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

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  1. It sounds good to let the client decide what sexual behaviors are a problem, but I can think of some situations where I’d hope clinicians wouldn’t take a client’s self-assessment at face value. As a young gay man I would of told you my sexual orientation bothered me, and I would of done anything I could to change it. Today, I regard so-called “reparative therapy” which attempts to turn people heterosexual as abusive.

    Your thoughts?

    • Well, folks can recover from an addiction if it’s what they want. Therapists do provide lots of info and assessment tools which can help clients get an understanding of their own behavior based in inner and outer reality. I don’t believe that people should be encouraged to “overcome” homosexuality. It is not a psychological problem. If a client thinks it is causing distress or self hate I would be inclined to explore those psychological issues. A big topic– I appreciate your comment!

  2. Sex/porn addiction is a myth. Why is it not listed in the DSM V? Because it is not backed by conclusive science. Pseudoscience is one of two drivers to sex/porn addiction vernacular, while the other is religion. Though they both are derived by level one errors in which one makes an erroneous judgment about the perceived danger of “too much sexual stimulae”, or even the superstition of a judgmental and almighty God who is watching your every move. ED for example does not occur by chronic pornography viewing but has more to do with heart disease. The way I see it is that men (in general) like to have a daily orgasm but find that being with a real woman who is turned on every day by them a fantasy. So they turn to pornography as an outlet for their higher libido. The only problem is that he, in all of his genetic authenticity, is a healthy sexual human being. Why use a label such as “addict” on normal people? My other question is, do you CSATs treat for those who have recurring wet dreams? My wet dreams often include pornographic imagery. Bottom line is that treatment for “sex addiction” is pseudo-therapy. Many times the issues go much deeper than the sex. And I would never claim that the spouse involved is completely blameless as you have asserted on your site. Life just isn’t that simple and one sided…nature/nurture as they say.

    • I have noticed that the author has not replied to you D, which implies that what you have stated is absolute and correct. I could not agree with you more unless a new level of agreement is created. She is the face of pseudo therapy, apparently in it for the money, or because she herself needs more training in this field.

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