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Tuesday, November 10, 2009

Overcoming Sexual Addiction in Therapy

As a psychotherapist in NYC who specializes in sexual addiction, I've helped many clients overcome problems with sexual addiction. Both men and women, heterosexual, gay or bisexual can suffer with sex addiction. Like most addictions, sexual addiction can occur regardless of a person's age, race, ethnic background, sexual orientation, profession, income, religion, and educational background.
Overcoming Sexual Addiction in Therapy

What is Sexual Addiction?
Let's start out with what sexual addiction is not: Just because someone has affairs or looks at porn doesn't necessarily mean that he or she is a sex addict. If someone is cheating on his or her spouse or partner, this is obviously a problem, but it doesn't necessarily mean that he or she is a sex addict.

According to Patrick Carnes, Ph.D., a psychologist who is an expert in the sexual addiction field and who has written several books about it (see Resources below), someone who has a sexual addiction usually has some of the following characteristics:
  • A pattern of uncontrolled sexual behavior
  • Consequences (sometimes severe) to this uncontrolled sexual behavior. These consequences might include problems in his/her relationships due to sexual acting out behavior; legal problems, including arrest; work-related consequences as more and more time is spent preoccupied with sex rather than work or, among other things, getting caught downloading Internet porn or chatting online; and other similar consequences.
  • Ongoing efforts to try to stop sexual acting out, but an inability to stop engaging in sexual acting out despite consequences.
  • Pursuing self-destructive and high-risk sexual behavior. This might include getting drunk or high on drugs that leads to acting out sexually; meeting strangers for sex; going to known "cruising" areas to have sex with strangers in areas where he or she might get caught, beaten up or killed; engaging in sex without using contraception which could lead to a sexually-transmited disease, and other similar self-destructive and high-risk behavior.
  • Using sexual acting out to deal with untreated anxiety and depression, and the need to engage in more frequent or more dangerous sexual acting out as the current level no longer excites as much or wards off feelings of low self esteem or feelings of inadequacies
  • Large mood swings around sexual activity
  • Spending a significant amount of time either preoccupied with sex, sexual acting out or recovering from sexual activities
  • Neglecting important social, occupational or recreational activities due to compulsive sexual behavior
How Does Sexual Addiction Start?
The current American Psychiatric Association's Diagnostic and Statistical Manual for psychiatric disorders does not include sexual addiction as a separate diagnosis. This might change in future editions.

However, current research has found that there can be a genetic predisposition for sexual addiction. Current research has shown that there is often a family history of addiction, whether it is drug addiction, alcoholism or sexual addiction. In addition to the genetic component, when there is a history of addiction, the person who grows up in such a family also learns to self-medicate as a way of coping with painful emotions.

Sexual Addiction (both online and off) Affects Both Men and Women

Sexual Addiction Can Affect Anyone Regardless of Sexual Orientation

The Cycle of Sexual Addiction:
According to Patrick Carnes, the cycle of sexual addiction usually begins when the person has bad feelings about him or herself ("I'm unlovable," "No one cares about me," "I'm a bad person," "My needs will never be met in an ordinary relationship," and other similar negative feelings. When something negative happens to this person, it seems to confirm his or her feelings of low self worth. Since he or she has not learned good coping skills or healthy ways to deal with emotional pain, this person resorts to sexual acting out.

Prior to the sexual acting out behavior, the person who struggles with sexual addiction usually dissociates (i.e., unconsciously distances himself from his feelings) and enters into somewhat of an altered state where there is an emotional split between who he is in his every day life and who he is when he is acting out sexually. He becomes preoccupied with sexual fantasies that enable him to distance himself from his emotional pain. Once he enters into this dissociated state, he is more likely to act out sexually. There is often a ritualization to the sexual acting out. For example, part of the ritual might be to go to a strip club, get sexually aroused and then go see a prostitute to pay for sex or go home and participate in online sexual chat rooms or engage in some other form of infidelity.

Getting Help For Sexual Addiction in Therapy

Sexual acting out often relieves tension or regulates a depressed or anxious mood momentarily. However, this relief or elevation in mood doesn't last long. After acting out sexually, the person often feels an inordinate amount of shame, humiliation, guilt, and, often a higher level of depression or anxiety. At that point, the person who suffers with sexual addiction might promise himself and/or his spouse (if he is caught) that he will never do it again. However, this is part of the cycle of addiction, and the increase in painful emotions is often what fuels the next episode of sexual acting out. As a result, he is caught in the vicious cycle of sexual addiction, often needing more frequent, more intense or more dangerous forms of sexual acting out. The sexual addiction becomes a way to self-medicate painful emotions, similar to how alcoholics and drug addicts use alcohol and drugs to self-medicate.

When I work with people who have problems with sexual addiction, I start with a consultation to see if the client and I are a good therapeutic match. A good therapeutic match means that there is a good rapport between the client and the therapist. This might not be evident in the first session because most people feel very uncomfortable and ashamed of having a problem with sexual addiction. However, the client should feel at least comfortable enough to want to return for another session. When treatment is going well, the therapeutic alliance builds over time as the client gradually learns to trust the therapist.

I also assess clients for their motivation for change. It's not at all unusual for people to feel ambivalent about coming for treatment. Often, people come into treatment primarily because a spouse or an employer has urged them to come. This might be what gets someone into treatment and, initially, motivation might be low. The client might not even be sure if he or she has a problem with sexual addiction. However, if there is a problem, it's possible to develop your own internal motivation to overcome sexual addiction. Internal motivation is essential for a good treatment outcome. If your primary focus remains that you're doing it for someone else rather than yourself, you might need to do some soul searching in order to get to a place where you feel that you're doing it for yourself and you deserve to overcome this problem and lead a happier life.

Getting Help For Sexual Addiction

It's also important to know whether there is an underlying depression, anxiety disorder, attention deficit disorder or some other underlying emotional issue or trauma that needs to be addressed.

During treatment, I help a client to understand what triggers his sexual acting out. I also help him or her to learn new ways of coping, which is also essential to having a positive treatment outcome.

When you can anticipate what triggers your sexual addiction and you have other healthy ways of dealing with these triggers, you're more likely to stop the cycle of sexually acting out.

Depending upon the client and the underlying emotional issues, I might use cognitive behavioral treatment, psychodynamic psychotherapy, clinical hypnosis (also known as hypnotherapy) or EMDR (Eye Movement, Desensitization and Reprocessing) or a combination of these forms of psychotherapy to treat sexual addiction.

Going to self help meetings like Sex Addicts Anonymous or Sexual Compulsives Anonymous and getting a sponsor is also usually very helpful. It is also important to educate yourself with current literature about sexual addiction (see Resources below for information about 12 Step meetings and books).

If you're suffering with sexual addiction, you're not alone. Many people who are sexually addicted have been helped with psychotherapy and 12 Step meetings.

I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist.  I work with individual adults and couples, and I have helped many clients to overcome sexual addiction.

To find out more about me, visit my web site: Josephine Ferraro, LCSW - NYC Psychotherapist

If you're thinking about treatment, you can call me at (212) 726-1006 to set up a consultation.

12 Step meetings:
Sex Addicts Anonymous:
Sexual Compulsives Anonymous:

Inpatient Treatment:
The Meadows:

Out of the Shadows: Understanding Sexual Addiction - By Patrick Carnes
Don't Call It Love: Recovery From Sexual Addiction - By Patrick Carnes
In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior - By Patrick Carnes
Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy - By Maureen Canning

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