Monthly Archives: October 2016

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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