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

3 Gateways to Intimacy: Things You Can Practice Doing Now

Intimacy is the ability to be real with a significant other, the ability to be known for who we really are.  And being seen in this way requires that we are secure enough to take a risk and be vulnerable.

Sex addiction has been described as an “intimacy disability.”  Addictive behaviors are ways to deal with stress and negative emotions; ways that do not depend on other people for soothing or emotional support.  Addicts feel mistrustful about being open with their needs and have a deep rooted belief that no one who really knew them could love them.

In recovery, addicts learn to reconnect with themselves and with their inner feelings without running away.  And they learn to reconnect with other people with more trust and less fear of rejection.

But addiction treatment does not automatically resolve all the addict’s fears about being known and about sharing all of themselves with a partner.  Becoming intimacy-“abled” is a much longer process than that of simply kicking an addiction.

Building intimacy skills

It is all very well to tell people to stop judging, to set appropriate boundaries or to “speak your truth in the moment.”  But these can seem pretty abstract and hard to put into practice.

Here are some specific kinds of behavior that the addict can focus on and some ideas about why they may help promote intimacy.

Nurturance

Nurturance involves giving someone what they need.  But in a relationship with a partner it also implies that the nurturer gives something (reassurance, food, listening, back rubs etc.) willingly and without resentment.  You don’t have to be a saint to nurture someone, and you can even do it because you are convinced that it is part of what you should do as a partner.  But real nurturance does mean that you give some attention to what the other person is feeling and that you are sincerely motivated to be kind to them.

Why does being nurturing foster intimacy?  Because it promotes empathy and an understanding of what your partner is like inside.  If done in the right spirit, nurturing makes us more able to be caring.  And taking care of someone is a way for them to feel our love and for our love to become deeper.

Also nurturing another person has the potential to bolster our own self esteem, even if that is not the original motivation.  When we give freely in this way it means that we are “full,” that we are not always worrying about our own need for self enhancement.

Mutual process

How do you relate to a partner when dealing with something specific in your life together?  It could be anything: an analysis of a movie you saw, a decision about buying furniture, or a discussion of one another’s plans and fears.

Addicts are all-or-nothing people: either we do it my way or we do it your way.  Instead of engaging in a constructive back and forth the addict will simply try to convince you of their own point of view.  If you are right they are wrong.

Approaching a question or topic as something to be decided together by a back and forth of ideas is new behavior for many recovering addicts.  But even if it is hard to believe that your partner could be right about anything, you can still practice listening and responding to what the other person says.

This is not the same as arguing your point and trying to convince the other person.  The point is to take a breath and allow the other person’s ideas to stimulate your thinking.

It is obvious how mutual process supports intimacy.  The “we” is greater than each of you alone.  In mutual processing you are building something together.

Shared experiences

It has been said that “love is not gazing into each other’s eyes, but it is gazing together at something else.”  When you can share and experience with someone you are automatically providing fertile ground for intimacy.

People who share intense experiences like being in combat in the armed services know that there is an automatic intimacy of a sort just from having gone through the same thing.  When we share something we re-affirm our common humanity because, to a great extent we have the same reactions to things.  This is especially true for powerful experiences like joy and triumph.

But sharing a joke or a sunset or a silly cat video can help feed intimacy.  This does not require any particular skill; simply that you make sure that you include times when you share experiences in your daily life together.

Fake it ‘til you make it

Fake it ‘til you make it is an idea that is often heard in 12-step meetings.  It means that you engage in healthy behavior even before you have fully embraced it.  And the theory is that in time you will come to feel that it is part of who you are.

In relationships it is also important to engage in specific caring behaviors and ways of relating.  Otherwise couples can end up endlessly talking, reading and “working on the relationship” without really getting anywhere.

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 

Is Your Relationship Addictive? Take the Self-Test

Relationships should feel good.  They should be happy and loving most of the time.  Addicts, recovering addicts and partners of addicts often have relationships that are the opposite.

As Patrick Carnes has pointed out in his writing, both sex addicts and their partners often have many similarities in their psychological makeup.  Both addicts and partners of addicts often come from families in which relationships were dysfunctional and appropriate nurturing was unreliable.

This early relational trauma leads to both fear of intimacy and fear of abandonment.  And these can lead couples into patterns of relating where each feeds the other’s unhealthy dynamics such as avoidance, manipulation, lack of openness, fear, and over-control.  See also my post “When Love Addicts Fall for Sex Addicts.”

Mistakes addicts and partners make

  • Mistaking sex for intimacy

Most sex addicts and many partners of sex addicts place an undue emphasis on sex as the most important aspect of the relationship or as the proof of whether the relationship is loving and devoted.  Sex addicts have little experience of healthy intimacy and place an undue emphasis on having their sexual needs met, either inside or outside the relationship.  Partners may allow themselves to see their addict’s powerful sexual attraction as the only or most important aspect of love and intimacy.

  • Lack of Courtship Skills

Addictive relationships often begin with sex.  By building a relationship on sex and romantic passion, addicts and their partners may ignore the process of getting to know each other in a healthy way.  There is nothing wrong with enjoying feeling swept away, but it shouldn’t prevent you from learning about one another as part of a process leading to healthy commitment.  In a more normal courtship, people take it slower and ask more questions about the other person’s situation, their relationship history, their feelings about relationships etc.  And they also do not approach the situation with any ideas about what they might need or want in another person (aside form feeling swept away).

  • Mistaking Intensity for devotion

Many addictive couples have patterns of high intensity and high drama in their relationships.  They may have frequent and even violent conflicts and they make often break up and get back together.  Their interaction may be characterized by jealousy, threat, competition, and fear, all of which are mistakenly interpreted as signs that the relationship is the most important and most deeply committed one in their life.  Nothing could be further from the truth.

  • Mistaking power for trust

People who feel inadequate to the demands of an intimate relationship or who are overly fearful of abandonment may have an excessive need for control in their relationships.  Instead of feeling safe and secure in the knowledge that they can deal with problems that arise, they are closed off and mistrustful.  This leads to a vigilance about what the other person is doing and a lack of openness in communication.  The excessive need for control is based in the person’s own insecurity about their ability to sustain a relationship, their worth as a partner and their partner’s reliability.

An addictive relationship self-test*

The items in the test below are informally compiled based on my clinical experience and reading on this topic.  These problems are not unique to addicts and may be experienced by anyone with impaired intimacy and relationship abilities.  But they are very characteristic of addicts and often of the partners of addicts as well.

  1. Growing up I didn’t see my parents as consistently loving, and contented with each other.
  1. My relationships typically start with an intense sexual attraction and rapid involvement.
  1. I find it easy to start relationships but they always get complicated.
  1. I find it hard to know how to get out of a bad relationship.
  1. I sometimes think I stay in a relationship because I am afraid of being on my own.
  1. I am afraid of my partner’s anger.
  1. I sometimes placate or manipulate my partner to avoid confronting things.
  1. I find it easy to get into thinking that my partner is to blame.
  1. My partner and I don’t talk about our feelings about the relationship.
  1. In my relationships one person is always less devoted than the other.
  1. Either I feel superior to my partner or I feel my partner is superior to me.
  1. I am dishonest with my partner at times to avoid upsetting him/her.
  1. When I am in a relationship my partner and I don’t socialize with friends as a couple very much.
  1. Either I or my partner is always trying to get us into some kind of therapy.
  1. I feel that having a good relationship is hopeless.

*Taken from my book Relationships in Recovery: a Guide for Sex Addicts who are Starting Over

When you look at this list of statements, it should be clear that what I am calling addictive relationships are characterized by things like negativity, turmoil and alienation.  A person who has the emotional development required for healthy intimacy would avoid or even run from such a relationship.  Without a level of openness, security and contentment it is impossible for relationships to succeed and for the partners to flourish.

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

Do Happily Married Men Go to Prostitutes?

I’ll go out on a limb and say that a married man who visits prostitutes repeatedly is probably not the happiest kid in the sandbox.  Although the wives of such men may feel the behavior reflects on their desirability, my experience tells me that such a pattern of behavior doesn’t have anything to do with the wife’s attractiveness.  It says something about the man who, most often loves and feels committed to his partner.

Paying for sex on a regular basis is not the norm, even for single men.  And it can be a sexually addictive behavior, in which case it has to do with the man’s emotional problems including his problems dealing with relationships.

Who are these men who pay for sex?

An article published earlier this year called What Kind of Men go to Prostitutes?  reviewed some of the recent research and survey data on men who visit prostitutes.  The studies indicate that between 1 and 3 percent of men in the U.S. have gone to a prostitute in any given year and about 14 % of men have paid for sex at some point in their lives.

The studies also indicate that men who hire prostitutes are only slightly more likely to be single than married.  And furthermore they do not appear to differ much from the general population of men.  The men’s reasons for having hired prostitutes were seen as predictable: wanting more sex, being unhappily married, being insecure about dating, wanting the excitement of risk, and wanting power and control.

An outcome study of men who attended a “John School”, a criminal diversion program for men who are arrested for paying for sex, reported that:

“Johns report a variety of reasons for why they purchase sex including the feeling that buying sex is an addiction. Interviews with “Johns” revealed that 83 percent of participants identified buying sex as an addiction (my italics) (Durchslag & Goswami, 2008).  Additionally, research suggests that men who participate in the commercial sex industry often view women as commodities and feel a sense of entitlement to sex. Interviews revealed that men who did not have a regular sexual partner also legitimized purchasing sex (Monto, 2000).”

The Johns as a group also consisted of married and single men.  Were all the married men paying for sex because they were unhappily married?  This is unlikely, because Johns as a group are characterized as unhappier than other men.  And besides, if they have problems with sexual behavior this could account for their unhappy marriage as much as the other way around.

Unfortunately there is not enough known about the demographics of the John population or the prevalence of psychological problems.  These are still very much being debated.

Paying for sex and sex addiction

I feel on firmer ground talking about the kinds of relationship dynamics that are commonly seen in men who show up for sex addiction treatment where paying for sex is one of their compulsive behaviors.

As with sex addicts in general, men who visit prostitutes most often have other sexually addictive behaviors.  These can include compulsive porn use, cybersex, strip clubs, and sometimes offending behaviors like exhibitionism and others.  Going to prostitutes is thus part of an pattern of sexually addictive acting out behaviors.

The fantasy element in sexually addictive behavior

Whatever the specific behavior, sexual acting out is always largely a fantasy.  It takes place outside of the person’s “real life” and it functions as a drug.  While engaging in the sexually addictive behavior, the addict escapes whatever is painful and achieves a totally gratifying experience on his own terms.  This implies that the man has issues that he cannot resolve, or issues he would rather escape than allow his adult self to face head-on.

The avoidance of intimacy in sexually addictive behavior

Paying for sex is exactly the same as any other sexually compulsive behavior in that it is part of a pattern of intimacy avoidance.  What is the addict escaping from when he is avoiding intimacy with a partner?  It is not that the prostitute has so much more to offer than the spouse.

The sex addict experiences intimate bonds as frightening and overwhelming.  Being with a prostitute is safe, limited and controlled interaction.  The addict can relax and feel safe from the dangers of getting hurt, abandoned, rejected or feeling inadequate.   The sex addict feels unlovable and insecure and meets his needs for sexual abandon in a contrived, compartmentalized way.

Sex addicts feel bad about their addictive behavior afterward but they continue to do it.  If a man who is not an addict visits a prostitute he may feel many things but he will not be driven to repeat the experience.

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