During my early years of sex therapy practice (late 1980’s, early 1990’s), the most common problems for which clients sought treatment (both individuals and couples counseling) were related to desire (low libido) and performance (premature ejaculation, difficulty attaining or maintaining erection).
Online Sexual Addiction
Toward the mid-1990’s, there began a trend of people seeking therapy and couples counseling because they were “caught” by their spouses engaging in cybersex—using the computer for sex. As the internet made sex more accessible, anonymous, and affordable, I began to see more and more clients referred for out of control sexual behavior or what became more commonly known as sex addiction. Like alcoholism, the term sex addiction for many people tends to be inflammatory, emotionally charged and often creates defensiveness and denial.
4 Points to Consider
To help determine if an individual has a problem in this area, consider the following:
- A person engaging in sexually compulsive behavior tends to minimize, rationalize, or deny their actions. Their distorted thinking allows the person to convince themselves that their behavior is acceptable. For example, a man tells himself that paying for sex is harmless since he is not getting emotionally involved and his wife is not as sexually driven as he.
- The person tries repeatedly, yet unsuccessfully, to discontinue the behavior. For example, after spending 4 or 5 hours surfing cybersex sites, the individual tells themselves he/she will cut-down or stop, but the behavior continues.
- The person continues to engage in the behavior despite significant negative occupational, social, legal, and/or health consequences. For example, a person spends hours on erotic websites while neglecting work and family responsibilities.
- There is a continued need to increase the novelty and intensity of the sexual experience because the current level of stimulation or activity is losing its arousal power. For example, engaging in phone sex is no longer arousing, the person now seeks to meet and have physical contact.
Sex Addiction Evaluation
Psychotherapy for sex addiction begins with a thorough evaluation that includes:
- A detailed description of the compulsive behavior including triggers, frequency, functions served, and pattern of engagement.
- History and evolution of the behavior.
- Family of origin dynamics particularly as they relate to intimacy, affection, and sex abuse and trauma history.
- Cognitive distortions used to maintain the behavior.
- Life stressors and self-care habits.
- Drug and alcohol use.
- Significant relationships and support system.
- Medical issues.
A comprehensive assessment is critical in designing an individualized treatment plan that will equip the client with tools and strategies necessary to better manage his/her sexual impulses and develop a sex life that is healthier, more balanced, and free of guilt and shame. Treatment is multi-faceted and often includes individual and group therapy, and support group participation.