Tag Archives: mental health

November 16, 2025 · 5:09 pm

What’s wrong with my approach?

He sat down before his laptop, extending a finger to the screen like he was adjusting controls, a pilot making final preparations ahead of the flight. He adjusted his seat, making it higher, or at least higher such that he could aim his gaze downwardly at me. A requirement, I figured. “Good morning,” he said chirpily. I returned a tense greeting, feeling a bit like I did the last time I was in a dentist chair. Where are those torturous needles, I wondered? I always imagine that when I go there, my hygienist will start off lightly, performing a gentle prodding here and there with puffy, soft fingers. The only pressure I’d feel would be in my gums as they harden, showing off their sturdy endurance. Hmm…looks good, you’re doing well, I expect to hear.

“So, what’s your problem with my approach?”, my colleague asked. My colleague? Are we intertwined, at odds, collaborative in any way. I don’t know else to call him. My interlocutor seemed best in the moment.

“Right, straight in, I see”. With the needles, I added inwardly. “Well, let’s see. Where to begin”. He chuckled, thinking this a friendly exercise. He opened his mouth, readying a statement. I think the question was a ruse. He didn’t really want me to start. He wanted to appear inviting, but actually spear in with his driving oratory, his oral assault. I opened up, bore my gums, my weakened incisors, and intoned, “I basically think that mental health treatment is a morally neutral exercise, as psychoanalysis prescribes, or has prescribed. And…”

“I guess that’s where we disagree”, he interrupted. He was still smiling. This was still a friendly exercise, though I knew what was coming next. “I mean, I understand that old school approach, taking a neutral position, but I think that has falsely justified a lot of neglect, especially of victims, over time”.

There were already balls in the air, forcing choices upon what to juggle. Old school? I mused. A pejorative term, I think, signifying a kind of philistine ageism: what’s old is out, or should be. What’s new is necessarily that and ought to be ushered in asap.

“We might, though you’ve stepped in before I’ve even named the alternative to neutrality. Should I yield and just…let you?”

“No, go ahead”

“By the way, are we recording?”

“Yes”. He was now terse: impatient to move on, or offended that I’d questioned his piloting skills.

“I think your approach is essentially moralistic. Dominantly so, actually. And I know what you might say, what you have said: that psychotherapy, or analysis, is an ethical framework. It is set up as an ethical entity, representing, if you will, moral values. However, it isn’t meant to be moralistic, I and many others think. It’s—”

“But what’s moralistic in my approach? I mean, I tell people it’s their choice, their decisions on what approach to take. I’m not forcing anything on anyone”

“For the moment, that’s besides the point I’m not yet making, because this part of the discussion isn’t about authority, as you’re suggesting. By moralistic, I mean offering the patient an idea, a lesson essentially, that is intended to leverage a change by appealing to their moral reasoning”

“Right”. More impatience, inflected with wary distrust.

I continued: “You, say such and such a behavior is wrong. You say it hurts others. You add that it hurts others in ways they haven’t noticed, either they didn’t know or didn’t want to know, and that distinction gets short shrift because the nature of their resistance is to be dismissed—”

“They’re narcissistic”

“—by assessment/partially diagnostic labels that are a shorthand for an explanation of why someone is acting in a certain way”

“Hold on, you don’t think that problem behaviors, the ones we typically speak of, are a result of narcissism?”

“I’m not saying that. I’m saying that labels like that are not motivational. If a person is stirred to an action that’s adaptive or not, they don’t go ‘well, I’m narcissistic’ as their half-conscious understanding of their desire in any given moment”

“Wouldn’t you agree that they’re not thinking of other people, specifically their loved ones, in such a moment?”

“We don’t know that, and I think you’re assuming that if they did think of loved ones, it would deter problem behaviors because that’s what thinking of loved ones does”

“Not necessarily. I know that people have mixed feelings towards loved ones, that they feel ambivalent. I get that”

“Well, I don’t hear that represented in your approach. As far as I can tell, it’s all about drawing attention to the negative effects of problem behavior with the expectation that your listener will then feel inspired to stop doing the problem behavior, thus healing can proceed. It’s like one of those TV ads that show half-starved, shivering animals laying in a shelter, looking miserable. You’re meant to feel sorry, get off your ass and either adopt one or make a donation. The ads not saying, what are your mixed feelings towards the neglected that might lead you to NOT act”

“Well, sure, you want people to act appropriately. What’s wrong with taking steps to elicit appropriate guilt?”

I stuttered, half-incredulously. Where to begin. “See, there’s the crux of your method: appropriate guilt. You think because you’ve called it that, and because your patient will consciously agree, as in agreeably if dolefully nod their head, that they will change their ways. What’s wrong with that? We don’t need therapists or analysts to play that role, is what’s wrong with that? That’s what preachers and social justice warriors are for, to persuade rather than explore thoughts, seeking to understand conflicting thoughts and feelings, not to vanquish them. You’re a mental health professional, and now I’ll be directive if not directly moralistic: it shouldn’t be that difficult to persuade you that persuasion as a tactic is at best limited as an intervention; at worst, it’s counter-effective. People resist being told what to do or manipulated in how to feel”

“That’s not what I do”

“I think it is what you do”

“It’s not. How can I persuade you?”

I paused. “Do you do case conferences with your colleagues, your team, as you put it?”

“Of course, we meet regularly, discuss cases, prepare a plan of action, discussion interventions”

“Do you each read transcripts from sessions, verbatim or near-verbatim notes, or make recordings, as we’re doing?”

“No”, he said tiredly.

“Then how do you really know how each of you is responding to patients’ process? How do you know how you’re persuading patients to experience appropriate guilt, as you put, or else being interested in their ambivalent feelings. And how, if you don’t hear instances of patient responses to your statements, how do you know if they’re really thinking about what you’re saying versus merely complying with your pronouncements? And why, for example, if they glean from the outset that you think they should feel guilty about their actions, would they even tell you about their mixed thoughts and feelings”

“Wait, aren’t you presuming that people will only share their feelings if they expect validation? I’d suggest that when people come to me, they already feel some guilt. I’ve not imposed that upon them, as you’re implying. They expect to hear push back. Secretly, I think—here’s an in-depth interpretation for you—they’ve longed for someone to take a hold of them and tell them what to do, persuade them that what they’re doing is against their values”

“That’s the authority piece, and you may have a point that people are looking for a version of parenting via the therapeutic relationship”

“Well then?”

Now I chuckled. “Interesting. You say that as if you think the matter resolved”

“Well, you seem like you’re affirming that a parent-like, values-validating approach is indicated, which would be healing. What’s next?”

“Indeed”

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September 14, 2025 · 5:58 am

Two attorneys chat about a child abuse law

Imagine a lead-up to the case of Harris, as in Kamala, representing the state of California, v. Mathews, Alvarez, and Owen: a case at least five years in the making; a case delayed multiple times because witnesses weren’t available at short notice, because one of the attorneys for either side became ill; because the judge in the case decided to go on vacation–who knows? And if you weren’t there for the projected week-long trial that became a day-and-a-half trial and ended abruptly, you won’t recognize so readily the elements outlined in this speculative dialogue. You might not know that a ten year old law that mandated changes to child abuse reporting law based on now 45 year old legislation had gotten bounced around between courts since 2019–officially remanded by the California Supreme court in 2020 with the decree that the state must demonstrate, via a trial, that the 2015 amendment to the 1980 Child Abuse and Neglect Reporting Act (CANRA) advances the cause of that earlier legislation. So, conjure two principals from the state attorney general’s office (I’ll call them A and B), chatting on the eve of the trial with one of them fretting yet plotting over what may happen:

A: So, a person does something that harms children, indirectly. They look at child porn. I know. I’m supposed to call it CSAM, child sexual abuse material. Whatever. But it does harm them directly, someone says–one of our witnesses: “It’s not a victimless crime”

B: Well, it isn’t

A: Question is, is that relevant? I can hear the other side, possibly the judge: “Oh, well then we must identify, locate, and then protect the victimized child, following those questions that appear on suspected child abuse report forms. And if this change to the law will achieve that, then okay”. Well, the thing is it won’t as far as we know, but it will stop the subject of the report from continuing the behavior.

B: And presumably deter however many others there are doing this behavior

A: No, that’s been increasing in a big way actually, not decreasing–what both our side and theirs call an “explosion” of CSAM on the internet.

B: So why’s that happening, the explosion?

A: It’s the technology…ya know, the growth of the internet, the sophisticated ways in which images can be stored and hidden

B: The internet? Not people’s desire to do the behavior, look at child porn?

A: Yes, but the technology has made it easier to find the images; meanwhile, the number of images are incredible so it’s hard to track them all. People who weren’t previously inclined to do this kind of thing can now. Or, the same number of people are doing it, roughly, but are able to do it more, gather ever more images, because of the technology. We’re not sure.

B: You mean despite us having this now ten year old reporting law to deter people. So, why have the law?

A: Well, the idea was that having the law, plus the amendment, would help us capture child porn users, not just those who produce, sell, or distribute–that was what the law previously said. But capturing porn users was never the purpose of the law–protecting children is–so we have to spin it that way somehow

B: I see. The plaintiffs will argue that there are more commonplace and more effective ways to capture child porn users, like acting on tips from the public, or by going through google, for example

A: Yes, and states do get thousands of tips per year from the public about child porn users, countless more than we get from psychotherapists reporting on their patients. Not sure about compelling google to violate privacy of their users, getting them to report, and of course they’d have tons more money to fight us in court than three therapists from California plus a pro bono lawyer.

B: Okay, well if we do capture them, the child porn users–let’s say we get better at that, or that more therapists report their patients to us–then what? Remind me, are we talking misdemeanors or felonies?

A: Depends on how much child porn they’ve been viewing or downloading. If it’s not so bad we can send ’em back to therapy, only we–meaning the state–would be in charge of the therapy at that point. Basically, we’d presume they’d lie about their behavior so we’d regularly use polygraphs to verify their disclosures.

B: So what if they tell the truth about more use of child porn?

A: Well, then they’d be in violation, which would lead to a custodial sentence probably. Or, if they lie about child abuse and they fail a polygraph, then the same result would follow

B: And if they’re not continuing to use child porn and they pass a polygraph, then what do they talk about in therapy?

A: I don’t know. Whatever else they talk about in therapy. They get reminded to not use child porn, I guess. Our expert witnesses don’t say much about that.

B: And what about the plaintiff witnesses. What might they say?

A: Well, they’ve just got the one, this forensic psychologist who says, or relays studies that say that breaches of confidentiality are damaging therapy efforts, that child porn users aren’t that dangerous to children in a direct way, according to research. Much of that testimony will be redundant since their attorney can get most of that info out of our witnesses in cross examination. Then, their witness might talk about what else happens in therapy, or what motivates child porn users, like medicating anxiety states, sexual traumas–theirs, not those of the children in the…ya know.

B: What will you ask him in the cross examination?

A: Actually, our best chance is if he doesn’t show, so I have an idea. Remember, the Supreme Court back in 2020 put it on us, the state, to show that the 2015 amendment to CANRA protects children, otherwise the limiting of confidentiality rights may be deemed unconstitutional. So, we’re in trouble here: we can’t show that therapist reports are even happening on this matter, let alone that they’re leading to rescues. We got an expert witness who says that child porn use directly harms children so it shouldn’t matter that we can’t locate victims via therapist reports, but that argument’s about increasing arrests, convictions, and mandated treatment, which isn’t the point of the reporting law. So, we need a get out of jail card and I think it’s in this “no more delays” decree that the judge ordered last month. If we finish up Tuesday afternoon because we limit to a bare minimum our questions for our witnesses–which their side won’t expect–we’ll rest our case and the judge will turn to them. Their attorney says their witness is coming on Thursday, which means he’ll have to ask for a continuance, which the judge will deny. Then, we object that we’re denied a chance to cross examine, so the witness testimony should be struck from the record. And, because he’s their only witness, we’ll move to dismiss, saying they’re not presenting a case, even though they will have asked most of the questions at that point. So…why are you smiling?

B: It’s ingenious

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August 25, 2025 · 4:37 am

A psychoanalyst and sex addiction specialist spar

G: Hey there, welcome. This is Graeme Daniels, psychoanalyst and author. I am a co-author of Getting Real About Sex Addiction and more recently, the author of An Analyst in Training, and I am the winner of the American Psychoanalytic Association’s Lee Jaffe prize for my paper, “Panal Treatment of an Alcoholic with Substitute Addictions”. I am here today with a guest, dr. Davide Sakmanov, host of the podcast, “the empathy coach”, plus the workbook, “do it the right way: a practical guide for behaving properly”. Davide Sakmanov, welcome to the show.

D: Thankyou for having me

G. So, Dr. Sakmanov—sorry, the doctor—is that a medical title?

D: No, it’s a sobriquet, as it were

G. A nickname? So, you’re Doctor Davide?

D: I prefer coach Davide. The doctor thing is more of a nom de guerre, if you will

G: Nom de guerre. So, this is war. And you’re not a doctor

D: Not as such

G: Or an academic?

D: Umm…define academic

G: a Ph.d, for example

D: No, not a Ph.d. Sorry, are we here to discuss my credentials?

G. Only if you don’t have any?

D: Alright, if it’s like that, then I’m an MSW, a CCPSC…

G: MSW—social work. CCPSC?

D: Certified Process Safety Professional

G. Is that a mental health credential?

D: It can be. Look, I thought we’re here to talk about my intervention model for the treatment of sex addicts and their impacted partners. You’ve written your big to-do paper on “substitute addictions” or whatever—good for you, and I read it in fact—but I’m here to talk about my model of care that emphasizes empathy. I call it the 2 Es idea—emphasis and empathy—that are the building blocks of a paradigm that has drawn countless listeners and followers…

G: Countless? I mean, if you’re referring to your podcast, it’s easy to track #s. It tells you how many people you have listening, so it’s only countless if you don’t know how to read numbers

D: Okay, thousands. Is that what you want to hear? I have thousands of listeners, and lots of readers

G: Lots?

D: Yes, lots. I’m popular. Very popular. You’re popular too, I’m sure, though I bet not AS popular as me

G: Okay, we’re popular. Maybe you’re more popular, let’s leave it at that, shall we? Let’s talk ideas

D: (relieved) Yes, thankyou. Gawd…

G: Okay, so in your model, the—lemme get this right, Recovery Empathy Couples Therapy Unified Mission– just thinking of what that spells, actually—you bring together couples who have been impacted by infidelity issues, sometimes other addiction issues (we’ll come back to what that means, maybe) to do interventions relating the traumatizing effects of cheating behavior, which includes use of online pornography, utilizing feedback from a treatment team of collaborating professionals. So, I’m curious in particular what that last part means, the “utilizing feedback” from a treatment team

D: Right, so as you probably know, old school therapy models, addiction models, recommend that the sexually misbehaving person, or perpetrator as we call him, does his personal therapy work privately while the woman does hers separately without any coordination that would make her feel safe. The thing is, as the partner, you have every right to know what he is doing and what his treatment plan consists of, and you get to weigh in as to what you believe will strengthen the relationship.

G: Well, there are a number of phrases there that bear exploration, but firstly, again, regarding “utilizing feedback” and say, the “right to know what he’s doing”: do you mean that impacted partners have a right to know, and therefore should know via feedback of a treating therapist, when a cheating behavior has occurred? Are you asking individual therapists to inform other therapists in a treatment team, and thereafter, their impacted partner clients, when a behavioral slip or relapse has occurred?

D: We can do it that way. I know of countless occasions when that has proven therapeutic both for the perpetrator of infidelity and the impacted partner. We know from our clinical experience that disclosing behavioral slips makes an impacted partner feel safer, plus it’s relieving for the other person to have that experience

G: Clinical experience. Not exactly proof, as you put it, but let’s say we agree that it can be therapeutic for an acting out person to reveal their secret behavior to a partner. But you’re suggesting, I think, that the disclosure would occur via an informant therapist, not the perpetrator, as you put it.

D. It doesn’t have to work like that. It would be best, I guess you’d say, if the perpetrator did the disclosing.

G: Under duress? Meaning, it would be “tell your partner or else we will”

D: See, I think you’re trying to make this something it’s not

G: I’m more than trying, I think I’ll succeed in making it sound like what it is. You’re saying that if a client in your program reveals to their individual therapist that they have slipped in their behavior—let’s say, looked at porn—then that individual therapist would communicate that information either directly to the impacted partner, or to that partner’s individual therapist, who would in turn relay that info to the impacted partner, yes?

D: Under the terms of an honesty agreement that we have our clients sign, then yes, that’s how that might play out. I don’t see a problem with that

G: The terms of an agreement? Is there an understood window of opportunity in which the acting out person must disclose to a partner?

D: We like 48 hours. We think that’s enough

G: Between disclosure to a therapist and thereafter to a partner, or between the onset of the behavior and disclosure to a partner?

D: Okay, well I guess the former in practical terms since the disclosure to us is when we’d remind the client of the honesty agreement

G: (upon pause) Do you find that they need reminding? Presumably, they are aware of this agreement all along, or certainly upon agreeing to it. You’d think it would influence whether they choose to share with a therapist an instance of cheating behavior, as your program defines that. Don’t you think that sets up a dynamic that contaminates the authenticity of disclosure? Why would your clients share their secrets with you if you’re going to either inform, in effect, their partners, or else guilt them into doing that?

D: I think you’re getting into the weeds here. Our method has helped untold number of couples heal after years, even decades of deceit and disloyalty

G: Which you seem to think you can dissolve with an honesty agreement and a “come to Jesus” moment in your office. I think you’d consider this matter “the weeds” because your training around confidentiality issues has been remedial

D: Remedial? Lemme tell you something, our program has gotten more positive feedback from all corners of this industry than your outdated psychoanalytic whatever…ever will

G: Again, I’m sure you’re a big hit on tik-tok

D: See, now you’re being a snob. Our program employs the golden seal of approval from leaders in the field of sex addiction: renowned experts in a condition that afflicts millions of men across the world

G: They’re experts in a condition not recognized by the AMA or APA, by the way.

D: It is recognized, meaning sexual compulsivity is recognized, by the WHO

G: Yeah, only as recently as 2017, and with a caveat within its criterion language that warns against diagnosis for moralistic reasons. You don’t merit diagnosis of sexual compulsivity disorder just because you “violated your own values”, like masturbating when you think it’s a religious sin, or because objectifying women via porn violates a feminist affectation. Also, why are men the only focus of your program? The pronouns you use imply that the perpetrators of this sexual abuse, as you think of it, are dominantly if not exclusively male

D: Not exclusively, but most are male. I think it’s harder for women, they have to face the stigma relating to their sexuality, so for them sex addiction or infidelity treatment is really shaming

G: which would be moot if the “right to know” or the “trauma” of their impacted partners were being privileged, as it is in your model. So, why wouldn’t male impacted partners be calling you in #s asking for you put their wives and girlfriends under privacy-violating cross-examination, to “hold their feet to the fire” with honesty agreements, full disclosures, polygraphs?

D: Like I said, I think it’s more complicated

G: Meaning you don’t know why you don’t attract male impacted partners

D: I think maybe they don’t want to appear weak so they don’t…who knows?

G: Sure, who knows? Women don’t want to be shamed for their sexual desires. Men don’t want to appear as victims, would rather act out and feel guilty—actually, that is something I think is true—but maybe these are side issues, “weeds” that are unworthy of attention, as far as you are concerned. Back to the main point: you think the impacted partner, likely female, has a “right to know” what the perpetrator is doing in his behavior. They have a right to know whether that perpetrator’s individual therapy is facilitating expression of appropriate guilt and awareness of the full impact of the perpetrator’s behavior upon their partner’s emotional, physical, and spiritual health

D: Absolutely!

G: And those perpetrators will gladly disclosure those slips and relapses, past and recent past, moved by your coaching about how their partners deserve to know the truth! They will be galvanized by learning the extent of their impact upon their loved ones—they will learn how they have induced hyper-arousal, high anxiety, self-blaming, in an innocent partner—and in developing this awareness, they will not only significantly reduce if not entirely halt their harmful sexual activity, they will take empathy to another level, privileging a definition of empathy as meaning the validation of an impacted partner’s feelings and perceptions, whether they are distorted or not: the “perpetrator” will eliminate argument from their repertoire of conversation; validation of their partner’s feelings and perceptions will become a near reflex. They will surrender their will to the power of God as they understand it. They will extinguish negative feelings that are denied but acted upon, and love…will prevail

D: I know you’re being sarcastic, but yes…all of that

G: Well, I doubt you understand all of that. And given your stance, plus—I will concede, that of many professional counselors, licensed and not—an astute consumer of psychotherapy might wonder why a mental health professional versus a clergyman is even necessary when it comes to infidelity treatment. A priest, or anyone for that matter, can say that an intimate partner has “a right to know” truths. Anyone can point out the common sense that secretive behaviors violate consciously made agreements about sexual exclusivity. What difference does it make that an “expert” can recite the criterion of PTSD syndrome. You want details? Vivid anecdotes to relate to? Go to CODA meetings. They existed long before you came up with what you think is your original “empathy” model.

D: Hold on. What is it you think I don’t understand?

G: Firstly, I don’t think you understand what I meant by “feelings that are denied but acted upon” because your model ignores unconscious process. I think you think that individuals can be coached to access their loving feelings, put aside what is implicit in acting out—angry feelings, underlying rage—and skip to guilt as a therapeutic tool that will heal. You think that perpetrators are NOT aware of the impacts of their behavior, hence needing education. They ARE aware to the extent that they attempted, at least, to keep their behaviors secret. To complicate matters, they are paradoxically in denial of impacts so as to protect themselves from feelings of guilt, which in turn stem from uncomfortable hostile feelings towards loved ones. It is therefore the INHIBITION of these thoughts, the failure to access AMBIVALENCE, that is THE PROBLEM. Your model, plus—I guess I’ll say, “countless” like it—emphasizes reactive love response designed to vanquish ambivalence. You think your clients or coachees can’t tolerate ambivalence, likely because you can’t tolerate ambivalence, so you preach “get over yourself” rhetoric

D: That’s not true. We talk about ambivalence. We understand ambivalence. We educate that ambivalence is normal

G: Yeah, educate, right. So, in this model of “She has a right to know” regarding slips, plus “what’s happening in the treatment”, that latter ambiguity implies that disclosure beyond the matter of perpetrating behaviors are subject to being relayed to the partner. Regarding empathy, if your client discloses a slip in empathy—let’s say, “I hated her guts yesterday”—that should be shared with the partner, or is there an agreed upon or tacit agreement that such thoughts would not be shared, and what would be the reason for not sharing? The client’s right to private thought? A fear that such thoughts would be traumatizing for the impacted partner, triggering a reactive outrage?

D: Probably more the latter. I see what you’re saying, there’s room for counselor discretion. I wouldn’t share that thought you mentioned. I think that would be re-traumatizing for the impacted partner, and plus I’d think that a defensive thought on the part of the guy

G: Probably true, though your thought about the impacted partner suggests an illustration of my earlier point: you think the impacted partner would not be able to tolerate the hostile feelings of her partner

D: She’d think he shouldn’t have those feelings, sure…

G: And you’d agree with her…

D: (Pause) yeah, I think so. Because I’d think he was being defensive. You said “probably” so maybe you disagree

G: I said probably because I wouldn’t foreclose the possibility that his anger may be legitimate, and that what’s defensive is the addictive acting out as a displacement, plus the inhibition of what may be a rightful protest

D: What rightful protest, hating his wife’s guts? How is that in any way healing?

G: Why do we have to rush to healing? Since neither of us is a doctor, can’t we look to understand the thought, which may only be an impulse, before we seek to eradicate it? So, forget informing the wife for the moment. If we did that, we’d likely get into managing or soothing her feelings, which I think interferes with the process of understanding, taking focus away from his internal problem. Besides, why not consider that the expression, “I hate her guts” is a reaction to a series of repressed thoughts, the content of which is obscured by what’s disturbing in the intense expression

D: Okay, I can see that, sort of…and I can see why we don’t have to share with an impacted partner, or encourage sharing with an impacted partner, every time this guy has an undesirable thought…

G: Right, so…

D: At the same time, I’d be concerned that by inviting more details about this rightful protest that is speculative, we’d be indulging a defensive pattern, which would take us in the wrong direction

G: That presumes a bi-linear process, plus the bias that all negative thoughts are a “slippery slope” that must be avoided. But lemme give an example: a man and his wife are in household garden together, having what at first seems like a benign disagreement about an arrangement of flowers. At first, the problem is that he had gone ahead with the flower arrangement without consulting with her. As they talk about it, the conflict escalates. He says, “what’s the problem?”. She says, “it looks fucking stupid!” and further starts cussing him out, after which he complains that she’s always abusing him or talking down to him. That scene ends with her storming off, shouting “I want a divorce” over her shoulder. Backstory is layered, the presenting problem at least 2-fold: 3 years ago, he was caught cheating on her, getting caught on film with another woman at a party—pictures and video posted online—then they went into couples counseling. He stopped the affair, acknowledged the pain he caused and listened to a lot of podcasts on that subject, has passed 3 polygraphs since, and generally lives in the proverbial doghouse. After a year of little more than mea culpas he says he started bringing up in couples therapy how she mistreats him…as in the flower arrangement instance. She admits she can cross a line and be harsh sometimes but says it’s because she’s still angry and traumatized about the betrayal of their marriage through his infidelities

D: (pause) So, what’s the issue? Doesn’t that make sense? She’s been traumatized by his betrayal, now she’s sensitive to his not talking about things with her, so she gets upset because, as you might think as an analyst, the flower thing is a substitute for the affair-seeking plus keeping it secret and ignoring her. The task is for him to acknowledge the links there, show that he understands why she’s upset, and apologize for the fact that he doesn’t share his thoughts with her while he goes about doing whatever he wants to do…

G: I agree with what you’re saying to an extent: I’ve no problem with acknowledgements, the apologies, especially for not sharing his thoughts, and I appreciate your “it actually isn’t what it is” attitude towards the seeming source of conflict, the flower arrangement. However, your position still presumes a unilateral disorder, likely grounded in, as you might put it, “old school” addiction narratives: that person has THE problem, etc. Anyway, the thing is this: he says the abusive language got worse after discovery of his affair-seeking, but the condescending attitude, her talking down to him, is long-standing, is almost as old as the relationship itself so it predates the betrayal, and to compound the problem with irony, when he brings this up either with her or with therapists—and they had at least one episode prior his acting out pattern, he claims—both his wife and therapists dismissed the subject

D: Well, I’m not sure I buy that, especially if they were in therapy before the sex addiction or just cheating behavior started. As for now, I generally think it’s a problem to muddy the waters of treatment, focusing on matters that could be just a way to excuse the acting out behavior

G: But that in itself strikes me as a splitting response—that is, a black and white way of looking at the problem. You deny the possible or maybe likely complexity of the problem because it takes focus away from a singularly defined task, and also because that background complexity appears to justify acts of escapism. No one is saying that. That’s rather what you are inferring from the speculation of an old relational dynamic for which both parties bear responsibility, even if those responsibilities are rendered asymmetrical by the betrayal of infidelity. In my “clinical experience”, a variety of problems get shelved and obscured by the specter of sexual betrayal: betrayals relating to substance use, money, parenting choices, to name some issues. Only the specter of violence supersedes sexual betrayal as a source of clinical attention. Indeed, this may be the principal reason why cheating or sexual betrayals perpetrated by women are marginalized in most models pertaining to these problems. What’s the priority? The safety of a partner discovered in her cheating behavior by an angry, or otherwise abusive male. I have no evidence of this bias per se, but maybe you can tell me: if you had a female client who had cheated on her male partner, would you insist on that honesty agreement and pressured disclosure if she said she was afraid of his temper?

D: (wearily pausing) I don’t know. Maybe you’re right in one sense about this being complicated, and maybe that’s because there isn’t a moral equivalence about these kinds of situations.

G: Wait, what do you mean by that, moral equivalence?

D: Well, basically that women have more cause to be afraid of men’s anger than the reverse

G: So, what are you saying? Does that set up a double standard with respect to honesty agreements? Do you employ “man up and get honest” interventions with male acting out partners, but then refrain from coercive rhetoric with the fewer female subjects you treat?

D: I don’t think of it as a double standard. Again, I think this is a moral equivalence issue

G: How about we call it rationalized asymmetry. There. I’ve coined a new piece of therapeutic jargon

D: Yeah, I don’t know. Like I said, I just think we’re getting into the weeds here on some of these issues. People come to me, they come to you, wanting help, practical help mostly, with what to do when they’ve done something, maybe a lot of something, that they feel bad about and they want to make a repair, express their love despite whatever other feelings they have, move on and be happy. That’s what it all about, I think, and all I can say is that I think my empathy model has helped a lot of people to find spiritual wellness, forgiveness, peace, and overall happiness. Exactly how many people, I don’t know…just…

G: Countless people. Yes, I know. Well, thank you for coming on the show, Mr. or Doctor Sakmanov

D: How about coach Dave?

G: Sure, anyway this has been an episode of Getting Real About…well, I’d say psychoanalysis, or formerly sex addiction—not sure what to call this at the moment. It isn’t quite what it is, maybe. Thanks for listening

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July 22, 2025 · 6:41 pm

Tools

I read your email earlier today and it’s been on my mind most of the afternoon–in between sessions, at least. I took some notes, wanted to retain elements as I wrote back: there was an incoming text. You immediately confessed. I was struck by what was tacit: the other woman, you’ve been caught, etc. Then the quick fallout. You leave the house. A custodial split is arranged. NO talking–par for the course, it seems. The next bit tells me where you’re at in my podcast series: you’ve thought about the Madonna/Whore split. Your wife’s the Madonna, the total saint. But you’re sexually incompatible, meaning you’re not asexual. 

Who knows what your rep is with her. Hypersexual? The dichotomizing would fit with how far apart you seem from each other. So, the psychological splitting became tangible. She wanted a divorce. You wanted to reconcile, but perhaps you didn’t know how to start the conversation. Actually, I find that most (usually men) in your situation know how to start the conversation: apologies, promises, reassurances, etc. It’s what comes next that’s the problem. It’s good that you don’t blame your wife for your acting out with a consensual partner. What’s not good is that you and your wife never resolved your differences about love and sex. For that you’re both to blame. 

That doesn’t mean the fuller conversation’s easy. It’s hard for a myriad of reasons, some of which implicate parenting rationales. Example: “Let’s not fight in front of the kids. It’ll be traumatic for them”. Great. I guess that means they’ll learn how to resolve conflict via peers, the internet, or some other magical influence. Actually, it means they’ll learn to say “I’m done with…” when they have interpersonal problems of their own, accept forgiveness when they don’t agree they’ve done anything to merit forgiveness, or offer forgiveness under similarly false pretenses; outsource their needs for love and sex, possibly abuse drugs, largely because dealing with difficult people is…well, too hard, it seems.

The sociocultural context you indicate does matter, as many of my podcast commentaries argue. I imagine you may have felt inhibited from raising the issue of sexual incompatibility, afraid you’d be rebuked for having excessive or perverse sexual needs; for objectifying women, or oppressing them with sexual entitlement; for “having only one thing on your mind”. There’s little to suggest that men in our progressively-minded society will feel in any way affirmed for feeling unwanted by their female partners. The concept of Narcissism, weaponized as it is in pop psychology circles (it’s amazing how many therapists actually know very little about theories of Narcissism), is employed to critique masculine ego and tame men’s desire. 

You ask a compelling question about how betrayed partners might reconcile. Where is the gray, you ask, in between profuse mea culpas and frozen impasses? These are the toughest of your questions. I don’t have a simple answer. I’ve worked with some betrayed (female) partners who come to recognize that the Narcissism in their marriages was shared–meaning, they’ve fell in love with and admired the strength in their male partners, their “winning” qualities. This is an important sociocultural point because pop psychologists who lament that men “don’t get in touch with their feelings (they mean vulnerability)” tend to overlook how traditional and even feminist women collude with that phenomenon via their attractions to stoical, ambitious, not observably vulnerable men. Reconciliation? Consciousness is where it starts, I’d say. After the apologies and assurances have been made, and each party has taken its share of “time-outs”, or employed other “tools” of how to manage feelings, then the task is to STOP managing feelings and instead really get into those thoughts and feelings like you’ve never done before. Question is, how bad is everyone willing to feel to get to the truth?

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June 24, 2025 · 1:41 am

You want honesty?

“I don’t feel like I can be honest”

The lament of the…well, of many people, but here, today, in this context, I’ll stick to an old chestnut–the compulsive person–and let the reader extrapolate what they will. What can’t they be honest about? their problem behaviors: drugs, sex, violence. If you have forbidden or just difficult thoughts are you meant to share them? Is there really a gap between thought and behavior? Think quickly, your compulsive self doesn’t think (think?) so. Meanwhile, doesn’t a complaint about honesty imply a willingness to listen to thoughts that acting out behaviors displace?

For those confused by that question, I shall retrace my steps and describe the concept of “acting out” as first explained by Freud (1914). Action replaces thought, feeling, and memory. Compulsive behaviors, for example, are substitutive: they displace energy from one objectionable idea to another, and the latter idea, though objectionable, is actually a lesser idea. That’s right, says the average dissenter, straining to understand this cant yet suspicious of its source…sounds NPR-like, or something. Yes, annihilating another or others in the plural may yield a sting of guilt, but it’s preferable to the sting of victimization, which is belittling, annihilating and, for the sake of posterity…so ultimately shaming. Make me great, as in big, again, not small. The small do not win, H.G. Wells be damned*.

An illustration, perhaps. A person has a complaint about an intimate partner–said partner has become less attractive physically. She’s a women whose hips have expanded. He’s a man sporting a “dad-bod”. Or, either has become difficult in some personal habit and is obstinate in the face of protest. “That’s your problem”, they dismiss, not perceiving the cliff of calamity that can greet such carelessness. The person who “acts out” with porn, drink, an affair, the reckless spending of money, is typically seeking an escape from such impasses. Not so fast, argue those cathected to the narratives of compulsivity. They aver that addicts will do what they do when they want to no matter what stressors or stimulants exist, therefore dog-whistling deflections are contra-indicated, if you please. Sorry, allow me a moment to slap my hand that taps on a keyboard, chastise the mind that thinks what it thinks. See, a question remains, slipping past the modern repressive: do the rules du jour mean that the “obstinate” partner is at fault for the mooted acting out that may or may not follow–ya know, that spending, hoarding, drinking, to infidelity and therefore betrayal hierarchy?

No, and the reader, if you haven’t already opened a new tab and becoming ensconced in a video instead, may notice that I will dodge dichotomies as if they are intellectual potholes. What I am saying is that conflict avoidance is the meta-essence of escapism, and that “acting out” and so-called betrayed partners share a responsibility–that’s right, share–for the relational phenomenon of checking out. Regarding those complaints about your physicality, your lessened drive, your attribution of “this is all you want” to your plaintive other, your wearying politics, or your fixed notions of what constitutes romance and “genuine love”–all the things about which you are politer, more open-minded during the the courting stage of a relationship. So, do you really want to talk about all that stuff, and potentially revise your views. Yes? No? What do you want?

** a reference to The War of the Worlds wherein the tiny, heroic virus does what humanity can’t: defeat the alien

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June 1, 2025 · 6:29 am

Adam is in charge

Infidelity treatment relies upon assumptions of asymmetry: you have perpetrator/victim, or wrongdoer/victim, or “survivor”—or the more right and the more wrong. This is why couples therapy, with its hoary repertoire of agreements, homework assignments, “boundaries”, is rife with tacit messages that obviate egalitarianism. The perpetrator owes the victim, not the reverse, so agreements are not symmetrical. Communication? That means inform the victim of what you’re doing and when. The victim or betrayed or impacted partner (whatever?) doesn’t have to inform the acting out partner (perpetrator of infidelity) of their whereabouts or activities.

This arrangement is based on a premise that often collapses in long-term or analytic psychotherapy, which is often why couples might prefer short-term therapy programs. To put is simply, its narratives are simpler.

Sexual betrayal is the most important traumatic betrayal in an adult intimate relationship, second only to violence. Betrayals relating to money or other material matters (i.e: hoarding behaviors) do not cross as high a threshold of moral abhorrence. Likewise, disputes about how or under what circumstances parents discipline children, or political divisions, simply do not register as high on the scale of marital or couples crises. Monogamy is our ego-syntonic signifier of specialness, a vestige of healthy narcissism that a crossection of traditional and progressive society clings to. It’s the bar we’re not meant to cross, the rule we’re not meant to break, and the lies that conceal this violation only compound the problem. Therefore, the perpetrator has no refuge in protesting the rule he implicitly agreed to upon signing up for the game. The eternal bind: if I said I wanted to____, you’d just say no…

The person who utters this line can usually locate its pedigree. They can recall the antecedent messages from childhood, in aggregate if not from specific instances. They learned early to “compartmentalize”: to postpone pleasure but also truth, and therefore plan the escape routes, the opportunities for play, keeping their artifices and desires secret so as not to intrude upon another desire: to not do harm; to stay in relationship with authority, or civil society. See, truth does harm. Desire is harmful, so we—the Superego—forbids. That’s religion, which feels autocratic and thus objectionable to some. It is necessary and benevolent, say its advocates. Regardless, all agree that the containment of desires call for compromises, agreements with varying degrees of importance attached. Some will call these agreements covenants.

Sexual exclusivity, fidelity in body if not mind, is a compromise traditionally agree upon. Secrecy, as in the segregation from awareness, is another idea of compromise, promulgated with less ceremony perhaps, but with more or less equal force. We’d extend this ethic to all matters between people, but on the matter of sex we are more sensitive. So, the sexual wrongdoer is a deviant, a transgressor, and under the protective canopy of sex addiction or infidelity treatment, they are neither rebels nor underdogs. Indeed, they are privileged abusers. And this is why treatment models aim primarily at men. As social underdogs whose sexuality has already been stigmatized by traditional society, women fit progressive society’s paradigm of whom we advocate for, so we’d need to alter the narrative and vocabulary when they present with the more euphemistically termed problem sexual behavior. Consult CHATgbt on trending jargon: “perpetrator” would not make the cut. Exit narcissism also. Enter PTSD or maybe internalized misogyny. Invoke tales of contracting STDs via similarly promiscuous men, unwanted pregnancies for which abortion options are unavailable; suffered violence at the hands of cuckolded men. Recall that in our moral schema, only violence trumps sexual betrayal in the scale of wrongdoing, so break out the apologist arguments, tilt that narrative into sympathy. Or, push it one step further with circular reasoning, unfalsifiable statements: Adam is in charge. 

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February 23, 2025 · 8:30 am

Bumper sticker treatment

I’ve heard it before a thousand times. I wrote about it in a book that was published three years ago by a prominent exponent of modern psyche literature: Rowman & Littlefield, now Bloomsbury. Getting Real About Sex Addiction could have been written twenty or thirty years ago, largely because not much has changed in that time. Some who toil in the field of sex addiction think that much has changed in that time because they weren’t in the field prior to that point and think that the things they observe and talk about weren’t being noticed before they came along. Well, some things, like bumper sticker treatment, have not changed at all.

              A woman calls me up, asks if I treat sex addiction, as my web profile suggests I do. I confirm that I do, though I add that I don’t presume that condition upon meeting a prospective patient. Rather, I assess a person’s situation over time, explore the meaning of concepts like addiction, compulsion, voyeurism, monogamy, sexual freedom, etc. “Uh-huh”, says the woman. “What about integrity?” she asks, which signals that she’s either done some reading on these subjects or else had a conversation or two with a sex addiction specialist. I think this because SA specialists like to use words like integrity while claiming they aren’t judgmental and aren’t looking to impose their morality on anyone. That means they think masturbation isn’t as sinful as religious zealots think it is, that pre-marital sex is normal and healthy, and that habitual porn use might be okay as long as one isn’t lying about it to an intimate partner. Pause. That is an area of moral judgmental, they might concede: don’t lie, or keep secrets and then lie when confronted about said secrets. Actually, that’s not a moral judgement, they’ll amend. It’s merely ethical, or it’s about values, which is conveniently broad and ambiguous. Ethics is not the same thing as morals. Ethics is morality light, and it’s humanistic, vaguely feministic, as opposed to being hoarily patriarchal and otherwise over-doggish.

              Anyway, my woman caller sort of blocked out of her mind the bit about exploring meaning because she’s already determined certain meanings. She dissociated, some might offer, on the hint of uncertainty—an aspect of her trauma, perhaps. When trauma is invoked in this context it’s another way of saying that thinking has stopped when something cognitively dissonant arises. She’s already diagnosed her husband as a sex addict having checked boxes on an online questionnaire and then watched videos about narcissism, which is often tagged as a sex addiction companion. “It’s not a diagnosis”, I say pedantically, referring to sex addiction, not narcissism. It doesn’t matter. It might as well be a diagnosis as far as this caller is concerned. She thinks several other labels are diagnoses also, all because someone has attached the word disorder to a series of bad words. She says she’s done her research. That doesn’t mean scholarly, peer-reviewed professional psyche literature. She’s been listening to a podcast about betrayed partners comprised entirely of female subjects, and speaking to a sex addiction specialist who delivered a familiar chestnut of preliminary telephone consultation: “his behavior has nothing to do with you”. It’s hard to say when this greatest hit of infidelity treatment intervention was first drawn from the pop psyche toolkit. Claudia Black’s Deceived, published in 2009, featured a chapter that was headed by the phrase, and I’ve heard it quoted back to me countless times since, at least. Apologists for this brand of proto-counsel will staunchly defend the necessity of making such a pronouncement early in a treatment episode, even before it has properly begun. The rationale includes the following: the importance of reducing blame that is typically directed at impacted partners, which includes the likelihood that the sexually addictive pattern has been lied about for protracted periods, possibly years, and that the betrayed partner has been made to feel stupid or crazy for having harbored suspicions of secretive, unfaithful behavior. Beyond the compulsivity of the behavior itself, this pattern of lying, of obfuscating (SA specialists like that word too) constitutes a form of psychological abuse tantamount to an act of rape. Therefore, it is necessary to validate the long-denied suspicions and declare a new era of healing wherein all assertions by the designated sex addict are taken with a fat grain of salt.

              Just one or two…or three, four, or five things to inject here: firstly, as suggested earlier, this assessment category—sex addiction—is not exactly an exactly defined condition, let alone something that can be pronounced with ironic impulsivity. So, as an introductory intervention, the treatment-orienting, bumper sticker pronouncement—“his behavior has nothing to do with you”—is predicated on an assessment of sex addiction that has not been properly made when this pearl of support is typically delivered the first time. It is an a priori, or presumptive supposition. Were a range of unfaithful behaviors cast as hitherto unknown, in which case the full scope of the behavioral pattern would also be unknown, the behaviors might be characterized as non-addictive, maybe aberrant, and therefore imbued with relational meaning: it was a “revenge” affair; the unfaithful partner was feeling lonely because the so-called impacted partner was verbally abusive, neglectful—in other words, the unfaithful behavior was very much to do with them, as it were. As the reader might glean, or know if having read my 2-year old blog entries or a handful of my podcast episodes over the last couple of years, this narrative is largely reserved for women who present for infidelity or sex addiction treatment. Actually, back up: the presumptive narrative is such that a would-be female patient would likely not be cast as a sex addict so quickly unless they were self-identifying as such.

              This is the real reason why sex addiction treatment is dominantly aimed at men—nothing to do with “lesser resources for women in psychotherapy”, which is a BS cover story promulgated informally by sex addiction cognoscenti who either ignore that most psychotherapists are now women, or they tacitly believe that anyone who hasn’t earned one of their precious sex addiction merit badge certificates is not really qualified to indoctrinate the consumer base with their bloated assumptions and derivative theories. The theory and meta-psychology on the gender disparity is as follows: many social workers, couples therapists, psychologists, etc., hold a semi-educated view that Freudian theory remains applicable to masculine sexuality and ego while asserting that it doesn’t apply to women. That Freudian theory holds that the human mind operates in a more or less economic manner, discharging libido, seeking to achieve a state of homeostasis that controls or lessens stimulation, including excitement and restive anxiety. Humans “discharge” is the idea, ultimately seeking equilibrium. The psyche or mental apparatus, as Freud put it, experiences vicissitudes, quotas of affect, a primarily quantitative manifestation of desire and need. Many still believe heartily that this theory of mind adequately explains masculine mentality, or at least masculine sexuality, therefore male sex behavior is not relational: “he” seeks pleasure regardless of context, or emotional state, much less the qualitative state of an intimate relationship. Ergo, the phenomenon of sex addiction, including the prejudice that it exists much more in men, is simply a derivative of this roughly one-hundred year old economic model of the mind.

              See, somewhere in the mid-20th century, along came object relations theory (a subdivision of psychoanalysis), plus humanistic and feminist influences upon modern psychology, to assert that not all minds work like this, and that women’s minds certainly don’t work like this, and that we should all think more positively, more wholesomely, more relationally, about what drives the human soul, whether we think religiously/spiritually about these matters or not. So, while “boys will be boys” ideas are readily grafted onto psyche assessments and verbose theoretical pronouncements, those of girls and women are nuanced to integrate elements of social conscious/unconscious forces: societal influences, the oppressive sexist external, not so much an impinging libidinal “drive” from within. For at least fifty years, the foot soldiers of our mental health army, including myself, have been trained to think that problems besetting the feminine are borne of social forces that are inhibitive, not an internal, biological compulsion, or a biological drive supplemented by an internalized social force that privileges rather than inhibits. Fifty years! That’s a long time to consider how things have changed or should change. It’s a long time to recite bullet points, learn the jargon, the right vocabulary, answer the questions correctly on an exam, or write the correct thing in an academic paper, or post on the Psychology Today letters to the editor, or more latterly, their popular blog-spaces, sympathetic, progressive ideas about psychological phenomena.

              Phenomenology is a big word signifying a rabbit-hole topic about why things are as they are, and how we as a collective got here in this state of affairs, as Esther Perel puts it. Bumper stickers, like letters to an editor, are likewise anachronistic, if better for the near-sighted. Blogs seem passe also, buried in the internet miasma. Tik tok and podcast presenters: these are the carriers of messaging these days, not writers. And the message is a formulaic, mini-essayistic delivery, something that will fly off the tongue and serve as a validating selling point—sorry, intervention tool—for a consumer who says they need treatment in order to learn something new about themselves, something they don’t understand, something previously unconscious…ya know, something that will make them feel better (NOT!). What do you want to hear? If you’re a provider, meaning a therapist, a social worker—a sex addiction “specialist”—what are you prepared to say if something rare happens, like a man calling you up for a consultation who claims that his wife is a sex addict, and he is a betrayed, impacted partner? The chestnut phrase coined by advocates, not neutrals, will come to mind. You know how it goes: “his…wait…her? His”, you start again, stammering because your tongue is letting you down, confused. Her behavior has nothing to do with you. Would you think it? Could you say it if you did?

And do we have to lean in further to gender stereotype to find what’s truly axiomatic amid bumper sticker thinking? So, as stated, I’ve heard the catch-phrases a thousand times. I’ve pushed back with something I’ve said maybe a hundred times, and written at least once before in, ya know, that book I mentioned. It’s this: of course, the person engaging in the behavior of taking their sexuality outside of a committed relationship is solely responsible for that likely repetitive behavior. The “acting out” person needs to own that, as SA specialists say, and not blame a partner for having gained weight or becoming conservative in their sexual tastes, or whatever the trope on this part of the debate is. Incidentally, the term “acting out”, widely used now in psychotherapy, was first coined by Sigmund Freud in 1914 as part of a paper that introduced another seminal term and idea, the “compulsion to repeat”. The concept of acting out refers to action (behavior) that unconsciously replaces thought, feeling, and memory. Okay, all that’s already too long for a bumper sticker, and simplistic treatment providers who con people with catch-phrases that make them feel better are reinforcing defenses when they, in effect, say you don’t have to look at your part in this. What’s this mooted “part”? It’s part two of the axiom, the twist if you like:

Addicts, non-addicts, cheaters, co-dependents, wives, husbands, boyfriends and girlfriends, theys and thems–whatever label you’re using to describe yourself: if you’re in a committed relationship then you have and have had a responsibility to talk, listen, and do those activities properly, as in think about what someone is saying to you, as in empathize, suspend for some indeterminate period how you think, even how you see the world. In psychoanalysis, this is termed “taking back projections”–yeah, I know, another catch-phrase. Take a look at your reactions to events, notice your struggle with dichotomies of good versus bad, villain versus hero, perpetrator versus victim, instead of good and bad, the idea that heroes and villains are contained in each of us but often projected onto others. No, once again, I don’t mean you’re responsible for someone else’s affair-seeking behavior or porn use. If you read this and then think, “so, you’re saying it’s my fault”, then you’re illustrating my point about the problem of dichotomizing. I mean that you’re responsible for the many problems in a relationship that you don’t want to deal with.

Try to explore the antecedents of your trauma responses and then notice that “….has nothing to do with you” in the context of an intimate adult relationship is a profoundly wrong suggestion. You think this is blaming, trying to get you to listen, and to think about what you bring to a flawed relationship? If you’re an impacted partner, you think this is “disrespecting” or not understanding your trauma? Okay, do a little research on that topic (trauma, I mean), and I don’t mean re-reading your favorite chapter in a self-help workbook. Actually, do a fair amount of research, act as if this is worth your time. Read American Psychiatric Association criteria for PTSD and find categories pertaining to avoidance of distressing stimuli, what afflicted persons do, repeatedly, to avoid uncomfortable feelings, alternating between states of dissociation, which essentially means emotional cut-off, hyper (meaning excessive) and hypo (under-reactive) states of arousal. Do a Wikipedia search on a man named Sandor Ferenczi, who wrote about trauma, childhood sexual abuse and how that impacts people in adulthood, nearly a hundred years ago. Revitalizing Freud’s once proposed and then renounced Seduction Theory, he paved the way for generations of traumatologists by arguing that episodes of trauma are not self-contained but rather re-enactments of developmental trauma, likely spawned in childhood. You’ll find that addictive states and those of trauma are eerily analogous, at times crossing over in individuals, otherwise blended within a dyad (a couple) in which the pathologies only appear to be segregated. This is probably why afflicted people tend to find and bond with each other, feeling compelled to repeat something forgotten.

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December 22, 2024 · 5:11 pm

Take the bus sweet sixteen

Sweet sixteen. Takes a while to get there, I’d say. Also, it’s not as sexy as it sounds; not the debutante ball it’s chalked up to be. It’s a pinnacle of a problem. Throw up thirteen. Fuck off fourteen. Gross fifteen. Sickness. You hang around teenagers, amid their sniffles, dripping of various fluids, you’ll feel under the weather fairly soon. And minimal conversation. In my teens I was missing because of television, video games that sucked the air from my brain, dulling my imagination. The fingers did the walking, and seemingly the thinking as they flitted about remotes, joysticks, or a keyboard. Now it’s a deft index digit skimming over the small buttons of a cell phone. Eyes scan over the dashing pages. They appear and then disappear like cells of thought dancing about. Get a word in—you know, words—and a head may pop up and recognize external stimuli. Something from within, a hunger, signals that sustenance of an original kind is necessary. An utterance, a cry or a bark burst out with a need. Food is soon engorged. A refrigerator is emptied. Check the front door. Food is often dashed there these days. No dice. The debris of packets, spills, and a stain is all that’s left of the consumption.

Does it peak at sixteen? Does it get better afterwards, this life of or with a teenager? Savage seventeen, asshole eighteen. Nearly done nineteen. It’s not as if they’re not aware of this state of affairs, these diseases they carry. I mean, who likes teenagers? Who says or writes nice things about them? Not me. Read the first paragraph. Adults mock them or wring their hands over them. Grandparents are wary, and strain to relate. Smaller children fear them as if they were monsters lurking in closets. They don’t understand their habits: the curious disarray of belongings, the expanse of ephemera; the clumps of tissue paper, bloodied or rendered sticky, tossed about a toilet. This is why teens start forming an identity, a sense of togetherness, of esprit de corps. The world is against them, or concerned for them, which is vaguely worse. We celebrate their individualism while we lament that very incipience because it intrudes and takes over. We envy the beginning of a prime: sexual confidence is not yet there but it’s coming; athletic prowess, litheness and invincibility are upon them whether they feel it, take advantage of it, or not. Lovingly, we hope this developmental combo of affliction and power will be like one of their illnesses: that it will pass soon and drift into memory, only to be revisited every five years with terrible reunions. The worst of us will not go to those events because they’re too painful. Or, we’ll go, but much later, long after the symptoms of adolescence have abated and others’ memory of our teenage selves has dwindled.

This was true in my case. Yes, I’m not a teenager. Not anymore. Not chronologically. It’s behind me. I’m in recovery now. Or it’s in disguise, hiding like a stash of dirty magazines. Magazines? What are those, asks a contemporary teen. Don’t get me wrong. I have warm feelings towards teenagers, the few that I know, that let me get to know them. They’re both terrible and wonderful, like I was. They compel my interest while they alienate and push away. Some of them plunder and gambol about– rolling objects ever at risk of knocking down the household furniture. When they rest, they seem immovable, forgetful, unrousable. An analyst once said to me that teens are the way they are because they are mimicking the ill or absent objects they are looking to rouse. By object he meant parent. Unconsciously, analysts use the word object to signify how parents start to feel as parents. Infants pull at, chew, or cling to their parents. They drape their limbs over their heads, hug knees and ankles. They grab and scratch, give you a cold at least once per financial quarter. Parenting a small child is a workout of chasing and wrestling, interspersed with household chores, seized naps, a comradely debriefing with a weary co-parent. The teen years grant a reprieve in the form of distance. The onset of puberty, the libidinal surge, generates space and tension: privacy and basic needs do battle, forcing outbursts that juxtapose rejection and appeal. Help. Guidance. Give. Then kindly fuck off.

You’d think they’d want this stage of life to be over; that they’d want to move on. But they linger, don’t they: teenagers. The affliction bleeds into the twenties, and for some, beyond. Certain habits, the masturbatory, the dissociative, solipsistic, drifting whimsy doesn’t seem to leave. We don’t want this period of indulgence blended with insecurity to go. It’s in the dishes left by the sink; the T-shirt spread over the washing machine, left for someone else to deal with. It’s in the stolid gaze, the hapless shrug that you receive when you ask after the thoughts that linked to these actions. Were there thoughts, you wonder? Was there shame, guilt, or rather conscience, ethics, righteousness: all the qualities that magically appear when the tables are turned, a divide is crossed. One day the adolescent finishes school, gets a job, assumes responsibility and has to lead, guide, or soothe another being. As a parent, you thought to give them a head start by getting a pet, or having a second child. Feed it, walk it, babysit them, etc. That was the point, you thought.

At some point, you thought to foster independence for your own good; to take a break, thinking a massive stage of the parenting job was done. Go online, sign up for Indeed. Download that App that will get you a credit card. Get a reference, network. Find out what a deductible means. These are your decreasingly patient instructions. Take a moment. No, take several. Take years, actually. Think back to when you were a teen, or just the last time a stage of life was coming to an end, forcing you to change. Routines stopped or altered. Someone or thing modifies a system, changes the rules, or the assumptions underlying the rules. Some of those teenagers are growing up and assuming authority because they are alright as teens. They’re polite to strangers, reflective when asked questions that call for meaning. That’s amazing, you think, when you first observe or hear of this–when you get those lovely yet irritating compliments from other adults about your kids. They (the kids) are still rebelling, actually, only it’s not called that when you’re in charge and you’re organized and well-spoken; when you’re empowered and separate from the enmeshed family tree. See, they only seem empowered, or entitled if you prefer, when they’re lounging on your dime, playing the music loud, drowning out your life. It feels not quite as threatening when they’re out and about, filling the sidewalks in packs, in gaggles of giggling, mutually-interrupting, shouting groups. Give them access to a car and this gets worse. Their windows are down and the heavy bass sounds of rap coupled with raucous singing is on public display. Not everyone in the pack is like this. On the sidewalk is a couple engrossed in an intimate moment. Hands in his pockets, a reticent boy is making an effort in the dawn of an aged ritual: he is solicitous and gentle. He is sweet, the accompanying girl will think. Sweet sixteen. Keeping his hands to himself, his head down, his glances glancing, he is not yet the boorish oaf he may soon appear to be. And the prim girl is likewise demure and self-effacing, not yet the disdainful, prickly woman she may “grow up” to become. Twenty years from now they’ll have a teenage boy or girl, or someone who will identify as neither: someone who will nonetheless expect basics of food and shelter, then games and fun; then free time and space to exercise free will, often with things that are not free. They cost money because of the rules that previous generations made. Yes, you might say to the requests that demand an easier passage through the world you made and they didn’t. Yes, you will help with some things, the things you know. Well, not all things. No, I won’t give you a ride, you’ll say, alluding to an old-fashioned artifact you might have used. Take the bus.

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October 10, 2024 · 5:13 am

Three years later

It’s three years after something bad happened. Someone left this plane, this earth, and they won’t return. It feels like stubbornness, like they’re off somewhere thinking of how to return but changing their mind, knowing it’s against the rules. Funny, he was both a rebel and a stickler for rules, my friend. In games, he was dogmatic, autocratic, plus a few other “ics” in the mix. He wanted things his way—that was the annoying, and ultimately tragic governing principle. Today, I say goodbye to him again, it being an anniversary. I recall the good parts of his self, and only allude to the bad, following the tacit rules of grief. My shoulds enter the fray, influenced by what others say and write, their forlorn and sentimentalist tributes. He was a good this, a great that. We miss him. We are grateful for the time we had together, etc. He had a range of qualities, from good to bad, plus a vast in-between that renders the binary choices less palatable. I feel some pressure to represent him fully, and yet to hold back, to speak around the truth, and in doing so, effect some manner of taking care.

              In a way, we’re following his lead. He led in this way, entering into the fray of most relationships, daggering in with his knifey wit, his manic rage. His truth. This was only sometimes, though the instances were memorable—indeed, they were traumatic, the way melt-downs usually are. Mostly, he was alternately aloof and jovial, and in this way protective of others while signaling the presence of an inveterate problem. He wouldn’t change, he often exuded. On occasion, he’d offer a promissory opposite: exhibiting a new self, cleaned up, polished, even wholesome. He could quote scripture, subscribe to conventional belief systems, be regularly friendly, consumerist, even mainstream in his tastes, his politics; an average good citizen. Only he wasn’t average. It was difficult masking the mild disappointment I might feel at these times—the disorienting reluctance to accept the loss of the miscreant genius in whose hijinks (largely un-violent) I lived vicariously. To watch him grow up was to let some part of my own childhood go. Recess is over. Time to go back to work. It’s like the malaise you feel when an exciting villain or clown gets subdued for the good of society. And there is no turning back. But there was a turning back, because in time his un-wholesome self would return, and in that return there would be a relief, plus a guilty pleasure that would vie with obligation. Yes, we must do something about this problem…someday.

              That someday never really came. A change came eventually, in the form of a passing, which started in a park on the outskirts of a city whose reputation is almost synonymous with the derelicted down and out. That was a place to collapse in and not wake up—to be picked up off the ground by stoical if diligent caregivers, anonymous to my dying friend. It would be hours before loved ones would gather and feel what he was already not feeling due a loss of consciousness, the horror of his last moments. If he could have spoken he might have told us to get lost, not wanting to be seen as he was then: bloated, pumped with chemicals that were meant to keep his kidneys going and thus keep him alive. He’d have whispered past the tube that was in his mouth that he didn’t want to be seen that way; that he wished he could be alone, for our benefit as well as his, because this ending was not worth watching. Get away, he might have said, his words slurring, his eyes glazing over, becoming dull. The lively clown, the sometimes villain, sometimes hero and more often something in between that friends and family adored, would not have wanted the final scene he was granted; the witnessing that he would have preferred to not have. Remember me differently, he would have pleaded. Think of me as I’ve been more often than not, more than three years ago.

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July 5, 2024 · 6:05 am

This is what Eric said

“I was a jerk,” says a patient about an argument with his spouse. He says the conflict was about dishes, and before that about whose turn it was to put the baby to sleep. Later, he reveals layers: he’s been trying to quit alcohol while his wife comes home drunk from a weekly “girls’ night”. He is further disentitled following her discovery of his recurrent porn use on their shared laptop a few weeks earlier. Their sex life has been negligible for nearly a year. They don’t talk about that. They argue about dishes.

In the treatment of compulsive sexual behaviors and their impacts upon loved ones, much attention is paid to the dual habits of pleasure seeking and conflict avoidance. Within the problem of conflict avoidance, an often employed if not directly identified habit is displacement, a defense mechanism first characterized by Sigmund Freud (1913) as that which transfers emotions from one idea to another to allay anxiety in the face of sexual and aggressive impulses. The alcoholic substitutes the bottle for the breast, gratifying an infantile oral impulse while disguising its expression. How does compulsive sex displace sexual instinct or substitute for it? Via perversion, Freud argued. Voyeurism, exhibitionism, fetishism, Don Juanism: these recurrent, habitual behaviors are all deemed unhealthy to one degree or another, but none is as “deviant” as an original sexual impulse from which the libidinal energy is displaced: incestuous desire.

Modern psychoanalysis does not insist that its unwitting patients engage in problem sexual behaviors because of an unconscious and unresolved Oedipal conflict, however much its adherents may think the theory still has merit. One derivative theory of displacement was popularized by Dr. Patrick Carnes in the treatment of what he terms sex addiction. Carnes (1983) explains that a sex addict holds negative core self-beliefs such as “I can’t trust anyone”, “no one would like me if they knew me”, and “my most important need is sex”. The antecedents of these beliefs are desexualized in Carnes’ model. The sex addict transfers onto ritualized sex his or her needs for companionship, tenderness, understanding, control and self-esteem; hence a rationale for a psychotherapeutic treatment that encourages patients to open up with their uncomfortable feeling states and seek alternative methods of affect regulation versus the “self-soothing” that compulsive sexual behaviors yield.

In diagnostic criteria and assessment protocols, “loss of control” is a sine qua non of substance use disorders and other addictive patterns. Amongst contemporary psychoanalysts who treat addiction, such as Dodes (2003), Director (2005), and Volkan (2021), a compulsive person’s loss of control is deemed paradoxical. The afflicted person seems drawn to experience that also appears to motivate an escape from the same phenomena. The alcoholic, sex addict, or compulsively “acting out” figure seems motivated to control an environment, other people; to seem omnipotent, in denial of “split off” states of vulnerability, of underlying helplessness. The result of their compulsive behavior, plus the indicator of a problem that merits treatment, is the loss of this sought-after control. Scrambling efforts to re-establish control are sometimes observed in extreme reversals, termed reaction formations by Freud (1907). The person with the escalating habit may adopt judgmental attitudes towards those who engage in the same problem behaviors. The impulse towards an opposing position (“I was a jerk”), or self-denial in the aftermath of a compulsive act, lessens the anxiety produced by the problem behavior in the first place.

The term “acting out”, often used by self-identifying sex addicts to denote a range of compulsive behaviors, is also derivative of psychoanalytic theory. Freud (1914) used the term acting out to indicate action that replaces memory, thought and feeling: “what is he acting out? His inhibitions, his attitudes, his pathological character traits”. This is a feature of the subject’s compulsion to repeat, in order to achieve mastery of trauma (via repetition), plus an unconscious desire to restore an original inorganic state (Freud, 1920). Death drive. An inclination towards insanity, “doing the same thing over and over again, expecting a different result”—self destructive action or tendency, a recovering addict might translate.

Regarding diagnosis, among the criteria for loss of control is the patient’s experience of “marked distress” related to recurrent behaviors and their impacts upon occupational or educational activity, or social and family functioning. Ley (2024) writes that it’s problematic if criteria for diagnosis is met simply because failure to control intense, sexual impulses or urges elicits distress due to moral incongruence based on religious values. Ley reports that he and others are pleased to see that the World Health Organization’s ICD-11 category of compulsive sexual behavior disorder (CSBD) features an exclusion statement for those whose marked distress is due entirely to moral judgments and disapproval about sexual impulses, urges, or behaviors. So, recurrent sexual behaviors should not be deemed out of control simply because they place someone at odds with religious dogma. But what about moral judgments that are not religious in pedigree, that are based upon a more fashionable Superego? What if, in the course of treatment, a subject is “educated” in a humanistic moral view which states that compulsive sexual behaviors demean and objectify women, or the view that CSBD induces betrayal trauma in impacted partners? If a subject is initially unmoved or unaware of the consequences of their behaviors but later exhibits distress because they’ve been taught that their behaviors harm loved ones and strangers, would they then meet criteria for the CSBD diagnosis? The question and grey area that’s being mined here is whether a person’s distress is externally-sourced and not the result of an internal conflict.

Psychoanalysis holds that assessment of that which is internalized is problematic when ideas are repressed and affects are dissociated. However, just because the subject is unconscious of internal experience doesn’t mean that distress isn’t in the psyche, there to be uncovered in treatment. The subject acts, repeats, instead of remembering, thinking, or feeling, and while Freud was not writing in the context of addiction per se when he conceptualized repetition compulsion, he may have provided with it the most important foundational idea in modern psychology pertaining to addiction. Further, this theory is relevant to treatment of impacted partners of sex addicts/those diagnosed with CSBD. Stephanie Carnes (2008) writes, “you may be questioning how your family background contributed to your choice to be in relationship with an addict. When older, it’s possible that you sought out mates who replicated aspects of your childhood”. In my experience, this kind of speculation is unpopular with some impacted partners, especially those who adopt a fixed, “your problem, not mine” attitude in treatment.

This patient’s idea for their own treatment is a palliative approach designed to offer emotional support and relief of suffering, not interpretations of underlying pathology that may lead to re-enactments of relationship problems. This is “victim-blaming”, assert clinicians who are allied to this position. Often, the result is a muddied clinical picture in which impacted partner patients are educated about complex trauma, which suggests developmental arrests that long predate the discovery of a partner’s compulsive sexual behaviors. Meanwhile, a preferred takeaway from treatment is that of an episodic trauma assessment and related syndrome, derived principally from the discovery-of-sexual behavior event, with long-standing lingering effects. The complexity is assigned to the extension of hyper and hypo arousal reactions to a variety of contexts, including “triggers” that don’t explicitly concern sexual behaviors. This patient feels threatened by any exploration of their pre-discovery, historical traumas, believing alongside their advocates that it will falsely mitigate the responsibility of their sexually compulsive partners.

A notable exception is their recognition of parallels to discovery events and prior clues towards disturbing problems. I find amongst impacted partners a tendency to remember instances in families of origin wherein family problems were denied or rationalized, or else censored from discussion until evidence of problems crossed a threshold—something like a discovery event—that compelled attention to the once ignored problems. These partners speak of “felt” experiences, times they knew something was wrong but didn’t protest, only to then feel betrayed and enraged when they later felt entitled to speak. Discovery of sexually compulsive patterns in their later partners does indeed replicate this history, they observe. One thing they won’t know is how this kind of phenomena was characterized in yet another psychoanalytic theory that has been paraphrased or re-branded by other models of treatment. What Freud called deferred action, or afterwardness as early as 1895, and what French psychoanalysts later called the apres-coup, refers to how sexuality in particular is transmitted in childhood via enigmatic messages, are constructed in fantasies, and are later presented in reality, the sexual-as-translated, which is then disturbing in effect. We don’t speak or even think of what we don’t or didn’t once understand, or that which is forbidden to speak of or think about. We speak about the dishes instead.

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