A discussion of how the Internet bypasses religion’s filters Dan Drake, MFT, CSAT Candidate 3

1. Religion, Internet Pornography, and Sex Addiction A discussion of how the Internet bypasses religion’s filters Dan Drake, MFT, CSAT Candidate 3

2. Objectives • Intro • Religiosity as a Protective Factor • Religiosity / Spirituality and Internet- based Compulsive Sexual Behaviors (ISAC) • Applications • Discussion

3. Introduction

4. Defining Terms • Sex Addiction • Internet-based Sex Addiction / Compulsivity (ISAC) • Religion / Religiosity • Spirituality • Religion as a Protective Factor

5. Religion as a Protective Factor

6. Religion in the U.S. • About 2/3 of Americans claim to be a member of a church or synagogue (Shafranske, 2011) • How important is religion (national sample as quoted in Shafranske, 2011): • 58% - Very Important • 30% - Fairly Important • 11% - Not Very Important • 1% - No Opinion

7. Religion and Spirituality as Distinct Factors • 3 Constructs: • Spiritual and Religious • Spiritual but not Religious • Neither Spiritual nor Religious • Hodge, Andereck, & Montoya (2007): • Spiritual AND religious lifestyles leads to lower addictive behaviors than none or also just spiritual – this is the most protective profile • Spiritual but not religious had LEAST protective influence (spirituality linked with self-esteem, and higher levels of unmoored spirituality can increase substance use, particularly if peers also use substances).

8. Religion as a Protective Factor • Means of social support/socialization • Physical illness • Coping with surgery • Health behaviors • Suicidality • Depression • Crime • General protective factor • Substance abuse / addictions • Sexual behavior among teens / adolescents • Sex addiction • Sexual attitudes / behaviors

9. Why Religiosity is a Protective Factor • Moral, Mental, Psychological development • Builds character (Sanchez, Garcia de Oliveira, & Nappo, 2008) • Norms internalized from religion (Barkan, 2006; Hodge, Andereck, & Montoya, 2007) • Teaches moral behavior (Barkan, 2006) • Builds sense of coherence, meaning, and control (Larson & Larson, 2003) • Enhances self-esteem (Barkan, 2006; Larson & Larson, 2003) • Religious / Subjective Experience • Belief in supreme being whose laws are for the benefit of the individual and who is a source of strength (Barkan & Greenwood, 2003; Sanchez, Garcia de Oliveira, & Nappo, 2008) • Socialization / Social support • Less likely to choose friends who use substances (Hodge, Andereck, & Montoya, 2007) • Positive peer relations (Larson & Larson, 2003) • Familial support often correlated with religiosity (Sanchez, Garcia de Oliveira, & Nappo, 2008) • Increases social ties (Barkan, 2006; Barkan & Greenwood, 2003; Trinitapoli & Regnerus, 2006) • Promotion of Positive Behaviors / Discouragement of Risk-Taking Behaviors • (Burris, Smith, & Carlson, 2009) • Discouragement of risk-taking behaviors (e.g., unsafe sexual activity, gambling, use of drugs, etc.) (Barkan & Greenwood, 2003) and positive behaviors (Trinitapoli & Regnerus, 2006) • Exclusionary practices among non-members (Trinitapoli & Regnerus, 2006)

10. Religion and Internet-Based Compulsive Sexual Behaviors

11. Prevalence of ISAC among people of faith • A poll of thousands indicated that 50% of Christian men and 20% of Christian women are addicted to pornography (http://christiannews.christianet.com/1154951956.htm) • Approximately 33%-40% of clergy in the U.S. report that they have struggled or are currently struggling with the use of pornography, largely through the internet (e.g., Abell, Steenbergh, & Boivin, 2006; Christianity Today Leadership Survey, 2001; Laaser & Gregoire, 2003; King, 2003, etc.). • 57% of pastors say that addiction to pornography is the most sexually damaging issue to their congregation (Christians and Sex Leadership Journal Survey, 2005). • A 1996 Promise Keepers survey at one of their stadium events revealed that over 50% of the men in attendance were involved with pornography within one week of attending the event • 20% of calls (in 2000) to Focus on Family were related to online porn (Ferree, 2002)

12. Religiosity and ISAC Why Internet-Based Compulsive Sexual Behaviors among religious population? • General addictive potential of the Internet • Emotional coping • Misunderstanding of addiction • Concerns around masturbation • Bifurcation of public/private • Rigidly held beliefs from family of origin • Shame • Impacted behavior, not attitudes • Unique issues among clergy

13. The addictive potential of ISAC • General addictive potential of internet-based sexual behaviors: • The Triple A Engine (Cooper, 1998) • Accessibility • Affordability • Anonymity • Acceptability (King, 1999) • Approximation (Ross & Kauth, 2002) • Escape (Young, 1999) • Cybersex as the crack cocaine of sex addiction (Carnes, 1996): Addiction (amount and variety) escalates extremely rapidly (Carnes & Scheider, 2002).

14. Religiosity and ISAC • Emotional Coping: • Many use the Internet for sexual arousal or providing a sexual outlet, but also use the Internet for: • To cope with negative emotions • Difficulty sleeping • Out of habit • Because of low self-esteem • To feel more relaxed • Sexual outlet where do not have to deal with others (Baltazar, Helm Jr., McBride, Hopkins, Stevens Jr., 2010)

15. Religiosity and ISAC • Misunderstanding of Addiction: • Common misunderstandings of sex in Christian circles (Ferree, 2002): • Confusion of terminology (addiction vs. “sin”) • Addiction equated to moral failure • Addiction implies pedophilia or offending behavior • Mistakes among clinicians from communities of faith: • Encouraging to get help only from clergy • Not utilizing supports in the secular community • Only emphasizing spiritual component • Encouragement only to repent • Ignoring 12-step groups • Failing to understand systemic nature of the disease (IP) • Encouraging partners simply to comply sexually (rather than realizing ISAC is an intimacy disorder)

16. Religiosity and ISAC • Masturbation: • Emphasis on sexual purity and historical position on non-marital sexuality creates guilt around developmentally normative behaviors • Furthermore, sin-based vocabulary and no clear Biblical ethic on masturbation creates confusion, shame, and further secrecy (See Kwee & Hoover, 2008) • Many stuck in compulsion to stop masturbating, which leads to vicious cycle and continued/escalated masturbatory patterns (Kwee, Dominguez, & Ferrell, 2007).

17. Religiosity and ISAC • Bifurcation of public/private and splitting of sexual behaviors: • Reaction Formation • Maintaining rigid doctrinal attitudes, public fervor and outward appearances while ignoring private practice (Levert, 2007) • Publically presenting a performance-oriented religiosity while hiding personal weakness or problems – Leads to perfectionism and shame/inadequacy (Nelson, 2003). • Less cognitive dissonance with online sexual behaviors than intercourse • Involvement more solitary and permissible / less objectionable than premarital or extramarital sexual activity with a partner (Abell, Steenbergh, & Boivin, 2006)

18. Religiosity and ISAC • Rigidly held beliefs from Family of Origin: • Rigid religious rituals employed to gain control of unmanageable behavior (see Laaser, 1992) • Rigidity from family of origin • Rigid and disengaged family systems already linked to SAC • Religious origins, messages, and rigid family structures can set up further public/private bifurcation (see Levert, 2007)

19. Religiosity and ISAC • Shame: • The shame hook: Rigid notions of morality + Negative view of sex + Natural biological urges + Addictive power of Internet-based sexual behaviors + Delayed adolescence = Bifurcation of self (moral outward appearance / sexual secrecy, shame, and escalating online behaviors) • Secretive compartmentalized sexuality creates shame and breeds continued isolation/fragmentation rather than seeking help.

20. Religiosity and ISAC • Impacted Behavior, NOT attitudes: • Religious behavior associated with sexual behavior, not as much in regards to sexual attitudes • E.g., Lefkowitz, Gillen, Shearer, & Boone (2004); Lo and Wei (2005)

21. Role Vocational consequences Isolation Narcissism Spiritual maturity Anger Accountability Entitlement Relationship Presence of other addictions Caregiving Issues around discovery Sexual anorexia Issues around disclosure Religiosity and ISAC • Unique issues of clergy: • Special consideration for pastors struggling with Internet addiction (see Laaser & Gregoire, 2003; King, 2003; Nelson, 2003, etc.):

22. Consequences • Consequences specific to religious population (i.e., Christians): • Worsened relationship with God • Increase in sexual behavior • Increased negative emotions • More permissive attitudes concerning sexual behavior (Baltazar, Helm Jr., McBride, Hopkins, Stevens Jr., 2010)

23. Implications / Applications

24. Language / methodology • There are too many ambiguities/equivocations around terms. We need a more coherent conversation around the terms “religiosity” and “spirituality” within the field of psychology • Because “spirituality” has become so vague we need to utilize more robust language for it (e.g., Roof’s (1999) “lived” religion)

25. Incorporating BOTH religiosity and spirituality • We can’t simply bifurcate religiosity / spirituality • Spirituality and religiosity are intertwined, and most people experience them together (Sanchez, Oliveira, & Nappo, 2008; Shifranske, 2011) • Making religion=bad and spirituality=good can confuse the terms • Spirituality that is not rooted in the concrete life of communities is in danger of drifting toward disembodied vagueness or general religiosity or unrestrained individualism" (Wendel, 2003, p.158).

26. For Clinicians How important is religion to our clients:

27. For Clinicians with Religious Clients • Tap into the protective resources clients are already utilizing • Recognize own personal biases • Know what to look for and what questions to ask • Look for other potential addictions / risk factors • Education • Be aware of damage / impact from prior attempts at help • Importance of shame reduction • Utilize client’s religious framework • Importance of building other coping resources • Help nuance understanding of religiosity/spirituality

28. For Clinicians • Tap into the protective resources clients are already utilizing • Design and implement programs to include religious components • Enlist support of religious leaders (e.g., clergy, chaplains, priests, rabbis, etc.) – collaborate • Utilizing clients’ already established religiosity for protective factors listed above • Continue referring to 12-step groups

29. For Clinicians • Recognize own personal biases • There is no consensus among mental health professionals about the dangers of porn or the use of the term "pornography addiction” (Singel, 2004). • Avoid mistakes among clinicians in communities of faith (Ferree, 2002) • Need to be aware that psychotherapy is a values-based engagement in which “religious, spiritual, and moral values implicitly embedded within clinical theory and expressed through the personal commitments of the clinician (Shefranske, 2011)

30. For Clinicians • Know what to look for and what questions to ask • There are a significant portion of religious individuals struggling with ISAC • Potentially even MORE individuals struggling with ISAC in religious communities than non-religious (Abell, Steenbergh, & Boivin, 2006).

31. For Clinicians • Look for other potential addictions / risk factors • Excessive work • Food restriction / overeating • Gambling • Alcohol use • Drug use • Etc.

32. For Clinicians • Know what religious clients might’ve experienced before coming into your office • Some clients might come to session with shame/damage from prior attempts at help • Rigid/abusive dynamics from Family of Origin • Might’ve experienced trauma, shame, and loss from faith community for “sexual sin” that has been exposed or disclosed (King, 2003)

33. For Clinicians • Importance of shame reduction • Creating a safe place where client can engage religion and psychology when might be client’s first time ever coming to a “secular” therapist • Importance of conceptualizing shame as a driver for self-perpetuating addiction cycle (kwee & Hoover, 2008) • Shame reduction to promote further honesty of sexual behaviors in therapeutic relationship and reduce splitting • Know that many from faith community will experience shame, which keeps them isolated, fragmented, and resistant to help

34. For Clinicians • Utilize client’s religious framework • Compulsive sexual behaviors most likely will look different than general population of sex addicts • Be open and non-prescriptive around masturbation – helps individuals arrive at own informed conclusions (Kwee & Hoover, 2008) • Need to challenge reaction formation but be careful not to disenfranchise client • Be aware of nuances of addiction as affected by faith (Levert, 2007) • Be sensitive and understanding of potential losses – identity, relationships, and/or vocation • Don’t have to share client’s faith to be effective (Larson & Larson, 2003)

35. For Clinicians • Importance of building intimacy, social functioning, and coping resources • Deepen relationships / intimacy • Importance of Group Psychotherapy • Teach functional relationship patterns that satisfy (Carnes, 2001) • Explore cognitive distortions / faulty belief systems that interfere with capacity for intimacy (Boies, Knudson, & Young, 2004) • Build support network, relationships, and intimate connection in the offline world. Teach social skills where needed (Boies, Knudson, & Young, 2004) • Help build more adaptive skills than sexual coping, increasing capacity for gratifying relationships (Kwee & Hoover, 2008).

36. For Clinicians • Help client find a more nuanced understanding of religiosity/spirituality, to integrate all parts of self including shadow. • Process notions of religiosity and spirituality currently and from FOO • Learn healthy views of sexuality, nuanced from religious tradition/teachings • Be aware of potential resistance to a balanced approach to recovery

37. For Clinicians • Education • Education of client: • For religious clients presenting with compulsive masturbation: Education on criteria for sex addiction and how client’s behavior does or does not meet criteria, as well as normalize feelings of confusion and guilt (Kwee & Hoover, 2008). • Dangers of ISAC and other ways to cope with sexual arousal and negative feelings (Baltazar, Helm Jr., McBride, Hopkins, Stevens Jr., 2010; Hamade, 2009). • Education of Professional: • Become familiar with how internet works, types of sexual activities online, implications for religious individuals; also with use of internet filters, monitoring software (Boies, Knudson, & Young, 2004; Weiss, 2007). For example, Internet filters (e.g., K9, NetNanny, Safe Eyes, etc.) and Accountability software (e.g., Covenant Eyes, Bsecure, etc.) • Ensure adequate training on religiosity/spirituality and to not impose own values or beliefs (Hodge, Cardenas, & Montoya, 2001)

38. R/S issues never included: In Treatment: 0% In Training: 18% R/S issues rarely included: In Treatment: 8% In Training: 47% R/S issues sometimes included: In Treatment: 43% In Training: 25% R/S issues often included: In Treatment: 35% In Training: 5% R/S issues included a great deal: In Treatment: 14% In Training: 4% Education for Clinicians Frequency of Religious / Spiritual (R/S) Issues in Treatment and in Training (Shefranske, 2011):

39. For Churches / Religious Institutions • Community • Be careful not to disenfranchise • Create safe space to dialogue about sexual issues • Helping clergy / religious leaders

40. For Churches / Religious Institutions • Building community • Provide both spiritual guidance AND community • Helps tap into protective resources of religiosity, particularly for those isolated or socially stunted through the use of internet for sexual arousal.

41. For Churches / Religious Institutions • Be careful not to disenfranchise – love, not shame • Because of moral dimension, people can be disenfranchised • Don’t lose moral framework but be careful to not perpetuate shame. • Goal isn’t moral perfectionism (specifically in regards to masturbation) • Be careful with reductionistic solutions (e.g., pray more, fast more, etc.) (see Kwee & Hoover, 2008) • Though well-meaninged, can lead to sense of failure • Drives addiction underground

42. For Churches / Religious Institutions • Create safe space to dialogue about sexual issues • Creating nonjudgmental atmosphere that doesn’t oversimplify sexual struggles (see Kwee, Dominquez, & Ferrell, 2007) • Address common misunderstandings of sex (Ferree, 2002) • Ultimately recognizing that we are sexual beings, and this comes from God as a GOOD thing

43. For Churches / Religious Institutions • Helping clergy / religious leaders • Provide support/connection to religious leaders rather than isolation • Help religious leaders to know what services/resources are available to them (Trihub, Mcminn, Buhrow Jr., & Johnson, 2010) • See religious people as “real people” – Resist putting leaders on a pedestal of perfection (Nelson, 2003) • Seeing sexual anorexia as part of the problem (Nelson, 2003) • Treatment protocol for pastors / clergy (Laaser & Gregoire, 2003)

44. Applications Ultimately, a patient's spiritual/religious commitment is potentially relevant to physical and mental health. Clinicians can respectfully inquire about the role spirituality/religion may play in a patient's life in taking the patient's history. For patients for whom spirituality/religion is relevant, opportunities await to collaborate with trained chaplains or spiritual counselors as part of the healthcare team to provide spiritual support or deal with spiritual distress in addressing particular patient needs (Larson & Larson, 2003).

45. The Institute for Sexual Health400 South Beverly Dr., Ste 316Beverly Hills, CA 90212 Dan Drake, MS, MA, MFT, CSAT Candidate 3 DanDrakeMFT@gmail.com (310) 415-5732