Traditional Treatments for Sexual Addictions

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1 Steven Donaldson, M.A., L.P.C Sexual compulsions don't have to rule your life. I can help. Please enjoy this article and then give me a call. You can break free. Traditional Treatments for Sexual Addictions 2010 by Steven Donaldson. All rights reserved How have sexual addictions traditionally been treated? Sexual addictions tend to be very persistent and have been considered highly treatment resistive by many mental health professionals. I personally have known many men who have struggled mightily against a sexual addiction they did not like or want for many years. They've tried accountability groups, individual psychotherapy, psychotherapy groups and 12-Step programs all without success. Some have even gone to very expensive residential treatment centers and still find themselves in the struggle of their lives against their compulsion. There are two possibilities here. One is that sexual addictions are so treatment resistant that there are few successes and that sometimes even the best efforts fail. The second possibility is that sexual addictions are poorly understood and that treatment professionals are poorly equipped to treat them. I am convinced that the second reason explains why sexual addiction are perceived as hard to treat. They involve deep psychological systems that are poorly understood; therefore treatment professionals are poorly equipped to treat them. Sexual addictions have only recently been identified as a mental disorder and science on the subject is sorely lacking. Any time science lacks in a psychological field of study, treatment comes to be dominated by the best marketers but not necessarily the best treatment. Outcome research is also lacking in this field, making it difficult to tell which treatments are effective and for whom. In this section I will briefly review the various treatments and talk about my experience of the pros and cons of each one. Could a 12 Step program be right for you? 12 Step programs for sexual addiction are based on the 12 Steps of Alcoholics Anonymous (A. A.). How did this program arise? In the late 1940s and early 1950s, psychiatry was essentially unable to treat alcohol addiction. Many professionals did not believe there was such a thing as alcoholism, and that alcoholics were simply people who liked to drink and made excuses for their behavior. Essentially, they considered alcoholism a character problem and not a medical or psychological problem. Many alcoholics who had sought treatment spent years in therapy unsuccessfully trying to stop drinking. Although there were treatment successes, treatment failure was the rule and no scientific research had been conducted to address the causes or treatment of alcoholism. It was at this point in history that the 12-Steps of Alcoholics Anonymous emerged onto the scene. People mostly men because of the mistaken belief that primarily men suffered from alcoholism began to find the answer to their addiction. The program of A.A. not only was an answer for many but, because it was cheap and

2 accessible, was the only practical answer for most alcoholics. The popularity and spread of A.A. is a testament to its success. Today A.A. can be found in almost any community around the world. In fact the program's success was so phenomenal that psychiatry incorporated the concepts of A.A. and today almost all methods of treating alcohol and drug addiction are based on the 12 Steps. Since that time, the 12 Steps have been applied to almost every compulsive disorder from sex offenders to gamblers to overeaters. In reality A.A. is not only a major contributor to the field of addictions but the primary contributor. This raises an important question: can the A. A. Model be successfully applied to sexual addiction? Let's take a closer look at how it works. There are four well organized 12 Step programs that are widely available for people seeking help with sexual addictions. There are S.A. (Sexoholics Anonymous), S.C.A. (Sexual Compulsives Anonymous), S.A.A. (Sex Addicts Anonymous) and S.L.A.A. (Sex and Love Addicts Anonymous). While there are a number of differences between these programs, the thing that is essential to all of them is that they utilize the 12 Steps of A.A. to achieve "sobriety" from sexual addiction. Following are the 12-Steps of S.A. In fact much of the language in their literature is copied almost verbatim from A. A. literature, simply replacing "lust", "sex" and "sexaholic" for "alcohol" and "alcoholic." Here are the 12 Steps used by Sexaholics Anonymous: 1. We admitted that we were powerless over lust -- that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10.Continued to take personal inventory and when we were wrong, promptly admitted it. 11.Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12.Having had a spiritual awakening as the result of these Steps, we tried to carry this message to sexaholics, and to practice these principles in all our affairs. To be sure, the sentiment of these Steps cannot be faulted. And, when looking at the record of success behind A. A., it is difficult to say anything negative about the 12 Steps especially because of the reverence that so many people hold for them. Hundreds of thousands of people would testify that they owe their life and their sanity the A. A. I do not wish to offend anyone yet I do want to share my experience with regard to the treatment of sexual addictions. I believe 12 Step programs are the most practical way for most sexually addicted men to deal with their sexual compulsion. This is certainly true for people who cannot afford or do not have access to effective psychological treatment. (The unfortunate truth is that there is little good treatment available because the science is so young and there simply is not enough good writing and training on the subject to adequately prepare treatment professionals.) In addition, 12 Step programs are probably the best option for men who do not have the ego strength to handle the intensive work required to alter deep psychological structures. Most sexually addicted men do have enough ego strength but there are some

3 who have other psychological problems that make them too fragile for intensive depth psychotherapy. The positive aspects of 12 Step treatment for sexual addictions are multiple. Programs like S.A. and S.A.A. are well established and accessible to almost anyone anywhere. When a person enters a meeting they are immediately welcome and are given clear instructions about what to do next. There is ample reading material, meetings, events and people with whom they can connect. Being with a group of people who have a similar problem has a powerful shame reducing effect. Members do not feel so alone. Those who are successfully dealing with their problem instill a sense of hope as they share their experience with the group. One also has a list of people he can call and talk to when he is feeling tempted to act out. This habit of reaching out to a person rather than their drug (sexual stimulation) is powerful and good treatment. For members who utilize this system well, they begin to make a connection between their sexual impulses and their emotional states. In my opinion this is the most powerful healing effect of 12 Step programs. There are, however, some difficulties with 12 Step programs as well. Probably the most important is their treatment failures. Most members of these programs are not able to achieve quick or last relief from their addiction. This is especially true for men who do not seek therapy in addition to their 12 Step program. And when that happens, they face the same problem with treatment failures that most spiritual and psychological programs do: the program blames the patient. For those people who are not able to achieve sobriety it is implied that they are not trying hard enough or following the program closely enough or that they simply are not motivated. In some instances this is true but most often it is not and it makes the poor addict feel worse than ever. Since sexual addicted men almost always have a deep sense of shame, they are more than willing to accept this explanation even when it is not true. Another aspect that I consider negative is that most members of the program consider it a life-time program. The common phrase is, "Once and addict, always an addict." In reality this statement is probably true for those who use shaming or repressive technique to battle their addiction. And for people that are unable to change the underlying psychological structures that create and fuel a sexual addiction, a lifetime program is probably necessary. Participants in 12 Step program don't merely gain membership they acquire a new identity. They see themselves and each other, not as men with sexual addictions, but, rather, Sex Addicts, or Sexaholics. The identity principle is constantly reinforced. Whenever members speak in group they begin by saying, "Hi, I'm Steve and I'm a Sexaholic." The purpose of this identity is to break the denial that is strongly associated with addictions and to create a sense of humility and dependence on their Higher Power for help and sanity. Although I understand the reason, I personally do not believe that taking on a life-time identity, especially a negative one, is the best solution for everyone. This is particularly true for men with very powerful shame who are not able to use this identification as literally nothing to be ashamed of. This an important area of distinction between alcohol and sexual addiction. Alcoholics spend their lives denying that they have a problem; labeling themselves as such is potent reminder that they have an addiction. By contrast, those who deal with sexual compulsivity need no such reminder. The vast majority of them are painfully, shamefully aware of their problem. I have worked with a number of men who had ego fragilities that experienced intense shame and were not able to make the 12 Step program work for them. For them, the Sexaholic identification only intensified the shame, further driving the addiction.

4 Further I believe that one of the reasons denial is so intense for sexually addicted men is that safe, effective, confidential and private treatment is not widely available. When most men think about going into treatment for a sexual addiction they imagine having to sit in a group and expose their most embarrassing secrets in utter humiliation. In reality this is not far from the truth. Many current treatment programs do practice these humiliating rituals. 12 Step groups are not generally too interested in the gory details of people's sexual exploits (which they call war stories) but this is the image that comes to mind for most men considering treatment. I believe that if more attractive options were available denial would not be the problem that it currently is. In summary, 12 Step programs are the most important event in the history of treating addictions of any sort. There are many powerful and important features of these groups that are powerfully healing for people who struggle with compulsive disorders and are probably the most practical and accessible means of treatment for most sexually addicted men. Unfortunately, 12 Step programs are not universally successful for all sexually addicted people and usually not effective without additional psychological help. In addition most members view it as a lifetime commitment and an identity which may not be the best treatment option for everyone. Individual psychotherapy There is very little direct literature on the subject of psychotherapy that specifically addresses the subject of sexual addictions. Psychotherapists, however, have treated sexual addictions for as long as psychotherapy has existed. Sexual acting out is really no different than any other form of acting out. When people are deeply depressed (whether they are aware of it or not) they convert internal unacceptable and forbidden feelings to external behavior that symbolize and yet deny their internal feeling states. The very roots of psychotherapy have been aimed at helping people integrate split off thoughts and feels that are experienced as unacceptable. Today the field of psychotherapy is very diverse in both theory and practice. Because sexual acting out and sexual addictions are so common, it is safe to assume that all forms of therapy have been applied to sexual addictions. Unfortunately, little, if any, good outcome research has been produced that would track the success or failure of specific types of therapy applied to sexual addiction. There certainly are many treatment successes using traditional forms of psychotherapy. Colleagues have told me about them and we see them in our clinic commonly. On the other hand, I have also seen many men in my practice who have told me that they have spent years in psychotherapy and have not been able to overcome their addiction. Obviously, some approaches work better than others. I have been able to help most of those so-called "failed cases" who have come to me and have my ideas as to what was missing in their therapy; I talk about that in the chapter "Why Treatment Doesn't Work." I certainly recommend that sexually addicted men find a good therapist. The research available clearly demonstrates that most men who are successful in overcoming sexual addiction utilize therapy as at least one form of their program. Because the nature of psychotherapy, that it is both a science and an art, finding a good therapist can be difficult. For some tips on finding a good therapist, visit my clinic's website, Although some would likely disagree, I personally recommend psychodynamic therapists over cognitive behavioral therapists. The reason for this is because I believe that sexual compulsions are not about sex (the unwanted behavior pattern) but, rather, underlying feelings that are unacknowledged and denied. Cognitive behavioral therapists try to identify

5 unwanted or dysfunctional thoughts and behaviors and creating treatment plans that help client decrease these thoughts and behaviors while replacing them with more realistic and useful ones. This type of therapy tends to work with only that information that is consciously available to the client and avoids attempts to explore unconscious material. In my experience sexual addictions are all about unconscious material. At the end of the day, those therapies that yield the best results ought to be explored first. I've found that psychodynamic therapy is stands the best chance of helping someone overcome compulsive sexual acting out. Psychotherapy groups Once again, there is little, if any, literature on group psychotherapy directly applied to sexual addictions. Clinicians in my city have led groups of this type for years. There must be hundreds more just like them across the United States. Some of the groups I have heard about seem misguided and humiliating to the participants while others seem very helpful and well run. I believe that the groups that are effective are the ones that focus on the right material. Groups that focus on the member's sexual behavior tend to only enhance shame and therefore increase the compulsion to act out. Eventually, members of these groups quit and feel more shameful and more like failures than before they began treatment or they become very rigid rule followers and generally unpleasant to be around. These latter folks are what 12 Step groups refer to as dry drunks. They may be "sober," but they are so obsessed with rules and not acting out that they alienate those around them. On the other hand groups that focus on the profound emptiness that causes the compulsion tend to be much more helpful. Highly effective groups understand the importance of anger in the healing process and encourage members to identify their disowned angry feelings and utilize them in facing their injuries and making changes in their lives. These groups are not afraid of anger and do not become overly anxious when a member experiences it. They are supportive of the rage that was forbidden and unacceptable in childhood. My fear is that most psychotherapy groups that are advertised specifically to treat sexual addictions avoid and repress anger, which has the unfortunate effect of repressing all the addicted man's feelings. When feelings are repressed, he experiences only depression and emptiness which is the condition that created the problem to begin with! Well-run groups, on the other hand, are a Godsend that can have a powerful healing effect. Poorly run groups may do more damage than good. Finding a good psychotherapy group can be a challenge. I believe finding a good general psychotherapy group is a better bet for the sexually addicted man than finding a good group that is specifically designed for treating sexual addictions. Psychodynamically oriented groups tend to focus more on the defenses against forbidden and unacceptable feelings than "addiction" groups. Why? Depressed people act out. The particular way they act out is not as important as the underlying causes the defenses against forbidden and unacceptable feelings. If you do find a group specifically designed to treat sexual addiction, make sure the focus of the group is not on sex itself, but on the exploration of feelings, particularly anger. Without this, the group will probably not accomplish its goal of treating sexual compulsions. To find a group near you, look into organizations in your community that advertise group

6 psychotherapy, such as You may also want to contact the American Group Psychotherapy Society (AGPA) at Accountability groups Many churches offer groups for people with specific issues, such as emotional problems, past traumatic abuse, over eating, depression, etc. It has become popular in recent year for churches to offer accountability groups for men with sexual compulsions. These groups are usually run by nonprofessional men who have some personal experience with sexual addiction. These groups to me seem to offer the same mixed blessing that psychotherapy groups offer. Some of these groups can be helpful, but my experience is that usually they are not adequately sophisticated to help men successfully overcome their sexual compulsion. Seldom do they have the necessary understanding of the underlying causes of sexual compulsion to be effective and often can make things worse. By the time most sexually addicted men get to me they have already experienced failure in several programs. They often feel like such failures that it is a wonder they want to try again. If they weren't so miserable I'm sure they would not. I have never met a man who successfully treated a sexual addiction using only an accountability group. In fact, to the contrary, I have met many who were so embarrassed and humiliated by their experience in these groups that they vowed never to seek help again. In summary, sexual addictions have traditionally been treated in a variety of ways including traditional psychotherapy, group psychotherapy, religious groups and 12 Step programs. Since there is little real science on the subject, understanding of sexual addictions is scarce and treatments have not been standardized, it is very difficult to tell how successful these treatments have been. What is clear is that many treatments are based on a misunderstanding of the nature of sexual addiction and can be more harmful than helpful. Because of the nature of repression, treatments that focus on repression of sexual impulses and associated feelings probably create more drive to act out rather than less. Effective treatment first must understand that sexually addicted men are depressed. Without a proper understanding of depression and its treatment little progress can be expected. In addition, effective treatment must understand the defensive structure of the sexually addicted man, including the function of the acting out and how shame turns rage away from people in the addicted man's world and toward himself.

Copyright 1980 Alcoholics Anonymous World Services, Inc. Mail address: Box 459 Grand Central Station New York, NY 10163. www.aa.

Copyright 1980 Alcoholics Anonymous World Services, Inc. Mail address: Box 459 Grand Central Station New York, NY 10163. www.aa. ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

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