What is involved in becoming a certified sex addiction therapist or counselor?
First, an important point to remember is that only therapists already licensed or otherwise credentialed in their particular counseling field (e.g. psychologists, clinical social workers, marriage counselors, pastoral counselors) are eligible to enroll in the CSAT training.
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
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
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
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
If you are a clinician working with sex addicts you may be struck by how often the addict is desperate to save their marriage or relationship. Sometimes to the point of being so obsessed with holding onto their relationship that it interferes with their focusing on treatment.
It may not be immediately obvious why this is so. Addicts appear to be focused mainly on themselves. Typically they:
-are sexually compulsive outside of the relationship
-are intimacy avoidant
-use coping skills which create distance
-lead a double life
We typically think of the spouse or partner of the addict on the other hand as the codependent:
-fearful of abandonment
-enmeshed and preoccupied with their partner
-emotionally constricted or volatile
-subject to self-doubt and insecurity.
And yet most married sex addicts entering treatment (more often they are men but by no means always) exhibit exactly these signs of codependency. They may exhibit them more than their supposedly “co-addict” partners.
Origins of codependence
People who exhibit codependence have typically had some kind of stress or inadequacy in their relationship with their care-givers early in life. This is sometimes referred to as “relational trauma.” This early relational trauma causes the child to grow up with mistrust of those close to him and to be insecure and avoidant regarding relationships and sometimes regarding the world in general.
Instead of growing up with a strong internalized sense of self, the codependent survives childhood by using one or another “strategy” by which to adapt to a less than nurturing situation. These strategies, like numbing out, distracting oneself, suppressing feelings, being over compliant, etc. take different forms depending on the kind of relational stress and the nature of the relationship with the parents.
But bottom line, the development of the sense of self is impaired in an attempt to get the caregiver’s approval or love. The codependent’s core belief is “my worth as a person depends on my value to someone else.”
In what way are sex addicts codependent?
Although sex addicts may have a façade, a “narcissistic false self” as it is sometimes called, they have typically grown up with some serious disruptions in their intimate relationships with caregivers. This can take the form of abuse, but not always. Often the parents of addicts are distant, repressed, rigid or disengaged.
Patrick Carnes has pointed out that relational trauma is “a powerful factor in the genesis of addictions and compulsions.” In Carnes’ theory the addict shares the same fears, mistrust and basic sense of unworthiness as a codependent. The lack of a strong sense of self and of self worth underlies the intimacy avoidance of addicts and the tendency to medicate their fears with sex and to split their sex life off from their normal life.
The belief that they are unworthy and that they are only lovable to the extent that they can please someone else, can lead to the addict’s extreme fear of abandonment and rejection by the very partner that they have betrayed.
A passage in the Co-Dependents Anonymous “Big Book” states this point clearly:
“Since the very nature of existence is relationships, and I had a disease that precluded my ability to maintain healthy relationships, I began to see that I was pretty well screwed.
I think of the disease of codependence as a tree.
The roots of the tree are my childhood abuse and neglect. The branches are my acting-out behaviors I developed to cope with life. Both the roots and the branches have to be healed (my italics).
I cannot stop the acting-out without healing the damage that spawned the behavior, and likewise, I cannot work on the roots if I’m still medicating myself with my addictions.”
Understanding and working through these underlying early childhood issues will dismantle the unconsciously held core beliefs and allow for the emergence of a real self and real intimacy with another. Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource
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:
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.
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
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
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
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
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.
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).
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.
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.
*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
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