Sex is a normal human need, but for some people, sexual behavior becomes compulsive, and the behavior remains out of control despite feelings of shame and harmful consequences. Experts know that sex addiction is not about sex. Instead, sexual behavior is used as an escape from unpleasant feelings—feelings that can be successfully addressed in psychotherapy.
You are the founder of the Marylebone Centre in London, which focuses on treating people with relationship problems, sexual compulsivity, and mood disorders. You were one of the first to address issues of sexuality in the U.K. Exactly how do you define sexual addiction?
The usual answer is that it is defined by four criteria: out of control, harmful consequences, not being able to stay stopped, and it has a function. As the first three potentially apply to sex in general, I focus on the last criteria: function. It is sex used to relieve painful and intolerable feeling states. These include depression, shame, anxiety, boredom, low self-worth and, sometimes, problems hidden in the structure of the primary relationship.
Is it a problem among women as well as among men?
It is said to be a problem for women, as well as men, but almost all of my patients have been men. The literature suggests that women are more prone to being “addicted” to relationships. The press is always ringing me up to ask about female sex addiction. I suspect that this is driven more by male hopefulness than by any other serious consideration.
How does sexual addiction begin?
It usually begins in adolescence, where sex can be a reliever of problem feeling states. When it is combined with a paraphilia, it could well start much earlier, in childhood. It can emerge later in life, often as a response to stress or trauma.
What prompted you to write this book?
I wrote the book as a self-help guide for people who do not have access to organized programs of treatment or who are not yet able to move forward in group treatment. It is based on my first book, CBT for Compulsive Sexual Behaviour: A Guide for Professionals. Cognitive-behavioral therapy has the best evidence-based effectiveness in the treatment of related disorders.
Does sex addiction exist apart from addiction to pornography?
How do people know whether they are sex-addicted?
The only person who can really know is the person himself. If it is a problem to him/her, then it is a problem.
What is the role of shame in sexual addiction?
Shame is a central driver for sex addiction. Unwanted sexual behavior creates more shame and a repeating cycle is set up.
What is the most misunderstood aspect of sexual addiction, in your experience?
It is not about the type of sex preferred or the amount of sex that is wanted. It is about the function of the behavior to relieve painful affect states. It is not sex for recreation or intimate purposes but sex as an analgesic.
Why are the strategies of cognitive-behavioral therapy a good match for sexual addiction?
Because they provide a systematic and structured process to help men understand and change the behavioral pattern. Our treatment program is evidence-based.
Are some particular elements of CBT the most helpful in treating sexual addiction?
There are four components that have been voted most useful by participants in treatment: the Trauma Egg [which gives information about developmental trauma], the Cycle of Addiction, the telling of your personal story for group feedback, and relapse prevention.
What is the role of partners of people with sexual addiction?
The most useful role is to be supportive of the partner’s desire to change the behavior.
What is the most surprising thing you discovered in researching this book?
Nothing surprises me about human nature.
If you had one piece of advice, what would it be and to whom would it be aimed?
I would tell people that it is only a problem, if it is a problem.
There is considerable disagreement whether the concept of sexual addiction exists. What do you say to those who argue it is not a scientifically valid construct?
I am fully aware of the controversy over the term “sex addiction” and, therefore, in therapeutic work I use the term “problematic sexual behavior.”
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