Sex Addiction

Sex addiction involves sex but isn’t normally about sex.

Article by Nicholas Conn | Medically Reviewed by Dr. Robert Lefever

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Typical behaviours such as sex online or sex outside of relationships are for many people only problems when they become a problem, and they become a problem because of their adverse impact on the people we are with (our partners, our families) and some unintended outcomes (financial or health concerns).

But who are we to judge?  And if we did, how would we make that judgment?  Would it be based on the likely harm to ourselves or others?  Would it be because of health concerns?  Would it be through a moral and ethical lens?

Sex addiction isn’t about sex because it’s about relationships.  The relationship you have with yourself and how easy or difficult you find relating to others.

To date, there is no scientific consensus regarding sexually compulsive behaviour – the labels of sexual compulsivity, sexual impulsivity, or sexual addiction are often interchangeable and the approaches towards treatment remain varied.

This can make it hard for the person seeking the help to know what is available, what is valuable or even what the problem is in the first place!

It is also difficult to make a decision about the right kind of help because we have an idea about what therapy and counselling are and don’t like what that idea says about us.

Support For Sex Addiction

It is incredibly important to draw upon the right type of support; this is one that allows us to feel both challenged and supported.

We are making judgements about expertise, curiosity, personality, rapport and communication skills  – they all matter in probably equal measure as we need to get along in order to make meaningful change.

Here’s a simple approach to listen out for when assessing the range of help and different types of help.  Back in the 1970s, a leading psychologist called Gerard Egan introduced the skilled helper model.  The book of the same name was written as a way for therapists to help people manage their problems in living more effectively and to become better at helping themselves.

At the heart of this approach is a 3 stage process:

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Whilst this is a straightforward approach it does require skill and resourcefulness on the part of the therapist.

It demands genuineness, respect and empathy to be successful. When sex addiction is the issue, there are probably some extra unique demands upon the therapist to be versatile.  This is because sexually compulsive behaviour has multiple potential sources and therefore multiple approaches to its understanding and treatment.

Stage 1 – Determining What’s Going On? There are some recurring patterns that indicate successful routes for the treatment of sex addiction.  For example, there are potential environmental factors or underlying issues based on previous trauma.  A leading expert in the field, Paula Hall uses the Opportunity, Attachment and Trauma (OAT)  framework to reflect a client’s experience.

A founding figure of UK approaches to sex addiction is Dr Thaddeus Birchard.  In one study, Dr. Birchard attributed the causes of sex addiction to some major factors:

Such actors are wide-ranging in impact and may not all have a pathological status (it doesn’t mean someone is “sick’).

Dr Birchard recommends treatment strategies with four essential tasks:

  1. Psycho-education (knowing what and why sex addiction is an addiction)
  2. Group work (feeling supported by others and reducing the shame)
  3. Family of origin exploration (knowing how this got set up in the first place)
  4. Facilitating access to the components of a good quality of life (enjoying a new version of yourself)

Stage 2 – Identifying what clients want instead.
In Plato’s Republic, Sophocles describes a period of his life when his preoccupation with sex stopped.  It was “like escaping from bondage to a raging madman”.

Sex addiction can be seen as a response to living a life that has little personal meaning. Making changes to our lives is complicated because many of us struggle to overcome negative thoughts and feelings.

By recognising and changing thought processes we can develop a healthy attitude to life and achieve new goals.

By finding life more personally meaningful we start to become happier.  Adjusting our thoughts and behaviour towards improved well being  – learning to be happier – means spending a lot of time re-addressing both how we think and how we act.

Stage 3 – how might the client take action? The process by which people intentionally change their addictive behaviours – with or without treatment – is not understood well enough.  It might be because setting goals and sticking to them is important but difficult.   It might be because addictive disorders are difficult to treat when the client is ambivalent or simply resistant to change.

What we do know is that modifying addictive behaviours involves progressing through five stages:

  1. pre-contemplation – not thinking about it
  2. contemplation – thinking about it
  3. preparation – moving from thinking to doing
  4. action- doing
  5. maintenance – keeping on doing

This approach provides us with a common set of change processes that we typically recycle through before finishing with the addiction.

Sustainable change is also related to performance capacity: our ability to improve relationships, create new ones and achieve our personal goals

The human brain is a social organ that is directly shaped by the interactions we have with others.  There are five social qualities that directly impact our threat and reward responses:

Five Social Qualities

  1. status (how significant we think we are)
  2. certainty (how much we can anticipate about what’s next)
  3. autonomy (how much control we think we have)
  4. relatedness (how we feel about our relationships with other people)
  5. fairness (the extent to which we feel life works against us)

The skilled helper supports change by helping clients address their everyday concerns, reducing their addictive process and providing them with a greater sense of wellbeing.

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