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.
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23 thoughts on “My curious paradox about sexual addiction

  1. Pingback: Further developments in ‘Sex Addiction’ | Pink Therapy Blog

  2. Hi,

    Its great that you write about how to Cure addiction and I was searching for this type article for my research. I am very happy to get information which I want from your blog.

    Thanks

    • Jane, you run a Sex Addiction Empire and your business is all about treating people (men) for what most sexologists would consider perfectly normal sexual activities – your website lists for example “sexual paraphilia’s (a need for unusual sexual stimulation) and/or any sexually offensive behaviour.” Offensive to whom? You? The wife of the client who enjoys her wearing silk stockings and high heels? Or who feels sexy wearing rubber rather than M&S cotton vests?

      I will NOT collude with shaming people for what are often innocuous and normal sexual behaviours because they are outside of some narrow heteronormative definitions of sexuality. Whilst missing what is really going on underneath the compulsive sexual acting out. Sexual compulsivity is not about being ‘out of control’ (or out of one’s partner’s control) sexually. It is much more likely to be a symptom of some deeper mental health problems and these need to be the focus for therapeutic help.

      Not trading on reinforcing endemic sexual shame for a fast buck, and then calling ME unbalanced and ignorant. I have read both Carnes and Weiss, they have it wrong in my humble opinion. Please read some critical sexologists like David Ley and perhaps then we can have a more informed and balanced conversation.

    • 1. Operating from six locations and listing Harley Street as a separate one clearly implied the building of an Empire. You might not feel like an Empress, but you clearly feel I am threatening your big business.
      2. Sex is a base and a primitive life force and energy, of course some people can feel out of control with it (if they’re engaging with it fully). People ALWAYS have choice about their behaviour and actions. I know you treat the symptoms but I’m saying you’re maybe missing the deeper psychopathology. Serious out of control behaviour which is dangerous and reckless might need more qualified and specialised treatment than a sex addiction counsellor can offer. Ley, and I agree with him, talks about bipolar depressions, or undiagnosed personality disorders are often going untreated/helped because the addiction counsellor is more concerned with the symptomatic sexualised behaviour and not trained to recognise and work with the deeper mental health distress.
      3. You DID call me ignorant and my blog unbalanced. It was MY blog, I used it to express MY 3 decades of experience in this field and MY views. That’s what blogging is for! It’s not about writing a balanced piece of reporting. It’s a BLOG! S
      I probably won’t be taking up your offer of your Diploma as I think I would learn very little and be too disruptive to the other students, although perhaps that might be a good way to try to give them some balance to their (mis)education.

  3. Hi Dominic,
    I know the good place that you come from and completely agree we need many paradigms and should not go about shaming people, pathologising, colluding, denying good science or our clients’ healthy rebalancing systems, or the range of experience people have who present as having lost control of their sexual activity in a way that is causing them distress. However, where I find it is difficult to have an informed discussion around this issue is that people are so polarised against the “addiction” model, often coming from myth-fueled, shaming and biased science AGAINST ANYONE who dare speak of ways that the addiction model can inform healing options to regaining a free, healthy, authentic sexual sense of self and others. Look through your post, it is full of negative assumption about the motives, methods, models of people who work with clients from a recovery model. For example, “colluding with”, “myth”, “unethical”, and that this is predominantly motivated by a heteronormative desire to bring everyone into religious conformity. Undoubtedly there are these social dynamics which are oppressively compounding, conflating and punitive for people from sexual minorities, but should we so defend against a different view with the bigoted filters that these are the dominant motives of people who include an addiction paradigm in their therapeutic models? I don’t recognise the approach you seem to think the recovery model is. It is so far from how the recovery model views the person and their living process, in my experience, though of course I’ve encountered a few bible-bashing fundamentalists who are in recovery – black-and-white thinking is sometimes part of the package of people who have gone to extremes in their “usage” be it drug, porn or religious doctrine. I only ever encounter the description of the recovery model you offer from very cliched perceptions of those who are just as invested in debunking addiction as a concept as they say the “addiction industry” is in promoting the addiction concept as the only valid one (which yes, there are a few, and there are exploitative people in all industries, from “sex positive” approaches to “addiction” approaches).
    Could we start from a place of less shaming, pathologising, myth-perpetuating and excluding of people who have found use for the addiction model in a sex positive, diversity affirmative, whole person, ethical and compassionate practice of psychotherapy? If we could get to a place of integration, which at the moment I think people who are not ashamed to call themselves “addiction” or “recovery” specialists are doing just a bit better, surely we can offer to our range of clients services which better meet their diverse needs and which they want to engage with. I really think we have the same good intentions towards our clients and the cultures could work better together. We don’t have to drop our bias for one model or another, we’re people and our clients want to work with us as people and people have preferences, what’s worked for one repels another. But there is so much more in common with these models and practices than you appear to be saying. For example “Sex is not an addiction. It is a natural biological drive”. Yes. I’m not as well read as you on the subject, but the emotional-psychological-biological-sociological-behavioural thing of “addiction” is built on paradoxes and I don’t think one model will ever have it wrapped up in science. I’m coming from exposure to people in recovery and the people who work with them and I think David Ley does not give accurate report of what I have seen there. And he does as much barrow boy pitching from his market stall as anyone. And I’m so glad you are being an important contributor in the important debate. But can we start from a place of not throwing stones?

    • Wise counsel Pam and I agree there are many people who report feeling helped by 12 step groups and Patrick Carnes and Sex Addicts Anon etc. There are also others who weren’t helped by those services.

      It’s difficult when there is no agreed treatment and no agreement event amongst those who subscribe to the concept of Sex Addiction as to what they mean and what would define it. With no clearly agreed criteria, it’s difficult to develop any evidence based treatments and many working in recovery will have their own model for what they feel works and how they want to treat it.

    • Pam – I ask out of curiosity not provocation: you could apply your argument here to gay reparative therapy – would you?

  4. I’m delighted to read this Dominic, the ‘sex addiction’ industry is rapidly growing, in large part for the usual reasons in this neo-capitalist world of making money rather than enabling people to live their lives in better ways. The move by some within the profession for recognition of this spurious pathology within the various psychiatric nosologies (DSM, ICD) tells us all we need to know, that this diagnostic invention has come about to line the pockets of therapists chasing the dollar of the private insurance companies.

    Of course people may at times feel compelled to engage in behaviours that are unhealthy and/or personally disturbing and that includes sexual behaviours but to locate this within a model of addiction is inherently flawed. I’ve seen large numbers of clients facing such challenges. The evidence however is clear and unequivocal that such behaviours do not fit within a model of addiction in any meaningful way. Not only that but this model of understanding also serves to pathologise people from sexual and gender minorities with growing numbers of people ‘diagnosed’ with ‘sexual addiction’ who might otherwise understand their sexual activities within a more constructive sex positive framework. Instead of seeking a ‘sex addiction therapist’, anyone facing a personal challenge concerning their sexual behaviour will be much better off engaging with a sex positive therapist who will work with the client’s own meaning-making process, the place of such behaviours in the broad context in which they emerge and facilitate the development of genuine insight and understanding, sustainable personal development and – if necessary – behavioural change to meet one of the many challenges that we all may face at various points throughout our lives.

    Darren

  5. Isn’t it advisable to treat deeper underlying problems rather than symptoms? You wouldn’t give someone an aspirin to treat a brain tumor, would you? People who come to me with the presenting problem of “sex addiction” (yes, they all know the current buzzwords and don’t have the expertise to critique what they are told), are filled with shame and self-loathing and tend to be very self-judgmental. They often have a very limited understanding of sexuality in general and their environment is equally uninformed and judgmental. As already stated here, this isn’t about “sex addiction” as a stand-alone syndrome, but about “sex addiction” as a defence against dealing with underlying issues, sometimes simply about a lack of understanding of what is “normal” and the resulting lack of self acceptance and often crippling shame. What’s “too much”? What’s “addiction”? What about the neurological research that finds no backing for an addiction model for sex and pornography? Shouldn’t disorders we diagnose be objectively quantifiable and measurable? There is too much value judgment here of what is abnormal and what isn’t. We should be dealing with what is really disrupting our patients lives, not be fooled by defences/symptoms. If the disruption is due to self-attacking brought on by a behaviour that in itself isn’t problematic, then eliminating the behaviour isn’t good therapy.

  6. In Marty Klein’s “Why ‘sexual addiction’ is not a useful diagnosis- and why it matters”, he claims that sex addicts say they are out of control but that this is just a metaphor i.e. , they feel out of control and controlling their impulses is very painful. Virtually everyone has the ability to choose how to control and express their sexual impulses and the concept of sexual colludes with peoples desire to shirk responsibility for their sexuality. Klein further goes on to say that the concept of sexual addiction prevents people form examining this feeling of powerlessness. Also trivialises sexuality and prevents any examination, assessment and treatment of the personality dynamics underlying sexual behaviour. The concept encourages people to deny the healthy guilt learned in childhood which allows them to control the sexual behaviours healthily. Further it prevents people from examining why they feel powerless which, through careful exploration, can lead to the source of personality growth and behaviour change.

  7. I would not call myself an expert, I do have many years experience working with clients on sexual and relationship issues. I do not find the addiction model useful in the sexual context. Part of the reason for this is the absence of an external agent that the client might be addicted to e.g. alcohol. The other reason is the lack of scientific evidence for this supposed condition (DSM V) Some clients in distress about their sexual behaviour may find behavioural therapy useful equally there is no doubt that many couple relationships are severely troubled by the sexual differences between them, but I don’t think that pathologising one of the partners is useful even when one of the partners supports that view. However the lack of credible scientific evidence means that this debate will continue and a variety of treatments will be offered and strong opinions held until we have the evidence. In the meantime all we can do is follow the old maxim of therapists down the ages “First do no harm.”

  8. I have lived and worked with addiction all my adult life, both as a recovering “sex addict”, personally diagnosed and “treated” by Patrick Carnes, and as a therapist/counselor, and yoga teacher/trainer working specifically with addiction recovery.

    The journey out of the prescriptive, confining assumptions that my sexual behaviour was caused by my personal “addiction” rather than deeper, more applied trauma, has been a very enlightening time and now, having made it to the end of the 1st week of the CSAT (Carnes Sex Addiction Training) I can safely and comfortably own for myself that I absolutely believe Sex Addiction is a myth.

    Much as I can respect that this is a Bog, and as such, although it is not mine, opinions can be expressed, I do not feel at liberty to express my very real and deep feelings about all that I experienced in being “trained” by Patrick Carnes in December last year, suffice to say that I can now turn my back on this mode of recovery and feel that there is much to be leaned from living and working with an approach that is non-judgemental, open-minded and compassionate, paying a careful attention to internal mental and emotional needs that once addressed, can profoundly change how people, including myself and all of my clients, deal with their needs.

    Dominic, I salute you in opening up the dialogue onto the page here.

    • Hi Carolyn, I just wanted to give my appreciation for your feedback here. As most know, I do work with people who present with compulsive sexual behaviours/addiction – whatever you want to call it. I’m not sure if I subscribe to the ‘addiction model’ – as I have yet to discover what that is? Most seem to assume they know, but I’ve never found out what it is – there seems to be so many!! I’m not fussed that it’s not yet ‘named’ in DSM5 – remember drug addiction is also not in there, but Drug Misuse Disorder is and also Compulsive Gambling. I also trained with Patrick Carnes and did not find his explanations or treatment approaches fitted with my training as a sex therapist at all. And I totally dispute the shame rhetoric around sex addiction and how it is used in diagnosis. I have a lot of respect for David Ley who I am in frequent contact with and very much appreciate his critique of the way the sex addiction industry has been established in the US. But please, let’s not throw the baby out with the bath water – this is far too big a debate to choose sides based on US cultural-based views.

  9. It seems that speaking against the sex addiction recovery model(s) can generate a lot of passion – as Jane says ‘I would fight your opinion with passion.’ It is unfortunate that the opportunity was then missed to deliver more content and ‘evidence’ or science to support such a fight. Instead, ‘passion’, protest and claims of persecution overwhelmed the subsequent short posts. The latter style of rhetoric is not dissimilar to my experience of Robert Weiss discussing sex addiction with LinkedIn sexologists who hold different perspectives to him. The essential arguments and discussions are occluded.

    Going back to the original pathology (lol) I suspect what prompted the original blogpost from Dominic is that sex addiction recovery is no longer a model for exploratory discussion or the steady elaboration of debate or dispute – it is becoming a MOVEMENT. As such it can be carried by the dangers of cult induced and guilt inducing discipleship exploiting a moral rhetoric derived from social norms which are sexually shaming and thus toxic, re-enforcing that shame and toxicity in the psyche of clients. The fanatical fervour that results might be what we witness here and elsewhere when we try to get to discussion points. But if sex addiction recovery is a movement that is based on an ideological fervour which shouts out differences of opinion, this will necessarily provoke a counter response from professionals. And as Dominic illustrates here, it is risky business to engage with the ‘passion’ of a movement rather than an informed or discursive scientific approach. Which professional would want the consequences of that?

    Back to the client in this context, the screening process of clients asking for cures from sex addiction would be crucial in the debate. Does a gay person want to be cured of ‘unwanted same-sex attraction’ because they love their wife and children or because they are too ashamed to live the vilified gay lifestyle that will be their lot if they dare to come out? Does the ‘sex addict’ want cure because they are shamed into living out social norms or because they are afraid of the sex positive lifestyle that suits their personality constitution, relational style and psychic temperament better? Or do both the gay person and sex addict seek a cure to their condition out of authentic choice, guilt or social humiliation? Then follow all the discussions about evidence and methodology – whether such an addiction actually exists. I link gay cure with sex addiction cure because there is an important link in the discussion around sexuality, desire and identity that gets drowned out in the moralising too and fro.

    Much to discuss and think about rather than whip up fights and passions – but risky business embarking on that – good luck Dominic!

  10. What other comments, Dominic. They do not seem to have come through.
    The problem of stigma is not just one for gays and lesbians, but for kinky, cis-gendered, and the hetero-normative. In order for 12 step therapies to work, one must accept stigma, then triumph over it be recovering. This is an inherently, but unnecessarily shaming process. Doug Braun-Harvey and Michael Vigorito’s ‘Out of Control Sexual Behavior’ is a much more ethically sound and client centered approach!

    • I’ve had to withdraw the comments of one commenter who works as a sex addiction therapist and who engaged a few times with this blog. She recently wrote to me (3 years after her comments appeared) requesting I take them down.

      Thanks for the recommendation of the book, I look forward to checking out their work Russell.

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