Untangling the Web: Treating Sex and Porn Addiction

1. Untangling the Web:Treating Sex and Porn Addiction • Robert Weiss LCSW, CSAT • Executive Director • The Sexual Recovery Institute • www.sexualrecovery.com

2. What Do These Men Have In Common? • Fmr. President Bill Clinton • Fmr. Senator Larry Craig • Fmr. Governor Elliot Spitzer • They are men whose sexual behaviorMORTALLY WOUNDED their ability to lead ... but what if their problem had been drinking or drugs e.g Patrick Kennedy?

3. Our Typical Client • 38 year old married working male • Wife found extensive porn or hook-ups in computer - says get help or you’re 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?

4. 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

5. Sex addiction can be… • A Stand Alone Diagnosis

6. 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

7. 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

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

11. Substances of Mood • Serotonin • Dopamine • Adrenaline • Endorphins • Oxytocin “the cuddle chemical”

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

13. In 12-Step Language ... • POWERLESS!

14. Sex Addiction is not about sex, it’s about the search for sex and desire for orgasm. It’s a‘process’ addiction.

15. Sexual Addiction Symptoms in Residential or Outpatient Clients • In the Client’s 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. • Having sex while in treatment

16. Sexual Addiction Symptoms in Residential or Outpatient Clients • In the Client’s 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

18. What makes online sex so popular and so exciting? • ACCESSIBILITY • AFFORDABILITY • ANONYMITY Adapted from the “Triple-A Engine” Al Cooper PhD. 1998

19. 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?

20. 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 don’t forget SEXTING

21. What’s the big dealIt’s just a guy thing…

22. 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

23. And now a word or two about ... • ...Spouses and Partners

24. Treatment is the Reclaiming of Reality

25. 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 ...

26. Initial Sexual Addiction Treatment is ... • Cognitive Behavioral and Task Oriented

27. 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

28. 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 • Doesn’t change without prior agreement

29. Simple SexualSobriety Plan • List of Behaviors I Want to Stop • A • B • C • D • E • F • List of Behaviors I Want to Add • A • B • C • D • E • F

30. 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

31. 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.

32. 12-step Groups for Sexual Addicts and Partners • Partner Support • S-Anon • Alanon • COSA • CODA • RCA - Couples • Sex Addict Support • SAA • SA • SCA • SLAA-Women • SRA

33. Treatment and Training Information • The Sexual Recovery Institutewww.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

35. Untangling the Web:Treating Sex and Porn Addiction • Robert Weiss LCSW, CSAT • Executive Director • The Sexual Recovery Institute • www.sexualrecovery.com