How Existential Anxiety Contributes to Out of Control Sexual Behavior (OCSB)

I began a discussion about Out of Control Sexual Behavior in two prior articles, What Causes Out of Control Sexual Behavior (OCSB)? and Treating Out of Control Sexual Behavior in Sex Therapy.

Existential Anxiety and Out of Control Sexual Behavior

Although there is no one particular cause for OCSB, in the last article I discussed certain common contributing factors to OCSB such as Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders such as depression and anxiety.  

Before going further, I want to emphasize that even though I'm discussing contributing factors to Out of Control Sexual Behavior, I'm in no way implying that people are unable to control their behavior or aren't responsible for their behavior.  Regardless of the possible contributing factors involved, each person is ultimately responsible for their own behavior.

What Are Existential Thoughts?

Basically, existential thoughts focus on the meaning and purpose of life and one's own mortality.  

For instance, people, who allow themselves to engage in these thoughts, struggle for a while with the aging process and thoughts of death.  But many of them eventually come to accept the limitations of their particular life, including death, and this acceptance allows them to find meaning and purpose in their life (see my article: Making Peace With the Aging Process).

Erik Erikson's 8 Stages of Psychosocial Development include the 7th Stage, Generativity vs Stagnation, which occurs during middle adulthood, which was originally thought to be from about the age 40 through to 65 (although with longer life expectancy, as compared to Erikson's time, many people believe that middle adulthood or midlife now extends into the 70s and beyond).

With regard to existential issues, Erikson's 7th Stage of Psychosocial Development represents a time when people consider the meaning and purpose of their life and what they can contribute that will have a lasting impact and legacy beyond their life.

This stage can last years and it can bring much anxiety, referred to as Existential Anxiety, along the way, especially if people try to avoid or suppress these thoughts.

What is Existential Anxiety?

In the current article, I'm focusing on Existential Anxiety as a contributing factor to OCSB as discussed in Sex Therapist Dr. Daniel N. Watter's book, The Existential Importance of the Penis.

Existential Anxiety

Existential Anxiety is the dread or panic someone experiences when they confront the limitations of their existence, including death.

For instance, one example is someone who experiences Existential Anxiety in midlife when they realize they feel stifled in their current circumstances or they haven't accomplished the things they wanted to accomplish earlier in their life (see my articles: Midlife Transitions: Reassessing Your Life and Midlife Transitions: Living the Life You Want to Live).

To make matters worse, they might realize that, due to their age and other life stage circumstances, they won't achieve what they hoped for in their life.  This realization can precipitate Existential Anxiety and an emotional crisis.  Some people refer to this as a "midlife crisis." 

Part of grappling with Existential Anxiety is accepting that death is an inevitable part of life.  This acceptance can serve to enrich life by encouraging people to live a meaningful life in whatever time they have left.

How is Existential Anxiety Related to Out of Control Sexual Behavior (OCSB)?

I believe the vast majority of people get through the psychological challenges of midlife and resolve their Existential Anxiety--even if they struggle with it for a number of years.  

However, there are many people who go through a long and difficult time with this stage and, in an attempt to ward off their Existential Anxiety, they engage in out of control behavior, including Out of Control Sexual Behavior (OCSB).

According to Dr. Watter, Existential Anxiety, especially fear of death, often involve sexual thoughts and behavior because sex is experienced as a life force--the opposite of death.  As a result, Out of Control Sexual Behavior is often used a maladaptive way of coping by repressing or neutralizing these fears.

Other instances where OCSB can manifest is when someone reaches the age when a parent died.  For instance, when a married man reaches the age when his father died from a massive heart attack, he can experience such overwhelming anxiety that he attempts to suppress this fear by engaging in extramarital affairs (see the clinical vignette below).

According to Dr. Watter, this is often uncharacteristic behavior for this person who doesn't understand what's driving this sexual behavior.  

It's important to note that, Existential Anxiety, doesn't always lead to OCSB--even among people who increase their sexual behavior due to the anxiety.  Existential Anxiety can lead to increased sexual activity that's not always out of control.  

But for the purpose of this article, I'm focusing on OCSB and how Existential Anxiety contributes to it.  

Clinical Vignette: Existential Anxiety and Out of Control Sexual Behavior (OCSB)

The following clinical vignette illustrates how Existential Anxiety contributes to OCSB.  As always, this vignette is a composite of many different cases with all identifying information changed or removed to protect confidentiality.  

Jack

When Jack was 10 years old, his father died suddenly from a massive heart attack.  His father, who was only 40 years old, had hardly ever been sick in his life, so his sudden death was a shock to the whole family, especially to Jack, who was close to his father.

Early Loss and Trauma

After his father died, as a young boy, Jack would often worry that his own heartbeat was irregular and that he might die suddenly too.  He would ask his mother repeatedly to feel his heartbeat and she would assure him that he wasn't having a heart attack.  

During adolescence, Jack and his friends were preoccupied with girls, and his fears of death weren't as much a part of his awareness.  He went on to date, enter into relationships, and he eventually got married to Celia.

Jack often thought about his father throughout his life, but he was especially preoccupied with these thoughts as he approached his 40th birthday because this was his father's age when he died.

Several months before his 40th birthday, Jack became so anxious that he had difficulty sleeping through the night.  He had frequent nightmares about seeing his father in the distance and trying to overcome obstacles--crowds of people or other physical barriers--to get to his father, all to no avail. He often woke up shaking in terror and bathed in sweat.  

During that time, Jack was assigned to manage a project at work where his boss, Alan, asked him to mentor a junior employee, Tina.  Alan assigned Tina to be Jack's assistant on the project, which included a trip to California to visit the project's client. 

Tina was an attractive single woman in her early 30s who admired Jack and who was eager to learn. Until then, throughout his 10 year marriage, Jack had never been faithful to Celia.  He often had sexual fantasies about other women, but he never thought of actually having an affair with another woman.  He loved his wife and he was satisfied with their sex life.  

But spending a week at a California hotel with Tina, who made it known that she was sexually attracted to Jack, turned out to be too much of a temptation, and they began having a passionate affair which continued when they returned to New York.

Although Jack felt guilty about cheating on his wife and lying to her about his late nights, he couldn't remember a time when he felt more alive.  His fear of death and nightmares about his father subsided.  

Although the affair ended when Tina moved out of state, Jack sought out other younger women who would be willing to have sexual affairs. At the time, Jack had no awareness that his sexual affairs were related to his fear of death.  

A few months later, Jack was having multiple affairs with several women during the same time period. He was upfront with these women that he was only interested in having affairs and he had no intention of leaving his marriage because he loved his wife and son.  He justified his uncharacteristic behavior to himself by telling himself that what his wife didn't know wouldn't hurt her.  

A year later, Jack was involved with three simultaneous affairs. He didn't know any of these women well and he was unaware that one of them, Becky, was emotionally unstable.  Even though their agreement was just to enjoy sex with no strings attached, Becky became emotionally attached to Jack. 

In a desperate and misguided attempt to have Jack to herself, Becky contacted Celia and told her about the affair.  Becky hoped that, by revealing the affair, Jack's wife would leave him and then he would be available to her.  

Celia was shocked and devastated by Becky's call. When Celia confronted Jack about Becky's call, he admitted that he was having multiple affairs and he was deeply upset that he hurt Celia.

During the two weeks when he stayed at a hotel at Celia's insistence, Jack had time to think about his infidelity and how it might cost him his marriage (see my article: Why Do People in Happy Relationships Cheat?).

While he was at the hotel, he ended all his affairs, including his affair with Becky.  She tried to manipulate him into continuing the affair with her by threatening to commit suicide. But although her threats frightened and angered him, Jack refused to allow her to manipulate him.

When Celia allowed Jack to come home, she told him that, although she was very hurt and she didn't know if she could trust him, she felt she had invested too much emotionally in their life to end the marriage.  So, she said she would be willing to work on their relationship if he was willing to attend couples therapy (see my article: What is Emotionally Focused Therapy For Couples?).

Couples Therapy For OCSB

Their couples therapist recommended that Jack also attend sex therapy to deal with his Out of Control Sexual Behavior (see my article:  What is Sex Therapy?).

Over time, he realized in sex therapy that he never overcame the loss of his father and, as he approached the same age as when his father died, his Existential Anxiety contributed to his OCSB.

His sex therapist was also a trauma therapist so, over time, Jack worked through the unresolved trauma of his father's death and his related existential fears about his own death.  

Gradually, as Jack worked through his early loss, he no longer felt the urge to ward off his existential fears of death by having extramarital sex.  He and Celia also gradually reconciled their marriage in couples therapy.

Conclusion

Out of Control Sexual Behavior (OCSB) can have many different contributing factors so there is no one-size-fits therapeutic approach.

An important component to overcoming OCSB is to understand the underlying issues, which are often unconscious, as in the vignette above about Jack.

Although the vignette is about a heterosexual man and OCSB is often associated with men, OCSB can occur with heterosexual women or in the LGBTQ population.

Unresolved trauma often leads to compulsive behavior due to the overwhelming anxiety involved.  This is true even for people who wouldn't normally engage in sexually compulsive behavior but who seek comfort in the sense of aliveness or distraction they experience in sexual affairs.

Understanding the underlying reasons for OCSB in no way condones it but, along with sex therapy, it's a positive step in changing this behavior.

Getting Help in Therapy

Out of Control Sexual Behavior is difficult to change on your own.

Rather than struggling on your own, seek help.

Individuals and couples attend sex therapy.

A skilled sex therapist who is also a trauma therapist can help you to overcome OCSB so you can lead a more fulfilling life.

About Me

I am a New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: What Are the Most Common Misconceptions About Sex Therapy).

In addition to being a Sex Therapist, I am also a Trauma Therapist (see my article: What is a Trauma Therapist?).

I work with individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

What Causes Out of Control Sexual Behavior?

Is Compulsive Sexual Behavior a "Sexual Addiction" or "Out of Control Sexual Behavior"?

The topic of compulsive sexual behavior (also known as hypersexuality) is a controversial topic in the mental health field because there are opposing views as to how to define it, what causes it and how to treat it. 

Treating Out of Control Sexual Behavior in Individual Sex Therapy

Some mental health experts believe compulsive sexual behavior is a sexual addiction and others see it as out of control sexual behavior (see my article: Treating Sexual Compulsivity: Is It a Sexual Addiction or Out of Control Behavior?).

As I mentioned in my previous article, language matters, especially in the mental health field.  

In the interest of being transparent about my professional views as a sex therapist who is sex positive, I want to emphasize that I do not see compulsive sexual behavior as an addiction, and I believe psychotherapists and other healthcare practitioners do clients a disservice by labeling it as an addiction.  

In my professional opinion (and the opinion of many contemporary sexual therapists in the field), not only is labeling sexual compulsivity as an addiction harsh and shame-inducing, it's also counterproductive in terms of treating it.  

Unlike alcohol and drug misuse, people who engage in compulsive sexuality can't be expected to give up sex.  Rather than pathologizing compulsive sexual behavior, a sexual health approach is more effective when a sex therapist looks for the underlying issues for each individual rather than taking a one-size-fits-all cookie-cutter approach that is often found in sexual addiction treatment.

The main proponents of the Out of Control Sexual Behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT who wrote Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.  

Instead of viewing this behavior as an addiction, they see it as sexual behavior that is out of control.  In their view it's a sexual problem but not a sexual disorder or an illness.  This is an important distinction between the OCSB and the sexual addiction approaches.

Other proponents of the OCSB view, like Dr. Neil Cannon, see sexual compulsivity as being related to unresolved trauma, unresolved mental health issues, relationship issues and problematic habits.

Out of Control Sexual Behavior (OCSB) and Problems With Self Regulation

The Out of Control Sexual Behavior perspective is a newer concept as compared to the sexual addiction model.  

The term OCSB, as defined by Braun-Harvey and Vigorito, refers to problems with self regulation of consensual sexual thoughts, urges and behavior despite negative consequences where the thoughts, urges and behavior feel out of control to the individual (the emphasis on "consensual" means that the OCSB model isn't meant for nonconsensual urges which lead to criminal behavior, like sexual assault or rape, which is treated by specialists in the mental health field who work with offenders).

OCSB focuses on hard to control sexual thoughts, urges and behavior rather than seeing the problem as a diagnosis or clinical disorder.  When someone engages in OCSB, they find it difficult to stop when they try to stop.  

Assuming that the sexual behavior is consensual, feeling out of control doesn't necessarily mean that an individual is out of control.  It's a subjective experience, so what feels out of control can mean different things to different clients.  This means that clinicians need to explore how each client experiences their sexuality.

What's the Difference Between Enjoying Sex and Out of Control Sexual Behavior (OCSB)?

Sex between consenting adults is a normal part of adult life among people who enjoy sex. Consensual sex is meant to be an enjoyable and pleasurable part of life.  

Out of Control Sexual Behavior, on the other hand, isn't about pleasurable sex. It's also not determined solely by sexual frequency because many people have pleasurable and frequent consensual sex which isn't problematic.  

OCSB involves repetitive thoughts, urges or behavior that create negative consequences including (but not limited to):

• Friction or conflict in a relationship, including the demise of a relationship due to infidelity (see my article: Why Do People in Happy Relationships Cheat?)

Treating Out of Control Sexual Behavior in Sex Therapy For Couples

• An excessive preoccupation with sex that interferes with daily activities, including work, studying and other activities

• Sexually inappropriate behavior on the job or in other areas of life, including sexual harassment or predatory behavior

What Causes Out of Control Sexual Behavior?

The causes of OCSB are not well understood and the sex therapy field could benefit from more research in this area.

Here are some of the current day hypotheses about what causes OCSB:

    OCSB and Attention Deficit Hyperactivity Disorder

Many mental health experts believe there is a correlation between OCSB and Attention Deficit Hyperactivity Disorder (ADHD).  

However, this doesn't apply across the board to everyone with ADHD. 

Some people with ADHD experience hypersexuality, which is a very high sex drive and others experience hyposexuality, which is a very low sex drive or lack of interest in sex.  

Both hypersexuality and hyposexuality can cause problems in a relationship.  

Hypersexuality related to ADHD can also cause problems with 

• Impulsive and compulsive sex 
• Risky sexual behavior
• Unprotected sex
• Unwanted pregnancy
• Cheating on partners in both monogamous and consensually nonmonogamous relationships
• Other related problems

It has been hypnothesized that the connection between OCSB and ADHD can be linked to:

• A Need For Stimulation: Some people with ADHD have a strong need for stimulation which can lead to excessive urges for new and exciting sexual activities that lead to higher stimulation.

• A Propensity For Risky Behavior: ADHD can involve an increased risk of sexually compulsive behavior as well as substance abuse.

• Escapism: People with ADHD often use sex as a form of self-regulating behavior to escape or self-medicate for stress and anxiety.

A comprehensive psychological assessment by a psychologist or a knowledgeable psychiatrist is necessary to either diagnosis ADHD or rule it out.

Currently, children who exhibit ADHD symptoms can be evaluated through their school psychologist and treated accordingly.

However, many adults with ADHD were not diagnosed when they were children because ADHD was either unrecognized or not understood, so many individuals with adult ADHD need to seek out their own assessment, diagnosis and treatment by ADHD mental health professionals.

    OCSB and Mood Disorders: Anxiety and Depression

Although many people with ADHD suffer with OCSB, not all OCSB involves ADHD.

Many people with anxiety or depression have problems managing their emotions, and they engage in hypersexuality as an attempt to regulate their emotions (see my article: Developing Skills to Manage Your Emotions).

They engage in hypersexuality as a way to seek temporary relief from their depressive or anxiety-related symptoms.  In those cases, what appears to be a sexual craving is often a maladaptive way of coping.

Hypersexuality can relieve symptoms related to the mood disorder, but since it only provides temporary relief, individuals with mood disorders will feel the urge to  be hypersexual again when their symptoms of anxiety or depression re-emerge.

    OCSB and Existential Anxiety

Existential anxiety is a dread or panic when an individual confronts the limitations of their existence.

Out of Control Sexual Behavior and Fear of Aging and Death

Dr. Daniel N. Watter, an existential psychologist and sex therapist, writes eloquently about the connection between men with existential anxiety and Out of Control Sexual Behavior in his book, The Existential Importance of the Penis.

Among other topics, Dr. Watter discusses how a fear of aging and death can precipitate uncharacteristic out of control sexual behavior among men.

Existential anxiety and Out of Control Sexual Behavior will be the topic of my next article.

Getting Help in Sex Therapy

Out to Control Sexual Behavior is treated in sex therapy because most other mental health professionals have no training or expertise in OCSB (see my article:  What is Sex Therapy?).

Sex Therapy is talk therapy. There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are the Most Common Misconceptions About Sex Therapy?).

Fear, shame and guilt often prevent people from getting help in sex therapy.  This is one reason why it's important to choose a sex therapist who has a sexual health perspective instead of an addiction or illness perspective.  

Understanding the unconscious underlying reasons for OCSB is key to achieving sexual health.

Whether the underlying issues involve anxiety, depression, ADHD, trauma, existential dread or other issues, once the underlying issues are discovered, a skilled sex therapist can help you to resolve these issues so you can have a pleasurable sex life without feeling out of control.

If you believe you're suffering with OCSB, seek help from a licensed mental health professional who is a sex therapist.

Taking the first step of contacting a sex therapist is often the most challenging, but it can also bring you a step closer to feeling in control and having a pleasurable sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Treating Sexual Compulsivity in Sex Therapy - Is It a Sexual Addiction or Out of Control Sexual Behavior (OCSB)?

Language matters, especially in the field of mental health.  When mental health professionals pathologize compulsive sexual behavior by defining it as a "sexual addiction," they do clients a disservice.  

This article will focus on the difference between treating sexual compulsivity as out of control sexual behavior (OCSB) as defined by Doug Braun-Harvey, LMFT and Michael A. Vigorito, LMFT in their book Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and treating the problem as a "sexual addiction," as in the work of Dr. Patrick Carnes (see my article: What is Sexual Health?).

Treating Sexual Compulsivity in Sex Therapy

What is Sexually Compulsive Behavior?

Let's start by defining sexually compulsive behavior.

Sexually compulsive behavior is an excessive preoccupation with sexual thoughts, urges and behavior where this behavior is disruptive and has a significant negative impact on a person's health, relationships, work and other important areas of life, including (but not limited to) the following issues:

• Recurrent sexual thoughts, urges and behaviors take up a lot of your time.

• These thoughts, urges and behaviors feel out of control to you.

• Despite repeated attempts, you have been unable to reduce or control these thoughts, urges and behavior on your own.

• Despite serious consequences, you continue to engage in out of control sexual thoughts, urges and behavior.

• You have problems establishing and maintaining relationships, jobs or other important areas in your life because of your sexually compulsive behavior.

Sexual Addiction vs Out of Control Sexual Behavior (OCSB)

As of this writing, there is a heated debate in the mental health field about whether sexually compulsive behavior should be seen as a sexual addiction or as out of control sexual behavior (OCSB).

Treating Out of Control Sexual Behavior in Sex Therapy

Proponents of the sexual addiction perspective see compulsive sexual behavior as similar to other forms of addiction, including alcoholism and drug addiction.  In this model people who engage in compulsive sex are seen as "powerless" over their behavior.  Dr. Patrick Carnes, who has written extensively about "sexual addiction" is one of the biggest proponents of this view.

The main proponents of the out of control sexual behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT.  They define six principles of sexual health in their book, Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.  Instead of viewing this behavior as an addiction, they see it as sexual behavior that is out of control.  In their view it is a sexual problem but not a sexual disorder or an illness.

Treating Out of Control Sexual Behavior in Sex Therapy

Other proponents of the OCSB view, like Dr. Neil Cannon, see sexual compulsivity as being related to unresolved trauma, unresolved mental health issues, relationship issues and problematic habits.

Treating Out of Control Sexual Behavior in Sex Therapy

OCSB is not a diagnostic term.  The term OCSB refers to problems with self regulation of sexual thoughts, urges and behavior despite negative consequences.

Why Does It Matter How Compulsive Sexual Behavior is Labeled?

In my opinion (and the opinion of many others in the sex therapy field), labeling someone who engages in compulsive sexual behavior as an "addict" is harsh and shame inducing.  

Treating Out of Control Sexual Behavior in Sex Therapy

People who are labeled in such a shame-inducing way are often too embarrassed to admit they have a problem or to get professional help.

Unlike drug and alcohol misuse, people who engage in sexually compulsive behavior cannot be expected to give up having sex so labeling behavior as a sexual addiction is counterproductive to resolving the problem.

Getting Help For Sexually Compulsive Behavior

If you are struggling with sexual compulsivity, you're not alone.  Help is available to you.

Depending upon the particular circumstances, sexually compulsive behavior can be treated in individual sex therapy or in couples therapy with a sex therapist.

Working with a sex positive sex therapist who treats sexual compulsivity as out of control sexual behavior (OCSB) rather than as an addiction is affirming to your sexual health and overall well-being.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples (see my article: What is Sex Therapy?).

I have helped many clients to overcome psychological trauma (see my article: What is Trauma Therapy?

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Sexually Compulsive Behavior as a Split Off Part of the Self

Sexually compulsive behavior often involves a split off part of the self that feels like a "not me" part (see my articles:  Overcoming Sexual Addiction in Therapy, Overcoming Internet and Porn Addiction, Sexual Addiction: Is a Compulsion For Viewing Internet Porn Ruining Your Marriage?, Infidelity: Married, Bored and Cheating Online, Infidelity on Social Media Sites, The Counterphobic Defense and Hypersexuality and Rationalization as a Form of Denial and Self Deception).  Often, although not always, that part is the result of an emotionally traumatic history.

Sexually Compulsive Behavior as a Split Off Part of the Self

People, who engage in sexually compulsive behavior, usually seek help in psychotherapy after there have been consequences for their behavior:  a spouse discovers multiple affairs, an employer confronts an employee about viewing online pornography at work, and so on.

Needless to say, there is usually a great deal of shame involved once a spouse or an employer confronts this type of behavior.  Combined with the fact that most people, including spouses and employers, don't understand sexually compulsive behavior and see it as a "moral failing," this just adds to the shame and makes it difficult for people to get help in therapy.

Prior to facing consequences and getting help, people who engage in sexually compulsive behavior often have little awareness of what triggers their behavior or the underlying psychological issues.

In therapy, people with sexual compulsions will often describe their behavior as feeling "split off" or separate from how they see themselves (see my article: Understanding the Different Parts of Yourself That Make You Who You Are and Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?).

For the purposes of this article, when I refer to a "split off" part from the self, I'm not referring to multiple personality disorder (now called Dissociative Identity Disorder or DID), although there are people with DID who are sexually compulsive.

To clarify, it's important to understand that dissociation occurs on a wide spectrum with DID occurring at the far end of the spectrum and more common forms of dissociation, like daydreaming, which we all do, as occurring on the other end.  There are some forms of dissociation which are actually helpful (see my article: How Compartmentalization Can Be Used as a Healthy Short Term Coping Strategy).

Between a common form of dissociation, like daydreaming and the other end of the spectrum of DID, there's everything in between.  So, the type of "split off" that I'm referring to is on the spectrum--far less than DID but more than just simple daydreaming.

To varying degrees, everyone has some split off parts that are just outside of their awareness and not considered a major problem. It's a matter of degree.

One of the goals of any psychotherapy is to help clients to become more psychologically integrated in order to bring split off parts into awareness.  The more psychologically integrated a person is, the healthier he or she is.

To simplify matters in the fictionalized vignette below, I discuss a fictionalized male client; however, women also engage in sexually compulsive behavior.

Ken
Ken began therapy after his wife discovered that he was watching pornography compulsively at night and contacting women online for sexually explicit discussions after his wife went to sleep.  Based on the computer browser history, she could see that this was a regular activity for Ken.

Sexually Compulsive Behavior as a Split Off Part of the Self

Prior to this discovery, his wife thought that Ken wasn't interested in sex because they had not had sex in many months.  But after she discovered Ken's online activity, she felt very upset, hurt and betrayed by him.  She gave him an ultimatum:  Get help or she would leave him.

When Ken came for his first therapy session, it was evident that he was very ashamed of his behavior.  He could barely look the therapist in the eye, and he had a lot of difficulty communicating why he was seeking help.  After several false starts, he told the therapist that he was there because his wife gave him the ultimatum and, after 20 years of marriage, he didn't want to lose his wife.

During the early phase of therapy, Ken rationalized his behavior by saying that he didn't see anything wrong with looking at pornography online or contacting women he didn't know for "harmless flirtation."  He said that these women lived in other parts of the country and he had no intention of ever meeting up with them, so he didn't see it as cheating on his wife.

As part of his early history, Ken revealed to his therapist that he began secretly looking at his father's Playboy magazines when he was nine years old and left alone at home while his parents went out.  He remembered the first time that he looked at the pictures of naked women in sexually provocative poses and how thrilling it was for him to secretly masturbate while fantasizing about these women.

As he continued to reveal his early history, he told his therapist that his parents often left him alone and, as an only child, he was lonely.  From other details that he revealed, his therapist realized that Ken wasn't just left alone a lot--he was emotionally neglected by his parents (see my articles:  What is Childhood Emotional Neglect? and What is the Connection Between Childhood Emotional Neglect and Problems Later on in Adult Relationships? and Growing Up Feeling Invisible and Emotionally Invalidated).

Fantasizing about the women in the magazine and imagining that he was with them made Ken feel less alone when his parents were out.  It was soothing to him, and he continued to look at porn from that time on with the same effect of feeling comforted and less alone.

Ken never revealed to his wife that he liked to look at pornography.  For him, it was a secret activity that belonged only to him, and he never discussed it with anyone.  He also assumed that his wife wouldn't understand and, based on her reaction, his fears were confirmed.

He somewhat resented that his wife was giving him this ultimatum to get help and he felt she was being unreasonable, "Why can't she just leave me alone about this?  I'm not hurting anyone."

Due to Ken's level of denial about his problems and the effect it had on his marriage, his therapist knew that he would probably leave therapy if she confronted him directly (see my article: When Clients Leave Therapy Prematurely and Clients Struggling With Shame Can Leave Therapy Abruptly).

Instead, initially, she took a more empathic approach and remained close to Ken's emotional experience and, at times, she made observations that she thought he could tolerate.

Although Ken stopped looking at pornography and contacting women at home, he didn't tell his therapist or wife that he used his computer at work to continue engaging in sexually compulsive behavior (although, at that point, he didn't see it as being sexually compulsive).  Ken rationalized to himself that he worked for a very large company with thousands of employees, so he didn't think he would get caught by the IT department.

But a few months later, Ken was called into his supervisor's office where his supervisor and the Human Resources director were waiting for him.  His supervisor told him that the IT department detected that Ken was looking at pornography online and this is against company policy.

He gave Ken a warning memorandum that this behavior wouldn't be tolerated and any other infractions against the company policy could result in termination.  He also recommended that Ken get psychological help.

Ken felt deeply mortified.  He tried to tell his supervisor that someone else might have gone on his computer while he was away from his office, but neither his supervisor or the HR director believed him.  They told him to take the rest of the day off.

Although he felt humiliated about what happened at work, Ken told his therapist about it.  He acknowledged that he had been keeping this a secret from her because he wanted to continue to look at porn and he really didn't see it as a problem.

But as his therapist reflected back to him the consequences of his behavior, Ken acknowledged that he was placing his marriage and career in jeopardy.  This was the first time that Ken didn't try to hide behind his usual rationalizations.

At that point, instead of feeling like he was being forced to come to therapy to appease his wife, Ken became internally motivated to understand and overcome his behavior.  He also agreed to attend a 12 Step program for sexually compulsive individuals and to get a sponsor in that program.

Once Ken became internally motivated, the work in therapy progressed.  His therapist talked to him about cross addiction so that Ken would understand that it was not unusual for people who were trying to overcome a particular addiction to form another addiction as a way to self soothe.

His therapist helped Ken to understand the various aspects that made him who he is, including the split off parts.  This is called Parts work or Ego States work.

Ken and his therapist worked on the underlying issues that triggered his sexual addiction, including loneliness and boredom (Coping With Addiction: Boredom as a Relapse Trigger).

They also did trauma work on early childhood issues related to emotional neglect.

After Ken began making progress in therapy and he was abstinent for six months, he and his wife were ready to attend couples therapy to repair their marriage.

Conclusion
With the advent of the Internet, compulsive sexual behavior has increased dramatically.

This behavior is usually difficult to overcome on your own.

The underlying roots of the problem are often (although not always) related to early childhood trauma.

Similar to any other form addiction, denial plays a significant role because it's usually too painful to acknowledge the problem.

Shame often keeps people who need help from ever seeking help.  They attempt to resolve the problem on their own but, like other forms of addiction, sexually compulsive behavior is progressive if people don't get professional help.

Although many people start therapy because they've been given an ultimatum by a spouse or an employer, the success of treatment is usually predicated on clients become internally motivated.

The work in therapy includes helping clients to develop the internal resources to remain abstinent and to deal with underlying issues, coping mechanisms to deal with triggers, and trauma work to resolve unresolved emotional trauma.

Clients, who have problems with sexually compulsive behavior, need psychoeducation from their psychotherapists about cross addiction so that they don't stop one addiction and revert to another one (i.e., stop watching pornography compulsively online and start another form of addiction like compulsive gambling, drinking excessively, abusing drugs, etc).

Getting Help in Therapy
Although people who engage in sexually compulsive behavior often feel alone and deeply ashamed of their behavior, the best chance of their overcoming these problems is to get help in therapy with a licensed mental health professional who specializes in this area.

Rather than suffering alone, if you've been unable to overcome your problems on your own, you could benefit from the help of a licensed psychotherapist.

Aside from overcoming your addictive behavior, attending therapy can help you to grow and lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during regular business hours or email me.