Is There Moral Incongruence Bias in Some Sex Therapists?

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Moral incongruence theory was introduced about 10 years ago by University of New Mexico psychologist Josh Grubbs, and it has been used to explain why so-called sex addicts don’t have more sex than other people but feel worse about it. When people hold moral beliefs about certain kinds of sexual behavior but still engage in those same behaviors, they are likely to experience shame and guilt, which often leads to depression, distress, and anxiety.

Unfortunately, most therapists who promote diagnosis and treatment for sex and porn addiction do little to help resolve these moral conflicts and instead focus on the sexual behaviors. This may be due to moral incongruence in the therapists themselves. Research recommends cognitive behavioral and acceptance and commitment therapies for the treatment of pornography-related difficulties. No research supports treatments that address pornography as an addiction.

New research by Justine Meador assessed views of pornography, sex and pornography addiction, and examined personal characteristics of the therapists. Meador collected data from 289 mental health professionals, including 55 certified sex addiction therapists (CSAT). Results revealed that 25 percent of CSATs had a personal history of seeking sex addiction treatment themselves, compared to less than 5 percent of non-CSAT therapists.

Other findings by Meador included:

• Mental health professionals who had higher levels of moral incongruence about their own sexuality were significantly more likely to diagnose porn addiction in other people.
• CSAT therapists were much more likely to diagnose individuals with porn addiction than non-CSATs.
• When considering clinical vignettes containing symptoms of depression or bipolar disorder along with pornography use, CSATs tended to diagnose porn or sex addiction rather than clinical diagnoses.
• Compared to non-CSAT therapists, CSATs had higher levels of personal disapproval of pornography.
• Compared to non-CSAT therapists, CSATs were more likely to be heterosexual, married, Republican, monogamous, and religiously affiliated.
• CSATs also reported much higher incomes than non-CSAT clinicians, with 46.4 percent of CSATs making over $150,000 a year, compared with only 21.5 percent of non-CSATs.
• Non-heterosexual therapists were significantly less likely to diagnose porn addiction or recommend porn addiction treatment and less likely to be morally condemning of pornography use.
• Republican therapists were the most likely to diagnose porn addiction and had the highest levels of moral disapproval of pornography.
• Religious therapists who were higher on a measure of narcissism were more likely than others to diagnose porn addiction.
• Therapists who identified as being non-monogamous were less likely to diagnose porn addiction or recommend this treatment.
• Marriage and family therapists had the highest level of disapproval of porn use among all clinician groups though counselors (most religious amongst all three and had the highest rate of having a personal history of porn and or sex addiction diagnosis or treatment. Social workers showed the lowest levels of moral disapproval of pornography use, were the least religious, and were least likely to diagnose addiction.
• Mental health professionals from the southwestern portion of the United States had the highest levels of moral disapproval of pornography and were the most likely to diagnose and treat porn addiction.

Source: Created by Dr. Ley via ChatGPT

Past research has consistently found that sex and porn addiction are diagnosed more by religious therapists and that religious individuals are more likely to self-identify as porn addicts, despite generally watching less pornography. Other research has also supported that many therapists may allow their biases to interfere in accurately diagnosing sexual problems. However, before Meador, no research had examined how personal experience of identifying as a sex addict or struggling with pornography interacted with religiosity, or with training and certification in sex addiction treatment.

I’ve written previously about how people’s internal struggles with their own sexuality can lead to them advocating for the restriction of other peoples’ sexuality, in a process known as a reaction formation. Last year, a law requiring age verification for viewing pornography was enacted in Louisiana. The legislator who wrote and introduced the bill is a conservative religious legislator who is also a certified sex addiction therapist.

Therapists who have high levels of internal conflict regarding their own sexuality and who view pornography with strong moral disapproval are at risk of inaccurate diagnostic practices and recommending unsupported treatments to their patients, when those patients are struggling with sexual difficulties. Persons who struggle run the risk of being morally shamed by therapists who have not resolved their own feelings about sexuality.

Asked by email what recommendations she'd give a person seeking help, Meador suggested:

I’d advise someone to first consider what feels problematic about their porn use and or sexual behaviors. Is it affecting their life in a way they want to change, or is the distress more related to conflicts with their (or their partner(s)) cultural values, upbringing, or moral beliefs? It’s crucial to find a therapist who respects personal values while also challenging harmful narratives that aren't supported by research. The goal of treatment should be to foster self-awareness, agency, and a fulfilling relationship with sexuality. My research shows that mental health professionals approach concerns about porn and sex from different perspectives and even if someone doesn't meet clinical criteria for compulsive sexual behavior disorder, many mental health professionals still diagnose clients experiencing distress with pornography use as having an addiction. It's very important to work with a therapist who can distinguish between compulsive behaviors and value-based conflicts to ensure their care aligns with their actual clinical needs.