The Treatment of (Sexual) Addiction

While I do talk about sexual addiction here, nearly all of this orientation may be superimposed over, and applied to any addictive process.  

Myths about the sexually addicted, and addictions in general run rampant in this culture, mainly focusing around themes of perversion, the lack of morality, predation and so on.  Here, I don’t want to address the sexual psychopath (I talk about personality disorders in other articles focused on Narcissism and Borderline Personality Disorders), rather, those whose addiction is akin to the alcoholic, or the compulsive gambler or shopper, the pathologic eater or the workaholic.  I want to talk about my understanding of the healing strategy of those who struggle with their addiction: who use sexual acting out, as a way of self-soothing, of self-medicating, of numbing a terrible fear of intimacy and maybe worse — and those for whom life has become unmanageable as a result.   

Signs and Symptoms

Sex addiction like any other can be difficult to spot from the outside.  Most addicts become skilled at hiding their behavior and can even keep the addiction secret from spouses, partners, and family members.  An individual might have a sex addiction though, if he or she exhibits some or all of the following behaviors:

      • Chronic, obsessive sexual thoughts and fantasies
      • Relations with multiple partners on a frequent basis, especially with strangers
      • Preoccupation with having sex, even when it interferes with daily life, productivity, work performance, etc.
      • Inability to stop compulsive sexual behaviors or restrain sexual activity
      • Putting oneself or others in danger due to sexual behavior
      • Engaging in illegal sexual activity with prostitutes, minors, or children
      • Need for dominance and control in sexual liaisons
      • Feeling remorse or guilt after sexual episodes
      • Negative personal or professional consequences due to sexual behavior

Since sex addiction can be difficult to diagnose, it’s important to remember that enjoying sexual activity, no mater how much,  does not make one a sex addict.  A sex addict is typically someone who has a compulsive need to perform sexual acts and appears to have no control over these impulses.

In my experience working with a variety of addictions, effective sexual addiction treatment strategies are similar to the strategies that work with substance abuse, or any other manifestation of the “addictive personality.”  The research seems to bear this out.  Generally, any addiction treatment uses a combination of approaches that include Cognitive Behavioral Therapy (CBT), group therapy, trauma-informed assessment and awareness, and 12-step recovery work.  Sometimes all of these, sometimes only a few.  One major treatment difference when dealing with sex addiction versus other addictions is the definition of sobriety.  Using substance abuse as an example, sobriety is defined as the complete abstinence from all mood-altering substances.  Sexual sobriety on the other hand, embraces an ongoing commitment to behavior change but not to long-term abstinence from sex.  So, sexual sobriety is more easily compared to the way we deal with eating disorders (understanding that clients cannot stop eating altogether).

Most often, the healing begins in collaboration with the counselor and/or 12-step sponsor, by defining the specific sexual behaviors that are (and are not) causing the chaos that has made the addicted life (within which is included CoDependants) so terribly unmanageable.  In early phases of the work, couple's counseling may only be periodically helpful, but individual counseling and support group involvement for CoDepedents is always encouraged. With help, a “sobriety contract” is often written by the client, which describes those dysfunctional sexual behaviors as well as the need and the commitment to abstain from them.  The contract also includes clarification of specific healthy, acceptable behaviors that will continue to be embraced as well as those newly created, and how they will enhance, enrich, empower the recovering person’s life, as well as those around him/her.

It’s easy to see that the definition of sexual sobriety, as well as the treatment plan have to be completely individualized and personalized for each client.  The sexual sobriety contract created by a 28-year-old single gay man will probably be very different than the contract created by a 48-year-old married man with three children.  In other words, the goals for behavior change are conceptualized and formulated on the basis of the specifics of the chaotic, unmanageable world that that led to treatment in the first place (angry spouse, STDs, trouble at work, arrest, concurrent drug abuse, etc.).  

In my orientation, healing has main roots in resolving the fear of intimacy, and often abandonment, including the fear of an abandoned future. Motivation is contained within the deep regret and remorse about having created such a paradoxically lonley life and it’s impact on others. Perhaps more importantly, the pain of having turned away from, having betrayed, having abandoned one’s own sense of Self, one's own "Soul's intent" for this lifetime, becomes catalytic.  In a way, the therapy becomes the healthy, transformative use of empowering regret!  It is the activation of remorse (rather that it’s implosion into depression or guilt and self-pity), that leads to the committed, creative abstinence from pain inducing sexual behaviors.  There comes the deep understanding of how this strong discipline, commitment and follow-through will alleviate his or her present-day suffering (and those around her/him), while also helping to build self-esteem, the potential for intimacy in relaitonship, and a sense of control over life in general.

If the process of stepping onto any healing path is going to be successful it must include a complete and total dedication to the discipline, commitment and followthrough with their chosen path of healing. That path typically includes:

      • Complete separation from harmful, painful, sexual behaviors, which are contrary to healing
      • Helping the addicted person move denial regarding the problematic nature of those activities
      • Grieving the loss of who he or she may have seen himself/herself to be (versus what that person’s sexual behavioral history reveals)
      • Learning that one can tolerate brief emotional discomfort, without numbing out, for personal growth and healing
      • Helping the addict understand how past trauma, abuse, and/or neglect have informed his or her early learning experiences and current dependency needs
      • Working through shame by helping the client view his or her adult sexual act out as a learned means of self-soothing, affect management, and dissociation (a back-fired coping mechanism) rather than an inherent character defect
      • Learning relapse prevention, self-care and stress management techniques, family conflict resolution, aftercare planning, and so on

Because it is very difficult for either active or newly sober sex addicts to distinguish between healthy and unhealthy sexual behaviors, a brief period of total sexual abstinence (masturbation included) is usually encouraged, especially while the client is in primary treatment (inpatient rehab if necessary).  Most often this period of abstinence lasts 30, 60, or 90 days, depending on the individual.  This allows the sexually addicted, again working in conjunction with his or her therapist and/or sponsor, a sexually stress-free, cooling off period in which to fully assess his/her romantic and sexual acting out patterns (seduction, manipulation, lies, etc.), their authentic “real” sexual/romantic values,  while also developing some basic coping skills that can be used when the desire to act out arises.  Most important within that abstinance period, is the reaquainting oneself to the abandoned "real" Self again, outside the context of a sexual relationship

Cognitive Behavioral Therapy looks at the role of self-defeating, often irrational thought patterns in creating of painful feelings, that lead to events that trigger and reinforce the addict’s desire to engage in compulsive sexual activity.  We then identify healthy ways for the client to short-circuit, and reinvent the process, like this: change the way you think about a thing, and you will change the way you feel about a thing.  Change the way you feel about a thing and, you will change the way you act/behave towards it.  CBT guides the transformation process from self-defeating, addictive thoughts to feelings and behaviors into a healthy, action orientation of self care and personal reinvention.  

Actions usually involve things like attending on-going group support, or getting to a support group meeting (very often 12-step) before acting out, or a crisis is created, reaching out to a peer/therapist/friend/family member for support, and actively developing a spiritual connection of some sort.  

Essentially, CBT focuses on living a sexually (and later, globally) disciplined, sober life in the here and now rather than on uncovering and processing past traumas.  As such, the therapist’s role, at least early on in recovery, is to guide a task-oriented, accountability-based methodology geared toward containment and transformation of the client’s problematic sexual behaviors.  Later, once  sobriety is firmly established, the therapist and client will likely encourage looking at other, deeper issues.

Of course, the process of  recovery usually presents challenges that can’t be dealt with solely in individual, one-on-one therapy.  Like other addictive issues, sexual sobriety, nearly always require external reinforcement and support if permanently change is the goal.  This is often a key dynamic in decreasing the likelihood of relapse.  Sexual addiction focused group therapy can be really helpful here.  Generally, the group contains between six and ten same-gender participants. (Co-ed sex addiction therapy groups?  Obviously a bad idea!).  The facilitated group setting is a great way for addicts work through remaining self-judgment, and to learn that their issues are not unique. This naturally goes a long way toward reducing the shame associated with their behaviors. Group therapy is also the ideal place to work through the denial that is so integral to any addiction. Such non-judgmental encounters are powerful not only for the addict being challenged, but for the addicts doing the confronting.  Everyone present learns how minimizations, justifications, and rationalizations sustain sexual acting-out.  Clients are also able to learn which interventions and coping mechanisms work best based on other members’ experiences.  To my mind, this is critical to the process of reacquainting with, and living into one’s authentic Self again.  

Those clients who struggle in more intractable with core concepts of healing, or they just can’t seem to establish a footing in sexual sobriety, may benefit from inpatient residential or intensive outpatient (IOP) sexual addiction treatment.  These  more intensive programs can last as little as two weeks or as long as several months, depending on the program and the client.

In addition to individual and group therapy (and perhaps inpatient or intensive outpatient treatment), sex addicts nearly always benefit from 12-step “S” meetings. Sexaholics Anonymous (SA), Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA), and Sexual Recovery Anonymous (SRA) are all nationwide programs for sexually addicted.  Some meetings are open to anyone who wishes to attend, while others are open only to those who identify as sexually addicted.  A few meetings are gender specific.  It is best to check ahead by looking meetings up online or by calling the group’s local hotline number.

In any case, all psychotherapy, especially involving addictions, must be personalized and tailored to individual needs, cultural and family values and belief systems.  Some will respond best to individual therapy supplemented by group and 12-step work.  Others will do best in group settings, making little progress one-on-one.  Still others will struggle utterly until they are physically separated from the people, places, and things that drive their addiction by the protective space of inpatient treatment.  The most important thing when dealing with sexually addicted is to recognize their individuality in this respect, and to respond accordingly rather than by attempting to force-feed any particular cookie-cutter approach, no mater how popular.  

I do hope this was helpful to you.  Of course, in the Lansing, Michigan area, feel free to contact me with any questions or comments:

Peter Roseman, Psy.S.
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