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Sex Addiction: A B.S. Excuse for Not Thinking

Sexual compulsions are real and they harm the person in their grip as well as others. But treating them like a problem -- something to be 'fixed' -- isn't working.

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Unfortunately, it is precisely because of this bias that the success rates of the 12-step treatment approach to sexual compulsions are so poor. Unlike alcohol, sex is a natural and normal part of human life. So is sexual fantasy. Unlike heroin, sex naturally engages issues of intimacy, power, autonomy, and love. Sexual arousal always has meaning. In fact, sexual excitement of any kind is impossible unless its mental and social context is specifically conducive to it. While the desire for sexual pleasure is natural, the how, where and why are not. Sexual desire actually begins in the mind and travels down. The "problem" of sexual addiction always involves the mind and the social world, never the desire itself.

In fact, by viewing someone’s sexual desires as addictions, 12-step approaches can subtly reinforce someone’s own pathological view of themselves. People struggling with sexual compulsions are already afraid of their sexuality, viewing it as an alien internal beast. To imply that the addict’s sexual fantasies and sources of satisfaction are, like alcohol to the alcoholic, a loaded gun, reinforces this belief, when in fact it’s simply another fantasy. The actual psychological reality is that the so-called addicts' desires and fantasies are perfectly understandable attempts to deal with anxiety and depression given the context of their personal histories, their painful and irrational views about themselves and about men and women, and their inability to imagine a healthier way of living. Once they’re helped to become aware of these meanings, they actually increase their self-compassion and are freer to exercise self-control.

Let me present just a few clinical examples to illustrate what I mean. One guy I treated used sex as a way to ward off depression. He felt fundamentally disconnected and grim even though he was outwardly successful and gregarious. When he had sex he felt alive and momentarily connected. He was constantly seeking out sexual partners as a desperate escape from painful internal feelings.

Another patient felt chronically responsible for making everyone else happy, particularly women, and most particularly his wife. This sense of responsibility came from his childhood. The only place he felt he could selfishly "take" and be safely indulged was when he hired a woman to have sex. As his external life became burdened more and more with responsibility, he began to compulsively seek out escorts and sexual masseuses.

Another man felt so privately inadequate he couldn’t approach “normal” women for fear of being shamed and rejected. He found solace in constantly exciting himself in Internet chat rooms where he could completely control the interaction and felt safe from the danger of rejection.

All of these guys felt driven, often obsessed, and sometimes took risks to fulfill their sexual desires. However, only one of them found a 12-step program even minimally helpful. All of them, however, found enormous benefit from gaining insight into their psyches. Only then could they make choices to restrain their behavior and face the anxieties that seemed to emerge in more "normal" relationships. The first patient was able to gradually risk facing his underlying depression. The second went into couples therapy with his wife where she was able to disconfirm his assumption that he was omnipotently responsible for her welfare, and the third took the risk of experimenting with a very low risk level of online dating. All of these shifts involved an appreciation of the meaning of compulsive sexual desire and behavior and none of them, in my view, would have been initiated if the addiction model were the only one used to approach the problem.

There’s such an antipathy today to considering the psychological meaning of behavior that I’m sure my own attempt here will provoke scorn in some quarters where it will be seen as a Freudian cop-out. On the other hand, the "addiction made me do it" approach seems to me a peculiar alternative since it has become clear that confessing to an addiction and entering a 12-step residential treatment program has become the gold standard of rationalization and manipulation for public figures caught with their proverbial pants down.