While most addiction-informed therapists have a fairly clear sense of the type of residential/inpatient rehab facility that will best serve a drug addicted or alcoholic client, where to go for “sex rehab” is often another story. Therapists and counselors of all stripes, along with their sex and porn addicted clients, can be challenged by a lack of knowledge about the work to be accomplished during inpatient sexual addiction treatment, and they can therefore be understandably confused by the 400 or so treatment center websites claiming to serve “the behavioral addictions” (sex, romance, eating, gaming, gambling, etc.) This post is an attempt to demystify the sex rehab issue, and to offer a few tips toward finding the right treatment facility based on specific client needs.
In many ways, the rhythm and feel of inpatient sex addiction treatment mirrors inpatient drug and alcohol work, relying to a great degree on similar program formats and therapeutic methodologies. The three main differences between chemical dependency treatment and sexual addiction treatment are the primary subject matter (sexual acting out), a differing definition of sobriety, and the strength of focus on high accountability with peers, social bonding, and trauma work.
In sex addiction rehab, as with other forms of inpatient treatment for addiction, the process starts with a thorough bio-psycho-social assessment, which looks not only at the client’s sexual addiction but at potential differential and/or co-occurring diagnoses. This is also where extensive evaluation of the client’s sexual and relationship history begins in earnest – a process that continues throughout treatment.
Following assessment, the early parts of the therapy process are highly directive and accountability-based, most often grounded in a combination of cognitive behavioral, educational, and process work around triggers, family systems, trauma, grief, relapse triggers, and the like. Group therapy, psychoeducation, and social learning all play significant roles in this early healing process. Typically, addicts are also exposed to twelve step meetings and principles.
The primary goals of inpatient sex addiction treatment are as follows:
- To temporarily remove the addict from the people, places, and things that trigger his or her addictive sexual behaviors
- To clearly delineate, in writing, which sexual behaviors are problematic and which are not (i.e., to create a written sexual sobriety contract)
- To confront and address denial about the actual dangers/harms/losses related to the addict’s problematic sexual behavior patterns (past, current, and future)
- To have the client give a complete, full, and open account of his or her entire sexual and romantic history (highly detailed but not graphic)
- To reduce shame and self-hatred by sharing and hearing such histories without judgment
- To reduce shame and self-hatred by helping the client identify the roots of his or her sexual acting out, promoting an understanding of trauma and related emotional injuries as strongly correlated to behavioral addictions
- To begin the process of delving into early-life trauma via experiential work, helping to further tie past experience to current behavior patterns
- To help the addict take full responsibility for his or her adult behavioral actions and choices, helping the addict understand that even though he or she may have been victimized early in life, that victimization does not eliminate accountability for the actions of active addiction
- To provide the addict with clear, workable, basic relapse prevention tools and a defined, integrated aftercare plan
- To encourage participation in lifelong, ongoing recovery from sexual addiction, which often includes long-term individual therapy, group therapy, and twelve step or faith-based support groups
A common misperception about most forms of intensive and residential addiction treatment is that addicts, having completed 30 to 60 days of care, are now “cured” of their addiction. In reality, there is no cure for the impulses and drives toward addiction, especially when the client is facing emotional stress. As with all chronic diseases, there is only ongoing healing and commitment to accountability and behavior change. The real goal is for sex addicts to leave rehab better prepared for the long-term process of healing, with less shame, better coping mechanisms, and a sense of what genuine connection and social support can bring them (acceptance, direction, help, etc.) In this way, we see that inpatient treatment is not the endgame for sex addicts; instead, it is one of many steps on the road to a healthier and more integrated life.
Unfortunately, finding a good sex addiction rehab is not as easy as one might think. Hoping to capitalize on the relatively recent Internet-driven increase in sexual addiction, many generalized addiction and mental health treatment centers now list “sexual addiction” as a subspecialty, even though they lack the organization and the properly trained staff needed to effectively assess and treat sex, porn, and relationship addictions. As such, if you have a sexually addicted client who is struggling to establish sobriety and you’re thinking about recommending inpatient treatment, you should keep the following guidelines in mind:
- The treatment facility should have a fully separate treatment program dedicated to sexual addiction. In other words, sex addiction treatment should not be a track in a larger behavioral or substance addiction treatment program.
- The program MUST be gender separate, with boundaries for same-sex attracted clients openly discussed.
- The program should have a primary focus on social learning, nonsexual peer bonding, shame reduction, and group therapy.
- Individual therapy should be conducted 1-2 times weekly with a primary therapist who also is the leader of the group therapy process (thereby reducing splitting, increasing trust, etc.)
- The primary treatment staff in a dedicated sexual addiction treatment program must have extensive experience and certification as sexual addiction treatment specialists. Keep in mind that “sex therapists” are not usually trained in sexual addiction treatment. Sexual addiction treatment specialists with a CSAT and/or an ATPSB certification are what you’re looking for.
- In addition to trained and certified primary sexual addiction therapists, the facility should also have general addictions professionals on staff to identify and deal with co-occurring addictive disorders.
- Trauma specialists with expertise in multiple treatment modalities should meet regularly with the client if/when needed, helping the client to identify and to begin the process of working through trauma-related issues. This work must always be titrated based on the ego strength of the client and his or her social support outside the therapy room. In other words, trauma work should never exceed the client’s “window of tolerance.”
- The treatment regimen should incorporate a strong family therapy component.
- The facility should have a proven track record of success, with former clients willing to anonymously speak about their experiences in treatment and their life post-treatment.
Having designed several highly regarded sexual addiction treatment centers – the Sexual Recovery Institute, the Center for Relationship and Sexual Recovery at The Ranch, and the Women’s Substance Abuse and Intimacy Disorders Program at Right Step DFW – I know what works and what does not in terms of keeping clients focused, present, and on-task. When sex addiction treatment centers meet the above criteria, you can feel confident in recommending them. If they fail in even one of these areas, keep searching.
Of note: After completing inpatient treatment, sex addicts will need to continue in outpatient therapy with a sexual addiction treatment specialist as well as a couples therapist (if there is a marriage or partnership involved), along with individual and group sessions addressing not only addiction but underlying trauma issues. A good inpatient treatment program will fully organize a detailed aftercare plan as part of the addict’s discharge process. The addict’s initial visit to his or her outpatient therapist is typically scheduled before the addict leaves treatment, and it should take place almost immediately after his or her return home.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships. For more information you can visit his website, www.robertweissmsw.com.