Treating Sex Addiction
By Dr. Randi Fredricks, Ph.D.
Treatment for sex addiction is most likely to be effective when it emerges from an integrated approach that brings
together a range of therapeutic modalities, is individually tailored and evolves as the patient progresses.
The most effective approach to treatment employs the theory that sex addiction represents an expression through sexual behavior of the addictive process: an enduring, inordinately strong
tendency to engage in some form of pleasure-producing behavior as a means of regulating affects or self-states that
are painful and potentially overwhelming due to impaired self-regulation. Consequently, treatment for sexual addiction
should address both the addictive sexual behavior and the underlying addictive process.
Addictive sexual behavior is addressed through behavioral symptom management, which consists primarily of relapse
prevention and other cognitive-behavioral techniques. Meanwhile, the addictive process is addressed primarily through
psychodynamic psychotherapy, therapeutic groups and psychiatric pharmacotherapy. Relapse prevention strategies help
individuals who use sexual behavior addictively to recognize factors and situations that are associated with an increased
risk of acting out sexually, to cope more effectively with sexual urges, to recover rapidly from episodes of symptomatic
behavior and to use such "slips" as opportunities to learn about how their recovery plans can be improved.
Relapse prevention conceptualizes urges to engage in addictive sexual behavior as signals of disruptive affect states, for
which the addict needs to develop healthier, more adaptive management. In thus shifting the focus from controlling the
behavior to understanding the affects, relapse prevention provides a natural bridge from behavior management to
psychodynamic psychotherapy.
Cognitive-behavioral techniques other than relapse prevention comprise directive, didactic procedures that focus not
on symptomatic sexual behavior, but on other aspects of a person's life that predispose him or her to rely on symptomatic behavior to cope with distressful affects and unmet needs. Applicable cognitive-behavioral techniques may be divided into two groups: skills training, which helps patients to learn thoughts and behaviors that will result in more effective management of their affects and meeting of their needs (e.g., anger management, assertiveness training); and lifestyle regeneration, which helps patients learn to achieve and maintain a healthy, balanced lifestyle.
The primary goals of psychodynamic psychotherapy in the treatment of sexual addiction are to enhance individuals' self-regulation and to foster their capacity for meaningful interpersonal connections. The fabric of psychodynamic psychotherapy is woven from three strands: understanding, integration and internalization.
Three Strands of Psychodynamics
Understanding focuses on the relationship between addictive sexual behavior and impaired self-regulation. When we understand that addictive behaviors typically are patients' attempts to regulate their affective states, which threaten to overwhelm them because their built-in regulation systems are impaired, our focus shifts from behavior to affect. Affects then guide our explorations: What affects are emerging? What events triggered the affects? What core beliefs, inner conflicts and personal history are involved?
Integration refers to the patient's personality. Automatically, without conscious intent or awareness, we engage in a variety of mental processes that function to protect us from emotional trauma. Most of these self-protective processes can be understood as ways of keeping out of our awareness material that we unconsciously imagine would be overwhelmingly painful or dangerous if we were to become aware of it.
The cornerstone of integration in psychotherapy is the fostering of patients' awareness of such material: their affects, needs, wishes, fears, inner conflicts, core beliefs and automatic ways of protecting themselves from emotional pain. Psychotherapeutic work tends to be most effective when it addresses issues in the here-and-now. In psychotherapy, the most here-and-now issues are those that concern the relationship between the patient and the therapist. Hence, these often are the most productive issues to address.
As a significant relationship develops between the patient and the therapist, the patient's basic inner models become activated, and the psychological factors that influence the patient's other significant relationships begin to affect how the patient perceives, experiences and acts toward the therapist. The therapeutic relationship then provides a safe environment in which the patient and the therapist together can explore the patient's basic inner models in "real time."
Bringing together in consciousness the various disintegrated aspects of a person's psychic processes gradually heals the personality and enables it increasingly to function as an integrated whole. The result is more conscious choice, more flexibility and more freedom.
Internalization is the process through which the self-regulation system-the built-in system that regulates our affects and sense of self-develops in early life. Through interactions between the maturing child and his or her responsive caregivers, regulatory functions that had been provided for the child by the caregivers gradually become integrated into the child's autonomous functional system. The capacity for such developmental internalization is greatest during early childhood, but it continues throughout life.
The function of internalization in psychotherapy derives from its role in the development of self-regulation. A primary means by which psychotherapy promotes the healing of impaired self-regulation is by providing new opportunities for patients to internalize self-regulatory functions that were not adequately internalized during childhood.
Therapeutic groups, including 12-step groups, can facilitate the development of abilities to make meaningful connections with others and to turn to people in times of need instead of turning to addictive behavior. Some therapeutic processes may be more likely to occur in groups than in individual psychotherapy.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
Book, P. (1997). Sex & love addiction, Treatment & recovery. New York: Lucerne Publishing.
Carnes, P. (1997). Don’t call it love. Minneapolis: Gentle Press.
Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis: CompCare.
Hyman, S. E. (1996). Shaking out the cause of addiction. Science, 273, 611-612.
Knauer, S. (2002). Recovering from sexual abuse, addictions, & compulsive behaviors. New York: Haworth Press.
Levine, M. P., & Troiden, R. R. (1988). The myth of sexual compulsivity. Journal of Sex Research, 25, 347-363.
Peele, S. (1998). The meaning of addiction. San Francisco: Jossey-Bass.
Peele, S., & Brodsky, A. (1991). Love and addiction. New York: Signet.
Peele, S., & Brodsky, A., & Arnold, M. (1991). The truth about addiction and recovery. New York: Simon & Schuster.
Silverman, S. (2001). Love sick. New York: Norton & Company.
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