If It Isn’t Sex Addiction, How Do You Treat It? (Part 2)

Earlier this week, I discussed some of the many reasons that “sex addiction” fails as a helpful clinical diagnosis. It’s a popular term, with vague, intuitive criteria. Every week, some person comes into my office saying his (non-psychologist) wife or girlfriend has diagnosed him as a sex addict. And every month or two, a celebrity gets caught with his hand in some sexual cookie jar, and the airwaves are filled with psychologists diagnosing him as a sex addict.

If you don’t even have to meet the person in order to diagnose this disease, if you don’t need to be a psychologist to diagnose this disease, how clinically robust can the concept be? That’s the sex addiction movement for you—it makes clinical training, skill, and experience superfluous. All you need is a strong opinion of “right” and “wrong” sex and a willingness to condemn someone else’s reality.

What pundits, spouses, and movement spokespersons call “sex addiction” can be many different things. For some people, it can be an expression of anxiety or depression. For some, it can be obsessive-compulsive disorder. For some, it can be a reflection of Asperger’s Syndrome, mild autism, or borderline personality disorder. And for some, what looks like sex addiction is actually the behavior of someone filled with hostility, loneliness, despair, or desperation to connect. Or it’s the behavior of someone who can’t communicate with their mate, deal with the aging process, or handle being in a relationship with little or no sex.

For some, “sex addiction” is part of a larger internet entanglement. After all, the human brain isn’t wired for the unlimited hunting that the internet offers, whether on eBay, NFL.com, or buttbustersUSA.

Not insignificantly, what looks like “sex addiction” to some is often a matter of sexual tastes that others don’t share—S/M, multiple partners, casual or anonymous sex, commercial sex workers.

So how do we treat “it”? Obviously, it depends on what “it” is. Here are some of the approaches I use with various versions of “it”:

* Ask what kind of sex life the patient wants; either help them negotiate it, or accept that they won’t get it with their current mate (or anyone they’d like to be with).

* Resolve the guilt and shame someone feels about their sexual desires. Guilt and shame can fuel repetitive, compulsive behavior, and make it difficult to connect with someone authentically.

* Medication when appropriate: anti-depressants, anti-anxiolytics, perhaps stronger drugs like mood stabilizers.

* Sex therapy to investigate and resolve possible sexual dysfunction, chronic need for risk-taking or breaking taboos, or rigidity in preferences, such as cross-dressing (not to eliminate paraphilias like cross-dressing, but to help someone integrate it into his/her life, and possibly expand their sexual interests).

* Serious couples counseling: hopelessness about serious discrepancies in desire or preferences is often the fuel for serial affairs, inappropriate flirting, or involvement with sex workers.

* Cognitive or other behavior therapy for internet disability or other phobias.

* Psychotherapy to enhance self-esteem and the ability to soothe oneself when frustrated; and to reduce fear of intimacy or pleasure, self-loathing, and self-defeating narratives.

Notice that a lot of these treatments don’t center on sexuality. That’s how we’re able to resolve a lot of the behavior that sex addiction programs can’t. Such programs aim far too low—to create life-long recovery rather than resolution and permanent change—and they focus way too much on sex. Which is ironic, since most sex addiction programs are run not by sex therapists, but by addiction specialists. I guess with only minimal training in sexuality, they get distracted by their clients’ sex lives.

Finally, let’s not forget that some “symptoms” of sex addiction don’t need treatment at all. They need a better understanding of the broad range of human sexuality, a bit of tolerance, and a culture that’s far less suspicious of eroticism. And a willingness for couples to confront their actual relationship (and for people to confront their actual desires), rather than taking the easy way out and demonizing sex.

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There’s still time to register for my last teleseminar of 2013. The topic is “If It Isn’t Sex Addiction, What Is It? And How Do You Treat It?” For more information, click here.

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