Sex and Drugs and No Rock and Roll

ImageHIV diagnoses in London last year, were up 21% on the previous year.  A staggering 1720 new cases of HIV were diagnosed in London alone which averages out at about five gay men being told every day that they’re HIV +ve and will soon have to spend the rest of their lives on medication.

I’m a close follower of the work of Antidote (they’re the specialist LGBT drugs and alcohol agency in London and part of London Friend) and I have learned a lot from them over the past couple of years.  I’d encourage you to follow David Stuart on Twitter.  https://twitter.com/davidastuart 

It’s my belief that this huge increase has come about through an increase in ChemSex (specifically the use of Crystal Meth, Mephedrone and GHB/GBL).  There is plenty of info online if you want to understand more about these drugs and if you’re a therapist, working in London or perhaps other major cities with large gay male populations I encourage you to do so.

Whilst all of the above is pretty damn terrible and we can speculate about WHY this new epidemic is happening, and I certainly have some theories of my own, (which I might blog about some other time) what’s prompted me to sit down at the computer tonight is to wonder aloud that there’s millions of pounds worth of HIV Prevention funds out there; how much of it is being directed toward the services that are targeting this most-at-risk group?

Around 25 people a week are diagnosed HIV +ve in London and whilst they may not all want to seek peer support in an 8 week group, or attend 1:1 counselling, I think it’s very unlikely that Terrence Higgins Trust has the resources available in service provision to deal with this new epidemic, but they have the lion share of the money.

As far as I can tell from the THT website there is ONE newly diagnosed group running in London and a low cost counselling service available at THT (counselling used to be free). PACE’s services have been cut, GMFA has lost it’s funding despite in my view an excellent track record in innovative HIV prevention.  The NHS psychologists at the Sexual Health Clinics are over stretched and over capacity are unable to meet the demands.

Some good news is, that there is an innovative Club Drug Clinic who have spotted and been responding to this new epidemic along with Antidote and the CODE Clinic held at 56 Dean Street and helping people manage their drug use for a while now.  So work IS being done on prevention.  I am just particularly concerned about service provision and support for the newly diagnosed.

Lest anyone thinks I’m making this post as a way of trying to drum up trade for people seeing private therapists, I’m not sure there is sufficient specialist knowledge amongst the private therapists on our Directory to manage to meet the demand or to deal with some of the complexities of people who’ve become infected through chemsex.  Having said that I am well aware that there are a quite a few of us who were working as therapists in the first AIDS epidemic in the mid-late 80’s.

I’m asking whether we as a community of service providers are ready, willing and able to respond to this new epidemic?

So now I am going to plug something!  Pink Therapy is for the second year, running a one day workshop looking at the many different motivations behind people abandoning condoms and how to work in a non-judgmental way to help these people set their own goals and work to them.  Places are ridiculously limited and so early booking is advised.

Dominic Davies
Director – Pink Therapy

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It’s High Desire NOT sexual addiction!

Recent research from functional MRI scans appear to show hypersexuality and “sex addicts” just have high desire.

This is something I’ve expected.  They may not even have a lot of sex, but a lot of desire, which keeps them preoccupied with sexual thoughts.  This seems a valuable piece of research and I hope to read the original paper to find out more.

My own experience over 30 years working with gay and bisexual men who present for help with “sexual addiction” is that they client’s are generally low on education and information about normative sexual behaviour and drives and very sex negative, or feel shame about their thoughts or behaviours or others tell them they are obsessed or ‘addicted’ then they may internalise this ‘diagnosis’ and consider themselves negatively. These people often come from religions which take a highly moralising view of what is healthy and what is sinful

One of the reasons why group work is a positive approach to sexual compulsivity is that it can show the range of ideas and sex negativity and people can realise there is a spectrum of behaviour and obtain some information about what is healthy and understand more about themselves.

Where sexual behaviour gets out of control, this is usually a symptom of some other distress and focussing solely on the sexual behaviour can deflect attention away from responding to the underlying trauma or more serious mental health difficulties.

Dominic Davies

Further developments in ‘Sex Addiction’

My blog from last week has caused some twitter debate between myself and another of the UK’s ‘Sex Addiction’ experts Paula Hall, who is author of a new British book and chair of ATSAC (Association for the Treatment of Sexual Addiction and Compulsivity). (My colleague Jack Flanagan recently reviewed the book for this Blog and compared it to a more robust counter theory of Sexual Addiction by David Ley: The Myth of Sex Addiction)

I took a closer look at the last Conference programme which happened back in January and saw a startling comparison between the cutting edge thinking on ‘sex addiction’ being discussed there, linking sex addiction with trauma and attachment theory as causes and EMDR as a possible treatment all proven through advances in neuroscience.

This reminded me of Joseph Nicolosi’s 2009 book putting forward his cutting edge theories on the causes and treatment of homosexuality. For those of you who don’t know, Nicolosi is the CEO of NARTH (National Association for Research and Therapy of Homosexuality). Nicolosi believes as you’ll see from the review linked above, that homosexuality is caused by Trauma and is an attachment disorder and treatable by amongst other things EMDR.

Nicolosi also claims neuroscience as his evidence for these new theories and in fact acknowledges the work of Dr Allan Schore one of the foremost experts on neuroscience and attachment theory in his acknowledgements to his book (although he misspells Dr Schore’s name) but cites Schore’s work throughout his book.

I’ve met Dr Schore at a lecture in London on Borderline Personality Disorder and he struck me as a sound and respected scientist and clinician and was somewhat surprised to see his work linked with Reparative Therapy and so I wrote to him to clarify his position on this as NARTH have a nasty habit of misattributing legitimate scientific work and bending it for their own ends.

I got this reply:

I am very disturbed to find that Nicolosi is using my work for that purpose. Thanks for letting me know this. There is absolutely no neuropsychological research evidence that homosexuality is a disorder, much less an attachment disorder. Period.

All kinds of people are using my work for various reasons, including bolstering their own theories, and there is nothing I can do about that. In the pages you sent Nicolosi is grafting my shame and attachment models on to gender identity disorders, something I have never even written about.

Allan N. Schore, Ph.D.

Editor, Norton Series on Interpersonal Neurobiology

Department of Psychiatry and Biobehavioral Sciences

UCLA David Geffen School of Medicine

It just makes you wonder when you see ‘neuroscience’ ‘attachment theory’ ‘trauma’ linked with shame and then tacked onto Reparative Therapy or indeed something so heavily contested and unreliably evidenced as Sexual Addiction whether Dr Schore has a point!

Dominic Davies
Founder and Director

Omissions in the Core Competencies

With the recent events in Russia over the state of LGBT+ rights and acceptance, we thought it might be interesting to point out a recent event which caused some concern.

During the revision of the Professional Competencies for Psychotherapists in Europe being drafted by the European Association for Psychotherapists (EAP)  it was noted by one of our Directory members, psychologist Dr Greg Madison that the extensive document held in it no mention of sexual minorities as ‘stimagtised’ groups. For a relatively sizeable ‘minority’ this appeared to be a glaring omission.

And it was. On closer examination it was confirmed that no mention of sexualities was given, although issues of gender had been. Pink Therapy founder, Dominic Davies contacted Tom Warnecke Vice Chair of UKCP to express his concern and an amendment was quickly proposed.

The issue itself is worth commenting upon, not simply because of the state of LGBT+ rights in Europe as of global interest, but for the concern raised when the sexualities are excluded from information that creates more understanding therapeutic support for stigmatised groups.

The Executive Council of EAP meeting occurs this month in Moscow, in which the amendment, which has now garnered additional support from the Irish Council for Psychotherapy, will be reviewed.

It is hoped that the location of this meeting will not affect the outcome of this particular amendment, and in the new Competencies there will be due consideration of sexual minorities.

Jack Flanagan

Classifying Sex: Debating DSM-5

On my way on the 4th and 5th July 2013 to the conference at the interdisciplinary Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) of the University of Cambridge. This is to listen social and political scientists, feminist scholars, sexologists, psychiatrists, historians of science, as well as mental health practitioners and sexual rights activists discuss the sexual classifications produced by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

This is also a good opportunity to highlight the research that Pink Therapy commissioned, concerning gender and sexually diverse couples experiences of relationship counselling, before an interested and global audience.

Joseph de Lappe

My curious paradox about sexual addiction

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I’m finding myself in a curious paradox regarding ‘sexual addiction’ and it’s one that I feel the time has come to speak out about.  I’m increasingly frustrated at seeing people claim expertise in something which most mental health professionals dispute exists.

How does one claim to be a sex addiction expert when even the expert psychiatrists of the American Psychiatric Association recently revised DSM V were not persuaded to include Hypersexual Desire Disorder, let alone recognise sexual addiction as a diagnosis eligible for treatment?

I’ve been working as a therapist with gay and bisexual men for over 30 years and I would say I have never met anyone I considered to be a “sex addict.”  I’ve met many men who have found themselves out of control with sex, or who have used sex compulsively, or even recklessly, but I wouldn’t call them “addicted.”  I’m also not happy to collude with their self pathologising and self diagnosing.  It just feels unethical to agree to treat someone for something that I don’t believe exists.  If the client is sure they are addicted, then I tend to refer them to others who are happy to collude with this belief.  I readily acknowledge many people feel their lives have been saved by 12 Step Programmes and Sex Addicts Anonymous and I don’t want to stand in the way of someone seeking that kind of help if they feel it’s going to fit their world view better.  However, I feel I have a different view and wish to reflect on the meaning and circumstances of someone’s behaviour through a less pathologising and more personally responsible lens.

For about a decade, I’ve been co-facilitating a workshop for therapists which reframes ‘sexual addiction’ in a variety of other less shaming and more sex positive ways and offers ways of working with this.  I think sexual shame is often at the heart of presentations from gay and bisexual men who present for help thinking they are sexually addicted.  In fact  shame is often at the heart of many presentations for gay men, and since we’re men who choose to love other men, then often this gets focussed around sexual behaviour.  But it’s not the sexual behaviour that needs treating – this is only symptom of other things.  Sex is NOT an addiction. It is a natural biological drive, which is as natural as breathing or eating.

Many years ago I was heartened to come across Marty Klein’s article and we made this core reading for our workshop.  More recently the excellent The Myth of Sex Addiction by David Ley makes a cogent argument and debunks the hype and faux science and covert religious dogma which has been responsible for compounding the shame and guilt of many gay and bisexual men.

Heterosexual men are of course also affected by the myth of ‘sex addiction’ but I think there are some unique features that mark heterosexual men and men who love other men as different that I am choosing to focus my energy and objections to tarring gay and bisexual men with this spurious diagnostic brush.  Both Klein and Ley dismantle ‘sex addiction’ as a concept for everyone anyway and I think they are extremely persuasive.  I just think at Pink Therapy we have some new paradigms to offer and some interesting ways to understand and work with people who are using sex compulsively and so it’s worth focussing on just that group in our training workshop.

So here I am claiming expertise and experience in working with something which I don’t really believe exists!  I too am a sex addiction expert!

Dominic Davies – Founder – Pink Therapy

Addendum 26 Jan 2016
One of the contributors to the discussion below requested their comments be withdrawn.  I hope this doesn’t detract from your making sense of all the other contributions who respond to her.