians in
the sex addiction field have developed general criteria for diagnosing sex
addiction. If an individual meets three or more of these criteria, he/she could be
considered a sex addict: Sexual addiction is often accompanied by other
addictions, such as an addiction to work or chemicals.
·The addict displays increasingly secretive behavior, deception, and withdrawal from those closest to
him;
·Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd
sex; frequently engaging in those behaviors to a greater extent or over a longer
period of time than intended;
·Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors;
·Inordinate amount of time spent in obtaining sex, being sexual, or recovering
from sexual experience;
·Preoccupation with the behavior or preparatory activities;
·Frequently engaging in sexual behavior when expected to fulfill occupational, academic, domestic, or
social obligations;
·Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic,
financial, psychological, or physical problem that is caused or exacerbated by the behavior;
·Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or
diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk ;
·Giving up or limiting social, occupational, or recreational activities because of the behavior;
·Experience of distress, anxiety, restlessness, or violence if unable to engage in the behavior at times
relating to SRD (Sexual Rage Disorder);
·Tolerance, as defined by either of the following:
·a need for markedly increased amount or intensity of the behavior to achieve the desired effect
·markedly diminished effect with continued involvement in the behavior at the same level or intensity
·Withdrawal, as manifested by either of the following:
·characteristic psycho-physiological withdrawal syndrome of physiologically described changes and/or
psychologically described changes upon discontinuation of the behavior
·the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
·There is a persistent desire or unsuccessful efforts to cut down or control the behavior;
·The behavior continues despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the behavior;
·Repeatedly and compulsively attempting to escape emotional or physical
discomfort by using ritualized, sexual behaviors such as masturbation,
pornography, including obsessive thoughts.
·Some individuals try to connect with others through highly impersonal intimate
behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism,
frotteurism, cybersex, sexual arousal to objects, situations, or individuals that
are not part of normative stimulation.
Adapted from the Society of Sexual Health literature.
The Consequences of Sexual Addiction
Loss of Important Aspects of Life
The life of a sex addict gradually becomes very small, in terms of the number of
surrounding loved ones. The freedom of self is impaired. Precious life energies
are consumed. The rapacious need for a particular type of experience in the
“erotic haze” (See Chapter II) drives the addict to spend untold hours in the
world of his addiction. With time, the compulsion begins to strip away all that
the person holds dear: close relationships, enjoyable activities and hobbies,
trust between himself and his partner, quality time with children, having a
spiritual/moral center, commitment to productive, meaningful employment and
financial security.
Depression
Profound depression (sometimes with suicidal thoughts), chronic low selfesteem, shame, self-hatred, hopelessness, despair, helplessness, intense
anxiety, loneliness, moral conflict, contradictions between ethical values and
behaviors, fear of abandonment, spiritual bankruptcy, distorted thinking,
remorse, and self-deceit are common.
Research shows that 70 to 75% of sexual addicts report having had suicidal thoughts related to their
sexual behavior patterns resulted in significant loss of self-esteem for both partners.
Breakdown of the Family
Often, sex addicts suffer from broken and distant relationships. The American
Bar Association reported a whopping 50% of the divorces it handled in 2009 had
cybersex implicated in them. Forty percent of sex addicts report severe marital
and other relationship problems, and sexual activities outside their primary
relationship. The sex addict is frequently absent (physically and/or emotionally),
resulting in a lack of parental role modeling. Pressure is placed on the spouse to
do “double duty” as partner and primary parent. Partners of sex addicts can
develop their own addictions and compulsions to drugs, food, and spending, for
example, in addition to psychosomatic problems, depression, and other
emotional difficulties. For most women, the discovery of their husband’s sex
addiction is emotionally devastating.
Physical Health Issues
Health consequences of sex addiction may include HIV infection, genital herpes,
HPV, syphilis, gonorrhea, and other sexually transmitted diseases (STDs). Sex
addicts have a highly increased risk of contracting an STD and of passing it
along to unknowing spouses or loved ones. Genital injury can result from sexual
acting out, addictive sadomasochistic sex can cause physical damage to the
body, and automobile accidents can result when the driver’s attention strays
from the road due to sexual texting, downloading porn, or sexually cruising other
drivers.
Legal Problems
Some sex addicts go to jail, lose their jobs, get sued, or have other financial and
legal consequences because of their compulsive sexual behavior. Financial
difficulties from the purchase of porn, use of prostitutes, and travel for the
purpose of sexual hook-ups and related activities can tax the addict’s financial
resources and those of his or her family, as do the expenses of legal
representation in divorce cases. Sixty percent of sex addicts report that they
have faced financial difficulties, 58% report having engaged in some form of
illegal activity, and 83% of sex addicts also had concurrent addictions such as
alcoholism, marijuana or other drug abuses, eating disorders, and compulsive
gambling. Many sex addicts also abuse alcohol and other drugs. When multiple
addictions coexist, untreated sex addiction complicates recovery from chemical
dependency and makes relapse to drug use more likely.
Serious legal consequences of sexual addiction can result if the sex addict’s
behavior escalates into sexual offenses such as voyeurism, exhibitionism, or
inappropriate touching and/or the use of child porn. Sexual harassment in the
workplace can be part of a sex addict’s repertoire, and may result in legal
difficulties.
Many addicts report that they live in a perpetual fear of exposure. For addicts involved in illegal sexual
activities (exhibitionism, voyeurism, etc.) as well as involvement in kiddie porn, arrest, incarceration
and public humiliation or prosecution are very real possibilities.
“Sexual addicts risk everything for the call of the erotic which promises euphoria and yet
never seems to deliver in a real, consistent way and is usually followed by remorse and
shame. Is the pleasure worth the consequences? It is when the negative consequences,
which are different for everyone, begin to outweigh these brief periods of erotic arousal that
the person seeks.”
Adapted from The Society for the Advancement of Sexual Health
Why Can’t the Addict Control his Sexual Behavior?
Most addicts would stop if they could.
It's been said that of all the addictions, sex is the most difficult to manage. This
syndrome is a complex mixture of biological, psychological, cultural, and familyof-origin issues, the combination of which creates impulses and urges that are
virtually impossible to resist despite the fact that acting them out produces
considerable long-term negative consequences, the addict simply cannot resist
his/her impulses. Individuals who are highly disciplined, accomplished and able
to direct the force of their will in other areas of life fall prey to sexual compulsion.
More importantly, people who love and cherish their partners can still be
enslaved by these irresistible urges.
From a biological standpoint, research has shown that certain formations in the right temporal lobe
make certain individuals more prone to sexual arousability from birth. Whether or not such an
individual becomes sexually compulsive or perverse then depends on the child's home environment.
Research has also shown that the inability to control sexual impulses is associated with neurochemical
imbalances in the nor-epinephrine, serotonin and dopamine systems. When the addict gets a sexual
“hit”, he is really getting a dopamine “hit”. Dopamine is the endorphin systems that provides pleasure.
The more sexually intense the acting out is, the more dopamine is sent to the brain. It is really these
neurochemicals, in particular dopamine, to which the sex addict is really addicted. After the orgasm,
dopamine levels drop precipitously and the person experiences depression, tension and irritability. Life
seems devoid of interest and non-sexual pleasure outside the “erotic haze” so he just bides his time
until he can get his next dopamine rush.
Biological predisposition contributes and combines with psychological factors.
One of the reasons the "erotic haze" (see Chapter 2) is so compulsory is that it
is an unconscious but maladaptive way to repair earlier disturbed, anxiety-laden
relationships. It shores up an inadequate sense of self which results from these
early-life interpersonal abandonments, and abuse. The illusory repair of
traumatic childhood experiences is compelling.
This combination of biological and psychological factors results in an "affective
disorder" in the sex addict. Feelings of depression, anxiety, boredom and
emptiness are quickly alleviated by immersing oneself in an imaginary world that
provides novelty, excitement, mystery and intense pleasure.
Sex addiction is better than Prozac. It heals, it soothes, it contains, it
provides a "safe place" free from the demands of actual performance, and
it gives an illusory sense of belonging. The sense of empowerment in the
illicit sex act rectifies "holes in the soul" and lifts the addict from feelings
of inadequacy, insufficiency, depression and emptiness into a state of
instant euphoria.
Sex addicts, as a group, are not having fun. They suffer enormously, from the shame, self-hatred and
humiliation which are the fodder in which they live.
And yet, they are consumed by an irresistible impulse to keep returning to the experience of intense,
euphoric pleasure that they know will create suffering for them in the long run.
It’s hard for any of us to walk away from pleasure, even when we know it is in our best interest. For
sex addicts, it’s nearly impossible. No price seems too high for them to pay because they are driven by
the mirage of a beautiful, ephemeral ghost that continually promises but never delivers. And, yet, they
keep returning to the empty well to quench their thirst.
Forms of Sex Addiction
·The pleasure of sex addiction comes in many forms. Examples of these include:
ocompulsive masturbation,
ointernet pornography,
opornographic movies, literature
ocybersex,
osexual fetishism,
oanonymous phone sex,
ouse of prostitutes and escorts,
omultiple extra-marital affairs,
oregular attendance at strip clubs,
omultiple and anonymous sexual partners,
oerotic e-mailing or texting,
otranssexual compulsion, cross-dressing, or submission to femme dommes.
None of the above examples as a singular act defines a sex addict, however, it is can be the frequency
and reliance on these activities, as well as using sexual behaviors to get non-sexual needs me which
may constitute addiction.
Underlying Dynamics of the Sex Addict
While the sexual behaviors differ for each addict, the underlying dynamics of the addiction are
the same. There is always an inability to form a healthy, consistent attachment to a cherished
loved one. Perhaps there was a mother who was unable to create a bond with her infant/child
that provided the attention, recognition, validation and appropriate physical contact needed.
The early environment surrounding the sex addict’s childhood was usually
shame-based. This means that The child’s self-esteem was damaged as a
result of a dysfunctional family or from traumatizing experiences with peers. A
sense of inadequacy and helplessness then colors a sex addict’s understanding
of self and the relationship with others. When they grow to adulthood, they may
use sexual behaviors to achieve a sense of adequacy, competence, safety and
power. Consequently, they feel an (illusory) sense of admiration and
recognition that was missing from their childhoods.
The Erotic Haze
Every sex addict experiences an immersion in what I have called the “Erotic Haze.” This is a A period
of time that may last 4-5 hours or longer, the unconscious mind overpowers the conscious mind,
making it impossible to see reality or make rational decisions. The sex addict fails to account for his
own enlightened self-interest or for the feelings of others. Instead, the body and mind are bathed the
brain in pleasure-enhancing endorphins. Time stands still.
Fantasy is the fodder of a person in the “Erotic Haze”. In many cases, sex
addicts perform some form of ritualized behavior. This usually precedes a
sexual act. For example, an addict may cruise in a car for hours looking for just
the right sex worker. He is enveloped through the “Erotic Haze” and gets
intense pleasure from the ritual. He is no longer in touch with reality.
When the sex addict is in this mental state, his needs are what matter most of all. He feels no anxiety
about responding to the needs of another. There is no fear of closeness, vulnerability or rejection. To
him, nothing feels as if it is a compromise. All that exists is the pleasure of the sexual fulfillment. It is
the only time in a sex addict’s life that he knows perfect control over the “other,” and this is distinctly
unlike what he experienced as a child.
The “Erotic Haze” is a totally compelling state, one in which sex addicts are
completely preoccupied.
Dual Personalities
Sex addicts have a private life and a public life. Some report a “Dr. Jekyll and
Mr. Hyde” experience with either side of the personality having different and
conflicting values and goals.
oSecrecy and deceit are the hallmarks of the Mr. Hyde persona.
oUneasiness, shame, guilt and fear of exposure are the constant companions of Dr. Jekyll.
The Devastating Effects
Married sex addicts often lose their spouse in the process. Children are
commonly neglected. There can be loss of a job and income from too many late
nights that interfere with optimal functioning. Being constantly preoccupied with
sex, they lose track of time; attention to detail is sacrificed.
Friendships that are not part of their sexual experience and normal recreational
activities usually decline or may abruptly end.
When the pain outweighs the pleasure, when self-respect is totally depleted, there may come a moment
of clarity. It is then, and only then, that they are ready to hang out the white flag and commit
themselves to sex addiction recovery.
What are the first steps to recovery?
As mentioned, The initial step is to go to a therapist to cultivate a healing
relationship in the context of interpersonal, individual psychotherapy. The clienttherapist relationship is like no other. You were initially wounded by your
relationships to others, so will you be healed by a new model of relating. Client
and therapist establish an atmosphere of safety, responsiveness and
acceptance. In such an atmosphere, it may be possible for you to take a leap
into trust and self-disclosure. You may find yourself able to find a voice to
previously unspoken experiences and feelings. Self-disclosure in the presence
of a trusted person goes a long way towards healing the shame and isolation
that binds you.
The rest of your treatment will develop from your relationship with your therapist.
If addiction to sexual behaviors is the tip of the iceberg, then the personality
deficits, recurring self-defeating patterns, abuse from early life relationships with
caretakers, unconscious conflicts and skewed perceptions about self and others
represent the larger, bottom of the iceberg. I contend that recovery from
addiction, freedom from enslaving, out-of-control, humiliating sexuality cannot
be achieved unless the issues on the bottom of the iceberg are resolved,
primarily through cognitive and psycho-dynamic psychotherapy.
Chapter 2
Goal and Objectives of Sex Addiction Recovery
Fifteen years ago, people didn't even know there was such a thing as sex addiction, never
mind how to get help for it. With Patrick Carnes' groundbreaking book Out of the Shadows:
Understanding Sex Addiction, people who suffer from self-destructive sexual acts had hope of
knowing what ailed them. Since then, the disorder has received tremendous attention from
the media and a whole new group of therapists trained to treat sex addiction.
The field, however, is still developing. People who seek counseling for this
debilitating addiction often don't know how or where to get help from a
competent clinician. Moreover, the path to sane sexuality -- the goals and
objectives that one should strive for -- are still sometimes muddy and confusing.
The Problems of Sex Addiction
·Solidifies his identity
·Feels shameful
·Is illicit, stolen, or exploitative
·Compromises values
·Draws on fear for excitement
·Reenacts childhood traumas
·Disconnects one from oneself
·Creates a world of unreality and fantasy
·Is self-destructive and dangerous
·Uses conquest or power
·Serves to medicate and kill pain
·Is dishonest
·Requires a double life
·Is grim and joyless
·Demands perfection
·Mistakes intensity for intimacy
·Requires novelty - intensity always has to be more than the last "hit"
·Gives way to self-hatred, loneliness and despair.
·Has no sexual "boundaries"
·Uses false intimacy as a way to avoid relational pain
·Preoccupation and ritualizations
·Is "doing to" someone
·Is devoid of communication
·Has no limits
·Benefits one person
·Is an uncontrollable energy
·Is emotionally distant
Other Considerations that Describe the Sex Addict
·Behavior leads to increasingly negative consequences but addict unable to control acting out
·Denies the behavior's seriousness
·Is the product of intense, unmet needs, coupled with the demand for perfect fulfillment and control of
relational pain
·Demands that life provides (an illusion of) reassurance and predictability which gives a sense of
getting self-centered psychological relief
·Is always a narcissistic endeavor - people are seen as "need-supplying objects", not as real human
beings; more interested in getting than giving
·Is ephemeral - physical orgasm provides a welcome rush of adrenaline, but by itself can only offer the
brief illusion of intimacy and belonging
·Uses sex is a conquest and abates the terrifying sense of not belonging.
·Sexual fantasy conjures up a perfect world of nourishment, love, generosity and tenderness.
·Are trapped in the paradox of being terrified of loneliness even as they act in ways that create further
loneliness
·In fantasy sex, have the freedom to be vulnerable and nurtured without fear. At
it's core, sexual fantasy is worship of self.
·Carry a sense of parental betrayal; parents unable to provide a positive role model of healthy intimacy
·Have no ability to regulate their emotions from within
·Risk relationships, financial loss, job jeopardy and physical safety
·Possesses a set of irrational cognitive distortions, including,
o"Sex is my most important need";
o"I am basically a bad, worthless person; no one could love me as I am;" "
oMy needs are never going to be met if I depend on others;"
o"I am valuable only if I am sexualized; being sexually desired makes me feel alive"
Patrick Carnes, Out of the Shadows: Understanding Sex Addiction
·Have deficits in the areas of social skills, interpersonal communication, stress control, anger
management and empathy for others
·Learned in childhood that feelings are dangerous, so learned how to mask their feelings, even from
themselves.
·Sex in the “euphoric haze” becomes his exclusive coping mechanism, preventing him from learning
higher coping mechanisms that make life more enjoyable.
The Goals of Sex Addiction Recovery:
·Diminish/eliminate shameful, compulsive sexual behaviors
·Learn to deal with urges/cravings by understanding that they are transitory and that they are not
imperatives to act out
·Know triggers and have behavioral strategies for dealing with them
·Develop a caring support system and identify individuals to contact when relapse is about to occur
and as a support for getting dependency needs met
·Reduction of denial, justification, rationalizations, minimalization and other distorted thoughts and
beliefs
·Replace negative core beliefs about the self with healthy self-esteem
·Heal the shame that both precedes and follows sexual acting out
·Re-frame slips/relapses from a sense of failure to an opportunity for learning new coping skills
·Develop an understanding of the unconscious internal factors driving sexual behavior
·Attain better self-regulation (of moods, feelings, behavior) through the gradual internalization the
nurturance, containment, and structure of various treatment modalities
·Improve capacity for interpersonal relationships
·Improve capacity to reflect on thoughts and feelings, with a resulting increase in inner control and a
decreased need to act out unwanted mental states
·Explore the functions the sexual activity is serving (relief from anxiety, momentary
intimacy, master feelings of powerless and helplessness from the past, etc.) so more
constructive strategies can be developed to get needs met
·Explore how sexual compulsion is an enactment of dysfunctional relating patterns from the past
·Develop a clear definition of healthy sexual patterns vs. shaming and self-harming sexual activities
·Reduce marital/relationship conflicts
·Increase understanding of need to control intimacy as a function of long-standing early
neglect and abuse.
Chapter 3
Treatment for Sex Addiction: Relapse Prevention
Overview
Relapse in sexual addiction recovery is a reality. While all addictions are relapse
prone, it is the sexual recovery community who suffer most from the
demoralization of repeated relapse. After all, we can live without ever being
around alcohol or drugs, but our sexuality is ever-present. Because ours is a
sexualized culture, triggers, cravings, urges, cues, and high-risk situations are
everywhere. The sex addict, despite his your best efforts to achieve continuous
abstinence, you may find yourself himself continually returning to your his
addiction despite the knowledge of the damage it inflicts on you him -- disease,
damage to primary relationship, social disapproval, financial loss, and
decreased self-esteem.
In times of stress, the lure of immediate gratification (the pleasure, "high",
tension reduction, relief of distress) calls you him and you he responds, puppetlike, to the perceived inevitability of relapse. When caught in the addiction cycle
of preoccupation, fantasies, euphoria, urges, cravings and the intense, and
driving need for comfort and gratification, retreat into the comfort of the "erotic
haze" is the only coping mechanism available to you him at the time. The erotic
haze is a dissociative state that allows the very real negative consequences of
your his behavior to recede from consciousness as the imperious need for
immediate gratification becomes your his exclusive focus. Most sex addicts
state that the sexual act itself is inconsequential. Hours spent in the dissociative
"erotic haze" meet certain non-sexual needs. It is this euphoric self-state that the
person is really addicted to.
With orgasm, the "bubble" breaks and reality sets in. Feelings of defeat, shame,
hopelessness and demoralization are common. Because your his only way of coping with
distressing feelings is sexualization, he returns to the addiction for relief of the pain
that's caused by the addiction because he doesn't see any alternatives. He blindly goes to the
source of the pain for relief of the pain. Thus we see the vicious, never-ending cycle of active
addiction. We keep returning to the source of the suffering for relief from the suffering which
creates more suffering so we again go to the source of the pain and so on and so on.
But there is hope. Addicts repeatedly return to their addiction because it's what they know.
The result of long-term addiction is a gradual erosion of the ability to choose different
alternatives to deal with life. An addict just entering treatment is in a state of nil-choice. A
relapse prevention program helps people who use sexual behavior addictively (1) to
recognize factors and situations that are associated with an increased risk of acting out; (2) to
cope effectively with sexual urges; (3) to recover rapidly from episodes to symptomatic
behavior; and (4) to use such "slips as opportunities to learn about how their recovery plans
can be strengthened.
You'll learn new coping skills, new options and new cognitive strategies to cope with external
and internal stressors. You'll become very familiar with the warning signs of your personal
relapse process and learn that you can intervene at many points in that process with a
healthy coping mechanism. Change a thought - and you're out of the downward spiral. Do
something different from you used to do - and you're propelled out of the erotic haze into
reality. Ingrained sexual habits can be transformed into behaviors that are under the
regulation of higher, more mature mental processes involving awareness and responsible
decision-making. You can begin to make a variety of choices that ultimately lead to the
enjoyment of pleasurable experiences that are non-sex related and have no negative
consequences. The goal of Relapse Prevention (RP) is the restoration of the ability
to choose, an increase in the client's awareness and choice about their behavior, to develop
coping skills and self-control capacities, and to generally develop a greater sense of
confidence, master, or self-efficacy in their lives.
Working an individualized relapse prevention program is not part of
treatment per se, but maintaining a relapse prevention (RP) program is probably
the most critical element involved in staying sexually abstinent. If the person
believes that the only goal of addiction treatment is abstinence, then little
attention is paid to the perils and demands of the journey towards
the maintenance of abstinence and continued growth as a person. In the
process of recovery you'll be faced with a plethora of temptations and stressors.
The pull of powerful old habit patterns will beckon you. Failure to anticipate and
plan for the stressors of recovery will result in immersion in the addiction cycle.
The phases of this cycle consist of preoccupation, dissociation, entering into the "erotic haze",
ritualization and sexual acting out, followed by despair, shame and guilt. The addict, because he has not
developed ways of coping with overwhelming emotions, sees his only option for relief from the shame
and self-loathing as the return to the beginning of the cycle. With time, the addiction cycle may
escalate, with greater intensity, more frequency, more risk and greater loss of control.
Relapse prevention intervenes before the client enters into the addiction cycle. While behavioral or
cognitive interventions are still possible in the preoccupation and dissociation stages, once the client
enters into the "erotic haze", it is almost impossible to stop the process.
Motivation - Values and Goals
The cultivation of meaningful, realistic goals and clarification of personal values
should precede the development a RP program. To counteract the pull of the
addiction, you need to know why you're motivated to work for addiction recovery.
You will your own life goals and enduring values that can guide you, as the
North Star, towards restoration, recovery from addiction and the achievement of
a satisfying and meaningful life. Most sex addicts want to achieve real
connection with others and not the mere illusion of connection. They want to
build the genuine self-esteem that comes from living out one's most cherished
ideals and values and from the ability to regulate their feelings and behaviors.
They want to stop the lies, secrets and deceptions that keep them in a perpetual
state of fear, shame and self-doubt. Luckily, these goals are attainable.
What it Takes
Working a RP programs requires three things of you.
Motivation. You need to be consistently aware of the negative consequences of
unregulated sexual behavior. Remembering the pain and suffering of being in
active addiction can be a great motivator to change. Another motivator to staying
active in dealing with addiction and working towards your life goals that would
be unachievable if you're involved in active addiction. The process of
continuously doing what you've committed to do is itself a strong motivator.
Active addiction gradually erodes your moral fiber and betrays your essential
values. Knowing what makes life meaningful to you and re-committing to your
essential values will be the motivational force and the foundation for the work
ahead.
Mindful awareness of your inner processes. Enhanced knowledge and
awareness of inner processes (see article on "Mindfulness Meditation.") is
necessary for most aspects of recovery, but more so in RP. Most of the warning
signs of relapse occur unconsciously. Mindful awareness brings them into
consciousness where they can be dealt with in adaptive ways. Mindfulness
meditation fosters a sense of detachment between addictive behavior and your
personal identity. Cultivating a "witness consciousness" that is balanced and
non-judgmental trains you to become your own mind-scientist. With mindful
awareness, you can see the warning signs of relapse as they happen so you
can take proper action. Through mindful awareness and with the help of your
therapist, you'll learn to think about your thinking and observe and detach from
painful emotional processes.
A willingness to learn new responses to old stimuli, an openness to new ways of
behaving and thinking and a continuing determination to practice new skills until
they become automatic is essential to making your relapse prevention program
work for you. One definition of "determination" is the ability to stay the
course regardless of thoughts and feelings. You just keep doing the next right
behavior on your addiction recovery plan, regardless of your feelings or your
perceived discomfort. Treatment of addiction means nothing if it's not used as a
springboard for taking healthy, constructive actions to replace the addiction.
The Basics
First you figure out what thought processes, high-stress situations and
behaviors lead to the end-point of acting out. Sexual relapse is the end-point of
a relapse process that may have begun last week, last month, or last year. You
don't get "struck" acting out. Sexual enactments don't come out of the blue.
There are many, many steps that lead to being in relapse mode. Cultivating
mindful awareness of the warning signs of your particular relapse process is
essential.
As you learn new recovery skills (or healthier coping mechanisms), you'll be able to use one of them as
an intervention at various places in the addiction cycle. When you become aware of the warning signs
of relapse, you immediately do something different than you've always done that will disrupt the pull
towards acting out.
When an addict has used immersion in the "erotic haze" as a coping mechanism to avoid pain
and deal with life stressors for an extended period, it becomes his exclusive way of coping
with life. However, the coping mechanism is maladaptive because it leads to sufferinginducing consequences. An RP program teaches adaptive coping skills that generate new
behavioral alternatives, new ways of thinking, new choices, new experiences and, combined
with other treatment modalities, offers a radically different way of being in the world.
How it Works
The Ball and Chain
When I work with clients on a RP program, I use the metaphor of a behavioral chain that has
many links. The bottom of the chain is relapse. Each link in the chain represents a relapse
warning sign that you can observe as it happens and immediately intervene with one of your
newly learned coping skills.
Even though it seems as though relapse descends upon you, a force beyond your control that comes
"out of the blue", in fact, there is a long chain of events that lead you there. You can learn to find and
control the chain of events that represent your particular relapse process. Clients learn how to go back
in time to reconstruct all the internal and external links of the chain (thoughts, feelings, behaviors,
urges, fantasies and external events) that have that led to relapse in their past.
Following is an example of one of a client's behavioral chain that led to relapse:
·Two days before his relapse, he went to the gym.
·At the gym, he thought members of the staff looked at him in a strange way.
·He interpreted their looks as judgments about himself.
·He felt both embarrassed and hopeless. He felt hopeless because it seems that would never feel normal
in any of the places he wanted to belong
·He went directly home without doing her errands because he didn't want to be seem by anyone.
·Lying on the couch while watching TV, he became sexually aroused and distracted from his earlier
feelings of embarrassment and helplessness.
·He went to the computer and looked for a site with free porn pictures.
·After his orgasm, he felt ashamed that he had look at porn after he had promised himself he wouldn't
do that again.
·He felt hopeless and depressed and thought about what a loser he was.
·He thought about how no one would ever love him.
·He thought he would go crazy if he couldn't be loved and sexually satisfied by a woman.
·He thought he has to prove himself that he could have sex with a woman and
that he was not a loser. He thought he needed to regain his self-control.
·
This client's chain brought him to a brothel where he had sex with a prostitute. Following his
experience, he felt an immediate sense of demoralization and shame. If uninterrupted, the displeasure
of the feelings of demoralization and shame will bring him right back to the beginning of the addiction
cycle.
This is an ordinary example of how you can end up doing exactly what you didn't want to do. When
your personal behavioral chain is pulling and you don't try to break it until it's too late, then you've
gone and gotten yourself just in the place you've been trying to avoid.
Again, the relapse didn't descend upon him as a cruel fate. It didn't just happen. It took a few dozen
steps for this client to arrive at relapse. At each of those steps, (or links in the chain) he could have
intervened with a cognitive change or a healthy behavior to prevent the relapse.
You need to become very aware of the links in the chain, especially when warning signs go off. The
next step is to look at each link in the chain and come up with alternatives (also called coping
mechanisms) that are ways to get out of the chain when you are caught in it. Change a thought, you've
off the chain. Do an alternative behavior, you're off the chain. These are the ways to free yourself from
becoming tangled up in the chain. An alternative is something you do instead of your usual response in
a situation. An alternative makes it possible for you to think and behave in a different way that you did
before.
You might want to pick up a copy of "Living Sober" (AA Worldwide) that provides plenty of ideas of
alternative, pleasurable behaviors and activities.
As you look at the sample behavioral chain, you can see a series of emotions,
thoughts and actions. You're not asked to do anything about the emotions just
now. Feelings come and go. Just notice that how you feel affects how you think
and what you do at a given time. You can't directly change feelings, but you can
become aware of them and how they affect the other parts of your life. What
you can change directly is how you think about things and what you do about
them. First you look for every cognitive distortion on your chain and come up
with alternatives ways of thinking that might be more in line with reality. Go
through the chain, replacing the thoughts that led you down the dark sexual
alternatives with better alternatives (Sbraga et al., 2000).
Next you look at the behaviors in you chain and come up with realistic alternatives. If you find yourself
in a high-risk situation, what could you have done instead? Write out a list of alternative behaviors that
will instantly get you off the chain. Think of lots of options, particularly options that are give nonsexual pleasure with no negative side effects. Write your new coping mechanisms on a card and carry
them with you.
Research has shown that people lapse, it is usually in response to negative feelings and to interpersonal
conflicts. These events should always to consider high risk.
You learn how to be good at using you coping skills to stop your relapse progression
by practicing. You are creating new, positive habits for yourself. These are habits that will take
you towards your goals instead of stealing away the best years of your life.
1.Managing Feeling-States
All addicts have problems with tolerating distressing inner states. Research shows that two types of
situations are especially high-risk for relapse: Negative emotional states and situations involving an
inter-personal conflict with a closed one. People go to any length to avoid certain feelings such as
shame, fear, anger, loneliness, emptiness, depression and so on. Addicts avoid feelings through sexual
acting out. You might consider other ways you have to not sit with feelings.
It is possible to control feelings for a bit of time, but they surface and fade away.
Handling feelings is essential in relapse prevention because how you feel has a
lot to do with sexual control problems. Sex addicts try to manage their emotions
with sex. Think for a moment how many times you have gone out looking for
sexual satisfaction when you were feeling hurt, lonely, rejected, sad, angry,
disrespected, anxious, depressed, fearful or unloved? And, of course, sex
makes you feel better - for a brief period. Unfortunately, this strategy of
managing feelings just doesn't work. If you really did a cost-benefit analysis of
sexual acting out, you might see that the benefit is fleeting and the costs...well,
you know what they are.
The reality is that if having all the sex you wanted could make you feel better or create a better life for
you; don't you think it would have happened by now? The problem is that sex, despite its allure and the
false promises it offers you, cannot make you feel better in a real or lasting sense. The authentic self is
not nourished or healed through sex.
So if you can't change your feeling and they just happen, what are we to do about painful feelings?
Here's the deal: DO ABSOLUTELY NOTHING ABOUT YOUR FEELINGS! Feelings, if you don't try
to get rid of them, come and go rather quickly. When people try to control their emotions, the feelings
don't get the chance to dissolve as they should. They just keep coming back. FEELINGS DON'T KILL
- THEY WILL NOT ANNIALATE YOU. THEY ARE NOT DANGEROUS. They create discomfort,
and then they pass away. The important thing is to remember that you can handle any of your feelings
that come up. You have a choice about whether or not to act out sexually and create more suffering.
In the same way, what do you do when you're triggered, hot, horny, aroused and
amorous? The answer is the same: DO NOTHING. Sex addicts have a false
belief that they must do something about it no matter what. This is a lie. People
feel aroused all the time and don't act on the feelings. Happily married people
are sometimes attracted to other people, but they don't have affairs. Priests and
nuns feel sexual arousal but they honor their vows. Certain engaged young
people choose to postpone sex until after marriage. Somehow, they all survive
without acting on sexual urges.
Learning to tolerate sexual arousal without being sexual is a gift you give to yourself.
Urges and cravings
Urges and cravings are physiological responses to internal or external triggers.
You experience being pulled by the wish for immediate gratification. An RP
program teaches you urge-management techniques. You are taught to
anticipate and accept these reactions as a normal part of your addiction cure.
You are taught to dies-identify with the urge and to view it dispassionately as an
alien force. I use hypnosis to set up imagery work with the client and ask him to
imagine it as a wave, watching it rise and fall as an observer and not to be
"wiped out" by it. This imagery technique is called "urge surfing" and refers to
visualizing the urge or craving as a wave that crests and then washes on to a
beach. In so doing, the client learns that rather than building until they become
overwhelming, urges and craving peak and subside rather quickly if they are not
acted on. The client further visualizes not being "swept away" but rather can see
himself riding the wave on a surf board. This imagery fosters detachment from
the urges and reinforces the temporary, fleeting nature of these phenomena.
Lapse Management
Despite planning and precaution, many clients committed to abstinence will experience a lapse after
initial abstinence. Lapse-management techniques strategies focus on halting the lapse to prevent an
uncontrolled relapse. I contract with the client to contact me as soon as possible after the lapse, and to
evaluate the situation for clues to the factors that triggered the lapse. The client is instructed to leave the
lapse-inducing environment and we immediately structure the experience as a slip-up, a mistake.
Furthermore, the client is taught to reconceptualize the episode as a single, independent event and to
see it as a mistake and not a disaster that can never be undone.
I find that clients who place the blame for the lapse on themselves and see it as a dead-end, a treatment
failure and experience shame and defeat are more like to move into full relapse mode. Other clients
who view the lapse as a mistake that needs correcting and an opportunity to learn what needs to be
changed in their RP strategy fare better in resisting the entrance back into the addiction cycle (Gorsky
et.al., 1986).
Sexual Fantasy as a Trigger
Sexual fantasies have to do with a wish for something. For you to discuss a
sexual fantasy is to admit that you have an unfulfilled sexual wish. There can be
shame associated with having that type of longing. Getting rid of a sexual
fantasy isn't really possible. Once again, I challenge you to handle sexual
fantasies by DOING NOTHING. People often try to get rid of their sexual
fantasies or pretend they don't have them. But trying not to think about them
may give them more energy.
Fueling fantasies to give a higher level of excitement isn't the way to go either. By "feeding" I mean to
make them longer, more detailed and stronger than they started out. People fuel fantasies to work
toward an inner "perfection." But it can take over your life. You check out of reality and check into
your fantasy. If you start holding real-life situations and people up to the standards of your fantasies,
there is no way they can measure up.
When fantasizing takes the place of reality, it's very unhealthy. Remember a fantasy is a fantasy
precisely because there are no downsides to it. There are no costs involved. Real life does not work that
way.
A fantasy can be dispelled by discussing and understanding it with your therapist. I have also found that
the fantasy life leaves a person as he matures and is getting satisfaction from real living. The fantasies
will simply fall away.
Lifestyle Regeneration
A focus on learning to achieve and maintain a healthy, balanced life-style is key. This is based on the
principle that a healthy, balanced life-style decreases one's vulnerability to change warning signs into
new behaviors and promotes mental and physical well-being in general. Issues addressed should
include diet, exercise, rest, recreation and the balance between work ("the shoulds") and play ("the
wants.").
Your lifestyle should be balanced with the "wants" and the "shoulds". Life stressors need to be balanced
by genuine pleasure, shared activities and just plain old fun.
Stress Management (Relaxation Training)
Stress is the silent killer for all of us -- more so for those involved in an addiction recovery program.
Learning to deal with stress is critical. There are a number of relaxation trainings and stress
management procedures I can draw upon to provide the client with a global increased perception of
control, thereby reducing the stress "load" that any given situation may pose. Such procedures as
progressive muscle relaxation training, recreational reading, yoga, meditation, exercise and selfhypnosis are useful in dealing with the hassles of daily life. Also, through engagement in stressmanagement techniques, you will gain mastery over arousal states and emotions which before were
believed to be beyond personal control.
An important component of relaxation skills is that you will learn the skill of "self-soothing" which can
give an experience of being able to generate within that which you've been seeking from without.
Skills Acquisition
Depending on each need, different clients need to be taught different skills. These may include:
Social Skills
Assertiveness Training
Communication Skills
Relationship Skills
Healthy Sexuality
Dating Skills
Positive Self-talk
Problem-Solving
Positive Self-talk
Problem-Solving
Chapter 3
Cognitive Therapy
"Men are disturbed not by things that happen, but by their opinion of the things
that happen." Epictetus (c. 50 - 120)
The philosophical basis for cognitive therapy goes back to the Stoic
Philosophers who taught that it is not the external event that causes
our distress, but rather our perception or interpretation of the event
that is distressing. According to the Stoics, people are capable of
considering alternative perceptions or interpretations by changing the
thoughts that underlie emotional distress or sexual dysfunction. This
ancient philosophy can help you in your therapy for sex addiction.
Cognitive models became popular in the early 1960's. Proponents of
this school assume the client's problems occur at two levels. The first
is the overt difficulty, such as depression or sex addiction. The second
involves addressing underlying psychological mechanisms and
psychological cognitive distortions, usually involving irrational beliefs
that cause the addictive behaviors.
Cognitive-behavioral therapies conceptualize psychological problems primarily in
terms of maladaptive learning, and are oriented toward assisting the individual to
learn more adaptive patterns of thinking and acting. This technique typically relies
on interventions that are directive, practical, task-oriented and educative in
nature.
It is important to understand the major premise of cognitive approaches to treatment: the overt problem
(sex addiction) originates within what cognitive behaviorists call the client's schemata. This is a
person's world view, or core belief system. The focuses of this approach is on how the client maintains
painful, harmful, or irrational behaviors. The primary approach utilizes some form of debate. This
involves pointing out to clients the irrationality of certain thoughts, beliefs and perceptions and the
construction and rehearsing of rational self-statements or other more functional cognitive strategies and
skills.
My focus when working with a cognitive model includes:
1. The focus is on stopping the undesired sexual behavior. Behavioral
modification techniques (Relapse Prevention Skills) and/or
pharmacotherapy are employed to help clients overcome addiction.
2. This is the "admission" stage and requires the patient to accept the
existence of a problem and to promise to keep no secrets from the
therapist.
3. In this stage, patients are taught stress management techniques so they no longer need to rely on
sexual behavior to alleviate their anxiety. I recommend physical exercise, and teach a combination of
breathing techniques, progressive relaxation, meditation and hypnosis to show clients that they do have
some power over their inner states.
4. This may be the most important stage of the program. It consists of cognitive therapy directed
towards repudiating the irrational beliefs that underlie sexual addiction through active questioning. It
allows clients to develop an awareness of beliefs. By asking questions clients develop an insight into
their thought process and how these influence their emotions and behavior. Accordingly the client
becomes aware of inappropriate beliefs and is helped to challenge them and change their behavior. The
process involves asking questions that support or refute the thought, asking about possible alternative
explanations. Questioning about the range of consequences of the thought and it's impact upon the
person and what would be the effects of believing the thought or of changing their thinking.
5. Patients are trained in such skills as assertiveness and problem solving in order to facilitate adaptive
social functioning.
6. Focus is on resolving whatever problems the individual has had in establishing and maintaining a
primary sexual relationship.
7. Learning what thought processes lead to "setting oneself up" for a return to relapse.
8. Developing a positive attitude towards healthy sex; cultivating an appreciation for the needs of one's
partners, learning pleasuring skills, using sex therapy if there is a sexual dysfunction.
9. Generating pleasurable sober activities and relationships - building a life worth
living.
The sex addict depends on sex to meet his emotional needs which he
is unable to meet through healthy coping skills. Sex becomes a coping
mechanism for dealing with stress, shame, guilt and isolation. It is a
way to connect without risking intimacy.
However, the addiction is never satisfied because sex is unable to
meet these needs because their source is historical and the need is
too great. In addition, the needs of the true self can never be met by
sexual activity.
Patrick Carnes sets out the unconscious belief systems that all sex
addicts need to refute.
·I am basically a bad, unworthy person.
·No one would love me as I am. My needs are never going to be met if I have to rely on others.
·Sex is my most important need.
While these are the core dysfunctional beliefs, there are many more beliefs, attitudes, or "cognitive
schema" that keep the addictive cycle in place. From my experience, some of them are:
·I am unable to tolerate boredom; sexual acting out is a good way to fill in the time.
·If not distracted by sex, I am filled with an intolerable sense of emptiness.
·Men are more sex-driven than women. As a man, I need to discharge that drive, or I'll go crazy.
·My sense of self is determined by how many women are attracted to me.
·The vicissitudes of life are either boring or unmanageable. There is no pleasure to be had in day-today life except for my "secret" world.
·Sex with my partner is a mechanical, deadening process which lacks spontaneity and excitement.
·If life does not provide excitement and high-stimulation, then I'll be bored and depressed forever.
·When I get an urge or impulse to act out sexually, I must succumb to that urge.
·In order for me to be a real man, I must have sex with as many women as I can. Furthermore, as the
man, I am responsible for my partner's pleasure through intercourse. Failing at intercourse is failing as
a man.
·Engaging in cybersex is my only means of getting away from the
stress and frustration of living. Sexuality is the only trustable means
of relating to others.
·I depend on sex to meet emotional needs which I am unable to meet through
healthy coping skills.
Addiction is self-perpetuating; it feeds on itself because of ingrained core beliefs as well as each
individual's dysfunctional beliefs about sex. In order to change the addictive cycle, one must change the
belief systems that underlie it.
Dysfunctional beliefs give rise to rationalization, minimalization and justification.
The addict, as the disease progresses, starts to see the world through cognitive
distortions designed to protect his sexual acting out. His whole perspective
becomes distorted to the point where he becomes increasingly out-of-touch with
reality.
In treatment for sex addiction, changing these beliefs is key.
Changing core beliefs is a challenge because they were imprinted at
an early age and have remained stable over time. Another reason
change is difficult is that these beliefs live in the unconscious mind.
The addict lacks awareness of his self-defeating beliefs. How can you
change something you don't even know you have? The cognitive
therapist will elicit these attitudes and beliefs and provides alternative
ways of thinking and perceiving.
I sometimes use hypnosis to gain access to the subconscious mind
where the beliefs, attitudes and cognitive schemas can be brought to
awareness and disputed.
I highly recommend David Burn's book "Feeling Good". In it he lists 10 cognitive distortions and ways
to dispute them. Study the cognitive distortions so you can begin to see how they operate in your life
and change them more realistic,
Chapter 4
Psycho-dynamic Psychotherapy
In my opinion, long-term psycho-dynamic therapy is the most
efficient way to cultivate healthy personality development. The most
comprehensive treatment for addiction combines the empathy, insight
and relational abilities of a psycho-dynamic psychotherapist with the
12-step orientation and cognitive-behavioral strategies of an addiction
specialist.
What is Psycho-dynamic Psychotherapy?
The primary focus of psycho-dynamic treatment is on your internal structural
deficits rather than on your addictive symptoms. Besides compensating and
repairing deficits in the self stemming from childhood misattunements with early
caretakers, it may also be the most appropriate treatment to help you to cope
with life stressors and painful emotional states that contribute to urges to engage
in addictive sexual behavior.
The focus of this type of therapy is to enhance your self-regulation and self-care, and to foster your
capacity for meaningful interpersonal connections. Psychotherapy serves these goals by facilitating the
development of healthy ways to regulate emotional self-states, for getting appropriate needs met in
reality, for resolving inner conflicts, and for taking care of yourself in a spectrum of areas.
Integration of your personality is an important element of psycho-dynamic therapy. Sex addicts live in
two worlds; the "normal" world of work and love and the "secret world" of sexual acting out. This split
in the personality results in having different value systems and goals for each part of your personality.
Psycho-dynamic treatment promotes personality integration by bringing together under the light of
consciousness the split, denied, dissociated and repressed aspects of your mental functions. Dr. Jekyll
and Mr. Hyde finally become one.
Some General Principles of Psycho-dynamic Therapy
·Focus is on feelings and expression of emotions. The therapist helps
you to describe and put words to feelings, including contradictory
feelings, feelings that are threatening, and feelings that you may not
initially be able to acknowledge.
·Exploration of attempts to avoid distressing thoughts and feelings.
·Knowing, but not knowing at the same time is the result of various
defenses the person uses to remain unaware. One aspect of this type
of therapy is actively focusing and exploring these avoidances. Patient
and therapist chip away at defenses so unconscious material can be
brought to consciousness where there is a chance of changing and
adapting to reality.
·Identification of recurring themes and patterns. Self-defeating patterns in patients' thoughts, feelings,
self-concepts, relationships and life experiences are put under a microscope.
·The past is alive in the present. Past experience, especially early family-of-origin issues, affects our
relation to, and experience of the present. The goal is not just to dwell on the past for its own sake, but
rather to help people free themselves from the bonds of past experience in order to live more fully in
the present.
·Focus on interpersonal relationships. Psycho-dynamic therapy emphasizes your interpersonal
experience. Problematic interpersonal patterns interfere with your ability to meet your emotional needs.
·Exploration of the entirety of mental life. Your encouraged to say whatever comes to mind. Thoughts
can range over various aspects of mental life, including desires, cravings, fears, fantasies, dreams and
daydreams. All of this is a rich source of information about how you view yourself and others, interpret
and make sense of experiences, avoids aspects of experience, or interferes with potential capacity to
find greater enjoyment, ease and meaning in life.
The goals of this type of therapy extend beyond healing the symptom (compulsive sex) but also foster
the positive presence of inner capacities and resources. These might include more fulfilling
relationships, more effective use of your talents and abilities, maintain a realistic sense of self esteem,
tolerate a wider array of strong feelings without acting out, have more satisfying sexual experiences,
greater understanding of yourself and others and face life's challenges with greater freedom and
flexibility. These goals are explored through self-reflection, self-exploration and self-discovery that
take place in the context of a safe and deeply authentic relationship between the therapist and you.
Personality Factors Common to Sex Addicts
That are Addressed in Psycho-dynamic Therapy
·Sexually compulsive behavior helps you manage fluctuating affects, self-sooth, and maintain selfesteem. Sex distracts from painful feelings and thoughts, counteracts inner emptiness, replaces feelings
of fragmentation with an illusion of control, and temporarily bolsters self esteem.
·Sexual activity is a form of self-medication, used to make unbearable
feelings and self-states bearable. Addiction furnishes externally what
cannot be provided internally.
·Sexually compulsive individuals often have personalities with narcissistic features.
·Poor capacity for self-regulation, self-efficacy and self-care
·Sex Addicts tend to have difficulties sustaining relationships and feeling close to others.
·Problems in family-of-origin where their individuality and needs were often ignored or punished.
·In childhood, the true, authentic personality needed to go
"underground" to please narcissistic parents; parts of the personality
were then "split off " and are enacted through sexual activity as the
adult.
·The person affected alternates between deprivation of needs/feelings and unrestrained indulgence.
This state is marked by significant splitting and minimal integration. (The Dr. Jekyll/Mr. Hyde
Syndrome)
·Deviant sex provides a much-needed connection with another without the "danger" of relatedness.
·Brief sexual encounters are seen as emotionally safe. They have a fixed ending point, no strings
attached and have little room for conflict. Furthermore, anonymous partners cannot readily reject you
upon the discovery of your real or perceived flaws.
·Many sex addicts have a strong wish for control and a fear of vulnerability. They feel internally fragile
and prone to fragmentation.
·Sexual behaviors allow a feeling of control, power, triumph or omnipotence that compensates for
early-life feelings of helplessness and powerlessness. Most likely a ritualized sexual enactment turns
trauma into triumph and is a repetition compulsion with the unconscious aim of repairing the original
childhood trauma. Dysfunctional relationships developing out of the trauma are enacted through sexual
activity.
·The details of a sexual enactment, and the fantasies that fuel it, are laden with symbolic meaning and
are an aid in understanding the themes of inner conflict driving the behavior.
The Fruits of Treatment
Psycho-dynamic therapy can help you to develop:
·An understanding of the internal factors driving your sexual behavior;
·Better self-regulation through internalization of your nurturance, containment and structure of the
therapeutic environment;
·Improve your capacity for interpersonal relationships and healthy sexuality;
·Improve your capacity for working at an optimal level;
·Improve your access to creative inner resources;
·Improve your capacity to reflect on thoughts and feelings, with a resulting increase in inner control
and a decreased need to act out unwanted mental states;
·Integration of the private and public selves: Dr. Jekyll and Mr. Hyde become one;
·The therapist explores your sexual behaviors and fantasies in detail. Like dreams, they have symbolic
meaning and aid in understanding the structure of your personality as a whole.
Chapter 5
Group Therapy
Why Group Therapy for Sex Addicts?
Although the behaviors of sex addicts differ, all sex addicts share certain
similarities when you “act out”. Typically, you are disconnected from your
feelings. You substitute sexual behavior for emotional intimacy, and you have
distorted and painful interpersonal relationships. The problem of emotional
alienation is compounded particularly for men who in American culture, are
rarely connected to a social group in which they can bond and discuss feelings
with others.
Group therapy is a highly effective treatment for sex addicts. In a group
environment, no one person is singled out because everyone in the group
shares the same affliction. This commonality reduces shame and denial, limits
isolation, increases socialization skills and the development of empathy. More
importantly, the group format also fosters the development of intimacy and helps
sex addicts develop the coping skills they need to meet their emotional needs in
interaction with supportive others, rather than through sexual behaviors.
Below is a list of the processes and benefits of group therapy for sex addicts:
·You may have come to treatment feeling extremely hopeless. By seeing others
in addiction recovery, your faith is fostered in the belief that treatment can and
will be effective.
·You feel a sense of universality which helps you realize that an you’re not alone in your
addiction and that others have experienced similar problems. This experience tends to reduce
a member's sense of uniqueness and reinforces the fact that each person is not unique.
·Sex addicts are often alienated from others and experience a great deal of
shame and loneliness. The group provides a safe place to practice trusting
others. You may learn to feel free to care about each other because of this
climate of trust. You begin to see that you can talk about feelings and elicit
support.
·The therapist and group members offer effective ways to deal with life's
problems. Education about 12-step support groups, the addiction cycle,
identification of healthy relationships, re-framing the meaning of sexuality, and
relapse-prevention strategies are also imparted.
·The opportunity to help another person because you care (altruism) and to feel useful increases selfesteem. It also challenges one's own demoralized position. Helping other group members can mediate
this sense of worthlessness.
·Addicts learn basic interpersonal skills which help them turn to people, instead of relying upon
fantasy enactments in times of need. Group therapy helps you to develop new ways of relating to
people
·Group members serve as role models for other members through self-disclosure and honesty. When
the therapist listens attentively and provides direct eye contact and sympathetic expressions, she
promotes a positive attitude and an understanding of the importance of what you are saying. Through
modeling the therapist, group members learn how to help each other feel both supported and
understood. When one member shares his or her secrets, it encourages others to take risks as well. You
have the opportunity to see how others work through their problems without returning to destructive
behaviors.
·Members are able to connect with each other because a sense of cohesiveness develops. You begin to
take seriously the events that occur. It is what makes the group really matter to its members. Because
sex addicts have been hurt so badly in childhood, prior to group therapy, they tended to refrain from
trusting others or personally investing themselves in adult relationships. Immersion in a therapeutic
group can help heal and rectify the interpersonal wounds of childhood.
·Many group members experience catharsis. This is defined simply as the open expression of feelings,
which is extremely important for sex addicts who have often repressed their emotions. Sex addicts fear
that if they state where they are emotionally, they will alienate others. In fact, members of the group
generally learn those emotional experiences can promote feelings of connection with others and not a
sense of isolation.
·The sex addict’s lack of structure can be a trigger to acting out. In a group environment, however, a
support structure and a quasi-family provides support empathy, and understanding where it seemed
there once was none. Keeping your time structured through being in the company of family, friends
and recovery “buddies” helps to mediate that trigger.
·The Group provides accountability, which is another structure that addicts require to recover.
Individuals who are accountable to others throughout the course of their recovery are more likely to be
successful in achieving and maintaining sexual sobriety. The members of a therapy group provide an
extra level of accountability by taking an active role in others’ continued growth and success. Lack of
accountability is often another strong trigger for the sexually addicted.
Breaking free from this odious addiction can seem an overwhelming and
impossible task. In the group experience, addicts in recovery witness first hand
what is possible from others who are like themselves. Without hope and a sense
of direction, discouragement and self defeat can quickly lead to relapse, but
when the hope of sobriety is nourished, abstinence becomes more attainable.
Profound personal and interpersonal change and growth can occur in a
cohesive group. I believe it is a critical component of the mix.
A recent survey conducted by a sex addiction treatment rehab center gave
insight about which benefits their patients found most helpful. They said sharing
feelings, a sense of belonging and learning about recovery skills were most
helpful. Interestingly, the statement, “Revealing embarrassing things about
myself and still being accepted by others,” was the single most healing aspect of
group therapy. This finding suggests that acceptance and a sense of belonging,
perhaps the very aspects of intimacy that addicts most fear, are also the very
needs they are trying to get met through compulsive sex.
Chapter 6
Couples Counseling
Cybersex is the use of electronic communications for sexual diversion and
includes email, texting, and internet porn. The American Bar Association cites
that in 2011 a whopping 50% of the divorces it handles have cybersex
implicated in the couple’s demise. The harm and emotional wreckage to the
partner (co-addict) is enormous. As a result of cybersex, a couple’s marriage is
compromised and children within the home are harmed in numerous ways. They
suffer from the abandonment of both parents: one is obsessed with sex and the
partner is obsessed with the sex addict. In many cases, the children don’t
receive the care, time and attention they need and deserve. As a consequence,
this abandonment will affect their ability to forge healthy relationships as adults.
Below is a case example of a couple who suffered the consequences of
cybersex in their marriage. Although the article doesn’t describe the pain and
hard work this couple put into healing through relationship, it gives insight into
the problems of sex addiction. By definition, sex addiction is an intimacy
disorder, so couples work has to start with education about intimacy skills,
including honest self-disclosure, communication skills, healthy sex, having fun
and developing a joint vision of the future.
Rebuilding trust and forgiveness were key issues for the couple, Kathy and
Brad. Kathy took about a year before she could begin to trust and forgive. She
had to witness concrete actions from Brad including the commitment to his SAA
meetings and continuing treatment in individual and group counseling. She
needed to see honesty in all areas of life, dependability and consistency in
Brad’s actions. As a couple, they needed to spend more quality time together.
Forgiveness is a key ingredient in rebuilding trust. Forgiveness is something you
do for yourself, not for the other person. Forgiveness is freedom from
resentment. Partners of sex addicts rarely forget; Kathy spoke of painful images
of betrayal running through her head like movie reels. But she did forgive. She
reported that she still remembered the events, but the pain associated with the
memory diminished over the years.
With couples therapy over time, Kathy went from seeing Brad in a onedimensional way (“The Sex Addict”, “The Betrayer”, “The Bastard”) to seeing
him as a multidimensional human being who suffered from a debilitating
compulsion. Through involvement in her recovery from co-addiction, she moved
from being his adversary to his ally in recovery.
Kathy’s Point of View
“Imagine that your husband cheated on you with one woman. Now imagine that it was with
dozens of women,” said Kathy, 43, a nutritionist. “Sounds like Tiger Woods, right? Well, Brad
was the Tiger Woods of the Internet. He’d get incredibly graphic photos of women online and
then engage in smutty sex talk with them. And he used our credit card to pay for it! I feel
betrayed on so many levels — not only was Brad unfaithful but he had lied to me.
“This isn’t the man I fell in love with. Brad and I met at a party seven years ago and instantly
hit it off. He was handsome, funny, and interesting. And our upbringings were similar. We both
had parents who made us feel worthless. My mother was too self-centered to pay any
attention to me, and my dad was hypercritical. The men I dated before Brad were either
indifferent or constantly put me down — treatment I was used to from my parents. Brad was
different. He and I had a comfortable, easy relationship, and after two years we got married.
We decided not to have children because our own parental role models were so poor.
“About a year and a half into our marriage, Brad became withdrawn and sullen. He stopped
kidding around and wasn’t affectionate. Our sex life had always been great, but suddenly he
wasn’t interested. He’d spend hours tinkering in the basement. I had no idea what was going
on but hoped it was just a temporary midlife crisis.
“One day I went down to our basement to use the computer. I hit a key and up came a photo
of a naked woman on her back with her legs spread open. I was horrified. At first I thought it
was some random pop-up ad, but then I clicked around and found dozens of other images of
women engaged in all kinds of unbelievable sex acts. I snooped a bit more and found erotic
e-mails he’d written and even more photos. I felt as if I was married to a stranger. A perverted
stranger.
“When I confronted Brad, he said, ‘My friends and I goof around and sometimes exchange
photos. We’re just having fun.’ I wanted to believe him. We’d had a good marriage and I
couldn’t bear the thought of ending it.
“I lay in bed for three days, crying. I called in sick to work. I couldn’t talk to my friends because
I was too ashamed. Meanwhile, Brad kept insisting that I was overreacting. ‘You’re blowing
things out of proportion,’ he said.
“I worried that it was my fault, that he wasn’t attracted to me anymore. I’d put on weight since
our marriage, and even before that I didn’t have a body like the ones those online women
have. But they’re in their 20s, and I’m 43!
“I decided to try to get him interested again. I lost some weight and bought sexy
lingerie. Nothing has worked. In fact, Brad avoids me even more. We never
have sex. We barely talk, not even about what I caught him doing. It’s like
neither of us can bear to mention it. Mostly, we fight. I am so disgusted by his
porn problem that I wonder if I can ever trust him again.”
Brad’s Point of View
“I’m so ashamed of what I’ve done and how badly I’ve hurt Kathy,” said Brad, 43,
an X-ray technician. “She doesn’t even know how bad my habit really is, or how
much money I’ve spent on it. Cybersex is a sickness. I’ve stopped since she
caught me, but it’s a constant struggle to resist.
“I’ve been into porn since I was a teenager, when I’d sneak my dad’s Playboys from his
closet. He and I had a terrible relationship. The only emotion he ever expressed was anger,
and he was abusive, emotionally and physically. My mother was a total doormat. Even on the
rare occasions when she’d object to something he did to me, he’d shoot her a dirty look and
she’d back off.
“Dating was hard for me. I never connected with anyone, and none of my
relationships lasted long. I began dabbling in cybersex about a year before I met
Kathy, after a friend told me there were lots of hot women online who’d talk to
me. So I started going on adult sites and looking at photos of naked women.
Sometimes I’d e-mail back and forth with them. Then I moved on to the
telephone. I’d meet a woman online, I’d type in my credit card information, she’d
give me her phone number and we’d talk for an hour or two — for $12 a minute.
She’d ask me what kind of panties and perfume I’d like her to wear and what I
wanted her to do to me. As she’d talk, I’d masturbate. This happened about
twice a week. Eventually I started watching women performing sex acts on my
computer via live web cams.
“Then I fell in love with Kathy. She understood me, and together we laughed, went to movies,
and had fantastic sex. I felt more comfortable with her than with anyone I’d ever known. But
after we’d been married a year or so I started feeling out of sorts. I’d wake up anxious for no
reason. Being married felt like a burden. Basically I shut down.
“That’s when I turned to cybersex addiction again — my easy outlet, my quick
fix. Only this time I got more sucked in than ever. I’d be in the basement four,
five times a week. Sometimes I’d hear Kathy’s footsteps on the stairs and I’d
shut down the computer. Once she said, ‘You’re spending a lot of time online —
what’s going on?’ I said I was trying to sell stuff on eBay. Cybersex became the
most important thing in my life. Kathy and I were like roommates — the kind who
barely talk to each other.
“When Kathy discovered what I was up to, I tried to worm my way out of it. But I feel horrible.
I’ve been living in fantasy land, and I’m not sure I can stop. Kathy deserves better.”
The Therapist’s Point of View
“Not all experts believe that sex addiction is real. I do, and in Brad I saw the
classic case. He could not control his sexual thoughts and impulses and felt
compelled to act on them. His porn addiction had taken over his life and he was
lying about it.
“My first goal with this couple was to air the porn issue. Before coming to me they’d barely
discussed it. Instead they fought about things like who left the coffeemaker on. Neither had a
clue how to deal with the elephant in the room.
“In their first session Brad admitted to all that he’d been up to in the basement while Kathy
read or watched TV upstairs. ‘How could you?’ she wanted to know. He also confessed to
squandering nearly $25,000 on his habit in the past year, which he hid by snatching the credit
card bill as soon as it arrived. Shocked and enraged at all this, Kathy sobbed for most of the
hour.
“Even so, I could see the couple loved each other and wanted to save their
marriage. I explained the concept of sex addiction and urged Kathy to see Brad
as a human being with a problem, not a pervert. But her self-esteem had been
battered and she needed to feel secure. At my suggestion they moved their
computer into the family room and installed parental locks on adult sites.
“I also felt each of them would benefit from individual counseling. During my
sessions with Brad, we explored how his compulsion stemmed from his
childhood inability to please his father. After he married Kathy, similar anxieties
surfaced: that he could never satisfy her, emotionally or sexually. Instead of
trying to understand his feelings, he escaped to into internet porn addiction,
where he didn’t have to deal with a real-world woman or please anyone but
himself. As time went on he needed more and more intensity to get the same
high.
“By always keeping in mind the devastating marital damage that would result if
he gave in to temptation, Brad was able to control his impulses. He also joined
Sex Addicts Anonymous [SAA], where he had a ‘buddy’ to call for support.
“With Kathy, I helped her understand how her unhappy childhood had cast a shadow on her
adult life. She freely expressed both her bitterness about her past and her rage at Brad but
realized she had to move past them. I encouraged her to pursue activities that made her
happy, such as taking a writing course. Putting her feelings on paper boosted her confidence,
enabling her to empathize with Brad and to finally grasp that his cybersex habit had nothing to
do with who she was or how she looked. This breakthrough was key to repairing their
marriage.
“After a year of individual therapy the couple resumed couples counseling. This
time we focused on what was going right in their relationship. Kathy needed to
see that Brad was committed to reforming himself through addiction recovery,
and his hard work reassured her: He never missed a therapy session or SAA
meeting, and he not only pitched in more around the house but he also began
wooing her with flowers and date nights.
“Slowly their romance blossomed again. Today Kathy and Brad are transformed.
They enjoy each others company, go on weekend trips and have a robust sex
life. Brad still gets the occasional urge for cybersex, but he knows better than to
act on it. He’s taken on a leadership role at SAA, where he works with
newcomers. ‘I counsel men who pull over to the side of the road to watch
internet porn on their laptops,’ he said. ‘I feel so lucky I was saved — and our
marriage, too.’”
Chapter 7
12-Step Groups
Introduction
An effective approach to sex addiction treatment is The 12 Steps Program, involving group
membership and participation of peers through recovery. The program has it roots in the treatment of
alcohol addiction with a spiritual foundation. Since the program’s inception in 1936 by Alcoholics
Anonymous, the tenets of the 12 steps have been borrowed and modified, remaining a core component
of many other addiction treatment programs, including treatment for sex addiction. The 12 Steps
encompass levels of suggested progressions of lifelong healing. Central to recovery under the program
is the notion of “people helping people” such that those farther along in the program serve as example
to those who have similar afflictions and experiences. Personal stories by group members provide real
world inspiration to peers.
Within my practice, I recommend the 12 Program in unison with a therapeutic approach.
How Fellowship Heals
Sex addicts need to find positive activities as substitutions for their sexual acting out. For those who
choose it, 12-step meetings does this in abundance. The groups are comprised of many individuals
who care, who have similar stories and do not tire of hearing new ones. Because of this compassionate
support, members in the group may be able to gently confront the addict with his maladaptive
behaviors. Specifically, sex addicts begin to see that they share in common several behavioral
defenses. Defenses are the ego’s way of protecting one’s self from anxiety and in the case of sex
addicts often include:
·Denial, in which a person convinces himself that the unpleasant emotions are nonexistent,
·Rationalization, in which a person finds logical reasons to justify undesirable behavior, and,
·Magical thinking, an error in thinking in which an addict believes he can recover without
intervention, for example. It’s a form of self-protection which prevents inflicting new wounds
upon the self.
Sex addicts have in common a reduced capacity for impulse-control. In the 12 Step program, the
influence of these other individuals is gradually internalized, which means it becomes personal and part
of the self-governing structure of the self. The group itself, as a consistent, caring object also may be
internalized. Over time, the psychological wounds of growing up in a dysfunctional family can be
repaired through the acquisition of a new family that provides the empathic soothing and caring that
was missing in early childhood.
Sex addiction groups have regularly scheduled meetings with a predictable format, repetitive slogans
and messages. The structure of meetings provide a certain order -- a system --even ritual, which can
aid the addict in the development of healthy internalized self-governing structures.
Learning to Talk about Feelings
A mark of the addictive experience is feeling overwhelmed when faced with intense feelings. Some
addicts are unable to describe the sensations for which language seems inadequate. A 12-step meeting
offers a series of lessons that help find language to represent the self. The basic format of the meeting
is that people gather to speak of themselves and listen to others. This provides a powerful experience
in modeling how to use language to express feelings and experience, as well as reduce feelings of
shame. In this way, what was once felt to be unutterable is formulated into words which then defuse
overwhelming feelings.
Without influence, an addict’s central control is limited to his own way of thinking. There is a certain
type of control within the individual personality which can have its source only outside of the
personality - the moral principles advocated by a closely knit group. A peer group can effect change in
an individual against self-centered, gratification-oriented impulses. Instead, an involuntary feeling of
belongingness and allegiance to such a group takes hold.
The linchpin upon which the 12-step process is based is that an addict finally, unembarrassed,
acknowledges the need for participation in a caring community. The participation in the group is
understood that it exists without ulterior motives, and which accepts the individual totally for what he
is. A sex addict cannot thrive normally as a solitary structure; instead, it is essential that the self’s
survival and value require participation in a social structure or community. The development of a true
self is always participating with others in its realization and progress. Once this is acknowledged, this is
the beginning of the "unfreezing" of the developmental arrest and becomes an adaptive substitute for
the destructive, maladaptive addiction.
But it is only the beginning. The passage from infantile narcissism (or, having every whim gratified) to
emotional maturity and full humanity is ultimately accomplished by consistent immersion in working
the 12 steps.
How the Steps Heal
Step 1: We admitted we were powerless over alcohol - that our lives had become unmanageable.
The admission of powerlessness over the one's addiction is the first defeat of infantile egoism (an
immature view of self as foremost important). This is a first step in the assumption of responsibility.
During Step 1, the sex addict adopts the conviction that he can no longer engage in one's addiction.
This becomes an inarguable truth. The denial defense mechanism breaks down as the addict
increasingly sees that to give way to the impulse to "pick up" has far-reaching and devastating
consequences. The addict comes to terms with the essential paradox: you have to lose to win.
The term "surrender" permeates step work. There are two facets of surrender in the first step. The first
and surely the most significant, is formation of deep conviction that one is powerless over one's
addiction. One surrenders to the reality that he can never act on the impulse to "pick up". For
example, addicts progressing through this stage begin to view "One Day at a Time,” comprised of small
successes. This truth unfolds as recovery progresses. The second facet is that the addict is really
surrendering their sense of uniqueness. As one admits powerlessness, one no longer expects the world
to conform to one's own egocentric beliefs. The first step is a step toward "living life on life's terms".
It is making a decision that one is no longer driven by the desire for pleasure and is willing to be open
to accepting and coping with reality.
Step 2: Came to believe that a power greater than ourselves could restore us to sanity.
In this stage, the addict forms an openness to the possibility that a higher power exists. Such belief
propels an individual to develop boundaries. An egoistic perception is replaced by a new reality .
From a psychological developmental perspective, immature levels of personality structure are egoistic
in nature. All things seem related to one’s self, a condition that prevents the individual from seeing
others for who they really are. Rather, others are seen as extensions of oneself, making it impossible
for the individual to have anything but a self-centered point of view. The realization and acceptance of
some power need not be religious or even spiritual. The power merely needs to be seen as a force
greater than one's egoistic pursuits, and this puts in motion the abandonment of a grandiose posture.
One no longer expects the world to conform to the self’s own needs and wants. Rather, one learns to
live "Life on Life's Terms".
Step 3: Made a decision to turn our will and our lives over to the care of God as we understand Him.
This step suggests that another "surrender" be considered. Specifically, this step requires the surrender
of one's own willfulness in the decision-making process. When left to their own devices, addicts tend
to make decisions based only on their ego-centric motives and ways of seeing the world. The step
suggests a less self-driven version of reality which leads one to consider one's powerlessness over
many of the events that occur in one's life.
Step 3 sparks a renewal of trust in living and a loosening of ego-dominated self-sufficiency. Doing the
work of this step requires an understanding and acceptance of paradoxical thinking, meaning that the
addict learns he can achieve control by actually letting go of control. Prior to recovery, the addict
focuses intensely upon control issues (e.g., controlling use of the drug, controlling the amount of
damage caused by the using, and controlling emotional distance to minimize vulnerability). Such
focuses are held exclusive and sway over the addict's consciousness. Step 3 encourages a more
passive mode of letting go by surrendering and allowing events to unfold without futile attempts to
control outcomes.
Step 4: Made a searching and fearless moral inventory of ourselves.
This step represents the attempt to review one's life in as a meticulous and forthright way as possible,
listing the action and choices that have caused guilt and shame in oneself and harm to others. The
process of emotional development involves a degree of self-knowledge and self-awareness. This step is
an opportunity for the addict to see repetitive cognitions and behaviors that inhibit this process of
growth. When one sees the contribution that these "character defects" have made in one's own misery,
the process of projection onto other people and external events for unwanted inner states is reduced.
The focus in Step 4 is on the self and not the faults of others. The addict can't help but accept
responsibility for his life, a crucial step on the movement towards maturity.
The presence of the word "moral" needs special consideration in this stage. When the Dr. Jeckyll/Mr.
Hyde personalities of an addict (described in detail in another article – LINK) split the person
"dissociates" and, in a manner similar to multiple personality disorder, becoming two distinctive
personalities. The addict has his "normal" life and his "secret" life. The Dr. Jeckyll side of the
personality has one set of values, goals and beliefs, and the Mr. Hyde side has a completely different
set. I understand the despair, remorse and regret that follows an episode of acting out (When Dr.
Jekyll returns) as the realization that one has betrayed one's own values and moral injunctions.
Step 5: Admitted to ourselves, God, and another human being the exact nature of our wrongs.
The words "sex addict" and "secrecy" go hand in hand. The addict carries the weight of the knowledge
of what occurs in his "secret" world. If he shared the "secret" with another person, he would, in his
mind, be condemned to hell. He believes he would be despised. A diminishing sense of self esteem
contributes to a sense of isolation and alienation. With the 5th Step, the secret is out and this is good
news. The ability to know and accept oneself in the presence of complete disclosure to another
recovering addict is very freeing. One can let down one's defensive armor and have more of a sense of
ease with the world. The recovering person in revealing the content of their inventory to another,
defuses feelings of guilt and shame. Another significance of this step is that the paralyzing feelings of
isolation, fear, and mistrust of others begin to crumble as the interpersonal immersion in a caring
community begins.
Step 6: Became willing to have these defects removed.
From a psychological standpoint, an attitude of "willingness" is essential to the process of growth. It
puts the person in a less egocentric stance. It also conveys a breaking down of rigid defense
mechanisms that may have worked as a barrier of protection in the past to survive a frightening,
unstable childhood. Now, such defenses have outlived their usefulness and, in fact, contribute
negatively to the addict's here-and-now problems in living if they continue.
Step 7: Humbly asked Him to remove these shortcomings.
Humility is a word much discussed in 12-step meetings. It is desirable to have a modest view
of one’s importance. The posture of humility allows a person to quell excessive selfpreoccupation and instead, opens him/her up to having a sense of awe in the moment-to-
moment awareness of life, nature, God and fellow human beings. Gaining humility also
suggests a turning-point in personality development from the illusion of self-sufficiency to
having an interdependent view of relating to others, one that is reciprocal and enriching. Step
7 is the beginning of understanding that building character and remaining close to essential
values are more important activities than chasing the high of sex addiction. I quote from the
book Twelve Steps and Twelve Traditions (Alcoholics Anonymous Worldwide): "We never
thought of making honesty, tolerance and true love of man and God the daily basis of living.
We sought to gain a vision of humility as the avenue to true freedom of the human spirit."
Having a humble approach along with the admission of powerlessness leads to a softening of childish
demands for immediate gratification.
Step 8: Made a list of all persons we had harmed, and became willing to make amends to the all.
Achieving the quality of healthy interpersonal relationships is a mark of a person's stability and ability
to live comfortably with others. Here, we again come across the word "willingness", implying a deeper
insight into the self is necessary to overcome unnecessarily carrying responsibility for repetitive,
unsatisfying personal relationships. It is only by letting go of resentment of the (real or imagined) harm
done by others and instead focusing on what can be changed in oneself that the personality becomes
less emotionally vulnerable, less reactive, and more stable.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them
or others.
Step 9 is another deeply liberating step. After amends have been made, there are no reasons for the
addict to hide from the world for past deeds. Before recovery, those we were harmed or whom we
avoided out of shame had an exaggerated power over us. The step implies a readiness to take the
consequences of past behavior, which is important in developing new modes of being in the world. It
is an essential step in the development of a self and other orientation to living.
Step 10: Continued to take personal inventory and when we were wrong, promptly admitted it.
In Step 10 the goal is the development of better coping skills in dealing with the vicissitudes of daily
living. When thrown off emotional balance by people or new events, the process of taking a quick
inventory, admitting to errors in the now and and learning to forgive (or at least tolerate) the
imperfections of others is a sign of a stable person who has developed a new way of dealing with
reality. The practice of Step 10 releases one from the need to be right, and instead offers a truly
liberating way of operating in the world.
Step 11: Sought through prayer and meditation a conscious contact with God as we understood him,
praying only for knowledge of His will and the power to carry it out.
Research has consistently shown the psychological and physical benefits of prayer and meditation. The
person in recovery discovers that he is not a victim of his own mind and that he does have power over
the state of his inner life. Meditative techniques have a powerful influence in reducing the anxiety that
underlies most addictive behaviors. The individual can generate a sense of calm, focus and direction.
Psychologically, the 11th Step is a means for even deeper insight into one's motives and needs.
Recovering people are often befuddled about "knowledge of His will". It would seem to me that it is
not God's will, or anybody's will, that the addict return to using. It's probable that God's will includes
living a life that is not entirely self-centered or self-serving. Perhaps God's will includes living a moral
life, consistent with one's deepest values and beliefs. From a psychological standpoint, it is a conscious
contact with the higher self -- the best part of who we, as individuals, really are.
Step 12: Having had a spiritual awakening as a result of these steps, we tried to carry this message to
alcoholics and to practice these principles in all our affairs.
The inherently beneficial values of care for others, unconditional love, and genuine, honest relating
comprise the core of the recovery process, a process that produces a mature personality. Successful
application of this step would seem to define the essence of emotional maturity. To reach Maturity
means having an authentic self that has been able to develop adequate coping skills; a sense of
"agency" of the self that had been lost to the addiction; the ability to tolerate emotional pain with the
knowledge that all internal states are transitory; the development of healthy inter-personal relationships,
and a sense of purpose in living.
In summary, the addictive experience is marked by inter-personal difficulties and problems with
isolation, self-esteem, impulse control, lack of self-regulation among other symptoms. The problematic
dimensions of the addictive experience are addressed through the structure of "S" meetings. The
program, including the steps, provides cognitive strategies, compensatory mechanisms and
intra/interpersonal resources to assist the addict in successfully negotiating the vicissitudes of human
living and stay sober for good purpose.
Chapter 8
Hypnotherapy
Is Hypnosis REALLY a Serious Treatment Modality for Sex Addiction?
The usual response to the suggestion to one of my clients that hypnotherapy might be useful in the
treatment of sexual addiction is typical of the general public's misguided understanding of
hypnotherapy:
·"I'm afraid of going into trance - I might lose control"
·"You'll find out things about me that I don't even know myself",
·or, more typically, "I'm just not the type to benefit from hypnosis".
Hypnotic trance, however, is really nothing out of the ordinary; it is a natural experience that occurs
routinely in daily life. Daydreaming, fantasizing, driving a car, or watching TV are all trance states.
Almost everyone can be hypnotized. The old debate about whether or not a subject is "hypnotizable"
has become moot. Hypnosis happens when a person allows it to happen. A willingness to relax and
clear the mind, focus and imagine the things that are suggested lead to a receptive mental state which
induces a hypnotic effect.
A willingness to learn, and an attitude of receptivity coupled with practice, enhances the hypnotic
effect. Willingness is critical for you to experience yourself in a different way that effects change.
What is Hypnosis?
Hypnosis is an inner, altered state of consciousness in which the critical, logical, and conscious part of
the mind is temporarily suspended so access to the subconscious is available to receive suggestions for
new attitudes, beliefs and values. While you are in touch with the subconscious mind, new
psychological connections can be made.
When you can let yourself go into a goal-directed daydream, what happens is you dissociate yourself
from your surrounding environment. You become completely engrossed in your inner reality. You are
in an alternate state of awareness. This is called hypnotic trance.
While in a trance state one is open to suggestion and free to accept positive, healthy, constructive
suggestions without the interference of thoughts, objections, excuses and rationalizations.
How can hypnosis help recovery from sex addiction?
Hypnosis can stop the purely cognitive functions with which the person is familiar Hypnosis engages
him in new inner experiences which will produce new attitudes about sex This leads to a lessening of
the toxic core beliefs about the self which is the foundation for the process of addiction. Trance
induction is the use of the power of the unconscious mind to re-work the neurological wiring born of
childhood experiences. It is in childhood when unwanted, self-destructive impulses and behaviors are
first form and that continually result in adverse consequences. Trance induction allows development of
new pathways from that old wiring. Hypnosis is used to re-train your neurology to increase the ability
to tolerate unpleasant affects/feelings that are often triggers for sexual acting out.
Erotic Haze
In Chapter 2, I described “Erotic Haze”. The experience of the erotic haze is very intense and
compelling. One reason for its hold on people is that it is a psychologically stimulated neuro-chemical
state induced by the release of several brain chemicals. These include: adrenaline, dopamine,
endorphins and serotonin, all of which are produced and increased by the body when the sex addict
engages in intense sexual fantasy, rituals, and behaviors. In truth, maintaining the high of intensity
sensations which are evoked by sexual cruising and fantasy is more sought than the sexual act itself.
Like a gambler walking into the casino and before he even hits the slot machines, sex addicts are high
on their own neurochemistry long before actually acting out.
Besides the neuro-chemical high, what are the psychological factors that make this particular hypnotic,
erotic trance state so compelling for the sex addict? What makes this state so irresistible that money,
time, family, self-respect and sometimes sanity are sacrificed?
A Secure, Safe Place Within Yourself
A famous psychoanalyst once coined the term "holding environment", a normal condition which occurs
when an infant and an emotionally adequate mother form a bond that nullifies the infant's weakness
and creates a sense of being "held" in the world as the child grows to be a man.
During adulthood, the ability to draw on the earlier functions of the holding environment helps
maintain a stable sense of self. People who lacked an emotionally adequate mother (who could not
create this holding environment) will more often find themselves feeling anxious, fragmented, insecure,
and emotionally isolated. It is these chaotic, painful emotions that start the addict off in search of
immediate gratification through sex. In the frenzied search for a sexual encounter you may try to
recreate a holding environment that compensates for the lack of a secure sense of self and to rid
yourself of unwanted and uncomfortable feeling states. The choice of a specific sexual behavior may
be a compulsive attempt to find exactly the right way to be held - to be soothed, to be comforted - to be
re-assured.
Hypnotic techniques are effective in treating sex addicts because the sexually compulsive state (the
"erotic haze") is nothing more than a trance state in which you feel "held" in a constructive way. You
feel right at home in trance You’ve lived most of their lives in one. Hypnotherapy enables you to
experience a valuing, ego-enhancing, resourceful trance state that may enable you to find a way to be
(symbolically) held that leads to constructive, rather than destructive consequences. A good
hypnotherapist provides messages which inspire feelings of self-worth, self-value, plus the ability to
inhibit impulses. This allows you to tap into existing resources within so that messages are received at
a deep, unconscious level. Here lies significant potential to effect personality change at a profound
level.
Effective hypnotherapy helps the client to find parts of the self that sustain or restore the sense of a true
self so that aloneness is tolerated without the need to sexual acting out. Through self-hypnosis you can
experience a calming and self-valuing experience that is generated from within you. You can then be
freed from the prison of the compulsion to get your needs met by external sources that seem to always
disappointment. Moreover, hypnotherapy also affords a process of age-regression and re-framing that
allows for reparation of the original trauma of not being adequately held by an emotionally sustaining
mother.
New Attitudes towards Healthy, Related Sex
John Money, a famous sexologist, termed the phrase "Love Map" that refers to the programming that
each person has received from past experiences that give rise to your “arousal templates”. Using
hypnosis, mental models and arousal templates can be modified so that the urge for compulsive sex is
replaced with knowledge and appreciation of related sex.
Hypnosis enriches sexuality through six important facts:
1.Cognitive control is achieved.
2.Relaxation from anxiety and stress is accomplished.
3.Consciousness of one's own "thoughts" that may be negative about related sex can be recognized.
4.Positive imagery is used to enhance positive sex.
5.Natural physiological processes are freed to function normally.
6.The person acquires a new mental skill of self-control over his thoughts, emotions and over his body.
Sex, as we know, starts in the mind and physical responses travel downward. Hypnosis facilitates
healthy sex by changing negative attitudes toward sexuality, increasing communication between the
couple, and exploring new sexual techniques. Hypnosis can enhance the client's ability to focus
attention and increase sensory awareness, thereby facilitating increased arousal and pleasure.
It seems fair to say that hypnosis, perhaps combined with sex therapy, is the most effective way to
improve the human sexual experience. The recovering sex addict can be conditioned to want to
experience and enjoy person-to-person, mutual sex that serves to bond two people who care for each
other and know each other on all levels of intimacy.
Please contact my office to discuss your personal situation and to determine if hypnotherapy is right for
you.
Chapter 9
Neuro-Linguistic Programming
What is Neuro-Linguistic Programming (NLP)?
NLP is an approach to doing psychotherapy that was all the rage in the 70’s and early 80’s. It is a
model of the structure of your inner, subjective experience and how that experience influences
behavior. It provides a framework for eliciting the way you experience reality with a focus on
reorganizing that experience so you, as a human being, can optimally function in work, love and
recreation. NLP is designed to elicit information from the subjective (inner) world, to see the
limitations these experiences impose on each individual and to direct strategies to the conscious and
unconscious processes for the purpose of facilitating change towards a happier, more satisfying life.
How is NLP Employed in the Treatment of Sex Addiction?
Addiction, in all its forms, is a social epidemic and certainly represents an obstacle to a life well lived.
NLP’s methods, skills, and strategies (too numerous and complex to detail) allow for the construction
of a wider and more effective repertoire of internally generated alternatives to addiction. As is the case
with any major dysfunction or illness, sex addiction, or the process of being a sex addict, erodes the
internal repertoire of choices until life becomes determined by basically one primary factor: access to
sex and to the “erotic haze” that accompanies it. Stated in a different way, the acquisition of a sexual
“rush” determines the addict’s lifestyle and imposes severe limitations on life experience.
NLP offers “technology” for therapists to deliberately internally “install” various strategies and
processes, allowing you the required range of choices needed for you to move toward an addiction-free,
satisfying sense of well being in your life. It both increases your awareness of your internal processes
in measurable ways and provides specific methodologies for using information obtained through your
conscious/unconscious processes in the manner of one who has “enlightened self-interest.” If
internally no new choices or alternatives are generated in you, you will repeat – ad nauseum – choices
and behaviors that obviously no longer work in the present, but which at some point in time, appeared
to have produced results.
One of NLP’s precepts is that all behavior makes sense in the context in which it was originated (called
“Positive Intent of Behavior versus the Manifested Behavior”). Behavior, no matter how bizarre it may
appear to be (I think of fetishes), makes sense when it is perceived in the context of the choices
generated by the individual’s particular model of himself and the world. Addiction is not a matter of
making a wrong choice, but of not having sufficient internal choices – thus you act on old instruction or
generally outdated information that has no bearing on the present except that the present contains the
trigger that sets the old behavior in motion.
The more entrenched the behavior is, the more likely it is to be connected to early survival skills – the
need for protection, nurturing, feeling enlivened yet safe, or the need to explore the world as an
individual separate from mother (the sexual need for novelty and excitement). You can see that,
somehow-or-other, things went developmentally array in your childhood and the survival-seeking
pleasure of existence was not provided in the way you needed it to be provided. The result is that you
go to sexual excitement (remember of definition of sex addiction) to get non-sexual, emotional needs
met.
I suspect that the original positive intent of your behavior was to feel safe, valued, recognized, wanted
and alive. When compared to the “Manifested Behavior” – the addiction with all of its dreaded
consequences, you can clearly see that behavior that had an original positive intent in the past now
manifests as behavior that doesn’t satisfy your needs in a real, consistent, self esteeming enhancing
way, but rather produces most of the distressing internal and external circumstances of your life.
One of NLP’s contributions to sexual recovery is that it allows you to access and employ your internal
resources in order to have a repertoire of feelings and behaviors that you can refer to which can
appropriately take the place of compulsive sexuality by fulfilling some of your needs in realistic,
sustaining ways.
The NLP Strategy of Re-framing
“Re-framing” is an NLP stalwart strategy. To “re-frame” a stimulus (e.g. sexual urges) means
to change the meaning of the stimulus and thus to change the way you behave towards the
stimulus. To “re-frame” the past means to look at it differently in light of new information and
growing maturity.
When I was in therapy, I could only bemoan growing up in the chaos of life with two alcoholic parents.
I would regale the therapist with tales of the HORROR of it all! At some point in my development, I
began to have a series of positive memories about my parents. Although dysfunctional after their
illness took over, there were, in fact, many years of togetherness, closeness and fun. I have also come
to recognize that they were not bad people, just people with a bad disease. Despite it all, they managed
to march to the tune of their own drummer in terms of their lifestyle choices and engendered in me
enough love of learning to be able to write this book! So…voila! You can change the past, depending
on which frame you choose to put on it.
NLP uses a “Six-Step Re-frame” to work with a variety of unwanted behaviors, thoughts, feelings and
attitudes. In brief, these include:
Step 1: Identify the behavior to be changed.
In other words, what do you want and what stops you from getting there at this time. You may, for
instance, was to enjoy sexuality as an experience shared with a cherish partner that leaves you feeling
enlivened rather than depleted and self-hating. What stops you from getting there? Why, your
addiction, of course.
Step 2: Establish communication with the part of you that generates the behavior.
This is the part of you that revels in the experience of intense sexual pleasure and can’t figure out, for
the life of you, why you would ever want to stop. You need to understand that the addict part is part of
your early survival skills and will only change if presented with additional internal alternatives to the
addiction that responds as successfully, or preferably even better to the original needs.
Step 3: Separate the original, positive intention of the behavior from the actually
manifested addictive behavior.
Almost all of the techniques for recovery covered in this book include a process of “dissociating” from
the addiction.
Step 4: Create alternative behaviors to satisfy the intention.
Ask yourself: in what other ways might I feel safe, enlivened, protected? How might I give vent to my
leanings toward mystery, novelty and risk that aren’t sexual? Ask the “wise man” inside you for 3-5
ways of dealing with life other than with the use of sex or pornography.
Step 5: Check again with your “addict” part to see if he’ll accept at least one of the new choices.
Step 6: Ecological check.
The therapist asks you to check if there are any parts of yourself that appear to object to the preceding
negotiations and, if not, if you then feels that all of you is willing to support trying new behavior that
supports the original intention of the lustful behavior.
Summary
The Six-Step Re-frame represents some of the most significant models of NLP, the creation and
behavioral installment of an internal repertoire of choices to deal effectively with life events, the belief
that individuals have all the resources they need to lead satisfying lives, that the therapist’s job is to
help the client in accessing thee internal resources and that all behavior, no matter how bizarre, makes
sense in the context in which it was originated. It further demonstrates that there is a positive
connotation in all dysfunctional behavior. This connotation is the pivotal point for turning current
negative behavior around by offering an array of choices that responds more appropriately to the
original needs. Finally given the opportunity, the human being moves toward well being which can
only occur in the context of the continual creation of new internal alternatives and choices.
Chapter 10
PSYCHOPHARMACOLOGY
Sex addiction recovery typically involves at least psychotherapy,12 step groups(or Therapy Groups),
self-help groups and medication. Medication while not always necessary, can serve as the “water
wings “ for negotiating the changes necessary for growth .
Certain psychiatrists believe that addiction is maintained by mood-dependent motives and that
pharmacological treatment of the underlying mood disorder can diminish the urges and cravings
associated with the addiction to sex. Medications that enhance mood/feelings regulation also enhance
your ability to control impulses.
That there are chemical changes in the brain when you enter "the erotic haze" cannot be disputed.
Sexual arousal is a stimulated neuro-chemical state, induced by the release of adrenaline, serotonin,
dopamine and endorphins that occurs when you engage in intense sexual fantasy, rituals and behaviors.
You get high on your own neurochemistry long before you actually have sex. In fact, you may try to
stay in the "erotic haze" as long as you can, putting off any actual sexual release. A euphoric state not
dissimilar to the inner state of an opiate user occurs.
During recovery, certain medications can help sexual addicts alleviate compulsivity anxiety and
depression. Some medications act on brain chemicals linked to obsessive thought and behaviors and
reduce the chemical "rewards" of sexual behaviors. Which medication is best for you depends on your
overall situation and other mental health conditions or addictions you may have.
You may have to try several medications, or a combination of medications, to find what works best for
you with the fewest side effects. Medications used in addiction recovery treatment are often used
primarily for other conditions. They include:
·Antidepressants. Those most commonly used to treat compulsive
sexual behavior are selective serotonin re-uptake inhibitors (SSRIs).
These may include Prozac, Paxil, Zoloft and others. SSRi's often have
a side effect of a reduction in libido and sexual functioning which is
sometimes useful in recovering from addiction.
·Mood stabilizers. These medications are usually used to treat
mania, but research suggests that they also help addicts to reduce
uncontrollable sexual urges, in order to achieve sexual sobriety.
·Naltrexone. This medication is generally used to treat alcoholism/
and Drug addiction by blocking the part of your brain that experiences
pleasure from addictive behaviors.
·Anti-androgen. These medications reduce the biological effects of sex hormones in men and help free
them from addiction. Because they reduce sexual urges, anti-androgen are often used in men whose
sexual behavior is dangerous to others, such as pedophilia.
·Luteinizing hormone-releasing hormone (LHRH). This
medication may turn around the process of addiction and reduce
obsessive sexual thoughts by reducing the production of testosterone.
·Anti-anxiety medications. Examples include Klonopin, Ativan,
Librium, Valium and Xanax. These medications are used to reduce
serious anxiety and aggression in emergency situations, but are
generally avoided, as they may result in abuse of the chemical.
Chapter 11
MINDFULNESS MEDITATION
Introduction
Mindfulness is a method of awareness and introspection which involves a conscious attempt to focus
attention intensely on the present moment, noting thoughts, feelings, perception, images and sensation
without judging them, participating in them or acting on them. The contents of your mind appear and
disappear without reacting to them. You experiences on a fundamental level that every thought, desire,
urge or impulse dies a natural death if not fueled by emotional reaction or through behavioral
enactment.
What you can hope for initially is freedom from your fears and addictions to your desires, which can be
a hindrance to adhering to personal values and to the pursuit of meaningful goals in your life.
By becoming aware of inner body sensation, you can become aware of sexual urges before they
manifest in the form of thoughts, fantasies and behaviors. It also helps to manage strong emotions
(cravings and aversions) by using certain Buddhist-based cognitive strategies.
In my opinion, Mindfulness meditation can be used in treating sexual addiction, since traditionally it
has been used in treating cravings of all sorts. Working a successful relapse prevention program
requires enhanced awareness (mindfulness) of stressors, cues, triggers, thought processes, emotions and
cravings and urges that precede sexual acting out. Regular practice of meditation increases awareness
of all inner processes, including the ones that precipitate relapse.
Our perceptions are colored by emotions, desires, fears and fantasies. Sex addicts react more to their
own fantasized images project onto people than to the people themselves. Mindfulness enables you to
free your mind of all distorting influences and to achieve a state of equanimity or neutrality of mind.
How Mindfulness Meditation Works in Sex Addiction Recovery
The following mechanisms explain the ways in which mindfulness works:
·Anxiety reduction: Sexual addictions are mediated by anxiety reduction, not sexual desire
per se. Mindfulness meditation has been shown to reduce anxiety scores.
·Antidepressant effect: Sexual addiction can be described as a way of coping with
depression, anesthetizing painful feelings of loneliness, self-hatred and the dreaded sense of
emptiness experienced by so many addicts.
·Affect Regulation: Intense, painful feelings (affects) that you feels are overwhelming and
intolerable are neutralized and stabilized. When you can experience feelings as transitory and
ephemeral, the resulting effect is increased tolerance for distressing feelings and an
increasing ability to regulate your inner life.
·Development of healthy coping skills: Addiction is a misdirected way to cope with inner and
outer stressors. Meditation facilitates better coping mechanisms because without being in a
state of high emotional reactivity, your ability to cope with life by being present and not getting
overwhelmed or overly disturbed is enhanced.
·Mindfulness meditation helps to experience sexual cravings for sensation as the transitory
phenomenon that they are and increases a sense of detachment from these inner sensations that are at
the root of acting out.
·Mindfulness neutralizes emotionally charged traumatic experiences from the past that are stored in the
unconscious mind.
·The replacement of the altered state of consciousness involved in immersion in the erotic haze
("bubble") with the altered state of (higher) consciousness of meditation makes addictive behavior
unnecessary. Experience of a higher nature emerges during meditation which brings a new sense of
purpose in living. This new way of being (the "spiritual awakening" discussed in AA) assumes a
priority over the desire to indulge in compulsive sexual behaviors.
·Finally, when it is possible to free yourself from fears and fantasies, the mind attains greater
equanimity. You are able to self-sooth rather than having to chase a high from an external source. The
ability to exercise free choice is enhanced with a concomitant reduction in the shame of being out of
control and in a rise in self- esteem. When engaged in an active program of meditation, over time you
gradually aligns behaviors in a way that is consistent with your deepest values and long-term goals.
Shame and guilt are dramatically reduced. When peace is generated from within, the frenetic,
compulsive chase for sexual gratification that never quite satisfies is finally over. This state of mind in
itself is deeply satisfying and much more enjoyable than the transient and disillusioning excitement you
gets from addictions.
Suggested Reading
Insight Meditation: A Step-by-Step Course on How to Meditate
Sharon Salzberg
Meditation for Beginners
Jack Kornfield
Wherever You Go, There You Are
Jon Kabat-Zinn
Mindfulness in Plain English
Bhante Henepola Gunaratana
Everyday Zen: Love and Work
Charlotte J. Beck
Nothing Special: Living Zen
Charlotte J. Beck
Mindful Recovery: A Spiritual Path to Healing from Addiction
Thomas Bien, PhD. And Beverly Bien
(Audios)
Mindfulness for Beginners
Jon-Kabat-Zinn
Guided Mindfulness Meditation
Jon-Kabat-Zinn
Mindful Solutions for Addiction and Relapse Prevention
Stephanie Goldstein, PhD.
Guided Meditation (6 CD set)
Jack Kornfield
Useful Links
www.insightmeditationcenter.org
www.learning-modern-meditation.com
www.mindfulnessmeditationcenter.org
Chapter 12
“Brainlock” -- a Behavioral Modification Program.
“Brainlock, a 4-Step Self-help Guide for Treating OCD” is a book written by Jeffrey
Schwartz, M.D., a physician who spent most of his career treating and doing research
on Obsessive/Compulsive (OCD) behaviors. His has developed a four-part program
self-help program that can be used for any unwanted compulsive urges, desires and
behaviors.
Let’s go through Dr. Schwartz’s four-part program. It is similar to what I’ve written about
Relapse Prevention, but the point can’s be driven home enough – that if you immediately change
your behavior when you get an urge, the changed behavior will sooner of later create new neuropathways in your brain that will re-enforce your abstinence.
Step 1. “RELABEL”
You learn to Relabel unwanted fantasies, urges and behaviors. Call them
what they are in reality: the voice of your addiction. Addiction is a biological
condition that has to do with an imbalance of certain endorphins, mainly
dopamine and serotonin. It sends false messages from your brain, and you
are to recognize them as such. You must make a conscious effort to stay
grounded in reality because you must strive to avoid being tricked into
thinking that a sexual urge or craving is based on a real need. It is not.
Your sexual urges are symptoms of obsessive-compulsive disorder, combined with an impulsecontrol disorder, both of which are medical issues. Relabeling simply means calling the
unwanted cravings and urges by their real names – the voices of your addiction.
This is war and the enemy is the addiction monster in you. When
overwhelmed by cravings, you can say to yourself “It’s not me – it’s the
addiction.” You work constantly to prevent confusing your true self with the
voice of addiction.
I’ve been in AA recovery for 33 years. When I first started going to meetings, I would
hear, from time to time, someone say “The Disease Talks to Me”. What that meant, I
had no clue. It took years of recovery before I could cultivate a sense of myself as a
whole person who heard the voice of the addiction as something that was there, but IT
WAS NOT ME. A kind of separation had occurred between my true self and my
addictive self. All these years later, the addiction still whispers in my ear from time to
time, but I get amused, I don’t listen to it, and let it go on it’s way so that I can engage
in behaviors that are either productive or enjoyable and have no negative
consequences to my self-esteem.
The Impartial Spectator
Dr. Swartz, I think, may have been trained by a Buddhist-teacher. The development of the
“Impartial Spectator” evolves through Mindfulness Meditation (see Mindfulness article).
As I wrote in my article on relapse prevention, mindfulness awareness is essential to a sexual
recovery program. Awareness requires you to consciously recognize and make a mental note of
a disturbed feeling or urge. Your goal is to observe them rather than act on them. When you
develop a relationship with “The Impartial Spectator”, you can step back and say to yourself,
“This is just my brain sending me a false message. If I change my behavior at the point of the
urge, I’ll actually be changing how your brain works.”
Once a person with a compulsive disorder learns behavior therapy and resolves to
change his response to an intrusive sexualized thought or fantasy by not performing a
pathological behavior, a willful resolve gradually kicks in because a sense of personal
empowerment starts to develop.
Think of the “Impartial Spectator” as a vehicle for distancing your real person from your
addiction. Create a safety zone between your internal self and spirit, and the unwanted
compulsive urge. Rather than respond to the urge in a mechanical, driven way, you present
yourself with alternatives. It’s good to have some alternative behaviors up your sleeve, so you’ll
be ready when the voice of the “erotic haze” calls you.
RX: Action
Learning to overcome sexual compulsion is like learning to ride a bike. Once you learn, you
don’t forget, but getting good at it takes practice. In your recovery, it’s likely that you may fall
off, but you must get back on. If you give up, you’ll never learn. And you learn by falling off!
Passivity is your enemy. Activity is your friend. Having things you really need to do –activities
much more productive and creative that the illusional, nonsensical sexual ritual – is a great
motivator.
When you are capable of seeing quite clearly the difference between healthy behavior and
compulsive behavior, you are able to bring yourself around by zeroing in on reality.
A client of mine who used this system stated: ”Before, I was overtaken by sexual fantasies, urges
and cravings. I was overwhelmed. Now I know where they are going to get me – back in the
same self-hating self I don’t want to be in. So I’m ready. I don’t listen to my addiction because I
know it’s fake. I let it go quickly and so something that’s real and authentic.
STEP TWO: RE-ATTRIBUTE
If you wonder why you never seem to be free of sexual preoccupation, one of the
answers is that research has shown that the addictive brain is related to a biochemical
imbalance in the brain. In the Re-attribute step, you learn to place a lot of the blame
squarely on your brain: The addictive brain sends you a false message. If you change
the way you react to the false message, you can make your brain work better. Your
urge to go, puppet-like into the “erotic haze” will diminish. The pervasiveness of these
fantasies or urges in not a personal weakness. It is a false alarm caused by a short
circuit in the brain. When sex addiction sends a false message to your brain, you can’t
make it go away, but you don’t have to act on it.
If you have understood so far, perhaps you can use the author’s “fifteen minute” strategy. When
you get an urge to act destructively, wait for 15 minutes. During this time you actively keep
telling yourself, “These are not real thoughts. They are faulty messages from my brain.” After
15 minutes, the urge usually goes away and you begin to see that you have a sense of control
over your addiction. You are no longer a passive victim to addiction.
At some point, when sexual fantasies and desires to act out occur you realize – You are not going
to do it. Why not? BECAUSE THE REAL YOU DOESN’T WANT TO DO IT!
STEP 3: REFOCUS
Refocus tells you what to do while are trying to overcome urges to do compulsive
behaviors. It instructs you to “work around” those nagging needs by Refocusing your
attention on some useful, constructive, enjoyable activity. The key to the Refocus step
is to do another behavior/concentrate on something else. When you do, you are
repairing the broken gearshift in your brain. Your brain starts shifting more smoothly to
other behaviors.
You have to step aside, put the erotic pull aside, and work around it by putting your mind in
another place and doing another behavior, one that is more pleasant and functional.
Once you realize that the things that call you erotically have no deep meaning, that they’re just a
false alarm, a ghost from the past, you be able to largely ignore them and go about your business.
STEP 4: REVALUE
Revalue is an outcome of having worked the first three steps. With consistent practice, you will
quickly come to realize that your obsessive thoughts and compulsive behaviors are worthless
distractions to be ignored. With this understanding you will be able to devalue the pathological
urges and fend them off until they begin to fade.
If you do not actively Revalue these thoughts and urges as false messages coming from the brain
– messages with no spiritual, productive or inter-personal value whatsoever –and, if fact, are
shame filled and demoralizing.
The more clearly you see what the symptoms of sexual compulsions really are, the more rapidly
you can dismiss them as worthless garbage that are not worth paying attention to.
It would be good to use the Four Steps for gradually increasing periods. This means telling
yourself , “It’s all right – it’s just the voice of the addiction (Relabeling; then Re-attributing it to
faulty brain chemistry; Refocusing on a constructive, enjoyable behavior instead of one that will
lead you to the road of self-hate. Finally, Revalue the meaning of those fantasies or urges. You,
in essence, devalue those silly thoughts.
Dr. Jeffrey M. Schwartz wrote an exceedingly interested book that helps people deal with OCD
symptoms. I highly recommend this book because it can be applied to all compulsions,
including the prison of sex addiction.
Sex addiction is an impulse-control disorder; it is not an OCD syndrome. Compulsive behaviors
differ from OCD in that there is intense pleasure in sexually acting out; whereby there is not
pleasure in an OCD person washing her hands repeatedly. Frankly, it makes the job a bit harder
because the dopamine rush of the “erotic haze” and the intense pleasure of acting out can seem
irresistible.
The key problem in therapy for sexual addicts is how much people with this disorder make the
excessive, problematic, out-of-control and shaming behaviors “ego-dystonic,” that is, how much
can they come to find their behavior genuinely foreign to their own notion of who they are;
different than the values, goals and meanings that they most cherish.
People who are addicted to intense sexual pleasure come to expect pleasure to be taboo,
secretive, chaotic, and both soothing and exciting. Do they miss out on the extraordinary
pleasure that can be received from living a mindful life, staying in the now, and taking pleasure
in eating a peach or cooking a meal or seeing a sunset? This, too, is pleasure.
The Buddha warned against “cravings”, especially sexual arousal. He saw these constant
longing, wanting, cravings, to be the type of “attachment” that keeps people in “samsara” (the
suffering of life). His first Noble Truth was that life is suffering. The second Noble Truth was
that people suffer because of “cravings.”
We should live life with pleasure not for pleasure. Pleasure is ephemeral. The process
of obtaining intense sexual pleasure promises what it can’t deliver.
That’s why you feel so disenchanted, let down, shamed and disappointed after you act out. You
chase idealized perfect visions that turn out to be dust in your hands.
Chapter 15
From Sexual Addiction to Sexual Fulfillment
Over the years, the people I have worked with have used various words to describe the
end result of their compulsive sexual behaviors: words like shame, anger,
depression, anxiety, disappointment, self-hatred, hopelessness and
helplessness, usually describe their subjective experience after the orgasm is over.
Never have I worked with a person who described their sexually addictive experiences
with words like, fulfillment, satisfaction, closeness, or ecstasy.
Yet these are the kinds of states that optimal related sex offers. Exciting,
healthy, hot sex, comes from being relational, that is, connecting deeply
with both yourself and your partner. We are sexual beings from the day
we're born until the day we die. Sex is fundamental to our lives and seems
to be the area of life that most deeply touches our most personal issues.
Our sexuality is a core expression of who we are. We can hide with sex, we
can hide from sex, but when we are fully ourselves sexually, we no
longer have to hide.
For the sex addict, physical pleasure is fleeting and is only a numbing source for the excruciating
emotional pain that triggered the sexual act. It’s a fallacy for anyone to think that sex addicts
gain fulfillment from the sex act.
However, sexual desire and pleasure is our birthright. After all, we were created naked and with
complementary genitals. There must have been a plan in mind.
“We can hide with sex,
we can hide from sex,
but when we are
fully ourselves sexually, we no longer have to
hide.”
Good sex is a complex concoction of openness and secrecy, balance, risk
and control, and personal satisfaction. These ingredients foster mutual
fulfillment. Good sex –the quality kind that exists between healthy,
consenting partners – requires an ability to be totally immersed in the
moment (which is difficult for most people), ever-present to the sensuality
of yourself, your partner, and attentive to life. Exciting, hot sex comes from
being relational, that is, connecting deeply with both yourself and your
partner.
Can a sex addict return to the natural expression of sex and receive its benefits?
After you achieve a period of abstinence from self-destructive sexuality, you’re able to focus on
personal growth and intimate sexual relating. (Katehakis, pg. 67) A program of comprehensive
sex addiction therapy is a gradual process of moving from the addiction “arousal template” in the
brain, to a different (healthier and ultimately more satisfying) template. It’s a process of
redefining sex, and changing the addictive imprint born from faulty understandings about
sexuality and intimacy.
Exciting, intimate, tender, ecstatic, hot sex is attainable if you’re willing to
change your focus from non-related, self-centered sex to the joy of knowing
yourself and your partner in sexual ecstasy.
Chart Your Course and Choose the Path
In order to arrive at a destination, you have to have a map of the territory and a view of
what the destination holds for you. There are two paths from which to choose with one
path heading towards a healthy life, and the other towards self destruction. Knowing
the differences between compulsive sex and wholesome, related sex serves as the
compass for the journey.
The Gratification Difference
Addictive sex is based on immediate gratification and surrender to acting on impulses. Mature
sex is a choice; one that entails focusing on the entirety of the experience, not just the immediate
gratification of orgasm.
The discussion in this book so far has focused primarily on the different
ways to cease and desist sexual behaviors that you know are eroding your
self-esteem and your relationship. In AA terms, this involves “putting the
plug in the jug” of destructive behavior so that the business of recovery can
begin. Learning to choose how to stop the destructive behaviors and to
make a conscious choice about how to channel your sexual energies is
“clearing the runway” for optimal sex to develop.
The Urgency Difference
Addictive sex is compulsive sex, while sexual celebration emerges from conscious
deliberate choice. The compulsion of addictive sex, must be disentangled, understood
and put to rest. Psychoanalyst Sigmund Freud coined the term “repetition compulsion”
and it is referred to by therapists when they talk about an addict doing the “trauma”
work. You keep doing “it” (the sex act) over and over again until you get it right. But
you never do – get it right – because “it” happened in times past and the behavior is no
longer appropriate for your adult self. Having a sexual compulsion is like dying from
thirst, but always going to an empty well to quench it.
Compulsion is a mental pressure of internal origin compelling you to think, act, or react in
accordance with specific urges and energies that do no coincide with your habitual patterns of
thought. For a person with a sexual compulsion, there is a “must have” quality to a particular
sexual experience, regardless of a partner’s wants and needs. A compulsion is an irresistible
impulse to act, regardless of the rationality of the motivation. There is a sense of being driven; it
is obligatory -- somehow destined to occur despite your better judgment. Compulsion’s home
base is the unconscious mind where hurts and traumas of past experiences reside outside of
conscious awareness.
“Sexual compulsion” is an attempt to “undo” the traumatic experiences of the past.
You were powerless to effect change as a child because you didn’t have the resources
to take care of yourself. As an adult, through a repetition compulsion, you can achieve
a sense of mastery over the sense of helplessness you experienced as a child. But
this is faulty thinking.
A case in point:
A new client came for a consultation recently. His distress was centered around compulsive
enactments of themes of sexual dominance and submission where the female is fearful and
vulnerable and he assumes the power in the play. While he didn’t report any family-of-origin
traumas, he reported that he’d always had “a touch” of autism as a child. He felt disconnected to
his peers and especially shut out from the mystifying world of girls.
When he understands that his sexual fantasies and enactments were devised for him to
take an active role in contrast to his passive experiences of being socially unwanted;
when he recognizes that his sexual desires were based on a need to feel in control in
contrast to his childhood feelings of powerlessness; when he discovers and
acknowledges his own sense of self-esteem and appropriate self mastery, my hope is
that he will be relieved of the compulsion and be free to explore equality in his
relationships with women.
In another case:
A former client had witnessed the protracted suffering and death by cancer of his
beloved mother when he was six years old. His father was not able to give him the
space to grieve the death, telling him he needed him to be the “little man” in the family.
Years later, with unresolved grief as a catalyst, he became a compulsive cross-dresser
and ruined his marriage. If he hadn’t been able to keep mother alive back when, he
would keep her alive through becoming her in his cross-dressing erotic haze. Only
when he was able to “do the grief work in therapy” was he able to lose interest in
wearing women’s clothing.
Healthy sex enhances your self-esteem and allows you to enjoy and control your sexual energies
without guilt, fear or shame.
Shame strikes deepest into the human psyche; it is a sickness within the self, a disease
of the spirit. It is the feeling of indignity, of defeat, of transgression, of inferiority and of
alienation. Shame is experienced as an inner torment. It is a wound made from the
inside, dividing us both from ourselves and from one another. Shame violates our
essential dignity as human beings.
The person feeling shame thinks, “Whether all eyes are upon me or only my own, I feel
deficient in some vital way as a human being.” The disturbance within the self produced
shame, impacts not only self-esteem, but also the development of identity and the
pursuit of intimacy. When shame captures the addictive personality, it grows like a
cancerous growth. Shame precedes and enables sexual addiction. It follows sexual
acting out. Addicts often suffer another bout of sexual acting out to alleviate the shame
of acting out! Until treatment, it is a vicious, never-ending cycle.
Children can experience shame beginning from a very early age. Dysfunctional
(non-nurturing) families that are emotionally, sexually or physically abusive serve as the
spark that heats hot-beds of shame for their off springs. Neglect that is physically or
emotionally depriving also contributes to the formation of a shame-bound personality in
a child. The family isn’t the only source of shame; problems with peer relationships at
school can also be very traumatizing.
When an afflicted child reaches adulthood, he is haunted by shame. Combine this
with the cultural messages about the “sinfulness” of sex and that a large part of the
population feels shameful about sexual needs. Indeed, many of the dynamics of sex
addiction are about managing sexual shame. Intense sexual arousal obviates sexual
shame and allows for sexual activity. Sexual addiction makes sex so desirable it
overrides shame.
Shame is an integral part of your “Addictive Prison”. In the first place, shame-bound
people do shameful sexual behaviors. So shame precedes the acting out. There is one
particular feature of every addiction which is central to understanding the addictive
process: a profound, discouraging sense of powerlessness over the addiction. The tail
increasingly comes to way to dog, engendering shame about the addiction itself. We
feel humiliated whenever we feel controlled by anything, but especially in the sexual
experience because of the shameful connotations communicated by family, church and
culture that sex is “bad”, “sinful”, “shameful”. Each time there is failure to break the
addiction and regain power over it, the sex addict feels defeated. He grows to hate
himself, disgusted by the helplessness, the lack of resolve, the lack of inner strength.
Getting treatment for shame is an essential part of recovery from addiction.
The Substitution and Escape Difference
Those who have a healthy sex life do not need substitutions or escape mechanisms in their
relationships. In contrast, the sex addict requires it.
The addiction serves as a substitute for shame-bound interpersonal needs. For example, the
alcoholic who has a relationship with his bottle has substituted something else for a human
relationship. All compulsive sexual acts are substitutes for human needs about which you feel
shame.
The addiction also functions as an escape from intense shame. Feelings of shame
encountered anew in daily life, may serve as triggers to re-experience shaming
experiences from early life. These often trigger an episode of sexually acting out, as a
way to soothe the pain of shame. However, each new addictive episode also
reproduces shame, which then activates the entire cycle, all over again.
The Truth Difference
In contrast to shame-based sex addiction, celebratory sex is open, not hidden. It involves honest
communication between lovers, not lies and duplicity. Healthy sex exalts the individual and the
couple. Sex addiction destroys both.
Right now, you maybe you have the experience of having two selves: the private self
and the public self; the solid family man and the sexual deviant; the social self and the
self that may spend six hours a day in isolation looking at pornography. I call it “The Dr.
Jeckyl and Mr. Hyde” syndrome.
Your “Secret World” is separate from your public self. The overwhelming need of your
secret self is to protect it and hide it from other parts of your life. If addictive sex requires
a double life, healthy sex enhances and celebrates who you really are, increases self
esteem, and is empowering.
“Lying and Duplicity” are Necessary to Keep Your “Secret World”, Secret!
Pivotal to all addictions is the defense mechanism of denial. It’s been said that DENIAL means
“Don’t Even Know I’m Lying”. So you lie to yourself. You lie to yourself about how out-ofcontrol you are, that you have a serious problem that requires professional treatment, that you’re
not hurting your spouse and children, that you’ve been isolated from friends and have stopped
hobbies and activities that you used to enjoy.
Shame is again the culprit. You feel that if you told the truth about your sexual experiences,
you’d be shamed, humiliated, rejected and abandoned.
Part of clearing the path to healthy sexuality means telling the truth about yourself – in a 12-step
program, to a trusted therapist or a close friend. Eventually you’ll need to have an open, honest
dialogue with your partner about your addiction.
“It is impossible to have an intimate, connected relationship with another person if you
carry a back-pack of secrets and lies.”
The Maturity Difference
Optimal sex requires a degree of psychological maturity. Perfect fulfillment of sexual potential
is never achieved. It is a lifelong pursuit of personal development. It involves the conquest of
self-centeredness, the transcendence of personal limitations, and the dauntless struggle to be fully
human and fully sexual with a cherished other. The depth of connection in related sex far
surpasses the fleeting physical pleasure of a sexually addictive behavior. Erotic, mature, intense
sex makes sex addiction look like child’s play because it requires maturity and mutual caring for
another that only an adult can bring into play.
Sex addiction is immature and narcissistic (self-centered). Like an infant, you require
immediate gratification and cannot put off gratification in the service of a long-term goal.
You may have problems in self-regulation. You cannot regulate your feelings internally.
You need a sexual activity to help you feel good. Also like infants and children, you
don’t have the ability to control your impulses. Impulse control is a mark of a healthy
personality which can reflect on impulses and urges, think them through, and make
decisions to let them pass.
With healthy sex, you have awareness and empathy for your partner’s experiences.
True eroticism arises from the particular energy created by two people who care for and
respect each other. Most therapists in the sex therapy field focus on being able to
sexually function. But “optimal” sex includes consideration of eroticism, intimacy and
personal meaning in sexual behavior. The human capacity for intimacy and attachment
gives profound emotional meaning to sexual experience. With these factors in place,
human beings are capable of profound sexual experiences.
The Scattered Mind vs. Moment-to-Moment Awareness Difference
Sustaining a healthy, balanced sex life requires mindful attention to your senses, to the
physical, emotional, intellectual and spiritual dimensions of yourself, as well as your
partner. In profound intimate sex, nothing exists beyond the immediate presence of the
two partners. Awareness of the room, or even the bed, may cease to exist as you are
embraced by the sensual, erotic sense of the NOW.
The mind is scattered when involved with addictive sex; thoughts run the gamut of
thoughts about past sexual splendor with no recall of the negative consequences
(euphoric recall) to thoughts about future sexual exploits (fantasy). However,
sumptuous sex with a cherished other requires the ability to maintain awareness of
moment-to-moment sensation. Depth of involvement in a sexual trance increases as
day-to-day reality fades, replaced by increasing concentration on the sexual reality of
the moment. At profound depths of involvement in the sensual/physical/sexual moment,
the individual becomes totally absorbed in the sexual reality and loses awareness of
extraneous events. There can be an ecstatic sense of preoccupation and
transformation in which self and other become one.
According to the wise words of Sophocles, "KNOW THYSELF" in order to know what
you want and need sexually. Then you need to have the courage and self-assurance to
communicate these desires to your partner, even in the face of possible rejection. You
are ready for intimacy and related sex only after you have achieved a core sense of
identity.
The outstanding quality of intimacy is the sense of being in touch with your
real self. When "the other" also knows and is able to express his real self,
intimacy happens. Intimacy can be defined as a close, trusting relationship
between two people who are both willing to be emotionally open and
honest with each other in spite of the risks that may be involved. Intimacy
is also the joy of being known and accepted by another who is loved. The
quest for intimacy is one of the oldest themes in Western civilization.
However, although most people chase after intense sex and intimacy, few
seem truly willing and able to find it.
Through the experience of intimacy, you may experience yourself in some new, different, and
more profound way. When I am close, I know you in your presence; when I am intimate I know
myself in your presence. Intimacy is a remarkable experience. To feel and know myself in the
presence of another is enlivening, enlightening, joyful and freeing. I can be who I am freely and
fully in the presence of another. It is the only true freedom we have as human beings.
Sexuality is both an expression of that intimacy and a bond that enhances intimacy. With this
kind of personal/sexual intimacy, your growth experience as humans is energized, enhanced, and
fueled. Intimacy is the most meaningful and courageous of human experiences. Through its
experience, it is possible for you to “grow yourself up.
Your personal well being and your ability to be intimate with another cannot survive your
dislike or disrespect of yourself. If you dislike yourself, you’ll never be comfortable with
your sexuality. If you hold a lot of self-judgment about your past sexual behaviors,
identify yourself as a whole, valuable person who has an addictive behavior.
Remember – who you are essentially is separate from your behaviors.
Sex addicts escape into the “erotic haze” which involves dissociation from true feelings; healthy
sex opens a person up to tremendous depth of feelings. In the addictive sexual state sexual
experience is an avoidance of connection with your partner and your own feelings in the present.
Addictive sex is devoid of love; in sexual recovery, sex is an expression of love. In intimate sex,
you no longer hide out through fantasizing about others or dissociating. You are fully present
with yourself and your partner, preparing for your journey into the erotic.
Good communication is crucial to healthy sex. You can greatly increase feelings of mutual
respect, emotional closeness and sexual pleasure when you and your partner know how to
communicate well with each other. Knowing how to talk openly and comfortably about sexual
wants and desires can help you address issues that come up from time to time in the normal
course of an on-going intimate/sexual relationship.
The “Inner Validating” vs. “External Validating Difference
Addictive sexuality involves the search for “reflected validation”; that is, “if she/he desires me, I
feel validated.” Healthy sex requires self-validation. You know you are sexy and desirable
because your sexuality is a God-given part of who you are. You have no need to validate your
sexuality through getting or not getting any particular response from your partner or through a
fantasy connection on the computer.
Self-validation produces an enhanced sense of self. Being “other-validated” you put your value
as a person in the hands of other people. You sculpt your behavior and attitudes on the basis of
not being rejected or judged by others. If you have a reflected sense of self, you see the result of
your actions as though through another’s eyes.
You can never have an authentic sense of self if you are “other-validated”. The
fear of being separated, rejected, abandoned or judged makes you concerned with the
response of the “other” or “others”, and so keeps you from being your real self and
ultimately prevents you from loving, since loving involves disclosing your true and
authentic self to another.
An Expanded Vision of Sexual Fulfillment
What prevents people from experiencing the upper limits of human sexual potential?
·Adherence to rigid gender-role stereotypes where sexual behaviors are dictated by cultural
gender norms.
·Viewing the goal of sexuality as intense orgasms. For some, the number of
orgasms rather than their quality is the key to sexual fulfillment. It is a misconception
that orgasm and repetitive copulation capacity is the sole determinate of sexual
satisfaction. While orgasms are undeniably erotic, orgasms and eroticism are quite
different things. The fulfillment of sexual potential involves experiencing the upper limits
of physical sensation together with the capacity for intellectual, emotional, aesthetic,
and spiritual connectivity. Intense sexuality occurs within a context of profound emotion
and meaning.
The focus on intercourse in “normal” sexuality keeps dysfunctional gender-roles
in place. In this culturally embedded view of sexuality, the man must PERFORM and
the woman must be desirable. The focus on male sexual potency creates the most
common problem in sexual relating: PERFOMANCE ANXIETY. In addition to his
concern about the size and function of his penis, the male may have shame about his
anxiety! Now, how sexy is that? The man thinks he shouldn’t be anxious and feels
shameful. The result is that he becomes more emotionally isolated from his partner and
more turned off. Sex becomes something that isolates the lovers rather than bringing
them closer together. Sexual intensity is more a function of emotional maturation than
of physiological responsiveness.
The sex addict’s pursuit of intense orgasms per se, often interferes with repeated attainment of
transcendent eroticism and intimacy. As you know, orgasm can (and often does) occur without
profound personal meaning. The capacity for intimacy and intense, hot sex is a function of
personal development, rather than on physiological functioning.
·Seeking personal validation through sexual performance, It is essential that you
detach your self-esteem from your sexual “capacities,” and gender-role behavior.
Adequacy and eroticism should be detached from sexual functioning. There are
handicapped people who transcend their disability and maintain eroticism and selfesteem intact, even though they violate normal social expectations. Self-worth derived
from sexual performance perpetuates the continual need to perform with its attendant
anxieties.
·Lack of partner engagement. Self-centered, compulsive sexuality, in recovery, will
give way to a caring attachment to a partner. The partner is seen as the individual
person she is, rather than solely as a sex object. Sex addicts sometimes have deficits
in empathic listening and relating skills and may need to learn them to have more
satisfying relationships. In the intimate and sexual bond, you appreciate your partner’s
core potentialities, strengths and assets; as you disclose your wants and needs, you
also are accepting of the partner’s self; loving synergy is involved in partner
engagement.
·Misconceptions about the function of intimacy. I’ve worked with people who say
they want a healthy relationship. What, in fact, they are doing is desperately seeking
someone to reassure them that they are worth loving. The quest for intimacy is not
about the trials of knowing yourself and letting yourself be known; it’s about the quest
for a “reflected” or “other-validated” sense of self. These people have ego deficits in
validating and soothing themselves. Some people think they seek intimacy when what
they are doing is looking for someone to help carry the burden of a dissatisfying
relationship with themselves. When intimacy and sex are pursued to validate your selfimage and self-worth, you will never be able to really see and acknowledge someone
else. Moreover, you will never know your true, authentic self. The ability to selfdisclose and self-validate in the absence of validation from others is a disquieting and
challenging task, but it can be done. People involved in these types of “validate me!”
relationships become over-sensitive, reactive, combative, and controlling. This is not
the stuff that hot, loving sex is made of.
Does SexTakeWork?
For some people, climbing a mountain is unthinkable work; for others it is a vacation.
The sex addiction fantasy is that sexual gratification involves no effort at all. It’s like
wanting to have the benefits of running a marathon without ever actually running. Good
sex requires effort – but its effort that can result in self-transcendence and self-andother celebration. The romantic view of sex suggests that if you love your partner
(enough), and if your partner loves you (enough), desire and performance naturally
follow. Working at desiring sex is a bit tricky. Pushing yourself to desire when one is
not desirous is self-defeating. But working at the things that might effectively increase
desire for sex often requires advanced preparation.
This might include scheduling an “intimacy time” with your partner; sending the kids to
grandma’s for a few hours; disclosing your sexual dissatisfaction, demonstrating what you really
want, and struggling through one’s possible anxiety and embarrassment, It might involve losing
(or gaining) 30 pounds. It might involve keeping one’s integrity intact. Discarding the societal
pathological beliefs about sex and developing your own definition of good sex takes work.
Intense, erotic sex with a partner takes effort. However, effort in related, intense sex doesn’t feel
like work; in mediocre sex it does. Intense sex and profound intimacy take more effort than most
people want to invest. It takes a lot of personal development and work to mature enough to
tolerate intense intimacy and eroticism.
Sexuality that is like “kissing the face of God”
In health-based models of sexual potential, the upper limit of sexual desire is where one
meets the God-within.
For Plato, Eros has a transcendent manifestation when the subject seeks
to go beyond itself and form a communion with the other.
Eastern philosophy, particularly the Hindu tradition, sees physical sensual pleasure as one of
several paths to liberation and the union of the individual with the universal. Sexual relations are
considered a path to integration and expanded cosmic awareness. Eastern views celebrate sexual
pleasure as a value in its own right. Kama, “the pursuit of love and pleasure, both sensual
aesthetic”, is one of the goals of life in the Hindu tradition.
Eastern approaches to eroticism based on Tantric Yoga emphasize self-discipline in focusing
consciousness and sexual energy. Sexual potential is thought to require practice, discipline, and
understanding the interaction among spiritual, emotional, and physical dimensions. This
approach emphasizes spiritual and emotional transcendence through sex rather than orgasm.
In marked contrast, Christian-dominated Western society promotes a division between
spirit and body and is associated with original sin. In Western Christian mythology, sex
is a barrier to be overcome. Humans are urged to achieve salvation by denial of the
senses, especially the sexual impulses. Western culture and religion has failed to help
people to integrate sexuality and spirituality. Contemporary Western values inhibit the
exploration of human sexuality, rather than support it.
The role of sexuality in one’s spiritual development is evident when spirituality is conceptualized
as the integration of all aspects of the person and the actualization of one’s fullest potential.
Spiritual development divorced from religion and dogma is human development viewed from the
perspective of an ongoing integration that results from openness to the experience of selftranscendence.
From hot, erotic, related sex, you can begin to be open to spiritual energies you’ve never
experienced before because of the strong connection you’ve made both with your authentic self
and with your partner. Slowly your judgments strip away, together with your clothing, your
pride and your fears. The lovers’ experience coalesces into a swirling energy that rises and bursts
out of your head. When the boundaries of self and other are transcended in this swirl, it is
possible to achieve an experience of your incontrovertible connection to the universe.
The illusion of who you think you are, the mask of the false and social self, the need to perform
or look good, together with your ego, gradually drop. Peak experiences of self-transcendence
may occur. Shame is banished, replaced with deep serenity and contentment. Your thoughts and
your bodily tensions relax and slow down. Time stops. Consciousness expands. The experience
is similar to what the mystics describe as ecstasy.
Sexual potential comes from surrendering – that is, not trying. With a willingness to give
up control along with your egotistic preoccupations, you’re in a state of not knowing, of
just experiencing as you make a space for deep eroticism to emerge. Two dissolve into
one and a third energy, perhaps a spiritual energy, emerges. You meld into one entity
and touch the silence of the universe. (Katehakis, pg. 205).
Nothing beats it.
What does a sex addict need to learn in order to traverse the distance between sex addiction and
the achievement of full sexual potential?
As a sex addict, you need to learn:
·You cannot integrate heart and genitals. Heartless sex is mere mechanics and leaves people
feeling empty and disillusioned.
·To own your full power of sexuality with utmost respect for that power. This requires that you
be sexually assertive yet vulnerable and open.
·Take the responsibility and power associated with sex seriously.
·You may get your vanity satisfied with deviant sex, but you fear real connection.
·Impulse Control.
·Ability to listen to and adapt to the needs of your partner
·Sex that satisfies only physical needs misses out on the wonderful complexity of sex where
emotion, communication, sensuality, and relatedness are the context within which sexuality exist.
·You are torn between the mature adult you have become in other areas of life and an adolescent
sexual response that still controls your brain.
·You learned misguided ideas about sex from family and the general culture, which is sexnegative and sexist for both men and women. However, what has been learned can be unlearned
and recreated.
·A good sexual relationship is always based in authenticity.
·Growth in healthy intimacy involves naming, claiming and embracing old hurts and negative
scripts from the past and making conscious decisions to appropriately channel sexual energies
and to act with integrity.
·Cultivate the capacity for self-acceptance and willingness to embrace your wounds, mistakes
and limitations. You can’t have good sex if you don’t like yourself. Also, if you have accepted
yourself, you’ll be more comfortable with the authentic self-disclosure about your self, in
particular your sexual self, to a valued other.
·Intimate sex requires a level of self-awareness and of vulnerability which exposes you to
yourself. It may seem daunting, but the adventure of self-discovery is the only game in town.
·Optimal sex involves a gradual acceptance of one’s unique sexuality rather than being
caught in sex-negative messages from family, church, the media or the general culture.
·Cultivate the ability to listen, attend to, and have empathy for other people. It will make you a
better lover.
·Learn to tolerate being misunderstood when you have the courage to self-disclose your
authentic needs, wants, desires and fantasies.
·Growing in mature sexuality is about becoming real.
·Achieving full sexual potential involves whole body sex, not just genital sex. It includes
emotional, intellectual, social and spiritual connection and bonds which can catapult you into sex
that really packs a wallop.
·Addicts experience pseudo-intimacy – a shoddy replacement for the real things. Intense sexual
feelings substitutes for genuine intimacy.
·Compulsive sexuality, despite the intense high, causes self-rejection and alienates you from
your own experience and your own sense of self.
·Redefining sexuality is a process of self-confrontation and authentic self-disclosure in the
presence of a partner.
·Focusing only on genital performance circumvents the most powerful and most useful
aspects of sex: profound emotional intimacy.
·Sexual Potential considers eroticism, intimacy and personal meaning in sexual behavior.
(Katehakis, pg.
·At the further reaches of human sexual potential lies peak transcendental experience.
·A life filled with sexual acting out does is insufficient to trigger the process of personal growth
that can navigate the exploration of the fullness of human sexual potential.
·Optimal sex involves the dauntless struggle to be fully human with one’s partner.
·Profound personal growth in nonsexual areas is key in embracing your sexual potential.
·Sex can be so much more than a vehicle for our needs to feel good. It can be joyous and
illuminating. It can be a truly trans-formative force in our lives. Sexual intimacy can penetrate
the skins of our bodies as it penetrates the boundaries of our egos. Only then can we recognize
ourselves and our partner in the Mystery of existence itself.
In conclusion, I invite you to take up the challenge and adventure of reaching your full
sexual potential and to be and remain the erotic, celebratory, courageous, connected
and sexual being that you’re meant to be.
Suggested Reading
Hope and Recovery: A Twelve Step Guide for Healing From Compulsive Sexual
Behavior, Anonymous.
Mindful Recovery: A Spiritual Path to Healing from Addiction,
Thomas Bien, Beverly Bien.
Say Yes to Your Sexual Healing: Daily Meditations for Overcoming Sex Addiction, Leo
Booth.
Lust, Anger, Love: Understanding Sexual Addiction and the road to Healthy Intimacy,
Maureen Canning.
Mending a Shattered Heart: A Guide for Partners of Sex Addicts, Stephanie Carnes
A Gentle Path Through the Twelve Steps: The Classic Guide for All People in the
Process of Recovery, Patrick Carnes.
Out of the Shadows: Understanding Sexual Addiction, Patrick Carnes.
Don’t Call it Love: Recovery From Sexual Addiction, Patrick Carnes.
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior,
Patrick Carnes.
Breaking the Cycle: Free Yourself From Sex Addiction, Porn Obsession and Shame,
George Collins.
Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for
Addicts and Co-dependents, Ralph Earle.
Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction,
Alexandra Katehakis.
Healing the Wounds of Sexual Addiction, Mark Laaser.
The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography,
Wendy Maltz and Larry Maltz.
The Circle of Life: The Process of Sexual Recovery Workbook,
KJ Nivin.
The Sex Addiction Workbook: Proven Strategies to Help You Regain Control of Your
Life, Willian T. O’Donohue and Tamarqa Penix Sbraga.
False Intimacy: Understanding the Struggle of Sexual Addiction, Harry Schaumburg.
Sex Addicts Anonymous, Sex Addicts Anonymous Fellowship
Treating Pornography Addiction: The Essential Tools for Recovery,
Kevin Skinner.
Wired for Intimacy: How Pornography Hijacks the Male Brain, William M. Struthers.
Cruise Control: Understanding Sex Addiction in gay Men, Robert Weiss.
Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age, Robert
Weiss and Jennifer P. Schneider.
About the Author
Dorothy C. Hayden, LCSW, MBA, CAC, is a psychoanalytic psychotherapist who specializes in
chemical dependency, sex addiction, BDSM, fetishes, cross dressing and sexual perversion.
She has appeared on the British HBO show documentary “The Devil and the Flesh”, about
sexual power and celibacy, ABC’s “20/20” about the phenomenon of cybersex addiction, “The
Jenny Jones Show”, about adolescent homosexuality and “The Ricky Lake Show” about fetishes.
In addition, she has appeared on CNN’s Anderson Cooper “360” about transsexualism and is a
regular commentator on WBAI radio on the contemporary sexual scene including the polyamory
(non-monogamy) movement, dominance/submission lifestyles, and the
bondage/domination/sado/masochism (BDSM) community.
Ms. Hayden has been interviewed by such print media as The New York Post, Playgirl,
Cosmopolitan, New York Magazine and Time Out New York.
A published author, her 20+ articles have been translated into other languages and appear on
websites throughout the world. Her new e-book: “You Can Do This!! Twelve Ways to Treat Sex
Addiction and other Essays” is in press as of this writing.
Ms. Hayden graduated in 1995 from New York University with an M.S.W. and holds an M.B.A.
in marketing from Baruch College (1987). She attended advanced clinical training at the Post
Graduate Center for Mental Health, and the Object Relations Institute and the Training Institute
for Mental Health. A graduate of the Milton H. Erickson Institute for Psychotherapy and
Hypnotherapy, she uses hypnosis in working with fetishes, sexual dysfunction and sexual
enhancement. She is also certified in Neuro Linguistic Programming (NLP).
With twelve years of experience in the chemical dependency field and fifteen years as a sex
addiction therapist, she has worked in a number of the major drug and alcohol rehabs in the New
York City area and was awarded a CAC (Credentialed Alcoholism Counselor) certificate in 1994.
From 1993-1995, she was on the faculty of Mary Mount Manhattan College as an instructor in
their addictions counseling training program.
In addition, she trained with Patrick Carnes, the pioneer in the field of sex
addiction treatment who wrote the book: “Out of the Shadows:
Understanding Sexual Addiction”.
Ms. Hayden is affiliated with the Post Graduate Society for Psychoanalysis, the Association of
Sex Educators, Counselors and Therapists (ASECT) and the Society for the Advancement of
Sexual Health (SASH).
Testimonials
“If You Want to Understand Sex Addiction, Read This Book!
Rob Weiss, LCSW, C-SATS
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health and The Ranch.
"This new book by Dorothy Hayden sheds new light on sexual addiction and its
many forms of treatment. It is a comprehensive guide that adds practical strategies
and therapy tools for how to address sufferers from sexual addiction. This book is a
must-have for clinicians as it provides effective tools on how to address individuals,
couples, and groups struggling with this condition. Overall, the blend of academic
and real-life case studies throughout each chapter will help readers move in their
journey toward recovery." ---Dr. Kimberly S. Young -- founder and director, the
Center for Internet Addiction Recovery and author of Tangled in the Web:
Understanding Cybersex from Fantasy to Addiction
"Great stuff! Solid information for those who are looking for real help from this insidious issue.
A comprehensive overview of sexual addiction and treatment modalities. It's staying on MY
short list of recommended books for our clients here at Compulsion Solutions."
George N. Collins, Director
Compulsion Solutions
Author of "Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession, and Shame"
Co-author of "A Couple's Guide to Sexual Addiction"
Contents
Forward
Preface
Introduction
Chapter 1– What is Sex Addiction?
Chapter 2 – Relapse Prevention
Chapter 3 – Cognitive Therapy
Chapter 4 – Psychodynamic Psychotherapy
Chapter 5– Group Therapy
Chapter 6– Couples Counseling
Chapter 7-- 12-Step Programs
Chapter 8 – Hypnosis
Chapter 9 – NLP
Chapter 10 – Psychopharmacology
Chapter 11 – “Brainlock” – A Behavioral Modification Approach
Chapter 12 – From Sexual Addiction to Sexual Fulfillment
xi
Forward
Since the internet went mainstream only 20 years ago, its accessibility,
affordability and anonymity has spawned an eruption in the numbers of
people seeking clinical treatment for sexual addiction. This increased
variety of internet-based sexual content, together with the explosion of
sexual “hooking up” via smart phone apps and social media is veritably
changing the nature of human sexuality.
It is estimated that three to six percent of the general U.S. population
suffers from some form of addictive sexual behavior with self or others.
However, the current lack of a universally recognizable clinical diagnosis —
combined with a dearth of publicly funded research and ongoing cultural
shame and stigma regarding sexual disorders in general — likely prevents
many more individuals from identifying the problem and seeking help. The
numbers of people who suffer in silence from this addiction are staggering.
Available statistics are startling, indeed. According to US News and World Report, the
pornography industry takes in more than $8 billion a year, which is more than rock and
country music, and more than all Broadway productions, theater, ballet, jazz and
classical music combined.
·Every second, 28,258 internet users are viewing pornography.
·Eighty percent of our children age 15-17 have had multiple hard-core exposures to internet
porn.
·Pornography is big business--with $10 billion to $14 billion in annual sales.
The author of an article in the New York Times Magazine, Frank Rich,
suggests that pornography is bigger than any of the major league sports,
perhaps bigger than Hollywood. Porn is "no longer a sideshow to the
mainstream...it is the mainstream," he says.
As the problem has bounded forward in the last decade, research into new methodologies for
treatment is just keeping its head above water. Although a number of excellent books about are
on the market, supply has not kept track with peoples’ hunger for new ideas about how to escape
the stronghold of this .
“Total Sexual Addiction Recovery – A Guide to Therapy” makes a new contribution to
the field. Besides offering an overview of the nature of the beast and information about
how to achieve fulfilling sex during and after recovery, the book offers numerous
chapters about how existing therapy methods can be used to treat . The end result is
that the reader is given a breath and depth of understanding about what a
comprehensive therapy program for sex addiction might look like.
Who better to write this particular book than Dorothy Hayden? Dorothy and I have been
aware of each other’s careers for 15 years, in the days that we were both the singular
writers about sex addiction for PsychCentral.com. Ms. Hayden is not only trained in sex
addiction, but has remained an astute student of contemporary psychoanalysis. She’s
the rare combination in a therapist of one who has not only the concrete skills of an , but
the psychological sophistication to understand and treat all aspects of the addict’s
personality.
Put this together with her over-30 years of personal recovery in a, her
training in Hypnosis and Neuro-Linguisitic Program, Group , and you have
the exact person to write a book about the multi-dimensional aspects of .
Dorothy not only helps people to stop compulsive, destructive sexual acting out, but she uses her
analytic skills to pull the disorder out from its roots for the fortunate who have been her clients.
Robert Weiss, LCSW, CSAT-S
Founding Director of The Sexual Recovery Institute
Director of Sexual Disorders Services at Elements Behavioral Health and The Ranch.
Preface
I wrote this book because I saw a need for current models of sex addiction treatment to
become more comprehensive in their approach. Existing sex addiction therapy focuses
mostly on behavioral modification skills to stop compulsive sexual acting out. However,
the high rate of people who repeatedly return to their preferred sexual behavior despite
treatment attests to the fact that the current treatment philosophy is insufficient to
achieve satisfactory results.
If sexual acting out is the tip of the iceberg, representing a symptom of the problem, the
personality deficits that give rise to addiction are the bottom of the iceberg. These deficits and
vulnerabilities need to be addressed and healed for there to be any significant improvement in the
person’s overall life satisfaction. And people who have overall life satisfaction tend not to get
involved with addiction.
Treatment that merely stops the sexual acting out is no treatment at all. The symptom
can clear up, but what gave rise to the addiction behavior can remain. Sex is not the
problem in sex addiction. The problem lies much deeper. Sexual acting out is merely
symptom or sign of other conscious and unconscious troubles. Total sexual recovery is
assured from the use of different therapeutic techniques that go blow the surface to
heal the personality problems that give rise to unwanted behavior. The comprehensive
treatment suggested in this book pulls out the problem of sexual addiction up by its
roots.
This book differs from other books about treatment because it offers a look into a
number of different therapies that help individuals recover. While some of the
techniques promote abstinence from compulsive behavior, others deal with such things
as resolving childhood abuse and conflicts, changing the thoughts and beliefs that keep
the addiction in place, learning self-soothing techniques to replace the sense of safety
and soothing found in the addictive experience, addressing the intimacy dysfunction that
is invariably concomitant with sex addiction, and changing the person’s “arousal
template” from deviant, compulsive sex to having the ability to experience of related sex
that is vital, alive, exciting and that can bring someone to the heights of sexual ecstasy.
The book is divided into three parts. The first part offers a discussion on the nature of
addiction itself and provides a multi-dimensional look at the phenomenon of sex
addiction. “You must know the enemy before you can do battle with it.”
The second part of the book describes different therapeutic methods that
can be used in sex addiction recovery. My hope is that familiarity with
these a number of different therapeutic techniques will give you a deeper
understanding of the compulsion and provide you with the hope that not
only can treatment work but there are a variety of ways to achieve the goal
of sexual sanity and personal fulfillment.
Finally, the third part of the book could just as well be entitled “Is There Sex After the
Revolution?” Most books about sex addiction, and most treatment philosophies, don’t
offer a replacement for sexual abstinence. Sex is such a pivotal part of who we are and
is so much fun, who wants to be “abstinent” from it? The final chapter seeks to provide
you with ideas and techniques to achieve your full sexual potential. The pleasure of
related, connected sex will make the fleeting pleasure of addictive sex seem like child’s
play.
My true motivation for the writing the book is to deliver one predominant message: There is
hope. There is a way to go. There is an end to the madness. What may seem hopeless is, in fact,
doable. With the right understanding of the problem and the right therapy, you can do what
legions of others have done – break free from the shackles of sex addiction.
Acknowledgments
My first and most important acknowledgment is to the patients I have treated over the
last 15 years. Their journey has been my journey – as an author, a psychotherapist and
a person. Having had the privilege of being included in their process of being once
defeated, confused, helpless victims of the horrific addiction to sex, I have witnessed
them become restored to the fullness of their sexuality and their humanity.
I have seen first-hand, and over-and-over again, the resiliency of the human spirit to grow, live
and love. I thank each and every one of them.
For my training in the field of sex addiction, I thank Patrick Carnes, PhD. And Edward Ragsdale,
PhD. Dr. Ken Adams has also been enormously helpful in helping me to deepen my
understanding of the multi-dimensional aspects of addiction.
The people who have most influenced my development as a psychoanalyst are teachers,
supervisors and mentors from The Post Graduate Center for Mental Health, The Object Relations
Institute and The Training Institute for Mental Health. Special thanks to Chuck Strozier, PhD.,
Pauline Pinto, LCSW, Jean Kemble, MS, Mark Wayne, LCSW, Larry Lewis, Ph. D., Michael
DiSimone, DSW, among others.
A book is never written alone. My ever-supportive friend and editor, Doreen Lewis, has been
instrumental in molding my writing skills and achievements.
Lastly, to my partner, Victor, for his unending faith in me and for providing the support that freed
up the time and space for me to write this volume.
xiii
Introduction
What is Addiction?
To be at risk for addiction, two psychological conditions seem to exist during childhood.
·First, the child has become over- reliant on sources of comfort outside of himself to provide a
feeling of being soothed, safe and secure.
·Second, the child had difficulty making a healthy separation from the primary parent, with later
concerns that closeness and intimacy can be dangerous.
Both of these conditions come about as a result of failure in empathy and attunement in the
parent-child relationship that leaves the child feeling misunderstood, unsupported and potentially
unloved. What develops is a “developmental arrest”, so that the adult in later life (like a child) is
driven above all to seek pleasure and avoid the pain of living. Not having developed a sense of
confidence and rigorous self-esteem that growing up in a nurturing environment would have
provided, the person feels inadequate and vulnerable. The demands of reality appear too
challenging and overwhelming.
This theme of using a particular relationship to objects or behaviors to manipulate moods so
that a desired emotional/ physical state occurs that provides needed internal benefits such as
pleasure, gratification, safety, security or arousal is one definition of addiction. It provides the
addict with predictable and stable gratification, but the experience has concomitant costs.
Eventually these costs outweigh the subjective benefits the addiction affords. Nevertheless,
people continue in their addiction, ready to pay the price extracted, as long as they perceive it as
providing the needed gratifications.
When active addiction sets in, the problems the individual experiences in
dealing with the ups and downs of living seem to be magically solved. The
addiction is the glue that holds together the different parts of a fragile self. It
reinforces a false sense of omnipotence, grandiosity and perfection and
blots out aspects of reality that are not in concert with that perception. It
anesthetizes the individual from unwanted feelings and the uncomfortable
aspects of finding and expressing the true self. It defends against the need
for intimacy or closeness, as the addict relies only on his addiction for a
sense of pseudo-intimacy.
The “hook” of the addiction that keeps him coming back for more is that it gives people feelings
and gratifying sensations that they are not able to get in other ways. It may block out sensations
of pain, uncertainty, or discomfort. It may create powerfully distracting sensations that focus and
absorb attention. It may enable a person to forget, to feel “okay” about, insurmountable, or even
mundane, problems. It may provide feelings of security or calm, of self-worth or
accomplishment, of power or control, of intimacy or belonging, despite the knowledge that these
experiences are fleeting and artificial.
However powerful and gratifying the addictive experience may be, there are costs to be
reckoned. Addictions make people less aware of and less able to respond to other people,
events, and activities. Ironically, the addictive experience reinforces and exacerbates the
problems the person wanted to desperately wanted to evade in the first place. In the persons'
inner life, the addiction has significant benefits and makes things things seem better. However,
in the real world, it makes everything worse. Jobs, marriages, friendships fall away; health
deteriorates; debts increase; opportunities disappear; the day-to-day business of ongoing living is
neglected The person becomes increasingly detached from nourishing contacts, essential
responsibilities, meaningful long-term goals, recreation and hobbies and core values.
Even in the face of devastating consequences to his external and internal worlds, the addict holds
on tenaciously to his only source of identity, stability, comfort and support - the drug.
Moreover, over the years, addictive behavior becomes “reinforced”, or embedded, as an
exclusive coping mechanism. Higher coping mechanisms have not been developed through the
years of using, so as the reality consequences have been piling up, the person's ability to deal
with them has been plummeting in the personal stagnation of life in addiction.
A developmental arrest keeps a part of the personality immature. The result can be personality
deficits that leave the potential addict without the capacity to regulate inner feelings of distress,
to delay gratification, to exercise impulse control, to recognize and articulate feelings, or to
create meaningful attachments to others.
So for an addict, to be without the addiction would feel like personal annihilation.
The inner world of the addict is characterized by intense feelings that are often experienced as
unbearable, overwhelming and permanent. These feelings form the context within which the
addict lives. The actions and choices of an active addict are organized around an attempt to
manage intense feelings. No obstacle is too formidable as the addict, in an attempt to feel
"normal", succumbs to the irresistible impulse to indulge. Unfortunately, the strength of the urge
to act out on the addiction obliterates the ability to reflect upon the potentially devastating
consequences of his actions.
Addiction is always experienced as a profound sense of alienation from self and others, since the
ability to establish meaningful inter-personal relationships is often crippled by toxic experiences
with early-life caretakers. I quote a former client:
” I was alone and it was loneliness and it was intense. I think the only love in life has
been the drug...I just felt so alone...I was sad, so lonely, so isolated. I knew I wasn't
being me... that I could be different, but I couldn't with people. As far as having some
friends, really being close to somebody, there wasn't anybody...I just wasn't able to keep
connections.”
An addiction may involve any strong attachment or sensation that grows to proportions
that it damages a person's life or self-hood. Addiction – the single-minded grasping or
chasing of a seemingly magic object, behavior or involvement; the loss of control,
perspective and priorities – is not limited to drug and alcohol addictions. When a person
becomes addicted, it is not to a chemical but to a particular type of relationship that
affords a particular experience. Anything that a person finds sufficiently consuming and
that seems to remedy deficiencies in the person's life can serve as an addiction. The
addictive potential of a substance or experience lies in the meaning it has for a person.
It is only when the pain of active addiction outweighs its diminishing benefits that the addict
holds out the white flag and asks for help so that he can get free from his addiction.
The Problem of Sex Addiction
Addiction to sexual behavior is a complex disorder that incorporates many
aspects of your personality, bio-chemistry, sociocultural environment,
family-of-origin issues, thinking/feeling processes, self-esteem, and quality
of relations with others. I see sex addiction as a prism; depending on the
angle you hold it up to, the light can make it can look completely different.
The complexity of addiction to sex is shown by the fact that psychologists
still don't know if it's a symptom of an obsessive-compulsive disorder, an
impulse-control disorder, or an addictive disorder. The fact that it was only
recently left out of the DSM-V and so not rec distinct as a distinct disorder
means that not much substantive research has been done to understand
this multidimensional condition.
We do know that sexual addiction represents an expression of the same processes of
addiction that underlie all compulsive behaviors: an enduring, inordinately strong
tendency to engage in some form of pleasure-producing behavior to regulate unwanted
emotional states that are painful and potentially overwhelming. Also common to all
addictions, underlying the symptom of the sexual behavior are problems with self-care
and self-regulation. Achieving a sense of “self-governance” is part of addiction recovery
treatment.
Being perpetually ensnared in the jaws of the addiction cycle with its loss-of-control,
shame and distress, together with its negative impacts on
work/relationships/finances/self-esteem, is demoralizing. Yet the perceived benefits
seem to outweigh the high cost of the behavior, as you experience the lure of the sexual
rush to be irresistible and compelling, regardless of inevitable consequences.
Recovery from sexual addiction must address both the destructive addictive sexual
behaviors as well as the underlying addictive process. The challenge of the therapist
who offers a sex addiction treatment program is that of presenting a variety of treatment
approaches to accommodate and treat the addict on multiple levels. The therapist
needs to have the concrete skills of an addiction counselor as well as the clinical
training and sophistication to treat underlying issues.
Treatment for sex addiction, then, is most likely to be effective when it emerges from an
integrated, comprehensive approach that brings together different treatment methods, is
individually tailored to your personality and evolves as you progress.
This book includes a comprehensive overview of sex addiction so you can understand
the nature of the beast; a series of chapters about the different methods of addressing
recovery from sex addiction, and a final chapter about the shifts required to have
“optimal” sexual experience, or the achievement of your sexual potential.
The goal of the book is to present a number of therapeutic strategies that can help free you from
the shackles of addiction. My hope is that each chapter will provide more understanding and
more hope that getting out of the snake-pit of sexual compulsion is doable. Not only is it doable,
there are a variety of ways to do it.
This book will look at therapy for sex addiction from a variety of angles.
Each chapter discusses part of the overall process of total sex addiction
recovery. Chapters include:
·Overview of Sex Addiction: Understand the enemy so you can devise strategies for
victory.
·Relapse prevention. This is the critical first step in recovery from
addiction. You will learn to free yourself from repetitive, compulsive,
shameful sexual behaviors.
·Pharmacological (as the “water wings” of treatment) to help with
impulse control, anxiety and depression that may contribute to the
experience of strong sexual urges.
·12-Step Groups cultivates a support system to help sex addicts and is an
opportunity to work the 12-steps as an avenue to psychological and
spiritual maturity.
·Cognitive-behavioral therapy. The Stoic Philosophers’ theories are the foundation of
CBT. The basic idea is that we don’t suffer from the external event; we suffer from the
interpretation (thoughts) about the event. We examine a series of belief systems
common to most sex addicts to see how they are based in the past and cause suffering
in the present. Change a thought, change a destiny.
·Group therapy. This is a vital part of treatment for addiction. Addicts learn
intimacy and work through issues of trust. A cohesive group can supply
understanding, acceptance and empathy – things that may have been
missing in your past.
·Psycho-dynamic therapy. This is the nuts and bolts of treatment for
addiction. A one-on-one relationship that heals, rather than harms, can
rectify the hurt from the past by providing a different model for relating. The
therapist considers your whole personality. Unconscious conflicts, hurts,
wounds,shame, feelings of inadequacy, amongst other issues that
underlies sexual acting out become more conscious to the person who
then is able to exercise self-control through understanding and insight.
·Couples counseling Sex addiction is usually devastating to your
partner. If the couple-hood is to remain intact, couples counseling is
essential.
·Hypnosis. Don’t be afraid of trance; you’ve been in one all your life.
·
·Mindfulness Meditation It’s impossible to change without awareness of your inner
process and the ability to be aware of another person.
·Brainlock: A behavioral approach to treating compulsive behavior.
·Conclusion: “From Sexual Addiction to Sexual Fulfillment”. Here’s how to get the total
sexual experience that the addiction was searching for but missed the mark.
As a therapist who’s worked in the field of addictions for over 25 years, it’s been my experience
that an entire repertoire of treatment skills, strategies and techniques (arrows in the quill) are
necessary to match each client’s own set of fingerprints, and his uniqueness as a human being.
Therefore, the more treatment can be directed specifically to a particular addict and his family,
the more effective it will be.
What are some of the specific goals of comprehensive therapy for sex addiction?
·To resolve ambivalence about change
·To prepare you to prevent relapse by helping you to recognize triggers, urges and cravings, and
arm yourself with specific tools for dealing with them
·To recognize and work through painful feelings from childhood that remain alive in the present.
·To put issues of shame and a sense of inadequacy to bed.
·The discovery of underlying issues of all addiction including lack of self regulation and
self care as well as an inability to exercise restraint in the face of destructive impulses;
·To recognize and change unconscious belief systems about self, others and the world, including
sexuality and intimacy;
·To implement sex therapy techniques to overcome obstacles to intimate sexual experience;
·To trace the origins of unhealthy relationship patterns that stem from childhood so you can
recognize that what worked in the past may be destructive in the present;
·To become educated about intimacy skills and attitudes about sex that will help you experience
“related sex” as more fulfilling than narcissistic self-centered sex.
Chapter 1
What is sex addiction?
First, let us consider what sex addition is NOT: Sex addition is not defined by sexual desire. Sex
addiction is not defined by the type of sexual act performed. It isn’t defined by the frequency of sexual
activity.
Rather, sex addiction is defined by the addict’s continual use of sexual
urges, cravings, fantasies and behaviors to gratify non-sexual needs that
echo from the emotional deficiencies of his early life. Sex addiction is a
misuse of sex. Sex is, after all, only sex. It can't heal the wounds in your
soul.
Manifested as a compulsive cycle of preoccupation, ritualized sexual behavior, and despair, sex
addiction is an obsessive relationship to sexual thoughts, fantasies or activities that an individual
continues to engage in despite adverse consequences. These thoughts, fantasies or activities occupy a
disproportionate amount of "psychic space" (the inner world of the addict that isn't conscious, but is
emotionally powerful enough to overrule thinking). These thoughts result in an imbalance in the
person's overall functioning in important areas of life, such as work and marriage. Distress, shame and
guilt about the behaviors erode the addict's already fragile sense of self.
It is this fragile sense of self at core, born of a lack of attunement with early caregivers, that seeks
solidification through the perceived power and control of sex. A sense of masculinity, which may have
been enfeebled through his psycho-sexual development, is perceived to be strengthen by the
compulsive sexual experience.
Sexual addiction is invariably a symptom of an attachment disorder which hinders the individual in
forming and maintaining intimate relationships. Central to the disorder is the inability of the individual
to adequately bond and attach. At it’s core, addiction is a symbolic enactment of deeply entrenched
unconscious dysfunctional relationships with self and others.
While the definition of sex addiction has similar features as that of other
addictions, sexual compulsion is set apart from other addictions in that sex
involves our innermost unconscious wishes, needs, fantasies, fears and
conflicts.
Like other addictions, it is relapse-prone.
What are the Signs/Symptoms of Sex Addiction?
While there currently is no diagnosis of sex addiction in the DSM-IV, clinicians in
the sex addiction field have developed general criteria for diagnosing sex
addiction. If an individual meets three or more of these criteria, he/she could be
considered a sex addict: Sexual addiction is often accompanied by other
addictions, such as an addiction to work or chemicals.
·The addict displays increasingly secretive behavior, deception, and withdrawal from those closest to
him;
·Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd
sex; frequently engaging in those behaviors to a greater extent or over a longer
period of time than intended;
·Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors;
·Inordinate amount of time spent in obtaining sex, being sexual, or recovering
from sexual experience;
·Preoccupation with the behavior or preparatory activities;
·Frequently engaging in sexual behavior when expected to fulfill occupational, academic, domestic, or
social obligations;
·Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic,
financial, psychological, or physical problem that is caused or exacerbated by the behavior;
·Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or
diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk ;
·Giving up or limiting social, occupational, or recreational activities because of the behavior;
·Experience of distress, anxiety, restlessness, or violence if unable to engage in the behavior at times
relating to SRD (Sexual Rage Disorder);
·Tolerance, as defined by either of the following:
·a need for markedly increased amount or intensity of the behavior to achieve the desired effect
·markedly diminished effect with continued involvement in the behavior at the same level or intensity
·Withdrawal, as manifested by either of the following:
·characteristic psycho-physiological withdrawal syndrome of physiologically described changes and/or
psychologically described changes upon discontinuation of the behavior
·the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
·There is a persistent desire or unsuccessful efforts to cut down or control the behavior;
·The behavior continues despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the behavior;
·Repeatedly and compulsively attempting to escape emotional or physical
discomfort by using ritualized, sexual behaviors such as masturbation,
pornography, including obsessive thoughts.
·Some individuals try to connect with others through highly impersonal intimate
behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism,
frotteurism, cybersex, sexual arousal to objects, situations, or individuals that
are not part of normative stimulation.
Adapted from the Society of Sexual Health literature.
The Consequences of Sexual Addiction
Loss of Important Aspects of Life
The life of a sex addict gradually becomes very small, in terms of the number of
surrounding loved ones. The freedom of self is impaired. Precious life energies
are consumed. The rapacious need for a particular type of experience in the
“erotic haze” (See Chapter II) drives the addict to spend untold hours in the
world of his addiction. With time, the compulsion begins to strip away all that
the person holds dear: close relationships, enjoyable activities and hobbies,
trust between himself and his partner, quality time with children, having a
spiritual/moral center, commitment to productive, meaningful employment and
financial security.
Depression
Profound depression (sometimes with suicidal thoughts), chronic low selfesteem, shame, self-hatred, hopelessness, despair, helplessness, intense
anxiety, loneliness, moral conflict, contradictions between ethical values and
behaviors, fear of abandonment, spiritual bankruptcy, distorted thinking,
remorse, and self-deceit are common.
Research shows that 70 to 75% of sexual addicts report having had suicidal thoughts related to their
sexual behavior patterns resulted in significant loss of self-esteem for both partners.
Breakdown of the Family
Often, sex addicts suffer from broken and distant relationships. The American
Bar Association reported a whopping 50% of the divorces it handled in 2009 had
cybersex implicated in them. Forty percent of sex addicts report severe marital
and other relationship problems, and sexual activities outside their primary
relationship. The sex addict is frequently absent (physically and/or emotionally),
resulting in a lack of parental role modeling. Pressure is placed on the spouse to
do “double duty” as partner and primary parent. Partners of sex addicts can
develop their own addictions and compulsions to drugs, food, and spending, for
example, in addition to psychosomatic problems, depression, and other
emotional difficulties. For most women, the discovery of their husband’s sex
addiction is emotionally devastating.
Physical Health Issues
Health consequences of sex addiction may include HIV infection, genital herpes,
HPV, syphilis, gonorrhea, and other sexually transmitted diseases (STDs). Sex
addicts have a highly increased risk of contracting an STD and of passing it
along to unknowing spouses or loved ones. Genital injury can result from sexual
acting out, addictive sadomasochistic sex can cause physical damage to the
body, and automobile accidents can result when the driver’s attention strays
from the road due to sexual texting, downloading porn, or sexually cruising other
drivers.
Legal Problems
Some sex addicts go to jail, lose their jobs, get sued, or have other financial and
legal consequences because of their compulsive sexual behavior. Financial
difficulties from the purchase of porn, use of prostitutes, and travel for the
purpose of sexual hook-ups and related activities can tax the addict’s financial
resources and those of his or her family, as do the expenses of legal
representation in divorce cases. Sixty percent of sex addicts report that they
have faced financial difficulties, 58% report having engaged in some form of
illegal activity, and 83% of sex addicts also had concurrent addictions such as
alcoholism, marijuana or other drug abuses, eating disorders, and compulsive
gambling. Many sex addicts also abuse alcohol and other drugs. When multiple
addictions coexist, untreated sex addiction complicates recovery from chemical
dependency and makes relapse to drug use more likely.
Serious legal consequences of sexual addiction can result if the sex addict’s
behavior escalates into sexual offenses such as voyeurism, exhibitionism, or
inappropriate touching and/or the use of child porn. Sexual harassment in the
workplace can be part of a sex addict’s repertoire, and may result in legal
difficulties.
Many addicts report that they live in a perpetual fear of exposure. For addicts involved in illegal sexual
activities (exhibitionism, voyeurism, etc.) as well as involvement in kiddie porn, arrest, incarceration
and public humiliation or prosecution are very real possibilities.
“Sexual addicts risk everything for the call of the erotic which promises euphoria and yet
never seems to deliver in a real, consistent way and is usually followed by remorse and
shame. Is the pleasure worth the consequences? It is when the negative consequences,
which are different for everyone, begin to outweigh these brief periods of erotic arousal that
the person seeks.”
Adapted from The Society for the Advancement of Sexual Health
Why Can’t the Addict Control his Sexual Behavior?
Most addicts would stop if they could.
It's been said that of all the addictions, sex is the most difficult to manage. This
syndrome is a complex mixture of biological, psychological, cultural, and familyof-origin issues, the combination of which creates impulses and urges that are
virtually impossible to resist despite the fact that acting them out produces
considerable long-term negative consequences, the addict simply cannot resist
his/her impulses. Individuals who are highly disciplined, accomplished and able
to direct the force of their will in other areas of life fall prey to sexual compulsion.
More importantly, people who love and cherish their partners can still be
enslaved by these irresistible urges.
From a biological standpoint, research has shown that certain formations in the right temporal lobe
make certain individuals more prone to sexual arousability from birth. Whether or not such an
individual becomes sexually compulsive or perverse then depends on the child's home environment.
Research has also shown that the inability to control sexual impulses is associated with neurochemical
imbalances in the nor-epinephrine, serotonin and dopamine systems. When the addict gets a sexual
“hit”, he is really getting a dopamine “hit”. Dopamine is the endorphin systems that provides pleasure.
The more sexually intense the acting out is, the more dopamine is sent to the brain. It is really these
neurochemicals, in particular dopamine, to which the sex addict is really addicted. After the orgasm,
dopamine levels drop precipitously and the person experiences depression, tension and irritability. Life
seems devoid of interest and non-sexual pleasure outside the “erotic haze” so he just bides his time
until he can get his next dopamine rush.
Biological predisposition contributes and combines with psychological factors.
One of the reasons the "erotic haze" (see Chapter 2) is so compulsory is that it
is an unconscious but maladaptive way to repair earlier disturbed, anxiety-laden
relationships. It shores up an inadequate sense of self which results from these
early-life interpersonal abandonments, and abuse. The illusory repair of
traumatic childhood experiences is compelling.
This combination of biological and psychological factors results in an "affective
disorder" in the sex addict. Feelings of depression, anxiety, boredom and
emptiness are quickly alleviated by immersing oneself in an imaginary world that
provides novelty, excitement, mystery and intense pleasure.
Sex addiction is better than Prozac. It heals, it soothes, it contains, it
provides a "safe place" free from the demands of actual performance, and
it gives an illusory sense of belonging. The sense of empowerment in the
illicit sex act rectifies "holes in the soul" and lifts the addict from feelings
of inadequacy, insufficiency, depression and emptiness into a state of
instant euphoria.
Sex addicts, as a group, are not having fun. They suffer enormously, from the shame, self-hatred and
humiliation which are the fodder in which they live.
And yet, they are consumed by an irresistible impulse to keep returning to the experience of intense,
euphoric pleasure that they know will create suffering for them in the long run.
It’s hard for any of us to walk away from pleasure, even when we know it is in our best interest. For
sex addicts, it’s nearly impossible. No price seems too high for them to pay because they are driven by
the mirage of a beautiful, ephemeral ghost that continually promises but never delivers. And, yet, they
keep returning to the empty well to quench their thirst.
Forms of Sex Addiction
·The pleasure of sex addiction comes in many forms. Examples of these include:
ocompulsive masturbation,
ointernet pornography,
opornographic movies, literature
ocybersex,
osexual fetishism,
oanonymous phone sex,
ouse of prostitutes and escorts,
omultiple extra-marital affairs,
oregular attendance at strip clubs,
omultiple and anonymous sexual partners,
oerotic e-mailing or texting,
otranssexual compulsion, cross-dressing, or submission to femme dommes.
None of the above examples as a singular act defines a sex addict, however, it is can be the frequency
and reliance on these activities, as well as using sexual behaviors to get non-sexual needs me which
may constitute addiction.
Underlying Dynamics of the Sex Addict
While the sexual behaviors differ for each addict, the underlying dynamics of the addiction are
the same. There is always an inability to form a healthy, consistent attachment to a cherished
loved one. Perhaps there was a mother who was unable to create a bond with her infant/child
that provided the attention, recognition, validation and appropriate physical contact needed.
The early environment surrounding the sex addict’s childhood was usually
shame-based. This means that The child’s self-esteem was damaged as a
result of a dysfunctional family or from traumatizing experiences with peers. A
sense of inadequacy and helplessness then colors a sex addict’s understanding
of self and the relationship with others. When they grow to adulthood, they may
use sexual behaviors to achieve a sense of adequacy, competence, safety and
power. Consequently, they feel an (illusory) sense of admiration and
recognition that was missing from their childhoods.
The Erotic Haze
Every sex addict experiences an immersion in what I have called the “Erotic Haze.” This is a A period
of time that may last 4-5 hours or longer, the unconscious mind overpowers the conscious mind,
making it impossible to see reality or make rational decisions. The sex addict fails to account for his
own enlightened self-interest or for the feelings of others. Instead, the body and mind are bathed the
brain in pleasure-enhancing endorphins. Time stands still.
Fantasy is the fodder of a person in the “Erotic Haze”. In many cases, sex
addicts perform some form of ritualized behavior. This usually precedes a
sexual act. For example, an addict may cruise in a car for hours looking for just
the right sex worker. He is enveloped through the “Erotic Haze” and gets
intense pleasure from the ritual. He is no longer in touch with reality.
When the sex addict is in this mental state, his needs are what matter most of all. He feels no anxiety
about responding to the needs of another. There is no fear of closeness, vulnerability or rejection. To
him, nothing feels as if it is a compromise. All that exists is the pleasure of the sexual fulfillment. It is
the only time in a sex addict’s life that he knows perfect control over the “other,” and this is distinctly
unlike what he experienced as a child.
The “Erotic Haze” is a totally compelling state, one in which sex addicts are
completely preoccupied.
Dual Personalities
Sex addicts have a private life and a public life. Some report a “Dr. Jekyll and
Mr. Hyde” experience with either side of the personality having different and
conflicting values and goals.
oSecrecy and deceit are the hallmarks of the Mr. Hyde persona.
oUneasiness, shame, guilt and fear of exposure are the constant companions of Dr. Jekyll.
The Devastating Effects
Married sex addicts often lose their spouse in the process. Children are
commonly neglected. There can be loss of a job and income from too many late
nights that interfere with optimal functioning. Being constantly preoccupied with
sex, they lose track of time; attention to detail is sacrificed.
Friendships that are not part of their sexual experience and normal recreational
activities usually decline or may abruptly end.
When the pain outweighs the pleasure, when self-respect is totally depleted, there may come a moment
of clarity. It is then, and only then, that they are ready to hang out the white flag and commit
themselves to sex addiction recovery.
What are the first steps to recovery?
As mentioned, The initial step is to go to a therapist to cultivate a healing
relationship in the context of interpersonal, individual psychotherapy. The clienttherapist relationship is like no other. You were initially wounded by your
relationships to others, so will you be healed by a new model of relating. Client
and therapist establish an atmosphere of safety, responsiveness and
acceptance. In such an atmosphere, it may be possible for you to take a leap
into trust and self-disclosure. You may find yourself able to find a voice to
previously unspoken experiences and feelings. Self-disclosure in the presence
of a trusted person goes a long way towards healing the shame and isolation
that binds you.
The rest of your treatment will develop from your relationship with your therapist.
If addiction to sexual behaviors is the tip of the iceberg, then the personality
deficits, recurring self-defeating patterns, abuse from early life relationships with
caretakers, unconscious conflicts and skewed perceptions about self and others
represent the larger, bottom of the iceberg. I contend that recovery from
addiction, freedom from enslaving, out-of-control, humiliating sexuality cannot
be achieved unless the issues on the bottom of the iceberg are resolved,
primarily through cognitive and psycho-dynamic psychotherapy.
Chapter 2
Goal and Objectives of Sex Addiction Recovery
Fifteen years ago, people didn't even know there was such a thing as sex addiction, never
mind how to get help for it. With Patrick Carnes' groundbreaking book Out of the Shadows:
Understanding Sex Addiction, people who suffer from self-destructive sexual acts had hope of
knowing what ailed them. Since then, the disorder has received tremendous attention from
the media and a whole new group of therapists trained to treat sex addiction.
The field, however, is still developing. People who seek counseling for this
debilitating addiction often don't know how or where to get help from a
competent clinician. Moreover, the path to sane sexuality -- the goals and
objectives that one should strive for -- are still sometimes muddy and confusing.
The Problems of Sex Addiction
·Solidifies his identity
·Feels shameful
·Is illicit, stolen, or exploitative
·Compromises values
·Draws on fear for excitement
·Reenacts childhood traumas
·Disconnects one from oneself
·Creates a world of unreality and fantasy
·Is self-destructive and dangerous
·Uses conquest or power
·Serves to medicate and kill pain
·Is dishonest
·Requires a double life
·Is grim and joyless
·Demands perfection
·Mistakes intensity for intimacy
·Requires novelty - intensity always has to be more than the last "hit"
·Gives way to self-hatred, loneliness and despair.
·Has no sexual "boundaries"
·Uses false intimacy as a way to avoid relational pain
·Preoccupation and ritualizations
·Is "doing to" someone
·Is devoid of communication
·Has no limits
·Benefits one person
·Is an uncontrollable energy
·Is emotionally distant
Other Considerations that Describe the Sex Addict
·Behavior leads to increasingly negative consequences but addict unable to control acting out
·Denies the behavior's seriousness
·Is the product of intense, unmet needs, coupled with the demand for perfect fulfillment and control of
relational pain
·Demands that life provides (an illusion of) reassurance and predictability which gives a sense of
getting self-centered psychological relief
·Is always a narcissistic endeavor - people are seen as "need-supplying objects", not as real human
beings; more interested in getting than giving
·Is ephemeral - physical orgasm provides a welcome rush of adrenaline, but by itself can only offer the
brief illusion of intimacy and belonging
·Uses sex is a conquest and abates the terrifying sense of not belonging.
·Sexual fantasy conjures up a perfect world of nourishment, love, generosity and tenderness.
·Are trapped in the paradox of being terrified of loneliness even as they act in ways that create further
loneliness
·In fantasy sex, have the freedom to be vulnerable and nurtured without fear. At
it's core, sexual fantasy is worship of self.
·Carry a sense of parental betrayal; parents unable to provide a positive role model of healthy intimacy
·Have no ability to regulate their emotions from within
·Risk relationships, financial loss, job jeopardy and physical safety
·Possesses a set of irrational cognitive distortions, including,
o"Sex is my most important need";
o"I am basically a bad, worthless person; no one could love me as I am;" "
oMy needs are never going to be met if I depend on others;"
o"I am valuable only if I am sexualized; being sexually desired makes me feel alive"
Patrick Carnes, Out of the Shadows: Understanding Sex Addiction
·Have deficits in the areas of social skills, interpersonal communication, stress control, anger
management and empathy for others
·Learned in childhood that feelings are dangerous, so learned how to mask their feelings, even from
themselves.
·Sex in the “euphoric haze” becomes his exclusive coping mechanism, preventing him from learning
higher coping mechanisms that make life more enjoyable.
The Goals of Sex Addiction Recovery:
·Diminish/eliminate shameful, compulsive sexual behaviors
·Learn to deal with urges/cravings by understanding that they are transitory and that they are not
imperatives to act out
·Know triggers and have behavioral strategies for dealing with them
·Develop a caring support system and identify individuals to contact when relapse is about to occur
and as a support for getting dependency needs met
·Reduction of denial, justification, rationalizations, minimalization and other distorted thoughts and
beliefs
·Replace negative core beliefs about the self with healthy self-esteem
·Heal the shame that both precedes and follows sexual acting out
·Re-frame slips/relapses from a sense of failure to an opportunity for learning new coping skills
·Develop an understanding of the unconscious internal factors driving sexual behavior
·Attain better self-regulation (of moods, feelings, behavior) through the gradual internalization the
nurturance, containment, and structure of various treatment modalities
·Improve capacity for interpersonal relationships
·Improve capacity to reflect on thoughts and feelings, with a resulting increase in inner control and a
decreased need to act out unwanted mental states
·Explore the functions the sexual activity is serving (relief from anxiety, momentary
intimacy, master feelings of powerless and helplessness from the past, etc.) so more
constructive strategies can be developed to get needs met
·Explore how sexual compulsion is an enactment of dysfunctional relating patterns from the past
·Develop a clear definition of healthy sexual patterns vs. shaming and self-harming sexual activities
·Reduce marital/relationship conflicts
·Increase understanding of need to control intimacy as a function of long-standing early
neglect and abuse.
Chapter 3
Treatment for Sex Addiction: Relapse Prevention
Overview
Relapse in sexual addiction recovery is a reality. While all addictions are relapse
prone, it is the sexual recovery community who suffer most from the
demoralization of repeated relapse. After all, we can live without ever being
around alcohol or drugs, but our sexuality is ever-present. Because ours is a
sexualized culture, triggers, cravings, urges, cues, and high-risk situations are
everywhere. The sex addict, despite his your best efforts to achieve continuous
abstinence, you may find yourself himself continually returning to your his
addiction despite the knowledge of the damage it inflicts on you him -- disease,
damage to primary relationship, social disapproval, financial loss, and
decreased self-esteem.
In times of stress, the lure of immediate gratification (the pleasure, "high",
tension reduction, relief of distress) calls you him and you he responds, puppetlike, to the perceived inevitability of relapse. When caught in the addiction cycle
of preoccupation, fantasies, euphoria, urges, cravings and the intense, and
driving need for comfort and gratification, retreat into the comfort of the "erotic
haze" is the only coping mechanism available to you him at the time. The erotic
haze is a dissociative state that allows the very real negative consequences of
your his behavior to recede from consciousness as the imperious need for
immediate gratification becomes your his exclusive focus. Most sex addicts
state that the sexual act itself is inconsequential. Hours spent in the dissociative
"erotic haze" meet certain non-sexual needs. It is this euphoric self-state that the
person is really addicted to.
With orgasm, the "bubble" breaks and reality sets in. Feelings of defeat, shame,
hopelessness and demoralization are common. Because your his only way of coping with
distressing feelings is sexualization, he returns to the addiction for relief of the pain
that's caused by the addiction because he doesn't see any alternatives. He blindly goes to the
source of the pain for relief of the pain. Thus we see the vicious, never-ending cycle of active
addiction. We keep returning to the source of the suffering for relief from the suffering which
creates more suffering so we again go to the source of the pain and so on and so on.
But there is hope. Addicts repeatedly return to their addiction because it's what they know.
The result of long-term addiction is a gradual erosion of the ability to choose different
alternatives to deal with life. An addict just entering treatment is in a state of nil-choice. A
relapse prevention program helps people who use sexual behavior addictively (1) to
recognize factors and situations that are associated with an increased risk of acting out; (2) to
cope effectively with sexual urges; (3) to recover rapidly from episodes to symptomatic
behavior; and (4) to use such "slips as opportunities to learn about how their recovery plans
can be strengthened.
You'll learn new coping skills, new options and new cognitive strategies to cope with external
and internal stressors. You'll become very familiar with the warning signs of your personal
relapse process and learn that you can intervene at many points in that process with a
healthy coping mechanism. Change a thought - and you're out of the downward spiral. Do
something different from you used to do - and you're propelled out of the erotic haze into
reality. Ingrained sexual habits can be transformed into behaviors that are under the
regulation of higher, more mature mental processes involving awareness and responsible
decision-making. You can begin to make a variety of choices that ultimately lead to the
enjoyment of pleasurable experiences that are non-sex related and have no negative
consequences. The goal of Relapse Prevention (RP) is the restoration of the ability
to choose, an increase in the client's awareness and choice about their behavior, to develop
coping skills and self-control capacities, and to generally develop a greater sense of
confidence, master, or self-efficacy in their lives.
Working an individualized relapse prevention program is not part of
treatment per se, but maintaining a relapse prevention (RP) program is probably
the most critical element involved in staying sexually abstinent. If the person
believes that the only goal of addiction treatment is abstinence, then little
attention is paid to the perils and demands of the journey towards
the maintenance of abstinence and continued growth as a person. In the
process of recovery you'll be faced with a plethora of temptations and stressors.
The pull of powerful old habit patterns will beckon you. Failure to anticipate and
plan for the stressors of recovery will result in immersion in the addiction cycle.
The phases of this cycle consist of preoccupation, dissociation, entering into the "erotic haze",
ritualization and sexual acting out, followed by despair, shame and guilt. The addict, because he has not
developed ways of coping with overwhelming emotions, sees his only option for relief from the shame
and self-loathing as the return to the beginning of the cycle. With time, the addiction cycle may
escalate, with greater intensity, more frequency, more risk and greater loss of control.
Relapse prevention intervenes before the client enters into the addiction cycle. While behavioral or
cognitive interventions are still possible in the preoccupation and dissociation stages, once the client
enters into the "erotic haze", it is almost impossible to stop the process.
Motivation - Values and Goals
The cultivation of meaningful, realistic goals and clarification of personal values
should precede the development a RP program. To counteract the pull of the
addiction, you need to know why you're motivated to work for addiction recovery.
You will your own life goals and enduring values that can guide you, as the
North Star, towards restoration, recovery from addiction and the achievement of
a satisfying and meaningful life. Most sex addicts want to achieve real
connection with others and not the mere illusion of connection. They want to
build the genuine self-esteem that comes from living out one's most cherished
ideals and values and from the ability to regulate their feelings and behaviors.
They want to stop the lies, secrets and deceptions that keep them in a perpetual
state of fear, shame and self-doubt. Luckily, these goals are attainable.
What it Takes
Working a RP programs requires three things of you.
Motivation. You need to be consistently aware of the negative consequences of
unregulated sexual behavior. Remembering the pain and suffering of being in
active addiction can be a great motivator to change. Another motivator to staying
active in dealing with addiction and working towards your life goals that would
be unachievable if you're involved in active addiction. The process of
continuously doing what you've committed to do is itself a strong motivator.
Active addiction gradually erodes your moral fiber and betrays your essential
values. Knowing what makes life meaningful to you and re-committing to your
essential values will be the motivational force and the foundation for the work
ahead.
Mindful awareness of your inner processes. Enhanced knowledge and
awareness of inner processes (see article on "Mindfulness Meditation.") is
necessary for most aspects of recovery, but more so in RP. Most of the warning
signs of relapse occur unconsciously. Mindful awareness brings them into
consciousness where they can be dealt with in adaptive ways. Mindfulness
meditation fosters a sense of detachment between addictive behavior and your
personal identity. Cultivating a "witness consciousness" that is balanced and
non-judgmental trains you to become your own mind-scientist. With mindful
awareness, you can see the warning signs of relapse as they happen so you
can take proper action. Through mindful awareness and with the help of your
therapist, you'll learn to think about your thinking and observe and detach from
painful emotional processes.
A willingness to learn new responses to old stimuli, an openness to new ways of
behaving and thinking and a continuing determination to practice new skills until
they become automatic is essential to making your relapse prevention program
work for you. One definition of "determination" is the ability to stay the
course regardless of thoughts and feelings. You just keep doing the next right
behavior on your addiction recovery plan, regardless of your feelings or your
perceived discomfort. Treatment of addiction means nothing if it's not used as a
springboard for taking healthy, constructive actions to replace the addiction.
The Basics
First you figure out what thought processes, high-stress situations and
behaviors lead to the end-point of acting out. Sexual relapse is the end-point of
a relapse process that may have begun last week, last month, or last year. You
don't get "struck" acting out. Sexual enactments don't come out of the blue.
There are many, many steps that lead to being in relapse mode. Cultivating
mindful awareness of the warning signs of your particular relapse process is
essential.
As you learn new recovery skills (or healthier coping mechanisms), you'll be able to use one of them as
an intervention at various places in the addiction cycle. When you become aware of the warning signs
of relapse, you immediately do something different than you've always done that will disrupt the pull
towards acting out.
When an addict has used immersion in the "erotic haze" as a coping mechanism to avoid pain
and deal with life stressors for an extended period, it becomes his exclusive way of coping
with life. However, the coping mechanism is maladaptive because it leads to sufferinginducing consequences. An RP program teaches adaptive coping skills that generate new
behavioral alternatives, new ways of thinking, new choices, new experiences and, combined
with other treatment modalities, offers a radically different way of being in the world.
How it Works
The Ball and Chain
When I work with clients on a RP program, I use the metaphor of a behavioral chain that has
many links. The bottom of the chain is relapse. Each link in the chain represents a relapse
warning sign that you can observe as it happens and immediately intervene with one of your
newly learned coping skills.
Even though it seems as though relapse descends upon you, a force beyond your control that comes
"out of the blue", in fact, there is a long chain of events that lead you there. You can learn to find and
control the chain of events that represent your particular relapse process. Clients learn how to go back
in time to reconstruct all the internal and external links of the chain (thoughts, feelings, behaviors,
urges, fantasies and external events) that have that led to relapse in their past.
Following is an example of one of a client's behavioral chain that led to relapse:
·Two days before his relapse, he went to the gym.
·At the gym, he thought members of the staff looked at him in a strange way.
·He interpreted their looks as judgments about himself.
·He felt both embarrassed and hopeless. He felt hopeless because it seems that would never feel normal
in any of the places he wanted to belong
·He went directly home without doing her errands because he didn't want to be seem by anyone.
·Lying on the couch while watching TV, he became sexually aroused and distracted from his earlier
feelings of embarrassment and helplessness.
·He went to the computer and looked for a site with free porn pictures.
·After his orgasm, he felt ashamed that he had look at porn after he had promised himself he wouldn't
do that again.
·He felt hopeless and depressed and thought about what a loser he was.
·He thought about how no one would ever love him.
·He thought he would go crazy if he couldn't be loved and sexually satisfied by a woman.
·He thought he has to prove himself that he could have sex with a woman and
that he was not a loser. He thought he needed to regain his self-control.
·
This client's chain brought him to a brothel where he had sex with a prostitute. Following his
experience, he felt an immediate sense of demoralization and shame. If uninterrupted, the displeasure
of the feelings of demoralization and shame will bring him right back to the beginning of the addiction
cycle.
This is an ordinary example of how you can end up doing exactly what you didn't want to do. When
your personal behavioral chain is pulling and you don't try to break it until it's too late, then you've
gone and gotten yourself just in the place you've been trying to avoid.
Again, the relapse didn't descend upon him as a cruel fate. It didn't just happen. It took a few dozen
steps for this client to arrive at relapse. At each of those steps, (or links in the chain) he could have
intervened with a cognitive change or a healthy behavior to prevent the relapse.
You need to become very aware of the links in the chain, especially when warning signs go off. The
next step is to look at each link in the chain and come up with alternatives (also called coping
mechanisms) that are ways to get out of the chain when you are caught in it. Change a thought, you've
off the chain. Do an alternative behavior, you're off the chain. These are the ways to free yourself from
becoming tangled up in the chain. An alternative is something you do instead of your usual response in
a situation. An alternative makes it possible for you to think and behave in a different way that you did
before.
You might want to pick up a copy of "Living Sober" (AA Worldwide) that provides plenty of ideas of
alternative, pleasurable behaviors and activities.
As you look at the sample behavioral chain, you can see a series of emotions,
thoughts and actions. You're not asked to do anything about the emotions just
now. Feelings come and go. Just notice that how you feel affects how you think
and what you do at a given time. You can't directly change feelings, but you can
become aware of them and how they affect the other parts of your life. What
you can change directly is how you think about things and what you do about
them. First you look for every cognitive distortion on your chain and come up
with alternatives ways of thinking that might be more in line with reality. Go
through the chain, replacing the thoughts that led you down the dark sexual
alternatives with better alternatives (Sbraga et al., 2000).
Next you look at the behaviors in you chain and come up with realistic alternatives. If you find yourself
in a high-risk situation, what could you have done instead? Write out a list of alternative behaviors that
will instantly get you off the chain. Think of lots of options, particularly options that are give nonsexual pleasure with no negative side effects. Write your new coping mechanisms on a card and carry
them with you.
Research has shown that people lapse, it is usually in response to negative feelings and to interpersonal
conflicts. These events should always to consider high risk.
You learn how to be good at using you coping skills to stop your relapse progression
by practicing. You are creating new, positive habits for yourself. These are habits that will take
you towards your goals instead of stealing away the best years of your life.
1.Managing Feeling-States
All addicts have problems with tolerating distressing inner states. Research shows that two types of
situations are especially high-risk for relapse: Negative emotional states and situations involving an
inter-personal conflict with a closed one. People go to any length to avoid certain feelings such as
shame, fear, anger, loneliness, emptiness, depression and so on. Addicts avoid feelings through sexual
acting out. You might consider other ways you have to not sit with feelings.
It is possible to control feelings for a bit of time, but they surface and fade away.
Handling feelings is essential in relapse prevention because how you feel has a
lot to do with sexual control problems. Sex addicts try to manage their emotions
with sex. Think for a moment how many times you have gone out looking for
sexual satisfaction when you were feeling hurt, lonely, rejected, sad, angry,
disrespected, anxious, depressed, fearful or unloved? And, of course, sex
makes you feel better - for a brief period. Unfortunately, this strategy of
managing feelings just doesn't work. If you really did a cost-benefit analysis of
sexual acting out, you might see that the benefit is fleeting and the costs...well,
you know what they are.
The reality is that if having all the sex you wanted could make you feel better or create a better life for
you; don't you think it would have happened by now? The problem is that sex, despite its allure and the
false promises it offers you, cannot make you feel better in a real or lasting sense. The authentic self is
not nourished or healed through sex.
So if you can't change your feeling and they just happen, what are we to do about painful feelings?
Here's the deal: DO ABSOLUTELY NOTHING ABOUT YOUR FEELINGS! Feelings, if you don't try
to get rid of them, come and go rather quickly. When people try to control their emotions, the feelings
don't get the chance to dissolve as they should. They just keep coming back. FEELINGS DON'T KILL
- THEY WILL NOT ANNIALATE YOU. THEY ARE NOT DANGEROUS. They create discomfort,
and then they pass away. The important thing is to remember that you can handle any of your feelings
that come up. You have a choice about whether or not to act out sexually and create more suffering.
In the same way, what do you do when you're triggered, hot, horny, aroused and
amorous? The answer is the same: DO NOTHING. Sex addicts have a false
belief that they must do something about it no matter what. This is a lie. People
feel aroused all the time and don't act on the feelings. Happily married people
are sometimes attracted to other people, but they don't have affairs. Priests and
nuns feel sexual arousal but they honor their vows. Certain engaged young
people choose to postpone sex until after marriage. Somehow, they all survive
without acting on sexual urges.
Learning to tolerate sexual arousal without being sexual is a gift you give to yourself.
Urges and cravings
Urges and cravings are physiological responses to internal or external triggers.
You experience being pulled by the wish for immediate gratification. An RP
program teaches you urge-management techniques. You are taught to
anticipate and accept these reactions as a normal part of your addiction cure.
You are taught to dies-identify with the urge and to view it dispassionately as an
alien force. I use hypnosis to set up imagery work with the client and ask him to
imagine it as a wave, watching it rise and fall as an observer and not to be
"wiped out" by it. This imagery technique is called "urge surfing" and refers to
visualizing the urge or craving as a wave that crests and then washes on to a
beach. In so doing, the client learns that rather than building until they become
overwhelming, urges and craving peak and subside rather quickly if they are not
acted on. The client further visualizes not being "swept away" but rather can see
himself riding the wave on a surf board. This imagery fosters detachment from
the urges and reinforces the temporary, fleeting nature of these phenomena.
Lapse Management
Despite planning and precaution, many clients committed to abstinence will experience a lapse after
initial abstinence. Lapse-management techniques strategies focus on halting the lapse to prevent an
uncontrolled relapse. I contract with the client to contact me as soon as possible after the lapse, and to
evaluate the situation for clues to the factors that triggered the lapse. The client is instructed to leave the
lapse-inducing environment and we immediately structure the experience as a slip-up, a mistake.
Furthermore, the client is taught to reconceptualize the episode as a single, independent event and to
see it as a mistake and not a disaster that can never be undone.
I find that clients who place the blame for the lapse on themselves and see it as a dead-end, a treatment
failure and experience shame and defeat are more like to move into full relapse mode. Other clients
who view the lapse as a mistake that needs correcting and an opportunity to learn what needs to be
changed in their RP strategy fare better in resisting the entrance back into the addiction cycle (Gorsky
et.al., 1986).
Sexual Fantasy as a Trigger
Sexual fantasies have to do with a wish for something. For you to discuss a
sexual fantasy is to admit that you have an unfulfilled sexual wish. There can be
shame associated with having that type of longing. Getting rid of a sexual
fantasy isn't really possible. Once again, I challenge you to handle sexual
fantasies by DOING NOTHING. People often try to get rid of their sexual
fantasies or pretend they don't have them. But trying not to think about them
may give them more energy.
Fueling fantasies to give a higher level of excitement isn't the way to go either. By "feeding" I mean to
make them longer, more detailed and stronger than they started out. People fuel fantasies to work
toward an inner "perfection." But it can take over your life. You check out of reality and check into
your fantasy. If you start holding real-life situations and people up to the standards of your fantasies,
there is no way they can measure up.
When fantasizing takes the place of reality, it's very unhealthy. Remember a fantasy is a fantasy
precisely because there are no downsides to it. There are no costs involved. Real life does not work that
way.
A fantasy can be dispelled by discussing and understanding it with your therapist. I have also found that
the fantasy life leaves a person as he matures and is getting satisfaction from real living. The fantasies
will simply fall away.
Lifestyle Regeneration
A focus on learning to achieve and maintain a healthy, balanced life-style is key. This is based on the
principle that a healthy, balanced life-style decreases one's vulnerability to change warning signs into
new behaviors and promotes mental and physical well-being in general. Issues addressed should
include diet, exercise, rest, recreation and the balance between work ("the shoulds") and play ("the
wants.").
Your lifestyle should be balanced with the "wants" and the "shoulds". Life stressors need to be balanced
by genuine pleasure, shared activities and just plain old fun.
Stress Management (Relaxation Training)
Stress is the silent killer for all of us -- more so for those involved in an addiction recovery program.
Learning to deal with stress is critical. There are a number of relaxation trainings and stress
management procedures I can draw upon to provide the client with a global increased perception of
control, thereby reducing the stress "load" that any given situation may pose. Such procedures as
progressive muscle relaxation training, recreational reading, yoga, meditation, exercise and selfhypnosis are useful in dealing with the hassles of daily life. Also, through engagement in stressmanagement techniques, you will gain mastery over arousal states and emotions which before were
believed to be beyond personal control.
An important component of relaxation skills is that you will learn the skill of "self-soothing" which can
give an experience of being able to generate within that which you've been seeking from without.
Skills Acquisition
Depending on each need, different clients need to be taught different skills. These may include:
Social Skills
Assertiveness Training
Communication Skills
Relationship Skills
Healthy Sexuality
Dating Skills
Positive Self-talk
Problem-Solving
Positive Self-talk
Problem-Solving
Chapter 3
Cognitive Therapy
"Men are disturbed not by things that happen, but by their opinion of the things
that happen." Epictetus (c. 50 - 120)
The philosophical basis for cognitive therapy goes back to the Stoic
Philosophers who taught that it is not the external event that causes
our distress, but rather our perception or interpretation of the event
that is distressing. According to the Stoics, people are capable of
considering alternative perceptions or interpretations by changing the
thoughts that underlie emotional distress or sexual dysfunction. This
ancient philosophy can help you in your therapy for sex addiction.
Cognitive models became popular in the early 1960's. Proponents of
this school assume the client's problems occur at two levels. The first
is the overt difficulty, such as depression or sex addiction. The second
involves addressing underlying psychological mechanisms and
psychological cognitive distortions, usually involving irrational beliefs
that cause the addictive behaviors.
Cognitive-behavioral therapies conceptualize psychological problems primarily in
terms of maladaptive learning, and are oriented toward assisting the individual to
learn more adaptive patterns of thinking and acting. This technique typically relies
on interventions that are directive, practical, task-oriented and educative in
nature.
It is important to understand the major premise of cognitive approaches to treatment: the overt problem
(sex addiction) originates within what cognitive behaviorists call the client's schemata. This is a
person's world view, or core belief system. The focuses of this approach is on how the client maintains
painful, harmful, or irrational behaviors. The primary approach utilizes some form of debate. This
involves pointing out to clients the irrationality of certain thoughts, beliefs and perceptions and the
construction and rehearsing of rational self-statements or other more functional cognitive strategies and
skills.
My focus when working with a cognitive model includes:
1. The focus is on stopping the undesired sexual behavior. Behavioral
modification techniques (Relapse Prevention Skills) and/or
pharmacotherapy are employed to help clients overcome addiction.
2. This is the "admission" stage and requires the patient to accept the
existence of a problem and to promise to keep no secrets from the
therapist.
3. In this stage, patients are taught stress management techniques so they no longer need to rely on
sexual behavior to alleviate their anxiety. I recommend physical exercise, and teach a combination of
breathing techniques, progressive relaxation, meditation and hypnosis to show clients that they do have
some power over their inner states.
4. This may be the most important stage of the program. It consists of cognitive therapy directed
towards repudiating the irrational beliefs that underlie sexual addiction through active questioning. It
allows clients to develop an awareness of beliefs. By asking questions clients develop an insight into
their thought process and how these influence their emotions and behavior. Accordingly the client
becomes aware of inappropriate beliefs and is helped to challenge them and change their behavior. The
process involves asking questions that support or refute the thought, asking about possible alternative
explanations. Questioning about the range of consequences of the thought and it's impact upon the
person and what would be the effects of believing the thought or of changing their thinking.
5. Patients are trained in such skills as assertiveness and problem solving in order to facilitate adaptive
social functioning.
6. Focus is on resolving whatever problems the individual has had in establishing and maintaining a
primary sexual relationship.
7. Learning what thought processes lead to "setting oneself up" for a return to relapse.
8. Developing a positive attitude towards healthy sex; cultivating an appreciation for the needs of one's
partners, learning pleasuring skills, using sex therapy if there is a sexual dysfunction.
9. Generating pleasurable sober activities and relationships - building a life worth
living.
The sex addict depends on sex to meet his emotional needs which he
is unable to meet through healthy coping skills. Sex becomes a coping
mechanism for dealing with stress, shame, guilt and isolation. It is a
way to connect without risking intimacy.
However, the addiction is never satisfied because sex is unable to
meet these needs because their source is historical and the need is
too great. In addition, the needs of the true self can never be met by
sexual activity.
Patrick Carnes sets out the unconscious belief systems that all sex
addicts need to refute.
·I am basically a bad, unworthy person.
·No one would love me as I am. My needs are never going to be met if I have to rely on others.
·Sex is my most important need.
While these are the core dysfunctional beliefs, there are many more beliefs, attitudes, or "cognitive
schema" that keep the addictive cycle in place. From my experience, some of them are:
·I am unable to tolerate boredom; sexual acting out is a good way to fill in the time.
·If not distracted by sex, I am filled with an intolerable sense of emptiness.
·Men are more sex-driven than women. As a man, I need to discharge that drive, or I'll go crazy.
·My sense of self is determined by how many women are attracted to me.
·The vicissitudes of life are either boring or unmanageable. There is no pleasure to be had in day-today life except for my "secret" world.
·Sex with my partner is a mechanical, deadening process which lacks spontaneity and excitement.
·If life does not provide excitement and high-stimulation, then I'll be bored and depressed forever.
·When I get an urge or impulse to act out sexually, I must succumb to that urge.
·In order for me to be a real man, I must have sex with as many women as I can. Furthermore, as the
man, I am responsible for my partner's pleasure through intercourse. Failing at intercourse is failing as
a man.
·Engaging in cybersex is my only means of getting away from the
stress and frustration of living. Sexuality is the only trustable means
of relating to others.
·I depend on sex to meet emotional needs which I am unable to meet through
healthy coping skills.
Addiction is self-perpetuating; it feeds on itself because of ingrained core beliefs as well as each
individual's dysfunctional beliefs about sex. In order to change the addictive cycle, one must change the
belief systems that underlie it.
Dysfunctional beliefs give rise to rationalization, minimalization and justification.
The addict, as the disease progresses, starts to see the world through cognitive
distortions designed to protect his sexual acting out. His whole perspective
becomes distorted to the point where he becomes increasingly out-of-touch with
reality.
In treatment for sex addiction, changing these beliefs is key.
Changing core beliefs is a challenge because they were imprinted at
an early age and have remained stable over time. Another reason
change is difficult is that these beliefs live in the unconscious mind.
The addict lacks awareness of his self-defeating beliefs. How can you
change something you don't even know you have? The cognitive
therapist will elicit these attitudes and beliefs and provides alternative
ways of thinking and perceiving.
I sometimes use hypnosis to gain access to the subconscious mind
where the beliefs, attitudes and cognitive schemas can be brought to
awareness and disputed.
I highly recommend David Burn's book "Feeling Good". In it he lists 10 cognitive distortions and ways
to dispute them. Study the cognitive distortions so you can begin to see how they operate in your life
and change them more realistic,
Chapter 4
Psycho-dynamic Psychotherapy
In my opinion, long-term psycho-dynamic therapy is the most
efficient way to cultivate healthy personality development. The most
comprehensive treatment for addiction combines the empathy, insight
and relational abilities of a psycho-dynamic psychotherapist with the
12-step orientation and cognitive-behavioral strategies of an addiction
specialist.
What is Psycho-dynamic Psychotherapy?
The primary focus of psycho-dynamic treatment is on your internal structural
deficits rather than on your addictive symptoms. Besides compensating and
repairing deficits in the self stemming from childhood misattunements with early
caretakers, it may also be the most appropriate treatment to help you to cope
with life stressors and painful emotional states that contribute to urges to engage
in addictive sexual behavior.
The focus of this type of therapy is to enhance your self-regulation and self-care, and to foster your
capacity for meaningful interpersonal connections. Psychotherapy serves these goals by facilitating the
development of healthy ways to regulate emotional self-states, for getting appropriate needs met in
reality, for resolving inner conflicts, and for taking care of yourself in a spectrum of areas.
Integration of your personality is an important element of psycho-dynamic therapy. Sex addicts live in
two worlds; the "normal" world of work and love and the "secret world" of sexual acting out. This split
in the personality results in having different value systems and goals for each part of your personality.
Psycho-dynamic treatment promotes personality integration by bringing together under the light of
consciousness the split, denied, dissociated and repressed aspects of your mental functions. Dr. Jekyll
and Mr. Hyde finally become one.
Some General Principles of Psycho-dynamic Therapy
·Focus is on feelings and expression of emotions. The therapist helps
you to describe and put words to feelings, including contradictory
feelings, feelings that are threatening, and feelings that you may not
initially be able to acknowledge.
·Exploration of attempts to avoid distressing thoughts and feelings.
·Knowing, but not knowing at the same time is the result of various
defenses the person uses to remain unaware. One aspect of this type
of therapy is actively focusing and exploring these avoidances. Patient
and therapist chip away at defenses so unconscious material can be
brought to consciousness where there is a chance of changing and
adapting to reality.
·Identification of recurring themes and patterns. Self-defeating patterns in patients' thoughts, feelings,
self-concepts, relationships and life experiences are put under a microscope.
·The past is alive in the present. Past experience, especially early family-of-origin issues, affects our
relation to, and experience of the present. The goal is not just to dwell on the past for its own sake, but
rather to help people free themselves from the bonds of past experience in order to live more fully in
the present.
·Focus on interpersonal relationships. Psycho-dynamic therapy emphasizes your interpersonal
experience. Problematic interpersonal patterns interfere with your ability to meet your emotional needs.
·Exploration of the entirety of mental life. Your encouraged to say whatever comes to mind. Thoughts
can range over various aspects of mental life, including desires, cravings, fears, fantasies, dreams and
daydreams. All of this is a rich source of information about how you view yourself and others, interpret
and make sense of experiences, avoids aspects of experience, or interferes with potential capacity to
find greater enjoyment, ease and meaning in life.
The goals of this type of therapy extend beyond healing the symptom (compulsive sex) but also foster
the positive presence of inner capacities and resources. These might include more fulfilling
relationships, more effective use of your talents and abilities, maintain a realistic sense of self esteem,
tolerate a wider array of strong feelings without acting out, have more satisfying sexual experiences,
greater understanding of yourself and others and face life's challenges with greater freedom and
flexibility. These goals are explored through self-reflection, self-exploration and self-discovery that
take place in the context of a safe and deeply authentic relationship between the therapist and you.
Personality Factors Common to Sex Addicts
That are Addressed in Psycho-dynamic Therapy
·Sexually compulsive behavior helps you manage fluctuating affects, self-sooth, and maintain selfesteem. Sex distracts from painful feelings and thoughts, counteracts inner emptiness, replaces feelings
of fragmentation with an illusion of control, and temporarily bolsters self esteem.
·Sexual activity is a form of self-medication, used to make unbearable
feelings and self-states bearable. Addiction furnishes externally what
cannot be provided internally.
·Sexually compulsive individuals often have personalities with narcissistic features.
·Poor capacity for self-regulation, self-efficacy and self-care
·Sex Addicts tend to have difficulties sustaining relationships and feeling close to others.
·Problems in family-of-origin where their individuality and needs were often ignored or punished.
·In childhood, the true, authentic personality needed to go
"underground" to please narcissistic parents; parts of the personality
were then "split off " and are enacted through sexual activity as the
adult.
·The person affected alternates between deprivation of needs/feelings and unrestrained indulgence.
This state is marked by significant splitting and minimal integration. (The Dr. Jekyll/Mr. Hyde
Syndrome)
·Deviant sex provides a much-needed connection with another without the "danger" of relatedness.
·Brief sexual encounters are seen as emotionally safe. They have a fixed ending point, no strings
attached and have little room for conflict. Furthermore, anonymous partners cannot readily reject you
upon the discovery of your real or perceived flaws.
·Many sex addicts have a strong wish for control and a fear of vulnerability. They feel internally fragile
and prone to fragmentation.
·Sexual behaviors allow a feeling of control, power, triumph or omnipotence that compensates for
early-life feelings of helplessness and powerlessness. Most likely a ritualized sexual enactment turns
trauma into triumph and is a repetition compulsion with the unconscious aim of repairing the original
childhood trauma. Dysfunctional relationships developing out of the trauma are enacted through sexual
activity.
·The details of a sexual enactment, and the fantasies that fuel it, are laden with symbolic meaning and
are an aid in understanding the themes of inner conflict driving the behavior.
The Fruits of Treatment
Psycho-dynamic therapy can help you to develop:
·An understanding of the internal factors driving your sexual behavior;
·Better self-regulation through internalization of your nurturance, containment and structure of the
therapeutic environment;
·Improve your capacity for interpersonal relationships and healthy sexuality;
·Improve your capacity for working at an optimal level;
·Improve your access to creative inner resources;
·Improve your capacity to reflect on thoughts and feelings, with a resulting increase in inner control
and a decreased need to act out unwanted mental states;
·Integration of the private and public selves: Dr. Jekyll and Mr. Hyde become one;
·The therapist explores your sexual behaviors and fantasies in detail. Like dreams, they have symbolic
meaning and aid in understanding the structure of your personality as a whole.
Chapter 5
Group Therapy
Why Group Therapy for Sex Addicts?
Although the behaviors of sex addicts differ, all sex addicts share certain
similarities when you “act out”. Typically, you are disconnected from your
feelings. You substitute sexual behavior for emotional intimacy, and you have
distorted and painful interpersonal relationships. The problem of emotional
alienation is compounded particularly for men who in American culture, are
rarely connected to a social group in which they can bond and discuss feelings
with others.
Group therapy is a highly effective treatment for sex addicts. In a group
environment, no one person is singled out because everyone in the group
shares the same affliction. This commonality reduces shame and denial, limits
isolation, increases socialization skills and the development of empathy. More
importantly, the group format also fosters the development of intimacy and helps
sex addicts develop the coping skills they need to meet their emotional needs in
interaction with supportive others, rather than through sexual behaviors.
Below is a list of the processes and benefits of group therapy for sex addicts:
·You may have come to treatment feeling extremely hopeless. By seeing others
in addiction recovery, your faith is fostered in the belief that treatment can and
will be effective.
·You feel a sense of universality which helps you realize that an you’re not alone in your
addiction and that others have experienced similar problems. This experience tends to reduce
a member's sense of uniqueness and reinforces the fact that each person is not unique.
·Sex addicts are often alienated from others and experience a great deal of
shame and loneliness. The group provides a safe place to practice trusting
others. You may learn to feel free to care about each other because of this
climate of trust. You begin to see that you can talk about feelings and elicit
support.
·The therapist and group members offer effective ways to deal with life's
problems. Education about 12-step support groups, the addiction cycle,
identification of healthy relationships, re-framing the meaning of sexuality, and
relapse-prevention strategies are also imparted.
·The opportunity to help another person because you care (altruism) and to feel useful increases selfesteem. It also challenges one's own demoralized position. Helping other group members can mediate
this sense of worthlessness.
·Addicts learn basic interpersonal skills which help them turn to people, instead of relying upon
fantasy enactments in times of need. Group therapy helps you to develop new ways of relating to
people
·Group members serve as role models for other members through self-disclosure and honesty. When
the therapist listens attentively and provides direct eye contact and sympathetic expressions, she
promotes a positive attitude and an understanding of the importance of what you are saying. Through
modeling the therapist, group members learn how to help each other feel both supported and
understood. When one member shares his or her secrets, it encourages others to take risks as well. You
have the opportunity to see how others work through their problems without returning to destructive
behaviors.
·Members are able to connect with each other because a sense of cohesiveness develops. You begin to
take seriously the events that occur. It is what makes the group really matter to its members. Because
sex addicts have been hurt so badly in childhood, prior to group therapy, they tended to refrain from
trusting others or personally investing themselves in adult relationships. Immersion in a therapeutic
group can help heal and rectify the interpersonal wounds of childhood.
·Many group members experience catharsis. This is defined simply as the open expression of feelings,
which is extremely important for sex addicts who have often repressed their emotions. Sex addicts fear
that if they state where they are emotionally, they will alienate others. In fact, members of the group
generally learn those emotional experiences can promote feelings of connection with others and not a
sense of isolation.
·The sex addict’s lack of structure can be a trigger to acting out. In a group environment, however, a
support structure and a quasi-family provides support empathy, and understanding where it seemed
there once was none. Keeping your time structured through being in the company of family, friends
and recovery “buddies” helps to mediate that trigger.
·The Group provides accountability, which is another structure that addicts require to recover.
Individuals who are accountable to others throughout the course of their recovery are more likely to be
successful in achieving and maintaining sexual sobriety. The members of a therapy group provide an
extra level of accountability by taking an active role in others’ continued growth and success. Lack of
accountability is often another strong trigger for the sexually addicted.
Breaking free from this odious addiction can seem an overwhelming and
impossible task. In the group experience, addicts in recovery witness first hand
what is possible from others who are like themselves. Without hope and a sense
of direction, discouragement and self defeat can quickly lead to relapse, but
when the hope of sobriety is nourished, abstinence becomes more attainable.
Profound personal and interpersonal change and growth can occur in a
cohesive group. I believe it is a critical component of the mix.
A recent survey conducted by a sex addiction treatment rehab center gave
insight about which benefits their patients found most helpful. They said sharing
feelings, a sense of belonging and learning about recovery skills were most
helpful. Interestingly, the statement, “Revealing embarrassing things about
myself and still being accepted by others,” was the single most healing aspect of
group therapy. This finding suggests that acceptance and a sense of belonging,
perhaps the very aspects of intimacy that addicts most fear, are also the very
needs they are trying to get met through compulsive sex.
Chapter 6
Couples Counseling
Cybersex is the use of electronic communications for sexual diversion and
includes email, texting, and internet porn. The American Bar Association cites
that in 2011 a whopping 50% of the divorces it handles have cybersex
implicated in the couple’s demise. The harm and emotional wreckage to the
partner (co-addict) is enormous. As a result of cybersex, a couple’s marriage is
compromised and children within the home are harmed in numerous ways. They
suffer from the abandonment of both parents: one is obsessed with sex and the
partner is obsessed with the sex addict. In many cases, the children don’t
receive the care, time and attention they need and deserve. As a consequence,
this abandonment will affect their ability to forge healthy relationships as adults.
Below is a case example of a couple who suffered the consequences of
cybersex in their marriage. Although the article doesn’t describe the pain and
hard work this couple put into healing through relationship, it gives insight into
the problems of sex addiction. By definition, sex addiction is an intimacy
disorder, so couples work has to start with education about intimacy skills,
including honest self-disclosure, communication skills, healthy sex, having fun
and developing a joint vision of the future.
Rebuilding trust and forgiveness were key issues for the couple, Kathy and
Brad. Kathy took about a year before she could begin to trust and forgive. She
had to witness concrete actions from Brad including the commitment to his SAA
meetings and continuing treatment in individual and group counseling. She
needed to see honesty in all areas of life, dependability and consistency in
Brad’s actions. As a couple, they needed to spend more quality time together.
Forgiveness is a key ingredient in rebuilding trust. Forgiveness is something you
do for yourself, not for the other person. Forgiveness is freedom from
resentment. Partners of sex addicts rarely forget; Kathy spoke of painful images
of betrayal running through her head like movie reels. But she did forgive. She
reported that she still remembered the events, but the pain associated with the
memory diminished over the years.
With couples therapy over time, Kathy went from seeing Brad in a onedimensional way (“The Sex Addict”, “The Betrayer”, “The Bastard”) to seeing
him as a multidimensional human being who suffered from a debilitating
compulsion. Through involvement in her recovery from co-addiction, she moved
from being his adversary to his ally in recovery.
Kathy’s Point of View
“Imagine that your husband cheated on you with one woman. Now imagine that it was with
dozens of women,” said Kathy, 43, a nutritionist. “Sounds like Tiger Woods, right? Well, Brad
was the Tiger Woods of the Internet. He’d get incredibly graphic photos of women online and
then engage in smutty sex talk with them. And he used our credit card to pay for it! I feel
betrayed on so many levels — not only was Brad unfaithful but he had lied to me.
“This isn’t the man I fell in love with. Brad and I met at a party seven years ago and instantly
hit it off. He was handsome, funny, and interesting. And our upbringings were similar. We both
had parents who made us feel worthless. My mother was too self-centered to pay any
attention to me, and my dad was hypercritical. The men I dated before Brad were either
indifferent or constantly put me down — treatment I was used to from my parents. Brad was
different. He and I had a comfortable, easy relationship, and after two years we got married.
We decided not to have children because our own parental role models were so poor.
“About a year and a half into our marriage, Brad became withdrawn and sullen. He stopped
kidding around and wasn’t affectionate. Our sex life had always been great, but suddenly he
wasn’t interested. He’d spend hours tinkering in the basement. I had no idea what was going
on but hoped it was just a temporary midlife crisis.
“One day I went down to our basement to use the computer. I hit a key and up came a photo
of a naked woman on her back with her legs spread open. I was horrified. At first I thought it
was some random pop-up ad, but then I clicked around and found dozens of other images of
women engaged in all kinds of unbelievable sex acts. I snooped a bit more and found erotic
e-mails he’d written and even more photos. I felt as if I was married to a stranger. A perverted
stranger.
“When I confronted Brad, he said, ‘My friends and I goof around and sometimes exchange
photos. We’re just having fun.’ I wanted to believe him. We’d had a good marriage and I
couldn’t bear the thought of ending it.
“I lay in bed for three days, crying. I called in sick to work. I couldn’t talk to my friends because
I was too ashamed. Meanwhile, Brad kept insisting that I was overreacting. ‘You’re blowing
things out of proportion,’ he said.
“I worried that it was my fault, that he wasn’t attracted to me anymore. I’d put on weight since
our marriage, and even before that I didn’t have a body like the ones those online women
have. But they’re in their 20s, and I’m 43!
“I decided to try to get him interested again. I lost some weight and bought sexy
lingerie. Nothing has worked. In fact, Brad avoids me even more. We never
have sex. We barely talk, not even about what I caught him doing. It’s like
neither of us can bear to mention it. Mostly, we fight. I am so disgusted by his
porn problem that I wonder if I can ever trust him again.”
Brad’s Point of View
“I’m so ashamed of what I’ve done and how badly I’ve hurt Kathy,” said Brad, 43,
an X-ray technician. “She doesn’t even know how bad my habit really is, or how
much money I’ve spent on it. Cybersex is a sickness. I’ve stopped since she
caught me, but it’s a constant struggle to resist.
“I’ve been into porn since I was a teenager, when I’d sneak my dad’s Playboys from his
closet. He and I had a terrible relationship. The only emotion he ever expressed was anger,
and he was abusive, emotionally and physically. My mother was a total doormat. Even on the
rare occasions when she’d object to something he did to me, he’d shoot her a dirty look and
she’d back off.
“Dating was hard for me. I never connected with anyone, and none of my
relationships lasted long. I began dabbling in cybersex about a year before I met
Kathy, after a friend told me there were lots of hot women online who’d talk to
me. So I started going on adult sites and looking at photos of naked women.
Sometimes I’d e-mail back and forth with them. Then I moved on to the
telephone. I’d meet a woman online, I’d type in my credit card information, she’d
give me her phone number and we’d talk for an hour or two — for $12 a minute.
She’d ask me what kind of panties and perfume I’d like her to wear and what I
wanted her to do to me. As she’d talk, I’d masturbate. This happened about
twice a week. Eventually I started watching women performing sex acts on my
computer via live web cams.
“Then I fell in love with Kathy. She understood me, and together we laughed, went to movies,
and had fantastic sex. I felt more comfortable with her than with anyone I’d ever known. But
after we’d been married a year or so I started feeling out of sorts. I’d wake up anxious for no
reason. Being married felt like a burden. Basically I shut down.
“That’s when I turned to cybersex addiction again — my easy outlet, my quick
fix. Only this time I got more sucked in than ever. I’d be in the basement four,
five times a week. Sometimes I’d hear Kathy’s footsteps on the stairs and I’d
shut down the computer. Once she said, ‘You’re spending a lot of time online —
what’s going on?’ I said I was trying to sell stuff on eBay. Cybersex became the
most important thing in my life. Kathy and I were like roommates — the kind who
barely talk to each other.
“When Kathy discovered what I was up to, I tried to worm my way out of it. But I feel horrible.
I’ve been living in fantasy land, and I’m not sure I can stop. Kathy deserves better.”
The Therapist’s Point of View
“Not all experts believe that sex addiction is real. I do, and in Brad I saw the
classic case. He could not control his sexual thoughts and impulses and felt
compelled to act on them. His porn addiction had taken over his life and he was
lying about it.
“My first goal with this couple was to air the porn issue. Before coming to me they’d barely
discussed it. Instead they fought about things like who left the coffeemaker on. Neither had a
clue how to deal with the elephant in the room.
“In their first session Brad admitted to all that he’d been up to in the basement while Kathy
read or watched TV upstairs. ‘How could you?’ she wanted to know. He also confessed to
squandering nearly $25,000 on his habit in the past year, which he hid by snatching the credit
card bill as soon as it arrived. Shocked and enraged at all this, Kathy sobbed for most of the
hour.
“Even so, I could see the couple loved each other and wanted to save their
marriage. I explained the concept of sex addiction and urged Kathy to see Brad
as a human being with a problem, not a pervert. But her self-esteem had been
battered and she needed to feel secure. At my suggestion they moved their
computer into the family room and installed parental locks on adult sites.
“I also felt each of them would benefit from individual counseling. During my
sessions with Brad, we explored how his compulsion stemmed from his
childhood inability to please his father. After he married Kathy, similar anxieties
surfaced: that he could never satisfy her, emotionally or sexually. Instead of
trying to understand his feelings, he escaped to into internet porn addiction,
where he didn’t have to deal with a real-world woman or please anyone but
himself. As time went on he needed more and more intensity to get the same
high.
“By always keeping in mind the devastating marital damage that would result if
he gave in to temptation, Brad was able to control his impulses. He also joined
Sex Addicts Anonymous [SAA], where he had a ‘buddy’ to call for support.
“With Kathy, I helped her understand how her unhappy childhood had cast a shadow on her
adult life. She freely expressed both her bitterness about her past and her rage at Brad but
realized she had to move past them. I encouraged her to pursue activities that made her
happy, such as taking a writing course. Putting her feelings on paper boosted her confidence,
enabling her to empathize with Brad and to finally grasp that his cybersex habit had nothing to
do with who she was or how she looked. This breakthrough was key to repairing their
marriage.
“After a year of individual therapy the couple resumed couples counseling. This
time we focused on what was going right in their relationship. Kathy needed to
see that Brad was committed to reforming himself through addiction recovery,
and his hard work reassured her: He never missed a therapy session or SAA
meeting, and he not only pitched in more around the house but he also began
wooing her with flowers and date nights.
“Slowly their romance blossomed again. Today Kathy and Brad are transformed.
They enjoy each others company, go on weekend trips and have a robust sex
life. Brad still gets the occasional urge for cybersex, but he knows better than to
act on it. He’s taken on a leadership role at SAA, where he works with
newcomers. ‘I counsel men who pull over to the side of the road to watch
internet porn on their laptops,’ he said. ‘I feel so lucky I was saved — and our
marriage, too.’”
Chapter 7
12-Step Groups
Introduction
An effective approach to sex addiction treatment is The 12 Steps Program, involving group
membership and participation of peers through recovery. The program has it roots in the treatment of
alcohol addiction with a spiritual foundation. Since the program’s inception in 1936 by Alcoholics
Anonymous, the tenets of the 12 steps have been borrowed and modified, remaining a core component
of many other addiction treatment programs, including treatment for sex addiction. The 12 Steps
encompass levels of suggested progressions of lifelong healing. Central to recovery under the program
is the notion of “people helping people” such that those farther along in the program serve as example
to those who have similar afflictions and experiences. Personal stories by group members provide real
world inspiration to peers.
Within my practice, I recommend the 12 Program in unison with a therapeutic approach.
How Fellowship Heals
Sex addicts need to find positive activities as substitutions for their sexual acting out. For those who
choose it, 12-step meetings does this in abundance. The groups are comprised of many individuals
who care, who have similar stories and do not tire of hearing new ones. Because of this compassionate
support, members in the group may be able to gently confront the addict with his maladaptive
behaviors. Specifically, sex addicts begin to see that they share in common several behavioral
defenses. Defenses are the ego’s way of protecting one’s self from anxiety and in the case of sex
addicts often include:
·Denial, in which a person convinces himself that the unpleasant emotions are nonexistent,
·Rationalization, in which a person finds logical reasons to justify undesirable behavior, and,
·Magical thinking, an error in thinking in which an addict believes he can recover without
intervention, for example. It’s a form of self-protection which prevents inflicting new wounds
upon the self.
Sex addicts have in common a reduced capacity for impulse-control. In the 12 Step program, the
influence of these other individuals is gradually internalized, which means it becomes personal and part
of the self-governing structure of the self. The group itself, as a consistent, caring object also may be
internalized. Over time, the psychological wounds of growing up in a dysfunctional family can be
repaired through the acquisition of a new family that provides the empathic soothing and caring that
was missing in early childhood.
Sex addiction groups have regularly scheduled meetings with a predictable format, repetitive slogans
and messages. The structure of meetings provide a certain order -- a system --even ritual, which can
aid the addict in the development of healthy internalized self-governing structures.
Learning to Talk about Feelings
A mark of the addictive experience is feeling overwhelmed when faced with intense feelings. Some
addicts are unable to describe the sensations for which language seems inadequate. A 12-step meeting
offers a series of lessons that help find language to represent the self. The basic format of the meeting
is that people gather to speak of themselves and listen to others. This provides a powerful experience
in modeling how to use language to express feelings and experience, as well as reduce feelings of
shame. In this way, what was once felt to be unutterable is formulated into words which then defuse
overwhelming feelings.
Without influence, an addict’s central control is limited to his own way of thinking. There is a certain
type of control within the individual personality which can have its source only outside of the
personality - the moral principles advocated by a closely knit group. A peer group can effect change in
an individual against self-centered, gratification-oriented impulses. Instead, an involuntary feeling of
belongingness and allegiance to such a group takes hold.
The linchpin upon which the 12-step process is based is that an addict finally, unembarrassed,
acknowledges the need for participation in a caring community. The participation in the group is
understood that it exists without ulterior motives, and which accepts the individual totally for what he
is. A sex addict cannot thrive normally as a solitary structure; instead, it is essential that the self’s
survival and value require participation in a social structure or community. The development of a true
self is always participating with others in its realization and progress. Once this is acknowledged, this is
the beginning of the "unfreezing" of the developmental arrest and becomes an adaptive substitute for
the destructive, maladaptive addiction.
But it is only the beginning. The passage from infantile narcissism (or, having every whim gratified) to
emotional maturity and full humanity is ultimately accomplished by consistent immersion in working
the 12 steps.
How the Steps Heal
Step 1: We admitted we were powerless over alcohol - that our lives had become unmanageable.
The admission of powerlessness over the one's addiction is the first defeat of infantile egoism (an
immature view of self as foremost important). This is a first step in the assumption of responsibility.
During Step 1, the sex addict adopts the conviction that he can no longer engage in one's addiction.
This becomes an inarguable truth. The denial defense mechanism breaks down as the addict
increasingly sees that to give way to the impulse to "pick up" has far-reaching and devastating
consequences. The addict comes to terms with the essential paradox: you have to lose to win.
The term "surrender" permeates step work. There are two facets of surrender in the first step. The first
and surely the most significant, is formation of deep conviction that one is powerless over one's
addiction. One surrenders to the reality that he can never act on the impulse to "pick up". For
example, addicts progressing through this stage begin to view "One Day at a Time,” comprised of small
successes. This truth unfolds as recovery progresses. The second facet is that the addict is really
surrendering their sense of uniqueness. As one admits powerlessness, one no longer expects the world
to conform to one's own egocentric beliefs. The first step is a step toward "living life on life's terms".
It is making a decision that one is no longer driven by the desire for pleasure and is willing to be open
to accepting and coping with reality.
Step 2: Came to believe that a power greater than ourselves could restore us to sanity.
In this stage, the addict forms an openness to the possibility that a higher power exists. Such belief
propels an individual to develop boundaries. An egoistic perception is replaced by a new reality .
From a psychological developmental perspective, immature levels of personality structure are egoistic
in nature. All things seem related to one’s self, a condition that prevents the individual from seeing
others for who they really are. Rather, others are seen as extensions of oneself, making it impossible
for the individual to have anything but a self-centered point of view. The realization and acceptance of
some power need not be religious or even spiritual. The power merely needs to be seen as a force
greater than one's egoistic pursuits, and this puts in motion the abandonment of a grandiose posture.
One no longer expects the world to conform to the self’s own needs and wants. Rather, one learns to
live "Life on Life's Terms".
Step 3: Made a decision to turn our will and our lives over to the care of God as we understand Him.
This step suggests that another "surrender" be considered. Specifically, this step requires the surrender
of one's own willfulness in the decision-making process. When left to their own devices, addicts tend
to make decisions based only on their ego-centric motives and ways of seeing the world. The step
suggests a less self-driven version of reality which leads one to consider one's powerlessness over
many of the events that occur in one's life.
Step 3 sparks a renewal of trust in living and a loosening of ego-dominated self-sufficiency. Doing the
work of this step requires an understanding and acceptance of paradoxical thinking, meaning that the
addict learns he can achieve control by actually letting go of control. Prior to recovery, the addict
focuses intensely upon control issues (e.g., controlling use of the drug, controlling the amount of
damage caused by the using, and controlling emotional distance to minimize vulnerability). Such
focuses are held exclusive and sway over the addict's consciousness. Step 3 encourages a more
passive mode of letting go by surrendering and allowing events to unfold without futile attempts to
control outcomes.
Step 4: Made a searching and fearless moral inventory of ourselves.
This step represents the attempt to review one's life in as a meticulous and forthright way as possible,
listing the action and choices that have caused guilt and shame in oneself and harm to others. The
process of emotional development involves a degree of self-knowledge and self-awareness. This step is
an opportunity for the addict to see repetitive cognitions and behaviors that inhibit this process of
growth. When one sees the contribution that these "character defects" have made in one's own misery,
the process of projection onto other people and external events for unwanted inner states is reduced.
The focus in Step 4 is on the self and not the faults of others. The addict can't help but accept
responsibility for his life, a crucial step on the movement towards maturity.
The presence of the word "moral" needs special consideration in this stage. When the Dr. Jeckyll/Mr.
Hyde personalities of an addict (described in detail in another article – LINK) split the person
"dissociates" and, in a manner similar to multiple personality disorder, becoming two distinctive
personalities. The addict has his "normal" life and his "secret" life. The Dr. Jeckyll side of the
personality has one set of values, goals and beliefs, and the Mr. Hyde side has a completely different
set. I understand the despair, remorse and regret that follows an episode of acting out (When Dr.
Jekyll returns) as the realization that one has betrayed one's own values and moral injunctions.
Step 5: Admitted to ourselves, God, and another human being the exact nature of our wrongs.
The words "sex addict" and "secrecy" go hand in hand. The addict carries the weight of the knowledge
of what occurs in his "secret" world. If he shared the "secret" with another person, he would, in his
mind, be condemned to hell. He believes he would be despised. A diminishing sense of self esteem
contributes to a sense of isolation and alienation. With the 5th Step, the secret is out and this is good
news. The ability to know and accept oneself in the presence of complete disclosure to another
recovering addict is very freeing. One can let down one's defensive armor and have more of a sense of
ease with the world. The recovering person in revealing the content of their inventory to another,
defuses feelings of guilt and shame. Another significance of this step is that the paralyzing feelings of
isolation, fear, and mistrust of others begin to crumble as the interpersonal immersion in a caring
community begins.
Step 6: Became willing to have these defects removed.
From a psychological standpoint, an attitude of "willingness" is essential to the process of growth. It
puts the person in a less egocentric stance. It also conveys a breaking down of rigid defense
mechanisms that may have worked as a barrier of protection in the past to survive a frightening,
unstable childhood. Now, such defenses have outlived their usefulness and, in fact, contribute
negatively to the addict's here-and-now problems in living if they continue.
Step 7: Humbly asked Him to remove these shortcomings.
Humility is a word much discussed in 12-step meetings. It is desirable to have a modest view
of one’s importance. The posture of humility allows a person to quell excessive selfpreoccupation and instead, opens him/her up to having a sense of awe in the moment-to-
moment awareness of life, nature, God and fellow human beings. Gaining humility also
suggests a turning-point in personality development from the illusion of self-sufficiency to
having an interdependent view of relating to others, one that is reciprocal and enriching. Step
7 is the beginning of understanding that building character and remaining close to essential
values are more important activities than chasing the high of sex addiction. I quote from the
book Twelve Steps and Twelve Traditions (Alcoholics Anonymous Worldwide): "We never
thought of making honesty, tolerance and true love of man and God the daily basis of living.
We sought to gain a vision of humility as the avenue to true freedom of the human spirit."
Having a humble approach along with the admission of powerlessness leads to a softening of childish
demands for immediate gratification.
Step 8: Made a list of all persons we had harmed, and became willing to make amends to the all.
Achieving the quality of healthy interpersonal relationships is a mark of a person's stability and ability
to live comfortably with others. Here, we again come across the word "willingness", implying a deeper
insight into the self is necessary to overcome unnecessarily carrying responsibility for repetitive,
unsatisfying personal relationships. It is only by letting go of resentment of the (real or imagined) harm
done by others and instead focusing on what can be changed in oneself that the personality becomes
less emotionally vulnerable, less reactive, and more stable.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them
or others.
Step 9 is another deeply liberating step. After amends have been made, there are no reasons for the
addict to hide from the world for past deeds. Before recovery, those we were harmed or whom we
avoided out of shame had an exaggerated power over us. The step implies a readiness to take the
consequences of past behavior, which is important in developing new modes of being in the world. It
is an essential step in the development of a self and other orientation to living.
Step 10: Continued to take personal inventory and when we were wrong, promptly admitted it.
In Step 10 the goal is the development of better coping skills in dealing with the vicissitudes of daily
living. When thrown off emotional balance by people or new events, the process of taking a quick
inventory, admitting to errors in the now and and learning to forgive (or at least tolerate) the
imperfections of others is a sign of a stable person who has developed a new way of dealing with
reality. The practice of Step 10 releases one from the need to be right, and instead offers a truly
liberating way of operating in the world.
Step 11: Sought through prayer and meditation a conscious contact with God as we understood him,
praying only for knowledge of His will and the power to carry it out.
Research has consistently shown the psychological and physical benefits of prayer and meditation. The
person in recovery discovers that he is not a victim of his own mind and that he does have power over
the state of his inner life. Meditative techniques have a powerful influence in reducing the anxiety that
underlies most addictive behaviors. The individual can generate a sense of calm, focus and direction.
Psychologically, the 11th Step is a means for even deeper insight into one's motives and needs.
Recovering people are often befuddled about "knowledge of His will". It would seem to me that it is
not God's will, or anybody's will, that the addict return to using. It's probable that God's will includes
living a life that is not entirely self-centered or self-serving. Perhaps God's will includes living a moral
life, consistent with one's deepest values and beliefs. From a psychological standpoint, it is a conscious
contact with the higher self -- the best part of who we, as individuals, really are.
Step 12: Having had a spiritual awakening as a result of these steps, we tried to carry this message to
alcoholics and to practice these principles in all our affairs.
The inherently beneficial values of care for others, unconditional love, and genuine, honest relating
comprise the core of the recovery process, a process that produces a mature personality. Successful
application of this step would seem to define the essence of emotional maturity. To reach Maturity
means having an authentic self that has been able to develop adequate coping skills; a sense of
"agency" of the self that had been lost to the addiction; the ability to tolerate emotional pain with the
knowledge that all internal states are transitory; the development of healthy inter-personal relationships,
and a sense of purpose in living.
In summary, the addictive experience is marked by inter-personal difficulties and problems with
isolation, self-esteem, impulse control, lack of self-regulation among other symptoms. The problematic
dimensions of the addictive experience are addressed through the structure of "S" meetings. The
program, including the steps, provides cognitive strategies, compensatory mechanisms and
intra/interpersonal resources to assist the addict in successfully negotiating the vicissitudes of human
living and stay sober for good purpose.
Chapter 8
Hypnotherapy
Is Hypnosis REALLY a Serious Treatment Modality for Sex Addiction?
The usual response to the suggestion to one of my clients that hypnotherapy might be useful in the
treatment of sexual addiction is typical of the general public's misguided understanding of
hypnotherapy:
·"I'm afraid of going into trance - I might lose control"
·"You'll find out things about me that I don't even know myself",
·or, more typically, "I'm just not the type to benefit from hypnosis".
Hypnotic trance, however, is really nothing out of the ordinary; it is a natural experience that occurs
routinely in daily life. Daydreaming, fantasizing, driving a car, or watching TV are all trance states.
Almost everyone can be hypnotized. The old debate about whether or not a subject is "hypnotizable"
has become moot. Hypnosis happens when a person allows it to happen. A willingness to relax and
clear the mind, focus and imagine the things that are suggested lead to a receptive mental state which
induces a hypnotic effect.
A willingness to learn, and an attitude of receptivity coupled with practice, enhances the hypnotic
effect. Willingness is critical for you to experience yourself in a different way that effects change.
What is Hypnosis?
Hypnosis is an inner, altered state of consciousness in which the critical, logical, and conscious part of
the mind is temporarily suspended so access to the subconscious is available to receive suggestions for
new attitudes, beliefs and values. While you are in touch with the subconscious mind, new
psychological connections can be made.
When you can let yourself go into a goal-directed daydream, what happens is you dissociate yourself
from your surrounding environment. You become completely engrossed in your inner reality. You are
in an alternate state of awareness. This is called hypnotic trance.
While in a trance state one is open to suggestion and free to accept positive, healthy, constructive
suggestions without the interference of thoughts, objections, excuses and rationalizations.
How can hypnosis help recovery from sex addiction?
Hypnosis can stop the purely cognitive functions with which the person is familiar Hypnosis engages
him in new inner experiences which will produce new attitudes about sex This leads to a lessening of
the toxic core beliefs about the self which is the foundation for the process of addiction. Trance
induction is the use of the power of the unconscious mind to re-work the neurological wiring born of
childhood experiences. It is in childhood when unwanted, self-destructive impulses and behaviors are
first form and that continually result in adverse consequences. Trance induction allows development of
new pathways from that old wiring. Hypnosis is used to re-train your neurology to increase the ability
to tolerate unpleasant affects/feelings that are often triggers for sexual acting out.
Erotic Haze
In Chapter 2, I described “Erotic Haze”. The experience of the erotic haze is very intense and
compelling. One reason for its hold on people is that it is a psychologically stimulated neuro-chemical
state induced by the release of several brain chemicals. These include: adrenaline, dopamine,
endorphins and serotonin, all of which are produced and increased by the body when the sex addict
engages in intense sexual fantasy, rituals, and behaviors. In truth, maintaining the high of intensity
sensations which are evoked by sexual cruising and fantasy is more sought than the sexual act itself.
Like a gambler walking into the casino and before he even hits the slot machines, sex addicts are high
on their own neurochemistry long before actually acting out.
Besides the neuro-chemical high, what are the psychological factors that make this particular hypnotic,
erotic trance state so compelling for the sex addict? What makes this state so irresistible that money,
time, family, self-respect and sometimes sanity are sacrificed?
A Secure, Safe Place Within Yourself
A famous psychoanalyst once coined the term "holding environment", a normal condition which occurs
when an infant and an emotionally adequate mother form a bond that nullifies the infant's weakness
and creates a sense of being "held" in the world as the child grows to be a man.
During adulthood, the ability to draw on the earlier functions of the holding environment helps
maintain a stable sense of self. People who lacked an emotionally adequate mother (who could not
create this holding environment) will more often find themselves feeling anxious, fragmented, insecure,
and emotionally isolated. It is these chaotic, painful emotions that start the addict off in search of
immediate gratification through sex. In the frenzied search for a sexual encounter you may try to
recreate a holding environment that compensates for the lack of a secure sense of self and to rid
yourself of unwanted and uncomfortable feeling states. The choice of a specific sexual behavior may
be a compulsive attempt to find exactly the right way to be held - to be soothed, to be comforted - to be
re-assured.
Hypnotic techniques are effective in treating sex addicts because the sexually compulsive state (the
"erotic haze") is nothing more than a trance state in which you feel "held" in a constructive way. You
feel right at home in trance You’ve lived most of their lives in one. Hypnotherapy enables you to
experience a valuing, ego-enhancing, resourceful trance state that may enable you to find a way to be
(symbolically) held that leads to constructive, rather than destructive consequences. A good
hypnotherapist provides messages which inspire feelings of self-worth, self-value, plus the ability to
inhibit impulses. This allows you to tap into existing resources within so that messages are received at
a deep, unconscious level. Here lies significant potential to effect personality change at a profound
level.
Effective hypnotherapy helps the client to find parts of the self that sustain or restore the sense of a true
self so that aloneness is tolerated without the need to sexual acting out. Through self-hypnosis you can
experience a calming and self-valuing experience that is generated from within you. You can then be
freed from the prison of the compulsion to get your needs met by external sources that seem to always
disappointment. Moreover, hypnotherapy also affords a process of age-regression and re-framing that
allows for reparation of the original trauma of not being adequately held by an emotionally sustaining
mother.
New Attitudes towards Healthy, Related Sex
John Money, a famous sexologist, termed the phrase "Love Map" that refers to the programming that
each person has received from past experiences that give rise to your “arousal templates”. Using
hypnosis, mental models and arousal templates can be modified so that the urge for compulsive sex is
replaced with knowledge and appreciation of related sex.
Hypnosis enriches sexuality through six important facts:
1.Cognitive control is achieved.
2.Relaxation from anxiety and stress is accomplished.
3.Consciousness of one's own "thoughts" that may be negative about related sex can be recognized.
4.Positive imagery is used to enhance positive sex.
5.Natural physiological processes are freed to function normally.
6.The person acquires a new mental skill of self-control over his thoughts, emotions and over his body.
Sex, as we know, starts in the mind and physical responses travel downward. Hypnosis facilitates
healthy sex by changing negative attitudes toward sexuality, increasing communication between the
couple, and exploring new sexual techniques. Hypnosis can enhance the client's ability to focus
attention and increase sensory awareness, thereby facilitating increased arousal and pleasure.
It seems fair to say that hypnosis, perhaps combined with sex therapy, is the most effective way to
improve the human sexual experience. The recovering sex addict can be conditioned to want to
experience and enjoy person-to-person, mutual sex that serves to bond two people who care for each
other and know each other on all levels of intimacy.
Please contact my office to discuss your personal situation and to determine if hypnotherapy is right for
you.
Chapter 9
Neuro-Linguistic Programming
What is Neuro-Linguistic Programming (NLP)?
NLP is an approach to doing psychotherapy that was all the rage in the 70’s and early 80’s. It is a
model of the structure of your inner, subjective experience and how that experience influences
behavior. It provides a framework for eliciting the way you experience reality with a focus on
reorganizing that experience so you, as a human being, can optimally function in work, love and
recreation. NLP is designed to elicit information from the subjective (inner) world, to see the
limitations these experiences impose on each individual and to direct strategies to the conscious and
unconscious processes for the purpose of facilitating change towards a happier, more satisfying life.
How is NLP Employed in the Treatment of Sex Addiction?
Addiction, in all its forms, is a social epidemic and certainly represents an obstacle to a life well lived.
NLP’s methods, skills, and strategies (too numerous and complex to detail) allow for the construction
of a wider and more effective repertoire of internally generated alternatives to addiction. As is the case
with any major dysfunction or illness, sex addiction, or the process of being a sex addict, erodes the
internal repertoire of choices until life becomes determined by basically one primary factor: access to
sex and to the “erotic haze” that accompanies it. Stated in a different way, the acquisition of a sexual
“rush” determines the addict’s lifestyle and imposes severe limitations on life experience.
NLP offers “technology” for therapists to deliberately internally “install” various strategies and
processes, allowing you the required range of choices needed for you to move toward an addiction-free,
satisfying sense of well being in your life. It both increases your awareness of your internal processes
in measurable ways and provides specific methodologies for using information obtained through your
conscious/unconscious processes in the manner of one who has “enlightened self-interest.” If
internally no new choices or alternatives are generated in you, you will repeat – ad nauseum – choices
and behaviors that obviously no longer work in the present, but which at some point in time, appeared
to have produced results.
One of NLP’s precepts is that all behavior makes sense in the context in which it was originated (called
“Positive Intent of Behavior versus the Manifested Behavior”). Behavior, no matter how bizarre it may
appear to be (I think of fetishes), makes sense when it is perceived in the context of the choices
generated by the individual’s particular model of himself and the world. Addiction is not a matter of
making a wrong choice, but of not having sufficient internal choices – thus you act on old instruction or
generally outdated information that has no bearing on the present except that the present contains the
trigger that sets the old behavior in motion.
The more entrenched the behavior is, the more likely it is to be connected to early survival skills – the
need for protection, nurturing, feeling enlivened yet safe, or the need to explore the world as an
individual separate from mother (the sexual need for novelty and excitement). You can see that,
somehow-or-other, things went developmentally array in your childhood and the survival-seeking
pleasure of existence was not provided in the way you needed it to be provided. The result is that you
go to sexual excitement (remember of definition of sex addiction) to get non-sexual, emotional needs
met.
I suspect that the original positive intent of your behavior was to feel safe, valued, recognized, wanted
and alive. When compared to the “Manifested Behavior” – the addiction with all of its dreaded
consequences, you can clearly see that behavior that had an original positive intent in the past now
manifests as behavior that doesn’t satisfy your needs in a real, consistent, self esteeming enhancing
way, but rather produces most of the distressing internal and external circumstances of your life.
One of NLP’s contributions to sexual recovery is that it allows you to access and employ your internal
resources in order to have a repertoire of feelings and behaviors that you can refer to which can
appropriately take the place of compulsive sexuality by fulfilling some of your needs in realistic,
sustaining ways.
The NLP Strategy of Re-framing
“Re-framing” is an NLP stalwart strategy. To “re-frame” a stimulus (e.g. sexual urges) means
to change the meaning of the stimulus and thus to change the way you behave towards the
stimulus. To “re-frame” the past means to look at it differently in light of new information and
growing maturity.
When I was in therapy, I could only bemoan growing up in the chaos of life with two alcoholic parents.
I would regale the therapist with tales of the HORROR of it all! At some point in my development, I
began to have a series of positive memories about my parents. Although dysfunctional after their
illness took over, there were, in fact, many years of togetherness, closeness and fun. I have also come
to recognize that they were not bad people, just people with a bad disease. Despite it all, they managed
to march to the tune of their own drummer in terms of their lifestyle choices and engendered in me
enough love of learning to be able to write this book! So…voila! You can change the past, depending
on which frame you choose to put on it.
NLP uses a “Six-Step Re-frame” to work with a variety of unwanted behaviors, thoughts, feelings and
attitudes. In brief, these include:
Step 1: Identify the behavior to be changed.
In other words, what do you want and what stops you from getting there at this time. You may, for
instance, was to enjoy sexuality as an experience shared with a cherish partner that leaves you feeling
enlivened rather than depleted and self-hating. What stops you from getting there? Why, your
addiction, of course.
Step 2: Establish communication with the part of you that generates the behavior.
This is the part of you that revels in the experience of intense sexual pleasure and can’t figure out, for
the life of you, why you would ever want to stop. You need to understand that the addict part is part of
your early survival skills and will only change if presented with additional internal alternatives to the
addiction that responds as successfully, or preferably even better to the original needs.
Step 3: Separate the original, positive intention of the behavior from the actually
manifested addictive behavior.
Almost all of the techniques for recovery covered in this book include a process of “dissociating” from
the addiction.
Step 4: Create alternative behaviors to satisfy the intention.
Ask yourself: in what other ways might I feel safe, enlivened, protected? How might I give vent to my
leanings toward mystery, novelty and risk that aren’t sexual? Ask the “wise man” inside you for 3-5
ways of dealing with life other than with the use of sex or pornography.
Step 5: Check again with your “addict” part to see if he’ll accept at least one of the new choices.
Step 6: Ecological check.
The therapist asks you to check if there are any parts of yourself that appear to object to the preceding
negotiations and, if not, if you then feels that all of you is willing to support trying new behavior that
supports the original intention of the lustful behavior.
Summary
The Six-Step Re-frame represents some of the most significant models of NLP, the creation and
behavioral installment of an internal repertoire of choices to deal effectively with life events, the belief
that individuals have all the resources they need to lead satisfying lives, that the therapist’s job is to
help the client in accessing thee internal resources and that all behavior, no matter how bizarre, makes
sense in the context in which it was originated. It further demonstrates that there is a positive
connotation in all dysfunctional behavior. This connotation is the pivotal point for turning current
negative behavior around by offering an array of choices that responds more appropriately to the
original needs. Finally given the opportunity, the human being moves toward well being which can
only occur in the context of the continual creation of new internal alternatives and choices.
Chapter 10
PSYCHOPHARMACOLOGY
Sex addiction recovery typically involves at least psychotherapy,12 step groups(or Therapy Groups),
self-help groups and medication. Medication while not always necessary, can serve as the “water
wings “ for negotiating the changes necessary for growth .
Certain psychiatrists believe that addiction is maintained by mood-dependent motives and that
pharmacological treatment of the underlying mood disorder can diminish the urges and cravings
associated with the addiction to sex. Medications that enhance mood/feelings regulation also enhance
your ability to control impulses.
That there are chemical changes in the brain when you enter "the erotic haze" cannot be disputed.
Sexual arousal is a stimulated neuro-chemical state, induced by the release of adrenaline, serotonin,
dopamine and endorphins that occurs when you engage in intense sexual fantasy, rituals and behaviors.
You get high on your own neurochemistry long before you actually have sex. In fact, you may try to
stay in the "erotic haze" as long as you can, putting off any actual sexual release. A euphoric state not
dissimilar to the inner state of an opiate user occurs.
During recovery, certain medications can help sexual addicts alleviate compulsivity anxiety and
depression. Some medications act on brain chemicals linked to obsessive thought and behaviors and
reduce the chemical "rewards" of sexual behaviors. Which medication is best for you depends on your
overall situation and other mental health conditions or addictions you may have.
You may have to try several medications, or a combination of medications, to find what works best for
you with the fewest side effects. Medications used in addiction recovery treatment are often used
primarily for other conditions. They include:
·Antidepressants. Those most commonly used to treat compulsive
sexual behavior are selective serotonin re-uptake inhibitors (SSRIs).
These may include Prozac, Paxil, Zoloft and others. SSRi's often have
a side effect of a reduction in libido and sexual functioning which is
sometimes useful in recovering from addiction.
·Mood stabilizers. These medications are usually used to treat
mania, but research suggests that they also help addicts to reduce
uncontrollable sexual urges, in order to achieve sexual sobriety.
·Naltrexone. This medication is generally used to treat alcoholism/
and Drug addiction by blocking the part of your brain that experiences
pleasure from addictive behaviors.
·Anti-androgen. These medications reduce the biological effects of sex hormones in men and help free
them from addiction. Because they reduce sexual urges, anti-androgen are often used in men whose
sexual behavior is dangerous to others, such as pedophilia.
·Luteinizing hormone-releasing hormone (LHRH). This
medication may turn around the process of addiction and reduce
obsessive sexual thoughts by reducing the production of testosterone.
·Anti-anxiety medications. Examples include Klonopin, Ativan,
Librium, Valium and Xanax. These medications are used to reduce
serious anxiety and aggression in emergency situations, but are
generally avoided, as they may result in abuse of the chemical.
Chapter 11
MINDFULNESS MEDITATION
Introduction
Mindfulness is a method of awareness and introspection which involves a conscious attempt to focus
attention intensely on the present moment, noting thoughts, feelings, perception, images and sensation
without judging them, participating in them or acting on them. The contents of your mind appear and
disappear without reacting to them. You experiences on a fundamental level that every thought, desire,
urge or impulse dies a natural death if not fueled by emotional reaction or through behavioral
enactment.
What you can hope for initially is freedom from your fears and addictions to your desires, which can be
a hindrance to adhering to personal values and to the pursuit of meaningful goals in your life.
By becoming aware of inner body sensation, you can become aware of sexual urges before they
manifest in the form of thoughts, fantasies and behaviors. It also helps to manage strong emotions
(cravings and aversions) by using certain Buddhist-based cognitive strategies.
In my opinion, Mindfulness meditation can be used in treating sexual addiction, since traditionally it
has been used in treating cravings of all sorts. Working a successful relapse prevention program
requires enhanced awareness (mindfulness) of stressors, cues, triggers, thought processes, emotions and
cravings and urges that precede sexual acting out. Regular practice of meditation increases awareness
of all inner processes, including the ones that precipitate relapse.
Our perceptions are colored by emotions, desires, fears and fantasies. Sex addicts react more to their
own fantasized images project onto people than to the people themselves. Mindfulness enables you to
free your mind of all distorting influences and to achieve a state of equanimity or neutrality of mind.
How Mindfulness Meditation Works in Sex Addiction Recovery
The following mechanisms explain the ways in which mindfulness works:
·Anxiety reduction: Sexual addictions are mediated by anxiety reduction, not sexual desire
per se. Mindfulness meditation has been shown to reduce anxiety scores.
·Antidepressant effect: Sexual addiction can be described as a way of coping with
depression, anesthetizing painful feelings of loneliness, self-hatred and the dreaded sense of
emptiness experienced by so many addicts.
·Affect Regulation: Intense, painful feelings (affects) that you feels are overwhelming and
intolerable are neutralized and stabilized. When you can experience feelings as transitory and
ephemeral, the resulting effect is increased tolerance for distressing feelings and an
increasing ability to regulate your inner life.
·Development of healthy coping skills: Addiction is a misdirected way to cope with inner and
outer stressors. Meditation facilitates better coping mechanisms because without being in a
state of high emotional reactivity, your ability to cope with life by being present and not getting
overwhelmed or overly disturbed is enhanced.
·Mindfulness meditation helps to experience sexual cravings for sensation as the transitory
phenomenon that they are and increases a sense of detachment from these inner sensations that are at
the root of acting out.
·Mindfulness neutralizes emotionally charged traumatic experiences from the past that are stored in the
unconscious mind.
·The replacement of the altered state of consciousness involved in immersion in the erotic haze
("bubble") with the altered state of (higher) consciousness of meditation makes addictive behavior
unnecessary. Experience of a higher nature emerges during meditation which brings a new sense of
purpose in living. This new way of being (the "spiritual awakening" discussed in AA) assumes a
priority over the desire to indulge in compulsive sexual behaviors.
·Finally, when it is possible to free yourself from fears and fantasies, the mind attains greater
equanimity. You are able to self-sooth rather than having to chase a high from an external source. The
ability to exercise free choice is enhanced with a concomitant reduction in the shame of being out of
control and in a rise in self- esteem. When engaged in an active program of meditation, over time you
gradually aligns behaviors in a way that is consistent with your deepest values and long-term goals.
Shame and guilt are dramatically reduced. When peace is generated from within, the frenetic,
compulsive chase for sexual gratification that never quite satisfies is finally over. This state of mind in
itself is deeply satisfying and much more enjoyable than the transient and disillusioning excitement you
gets from addictions.
Suggested Reading
Insight Meditation: A Step-by-Step Course on How to Meditate
Sharon Salzberg
Meditation for Beginners
Jack Kornfield
Wherever You Go, There You Are
Jon Kabat-Zinn
Mindfulness in Plain English
Bhante Henepola Gunaratana
Everyday Zen: Love and Work
Charlotte J. Beck
Nothing Special: Living Zen
Charlotte J. Beck
Mindful Recovery: A Spiritual Path to Healing from Addiction
Thomas Bien, PhD. And Beverly Bien
(Audios)
Mindfulness for Beginners
Jon-Kabat-Zinn
Guided Mindfulness Meditation
Jon-Kabat-Zinn
Mindful Solutions for Addiction and Relapse Prevention
Stephanie Goldstein, PhD.
Guided Meditation (6 CD set)
Jack Kornfield
Useful Links
www.insightmeditationcenter.org
www.learning-modern-meditation.com
www.mindfulnessmeditationcenter.org
Chapter 12
“Brainlock” -- a Behavioral Modification Program.
“Brainlock, a 4-Step Self-help Guide for Treating OCD” is a book written by Jeffrey
Schwartz, M.D., a physician who spent most of his career treating and doing research
on Obsessive/Compulsive (OCD) behaviors. His has developed a four-part program
self-help program that can be used for any unwanted compulsive urges, desires and
behaviors.
Let’s go through Dr. Schwartz’s four-part program. It is similar to what I’ve written about
Relapse Prevention, but the point can’s be driven home enough – that if you immediately change
your behavior when you get an urge, the changed behavior will sooner of later create new neuropathways in your brain that will re-enforce your abstinence.
Step 1. “RELABEL”
You learn to Relabel unwanted fantasies, urges and behaviors. Call them
what they are in reality: the voice of your addiction. Addiction is a biological
condition that has to do with an imbalance of certain endorphins, mainly
dopamine and serotonin. It sends false messages from your brain, and you
are to recognize them as such. You must make a conscious effort to stay
grounded in reality because you must strive to avoid being tricked into
thinking that a sexual urge or craving is based on a real need. It is not.
Your sexual urges are symptoms of obsessive-compulsive disorder, combined with an impulsecontrol disorder, both of which are medical issues. Relabeling simply means calling the
unwanted cravings and urges by their real names – the voices of your addiction.
This is war and the enemy is the addiction monster in you. When
overwhelmed by cravings, you can say to yourself “It’s not me – it’s the
addiction.” You work constantly to prevent confusing your true self with the
voice of addiction.
I’ve been in AA recovery for 33 years. When I first started going to meetings, I would
hear, from time to time, someone say “The Disease Talks to Me”. What that meant, I
had no clue. It took years of recovery before I could cultivate a sense of myself as a
whole person who heard the voice of the addiction as something that was there, but IT
WAS NOT ME. A kind of separation had occurred between my true self and my
addictive self. All these years later, the addiction still whispers in my ear from time to
time, but I get amused, I don’t listen to it, and let it go on it’s way so that I can engage
in behaviors that are either productive or enjoyable and have no negative
consequences to my self-esteem.
The Impartial Spectator
Dr. Swartz, I think, may have been trained by a Buddhist-teacher. The development of the
“Impartial Spectator” evolves through Mindfulness Meditation (see Mindfulness article).
As I wrote in my article on relapse prevention, mindfulness awareness is essential to a sexual
recovery program. Awareness requires you to consciously recognize and make a mental note of
a disturbed feeling or urge. Your goal is to observe them rather than act on them. When you
develop a relationship with “The Impartial Spectator”, you can step back and say to yourself,
“This is just my brain sending me a false message. If I change my behavior at the point of the
urge, I’ll actually be changing how your brain works.”
Once a person with a compulsive disorder learns behavior therapy and resolves to
change his response to an intrusive sexualized thought or fantasy by not performing a
pathological behavior, a willful resolve gradually kicks in because a sense of personal
empowerment starts to develop.
Think of the “Impartial Spectator” as a vehicle for distancing your real person from your
addiction. Create a safety zone between your internal self and spirit, and the unwanted
compulsive urge. Rather than respond to the urge in a mechanical, driven way, you present
yourself with alternatives. It’s good to have some alternative behaviors up your sleeve, so you’ll
be ready when the voice of the “erotic haze” calls you.
RX: Action
Learning to overcome sexual compulsion is like learning to ride a bike. Once you learn, you
don’t forget, but getting good at it takes practice. In your recovery, it’s likely that you may fall
off, but you must get back on. If you give up, you’ll never learn. And you learn by falling off!
Passivity is your enemy. Activity is your friend. Having things you really need to do –activities
much more productive and creative that the illusional, nonsensical sexual ritual – is a great
motivator.
When you are capable of seeing quite clearly the difference between healthy behavior and
compulsive behavior, you are able to bring yourself around by zeroing in on reality.
A client of mine who used this system stated: ”Before, I was overtaken by sexual fantasies, urges
and cravings. I was overwhelmed. Now I know where they are going to get me – back in the
same self-hating self I don’t want to be in. So I’m ready. I don’t listen to my addiction because I
know it’s fake. I let it go quickly and so something that’s real and authentic.
STEP TWO: RE-ATTRIBUTE
If you wonder why you never seem to be free of sexual preoccupation, one of the
answers is that research has shown that the addictive brain is related to a biochemical
imbalance in the brain. In the Re-attribute step, you learn to place a lot of the blame
squarely on your brain: The addictive brain sends you a false message. If you change
the way you react to the false message, you can make your brain work better. Your
urge to go, puppet-like into the “erotic haze” will diminish. The pervasiveness of these
fantasies or urges in not a personal weakness. It is a false alarm caused by a short
circuit in the brain. When sex addiction sends a false message to your brain, you can’t
make it go away, but you don’t have to act on it.
If you have understood so far, perhaps you can use the author’s “fifteen minute” strategy. When
you get an urge to act destructively, wait for 15 minutes. During this time you actively keep
telling yourself, “These are not real thoughts. They are faulty messages from my brain.” After
15 minutes, the urge usually goes away and you begin to see that you have a sense of control
over your addiction. You are no longer a passive victim to addiction.
At some point, when sexual fantasies and desires to act out occur you realize – You are not going
to do it. Why not? BECAUSE THE REAL YOU DOESN’T WANT TO DO IT!
STEP 3: REFOCUS
Refocus tells you what to do while are trying to overcome urges to do compulsive
behaviors. It instructs you to “work around” those nagging needs by Refocusing your
attention on some useful, constructive, enjoyable activity. The key to the Refocus step
is to do another behavior/concentrate on something else. When you do, you are
repairing the broken gearshift in your brain. Your brain starts shifting more smoothly to
other behaviors.
You have to step aside, put the erotic pull aside, and work around it by putting your mind in
another place and doing another behavior, one that is more pleasant and functional.
Once you realize that the things that call you erotically have no deep meaning, that they’re just a
false alarm, a ghost from the past, you be able to largely ignore them and go about your business.
STEP 4: REVALUE
Revalue is an outcome of having worked the first three steps. With consistent practice, you will
quickly come to realize that your obsessive thoughts and compulsive behaviors are worthless
distractions to be ignored. With this understanding you will be able to devalue the pathological
urges and fend them off until they begin to fade.
If you do not actively Revalue these thoughts and urges as false messages coming from the brain
– messages with no spiritual, productive or inter-personal value whatsoever –and, if fact, are
shame filled and demoralizing.
The more clearly you see what the symptoms of sexual compulsions really are, the more rapidly
you can dismiss them as worthless garbage that are not worth paying attention to.
It would be good to use the Four Steps for gradually increasing periods. This means telling
yourself , “It’s all right – it’s just the voice of the addiction (Relabeling; then Re-attributing it to
faulty brain chemistry; Refocusing on a constructive, enjoyable behavior instead of one that will
lead you to the road of self-hate. Finally, Revalue the meaning of those fantasies or urges. You,
in essence, devalue those silly thoughts.
Dr. Jeffrey M. Schwartz wrote an exceedingly interested book that helps people deal with OCD
symptoms. I highly recommend this book because it can be applied to all compulsions,
including the prison of sex addiction.
Sex addiction is an impulse-control disorder; it is not an OCD syndrome. Compulsive behaviors
differ from OCD in that there is intense pleasure in sexually acting out; whereby there is not
pleasure in an OCD person washing her hands repeatedly. Frankly, it makes the job a bit harder
because the dopamine rush of the “erotic haze” and the intense pleasure of acting out can seem
irresistible.
The key problem in therapy for sexual addicts is how much people with this disorder make the
excessive, problematic, out-of-control and shaming behaviors “ego-dystonic,” that is, how much
can they come to find their behavior genuinely foreign to their own notion of who they are;
different than the values, goals and meanings that they most cherish.
People who are addicted to intense sexual pleasure come to expect pleasure to be taboo,
secretive, chaotic, and both soothing and exciting. Do they miss out on the extraordinary
pleasure that can be received from living a mindful life, staying in the now, and taking pleasure
in eating a peach or cooking a meal or seeing a sunset? This, too, is pleasure.
The Buddha warned against “cravings”, especially sexual arousal. He saw these constant
longing, wanting, cravings, to be the type of “attachment” that keeps people in “samsara” (the
suffering of life). His first Noble Truth was that life is suffering. The second Noble Truth was
that people suffer because of “cravings.”
We should live life with pleasure not for pleasure. Pleasure is ephemeral. The process
of obtaining intense sexual pleasure promises what it can’t deliver.
That’s why you feel so disenchanted, let down, shamed and disappointed after you act out. You
chase idealized perfect visions that turn out to be dust in your hands.
Chapter 15
From Sexual Addiction to Sexual Fulfillment
Over the years, the people I have worked with have used various words to describe the
end result of their compulsive sexual behaviors: words like shame, anger,
depression, anxiety, disappointment, self-hatred, hopelessness and
helplessness, usually describe their subjective experience after the orgasm is over.
Never have I worked with a person who described their sexually addictive experiences
with words like, fulfillment, satisfaction, closeness, or ecstasy.
Yet these are the kinds of states that optimal related sex offers. Exciting,
healthy, hot sex, comes from being relational, that is, connecting deeply
with both yourself and your partner. We are sexual beings from the day
we're born until the day we die. Sex is fundamental to our lives and seems
to be the area of life that most deeply touches our most personal issues.
Our sexuality is a core expression of who we are. We can hide with sex, we
can hide from sex, but when we are fully ourselves sexually, we no
longer have to hide.
For the sex addict, physical pleasure is fleeting and is only a numbing source for the excruciating
emotional pain that triggered the sexual act. It’s a fallacy for anyone to think that sex addicts
gain fulfillment from the sex act.
However, sexual desire and pleasure is our birthright. After all, we were created naked and with
complementary genitals. There must have been a plan in mind.
“We can hide with sex,
we can hide from sex,
but when we are
fully ourselves sexually, we no longer have to
hide.”
Good sex is a complex concoction of openness and secrecy, balance, risk
and control, and personal satisfaction. These ingredients foster mutual
fulfillment. Good sex –the quality kind that exists between healthy,
consenting partners – requires an ability to be totally immersed in the
moment (which is difficult for most people), ever-present to the sensuality
of yourself, your partner, and attentive to life. Exciting, hot sex comes from
being relational, that is, connecting deeply with both yourself and your
partner.
Can a sex addict return to the natural expression of sex and receive its benefits?
After you achieve a period of abstinence from self-destructive sexuality, you’re able to focus on
personal growth and intimate sexual relating. (Katehakis, pg. 67) A program of comprehensive
sex addiction therapy is a gradual process of moving from the addiction “arousal template” in the
brain, to a different (healthier and ultimately more satisfying) template. It’s a process of
redefining sex, and changing the addictive imprint born from faulty understandings about
sexuality and intimacy.
Exciting, intimate, tender, ecstatic, hot sex is attainable if you’re willing to
change your focus from non-related, self-centered sex to the joy of knowing
yourself and your partner in sexual ecstasy.
Chart Your Course and Choose the Path
In order to arrive at a destination, you have to have a map of the territory and a view of
what the destination holds for you. There are two paths from which to choose with one
path heading towards a healthy life, and the other towards self destruction. Knowing
the differences between compulsive sex and wholesome, related sex serves as the
compass for the journey.
The Gratification Difference
Addictive sex is based on immediate gratification and surrender to acting on impulses. Mature
sex is a choice; one that entails focusing on the entirety of the experience, not just the immediate
gratification of orgasm.
The discussion in this book so far has focused primarily on the different
ways to cease and desist sexual behaviors that you know are eroding your
self-esteem and your relationship. In AA terms, this involves “putting the
plug in the jug” of destructive behavior so that the business of recovery can
begin. Learning to choose how to stop the destructive behaviors and to
make a conscious choice about how to channel your sexual energies is
“clearing the runway” for optimal sex to develop.
The Urgency Difference
Addictive sex is compulsive sex, while sexual celebration emerges from conscious
deliberate choice. The compulsion of addictive sex, must be disentangled, understood
and put to rest. Psychoanalyst Sigmund Freud coined the term “repetition compulsion”
and it is referred to by therapists when they talk about an addict doing the “trauma”
work. You keep doing “it” (the sex act) over and over again until you get it right. But
you never do – get it right – because “it” happened in times past and the behavior is no
longer appropriate for your adult self. Having a sexual compulsion is like dying from
thirst, but always going to an empty well to quench it.
Compulsion is a mental pressure of internal origin compelling you to think, act, or react in
accordance with specific urges and energies that do no coincide with your habitual patterns of
thought. For a person with a sexual compulsion, there is a “must have” quality to a particular
sexual experience, regardless of a partner’s wants and needs. A compulsion is an irresistible
impulse to act, regardless of the rationality of the motivation. There is a sense of being driven; it
is obligatory -- somehow destined to occur despite your better judgment. Compulsion’s home
base is the unconscious mind where hurts and traumas of past experiences reside outside of
conscious awareness.
“Sexual compulsion” is an attempt to “undo” the traumatic experiences of the past.
You were powerless to effect change as a child because you didn’t have the resources
to take care of yourself. As an adult, through a repetition compulsion, you can achieve
a sense of mastery over the sense of helplessness you experienced as a child. But
this is faulty thinking.
A case in point:
A new client came for a consultation recently. His distress was centered around compulsive
enactments of themes of sexual dominance and submission where the female is fearful and
vulnerable and he assumes the power in the play. While he didn’t report any family-of-origin
traumas, he reported that he’d always had “a touch” of autism as a child. He felt disconnected to
his peers and especially shut out from the mystifying world of girls.
When he understands that his sexual fantasies and enactments were devised for him to
take an active role in contrast to his passive experiences of being socially unwanted;
when he recognizes that his sexual desires were based on a need to feel in control in
contrast to his childhood feelings of powerlessness; when he discovers and
acknowledges his own sense of self-esteem and appropriate self mastery, my hope is
that he will be relieved of the compulsion and be free to explore equality in his
relationships with women.
In another case:
A former client had witnessed the protracted suffering and death by cancer of his
beloved mother when he was six years old. His father was not able to give him the
space to grieve the death, telling him he needed him to be the “little man” in the family.
Years later, with unresolved grief as a catalyst, he became a compulsive cross-dresser
and ruined his marriage. If he hadn’t been able to keep mother alive back when, he
would keep her alive through becoming her in his cross-dressing erotic haze. Only
when he was able to “do the grief work in therapy” was he able to lose interest in
wearing women’s clothing.
Healthy sex enhances your self-esteem and allows you to enjoy and control your sexual energies
without guilt, fear or shame.
Shame strikes deepest into the human psyche; it is a sickness within the self, a disease
of the spirit. It is the feeling of indignity, of defeat, of transgression, of inferiority and of
alienation. Shame is experienced as an inner torment. It is a wound made from the
inside, dividing us both from ourselves and from one another. Shame violates our
essential dignity as human beings.
The person feeling shame thinks, “Whether all eyes are upon me or only my own, I feel
deficient in some vital way as a human being.” The disturbance within the self produced
shame, impacts not only self-esteem, but also the development of identity and the
pursuit of intimacy. When shame captures the addictive personality, it grows like a
cancerous growth. Shame precedes and enables sexual addiction. It follows sexual
acting out. Addicts often suffer another bout of sexual acting out to alleviate the shame
of acting out! Until treatment, it is a vicious, never-ending cycle.
Children can experience shame beginning from a very early age. Dysfunctional
(non-nurturing) families that are emotionally, sexually or physically abusive serve as the
spark that heats hot-beds of shame for their off springs. Neglect that is physically or
emotionally depriving also contributes to the formation of a shame-bound personality in
a child. The family isn’t the only source of shame; problems with peer relationships at
school can also be very traumatizing.
When an afflicted child reaches adulthood, he is haunted by shame. Combine this
with the cultural messages about the “sinfulness” of sex and that a large part of the
population feels shameful about sexual needs. Indeed, many of the dynamics of sex
addiction are about managing sexual shame. Intense sexual arousal obviates sexual
shame and allows for sexual activity. Sexual addiction makes sex so desirable it
overrides shame.
Shame is an integral part of your “Addictive Prison”. In the first place, shame-bound
people do shameful sexual behaviors. So shame precedes the acting out. There is one
particular feature of every addiction which is central to understanding the addictive
process: a profound, discouraging sense of powerlessness over the addiction. The tail
increasingly comes to way to dog, engendering shame about the addiction itself. We
feel humiliated whenever we feel controlled by anything, but especially in the sexual
experience because of the shameful connotations communicated by family, church and
culture that sex is “bad”, “sinful”, “shameful”. Each time there is failure to break the
addiction and regain power over it, the sex addict feels defeated. He grows to hate
himself, disgusted by the helplessness, the lack of resolve, the lack of inner strength.
Getting treatment for shame is an essential part of recovery from addiction.
The Substitution and Escape Difference
Those who have a healthy sex life do not need substitutions or escape mechanisms in their
relationships. In contrast, the sex addict requires it.
The addiction serves as a substitute for shame-bound interpersonal needs. For example, the
alcoholic who has a relationship with his bottle has substituted something else for a human
relationship. All compulsive sexual acts are substitutes for human needs about which you feel
shame.
The addiction also functions as an escape from intense shame. Feelings of shame
encountered anew in daily life, may serve as triggers to re-experience shaming
experiences from early life. These often trigger an episode of sexually acting out, as a
way to soothe the pain of shame. However, each new addictive episode also
reproduces shame, which then activates the entire cycle, all over again.
The Truth Difference
In contrast to shame-based sex addiction, celebratory sex is open, not hidden. It involves honest
communication between lovers, not lies and duplicity. Healthy sex exalts the individual and the
couple. Sex addiction destroys both.
Right now, you maybe you have the experience of having two selves: the private self
and the public self; the solid family man and the sexual deviant; the social self and the
self that may spend six hours a day in isolation looking at pornography. I call it “The Dr.
Jeckyl and Mr. Hyde” syndrome.
Your “Secret World” is separate from your public self. The overwhelming need of your
secret self is to protect it and hide it from other parts of your life. If addictive sex requires
a double life, healthy sex enhances and celebrates who you really are, increases self
esteem, and is empowering.
“Lying and Duplicity” are Necessary to Keep Your “Secret World”, Secret!
Pivotal to all addictions is the defense mechanism of denial. It’s been said that DENIAL means
“Don’t Even Know I’m Lying”. So you lie to yourself. You lie to yourself about how out-ofcontrol you are, that you have a serious problem that requires professional treatment, that you’re
not hurting your spouse and children, that you’ve been isolated from friends and have stopped
hobbies and activities that you used to enjoy.
Shame is again the culprit. You feel that if you told the truth about your sexual experiences,
you’d be shamed, humiliated, rejected and abandoned.
Part of clearing the path to healthy sexuality means telling the truth about yourself – in a 12-step
program, to a trusted therapist or a close friend. Eventually you’ll need to have an open, honest
dialogue with your partner about your addiction.
“It is impossible to have an intimate, connected relationship with another person if you
carry a back-pack of secrets and lies.”
The Maturity Difference
Optimal sex requires a degree of psychological maturity. Perfect fulfillment of sexual potential
is never achieved. It is a lifelong pursuit of personal development. It involves the conquest of
self-centeredness, the transcendence of personal limitations, and the dauntless struggle to be fully
human and fully sexual with a cherished other. The depth of connection in related sex far
surpasses the fleeting physical pleasure of a sexually addictive behavior. Erotic, mature, intense
sex makes sex addiction look like child’s play because it requires maturity and mutual caring for
another that only an adult can bring into play.
Sex addiction is immature and narcissistic (self-centered). Like an infant, you require
immediate gratification and cannot put off gratification in the service of a long-term goal.
You may have problems in self-regulation. You cannot regulate your feelings internally.
You need a sexual activity to help you feel good. Also like infants and children, you
don’t have the ability to control your impulses. Impulse control is a mark of a healthy
personality which can reflect on impulses and urges, think them through, and make
decisions to let them pass.
With healthy sex, you have awareness and empathy for your partner’s experiences.
True eroticism arises from the particular energy created by two people who care for and
respect each other. Most therapists in the sex therapy field focus on being able to
sexually function. But “optimal” sex includes consideration of eroticism, intimacy and
personal meaning in sexual behavior. The human capacity for intimacy and attachment
gives profound emotional meaning to sexual experience. With these factors in place,
human beings are capable of profound sexual experiences.
The Scattered Mind vs. Moment-to-Moment Awareness Difference
Sustaining a healthy, balanced sex life requires mindful attention to your senses, to the
physical, emotional, intellectual and spiritual dimensions of yourself, as well as your
partner. In profound intimate sex, nothing exists beyond the immediate presence of the
two partners. Awareness of the room, or even the bed, may cease to exist as you are
embraced by the sensual, erotic sense of the NOW.
The mind is scattered when involved with addictive sex; thoughts run the gamut of
thoughts about past sexual splendor with no recall of the negative consequences
(euphoric recall) to thoughts about future sexual exploits (fantasy). However,
sumptuous sex with a cherished other requires the ability to maintain awareness of
moment-to-moment sensation. Depth of involvement in a sexual trance increases as
day-to-day reality fades, replaced by increasing concentration on the sexual reality of
the moment. At profound depths of involvement in the sensual/physical/sexual moment,
the individual becomes totally absorbed in the sexual reality and loses awareness of
extraneous events. There can be an ecstatic sense of preoccupation and
transformation in which self and other become one.
According to the wise words of Sophocles, "KNOW THYSELF" in order to know what
you want and need sexually. Then you need to have the courage and self-assurance to
communicate these desires to your partner, even in the face of possible rejection. You
are ready for intimacy and related sex only after you have achieved a core sense of
identity.
The outstanding quality of intimacy is the sense of being in touch with your
real self. When "the other" also knows and is able to express his real self,
intimacy happens. Intimacy can be defined as a close, trusting relationship
between two people who are both willing to be emotionally open and
honest with each other in spite of the risks that may be involved. Intimacy
is also the joy of being known and accepted by another who is loved. The
quest for intimacy is one of the oldest themes in Western civilization.
However, although most people chase after intense sex and intimacy, few
seem truly willing and able to find it.
Through the experience of intimacy, you may experience yourself in some new, different, and
more profound way. When I am close, I know you in your presence; when I am intimate I know
myself in your presence. Intimacy is a remarkable experience. To feel and know myself in the
presence of another is enlivening, enlightening, joyful and freeing. I can be who I am freely and
fully in the presence of another. It is the only true freedom we have as human beings.
Sexuality is both an expression of that intimacy and a bond that enhances intimacy. With this
kind of personal/sexual intimacy, your growth experience as humans is energized, enhanced, and
fueled. Intimacy is the most meaningful and courageous of human experiences. Through its
experience, it is possible for you to “grow yourself up.
Your personal well being and your ability to be intimate with another cannot survive your
dislike or disrespect of yourself. If you dislike yourself, you’ll never be comfortable with
your sexuality. If you hold a lot of self-judgment about your past sexual behaviors,
identify yourself as a whole, valuable person who has an addictive behavior.
Remember – who you are essentially is separate from your behaviors.
Sex addicts escape into the “erotic haze” which involves dissociation from true feelings; healthy
sex opens a person up to tremendous depth of feelings. In the addictive sexual state sexual
experience is an avoidance of connection with your partner and your own feelings in the present.
Addictive sex is devoid of love; in sexual recovery, sex is an expression of love. In intimate sex,
you no longer hide out through fantasizing about others or dissociating. You are fully present
with yourself and your partner, preparing for your journey into the erotic.
Good communication is crucial to healthy sex. You can greatly increase feelings of mutual
respect, emotional closeness and sexual pleasure when you and your partner know how to
communicate well with each other. Knowing how to talk openly and comfortably about sexual
wants and desires can help you address issues that come up from time to time in the normal
course of an on-going intimate/sexual relationship.
The “Inner Validating” vs. “External Validating Difference
Addictive sexuality involves the search for “reflected validation”; that is, “if she/he desires me, I
feel validated.” Healthy sex requires self-validation. You know you are sexy and desirable
because your sexuality is a God-given part of who you are. You have no need to validate your
sexuality through getting or not getting any particular response from your partner or through a
fantasy connection on the computer.
Self-validation produces an enhanced sense of self. Being “other-validated” you put your value
as a person in the hands of other people. You sculpt your behavior and attitudes on the basis of
not being rejected or judged by others. If you have a reflected sense of self, you see the result of
your actions as though through another’s eyes.
You can never have an authentic sense of self if you are “other-validated”. The
fear of being separated, rejected, abandoned or judged makes you concerned with the
response of the “other” or “others”, and so keeps you from being your real self and
ultimately prevents you from loving, since loving involves disclosing your true and
authentic self to another.
An Expanded Vision of Sexual Fulfillment
What prevents people from experiencing the upper limits of human sexual potential?
·Adherence to rigid gender-role stereotypes where sexual behaviors are dictated by cultural
gender norms.
·Viewing the goal of sexuality as intense orgasms. For some, the number of
orgasms rather than their quality is the key to sexual fulfillment. It is a misconception
that orgasm and repetitive copulation capacity is the sole determinate of sexual
satisfaction. While orgasms are undeniably erotic, orgasms and eroticism are quite
different things. The fulfillment of sexual potential involves experiencing the upper limits
of physical sensation together with the capacity for intellectual, emotional, aesthetic,
and spiritual connectivity. Intense sexuality occurs within a context of profound emotion
and meaning.
The focus on intercourse in “normal” sexuality keeps dysfunctional gender-roles
in place. In this culturally embedded view of sexuality, the man must PERFORM and
the woman must be desirable. The focus on male sexual potency creates the most
common problem in sexual relating: PERFOMANCE ANXIETY. In addition to his
concern about the size and function of his penis, the male may have shame about his
anxiety! Now, how sexy is that? The man thinks he shouldn’t be anxious and feels
shameful. The result is that he becomes more emotionally isolated from his partner and
more turned off. Sex becomes something that isolates the lovers rather than bringing
them closer together. Sexual intensity is more a function of emotional maturation than
of physiological responsiveness.
The sex addict’s pursuit of intense orgasms per se, often interferes with repeated attainment of
transcendent eroticism and intimacy. As you know, orgasm can (and often does) occur without
profound personal meaning. The capacity for intimacy and intense, hot sex is a function of
personal development, rather than on physiological functioning.
·Seeking personal validation through sexual performance, It is essential that you
detach your self-esteem from your sexual “capacities,” and gender-role behavior.
Adequacy and eroticism should be detached from sexual functioning. There are
handicapped people who transcend their disability and maintain eroticism and selfesteem intact, even though they violate normal social expectations. Self-worth derived
from sexual performance perpetuates the continual need to perform with its attendant
anxieties.
·Lack of partner engagement. Self-centered, compulsive sexuality, in recovery, will
give way to a caring attachment to a partner. The partner is seen as the individual
person she is, rather than solely as a sex object. Sex addicts sometimes have deficits
in empathic listening and relating skills and may need to learn them to have more
satisfying relationships. In the intimate and sexual bond, you appreciate your partner’s
core potentialities, strengths and assets; as you disclose your wants and needs, you
also are accepting of the partner’s self; loving synergy is involved in partner
engagement.
·Misconceptions about the function of intimacy. I’ve worked with people who say
they want a healthy relationship. What, in fact, they are doing is desperately seeking
someone to reassure them that they are worth loving. The quest for intimacy is not
about the trials of knowing yourself and letting yourself be known; it’s about the quest
for a “reflected” or “other-validated” sense of self. These people have ego deficits in
validating and soothing themselves. Some people think they seek intimacy when what
they are doing is looking for someone to help carry the burden of a dissatisfying
relationship with themselves. When intimacy and sex are pursued to validate your selfimage and self-worth, you will never be able to really see and acknowledge someone
else. Moreover, you will never know your true, authentic self. The ability to selfdisclose and self-validate in the absence of validation from others is a disquieting and
challenging task, but it can be done. People involved in these types of “validate me!”
relationships become over-sensitive, reactive, combative, and controlling. This is not
the stuff that hot, loving sex is made of.
Does SexTakeWork?
For some people, climbing a mountain is unthinkable work; for others it is a vacation.
The sex addiction fantasy is that sexual gratification involves no effort at all. It’s like
wanting to have the benefits of running a marathon without ever actually running. Good
sex requires effort – but its effort that can result in self-transcendence and self-andother celebration. The romantic view of sex suggests that if you love your partner
(enough), and if your partner loves you (enough), desire and performance naturally
follow. Working at desiring sex is a bit tricky. Pushing yourself to desire when one is
not desirous is self-defeating. But working at the things that might effectively increase
desire for sex often requires advanced preparation.
This might include scheduling an “intimacy time” with your partner; sending the kids to
grandma’s for a few hours; disclosing your sexual dissatisfaction, demonstrating what you really
want, and struggling through one’s possible anxiety and embarrassment, It might involve losing
(or gaining) 30 pounds. It might involve keeping one’s integrity intact. Discarding the societal
pathological beliefs about sex and developing your own definition of good sex takes work.
Intense, erotic sex with a partner takes effort. However, effort in related, intense sex doesn’t feel
like work; in mediocre sex it does. Intense sex and profound intimacy take more effort than most
people want to invest. It takes a lot of personal development and work to mature enough to
tolerate intense intimacy and eroticism.
Sexuality that is like “kissing the face of God”
In health-based models of sexual potential, the upper limit of sexual desire is where one
meets the God-within.
For Plato, Eros has a transcendent manifestation when the subject seeks
to go beyond itself and form a communion with the other.
Eastern philosophy, particularly the Hindu tradition, sees physical sensual pleasure as one of
several paths to liberation and the union of the individual with the universal. Sexual relations are
considered a path to integration and expanded cosmic awareness. Eastern views celebrate sexual
pleasure as a value in its own right. Kama, “the pursuit of love and pleasure, both sensual
aesthetic”, is one of the goals of life in the Hindu tradition.
Eastern approaches to eroticism based on Tantric Yoga emphasize self-discipline in focusing
consciousness and sexual energy. Sexual potential is thought to require practice, discipline, and
understanding the interaction among spiritual, emotional, and physical dimensions. This
approach emphasizes spiritual and emotional transcendence through sex rather than orgasm.
In marked contrast, Christian-dominated Western society promotes a division between
spirit and body and is associated with original sin. In Western Christian mythology, sex
is a barrier to be overcome. Humans are urged to achieve salvation by denial of the
senses, especially the sexual impulses. Western culture and religion has failed to help
people to integrate sexuality and spirituality. Contemporary Western values inhibit the
exploration of human sexuality, rather than support it.
The role of sexuality in one’s spiritual development is evident when spirituality is conceptualized
as the integration of all aspects of the person and the actualization of one’s fullest potential.
Spiritual development divorced from religion and dogma is human development viewed from the
perspective of an ongoing integration that results from openness to the experience of selftranscendence.
From hot, erotic, related sex, you can begin to be open to spiritual energies you’ve never
experienced before because of the strong connection you’ve made both with your authentic self
and with your partner. Slowly your judgments strip away, together with your clothing, your
pride and your fears. The lovers’ experience coalesces into a swirling energy that rises and bursts
out of your head. When the boundaries of self and other are transcended in this swirl, it is
possible to achieve an experience of your incontrovertible connection to the universe.
The illusion of who you think you are, the mask of the false and social self, the need to perform
or look good, together with your ego, gradually drop. Peak experiences of self-transcendence
may occur. Shame is banished, replaced with deep serenity and contentment. Your thoughts and
your bodily tensions relax and slow down. Time stops. Consciousness expands. The experience
is similar to what the mystics describe as ecstasy.
Sexual potential comes from surrendering – that is, not trying. With a willingness to give
up control along with your egotistic preoccupations, you’re in a state of not knowing, of
just experiencing as you make a space for deep eroticism to emerge. Two dissolve into
one and a third energy, perhaps a spiritual energy, emerges. You meld into one entity
and touch the silence of the universe. (Katehakis, pg. 205).
Nothing beats it.
What does a sex addict need to learn in order to traverse the distance between sex addiction and
the achievement of full sexual potential?
As a sex addict, you need to learn:
·You cannot integrate heart and genitals. Heartless sex is mere mechanics and leaves people
feeling empty and disillusioned.
·To own your full power of sexuality with utmost respect for that power. This requires that you
be sexually assertive yet vulnerable and open.
·Take the responsibility and power associated with sex seriously.
·You may get your vanity satisfied with deviant sex, but you fear real connection.
·Impulse Control.
·Ability to listen to and adapt to the needs of your partner
·Sex that satisfies only physical needs misses out on the wonderful complexity of sex where
emotion, communication, sensuality, and relatedness are the context within which sexuality exist.
·You are torn between the mature adult you have become in other areas of life and an adolescent
sexual response that still controls your brain.
·You learned misguided ideas about sex from family and the general culture, which is sexnegative and sexist for both men and women. However, what has been learned can be unlearned
and recreated.
·A good sexual relationship is always based in authenticity.
·Growth in healthy intimacy involves naming, claiming and embracing old hurts and negative
scripts from the past and making conscious decisions to appropriately channel sexual energies
and to act with integrity.
·Cultivate the capacity for self-acceptance and willingness to embrace your wounds, mistakes
and limitations. You can’t have good sex if you don’t like yourself. Also, if you have accepted
yourself, you’ll be more comfortable with the authentic self-disclosure about your self, in
particular your sexual self, to a valued other.
·Intimate sex requires a level of self-awareness and of vulnerability which exposes you to
yourself. It may seem daunting, but the adventure of self-discovery is the only game in town.
·Optimal sex involves a gradual acceptance of one’s unique sexuality rather than being
caught in sex-negative messages from family, church, the media or the general culture.
·Cultivate the ability to listen, attend to, and have empathy for other people. It will make you a
better lover.
·Learn to tolerate being misunderstood when you have the courage to self-disclose your
authentic needs, wants, desires and fantasies.
·Growing in mature sexuality is about becoming real.
·Achieving full sexual potential involves whole body sex, not just genital sex. It includes
emotional, intellectual, social and spiritual connection and bonds which can catapult you into sex
that really packs a wallop.
·Addicts experience pseudo-intimacy – a shoddy replacement for the real things. Intense sexual
feelings substitutes for genuine intimacy.
·Compulsive sexuality, despite the intense high, causes self-rejection and alienates you from
your own experience and your own sense of self.
·Redefining sexuality is a process of self-confrontation and authentic self-disclosure in the
presence of a partner.
·Focusing only on genital performance circumvents the most powerful and most useful
aspects of sex: profound emotional intimacy.
·Sexual Potential considers eroticism, intimacy and personal meaning in sexual behavior.
(Katehakis, pg.
·At the further reaches of human sexual potential lies peak transcendental experience.
·A life filled with sexual acting out does is insufficient to trigger the process of personal growth
that can navigate the exploration of the fullness of human sexual potential.
·Optimal sex involves the dauntless struggle to be fully human with one’s partner.
·Profound personal growth in nonsexual areas is key in embracing your sexual potential.
·Sex can be so much more than a vehicle for our needs to feel good. It can be joyous and
illuminating. It can be a truly trans-formative force in our lives. Sexual intimacy can penetrate
the skins of our bodies as it penetrates the boundaries of our egos. Only then can we recognize
ourselves and our partner in the Mystery of existence itself.
In conclusion, I invite you to take up the challenge and adventure of reaching your full
sexual potential and to be and remain the erotic, celebratory, courageous, connected
and sexual being that you’re meant to be.
Suggested Reading
Hope and Recovery: A Twelve Step Guide for Healing From Compulsive Sexual
Behavior, Anonymous.
Mindful Recovery: A Spiritual Path to Healing from Addiction,
Thomas Bien, Beverly Bien.
Say Yes to Your Sexual Healing: Daily Meditations for Overcoming Sex Addiction, Leo
Booth.
Lust, Anger, Love: Understanding Sexual Addiction and the road to Healthy Intimacy,
Maureen Canning.
Mending a Shattered Heart: A Guide for Partners of Sex Addicts, Stephanie Carnes
A Gentle Path Through the Twelve Steps: The Classic Guide for All People in the
Process of Recovery, Patrick Carnes.
Out of the Shadows: Understanding Sexual Addiction, Patrick Carnes.
Don’t Call it Love: Recovery From Sexual Addiction, Patrick Carnes.
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior,
Patrick Carnes.
Breaking the Cycle: Free Yourself From Sex Addiction, Porn Obsession and Shame,
George Collins.
Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for
Addicts and Co-dependents, Ralph Earle.
Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction,
Alexandra Katehakis.
Healing the Wounds of Sexual Addiction, Mark Laaser.
The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography,
Wendy Maltz and Larry Maltz.
The Circle of Life: The Process of Sexual Recovery Workbook,
KJ Nivin.
The Sex Addiction Workbook: Proven Strategies to Help You Regain Control of Your
Life, Willian T. O’Donohue and Tamarqa Penix Sbraga.
False Intimacy: Understanding the Struggle of Sexual Addiction, Harry Schaumburg.
Sex Addicts Anonymous, Sex Addicts Anonymous Fellowship
Treating Pornography Addiction: The Essential Tools for Recovery,
Kevin Skinner.
Wired for Intimacy: How Pornography Hijacks the Male Brain, William M. Struthers.
Cruise Control: Understanding Sex Addiction in gay Men, Robert Weiss.
Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age, Robert
Weiss and Jennifer P. Schneider.
About the Author
Dorothy C. Hayden, LCSW, MBA, CAC, is a psychoanalytic psychotherapist who specializes in
chemical dependency, sex addiction, BDSM, fetishes, cross dressing and sexual perversion.
She has appeared on the British HBO show documentary “The Devil and the Flesh”, about
sexual power and celibacy, ABC’s “20/20” about the phenomenon of cybersex addiction, “The
Jenny Jones Show”, about adolescent homosexuality and “The Ricky Lake Show” about fetishes.
In addition, she has appeared on CNN’s Anderson Cooper “360” about transsexualism and is a
regular commentator on WBAI radio on the contemporary sexual scene including the polyamory
(non-monogamy) movement, dominance/submission lifestyles, and the
bondage/domination/sado/masochism (BDSM) community.
Ms. Hayden has been interviewed by such print media as The New York Post, Playgirl,
Cosmopolitan, New York Magazine and Time Out New York.
A published author, her 20+ articles have been translated into other languages and appear on
websites throughout the world. Her new e-book: “You Can Do This!! Twelve Ways to Treat Sex
Addiction and other Essays” is in press as of this writing.
Ms. Hayden graduated in 1995 from New York University with an M.S.W. and holds an M.B.A.
in marketing from Baruch College (1987). She attended advanced clinical training at the Post
Graduate Center for Mental Health, and the Object Relations Institute and the Training Institute
for Mental Health. A graduate of the Milton H. Erickson Institute for Psychotherapy and
Hypnotherapy, she uses hypnosis in working with fetishes, sexual dysfunction and sexual
enhancement. She is also certified in Neuro Linguistic Programming (NLP).
With twelve years of experience in the chemical dependency field and fifteen years as a sex
addiction therapist, she has worked in a number of the major drug and alcohol rehabs in the New
York City area and was awarded a CAC (Credentialed Alcoholism Counselor) certificate in 1994.
From 1993-1995, she was on the faculty of Mary Mount Manhattan College as an instructor in
their addictions counseling training program.
In addition, she trained with Patrick Carnes, the pioneer in the field of sex
addiction treatment who wrote the book: “Out of the Shadows:
Understanding Sexual Addiction”.
Ms. Hayden is affiliated with the Post Graduate Society for Psychoanalysis, the Association of
Sex Educators, Counselors and Therapists (ASECT) and the Society for the Advancement of
Sexual Health (SASH).