I have been working in the field of sexual compulsivity for almost twenty years and during that time I have seen a seen a shift in the attitudes and education of medical and clinical professions. For a long time sexual compulsivity was seen as an unsubstantiated disorder. It was not legitimized by clinical trials, research studies or even more profound, recognized in the Diagnostic and Statistical Manual of Mental Disorders. However, in recent years the attitudes and treatment is shifting both professionally and culturally. These changes are positive, but still I pause. I believe we can do better. Diagnosing and assessing sexual disorders is challenging. Not for the client whose behaviors are overt, having been caught with evidence in hand. This disorder can be a pattern of complex interactive behaviors that often leave the professional perplexed.
Or even more profound leave them believing they have a complete assessment of the subjective world of the addict. At The Meadows extended care treatment specifically for sexual disorders, Dakota we have seen clients, (mixed gender population) who were not diagnosed with sexual disorders. Fortunately skilled clinicians saw signs or red flags and were astute enough to refer them to Dakota.
Consider this case. A female patient came into primary care with the following presenting issues: depression, alcohol abuse, self-reported "flirting" while drinking. A skillful clinician was able to see the indicators of a sexual disorder. By the time the client discharged from extended care the clients list of sexual behaviors included; compulsive masturbation, masturbation to the point of injury, erotic literature, sexual fantasy, seductive role sex, Internet pornography including sado masochism and rape sites.
Consider the case of a 31-year-old female. Her presenting issues upon admit included; depression, Post Traumatic Stress Disorder and love addiction. After five weeks in extended care she had disclosed sexual behaviors including; working as a prostitute and stripper, seductive role sex, phone sex, affairs, anonymous sex (sex clubs and swinging), working as a dominatrix, use of urination and defecation for sexual arousal and sexually exploited by boss.
The same is true for men. This is especially true in cases where men have had same sex encounters but identify as heterosexual. The confusion and shame is so overwhelming they do not disclose, keeping it a secret. They may be willing to talk about a pornography stash or acting out with prostitutes but a complete sexual disclosure is something they are unwilling to risk.
As we all know in addiction, it is the secrets that kill. It is the shame associated with the secrets that compel the compulsive lying. It is vital that we as clinicians create a safe and healing environment for the client to unburden themselves with the truth.
I often say this work is not for the faint at heart. Sexual addiction can lead our clients into very dark, socially unacceptable behaviors that can be both shocking and disturbing. It is our responsibility as clinician to hold that safe place for our clients to heal.
This may seem like a rudimentary statement but consider the previous case; it is much easier and or comfortable to explore issues of love addiction then the dark and seedy reality of a client who views defecation as sexually gratifying.
I like the idea that it is my responsibility as a therapist to hold temporarily for the client the burden of this shame. I respectfully and skillfully urge the client to describe his or her shame and the behavior it has generated. The client hands it off to me for storage until that time in our therapy when I can hand it back to him or her for inspection. At that point, the client has grown able to appreciate that he or she is not endemically evil, but is the victim of abuse.
I am able to hold the shame, the anxious hope, whatever belief system, or whatever emotion the client is feeling, and say to this suffering and trusting person, "You know what? I believe you can work through this, and that you can and will become even more than you now believe is possible. And I will hold all the shame or other emotion for you while we are doing this work together."
What can make for successful interventions is becoming the solid ego state against which the wounded ego can collide, yet survive. I mirror for them the respect, understanding, and safety they have never known. The wounded part begins to heal. The therapist becomes the good parent. The client internalizes that identity. The healing takes place within the therapeutic relationship.
The goal of early treatment is to help clients trust that I respect them in their full humanity, even the darkest parts. I want them to understand that I can deal with their demons and find the healthy soul trapped within. This is the beginning of the healing.
Sexual Recovery is one of a series of cutting-edge workshops offered at The Meadows. These workshops are designed both to meet the needs of those who have not experienced our inpatient treatment and as a source of renewal for our alumni.
Sexual Recovery is a five-day workshop that examines sexual compulsive issues and behaviors. Often we do not talk about our sexual experiences because the subject carries too much shame. This workshop helps to lift the shame and resolve sexual dilemmas and self-destructive behaviors. Chief among these compulsive behaviors are:
Sexual obsession and intrigue
Compulsive masturbation with or without pornography
Compulsive use of cybersex
Use of prostitutes, strip clubs, peeping or sex bookstores
Multiple or serial relationships
The Sexual Recovery workshop is best for those who want to
Jumpstart their recovery process
Acquire tools to support continuing recovery
These workshops are scheduled as "men only" and "woman only" and are offered periodically throughout 2010. More detailed information about the Sexual Recovery workshop is available by visiting our website or by emailing our Intake Department.
And for commentary on the topic of Sexual Addiction, please visit Maureen Canning's blog on the subject.
This article is an excerpt from Maureen’s newly released book, Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy. For more details, visit themeadows.org.
Sex is one of the most powerful forces in the human condition. It can drive individuals to the pinnacle of emotional and physical ecstasy or, conversely, spiral other people into depths of despair and anguish. The power of sexual energy and expression exists because our sexuality is tied, or connected, to the core of who we are; it is our essence, our life force, our creativity, and our passion.
A sense of self means an inner knowing, a clarity of our true nature or authenticity. In healthy sexual expression, there is desire, connection, and a sense of well-being. The act of expressing one’s self sexually results in a positive, life-enhancing experience; it is an expression of love, an exchange of mutual pleasuring and respect that leads to an intimate connection.
The sexual compulsive person may think this is what he or she is experiencing. However, the opposite is true. Sex for the addict is about intensity, danger, power, and control. It is about emotional numbing, conquering, and getting high. Sex becomes a commodity to be manipulated, a means to a selfdefeating end. Sex and love become a game to play, an avoidance, a push/pull, or a hunger so powerful that the addict will risk everything to reach that sexual high.
No risk or consequence has stopped the addict: disease, financial ruin, lost relationships, legal injunctions, career setbacks, or self-respect. The addict is caught in an intoxicating dance that has induced a delusional reality.
This is the cycle of sex addiction, and it is deadly—not always in physical form, but most assuredly in emotional experience. This “soul” death is temporarily allayed when the addict is on the “hunt” for sex or, at the other extreme, is avoiding sex at all costs. At either end of the spectrum, the addict feels in control and powerful. This is the high, a chemical release that is as addicting as any drug. When these chemicals—or the high— are induced, euphoria washes over the addict, creating the illusion of complete immunity to the realities of his or her internal ache.
Sexual addiction is not a moral issue; it is a coping mechanism born out of the addict’s wounding. The types of wounding can be as diverse as the addicts themselves. Not all addicts are aware of their “wounding,” as abuse or trauma is often covert. When a person is wounded or traumatized, he or she must learn to cope, often without understanding or support. In order to cope or escape their painful realities, addicts may use drugs, alcohol, food, shopping, staying busy, controlling others, or work. Sex addicts escape through sex.
The second half of this book excerpt is available in the September issue of The Cutting Edge.