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Treating Sexual and Pornographic Addictions

Mark B. Kastelman

Sex and porn addictions require therapists with special training in these areas for patients to have a good chance of recovery. These illnesses are very difficult to treat, with relapses the norm. There are no training programs in traditional medical schools, graduate schools of psychology or social work that deal with this kind of addictive problem. And while this will undoubtedly change in the next few years, anyone now seeking professional help will need to check very carefully the background experience of any therapists that they might choose to treat them.

What you are looking for is a "sex addiction therapist" from any of the mental health healing disciplines who has a good track record in treating this problem and personal values that are reasonably congruent with the patient's values. Suggestions will be given shortly on how to find such a therapist.

In addition to having a competent, qualified sex addiction therapist, the patient will also need to attend regularly - (90% of the time) for two years or longer - weekly meetings of Sexaholics Anonymous (or other similar 12-step support group). These groups (free of charge) meet in nearly every fair sized city in America and their address and location can be found in the business pages of the phone book or by contacting Alcoholics Anonymous, who can give directions to the caller on location and time of meetings of the sexaholic group. It will be at these meetings that patients can inquire of fellow members or attendees the names of competent therapists they are individually meeting with and have found helpful and competent in receiving their own treatment. Another source of referrals is to call the National Council of Sexual Addiction & Compulsivity, who have a register of most therapists in the U.S. doing treatment in this area: 770-989-9754.

In my experience of 25 years in treating approximately 350 of these patients I find, if married, nearly universally the wives are traumatized by the husbands lies, deceptions, and-out-of-bounds sex behavior, and need treatment, too. If the wife decides to stay in the marriage for a while longer, I engage her in joint treatment with her husband. I have found that if I successfully heal the husband of his addiction but have an angry, hostile, wounded wife who can never trust or forgive her husband even though she remains in the marriage, it greatly increases the risk of relapse in the husband as he attempts unsuccessfully to placate and deal with major marital turmoil. The wife's wounding has to be addressed as well as have both parties participate in marital therapy. Thus I nearly always attempt to have the wife join with the husband in our therapy sessions. This usually predicts a successful outcome if both stay in the healing program. This program works and is successful if both parties stay with it. Sometimes the husband will find himself with years of sobriety and feel he's all "cured" and doesn't need to still attend his group meetings or therapy sessions anymore. Why waste time and money when he's doing so well? This can be very risky. And it greatly increases the chances for relapse. What I do when patients start experiencing long-term sobriety is gradually lengthen the time interval between therapy sessions. So eventually we may be meeting once every month, or six to eight weeks or longer.

The specifics of treatment by the therapist will not be presented in detail here other than to mention that we do marital therapy, put the couple in marital communication workshops (such as Marriage Enrichment), do a lot of work with relapse prevention, identify the triggers to acting out and develop strategies to protect them from the triggers, fortify them to deal with the "wave," and help them reduce and eliminate masturbation to
pornography, since this increases the power of their addictive illness over them and is the royal road to acquiring new sexual addictions or paraphilias which might be acted out. We also strongly emphasize a "no secrets" rule, and how vital this is to healing.

We treat concomitantly any other addictions which they might have. All have to be treated together, otherwise the patient just shifts back and forth between addictions with no real long-term healing. We teach them the three-second rule to manage and control intrusive thoughts and imagery. We give them a lot of reading to do in the sex addiction area (like the Carnes' books, and the "white book," created by S.A. and filled with successful recovery biographies, plus monographs on many other related topics). We want them to be "world experts" on the nature of sex addiction, its genesis, its course, and helpful treatment procedures.

We also find it most important that they have hope and assured knowledge that the illness is treatable and they can get their free agency back again and have rational control over their previously driven irrational behavior. They see how this is possible as they attend S.A. and see and hear the testimonies of other people who now have long-term sobriety. These were people who were in much worse shape than they when entering treatment.

We deal with spiritual issues in therapy when this is appropriate to the unique circumstances and values of the client. We also deal with deep woundedness arising out of early life traumas which now make them vulnerable to seeking out quick-fix sexual acting out as a solution, which really doesn't work in the long-term. I also give a lot of verbal praise and genuine appreciation in response to even their smallest gains and good behavior. I never criticize or put them down when there are relapses. I just say, "This is exactly why we meet in therapy - to strengthen you and develop new strategies to deal with temptation. Now if this situation were to occur again, what might be a more powerful way to deal with it? To resist it? To remain sober? …etc.,"

Male teenage patients can be quite challenging. Many deny that it is a problem and consistently lie about the details of their involvement with it. Their motivation to change may be nonexistent. They are usually brought in for treatment by an angry and/or sorrowful parent and often tend to be uncooperative and passive/aggressive in dealing with the problem. It may be helpful to consider family therapy and be therapeutically confrontive in dealing with the issues that arise. Fairly drastic limitations on home computer/Internet use may be necessary. If 17 or older, I put them into a regular S.A. group with, possibly, the father also attending to be a support to the son and be someone he can talk with about the various issues as they arise.

Mark B. Kastelman

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