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Sex

A Case of "Sex Addiction"? A Successful Individual Treatment

How can we help someone who acts out sexually? By not focusing too much on sex.

Key points

  • When people act out sexually, it's often a clumsy way of meeting emotional needs.
  • Curiosity is an essential part of reestablishing intimacy.
  • Labelling someone a "sex addict" can increase their shame.

Recap: In Part I, we met Jonas and Marge, married for 17 years. While they hadn't had sex together for the last 10 years, Jonas had been acting out sexually in a variety of ways practically the entire time. He eventually went into therapy and treatment for "sex addiction"—which he found rigid, judgmental, and sex-negative. In his subsequent work with me he was pushy and impatient, surprised that we talked about sex only occasionally. And so he gradually changed—and eventually became curious about his wife and himself. Below is Part II.

One day he was relating yet another story of hiring young women for sex when I asked, “Jonas, what were you wanting when you hired Linda and Juana?” Startled, he looked at me, a bit impatient that I didn’t seem to understand. “They were call girls,” he said. “We were, you know, gonna spend a few hours having a good time.”

“Yes,” I said. “As you were booking the evening, exactly what were you hoping you would feel during and after the event?” Apparently he had never considered the question. He took a while to answer; when he did, he seemed surprised. “I wanted to feel special,” he said. “I wanted to feel liked, and attractive, and like they were glad to be there with me.”

“Hmm, no huge orgasm, no world-class blowjob, no hours-long intercourse. Right?” “Well,” he answered, “I sure was planning on enjoying myself.” Yes, I said, of course. “But let’s notice how you described that—feeling relaxed and enjoying some attention, with no concern about disappointing anyone or having to apologize for being greedy.” He found my description interesting.

The Power of Sadness

The following week, he said, “I thought about last session all week. I don’t know why, but every time I did, I got sad.” “That’s great,” I said to his surprise. “You let yourself be touched by our talk. You recognized your own neediness—and the other side of that, the pain of your unmet emotional needs.”

This launched a series of sessions about that neediness: feeling insecure and wanting reassurance; wanting touching for its own sake, not just for sex; feeling isolated, unable to speak to his wife or friends about aging, money worries, or various kinds of loss; fantasizing about being forgiven for all his deceit.

I was sympathetic, and kept gently returning him to his various uncomfortable feelings. His long stories came less frequently, and he often interrupted himself. Several times he said he felt embarrassed by what he was learning about himself. I was sympathetic about that, too. He started saying things like “I don’t want to need to go to prostitutes,” and “I want my wife to know how I’m changing.”

We talked about resolving his insecurity—feeling “secure,” stable, adequate, attractive, and most of all, relaxed. “This is the scariest stuff we’ve ever done,” he said.

“One more thing I’ve learned about sex with prostitutes,” he said one day. “I don’t worry about them getting too close to me, wanting to know everything about me, becoming dependent on me. That’s how I am with Marge,” he said. “I guess you’d say I’m afraid of getting too close to her.” I smiled. “You’re getting good at this therapy thing,” I said.

Speaking to Her Differently

Meanwhile, he started talking to his wife differently—like a companion, rather than a bully or a performer.

To their mutual surprise, she melted a bit. Little by little, they became friends again. We talked about him feeling nervous about getting closer to her, and he bravely marched straight toward her.

With the occasional (and predictable) clumsy misstep, they gradually got closer. They sat together while watching TV. They held hands while walking. They said good morning and good night to each other.

And his serial infidelities? Over the years they’d had about a million awful conversations when she would demand to know how he “could do such a thing,” and he would either defend himself or admit he was the scum of the earth. Either way, they’d get nowhere, setting the stage for the next ritualized, unproductive talk.

One day, for the first time ever, he asked her if they could please talk about it—“the scariest thing I ever did,” he told me later. He told her he felt terrible about what he’d done, about having felt both justified and out of control at the same time. He talked about feeling like he was getting old, losing a step both at work and on the softball field. He talked about using sex workers to get himself through one more lonely day on the road—“a sugar high followed by a crash, with no one to talk to about it.” And he talked about his own discovery in therapy that sex with prostitutes was about way more than sex—in fact, not about sex very much at all.

To Marge’s credit, she listened. She was angry, she was surprised, she was sad. Oh was she angry. But she listened. She met him—wary at first, of course—in this new place of vulnerability. “It sounded so different from all our other talks about this,” he recalled her saying. “It sounded real.” And it was.

A Series of New Conversations

That launched a series of conversations in which Marge talked about the pain of being betrayed by someone she loved. In contrast to previous conversations, she talked very little about him. She mostly talked about her disbelief, her grief, the destabilizing effect the repeated infidelities and their emotional separation had had on her. And he listened, letting it in. “And feeling like total crap,” he later told me.

One day he came in and told me “We did more than hold hands this week. We, y’know, made out. Kissing with tongues, hugging each other, smelling her hair. Does that sound lame?”

“How do you feel about it?” I asked. “It was great,” he smiled.

The next week they made out again. But he was grumpy. “We’re still miles away from sex,” he said. I sympathized and reviewed some of his terrific progress. “But this is taking forever,” he complained. “Yes,” I replied, “which seems to be the perfect pace.”

Over the next few weeks, I reminded him of what I’d been saying for over a year: when he and Marge do re-engage sexually, it won’t be like a porn film, like being with a hooker, or like when they were newlyweds. At best it will be pleasant, friendly, and arousing, along with scary, confusing, and clumsy. “Hopefully, you’ll laugh once or twice, too,” I added.

“I didn’t really believe you when you started saying this last year,” Jonas recalled. “But I do now. I really want it, but I’m also scared to death that we might actually do it.” I underlined that after a 10-year hiatus, and all this buildup and hope and fear, sex might be anti-climactic.

“I can’t believe I’m saying this,” he said with a tone of wonder, “but in some ways I hope it is.”

And when he came in the following week, he reported three things: They had sex. It was warm and scary and all the other things we’d talked about. They had indeed laughed not once, but twice. “And you know what,” he said just a little proudly, “it was slightly anti-climactic.”

“Great,” I said. “Have anti-climactic sex a few more times. Relax and get to know each others’ bodies some more. Then you two will be ready for, well, ordinary sex.”

“Ordinary sex, with someone who I know loves me,” he said, “with or without laughing. Sounds great.”

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