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Before he even sat down, my new patient blurted out why he had come. "My wife says I'm a sex addict, and she demands I get treated immediately," he said.
I've been a Licensed Marriage & Family Therapist and Certified Sex Therapist for 30 years. That's some 30,000 sessions with men, women, and couples--a ringside seat at the human circus.
The guy was yet another supposed "sex addict." I listened to his story carefully, and told him I sympathized with how he had damaged his life and hurt people with bad sexual decisions.
"But I don't treat ‘sex addiction,'" I said. I think it's a bogus concept.
"But you have to treat my sex addiction," the guy pleaded.
Since the day I opened my practice, I've seen people going to massage parlors, strip clubs, and hookers. I'm always working with several men and women having affairs, or dealing with the aftermath of one. And every few months someone brings in their mate because their constant flirting is way, way over the top.
But until about three years ago no one ever came in claiming to be a sex addict, or saying that his partner told him he was one. The number of these people has grown tremendously. Not the number of people acting out sexually-just the number of people using the magic words "sex addict" or "sex addiction."
The poor guy looked like a lot of Silicon Valley engineers: light blue button-down shirt, khaki pants, shoes that desperately needed a shine. He had started going to a massage parlor a few months after his baby was born. After about eight or nine desultory hand jobs in the course of a year, he'd confessed to his wife.
I told him I might work with him, but why did he need this specific approach?
"Because Maria said that either I'm a sex addict and I couldn't help it and I need treatment, or I'm just a selfish bastard and she wants a divorce."
He wanted to keep his marriage and kid. To do so, he had to admit he had a disease and get it treated. He was desperate. He would do anything. I told him I might be able to help him deal with the power struggle in his marriage, and help him stop avoiding conflict (his wife happily abandoned him when she had the much-wanted baby, then unilaterally invited her mother to move in with them for a year-and he couldn't confront her because "I love her so much"). I said I could probably help him feel better about himself, and help him feel less guilty about masturbating.
But I couldn't treat his sex addiction because I didn't believe he had such an ailment. In tears, he left. The town's best-known sex therapist had failed him.
I saw a guy last fall in an even more extreme situation. His wife had caught him seeing out-of-town prostitutes. Not only did she decide he was a sex addict (and porn addict), she demanded he begin treatment at an in-patient facility. He asked what I thought of that.
"Is your wife a psychologist or an addictionologist?"
"No."
"Well, I don't find ‘sex addiction' a clinically meaningful or useful term," I said. "But if I did--if I were a professional who claims to be a serious sex addiction specialist--I would probably say you had some symptoms of this disorder. I would then give you some tests, interview you, and evaluate you. Then I'd prescribe a treatment program, which might include attending 12-step meetings, reading books, being in a group, or even going into a hospital."
"But since your wife isn't a psychologist or an addiction specialist," I continued, "I wonder why she feels qualified to not only diagnose you, but to prescribe an extremely complex treatment program."
He hadn't looked at it that way. He asked what I would suggest.
I don't treat sex addiction. The concept is superficial. It isn't clearly defined or clinically validated, and it's completely pathology-oriented. It presents no healthy model of non-monogamy, pornography use, or stuff like S/M. Some programs eliminate masturbation, which is inhumane, naïve, and crazy.
Oh, I observe people with obsessive-compulsive disorder, bipolar disorder, post-traumatic stress disorder, depression, and a few other exotic states. That accounts for some of what laypeople call "sex addiction."
What I mostly see instead of "sex addicts" is people who are neurotic or narcissistic. They can't quite believe that the normal rules of life ("tell the truth," "all behavior has consequences") apply to them. They make promises they intend to keep-but then they want relief from frustration, or loneliness, or anxiety so much, they are unwilling to keep their promises, even promises to themselves. And some "sex addicts" just can't come to terms with having one, relatively brief, life. They want several lives, so they can have everything.
"So tell your wife the truth," I said. "Tell her you're concerned about your behavior just like she is. Tell her you want to change it just like she wants. Tell her you're concerned about your ability to do that just like she is. And tell her that you understand she's in a lot of pain, that you caused it, and that you feel great regret."
While all that consensus should provide her some relief, and maybe even create some intimacy, it still doesn't give her the credentials to diagnose and specify her husband's treatment. Her pain is valid. Her proposed solution isn't. She wants to regain a sense of control. Telling him what's wrong with him and demanding a particular treatment isn't.
"I think you're the one to help me," said the would-be patient. "But let me talk to my wife about your approach. If she agrees, I'll call for another appointment."
