Posted by: counselorcarmella | August 13, 2012

Some Basic Info on Sex Addiction

During my time at Crossroads, I have  attended two workshops on treating those with sexual addiction and their spouses.    The first was given by Len Fredrickson MSW, LISW-CP, CCSAS.  He used to have  a sex addiction treatment program here in  Columbia SC but has now relocated to NC.  The other presentation I attended was presented by  Dr. Tom Barbian, director of the Christian Counseling Center at First Presbyterian Church here in Columbia.    He and Dee Parlatto run an outpatient program for sex addicts and their spouses there that includes groups and individual counseling.
  This is where I refer people for evaluation and treatment of a possible sex/love addiction. I don’t see myself ever pursuing specialization in this field, but I’m glad to know some folks who  do to refer to.
Sex addiction is not an official  mental health diagnosis. Some believe it is an impulse control disorder while others categorize it as an obsessive compulsive disorder. However it is   named or categorized, the reality is that this problem isn’t going away.  Its getting worse.  Some clinicians still don’t believe  in it, or don’t like the term itself. but   its hard to argue with reality. In so many cases, this is clearly  so much more than someone  misbehaving and looking for  something to call it that   gets them off the hook in terms of responsibility. Our culture is more and more sexualized and kids are exposed to sexual material at younger ages. Explicit materials and sites  where people can find other people  interested in the same sorts of sexual activities to hook up with are just a click away on the Internet. We are becoming more and more of an “instant gratification” and “If I want it,I should be able to have it” culture.  Families are breaking down and people are more isolated and looking for   ways to numb out, distract, and meet emotional  needs.  Sex addiction can be the result for   plenty of  people, menn and women, young  and old, married and unmarried, etc.
I have worked several cases where this was an issue. Most of the time, a devastated wife  comes in  and talks about how, even though she’s ready willing and able, her husband would rather  masturbate to pornography than   have sex/make love with her.  These women wonder what’s “wrong”  with them or why their husbands don’t want them.  They’re waking up in the middle of the night to  discover  their  husbands still up and online. When they ask what he’s doing, he gets all  defensive and immediately   closes things down so she can’t see what was just on the screen. He’s irritable and disengaged from her and the kids. He jumps on the computer as soon as he gets home and stays on it until all hours. They’re tired of going on the computer and finding  what he’s looked at and fighting with him about it.  They’re disgusted and angry.
I’ve worked with women who’s husbands have repeated affairs or inappropriate virtual interactions with women.  They  get caught, apologize and cry and swear they won’t do it again and tell her to trust them and then they do it  again and again. They may say they didn’t mean to or that things “just happened.”  They’re flirtatious and attentive to  other women at work or  at social gatherings and have  an awful lot of female friends they’re texting, on FaceBook with, or  getting together in person with for one reason or another. Any time there’s a fight or a problem, these men  seek affirmation elsewhere.  These women  worry that the littlest issue will send him scurrying to find  someone either  at a bar, over theInternet to meet in person, or virtually, to  run to for comfort and   to feel worthy.  They feel like, if they ever say “No” to sex, he’ll go  find someone  who will say “Yes” and then blame them for not being willing to meet his  needs  whenever and however he asks. Meanwhile, their husbands accuse them of being suspicious and paranoid. 
Maybe he’s wanting to do things that make her more and more uncomfortable  like dressing up, watching porn, having threesomes, going to swingers’ clubs, or other activities. She’s not into that stuff and isn’t sure why he wants those things. Women have come to me after finding out they have an STD because  of their husband’s lack of faithfulness.   They’ve found the phone or credit card bills where he’s been calling sex chat lines or  ordering pay per view porn. Some of them come because their children  found things on the computer or  stashed around the house.   They feel victimized, betrayed,  and unable to trust. They don’t understand why he lies and doesn’t care about their feelings and won’t stop.
She talks to him about trust and  fidelity and thinks things are “better”  but  sooner or later, its back to the same thing. After it happens several times, she starts wondering if her  man has  “some kind of problem.” Some of them want their husbands to  try and get help.  They want to know how to “get through” to him. Others have had enough and want out of the relationship.   
No matter what they want to do about their situation, I have to try and help these women understand that its not about their desirability as women. Its about  impossible standards that no real person can live up to. Its about the escape of fantasy vs  imperfect reality. Its about their men  becoming desensitized  and  needing the high-intensity stimuli  that is only available on line.  Or, it is about their men being used to  more variety and novelty than a monogamous relationship can provide.  Or, it is about their men being afraid of true intimacy.  They’re afraid of  having to  consider another person’s needs and feelings in their pursuit of pleasure and of getting emotional and physical needs met primarily in the context of a long-term monogamous relationship. Some of these guys  seem to need several women at any given time to get enough attention and external validation.  One woman could never be enough.  Some of these men are hooked on the  thrill of the chase and the conquest and the feelings of power that gives them.  Some people get turned on by the idea of doing something  forbidden or  risky. The prospect of getting caught makes things  more exciting.         
I have occasionally met the husbands or boyfriends, but usually not.   They don’t  seek counseling very often.  When they do, they seem pretty invested in explaining why they don’t have a problem or  in  justifying their behaviors.    Or, they come to counseling saying they’re having relationship problems or   depression or something when the real issue is sex addiction.  I may or may  not figure this out during the time I’m working with them.
In fairness, women  can have sex  addiction problems, too. There have been several cases I’ve worked with in which women have had repeated affairs and seem to need attention and  affection at levels that are destructive.  These women  need a man to tell them their special and beautiful and wanted and  will find one if the one they’re with isn’t giving them that. Their emotional needs lead them to repeated  episodes of infidelity or to random hook ups and risky choices.  Some of them have left to be with  the new man they think can give them what they need only to realize later that they  ruined their families for a fantasy that couldn’t hold up in real life. 
Women  seem to  be addicted to   the idea and  the feelings that go along with “love'” or being “in love” more than just to sex, but  can feel that  giving men sex  is the only way they can be sure they’re wanted or needed.  They don’t know how to say  no or how to set proper boundaries.  They  can’t be alone and run from one unhealthy relationship to another just to be with someone.  They use their bodies and   sexuality to get attention. Their desperation gets them in all kinds of difficult and/or abusive situations,  involved with married  men, and all sorts of other  less-than-ideal situations. They’ll stay with the man who  cheats on them repeatedly or is abusive because they “love him” and don’t want to be alone.
Some of these cases can be  partly due to  mental health disorders such as manic episodes that are a part of bipolar disorder.  In other cases,  seductive or  clingy/desperate behaviors are related to  personality issues such as    borderline, histrionic,  narcissism, or dependent personality disorders.  They may also have substance abuse issues. They may be using  sexual outlets inappropriately because of, or  to try and deal with, depression, anxiety disorders,  previous trauma, or attention deficit disorder. These  co occurring issues are  common in men and women.   
Some people get in legal trouble because of their sexual “acting out.”  They’re exposing themselves,  peeping through windows,  being inappropriate towards chhildren or other adults, or other socially unacceptable behaviors.  They’re busted for picking up prostitutes.  I haven’t had any of these cases, but these can be   other consequences of  sex addiction. Some people get in trouble at work  for viewing porn on their work computers, or for  trying to find hook up partners using work computers.   They’re “inappropriate” with colleagues, etc.   Some of these folks are referred to counseling as a condition of  probation or  in order to keep their job.
Like any other addiction, these behaviors can  take over a person’s life and become completely out of control.  The person can be facing  very negative consequences and continue to  engage in these behaviors when doing so makes no sense to the  people who care about them. There are a lot of tools available on line for helping someone decide whether they might have  some form of sex addiction.  There is lots of info and even some on line support.  It may be tempting to go that route rather than to have to talk with someone face-to-face about this possible problem.  Online resources  provide limitted help, however.  True evaluation and treatment needs to involve a counselor who has received  specific training to meet the needs of these clients.
CSAT certification seems to be the most well-established credential.  CCSAS is  a credential for  those who approach treatment from a Christian perspective. There is no official license so the certification is tacked on to  the  clinician’s other credentials, such as LPC, LCSW, or LMFT. Most  therapists do not receive this sort of training in their  degree programs, and though well meaning, may not be very helpful to these individuals or couples. Just because someone does marital therapy, that doesn’t mean they’re equipped to treat sex addiction. Couples work  related to ssex addiction isn’t the same as  couples therapy for other issues, though other issues may be addressed.  The same is true for individual counseling. 
Sex addiction is a specialized type of treatment.  It is much more than  simply getting a person to stop certain behaviors (finding someone to hook up with,  viewing porn, compulsive masturbating,  going to strip clubs, etc).  That’s why  just getting the person to “promise to stop” is  rarely if ever effective. That’s just the beginning. Trained and certified specialists  address deeper issues related to trauma and intimacy that often fuel sex addictions.  They  go deeper with the person and the couple  so that there is true insight and healing that addresses  the factors that created and nurtured the addiction. These can be related to childhood issues,  fear of closeness,  lack of coping skills, other psychological  and addiction issues, and other factors.  The whole person approach of addressing the  physical, emotional, relational, mental, and  spiritual seems most effective.  Treating co occurring disorders is also very important. 
Minimally,  individual  counseling, group counseling,  work with the addict and their partner (if there is one), and 12 step support groups with sponsors and individual accountability are all parts of  recovery. There are solid residential programs all over the US, as well as  outpatient programs that include individual and group counseling for sex addicts and their spouses. If clients attend a residential  program or an intensive treatment program for a weekend, they are encouraged to follow up with  certified counselors and support groups in their own community after returning home. This after care and ongoing treatment    provides the best opportunity to  stay on track and continue the recovery and healing process.  It is not a quick or easy process, and as with other addictions, relapse is  common.  Unlike  alcohol or drugs, the goal is not necessarily to never have sex again.  It is  about   having relationships  that are healthy and  healthy views of sex and sexuality.  Some clinicians also do telephone counseling or  online counseling if  there are no providers near where a person lives.
SPECIFIC PLACES TO LOOK FOR TRAINED PROFESSIONALS: – lists therapists who have fulfilled the requirements as a Certified Sexual Addiction Therapist (CSAT), – lists therapists who are members of the Society for the Advancement of Sexual Health, an association for professionals who treat sex addiction and trauma.


Group accountability is also vital. This often includes local 12 step support groups, such as  Sexaholics Anonymous, Sex Addicts  Anonymous, or other similar groups.
Sexaholics Anonymous
Sex Addicts Anonymous
Sex and Love Addicts Anonymous
Having an individual “sponsor” or accountability partner is also important.  This person  should not be a spouse but should be a “friend” to the marriage as far as  insisting on honesty and transparency.
The hardest part is getting someone with a sex addiction issue to be honest and open to receiving help.   Many  don’t get into treatment until court ordered to do so.    Even then, they may not own their problem or  be  willing to work on it. Sex addiction therapists are not  judgmental or  easily shocked and their services are  usually confidential.    They understand guilt and shame and how hard it can be to   make, or even consider making,  changes.   They are there to help clients  take  on this  process in a supportive and structured environment.
See part two of this piece for  additional links, names and resources. 

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