Case Study, Addicted to Sex: There Are No Shortcuts in Treating SA

By Katehakis, Alexandra | Psychotherapy Networker, March/April 2010 | Go to article overview

Case Study, Addicted to Sex: There Are No Shortcuts in Treating SA


Katehakis, Alexandra, Psychotherapy Networker


Case Study

By Alexandra Katehakis

Addicted to Sex

There are no shortcuts in treating SA

While the subject of Sex Addiction (SA) no longer draws snickers or skepticism, defining it precisely and treating it still puzzles most psychotherapists. Marked by compulsive, out-of-control sexual behaviors that damage every part of a person's life--work, family life, personal well-being, and love--SA makes thinking about, seeking, and getting sex the organizing principle of a person's existence. As much of an addiction as one to drugs, gambling, or alcohol, it can shred the fabric of personal life, create serious legal problems, and ruin physical health. Because sex addiction so often has roots in ­disordered attachment patterns, stemming from childhood abuse or neglect by parents or primary caregivers, many who have sexual addictions experience extreme difficulty for-ming stable, loving relationships.

As with any other addiction, the primary goal is long-term sobriety, which with these clients means noncompulsive sexual behavior. Treatment is initiated with a contract, often written, between the addict and therapist that lists specific behaviors from which the addict promises to abstain (a temporary period of complete sexual abstinence may also be required) and a 12-step recovery program. Because childhood trauma is so often implicated in SA, leaving many clients with a damaged ability to form relationships, they also need long-term intensive individual and group therapy directed at fundamental attachment issues in addition to the 12-step programs. Doing this kind of work isn't for the impatient or fainthearted. Since these clients are often terrified, hostile, or numb at the core, they're among the most challenging to treat. Doing this work, I frequently find myself required to recognize, track, and soothe my own intense physical and emotional reactions, such as fear, anger, discouragement, and the temptation to distance myself defensively in the face of powerful provocations.

Typically, I begin by having the client make a list of behaviors that are secretive, shaming, or abusive--usually focused on the behaviors that the client himself most wants to stop. Once clients have 30 days of sexual sobriety, they join a group with other self-identified sex addicts. These groups are unlike 12-steps meetings because they not only help each individual refrain from sexually destructive behaviors, but also encourage each member to engage in group interaction and psychoeducation, focus on the experience of locating feeling states in the body, and express those feelings in a safe environment.

We already know, through numerous empirical studies, that group therapy is essential for addicts of all kinds. Thanks to developments in brain science, we've begun to understand why: both the autonomic nervous system and the brain's neural wiring actually change in response to the emotions generated by regular, sustained human connections. For sexual addicts, groups are particularly important for undercutting denial and reducing shame, while offering supportive, trustworthy relationships. The groups give many of my clients their first experience of being genuinely seen and heard by others and of learning to see and hear others in turn. Through them, clients come to understand and feel how early, deep, chronic attachment wounds hobbled their capacities for connection, self-regulation, and self-awareness, all of which made them susceptible to their behavioral addictions.

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Jim, a mid-level executive in a transport company, was 34 years old when he came to see me, though he looked much older--stooped over and somewhat disheveled in appearance. He sullenly told me that he'd come into therapy only because his wife, Beth, had repeatedly discovered him looking at pornography and threatened to leave with their daughter if he didn't get help. At his first session, he was arrogant and surly, responding with peevish defensiveness to every suggestion I made. …

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