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Treatment of Sexual Addiction

I am going to be using the blog from 2 weeks ago- 5 Possible Causes of Sex Addiction to briefly discuss treatment approaches for this problem depending on the corresponding possible cause.

As with many other “diagnoses,” there can be multiple factors that could lead to someone being sexually addicted. Here are five possible causes that I have observed in my clinical work:

1)   There was early sexual, emotional or physical trauma in the addicted person’s early life. Victims of trauma adapt psychologically and neurobiologically to trauma in ways that help the person cope with the overwhelming feelings of trauma but can lead to maladaptive behaviors. In other words, in the service of emotional regulation of intense pain, the person’s brain and psyche can develop in ways that could lead to someone acting out sexually to cope.

Treatment when sexual addiction is due to early trauma is to treat the trauma. I personally use EMDR (Eye Movement Desensitization and Reprocessing) that can help people process the trauma relatively quickly and painlessly. You can say that the sexual acting out is a behavioral way to regulate the emotions that the trauma had evoked. Once the trauma is processed, there usually is more work to be done since the person needs to still learn how to regulate emotions more maturely and open up to healthier patterns in relationships. Sometimes however, we have to stabilize the person and/or couple emotionally before doing the trauma work. Trust between therapist and client has to be established and in the case of the couple, we want to create an atmosphere of deeper understanding, support and compassion.

2)   I have found that sex addicts often did not have a way of being “healthily” dependent as children. We all have both independent and dependent aspects to us; it is natural and normal. Yet, for some people, especially when they were most vulnerable such as at a young age, they learned to hide their vulnerabilities because parents did not allow them to be “small” people that can depend on them emotionally. They had to be tough or “buck up” and learned not to rely on others to help them out of their emotional state. So, similar to # 1 above, these people have learned maladaptive ways to regulate their emotions, in this case to suppress those tender feelings and not count on other people. These people may grow up to be unhealthily dependent including being dependent on their sexual feelings as a way to access that dependent part. It is very limiting and people that cope this way have a hard time getting close to people. It is easier for them (in the short run) to act out sexually.

Like the scenario in number 1 above, EMDR may be a useful approach to help the client develop the internal resources to trust. If there was neglect, once resources of trust are installed, the trauma of neglect can be processed. There are processes that could help the client experience the trust that they long since have given up on and using bilateral brain stimulation (an important step of EMDR), the client can consolidate this very undeveloped feeling. Then, I might do couples therapy to help the client with the sex addiction experience what I have called above- ‘healthy dependence.’ Among the variety of techniques I use are helping the client think about what he or she wants and learning to ask for them. This actually can very difficult for some people. I also help them become better receivers of sensual and sexual touch from their partner. The goal ultimately is to help the client increase his or her capacity to give and receive love to and from their intimate partner.

3)   Some research suggests that it may be genetic. That may be one of the reasons sex addiction can run in families. Of course that is not an excuse; it just may be that if one knows that a family member already has this problem that he or she needs to be more alert to sex addiction being a possible coping mechanism or developing habit.

Here, I focus on what the client can do about the problem. Despite genetic correlations, cognitive and behavioral change can go a along ways towards helping individuals and couples have more mature ways of getting their emotional and sexual needs met.

4)   The person feels empty, has no significant purpose and/or is understimulated. We all have a healthy impulse to feel alive and when we are not living compelling lives; lives that are stimulating and purposeful, we can be understimulated. Some people in this circumstance can upregulate themselves, meaning increase their sense of aliveness, by looking at porn or acting out sexually in some other way that would temporarily pull them away from their emptiness and give them a sense of being more alive.

Treatment here consists of helping the client find what thrills his or her soul. Discovering the client’s purpose is a focus of treatment. The client has to learn how to look inside of himself and listen to his (sometimes subtle) inner promptings. What interests him? What does he want to learn? What activities would he like to do if he was not fearful, lazy, etc? How has he not supported himself in life and in relationships? Has he been too adaptive? Has he not expressed himself? These are some of the questions that he learns to ask and then goes about discovering the answers.

5)   The person fears intimacy or has trouble initiating sexual activity in a mature relationship. This person usually avoids the possibility of being rejected, abandoned or feeling inadequate so resorts to less mature, less emotionally risky sexual acting out behaviors. (That is not to say that there may be other real significant risks in meeting one’s sexual needs in this maladaptive way!)

Treatment focuses on validating the fears of the client followed by helping the client begin to risk. I tend to help the client realize that the problem is that his or her self-esteem is too dependent on the reactions of others. I help the client generate his or her own self-esteem. With higher self-esteem, it is much easier to risk being rejected because rejection does not lead to a loss of sense of self.

Of course, in real life clinical work, these 5 above causes and treatments can be blended. There is much overlap. For example, a person who has been traumatized early in life will probably also need to learn how to generate his or her own self-esteem. In this case though, once the trauma is processed (by an approach such as EMDR), it is far easier to help the person feel that sense of worthiness. If you or someone you know is resonating with any part of this blog, please know that I am here to help. There are reasons why people have problems, including the problem of sex addiction. Let me help you transform your life as well as your intimate relationship!

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