With the growth of lax attitudes toward sexuality in our culture since the 1960’s and ‘70’s there appears to be an increased struggle with overpowering and dysfunctional aspects of human sexuality. These struggles have come to be understood as sexual and relational process addictions. They have been on the increase over the past two decades. This problem has exploded with the increased availability of internet on the world-wide web—most recently with the development of cell phones, computer notebooks and personal MP3 players.
The earlier increase in freedom springing from the loosening of sexual restraints in the last half of the 20th Century has combined with the more recent increase in accessibility and privacy through the internet to result in an unprecedented explosion of sexual and relational addictions, increasingly visible today. Where relational freedom and self-control are concerned, we are also attempting to “Have our cake and eat it too” in this age of the early 21st Century: More freedom exists in the mores of the current culture to accept many types of relational and sexually oriented options, yet in some instances we are drawing more stringent boundaries and expectations about them (specifically in the areas of sexual molestation and sexual assault, and rightly so). However, this confusion only adds to the problem, making solutions more complicated and difficult. On the one hand, society is moving toward ever increasing acceptance of multiple forms of sexual and romantic expression—from recreational sex to sequential monogamous relationships to informal co-habitation to covenantal marriage. Yet the loosening of these boundaries on one level logically flies in the face of increasing intolerance of sexual coercion, manipulation, and ever-widening degrees of sexual objectification (beginning with the preponderance of males to engage with females in this way as a means of satisfying their own needs). The fallacy is to believe these opposing movements of sexual freedom and sexual responsibility can both proceed apace without great discord and dysfunction increasing along with them. Yet the principles understood about addiction in both the professional and 12-Step fields contain time-held wisdom we can apply to these growing problems.
To help clarify the broad spectrum of difficulties within this phenomenon, the clinical definitions of “abuse” and “addiction” bring understanding. “Addiction” involves qualities of increasing intensity, frequency and resilience, making it enslaving and gravely destructive. For something to be addictive, it must have a quality of increasing intensity and frequency over time that resists destructive consequences resulting from it. Common examples include the loss of a job or promotion, the loss of a marriage, due to the addictive behavior. Additionally, addiction requires patterns of increasing frequency—or intensity of amount—in order to bring about the equal sense of release and satisfaction.
In contrast, “abuse” only needs to involve using a substance or behavior once—or with regularity—in a way that is destructive, unhealthy, or improper. A common example surrounds the consumption of alcohol: It can be consumed non-abusively in a healthy and beneficial manner. It can also be consumed in a way that is unhealthy, dangerous, destructive or foolish (singularly or repeatedly). This exemplifies alcohol abuse. When additionally consumed with enslaving intensity, frequency and resiliency, it becomes alcohol addiction.
This dual understanding applies to behavioral addictions also, which include problems like eating disorders and sexual addiction. A broad spectrum of sexual problems can fall into both “abusive” and “addictive” patterns. No matter what form, the treatment model for sexual addiction effectively deals with both addiction and abuse of sexual behavior. It is humbling to realize that for any person, patterns of abuse can slide into patterns of addiction. Consequently, the intensity of approach in both the addiction and 12-Step models provide essential tools to effectively manage sexual and relational problems stemming from sexual addiction.
“Hitting bottom”, coming to the end of yourself and “admitting powerlessness over addictive behavior” are some of the first principles covered in 12-Step programs. The common traits of denial and rationalization are dismantled and overcome through this essential step in dealing with sexual addiction. Dr. Mark Laaser, a leader in the field and colleague of Dr. Patrick Carnes, asks his clients two initial questions: “Do you want to be healed? (i.e. to get well)” And “What are you willing to die for?” Every person struggling with unwanted sexual behavior must essentially address these questions: Many reasons exist for someone to seek help with sexual addiction—the onset of a crisis or dilemma compels them to seek help. These deeper questions focus on the trickier issues of self-motivation and total commitment necessary at the outset for true healing and change to occur. Hence, the question of whether the addict wants to get well. He or she may know they have a problem, and wish for it to go away, but the deeper question of true desire needs to be clarified and resolved: “Do you truly believe you have a problem and do you truly want to be free from this problem?” An honest answer to this question must involve confronting personal levels of desire for the sexual behavior that must be wrestled with and resisted through some form of self-discipline. Failing to acknowledge this and to equally acknowledge the need to learn to “live without sex” will derail any addicts’ ability to begin breaking cycles of denial and rationalization common to all addictions. This is no easy struggle. Hence the need for the 2nd question of commitment: In order to overcome sexual addiction, the addict will have to go through a process that feels like he or she is dying, or that something essential to existence is being removed. This intensity of need drives all addiction. Sexual addiction is no exception. In order to overcome, the addict must be willing to pay any price in order to be free. This is an extreme commitment. In order for any success, the addict must engage an initial assent of the will (i.e. “choice”) with eyes fully open to these questions. Coming to this point of crisis springs the addict into full engagement of this arduous journey. Hence the 12 Step’s inclusion of a Higher Power and the intention to achieve success “with God’s help” is essential for any ultimate success.
So what does therapy for sexual addiction involve? After discussing the nature of addiction and establishing initial willingness, as discussed above, the next step involves gaining a detailed “sexual history”, in order to evaluate the nature and scope of an individual’s sexual struggles. This includes exploring both the modeling of sexuality in the family of origin, and the individual’s history of personal sexual development and sexual behavior. Discussing these details provides key insight into factors involved in someone’s struggle with sexual addiction. From here, an education into triggers and rituals connected with sexual acting out can be approached through the individual’s specific patterns of sexual development and addiction.
Often a sexual addict’s marriage needs immediate help. When possible, it’s best to do this simultaneously with individual treatment, and can often be done by the same therapist. Sometimes the spouse of the addict will also need more help in addressing overwhelming emotions and reactions to the sexual addiction, including resulting questions of “where do we go from here?” These issues can frequently be addressed adequately in the marital work; but sometimes a separate individual therapist is needed to help the spouse. It is best for this therapist to be trained in issues of sexual addiction, which includes helping the spouse process the turmoil and look for the best ways forward. Often, a therapist of the same gender as the spouse is most helpful for these situations. In marital work, the therapist primarily explores issues of broken trust and how to repair them, educates and promotes healthy back-and-forth communication surrounding emotional pain in the marriage and the effects addiction has upon it, and provides ongoing support and education regarding milestones and challenges in repairing the relationship.
Depending on the nature of the addiction, there are multiple treatment options for sexual addicts and their spouses: The most readily available is outpatient counseling. In the Chicago-land area, Associates in Professional Counseling offers treatment for individuals—including young adults and adolescents— as well as couples and addict-spouses dealing with problems stemming from sexual addiction. They provide individual treatment for addicts, combined with marital counseling as needed. They also provide individual treatment for addict’s spouses. They have trained male and female therapists in this field. They work actively with clients to connect with 12-Step programs, including Sexaholics Anonymous and S-Anon (for addict spouses), in order to help them establish a successful sobriety and recovery program and to aid in healing the marital strife. For adolescents and young adults, they work with parents to better understand and work with their children in healthy ways surrounding this issue. They also identify complicating conditions such as depression, anxiety or obsessive compulsive traits. They are willing to work with psychiatrists in medication management and to provide recommendations for such treatment.
Another option is intensive residential treatment. KeyStone Center Extended Care Unit is one such option for issues surrounding sexual compulsivity and trauma. The residential center is a 16-bed treatment program located in Suburban Philadelphia. The Extended Care Unit treats multiple addictions and co-occurring disorders. Treatment components address the cognitive, behavioral, spiritual, emotional and psychological aspects of addiction and recovery. The length of stay varies in this twelve-step based program and ranges depending upon individual needs and completion of specific therapeutic tasks. The minimum length of stay is 4 weeks. Keystone also offers couples Intensive Weekends. These intensives run on a quarterly basis and are intended for couples who desire to further their recovery process and gain understanding and insight into current concerns in their relationships. Each weekend workshop is open to any couple having made strides in their recovery program and are looking to move into more in-depth discussions. These weekends are limited to only a handful of couples to increase the amount of individualized time and attention.
Bibliography and Further Reading:
Out of the Shadows: Understanding Sexual Addiction by Patrick Carnes
Don’t Call It Love: Recovery from Sexual Addiction by Patrick Carnes
Healing the Wounds of Sexual Addiction by Dr. Mark R. Laaser
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