In the 1980s, addiction models were becoming increasingly popular, and the sex addiction model tagged onto that wave. Twelve-step groups on behavioral addictions were forming everywhere. The groups, as well as the information, were easily accessible, and clients understood the concept immediately. I became a certified sex addiction therapist, and fully embraced the model until 2010 when I began to see some serious flaws. For instance:
* Sex is not as simple as I had learned. It is far more complicated and messy psychologically, both very ordinary and very weird in everyone. Sexuality is a kind of mystery to us all, and may take us in all kinds of unexpected directions.
* The definition and treatment of sexual addiction is complicated by values, morality, and religious overtones of treatment providers. In the sex addiction model, sexual recovery is left to the therapist’s and spouse’s moral judgment and discretion. It lacks an informed, educated and research-oriented basis to assist the client to achieve his own sexual health.
* As our understanding of the range of human sexuality has expanded, many within our profession have ceased to pathologize certain sexual behaviors, recognizing that, practiced in safe and consensual ways, such behaviors often not only enhance people’s happiness and well being, but are neither “unnatural” nor “abnormal.” Rather they are part of the panoply of pleasure available to us as sexual beings.
* The sex addiction model uses a widely used and widely available sexual addiction screening test, which therapists can administer to recognize areas that are “problematic” within their clients’ “arousal template.” Clients are asked if they have purchased romantic novels and sexually explicit magazines, spent time and money in strip clubs, have paid prostitutes, or even if anyone has been upset by their behavior. They are asked if they regularly engage in sado-masochistic behavior, or regularly attend bathhouses, sex clubs, or porn shops, and whether they cruise parks. Thus, the test implicitly decides that viewing and purchasing romantic novels and sexually explicit magazines, or any of these other behaviors is wrong. However, many people do all these things and never have a problem.
* All too often, sex addiction therapy’s focus is on altering sexual behavior. For example, in the SA model a man who can’t stop undressing women in his mind is encouraged to manage his lust by self-policing how long he looks at a woman— the three-second rule. The assumption is that simply stopping the addictive behavior will bring him back to healthy sex and marriage. This keeps the focus on the sexual behavior, actually making things worse by putting the client at odds with his or her sexuality and actually causing the behaviors to increase. However, I have rarely experienced this to be successful.
Jack Morin, in his book, Erotic Mind, says it best: “If you go to war with your sexuality you will lose and cause more chaos than you started.” Doug Harvey Braun, author of "Treating Out Of Control Sexual Behaviors: Rethinking Sex Addiction" cautions removing a person’s erotic life in the process of trying to treat their so-called addiction, referring to it as an “eroticectomy.” In the sex addiction model the client is led to believe that if they return to that sexual behavior they will relapse into sexual compulsivity. So they build a life around avoiding the behaviors and fantasies with strong boundaries rather than accepting and befriending this part of themselves and learning to control it rather than it controlling them.
Encouraging this kind of deprivation and limitation inadvertently contributes to controlling the client rather than helping the client gain mastery over his own sexuality. How often in our own experience have we found that when we are told we must stop some behavior, it makes the behavior seem even more attractive?
Too often we assume that “sick” sexual behaviors — BDSM, cross-dressing, or other atypical sexual interests — have to be ended through a program of renunciation and abstinence, even though the American Psychiatric Association has very clear guidelines in the DSM-5 on the difference between kinks (paraphilias) and the psychological disorders associated with kinks. I once supervised a therapist who believed that if someone was into spanking, something was wrong because, in her opinion, pain and pleasure should never be combined. This ignores the research that shows that, for some, pleasure and pain combined is and can be normative and erotic. One sex addiction therapist I knew believed it was wrong for a man to wear woman’s clothing for sexual arousal because, “Why would the man want to humiliate himself in this way?” We now know more about transgender issues and how normative it is for many straight men to enjoy dressing in women’s clothes and underwear, and how it isn’t at all humiliating for them. This therapist was using his own bias or belief system rather than the latest science to treat his client, and needs to expand his understanding and protect the client from his countertransference.
Sex therapist Marty Klein has written, “The mission of sex addiction therapists is to put everyone in the missionary position.” Having come from the inside of the trainings and discussions, I can’t disagree with him.
Nowadays, using the framework of sex addiction is the last thing I might consider when someone comes into my office struggling with out-of-control sexual behaviors. I look for comorbid conditions and diagnoses such as anxiety, depression, post traumatic stress disorder, or bipolar disorder, to name a few. I don’t zero in on the sexual behavior, and I encourage the client to consider his own values around his sexuality, and to separate himself from the values he has learned elsewhere.
We as therapists need to self-reflect and evaluate where we stand on working from a sex addiction model, or whatever we believe to be healthy versus non-healthy sexuality, and make sure we are not imposing our beliefs and views onto the client. As well, a therapist needs to explore whether or not
the client has been sexually abused or has one of a number of disorders. It’s good to rule out things, but it’s also good not to assume something is happening without consistent supporting evidence.
The important thing that I have realized is it is best to come from a strength-based and sex-positive place and not from pathology and disease.