Saturday morning sex talk


Not the appropriate time, you might think, for a discussion about sex. Or maybe it is. Who knows. Funny, that was the prevailing theme of the talk I’d arranged at Walnut Creek Library, within its Las Trampas room, overlooking Broadway street. It was a bright, sunny early fall morning today. Few showed up—only four—to discuss an article in the latest issue of The Therapist, which rather decried the sex addiction treatment industry, which I was looking to promote.

Sort of.

One of my gigs is with a small agency in WC called Impulse Treatment Center, which for thirty years has provided group therapy for men primarily, who struggle with sexual behaviors that disrupt their lives: porn use, prostitution, visiting strip clubs, sexual massage establishments, and so on–behaviors that fit a distinctly masculine stereotype. In theory, there are female sex addicts also, but how they are manifesting is one of the unanswered questions blocking the admission of a sex addiction-like diagnosis into the APA’s Diagnostic Standards Manual (DSM-V)

I passed out some assessment tools that are used in intake processes, referring to the Sexual Addiction Screening Test (SAST) as designed and (somewhat) evolved by Patrick Carnes over the last twenty years, but focusing on a new tool called the HBI-19. This Hypersexual Disorder Inventory tool, designed by researchers at UCLA, aims less at a list of behaviors as it does an individual’s internal experience of sexual activity. The specific behaviors that are commonly associated with sex addiction are not even indicated on the HBI-19, inclining the observer to consider a more subjective understanding of a problem.

Unlike some, I’ve no problem with this, for it seems to me that assessing addiction based upon criteria of specified behaviors, or the frequency of said behaviors, misses the point of assessment. Currently, and all too often, addiction is determined via an externalized focus. What do I mean? I mean that addiction (and therefore treatment) tends to be considered when individuals cross certain thresholds: when they’ve broken the law, or been discovered by a spouse or partner—when they’ve been exposed, which presumably constitutes the loss of control watershed that so many cite as their hitting bottom experience.

Others might assert that problems exist because sexual behaviors cause conflict with values, thus leading to depression, low esteem, and social isolation. A recognition of these factors is promising as far as treatment is concerned. The more an individual’s motivation is internal—that is, not defined or mandated by others—the more available an individual is for an authentic therapy experience, whether that episode is with an individual practitioner or a group of peers.

Yet the internal motivation of those seeking care is precisely what is being attacked in some quarters. Jay Blevins, the author (or editor—it’s not clear) of the article “How concepts of sex and porn addiction are failing our clients”, asserts that “sex negative forces” (what a term!) in the sex addiction treatment field, headed by the likes of Carnes, incorporate scare tactics about ‘unsafe’ practices, and moral judgements derived from religious values, which further a homophobic (but not anti-male?) social agenda.

Blevins makes a good point that the purported medical consequences of extensive porn use (such as erectile disorder) are not supported by scientific data, but the term addiction was never intended to be used as a medical term—for that we have the term dependence. Addiction is a cultural term, drawing attention to a psychological or–as the 12-step community asserts–a spiritual problem. Whether personal distress is generated from an internal examination versus an oppressive assimilation of institutional mores, as people like Blevins assert: that’s for each person to decide.

Graeme Daniels, MFT



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Your Sexually Addicted Spouse: a review


A subdivision of sex addiction treatment is a therapeutic effort–a worthy effort–directed at partners of so-called sex addicts. Within the model more or less introduced by Patrick Carnes, and promulgated by his (followers?), a Co-Addict model emerged over the last three decades, which has been written about by the likes of Stephanie Carnes (his daughter) and Claudia Black, author of Deceived. Then, as the Co-Addict model  was being criticized as either ill-conceived or derivative, another model of partner treatment emerged called the Relational Trauma Model, which is somewhat preciously described as “a paradigm shift” by its adherents. One of its notable guidebooks is the Barbara Steffens/Marsha Means penned work, Your Sexually Addicted Spouse. Check out the reviews on Amazon and you’ll find, for the most part, gushing statements of gratitude from its targeted readership: “This book really helped me”, or “Finally, a book that addresses trauma” (actually, innumerable books related to SA address trauma). There are some dissenters, women who bristle at the victim-identification focus; the vague suggestions as to solutions–what to do. I’m a dissenter also, for the following reasons.

Several problems with this book: firstly, it aspires to a gender neutral position, using terms like spouse instead of wives or husbands, but of its two dozen or so testimonials from betrayed partners, not a single account is from a male partner of a woman (or even male) sex addict–a glaring problem in the development of this field, especially if the POV of the gay community is to be known. Secondly, the book goes to great lengths to disparage the so-called ‘Co-Addict’ model of care, hitherto directed at partners of sex addicts. The term Co-Addict, previously espoused by apparently like-minded colleagues such as Claudia Black and Stephanie Carnes, is now “invalidating”, a residue of a pathologizing bias. However, if one reads the recommendations and characterizations in Carnes’ and Black’s work, the reader would find remarkable similarities between their opinions and those of Steffens and Means. The same reactive, as in controlling behaviors of partners are identified (and discouraged) by these supposedly disagreeing authors, and while the ‘Co-Addict’ reactions are deemed ‘normal’ in Steffens’ and Means’ model, the characterization of betrayed response is dubbed ‘natural’ in Carnes’ and Black’s literature.

Hmm? Not exactly a gulf in empathetic reaction. Anyway, trauma is the new word: the more palatable, “evidence-based”, client-friendly word. Trauma is popular amongst readers of self-help literature, more so than ‘Co-Addict’, or ‘personality disorder’, perhaps because trauma connotes victimhood. The intent of RT practitioners is reasonable enough: when they use the word trauma, the accent of approach is upon empathy for suffering, the prospect of survival versus ‘victimhood’; less so upon implied criticism of behaviors (which again is there, but in muted form), or the inference of an underlying disorder with a backstory. However, not only is this position facile, it presents the issue of so-called relational trauma in a confusing way. For example, a passage in Your Sexually Addicted Spouse presents PTSD as a lifelong condition, entailing “coping mechanisms that become ingrained in personality”. Doesn’t that sound like a personality disorder? One gets the sense in books like this that marketing trumps clinical accuracy, and that concepts get conflated, like personality disorder and trauma. But personality disorder is not a nice term. Nor is Co-Addict. Nor is addict, for that matter, but Steffens and Means would have the reader reserve pathology for the people we’re meant to be angry at: the addicts. The men.

What do men think, other than me?

We don’t know. They don’t read books like this, so as far as promoting books like Your Sexually Addicted Spouse is concerned, it doesn’t matter.

Graeme Daniels, MFT



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Another three minutes with the CAMFT board

Graeme Daniels, MFT

These CAMFT board meetings: they happen three or four times a year, in hotel conference rooms up and down the state, always on a Saturday. The board of the California Association of Marriage and Family Therapists consists of a dozen members, men and women who don’t talk like therapists, but rather business people or lawyers. They don’t even seem to think like therapists, but for three minutes at a time at the outset of these all day gatherings, they promise to listen to therapists.

Being listened to is not something I expect, necessarily. Recently, it’s been hard going, getting others to take things in. There are clients as well as certain others who don’t return calls. Publishers and agents who won’t respond to e-mails. Even Pete Townshend, who asked to meet me after my Tommy paper got published, didn’t have much to say and walked off before I could start a conversation. Why? I wonder. Why am I so drawn to unavailable men? Anyway, at eight-thirty on a Saturday morning, my friend Ben and I showed up at a San Francisco hotel ready to be listened to, about AB1775, that stupid child porn law I’ve been blogging about, and—from Ben, mostly—the problem of insurance companies not paying claims. That’s actually far more serious, I later thought after hearing him speak.

At eight thirty we were ready to take part in one of these ‘members forum’ segments of a board meeting. They are supposed to last thirty minutes and proceed on a first come first serve basis. Wading through a vestibule, entering the room allocated for the proceeding, Ben and I found ourselves alone, gazing at an array of chairs circling a large table. Moments later, board members sauntered in, chatting, carrying cups of coffee, schmoozing. They looked at us and acted surprised, as they’d not been told there would be ‘observers’ this time around. A woman I recognized named Cathy Atkins, who also recognized me, took a quick look my way but then glanced off, choosing to admonish Ben: “in future, perhaps you could write us an e-mail, let us know you’re coming.” Weird, I thought. Last time I came to this thing there were about a dozen ‘observers’, all ready to speak—no RSVP seemed necessary. I once saw a video of one of these meetings in which the room was filled with over fifty members, also lining up to speak. And by speak I really mean protest. Something’s changed, I realized. The spirit of dissent in this organization has, shall we say, diminished?

After a call-to-order and reading of agendas, a woman in charge announced it was time for our members’ forum to begin. Slightly disorganized, she asked who had the timer for the three minute segments. Then, looking down at the forum sign-in sheet, which contained only two names (Ben and I), she looked over and beckoned me to speak, pronouncing my name correctly, which rarely happens on a first reading. I’d have been impressed but for the sight of the woman next to her, whispering her knowledge of who I was, which was both gratifying and not. The three women at the head of the table were the new president of the board, plus two lawyers. The femicratic air was balanced by four or five men, most of whom sat at the other end of the table, looking detached, if thinly adversarial.

I began speaking through the anticipated personal blocks: the dry parch in my throat, which can drain the life from my hard syllables; the halting pass at stretched vowel sounds—a more common nemesis of mine. Then there were the externals to contend with: the expressions of a dozen people, most of whom gave effortful looks of interest; some bothered to twist their necks around to face me. There were one or two earnest faces, and even a faint nod from a former president—warmly supportive, if relieved to no longer be in charge. So, here’s what I said.


1.)      A year ago I was at this meeting in Santa Clara protesting 3 things: the passage of bill AB1775, which now mandates therapists to report ‘downloading’, ‘streaming’, or ‘viewing’ material depicting sexual conduct of minors;

2nd: CAMFT or CAMFT attorneys’ role in not only endorsing the bill, but writing it.

3rd: CAMFT’s misrepresentation of several aspects of AB1775 to the CAMFT membership

2.)      Yet it was clear to me after listening to a later ¾ hour discussion by this board that several members were like many therapists I’ve spoken to: they had not fully understood the implications of this bill at the time of its writing. They regretted their support.

3.)      Others appeared to support the bill, but with dubious arguments: that offenders should be reported to authorities, and by implication persecuted, not treated because “sex offender treatment is not effective”. This is an unfair and reductionist view. Another member, unwittingly paraphrasing the US attorney general, suggested that viewers of underage porn enable its production and are AWARE of the exploitation entailed in child porn. Interesting–not to mention one of our society’s staggering hypocrisies. So if we were aware of the child poverty, the exploitative labor conditions around the world ‘enabled’ by our innumerable consumer choices, would we be culpable…reportable? This insipid bill was written for facile people who concern themselves with exploitation, but only as it pertains to sex.

4.) But finally, for the future: member Mark Perlmutter argued that CAMFT should take a second look, as in scrutinize AB1775 in 2017, with a task force that CAMFT members might be invited to join. Well, 2017 is three months away. My requests to be a part of a task force have been ignored or deflected. I cannot get straight answers from CFS officials as to whether abuse reports have increased because of the new law. Well, they’ve gotten none from me, I’m proud to say. And the director of the SJPD internet crimes against children task force does not return my calls. Perhaps he doesn’t talk to therapists. Perhaps, like some lawyers and legislators, he’s got better things to do.

Graeme Daniels, MFT




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Sex addiction stigma debate (part two)

  She spoke haughtily, which has a peculiar effect on me: I start questioning my right to think. “You’re speaking of men who acted out with their sexuality, and society is pushing back against…

Source: Sex addiction stigma debate (part two)

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Sex addiction stigma debate (part two)


She spoke haughtily, which has a peculiar effect on me: I start questioning my right to think. “You’re speaking of men who acted out with their sexuality, and society is pushing back against that kind of privilege.”

“Acting out? Wait, are we now talking about something different than when you spoke of female sex addiction?”

“The men you indicated are compulsive philanderers, porn addicts, acting upon an exaggerated sense of entitlement. Women are no longer willing to tolerate that.”

“Whereas female sex addiction is…different?”

“Women are stigmatized for simply having sex before marriage. Men aren’t!”

“Okay, but women are not being assessed as sex addicts for simply having sex before marriage.”

She waved her hand in an expansive fashion. “No, but that’s part of the context, that generally lesser tolerance for their sexual freedom. It just makes it harder for women who do have problems to come forward and get help.”

I tilted my head, affecting skepticism.

“I can see you’re having a hard time accepting this.”

“You say ‘accepting this’ like you’ve already landed a truism, and I’m like a holocaust denier or something.”

“Seriously, you don’t think society has traditionally been harsher, more devaluing of women’s sexual behavior than men’s.”

“Traditionally is a key word there. Time’s change. Not sure I accept the conclusion based upon your premise.”

She shook her head. “You lost me,” she said.

“So let’s go back to the earlier point. You say that women feel a greater stigma around their sexuality than men, right? And this stigma, which is a societal phenomenon, is internalized by women, causing extra layers of shame?”

“Correct,” my colleague said cautiously.

“Well, consciousness leads to change. That’s the basic promise of our profession, after all. Now again, we’ve had at least two generations since the so-called sexual revolution, which sought to liberate men and women from sexually repressive values. I think many women now externalize the problem of that stigma you reference. They resent society’s traditionalist constraint of their sexuality, and therefore push back against institutions, including schools of thought like sex addiction treatment models, that would pathologize that newfound sexual freedom. It’s like when political outcasts used to get diagnosed with schizophrenia and other mental illness labels: I think some people think the term sex addiction is a sex police invention, and I think it at least one alternative reason why women especially, as well as the gay community, might reject sex addiction treatment.”

My colleague offered a soft utterance, one aimed at neither agreement nor concession, but merely diffused conflict. I think she wasn’t sure if we were saying different things.

“Interesting,” she said neutrally. “Still, I think the women that I see and talk to retain that traditional internalization, and they hold other women to the standard they believe in.”

“With respect, most of the women you speak to are over fifty, and their husbands are John Wayne-types.”

“Maybe. But I just don’t think men judge each other about sexual misbehavior as women judge other women who act out.”

I sort of rolled my neck, like I was straining to take this in.

“You don’t agree? You don’t think men encourage other men, even boys, implicitly or not, to be sexually active, to have as many partners as possible?”

“I’m not sure that matters with respect to the issue at hand. If women, traditionally or presently, stigmatize men for their sexual misbehavior, and you aren’t disputing that—merely justifying it, sort of—then men will have problems in relationships. Period. It doesn’t matter what the ‘patriarchy’ thinks today. If I cheat on my wife, for example, it’s not like I can say, ‘but my buddy Jay says it’s cool’ and expect everything to be all good with her. And that’s what matters to the men who seek treatment, who are mandated into treatment: they want to fix things with their partners.”

She shrugged coolly, apparently more at home debating this issue amid tangents.

“Seems to me it’s the same for women, only I think history and tradition lingers more than you believe it does. But if, as you suggest, it doesn’t matter so much—this matter of stigma, whether it’s directed by the same sex or not—then what’s this discussion about?” She shrugged again, this time presaging finality. Suddenly, she sounded weary, not so much curious, only I wasn’t done.

“Because it seems important, this question of why people go into treatment and why they don’t—why women don’t seek treatment, which is what you said today, only your bias suggests that women are being under-served, which implies women would choose sex addiction treatment if they were offered it. Like I said, it’s 2016. I think many, perhaps most women are shedding terms like ‘slut’ and ‘whore’, or trying to, anyway—and that places the problem in society, not in individuals. Meanwhile, I think men are internalizing what’s happening to some of their fellow alpha males. That lesser judgement, or entitlement, that you perceive? It has a flip side, one that’s center-stage now. Justly or not, the men I talk to take on board labels like ‘horndog’, accepting their comparison to animals, their compliant exile to the ‘doghouses’ when they’ve ‘strayed’. Then they sit with me, feeling incompetent and saying, ‘I was never raised to share my feelings’, having internalized that feminine critique also.

Joanne averted her eyes, like she wanted out of this conversation; it’s ambiguous agenda and questioning of trends. What would she do with this, I could hear her thinking. She finished her coffee, asked a passing waitress where the bathroom was. The epicene worker whom she stopped had an untroubled, these-matters-are-not-on-my-radar look about her. She (I think) wordlessly pointed to a door just beyond our table, concealed by a disorganized gathering. It was a tiny room, this bathroom—not big enough for the café’s throngs, and amongst customers, unbeknownst to café owners, it was controversially unisex.

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Sex addiction stigma debate (part one)


During a local talk on sex addiction to an earnest group of Saturday morning listeners, my two female colleagues, Joanne and Gina, and I gave a modest introduction to the demographics of our business. As we sat listening to one another, we gave supportive nods, affirming all of our thoughts, though in truth, a couple of my one colleague’s ideas had me bristling. One of her chestnuts concerns the under-researched area of female sex addiction: “as shameful as this condition is for the men, it is especially stigmatizing for the women.” She also said something about men being raised with a ‘John Wayne’ model of emotional expression, and were thus constricted, suffering from intimacy disorders, which in turn impacts their partners. Everyone nodded, including me, only more faintly. I didn’t say anything contrary, partly because of time constraints, partly because of the agreeable ambience in the room, and also, frankly…I’m not sure how important this issue is.

It seems worth writing about, anyway. And arguing about, I guess. As Joanne made one or two other similarly-themed remarks, I recalled the comments of her junior colleague, Gina, from a day earlier, during a staff meeting at our shared agency. At that time the context was our much maligned room schedule board, admittedly outdated, but still in use because no one wants to take time to devise a new system, or tear down our old but beloved white board, streaked as it is with cheesy black demarcation strips and years’ worth of dry erase pen smudges. An online calendar would be best, chirped our newest colleague, proclaiming it is 2016, after all, not 1972.

Not 1972. My mind turned back to the present context and Joanne’s assertions. Frozen in time, I think. Afterwards, over coffee, I told her that I thought some of her pronouncements tired and superannuated, though I didn’t quite put it like that. How so? She queried, comfortably unoffended.

“Well, let’s take the one about women and sexual stigma. You say that women feel an extra layer of stigma in society about sex addiction, and therefore shy away from treatment or recovery, which is why we have less research about them.”

“That’s right.”

“Okay, but the point seems moot, because men aren’t seeking treatment either.” Her head sort of went crooked at this point, indicating surprise and perhaps something else; a playful rebuke, maybe. I was nit-picking, or something. Anyway, I continued. “You said later in the talk that many if not most of the men in our program are mandated: there because of a court order, or a demand from a disgruntled partner. So in my opinion the more pertinent question is this: if there are scores of untreated female sex addicts out there, why aren’t their disgruntled partners mandating treatment?”

She was unperturbed by this challenge, but still waffled with unconvincing polemics. Husbands and boyfriends are less forgiving, she opined, and also—many of those women’s partners are also sex addicts; that women are more judgmental of each other’s sexuality than men are. She spoke with authority on these points, as if she had volumes of data at her disposal. We don’t know these things, I contested, though I sort of agreed with the middle assertion, while thinking the first and the third contradicted each other. We danced around items of research for a bit, eventually dissolving the ‘evidence-based’ part of the discussion and finally dropping into what’s left: what people actually think, which is what matters. I countered her first idea: “While there may be something to your first point—the humiliated male being an especially unforgiving figure—I’m not sure that history or tradition shows that the cuckolded man is a fiercer image than the ‘hell hath no fury’ woman. But regardless, as Gina would say, this is not 1272, or 1972, and by the way, millennials don’t even know who John Wayne was.”

“What’s your point?”

“My point is this: over the last generation, possibly two, most of the scarlet-lettering that happens in society—at least that which gets media attention—has been aimed at men. Or maybe you can tell me: who would be the female equivalents of Tiger Woods, Anthony Wiener, Elliot Spitzer…Bill Clinton?”

“That’s different,” she said, a bit sharply. It was on.


Graeme Daniels, MFT

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And sharks do not eat gas tanks


It’s not as though suspension of disbelief isn’t a thing. In Ian McEwan’s The Cement Garden, the reader has to believe that three children, whose parents have both died of separate illnesses in quick succession, can live undetected by neighbors, schools, police or social services, for several weeks, even as corpses rot in their home’s basement. In Jaws, that trauma-inducing film of my youth, the viewer must accept (or not think too much about) if wanting an optimal thrill, that sharks might leap across boat decks or swallow gas tanks.

In my novel, Venus Looks Down On A Praise Vole, there are numerous events, plot points and situations that stagger credulity to one degree or another, though none are fantastical in nature. Somewhat mundanely, the reader is meant to believe that my protagonist, Dr. Daniel Pierce, a psychologist, can pursue a career while regularly drinking in between sessions; that he could spend several hours in the company of a transgendered individual (admittedly in a pre-op stage) and not notice the person’s transformation; that he could forget names and patient details, not maintain adequate records, stop listening to people, actively dislike some of his patients, and still be a practicing clinician.

Well, that’s why he’s taking a break from his practice. Daniel Pierce goes on hiatus. That’s the opening plot point: his recognition of his falling apart, his need to stop working and deal with issues, some bad habits, and some losses: the estrangement of his son, the recent passing of his wife. But before he’s even fashioned a plan of restful inaction, his working life pushes back, or rather pulls him back into a working stance, only it will be a much different day on the job, what happens next. It will suspend his disbelief, make him think before the adventure’s done that he’s being seduced, patronized, rescued, recruited, chased…scapegoated.

Perhaps the most difficult event to accept is Pierce’s meeting of a former client in a sober living home. Kirkus reviews made this complaint, thinking it unrealistic that a psychologist would drop out of society, drop into a rehab-like environment, and meet one of his former patients, and even have the man as a roommate. Even if I hadn’t given cursory hints that this might happen—indicating that my unnamed setting is a small town; a hackneyed statement that the world is small—I’d grumble about this critique. After all, what’s so hard to accept? That a mental health professional would have a drug or drinking problem, need treatment or a retreat? That he wouldn’t take special care to avoid contact with his client base? Perhaps my reviewer isn’t aware that certain professionals—doctors and airline pilots, for example—do require or demand segregated, occupation-specific services, precisely because of this concern. It’s actually quite strange that the accommodations that are afforded these professional groups aren’t made for psychologists and other professional counselors.

But for me, this rather ordinary discussion misses an important point: namely, that a strict adherence to what is orthodox or realistic isn’t the most important aspect of a fiction; hence the term fiction. I had Daniel Pierce leave the structure he was in, or the rut he was in, because in order to regain his vitality and sense of mission, he has to leave not only his comfort zone, but almost his entire frame of reference. That’s an equally important axiom of drama, surely. Therefore, he has to perform an impromptu therapy in the most unlikely of circumstances; he has to not conform, challenge authority in ways he never has before. He has to observe ugliness that he’d previously been sheltered from; rethink gender, justice, his oldest notions of fitting in. In being responsible, being anything close to a heroic figure, he must consider that he may be right or wrong about the judgments he ultimately makes, but make his decision anyway.



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