Authentic sexual needs

Our work as therapists can at times be about helping our clients discover, explore and express their needs. Like the need to be loved, supported or understood for instance. And so, we stay in the moment, with what it means to have needs and to acknowledge their authenticity and realness.

When it comes to sexual needs, how can we stay with the authenticity and realness of what the client brings? Indeed have we confronted our shadows around sex, or do we jump into trying to determine what makes sexual needs appropriate, moral, pathological… Have we found the special ruler to measure a piece of string? Who can establish that one’s sexual needs are problematic but the person themselves (sometime after long exploration).

Yet hypothesis or “diagnosis” of sexual addiction are becoming main stream and money earners for some ‘specialists’. Whilst diagnosis of hypo sexual desire disorder are undermining and patronise the asexual population. How helpful or accurate are these formulations?

Looking at couples, infallibly their own level of sexual desire will differ and may vary with time. Which one has the right level? The one who wants more sex or the one who wants less? ‘Sex specialists’ state that a six months period with no sexual activity is problematic. Peer pressure to have sex is also rife, specially within sexual minorities where a sense of identity and belonging is often built upon ‘sexual identity’.

So we are trapped between a cock-measuring attitude (who has the most of it) and a normative approach (average, statistics and research).

How can we affirm our clients authentic sexual needs, whether they’d rather hold hand and cuddle their partner in front of the TV with a nice slice of cake or have fun in sex clubs and saunas twice a week?

Dominic Davies and TIm Foskett explore the misconception of sexual addiction in Gay and Bisexual men in their training day “I am too sexy” (16 November 2013) whilst on the following day I will explore our understanding of low sexual activity and desire across sexual preferences on a day called “Asexualities: intimacy and desire” (17 November 2013).

So why don’t you join us in this learning, get your rulers out and break them.

Olivier Cormier-Otaño MBACP Accred, AASDT
Clinical Associate

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.

Comparing arguments for and against classification of ‘sex addiction’

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The official release of the DSMV has happened and there is more than enough material to begin a discussion upon. For Pink Therapy, the reframing of GID – Gender Identity Disorder  as Gender Dysphoria- seems a good decision, given the DSM needs to have this as a treatable condition for insurance purposes.  We’re hoping the WHO ICD committee will be bolder.

Something that has won our attention has been the debate that has raged over Hypersexual Desire Disorder (aka ‘sexual addiction’), and whether it can be advised to be a disorder.

The APA has, for the moment, left it out of the new DSM. It is worth clarifying Pink Therapy’s position on ‘sexual addiction’, which is that it is a not an appropriate classification for people who experience problems they find relate or stem from their sex lives.

The APA have said there was not enough evidence to suggest that sex, the thought of/act of etc, could be addictive in the way analogous with addictive substances (such as cocaine) or gambling. Therefore, it could not be included.

While sexual addiction (or hypersexual disorder) does struggling toward a definition at the best of times, it often requires that a person wants ‘it’ too much, sexual gratification. And that this wanting can make itself apparent in behaviours directly sexually or indirectly linked to sexuality.

There is a profound abundance of literature exploring these topics. Two of interest, both for the writers and as a means of comparison, are ‘Understanding and Treating Sex Addiction’, by celebrity relationship and sex therapist Paula Hall. The other is ‘The Myth of Sex Addiction’, by David Ley, a clinical psychologist based in New Mexico whose career has often dealt with issues of sexuality.

Hall’s book is, overall, an extremely negative take on sex, and provides case studies driven in trying to reveal the potential for sex to break apart relationships. There is a profligacy of models and labels for the different dangers posed by sex, and the routes to recovery, however the essential point comes across as time and time again as: deny your libido, or be subject to runaway lust.

While Hall herself might deny this claim (“no, that’s not the point, the point is: if your sex is destructive, then deny it”), it seems she offers only the correlative relationship between sex and ‘pathological’ (be always wary of that word) behaviour, and not causative.

Considering some things known of sex – that it releases torrents of happy chemicals into your body, that it establishes emotional intimacy with other people – Hall’s detailing of ‘symptoms’ of sex addiction such as ‘loneliness’ and ‘unhappiness’, seems to argue against more evidence-based understandings of our relationship with sex. She doesn’t once mention that, for many, sex can be a healthy coping mechanism for a stressful job or lifestyle.

Ley’s book offers these arguments, certainly, and more to the sex addiction conversation. However, the two key things this writer took out of the book from first read were: Western society takes a moral perspective on sex, which is often pathological (that is not to say only the West does this, however), and this has meant we find it easier to understand that something so evil as sex could be in fact unhealthy in real, diagnostic terms. The corollary of this is that we shouldn’t be too trigger-happy when labelling a behaviour as ‘bad’, especially when we know the benefits and importance of that behaviour (sex).

One of Ley’s most convincing argument is, of course, the one from evidence. He talks about the ancient civilisations that hosted orgies (mixed sex, same sex, whatever!) these orgies took place across continents, and included the Greeks, who  so often are described as the founders of Western civilisation. And not one account of the Greeks suggests that relatively uninhibited sex had anything to do with anything wrong in those societies.

Jack Flanagan

Reference

‘Understanding and Treating Sex Addiction’, Paula Hall, http://www.amazon.co.uk/dp/0415691915
‘The Myth of Sex Addiction’, David Ley, http://www.amazon.co.uk/Myth-Sex-Addiction-David-Ley/dp/1442213043