For the most part, effective sexual addiction treatment strategies mirror the techniques that have also proven useful with substance abuse treatment. In short, sex addiction treatment specialists rely on a combination of cognitive behavioral therapy (CBT), group therapy, trauma-informed assessment and awareness, and 12-step recovery work. One major treatment difference when dealing with sex addiction versus substance addiction is the definition of sobriety. With substance abuse, sobriety involves complete abstinence from all mood-altering substances, whereas sexual sobriety involves an ongoing commitment to behavior change but not long-term abstinence from sex. As such, sexual addiction sobriety is more easily compared to the way we handle eating disorders (understanding that clients cannot stop eating altogether).
As a first step toward creating sexual sobriety, a recovering sex addict, working with his or her therapist and/or 12-step sponsor, carefully defines the specific sexual behaviors that are (and are not) causing profound dysfunction in his or her life. Once those behaviors are clearly delineated, a written “sexual sobriety contract” is created, plainly stating which sexual behaviors the client will need to abstain from, and which are healthy and acceptable for that specific individual (taking into account his or her values, beliefs, and life-goals). As such, the definition of sexual sobriety can differ for each client. For example, the sexual sobriety contract created by a 28-year-old single gay man will probably be very different than the contract created by a 48-year-old married man with three children. In other words, a sex addict’s goals for behavior change are rooted in the problematic behaviors that brought that person into treatment in the first place (angry spouse, STDs, trouble at work, arrest, concurrent drug abuse, etc.), and also in that person’s life goals for the present and the future. In this way, the addict’s motivation for change both starts and remains high, as the addict sees that the elimination of problematic sexual behaviors will alleviate his or her present-day issues, while also helping to build self-esteem and a sense of control over life.
When sex addicts enter a sexual addiction/intimacy disorders treatment setting, clinical goals typically include:
- Separating the addict from his or her harmful sexual behaviors
- Breaking through the addict’s denial regarding the problematic nature of those activities
- Helping the client grieve the loss of who he or she may have seen himself/herself to be (versus what that person’s sexual behavioral history reveals)
- Helping the addict understand how past trauma, abuse, and/or neglect have informed his or her early learning experiences and current dependency needs
- Reducing shame by helping the client view his or her adult sexual act out as a learned means of self-soothing, affect management, and dissociation (a misguided coping mechanism) rather than an inherent character defect
- Providing relapse prevention, self-care and stress management techniques, family crisis resolution, aftercare planning, and the like
Because it is very difficult for either active or newly sober sex addicts to distinguish between healthy and unhealthy sexual behaviors, a brief period of total sexual abstinence (masturbation included) is usually encouraged, especially while the client is in primary treatment. Most often this period of abstinence lasts 30, 60, or 90 days, depending on the individual. This allows the sex addict, again working in conjunction with his or her therapist and/or sponsor, a sex-free cooling off period in which to fully assess his/her romantic and sexual acting out patterns (seduction, manipulation, lies, etc.) while also developing some basic coping skills that can be used when the desire to act out arises.
As mentioned above, Cognitive Behavioral Therapy is the recommended therapeutic modality for treating addiction. For those unfamiliar with this work, CBT looks at the emotions and events that trigger and reinforce the addict’s desire to engage in compulsive sexual activity, and then it identifies healthy ways for the client to short-circuit the process. In other words, CBT teaches addicts to transition their addictive sexual thoughts and behaviors into healthy self-care actions – usually things like going to a 12-step meeting, reaching out to a peer/therapist/friend/family member for support, and actively developing a spiritual connection. Essentially, CBT focuses on living a sexually sober life in the here and now rather than on uncovering and processing past traumas. As such, the therapist’s role, at least early on in sexual sobriety, is to implement a task-oriented, accountability-based methodology geared toward containment of the client’s problematic sexual behaviors. Later on, once sexual sobriety is firmly established, the therapist and client can look at other, deeper issues.
Unsurprisingly, the process of sexual recovery often presents challenges that can’t be dealt with solely in individual, one-on-one therapy. Like other addicts, sex addicts nearly always require external reinforcement and support if they want to permanently change their deeply rooted patterns of behavior. Sex addiction focused group therapy can be extremely helpful in this regard. Generally, a treatment specialist works with between six and ten same-gender sex addicts. (Co-ed sex addiction therapy groups are a bad idea!) The facilitated group setting is a great way for sex addicts to learn that their problems are not unique, which goes a long way toward reducing the shame associated with their behaviors. Group therapy is also the ideal place to confront the denial that is so integral to sexual addiction. Such confrontations are powerful not only for the addict being confronted, but for the addicts doing the confronting. As such, everyone present learns how minimizations, justifications, and rationalizations sustain sexual addiction. Clients are also able to learn which interventions and coping mechanisms work best based on other members’ experiences.
If clients are struggling with core concepts of healing, or they just can’t seem to establish a footing in sexual sobriety, they may benefit from inpatient residential or intensive outpatient sexual addiction treatment. These intensive programs can last as little as two weeks or as long as several months, depending on the program and the client.
In addition to individual and group therapy (and perhaps inpatient or intensive outpatient treatment), sex addicts nearly always benefit from 12-step “S” meetings. Sexaholics Anonymous (SA), Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA), and Sexual Recovery Anonymous (SRA) are all nationwide programs for sex addicts. Some meetings are open to anyone who wishes to attend, while others are open only to those who identify as sexually addicted. A few meetings are gender specific. It is best to check ahead by looking meetings up online or by calling the group’s local hotline number.
Needless to say, every sex addict’s treatment arc is different. Each individual arrives with specific problematic sexual behaviors and a unique background, so each client needs an approach tailored to his or her particular needs. Some will respond best to individual therapy supplemented by group and 12-step work. Others will do best in group settings, making little progress one-on-one. Still others will struggle utterly until they are physically separated from the people, places, and things that drive their addiction by the protective walls of inpatient treatment. The most important thing when dealing with sex addicts is to recognize their individuality in this respect, and to respond accordingly rather than by attempting to force-feed any particular approach, no matter how much success you’ve had with that approach in the past.
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, along with numerous peer-reviewed articles and chapters.