Sex Addiction is Real: Just Ask a Sex Addict

The concept of sex addiction came from sex addicts. It was never imposed on them by clinicians– far from it. If you read the first of the personal stories in the Sex Addicts Anonymous “Big Book,” which includes an account of how SAA was founded 36 years ago this is clear. At that time people with compulsive forms of sexual behavior were receiving other forms of psychiatric treatment that were mostly doomed to failure; treatments like aversive conditioning or psychoanalysis. The groundbreaking work of Dr. Patrick Carnes and others created SAA as a way to treat sexual addiction in order to help themselves and ultimately to help others.

Listening to addicts, lots of them

And people have been steadily joining the ranks of self-identified sex addicts. Today SAA has 1,176 groups (regular weekly meetings) in the U.S., that are registered with the International Service Organization (ISO) of SAA. In addition there are 62 in Canada, 51 in the U.K., 31 in Central and South America and 48 in other locations including South Africa. There are 101 different registered telephone meetings and other electronic meetings.

These statistics are as of last October and the ISO informs me that the number of meetings has grown steadily by 10% per year in recent years. That’s a lot of people in SAA alone. And there are currently four additional 12-step self-help programs for sex addicts all modeled on Alcoholics Anonymous:

Sexaholics Anonymous (SA)
Sex and Love Addicts Anonymous (SLAA)
Sexual Compulsives Anonymous (SCA) and
Sexual Recovery Anonymous

Even this does not represent the whole picture. Nowadays many sex addicts can get appropriate treatment with therapists who specialize  in working with sex addiction. And of course there are many people struggling with sex addiction who are not getting any help at all, often because they don’t understand the nature of their problem, or because the psychiatric establishment has yet to educate the mass of clinicians as to the diagnostic issues.

The current wave of sex addiction denial

Today there is a rash of sex addiction denialism or misinformation fueled by some flimsy studies that have been easily discredited and gaining followers among those who feel judged or pushed around by the idea that someone might call them (or anyone) a sex addict. But in fact clinicians don’t go around looking for sex addicts or labeling people just because they exhibit certain behavior. People need to be evaluated on a case by case basis. This is partly because compulsive sexual behaviors can be a symptom of at least half a dozen other psychiatric disorders that don’t have anything to do with addiction.

But the “evidence” that porn and sex addicts are not exactly like drug addicts in this one experimental response in this or that isolated experiment is really largely irrelevant to the experience of thousands of sex addicts over decades. In the attempt to save patients from being mislabeled by clinicians, the deniers have ended up undercutting the recovery efforts of bona fide sex addicts. “Sorry, what you have may not be a “real” addiction; so maybe you don’t really need any help!”

The plural of “anecdote” is “data”

Most people and clinicians generally agree that sex is a good thing. People tend to show up for treatment when they, or someone who knows them, notice that their sexual behavior is way out of control and is causing a lot of problems. Some people have had their lives taken over by pornography, some have lost a job due to sexual behavior, others have been arrested more than once for indecent exposure, and some simply spend hundreds of thousands of dollars they can’t afford on prostitutes.

But whatever brings them into the office or the 12-step meeting, they still need to be helped to figure out if in fact they are a sex addict. This can be done by pointing them in the direction of the literature on the subject, by talking to other people with the same problems, and by well validated tests.

I have listened to numerous patients of mine, read hundreds of emails and blog comments and listening to sex addicts talk at hundreds of SAA meetings over the years. Many addicts are unsure to begin with about whether they really have an addiction. But for many there comes a point when the addict realizes that they simply have no control over this or that behavior. I have heard over and over again: “This is an addiction!” ” I can’t stop even though I desperately want to!” and ” I’m ashamed of what I do because it’s not who I am, yet I do it anyway!”

Other addicts will occasionally waver in their grasp on the addictive nature of the problem. This is not at all unusual. “So am I really an addict?” “So-and-so is so much worse than I am!” But of their own accord or because of many unsuccessful attempts to quit, they come back around to the need to approach the behavior as though it were on a par with alcoholism or drug abuse. Many will tell you that it is more addictive even than these.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Losing a Partner Complicates Sex Addiction Recovery

A sizable number of couples stay together through the upheaval of sex addiction. According to my educated estimate about half of all sex addicts in sex addiction recovery are working with a partner to try to repair the relationship.

By the same token many sex addicts end up losing their partner following the disclosure of sex addiction and the ensuing crisis. I have found that there are complications for recovery in both situations.

If the sex addict’s partner chooses to stay in the relationship, then the sex addict has certain advantages. The presence of a partner (and possibly children) very often provides a strong motivation for the addict to follow through with treatment and recovery. No matter what the addictive behavior, internet porn, prostitutes, hook-ups, etc. the married sex addict has a lot to lose by failing to get “sober”.  Also the presence of a partner adds a level of accountability. If the addict is truly engaged in recovery, then he or she will be committed to transparency and honesty with a partner and in general. Agreeing to tell all can help to give the addict a reason to be more conscientious about avoiding situations that might lead to relapse.

But what happens when the addict comes clean to a partner, becomes sincerely engaged in recovery and then the partner or spouse leaves? I would like to share my observations as to the impact of divorce on sex addiction recovery; both the negative impact and to whatever extent, the positive impact as well .

Negative impact of break-ups

  • Apart from the loss of motivation and accountability that was connected to the relationship, separation and divorce add serious emotional stresses to the situation. The end of any relationship, even a bad one, is experienced as a loss. This means that even for a person who was not struggling with addiction and recovery, there would be grief and deep feelings of abandonment.
  • As I have discussed elsewhere,  sex addicts tend to be highly co-dependent themselves even though they have lead a secret life outside their relationship. They are insecure and tend to base their self worth on the perceptions of others. The rejection of a break-up only reinforces their feeling of unworthiness which in turn can derail any new found sense of strength in recovery.
  • The turmoil surrounding a separation or divorce can become a serious distraction from the addict’s recovery routine. The mechanics of leaving familiar surroundings, finding a place to live, arranging to see their children if there are any, and dealing with the legal process of impending divorce proceedings can sap the addict’s energy and resources.
  • Addicts in a break-up will be experiencing a great deal of emotional pain and distress. Their typical way of dealing with negative emotions in the past was through escape into their addictive behavior. Thus the added emotional distress of shame and rejection increases the motivation to reach for their “drug”.
  • Most sex addicts have a problem dealing with boredom and loneliness without wanting to act out sexually. Isolation is not helpful to sex addiction recovery and the fact of suddenly being on their own can be a big risk factor, especially if break up has left them feeling less motivated to engage with supportive people.
  • The addict can become obsessed with the partner who has rejected them, thus leading them into destructive fantasies and delusional thinking. They may fantasize that they can win the partner back, or they may ruminate and become angry and resentful. They may also become obsessed with finding a new partner immediately in order to bolster their damaged sense of self and restore parity with the person they have lost. All of this obsessing and emotion pulls the addict away from reality and from the need to address their own recovery and growth.

Is there any upside to break-ups?

Obviously there may be advantages for the spouses and partners who feel that moving on is in their own best interests. But what about the addict? I believe that after the immediate crisis of the break-up and its impact on sex addiction recovery have subsided, the addict will be in a better position to assess the intimacy problems that almost certainly characterized the relationship. I contend that practicing addicts are drawn to partners and styles of relating that do not demand. In that sense, I think the practicing addict promoted a sort of dysfunctional situation both because it was somehow familiar and because it provided a situation that at once allowed and was an excuse for sexual acting out.

In sex addiction recovery, the divorced or separated addict has a chance to recover from the addiction and to learn a new kind of relating built on intimacy and trust.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

It’s OK to Have Bad Sex: The Sex Addict’s Difficult Adjustment

Sex addicts tend to be perfectionists.  And this is especially true in their attitude toward sex.  They are known for their all-or-nothing thinking, the tendency to view the world in terms of extremes.  In their sex life with a partner, sex addicts in recovery tend to carry with them an extreme and basically intolerant set of expectations. Just as an aside, there have been a slew of blogs and research survey findings that suggest that we are all having our sexual expectations distorted by the increasing pornification of our culture.  Some in the “feminist porn” movement and elsewhere have attempted to fight the idealized images and expectations shown in mainstream porn and in the “ambient porn” of movies, games, magazines and TV.  See also my journal article the findings of the APA task force on the sexualization of girls in our society.

The over importance of sex and orgasm

Sex addicts have as a core belief that sex is their most important need.  Thus sex addicts place an undue emphasis on sexual arousal and gratification.    Even before the advent of internet porn, sex addicts have always tended to be in a hurry to get to the sex act and to achieve the perfect orgasm.  If this didn’t happen all was lost. Having permission to have “bad sex”, i.e. sex that doesn’t match some perfect ideal, is a way to counteract the desperate need that sex addicts feel.  It can help relieve the pressure and can allow for times when the partners feel less energetic, more sensual etc.  It takes the focus off of “getting my needs met” and places it more on just having a sexual, physical experience with someone you are close to.

Fantasy standards of desirability

Because sex addicts are used to engaging in sex that is excessively loaded with fantasy content, (sex with strangers, cybersex, escorts, strip clubs, and of course pornography) they usually have perfectionistic (fantasy ridden) ideas about how women’s and men’s bodies should look.  This then results in the feeling that any sex with someone who doesn’t measure up to a fantasy standard of beauty or prowess is no good.  Hence the saying that to an addict “sex with a real woman is just bad porn.”

Unrealistic expectations about sexual behavior

Sex in the context of a relationship may seem boring to a sex addict.  In a real situation the addict has to deal with all kinds of awkward, messy and most importantly unpredictable elements.  These will almost certainly burst the addict’s fantasy bubble. In addition, sex addicts are used to fantasy scenarios that may involve all kinds of erotic behavior that their partner may not wish to engage in. We are asking the recovering sex or porn addict to adjust to what they may see as “plain vanilla” sex.

Paradoxically, sex in real life may also be more unpredictable and less boring.  Sex addicts are used to controlling the sexual experience from beginning to end.  In sex addiction, the addict has a preferred scenario or arousal template. This can evolve and escalate into more extreme behaviors, but the addict knows what he or she is going to get.  Real, relational sex is not so predictable.  This means things may end up unusually exciting and passionate or they may end up less so.

Expectations of hyper-arousal and porn induced ED

In addictive sexual acting out, the addict seeks a very extreme form of arousal and often seeks to prolong it.  This level of extreme or hyper-arousal is unlikely to exist in any everyday situation.  Furthermore there is beginning to be evidence that porn addiction in particular can lead men to experience erectile dysfunction when they attempt to have sex with a real person.  This porn induced ED, as it is called, is reversible when the addict abstains from porn use for a period of time.

The use of ED drugs like Viagra is becoming increasingly prevalent, even among younger men and men who don’t need it.  Addicts in particular may have exaggerated ideas about what they need to be able to do to “perform” sexually and may be very anxious in trying to have healthy sex with a partner.  It is normal for men to have a physical response to what is going on around them and sexual “performance” can vary for any number of reasons.  It is unfair, inaccurate and inhumane to see these fluctuations as a sign of something wrong or bad.  In recovery there is often a period of insecurity about sex but this is not a signal to panic and reach for ED drugs.

Sex can be a good thing no matter how it turns out

Sex addicts are so zeroed in on sex as central to life that they don’t realize that it is only one aspect, not the be-all and end-all.  Sex addicts find it hard to fathom the idea that, for many people, sex is great but has its proper place among many other great things in life.  In relationships sex is no doubt very important but it is a source of bonding as well as excitement and gratification.  The behavior of the partners and the level of arousal will exist in a broader spectrum or array of experience.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Not Sure if You’re a Sex Addict?

It is normal to feel uncertain about this question.  Addictions are partly self-defined; especially “process” addictions like gambling, food and sex addiction.  Doctors and therapists don’t go out of their way to look for sex addicts.  If someone comes to me for sex addiction help it is because they suspect that they are having a problem with some sexual behavior that is out of control or is causing serious problems.  A sex addiction therapist may help them decide if that is true and can evaluate other possible causes or co-occurring condition.  The official criteria and categories of sex addiction may help in the beginning.

But even after a person has sought help or support groups for sex addiction, they may continue to wonder if they really are a bona fide sex addict.  This is so common as to be a predictable occurrence at some point in recovery.

Someone who has serial affairs or who has a habit of watching a lot of internet pornography may find him or herself sitting in an SAA (Sex Addicts Anonymous) meeting next to a person who did jail time for viewing child porn or who compulsively visits prostitutes or who exposes himself on buses.  The behaviors of addicts are so varied that it invites comparison.  “Am I really the same as him? Surely my problem is qualitatively different and less serious!”

Doubt is not the same as denial or minimization (although these can be involved as well.)  Other things can cause a person to wonder whether they should define themselves as a sex addict.

Sex addiction may not be the “primary” addiction

Many recovering alcoholics and drug addicts have a tendency to use sex as a substitute drug.  Even if they recognize they are doing this they may discount it as secondary to or a product of their chemical dependency.  See also my post on alcoholics and sex addiction

This tendency to discount sexual issues is especially common when there is an “addiction interaction”.  This is the situation where addicts have more than one addiction (and a great many do) and where the two interact in various possible ways.  A sex addict may use drugs as a part of a ritual prior to sexual acting out or as a way to numb the shame afterward.

Addictions may be fused with other addictions

When two or more addictions are only engaged in at the same time (drinking always goes with seeing prostitutes, drugs are always involved with gambling and sexual acting out) they are said to be “fused”.  This makes it very hard to identify one addiction as the primary one and so the addict may go from one program to another or feel confused as to why they cannot see any change.  When different addictions lead back to one another then the addict must quit all of them at the same time if at all possible.

Sexual acting out may not be continuous

When we think of a compulsive behavior we think of the person as seeking it constantly.  Sometimes this is the case and sometimes not.  There are many sex addicts who have a pattern of intermittent acting out with “down time” between their episodes of sexual acting out.  The period between acting out may be caused by remorse, or it may just be that the cravings for that behavior do not return as powerfully right away.

This episodic pattern can be of any length.  And during the periods between acting out, the addict may think they are in good recovery.  Therapists look for a situation in which the addict can go a week, a month or even several months without acting out and then relapse, almost like clockwork.  This is like the smoker who claims he can quit because he’s done it hundreds of times.   They seem to have some control and can quit for a particular period of time—just not for good.

Also it is not unusual for sex addicts in the first year or two of recovery to get totally turned off to sex.  This is a swing to the opposite extreme of sexual anorexia but does not represent real sexual sobriety.

The person who can sexually “act out” in moderation

There are probably some people who engage in secret, illicit or even risky sexual behaviors but who really are using the behavior as an occasional escape, and one over which they have a lot of control.  It is hard to say how many such people there are but I suspect there are a lot given the current prevalence of porn use, cyber sex, and sexual hook-ups (not to mention infidelity).  These people would probably not show up in a sex addiction clinic.   But the dividing line is such that those behaviors engaged in by someone who really is an addict will eventually lead to more frequent, more destructive or more serious sexual acting out behavior.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Subtle Signs of Self Hate: Recovering Sex Addicts Find New Outlets

There is a common saying among sex addiction therapists that “sex addiction is not about sex, it’s about pain.”    Sex addicts use one or more sexually addictive behaviors such as internet pornography, frequent visits to prostitutes or sexual massage parlors, compulsive sexual hook-ups or serial affairs and so on as a drug of choice to escape stressful or unpleasant feelings.

Sex addicts, like most other kinds of addicts have long-standing doubts about their worth as people.  They have early life histories that have left them fearful of intimate relating.  They are afraid to be open or vulnerable.  They protect themselves from situations in which they feel insecure by retreating into their addictive behavior, their fantasy life of sexual acting out in which they are soothed, gratified and safe.

Addicts may continue to experience low self worth even as they are becoming stronger in their recovery.  It takes a long time to understand and work through the feelings of low self worth and even longer to become confident and comfortable in their own skin. 

Substitute ways of acting out in recovery

Recovering sex addicts who are reliably free of their sexual acting out behavior may exhibit certain behaviors which get in the way of their work, their ability to relate to other people and their intimate relationships.  They are finding new ways to “act out” their feelings and fears now that they can no longer use their drug of choice.

In their work life and social life addicts often exhibit their need to escape their deep self doubt in one or more predictable ways, such a

Conflicts at work.  Addicts may have trouble getting along with others and may be irritable in ways that they never were before.  This is due to the absence of their ability to soothe themselves with their sexual behavior.   

Compulsive overwork or workaholism.  Addicts may pour themselves into their work as a way to escape having to deal with people or relationships.  Work can take up all the space that is left over in which the recovering addict feels ill at ease.

Comparing, competing and contempt.  These are the narcissistic behaviors.  They are an attempt to avoid self doubt and self hate by constantly judging others and trying to be one up.

Need to please.  In the absence of an inner sense of worth and validity, many sex addicts become pleasers.  They feel safe and soothed when they have the approval of others.  This takes the place of a skill they have not yet mastered, that of speaking their truth and being clear about their needs and feelings.

In close relationships addicts will engage in behaviors that tend to put distance between them and their intimate partner.  In this way they escape the demands of intimacy which they feel inadequate to meet.  They do this even as they exhibit codependent behaviors like the need to fix and control.  They will

Subtle or passive aggressive hostility.  This can take many forms such as sarcasm, contempt, sighing, groaning, and eye rolling.  This behavior expresses feelings indirectly which the addict feels incapable of expressing directly. 

Provoke conflict.  Recovering addicts often feel dissatisfied and irritable.  They may project blame onto their partner for this and they may escape intimacy by creating a rift. This can come in cycles, almost like an abuse cycle of lashing out, remorse, reconciliation and repeat.

Flirt or engage in other mini-sexual behaviors.  As discussed in my previous post about subtle forms of betrayal, sex addicts in recovery may use behaviors like flirting, ogling or talking about other people sexually, or reaching out to old girlfriends or boyfriends online as a substitute for their earlier sexually addictive behavior.  This is a way to give themselves a small bit of their drug, a mini “fix.”

Avoid sex.  Sex addicts may take a long time to get comfortable with a sex life with their partner.   Even if they enjoy it, their whole inner sexual landscape has been revamped in recovery and they may have new fears about sexual intimacy such as sudden attacks of performance anxiety or other fearfulness such as jealousy.

Overcoming all of these insecurities and learning to feel and express feelings takes time and patience for both the addict and those around them.  Sex addicts in recovery are building a sense of self and acquiring a set of interpersonal skills that they never had before.  They will get there if they and their spouse or partner or trusted friends are honest about what is going on.

 

Is Healthy Masturbation Part of Sex Addiction Counseling?

I am returning to this topic because it is one that comes up repeatedly in sex addiction counseling.  Masturbation to pornographic images or fantasies is not necessarily an unhealthy thing on its own. But for sex addicts the uncontrollable acting out of particular sexual fantasies and the act of masturbating while having specific sexual fantasies are very similar processes.

If the addict’s preferred acting out behavior is visiting prostitutes, going to sexual massage parlors, anonymous sexual hook-ups, cyber sex, porn, serial seduction or more likely some combination of behaviors, the fantasies that accompany masturbation will likely mirror those activities.

Sex addicts have what therapists call an “arousal template,” the sexual scenario that they find most exciting. To the addict it is far more thrilling than any other sexual activity; it should really be called the hyper-arousal template.  It may be any one of a myriad of sexual experiences, remembered or imagined, but that scenario is what they return to when they masturbate.

If not an exact repeat of the behavior, the masturbation fantasy will likely contain the essential elements of the arousal template, such as dominance, submission, multiple partners, the feeling of being intensely desired, or any of an array of specific sexual acts or fetishes.

Risks of masturbation during recovery

A great many sex addiction therapists believe that in the initial phase of recovery when the addict is trying to abstain from compulsive sexual behavior, that sexual activity should be avoided entirely, including masturbation.  Even if masturbation is not part of the addict’s acting out scenario per se, it will most likely bring up fantasies of that activity which in turn could trigger the addict to relapse into the full-on behavior.

A sex addict who compulsively seeks sexual encounters with people he or she recruits from online sources such as personal ads may masturbate while thinking of these hook-up experiences.  But this can bring up urges for more, which in turn may lead to the addict “taking a quick look” at the online ads or photos, and then to actual acting out.

When sex addicts use masturbation to “relieve the tension” in order to (theoretically) avoid their preferred sexually compulsive behavior, they may be perpetuating their problem.

In sex addiction counseling we often discourage using masturbation in this way.  If it is a watered down version of the behavior the addict is trying to quit, it has the potential to simply prolong the process of withdrawal.  The addict is trying to “kick” the habit of a compulsive sexual behavior, one that is secret, alienated and often surrounded with shame.  And reliving that behavior in masturbation fantasies is like methadone maintenance for opiate addiction.  It is not the same as getting sober.

Adding masturbation back into the program

When in the recovery of the sex addict, or in the process of sex addiction counseling, is it appropriate to allow for masturbation?  Using masturbation in recovery depends on:

  • The addict’s ability to masturbate without addictive fantasies.  This is difficult for most sex addicts as they often find it hard to get aroused or to climax with different fantasies or no fantasies at all.
  • The addict’s ability to masturbate to orgasm and avoid “edging.”  Edging is the process of repeatedly bringing oneself to the edge of orgasm, pulling back and starting again as a way to prolong arousal.
  • The addict’s ability to plan to masturbate rather than doing it when a sexual urge arises.  The spur of the moment decision to masturbate may be due to urges or triggers that the addict should pay attention to and deal with in other ways than simply reacting sexually.

How masturbation can be useful in sex addiction counseling

Masturbation can be like a sexual laboratory.  Here are some of the ways in which the addict can use masturbation to explore and learn about himself or herself.

  • Psychological factors surrounding the act of masturbation.  Arousal and orgasm may bring up ideas, voices from the past that have played a role in shaping the addict’s sexuality.
  • Emotions or even “body memories” can crop up when masturbation is done without going off into the trance of addictive fantasies.  These emotions and memories may relate to past traumatic experiences that the addict has never worked through.
  • Some people in sex addiction counseling can experiment with changing their fantasies while masturbating.  They can use masturbation to “stretch the envelope” i.e. to go to fantasies and images that are more in the healthy range for them, like thinking about the person they love.  For some this will be a return to a more normal time in their life.

Some people have become free of sex addiction through years hard work in their sex addiction counseling program and have begun a new way of living.   For these recovered addicts, masturbation is often neither compelling or triggering.  It can then take its place as a normal kind of sexual activity.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

When are Sex Addicts Ready for a Relationship? Here’s a Checklist

Most sex addicts enter sex addiction treatment with a warped sense of what relationships are all about.  The relational trauma in early life that made them addicts also results in their having:

  • No models of healthy relating over time
  • No experience of giving or getting appropriate nurturing
  • No set of relationship skills such as openness and mutuality

Some sex addicts avoid relationships altogether, preferring to limit their intimate contact to porn, prostitutes, hook-ups, cybersex or other sexually addictive behaviors that allow them to avoid the demands of real connection with someone.

Other sex addicts form relationships and marriages while they are secretly active in their addictive behavior.  They too are avoiding intimacy.  They cannot share their deeper feelings with a partner due to fear of being hurt or abandoned.

Mistaken ideas about what relationships are for

Here are some of the superficial ideas that often form the sex addict’s paradigm of what a relationship is for:

  •  A relationship will bring me social recognition and acceptance in a world I want to belong to.
  •  A relationship with a glamorous person will make me proud and confident and make others envy me.
  • A relationship with the right person will provide the perfect balance to my life.
  • A committed relationship with children will make me a normal person with a normal life.
  • We will be considered a “great looking couple.”
  • The right relationship can cure my addictions.

These ideas come out of a sense of inadequacy and reflect the addict’s inability to imagine a healthy bond.  They reveal his or her narcissistic view of a relationship as a useful accessory and a partner as a fantasy.

Recovery lays the groundwork for relationships

In recovery sex addicts have gained enormously in the areas of self-awareness, self control, accountability, honesty, sharing and empathy.  They have learned to connect with themselves and with others.  And they have learned that they are worthy to be loved and that commitment requires vulnerability.  They are less self conscious, more confident and better at communicating.

All of this does not guarantee that the addict is ready for a relationship. Here are some questions that may help clarify whether the addict is ready to try again.

A relationship readiness checklist*

1.      I am more aware of what I am feeling at any given time and I am more able to identify feelings and think and talk about them.

2.      I have taken care of my basic health needs including having an STD test and other routine tests. If I have been prescribed psychotropic or other medication I follow up on appointments and on the use of medication.

3.      My ability to focus on whatever I am doing is improved and I don’t feel anxious and pulled in different directions as much.

4.      I enjoy having “down time” and I don’t feel like I have to do something all the time.

5.      I have learned that I can go to a counselor or other person I trust for help or advice and I can listen to what they say even if I disagree.

6.      I am aware of any problems I have with other addictions and I have done what I needed to do to address them.

7.      I have found ways to keep myself accountable regarding my addiction that rely on people other than a spouse or partner.

8.      I am willing to try out new activities and interests and I am OK if some things I try don’t work for me and others do.

9.      I am willing to experiment with changing my daily ritual.

10.  I have a greater sense of what I want and need and am clearer on what things interest me in life.

11.  I am more interested and confident in my work or other activities.

12.  I am more flexible and more tolerant than I used to be.

13.  I feel like I can stick up for myself when I need to without going overboard.

14.  I am not as self-conscious about initiating a social contact and I can be more comfortable just being myself.

15.  I no longer feel anxious or apprehensive when I am alone.  I would like a partner but I am OK without a partner.

Having achieved these milestones is a minimum requirement for a recovering sex addict who wants to start out with a new relationship.  But the addict will still have some work to do to.  Applying these new found skills in intimate relationship without repeating the mistakes of the past is the next biggest challenge in recovery.  It takes time, practice and a whole lot more self-examination.

*From my book “Relationships in Recovery: A Guide for Sex Addicts who are Starting Over.”

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Intimacy Disorder and the Healing Power of Confrontation

Sex addicts seem to be good at looking out for themselves, but in reality the opposite is the case.  They are most often crippled when it comes to relating in a confident and genuine way.  Instead of speaking their truth, sex addicts rely on avoidance, aggression, placating and manipulation.

I believe this is part of the codependence that is at the root of all addiction.  Sex addicts predictably approach other people with insecurity and mistrust.  They have early life experiences that leave them alienated: expecting little from others and fearing abandonment, abuse or neglect.  Being open and genuine in interpersonal intimacy is felt as stressful and potentially dangerous.  This is an intimacy disorder.

Aggression vs. assertion

Self assertion, including healthy confrontation, is actually the opposite of aggression in all the important ways.  What is the difference?

Assertion involves saying and doing things that will give you the best chance of getting what you need but not at someone else’s expense.

Aggression involves saying and doing things designed to get what you need at someone else’s expense.

If you are assertive you are clear about what you need and want but in a way that is respectful of the fact that the other person may or may not go along with what you want.  You have a right to ask for anything, but the other person has a right to say no.

In aggression, you try to push, bully, manipulate or frighten.  You make the other person do what you want but you create a negative experience which is harmful to them.  You get what you want but you damage the relationship.

Avoidance, placating and manipulation

Addicts are often so lacking in the confidence that they cannot tolerate being vulnerable to potential rejection or open to negotiation.  They seek instead to control the situation as a way to stay safe.  They may completely avoid talking about anything that goes on inside them.  Often they have a very elaborate “façade” by which they appear to be what they think the situation demands.

Other times addicts simply bury their own strong needs and feelings by just going along with whatever their partner wants.  Placating is a way of staying in control by dodging any situation which the partner might not like.  This works for the addict because although they resent playing this “childlike” role, they have an outlet, a secret life of acting out that allows them to gratify themselves unhindered and without risk.

Manipulation is another form of control that allows the addict to dodge real communication and avoids negotiation and compromise.  It can be aggressive, as when the addict “guilt trips” their partner or it can be underhanded, as when the addict pits someone else against their partner to achieve an outcome or dishonest, as when the addict flat out denies what their partner is experiencing and tries to distort their reality.

In any of the above examples, the addict is avoiding any real confrontation because (a) it is not something they feel they know how to do very well and (b) it is frightening to be transparent with their feelings and needs.  But intimacy in a relationship demands that both people be willing and able to be clear and open about what they want, how they feel, and how things affect them.  No one can do this all the time and no one can be expected to do it flawlessly.  But if one or both of the partners cannot put their needs out on the table they have placed a drastic limit on where the relationship can go.  Learning healthy confrontation can go a long way toward resolving intimacy disorder.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource 

Signs of a Porn or Sex Addiction Relapse

When a client who is trying to avoid a sex addiction relapse has had a slip I can often tell before they say anything about it.

At first I wasn’t sure what it was that I was seeing; whether it was just intuition or whether they were actually doing something different.  And with some clients I could tell right away and with others I couldn’t.  So what was the difference?

Signs of a relapse

When I see clients who have had a slip since the last time I saw them I can sometimes spot the following signs:

A difference of style.  The addict who is coming in laden with the knowledge that he has had a slip will likely be thinking about the fact that they have to discuss it with me.  This often results in their seeming to be superficially jocular or casual.  They seem to be tap dancing, probably because they feel embarrassed or ashamed about having let themselves and me down.

A difference in cognition.  To a greater or lesser extent, a sex addict who has had a slip or a relapse will be suffering from the aftereffects of their drug.  In order to go into the slip in the first place, the addict will have had to let go of part of their rational thinking, the part that has to do with weighing consequences, and thinking logically about the decision they are about to make.  This suspension of higher order thinking, being in the “bubble” as it is called, may have residual effects on their apparent ability to think clearly and communicate clearly.

Lack of focus.  The addict who has had a slip may seem scattered in the aftermath.  They are not completely able to integrate what they know they have done to endanger their recovery and part of them doesn’t want to think about it or about anything else.  They may deflect or divert the conversation and go off on tangents.  They may even be questioning their interest in recovery, their need to change or the appropriateness of the program.

When are these signs missing?

Why is it sometimes easier for me as a therapist to spot a client who has relapsed than it might be for other people in their life, even their partner?  And when are they able to fool me as well?

I think the answer has to do with the level of commitment to recovery that the addict has achieved.  Most of my clients are trying to be honest with me.  When they have something to say that they would previously have lied through their teeth about, they have an automatic high level of cognitive dissonance about it which causes some visible distress symptoms.

Likewise when the addict is still somewhat on the fence about whether and how much of their sexual acting out they really want to give up, then they will be better able to lie to themselves and therefore their deception will be more impenetrable.

It follows that the more someone has become committed to recovery the more difficult it will be for them to conceal the truth from someone they are close to.  When an addict has not really given up the need for secrecy as a way of life, they will more readily adopt a false persona that may be hard to see through.

An addict who has lied to his wife for years and then gotten into recovery may be better able to slip into old deceitful habits with her than with a new person such as a therapist.  The addict may have been doing well in recovery so far but when it comes to intimate relationships, recovery is more than just avoiding sex  addiction relapse. Relationship recovery and the building of honesty and trust is a long term process that involves revamping the entire basis of the relationship.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Is Sex Addiction Treatment Anti Sex?

Those who think that sex addiction treatment is anti-sex are not paying attention.  Some people who say they are “sex positive” claim that sex addiction therapists shame or judge their clients for their sexual behavior.  They go on to conclude that we are “sex negative” and wish to limit people’s sexual choices.

This is a big topic but I want to try to clarify some points about sex addiction treatment and its underlying assumptions.

Sex addiction is largely a self-defined problem

Sex addiction treatment does not label people as having a problem with their sexual behavior.  Rather we try to help people make that determination for themselves.  We do not assume that they are having too much sex or that their unusual sexual activities are unhealthy.

The idea the sex addiction therapists want everybody to have “missionary position” sex with an opposite sex partner in a committed relationship is a complete misrepresentation.  I had a client who got aroused by being choked during sex.  This is unorthodox, maybe even dangerous, and I don’t go out of my way to recommend it, but it wasn’t a problem for her because I thought there was something wrong with it.  Rather she herself decided it was a problem in her life.

How people decide sexual behavior is a problem

The criteria for whether or not someone has a sexual addiction or problem sexual behavior rely on the person’s own report of what is going on in their life.  Among these criteria are the ideas that the behavior has negative consequences in the person’s life.  These include such things as the following.

  • The pattern of sexual behavior is such that it gets in the way of their having or maintaining a kind of relationship that they want.  Often a spouse or partner insists that their behavior is out of control and intolerable.  And often the prospect of losing a loved one makes it clear to the client that they want to change their sexual behavior.  Other times the person’s sexual behavior prevents their being able to establish an intimate relationship with anyone.
  • The behavior causes them significant problems in their life such as getting fired for using pornography at work, getting hurt or arrested due to behaviors like indecent exposure, spending their paycheck on strip clubs and prostitutes or bringing sexually transmitted diseases home to their family.
  • Sometimes the consequences of the behavior have to do with internal discomfort, the feeling “I don’t want to be like this the rest of my life.”  In this case the negative consequence is the fact that the person can no longer ignore the extent to which their sexual compulsiveness or sexual preoccupation goes against their own value system.  I have heard people say “I don’t want to be that old guy sitting home alone watching internet porn for hours” or “I don’t want to keep spending all my time looking into neighbors’ windows hoping to see someone nude.”

In other words, sex addiction therapists don’t go out looking for addicts and trying to convince people that they have a problem.  This just doesn’t happen.  Addicts come to us in pain, often in crisis.

What happens in sex addiction treatment?

An initial period in which the addict abstains from all sex provides a way for the addict’s head to clear; it is not intended as a way of life.  Much as it is impossible to do counseling with someone who is high on drugs or alcohol, it is also hard to deal with a sex addict who is high on his/her drug of choice.  Sex addiction treatment proceeds to:

  • Help the addict define and understand the behavior that is of concern
  • Help the addict understand the origins of the behavior i.e. what drives it and its roots in early life experiences
  • Understand the role of other addictions such as drugs, alcohol, gambling or work as they interact with or support the sexual behavior.
  • Help the addict see that he/she is not alone; connecting with other addicts reduces shame and allows for an honest an open dialogue.

When we do sex addiction treatment in this way we are helping clients develop their own definition of sexual recovery and giving them the tools to get there.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource