Untangling the Web:

Treating Sex and Porn Addiction

Robert Weiss LCSW, CSAT
Executive Director The Sexual Recovery Institute www.sexualrecovery.com

What Do These Men Have In Common?

Fmr. President Bill Clinton Fmr. Senator Larry Craig Fmr. Governor Elliot Spitzer They are men whose sexual behavior MORTALLY WOUNDED their ability to lead ... but what if their problem had been drinking or drugs e.g Patrick Kennedy?

Our Typical Client

38 year old married working male Wife found extensive porn or hook-ups in computer - says get help or youre out. Married 7-10 years One or more children under age 6 Acted out with sex prior to marriage, then slowed or stopped - never informed wife

Why did he return to acting out?

Sex Addiction is Not

A Moral or Religious Stance A Symptom of Underlying Axis I Illness Fun Same Sex Interest or Activity Sexual Offending Fetish / Paraphilia Sociopathy Crystal Meth Addiction The End of a Relationship

Sex addiction can be

A Stand Alone Diagnosis

The Diagnosis Follows the Characteristics of All Addictions

Criteria for assessing Sex Addiction closely parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling: Loss of control Continuation despite adverse consequences
Obsession or preoccupation

The presence of all three criteria operationally defines addiction to any drug or behavior

Typical Sex Addict Behaviors

Compulsive Use of Porn (with or without masturbation) Anonymous Sex (met online or in sex clubs etc.) Adult Bookstores and Strip Clubs Sexual Exchange (i.e. Drugs or Favors for Sex) Prostitutes and Massage Parlors Cruising, Intriguing, Objectifying, Seduction Boundary Violations, Sexual Harassment Multiple Affairs / Anonymous Infidelity Abusing Power Relationships for Sex - Predatory

Addicted to sex?
Increased Heart Rate Shallow Breathing Perspiration- palms, underarms, etc. Reduced Intellectual Functioning Rush or Intensity Feeling

Substances of Mood
Serotonin Dopamine Adrenaline Endorphins Oxytocin the cuddle
chemical

ADDICTS CALL IT
The Bubble The Trance Spaced Out
Think ... Dissociative State Mood Alteration Trauma

In 12-Step Language ...

POWERLESS!

Sex Addiction is not about sex, its about the search for sex and desire for orgasm. Its a process addiction.

Sexual Addiction Symptoms in Residential or Outpatient Clients

In the Clients Behavior

Seductive Dress (especially after it is pointed out) Seeking out special relationships with other attractive
clients or staff for advice, friendship and direction Giving the stare.

History of CD relapse especially females Encouraging Dependency as a form of seduction Sneaking Porn into treatment - sharing porn in treatment. Consistent sexual references in jokes and conversation Consistent sexual objectification. Lack of empathy about how their sexual behavior affects
others.

Sexual Addiction Symptoms in Residential or Outpatient Clients

In the Clients History

Multiple abortions (females), multiple STDs (both sexes) Previous arrest or major life consequences related to sex Drugs/Alcohol used to help tolerate or enhance sex History of previous sexual acting out in treatment Drug use fused with sexual behavior Multiple past failed relationships due to affairs or infidelity Chronic or Compulsive Masturbation

What makes online sex so popular and so exciting?

ACCESSIBILITY AFFORDABILITY ANONYMITY

Adapted from the Triple-A Engine Al Cooper PhD. 1998

Online sexual content, chats and interaction has forced us to reassess sexuality in our culture. For example, today what do you consider to be

Infidelity?

Cybersex Addiction/Compulsivity: Range of Online Sexual Activities in 1999 ...

View and download pornography with or without masturbation Visit sexually-oriented chat rooms to voyeur or hook up with
someone Exchange sexually explicit e-mails Belong to online sex clubs, sex organizations or hooker review sites Engage in real-time one-on-one masturbation Plan ahead to sexually act out on the road Offender / Predator Behaviors Hire prostitutes to perform live sexual acts on command View and download illegal or deviant sexual images

And in 2009.. All of the above, only faster. on cell phones, laptops, social networking (yelp, twitter etc.) and dont forget SEXTING

Whats the big deal Its just a guy thing

Consequences of Compulsive Cybersex

Loss of time for work, family, recreation Family violence / relationship loss Loss of job because of cybersex at work Guilt and shame due to keeping secrets Decreased interest in sex with spouse Increased preoccupation with sex Increased overall sexual objectification Children potentially exposed to porn Increased interest in deviant sex Potential arrest for illegal online sex Escalation to off-line sex

And now a word or two about ...

...Spouses and Partners

Treatment is the Reclaiming of Reality

Please find a partner to your left or right, decide which of you will ask questions and who will answer and then ask the following:
1- How often you drink alcohol and how much do you drink. 2- How often you masturbate and what fantasies you use when doing masturbating? 3- How often do you pay for sex ...

Initial Sexual Addiction Treatment is ...

Cognitive Behavioral and Task Oriented

Initial Focus of Sex Addiction Treatment

Stop the acting out ASAP by making contracts
and plans Confronting denial and teach relapse prevention Carefully reviewing a sexual history Providing Appropriate Tasks and Interventions Spouse, job & family crisis resolution Shame reduction Holding the client accountable! 12-step, therapy or faith-based group referral

And Sexual Sobriety is

A clear and well defined written plan Based on client goals Mutually agreed upon Signed Sobriety plans are behavioral in nature Sobriety plans flow from the goals of the client Doesnt change without prior agreement

Simple Sexual Sobriety Plan

List of Behaviors I Want to Stop List of Behaviors I Want to Add

A B C D E F

A B C D E F

Treatment Error
Inadequate or poorly detailed history
(Not asking about prior arrests/offending behaviors etc.
Unfamiliarity with resources (porn blockers, 12-step)

Normalizing problematic sexual behavior Initially employing Psycho-dynamic, Analytic, Jungian and other non-cognitive behavioral method Not identifying triggers, patterns, rituals and behavioral escape methods (relapse prevention planning) Focusing too early on trauma

Treatment Error
Not addressing the sexual behavior as the primary initial treatment focus Not properly understanding and/or pathologizing the depth of the betrayal, grief, loss and rage of the partners and spouses NOT HOLDING CLIENTS ACCOUNTABLE Not getting supervision / consultation Not utilizing 12-step programs, faith based support groups, group therapy and psycho-education Not processing countertransference.

12-step Groups for Sexual Addicts and Partners

Sex Addict Support SAA SA SCA SLAA-Women SRA Partner Support S-Anon Alanon COSA CODA RCA - Couples

Treatment and Training Information The Sexual Recovery Institute

www.sexualrecovery.com IITAP - International Institute for Trauma, and Addiction Professionals www.iitap.com SASH - The Society for the Advancement of Sexual Health www.sash.net

Untangling the Web: Treating Sex and Porn Addiction

Robert Weiss LCSW, CSAT
Executive Director The Sexual Recovery Institute www.sexualrecovery.com