Yesterday I chatted with Dr Mary Deitch, President of SASH, about working with clients suffering with problematical sexual behaviour. I first heard Mary speak at the Farley Center when she presented on understanding the basics of problematical sexual behaviour. (See the slides for that presentation here). In the interview we discuss how to identify problematical sexual behaviour and the difference between what are sometimes termed lifestyle choices versus what is actually addictive behaviour. We also briefly discussed the disease model of recovery, attachment styles related to addiction and how useful clients can find attending meetings of 12 step fellowships, such as SA, SAA and SLAA.
The term ‘half-nighter’ has been recently coined to describe supposed new behaviour that is essentially a one night stand, without staying the night. None of this is new, however, as people have been having casual sex and departing before the sleep bit for donkey years. What might be new is the increased prevalence of ‘half-nighters’ when people would rather go back to their own bed for sleep after hooking up for sex. Dating apps could be the reason for this increase when one can search for sex in almost any given geographical area, at any time of the day or night, and be presented with a vast array of potential partners at a moment’s notice. When deciding if this behaviour is a problem or not the key is to understand if there are any negative emotional side effects. For instance, is there an empty feeling after a date and a preoccupation about the next potential date? If you think you might have a problem read the full article on dating apps and avoidance of intimacy.
Sex addiction is a term that typically produces wide ranging views from, on the one hand, some psychiatrists, who argue that there is insufficient evidence for the term to be included in the Diagnostic and Statistical Manual on Mental Disorders, to others in the therapeutic community, notably Dr Patrick Carnes and Paula Hall amongst others, who acknowledge the condition as an illness in the same way that alcoholism and gambling is treated. The term can also produce a fair degree of titillation, even amongst therapists, about the apparent glamour associated with the behaviour. I believe that if there is less emphasis on the word ‘sex’, and more emphasis is placed on the word ‘addiction’, then we might be better able to address the depth of the suffering that can take place for individuals and those associated with them.
Far from being glamorous, sex addiction can produce hugely detrimental effects on self esteem, self worth, professional reputation and on the maintenance of relationships. Of course, if your lifestyle choices do not produce any negative impacts on other parts of your life then it is not a problem.
In this interview Dr Patrick Carnes chats to Joe Polish, founder of the Genius Network about sex addiction, neuroscience and the most effective treatment for addictive behaviours. I have listened to this interview, usually as an mp3 file on my phone, many times and always seem to learn something new each time I listen to it. I believe that Dr Carnes is a legend and a visionary, given that he was talking about sex addiction as an illness in the early 1980s, when the definition of addiction in psychiatry was typically restricted to chemical dependence. These days there are more enlightened practitioners in the therapy field who acknowledge the real impact of behavioural addictions such as gambling and internet sex addiction.
This interview, as well as Dr Carne’s extensive publications, could be, perhaps should be, a staple diet on every psychology and psychotherapy course reading list in every discipline and modality. Essentially, Dr Carnes has long maintained that sexual addiction, like food addiction, develops in the brain through the bypassing of the executive functioning (the pre-frontal cortex) as the reward centres get flooded by the stimuli, in similar ways to the effects of cocaine usage. In the interview he articulates his ideas on attachment theory as possible causes of addiction and points to the dangers of the proliferation of cybersex activities through the internet, particularly for teenagers.
That is not to say that there is not still a lively debate about the evidence for what can be called an addiction. Darrel Regier, who was co-chair of the DSM task force which investigated the evidence to support revised classifications, maintained that there was insufficient evidence to reclassify sex as an addiction for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Regier maintained that the reward circuitry in the brain was not operative in the same way for sex as in (substance) addictive areas.
As yet there might not be the clinical evidence needed to justify the addiction term, for sexual addiction, but it could be argued that there is overwhelming anecdotal evidence about the problem. It is clear we need to fund more research into the problem, but it becomes very political very quickly, when we start thinking of web filters, censorship, impacts on economies (just think of Romania and the number of webcam models and the income stream) and actually who will fund the research.
Yesterday I had the pleasure of interviewing Paula Hall, sexual and relationship psychotherapist.
Paul Hall (pictured below) is a UK based sexual and relationship psychotherapist who has been specialising in the field of sex addiction for over 10 years. Paula has trained with Thaddeus Birchard in the UK and with Dr Patrick Carnes in the US. Paula is a founder member of ATSAC (Association for the Treatment of Sex Addiction and Compulsivity). Click here for a self assessment tool if you are worried about your sexual behaviour. She is a trainer on the UK’s first Professional Certificate in Sex Addiction Treatment.
In the interview we discuss the nature of sex addiction, the treatment models for sex addiction, 12 step recovery programmes, psycho-therapeutic modalities and her plans for the publication of her book on sex addition and treatment.