Tag Archives: sex addiction treatment

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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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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October 3, 2023 · 6:11 pm

Scarlet Letters are really blue

That sex addiction is an excuse for licentious behavior is itself one of contemporary society’s displacement arguments. It’s also a displacement to argue that sex addiction treatment is a coded endorsement of monogamy. It is. But this argument is only half made on behalf of the religious. What progressive-leaning, anti-religion commentators won’t add is that the monogamous implications of sex addiction treatment are made on behalf of the largely monogamous women who comprise the majority of impacted partners, who find in sex addiction treatment a partly-medical, partly-psychotherapeutic premise for an overreaching critique of masculine sexuality: the too frequent demands for sex of heterosexual men; the objectifying, “performative”, “penetrative”, but not “intimate” sexual needs of misattuned, inattentive, sexually remedial men.

Why am I going here in Getting Real About Sex Addiction? Well, I might not have had I not been encouraged to explore what editors and early readers described as “intersectionality”. Of course, they meant that sex addiction treatment intersects with matters of social justice in a way that draws attention to how social groups like women are disadvantaged in treatment circles, not how they have tacitly garnered allies and are seated at the side of righteous authority, being cast as “betrayed” or “survivors”, in keeping with monogamous agreements and trauma model theories. So, I did a naughty thing in mine and Joe Farley’s book and went the other way. The reason: I didn’t want to write a load of trite BS, basically. I know about the hoary biases that society and the medical establishment have aimed at girls and women over the decades, but at the risk of being glib or seeming dismissive about that which I haven’t endured personally, that’s not the zeistgeist that is in place within the field of sex addiction treatment, nor is it likely the trend in a profession now dominated by women (numerically, at least); and by the way, that “trend” has been in place for some time now.

Sex addiction treatment, its principles or underlying assumptions, intersect with our protean sexual mores, our notions of what is objectifying treatment of human beings, for example, because many practitioners in this field, and in the wider field of psychotherapy, routinely attach their interventions to thoughts about what is happening in the culture at large, all in the name of concepts like intersectionality. There can be no doubt that in some quarters, the matter of sex addiction is attached to movements against sex slavery, or so-called gender-based violence, and that protests against such phenomena are aimed against a sex addiction treatment population that is dominantly comprised of heterosexual men. The treatment of sex addiction—the invoked theory, if you like—is girded by psychoanalytically-derived observations of obsessive sexual fantasy that casts sex partners as sex objects, treating persons as interchangeable bodies and images, or part-objects, as they are also termed.

This dovetails with a feminist critique of masculine ego primarily, hence the pathologizing of men more than women in sex addiction circles—a reactionary trend. The pathologizing of women, by male practitioners especially, is largely discredited in the current discussion of sex addiction. To assess a female patient as a sex addict is to risk being branded a slut-shaming misogynist, perpetrating an iatrogenic, traumatizing intervention, thwarting the fragile sexual freedoms of women. If a female therapist were to assess a male patient as a sex addict, she might be branded a misandrist, but this is less likely, if only because most people, including many mental health professionals don’t even know that word. Such is the bumper sticker, Twitter (or “X”)-speak vocabulary of many in our society. Meanwhile, opponents of sex addiction treatment like to pretend that sex addiction theory is a fabrication of religious zealots because it is politically correct to scapegoat religion for all of the guilt and shame that stems from our neurotic relationship to sex.

The guilt and shame that feminists might like to induce in male sex addicts, or men in general, is not called guilt and shame when such feelings emerge. Not typically. Dodging religious associations with those words, they’d call the phenomena something else—justice, probably. Only in this respect would I concede that our book, Getting Real About Sex Addiction, is anti-feminist, because no less than any impacted partner of a sex addict, I do not like being gaslighted. Though not religious myself, I don’t think it’s right that religion takes so much on the chin in sex addiction treatment when social justice is the real moral lens of the field and has been for some time. Secondly, if you think that male sex addicts, or that masculine ego in general deserves a moral reckoning, I may say fair enough. But let’s stop pretending that treatment protocols, which have practitioner sex addiction specialists standing with polygraph machines nearby, full disclosure confessional exercises, all-day, or all-weekend workshops, and provisional labels of sex addiction (which is not yet recognized by the American Psychiatric Association) plus gratuitous extras like Narcissistic Personality Disorder (which is), are privileging its subjects. Stop pretending that your nomenclature is anything other than pejorative, and that your scarlet letter agendas haven’t turned blue.

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September 5, 2023 · 5:45 am

Theory filtered through politics

With choppy rhythm plus an aversion to run-on thought, the following sentence begins a paragraph in mine and Joe Farley’s book, Getting Real About Sex Addiction (I shall blame Joe for the choppy rhythm): “Undercurrents filter down into therapists’ offices, lurking as assumptions that inflect counsel”. This teasing opinion, one of many offhand expressions in our text, signals a critique of what lies in the cuts of sex addiction treatment. Via jargon, popular or theoretical, and often derivative of older, more esoteric theory, sex addiction specialists (and others, to be fair) impart a repertoire of ideas reflecting biases, and psychological theory, like scientific data, is a tool of manipulation; a means to an end.

In this blog, I’ve made numerous allusions to psychoanalytic theory or psychodynamic technique without giving many examples of either. Partly, the reason is that theory and especially interventions are hard to represent out of context, meaning case illustrations, and case illustrations are lengthy and, I suppose, not blog-worthy, though I’m not quite sure what I mean by that. I guess I mean something similar to my use of the word “teasing”: I’m introducing a book, not delivering it in serial form. Anyway, it seems apt to give illustrations of theoretical ideas, especially ones that can be represented economically. I’ve decided as much as I begin my latest and likely final perusal of copyedits and notice a certain pause upon the concept of reaction formation. It is a pause of sustained interest, not doubt.

Reaction formation is one of several fraught concepts in the Sigmund Freud lexicon: meaning, it is controversial, but that only depends upon its application. That in turn means that reaction formation is subject to bullying; it is a kicked around idea, used to represent standard thought, establishment thought, ill-advised thought…taken for granted thought. If you’re not an avid reader of psychoanalytic literature, you won’t know the term, but you’ll know its meaning. You’ll have observed its application, even employed it yourself, on countless occasions. Basically, the concept refers to a reversal of feeling based upon a defensive position that counters an uncomfortable thought and feeling. Wait, what does that mean? Well, it means something derived from a famous line in a Shakespeare play: “the lady doth protest too much”. When you take a position of opposition to something—a position of moral offense or disgust—a psychoanalyst will suspect that your offended position conveys the opposite of your desire, as a defense against a wish that is incompatible with ego, Superego, etc.

In our text, I make reference to reaction formation numerous times. The reason, as you might imagine, is that sex addiction, porn addiction, sexual deviancy, or just plain sex, is subject to moral objection, of course. In (fact?), what incurs moral objection or disgust more than sex, or that which falls under the general heading of sex? Anything? Notice I’m adding the word disgust to the term moral objection. This cues an example I noted in the manuscript: a man prone to sexually addictive habits, including certain “perversions”, elicits disgust from his wife, which he in turn finds arousing. This is an example of a paradoxical reaction—a reaction formation—to an adverse stimuli: to counter the unpleasant with a pleasure reaction, thus defending against anxiety and revulsion. More commonly, we tend to understand reaction formation as something like the wife’s reaction: a reaction of moral disgust to the sexual demands of her husband. Moral indignation: men only want one thing, etc.

What we suspect of her isn’t nice. It isn’t politically correct, to cue the secondary purpose of this entry: to indicate the selective application of this commonly known phenomenon with an obscure name. In the current zeitgeist, it is likely deemed sexist to interpret arousal from revulsion…at least as it pertains to what heterosexual men perceive in women. And don’t get me wrong. It is politically incorrect for some sensible reasons. Perceiving arousal within rejection has rationalized innumerous episodes of sexual harassment and assault, no doubt. Therefore, to rebuke an interpretation of reaction formation within a sexual rejection is to prevent danger. But that is about censoring thought due to fear of its behavioral corollary—not so much to cement a counter-truth that would govern the thought itself.

When reaction formations are deemed less dangerous, or else when they seem to represent worthy retributions, they are given a pass. In the realm of sex, we might therefore consider the issue of homosexuality. Within the history of psychoanalysis, and likely beyond amid a dominant heteronormative culture, homosexuality has been deemed a reaction formation, or again, as something like it. Freud offered that a same-sex sexual orientation results from a failure to properly identify with the opposite-sex parent; in the case of boys (Freud’s focus), it represents an excessive identification with a mother such that a boy would mirror her sexuality and thus aim libidinal interest at men. Mainstream society more or less agreed with this idea and at some point (possibly before Freud, for all I know) coined a derisive shorthand for this phenomenon: “mama’s boy”.  To be gay is to fail at acquiring a Superego, which in a dominant heteronormative culture means adopting the conscience and moral repertoire of the traditionalist, largely patriarchal system.

However, Superegos change because culture changes, and in the 21st century, within the largely diversified as well as secularized world of psychotherapy, Freud is often chastised for his sexism while his anti-religious positions are for the most part forgotten or ignored. As for homosexuality and the perception of that trait, another kind of reversal has taken effect, possibly a reaction formation of another kind. So, think of the following example: a man exhibits moral objection, even disgust, at the advances of another man towards him, and issues a rebuke to the offending figure. A commonly held opinion is to cast the man exhibiting the disgust as a homophobe. He is exhibiting a reaction formation: a reversal of idea to counter feelings within himself about which he is uncomfortable. He does not have a phobia in a medicalized sense (he doesn’t have panic attacks, necessarily), so the use of the term phobe or phobic is figurative and offhand. However, the assignment of reversed affect is in earnest.

And so, these examples illustrate the infiltration of social mores into psychological theory. Indeed, they illustrate how theory is subordinate to culture and historical change, whether that change is institutionally imposed, or else populist. Science has its data, its facts, and sometimes those facts define phenomena. In psychology, data is thin and is often spun to designate truth. Instead, it defines a surface layer of truth while an interior truth is left to speculation, theory, interpretation and bias. Speculation and theory represent what we want them to represent, only the “we” is variable. Some think the we is more inclusive than it once was. Probably. Or maybe. More substitutive, I’d suggest.

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July 24, 2022 · 4:34 pm

Female Sex Addicts: the protected species

“In the books, they say, rather wistfully, that men want to put their faces there. Return to mother, Keith. But I don’t agree. I don’t think men want to put their faces there.”

“Let me tell you what women want. They all want to be in it. Whatever it is. Among themselves they all want to be bigger-breasted, browner, better in bed—all that. But they want a piece of everything. They want in. They all want to be in it. They all want to be the bitch in the book.”

                                                                 —from London Fields, by Martin Amis

So we come to the topic of female sex addicts and the social/political undercurrents that shape the treatment of them. Nowhere in the realm of sex addiction treatment is the specter of gender bias more apparent than in this supposedly lesser studied area. As we might say in our book (and we don’t typically, to avoid cheesiness), let’s get real about something: the average therapist in this country, and certainly in California, is not a patriarchy-imposing old white male with a bow tie dispensing turgid interpretations with an air of aloofness. It (or, excuse me, she) is a white female, educated at varying points over the last 50 years, who talks a lot about “systems”, aims words like boundaries, empowerment at women especially, which is code for go for that position on that soccer team, go for that job or promotion, make sure you’re making as much money as men, and only have sex when you really want to. With male patients that tactical stance shifts. With men the tendentious terms are vulnerability, intimacy, comprising a code that says go home, help with the domestic chores, cook a meal or two, pick up that daughter from soccer practice, and with respect to sex, “hey, have you thought about what she thinks is sexy?”

See, the problem mainstream society has with Freud is not just that he told women they have penis envy, or that men are superior to women (actually, he thought the reverse in some ways), or that he told some women that their sexual victimizations were all in their heads, reflecting their desirous fantasies, not the revulsion contained in their symptoms (we only know that because he copped to this, in a famous case called Dora). It’s that he and his followers continued to follow Superego guidelines which instruct boys to identify with fathers, separate from mothers, and more or less adapt to and follow a traditionalist path versus the noble trail of social revolution. Therefore, latter day progressives, if they are inclined towards psychoanalysis or the exploration of the unconscious, tend to prefer the likes of Jung or Winnicott, or modern inter-subjectivists who instruct men to fem up, support the levelling of fields, do the equality thing, which means surrendering to inequality in some contexts, which is what the field leveling alludes to. Well, as mine and Joe Farley’s book and this blog often imply, it’s problematic if understandable to treat individuals not as individuals but rather as group representatives. Our book is more about helping individuals, not systems, which paradoxically meant devoting considerable print to how sex addiction treatment programs subtly background individuals within a systemic framework. The stories of individuals are richer, if diluted by generalities, the intrusions of groupthink. As for helping, as I consider that task in itself, our book isn’t necessarily “helpful” in the conventional sense of healing anyone or anything, much less a non-leveled system, with anything except thought. As much as anything, we just wanna say how things are.

Years before writing Getting Real About Sex Addiction, I’d talk with female therapists who either specialized in sex addiction or else worked with individuals and couples whose lives were impacted by this much-debated, is-this-a-thing condition. If a patient in question was a partner of an identified sex addict, they’d be called an impacted partner, or sometimes a betrayed partner; once they were called co-addicts—not so much anymore. Female sex addicts were and are another breed of client, lesser spotted in treatment circles, or lesser identified as such, anyway. Called Love addicts, maybe, which sounds nicer: you love, not so much lust. As for their partners, they’d be called…well, I’m not sure what they’d be called, actually, especially if they are male. Angry, unforgiving, abusive or potentially abusive men, if the decrees of my female colleagues were to be accepted—not “betrayed” partners. See, female sex addiction is a relatively rare bird. Not much has been written on the subject. Supposedly not much research has been done, and our text only references one book that is entirely devoted to it: Marnie Ferree’s edited 2013 volume, Making Advances: a comprehensive guide for treating female sex and love addicts. Therefore, despite the widespread understanding that sex addiction is a “pathologizing” label, the paucity of study about female sex addicts is cast as systemic neglect of women. As a system we are denying help borne of stigmatizing labels. Reminds me of the reductio ad absurdum from Dr. Strangelove: “Gentlemen, you can’t fight in here, this is the war room!”

Humor. My deflection, my coping with absurdity, revealing yet also distancing, because humor reveals what is out of synch—that I am out of synch with the times. Like Italian cinema of the early sixties (yeah, I know—not exactly trending), I leave the surfaces of earnest realism (*my bicycle has been stolen!), and spend time with interior lives, the contemplation of what’s happening on the inside. Humor draws attention to the contradictions, presenting a surprise, which shames, embarrasses, causes us to cover our mouths, our eyes. We laugh. We laugh it off. I have tried to laugh off contradiction and absurdity, being out of synch with the times, the zeitgeist that psychotherapists like to think they’re in front of. Stigma. That’s the reason women don’t enter therapy for the treatment of sex addiction. That’s an opinion I’ve heard numerous times from my fellow therapists—women mostly. The likelihood that most SAs enter treatment under duress having been “discovered” (thus rendering the prospect of “choosing treatment” moot) is ignored by the former argument. Anyway, the argument persists: to identify as a female sex addict is to risk hearing epithets like “slut” or “nymphomaniac”. From whom would they hear this in sex addiction treatment? Scores of slut-shaming, patriarchy-imposing male therapists who dominate our field in 2022 while feminist-leaning women struggle to achieve a foothold in the profession? Hmm…regardless, I’m sure men have it way easier: they only have to put up with terms like “pig”, “dog”, “pervert”, “gender violence perpetrator” or “asshole” from their relatively forgiving, not-as-angry, traumatized and sympathetic partners, and maybe the labels sex addict and narcissistic personality disorder from therapists who have so worked through their countertransference issues and wouldn’t dream of using clinical language to disguise ad hominem attacks.

Sarcasm. Yes I know. Very declasse of me. Anyway, back to the narratives: female sex addicts are continuously neglected by a pathologizing sex addiction treatment industry, and—let’s not forget—also by impacted male partners who somehow neglect to employ that mythical plurality of patriarchy-imposing male clinicians. Or, unlike girlfriends and wives, they simply overlook the option of mandating their female partners into treatment with relational ultimatums, or polygraph exams or uber-dignified “full disclosure” exercises to elicit honesty, hold accountable the assh—sorry, the empathy-deserving afflicted. When will women be granted the kind of celebratory, loving attention that Tiger Woods publicly received, or that Anthony Weiner once enjoyed to the benefit of his political career, or that jettisoned Pee Wee Herman into a career strato…wait, what happened to him?

Okay, stop it now

The men who take part in my therapy groups have gotten the updated memos. They’ve been told they are privileged so their sexually addictive behaviors will be excused by a society that simultaneously deems their behavior objectifying and indecent, unlike female sex addiction which is more relational, part of a misguided yet somehow less abusive repertoire of self-discovery. Well, they’re not paying for it, you see. Notwithstanding virtue-signaling terms like “self-discovery”, which attaches so-called problem behaviors to the cause of sexual freedom, or capitalist hypocrisy (some things we shouldn’t pay for. Really? I can think of worse things than sex that we contentedly pay for, regularly), or the thin tissue of horseshit that our profession pathologizes female sexuality more than it does that of men, those who proclaim that sex addiction is an excuse think that what constitutes an “excuse” is any response to sexually deviant or acting out behavior that is anything less than punitive action—ostracism, incarceration, castration, etc.—and is tantamount to an unjust act of clemency towards those who act with exploitative and objectifying intent, especially towards women. Given how disproportionately the term sex addiction is aimed at men versus women, it’s transparent that the concept of sex addiction lends women a 21st century narrative via which they can derogate male sexuality: in particular, male partners whose frequency of desire outstrips their own, or whose non-monogamist thinking, at least, may be religiously or irreligiously impugned.  

Which prompts a return to female sex addicts, whom we still neglect with our helpful-if-pathologizing sex addict labels, even in an essay that was meant to be about them: in Making Advances, the authors argue, “women are different than men. Their brains are different, socialization is different”. Further, they assert that women do best when a therapist is sensitive to their attachment histories, injuries and attachment needs. Now, do they mean to imply that men’s needs are not governed by trauma and attachment needs, or less so? Perhaps not, but given that these recommendations were delivered in the same passage as the “women are different” platitudes, one would think an inference along those lines could be made. Imagine if books, pundits, podcast-pontificators started calling out misandry the way they call out the misogyny of male sex addicts. Imagine if they knew the word misandry. Imagine if they started calling what female sex addicts do hate, not trauma; misandry instead of the tendentiously circular “internalized misogyny”; “toxic femininity” instead of sexual empowerment; sex addiction instead of its ennobling synonym, love addiction. Would their treatment still be condemned as “slut-shaming”? Recently, I’ve been hearing of men and women leaving marriages, seeking divorce because a partner won’t accept transition to a polyamorous lifestyle. Is that not a betrayal of a contract? is it a form of sexual entitlement, of “gender-based violence”? I’d bet that a woman leaving a marriage under that pretext is hearing from a progressively-minded therapist, someone who otherwise espouses betrayal trauma something like, “well, you’re exploring different sides of yourself for the first time”—said with airs of sympathy.   

Referring to the mythos of the ages, I refer in mine and Joe’s book to the legends of Uranus and Orpheus to represent the images that men hold in feminist society as rapists, seducers, opportunists…gazers. Elsewhere, I expound upon the Madonna-Whore complex, a mythopoeic term coined by Freud to denote the dichotomizing (splitting) of women by men into irreconcilable images: the ideal of the nurturing, wholesome woman versus the demeaned, sexualized “whore”, reflecting a struggle to overcome unconscious, Oedipal taboos against that which stirs sexual feelings towards anything resembling the maternal. In deference to the modern zeitgeist, I could have pointed to the Minotaur, the half-man, half Taurus who rapes and cannibalizes a hapless female virgin in The Labyrinth—the sculpted image of which caused a stir when presented by modern artist Damien Hirst. What a fuss, but also what a capturing of man’s present-day image. This conjuring precedes the man, not the woman who enters sex addiction treatment in contemporary culture, for there is little in trending or mythopoeic thought that draws attention to the ways women dichotomize men. What? You don’t even know what I’m talking about? Well, does the term Saint-Brute mean anything to you? Don’t you love a man in uniform, the guy with the snarl and the six-pack abs, and not so much that “nice guy” whom you later (like, when it’s time to “settle down”) declare is sexy because of his “acts of service”? The guy who is the “right” choice even though he’s a bit dull for you? Getting warmer? Anyway, that’s sidelined, cryptic thought, and things will remain this way until unctuous yet well-positioned thought-shapers decide that fields have been sufficiently leveled, human beings can go back to being individuals instead of group representatives, and gender commentary in our media and academic circles achieves a state of genuine parity.

             So, what am I saying of my female colleagues, most of whom I don’t know closely, with respect to how they treat male versus female sex addicts? And have I truly examined my own biases when I treat men versus women? I’ll certainly admit that more men come to me with the term sex addict poised upon their lips, at least in part because the term has been directed at them. Women? Not so much. They utter the term nervously, querulously, as if performing a reconnaissance of themselves, the concept, of me as a would-be listener, and possible judge. They’ve talked to women before, you see, and they’ve felt something odd: a mix of pious adherence to the zeitgeist values of the day—that you go, girl ethos that would protect women from slut-shaming society, blended with a sense of a familiar disdain. The modern ethos can’t quite block it out, it seems, and the women I talk to still perceive it, still feel the sting of the old Superego within the post-modern “be accountable” verbiage. Me, I’ll reference the buzz words, the subscriptive jargon, but usually with an air of otherness—I’ll observe it, detach myself from advocacy, and remain credulous of something undiscovered. I’ll ask the same questions of women that I’ll ask of men. I won’t point fingers with moralistic intent, figuratively or not. I’ll ask what is the impact upon significant others rather than instruct, or educate. I’ll ask patients to think, not to substitute my thinking for an absence of it. But I won’t collude with reversed, neo-double standards that my profession pretends don’t exist**. If you’re a first-time reader of this blog, you may not know what I’m getting at. Or maybe you will. Think of it this way: it’s 2022, not 1989. Take a look around, have a listen. Note the jargon that prevails in the Psychology Today articles, the latest books by Rebecca Solnit or Terrance Real; what the bumper stickers say; what tweets get re-tweeted versus ignored or excoriated.   

*an allusion to Vitorio De Sica’s 1948 film, The Bicycle Thief

**Ask an average SA specialist why fewer women than men are assessed and treated as sex addicts and they’ll likely say that there are fewer resources for women than men for the treatment of SA: this is BS in my opinion as it ignores the fact that 70% of licensed psychotherapists are women; or else it implies that practitioners must have the relatively slight Certified Sex Addiction Therapist (CSAT) credential (a referral base which may be lesser comprised of women) in order to treat SA. I think the plurality of women in the field of psychotherapy are more than capable, qualified (and certainly willing) to speak to women about their sexual behavior, whether it’s addictive or not, a problem behavior or not. BTW: SA specialists might also imply that SA is primarily a men’s issue, hence the disparity in care, though this sets up yet another circular argument within this field.

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July 9, 2022 · 10:14 pm

Betrayal Trauma

Someone asks me, “does betrayal trauma exist?”. Sounds like an analogy to, “does sex addiction exist?”. Okay, let’s nip the first one in the bud: of course, it exists. It’s like asking do wounds exist (trauma meaning wound)? The question is what does the fuller term mean? What does it mean in the context of sex addiction treatment? And most importantly, what are the implications of the term for a clinical process, especially one framed in systemic language?

What’s apparent is that the term betrayal trauma has clinical as well as moral/ethical implications. The clinical pertains to the syndrome of symptomology linked to trauma, as well as the strategies of intervention that are directed at trauma patients. In the context of sex addiction, it’s not clear whether most or even a significant number of impacted or betrayed partners meet full criteria for a PTSD diagnosis. As the reader may know, that designation requires meeting symptom criteria over several categories, and features phenomena like dissociation, avoiding stressors, being exposed to stressors, having nightmares and flashbacks, experiencing variable (and contradictory) states of hyper and hypoarousal. But in treatment trauma phenomena might be observed as therapists and patients discuss trauma as a subjectively-defined phenomenon. More generally, trauma pertains to a wounding event or pattern, but then also the attempt to adapt to that trauma, plus how that trauma impacts memory, perception, and reactivity to stressors. More specifically, the term betrayal trauma is grounded in a theory about developmental history. The term refers to situations wherein the subject has relied upon another for support and therefore must dissociate (deny/forget for the purposes of this context) awareness of betrayal in order to preserve the relationship, however abusive the relationship is. The concept is therefore also about dependency between people, and the theory’s pedigree lies in observations of a parent-child dynamic, echoing the theories of Freudians like Sandor Ferenczi, who famously taught concepts of “identification with the aggressor”, which informed awareness of the mooted Stockholm Syndrome, and his “confusion of tongues” concept, which refers to the over-stimulation of children via an adult/child seduction.

Principals of the sex addiction model haven’t ignored betrayal trauma. Patrick Carnes—he of the sex-addiction coining, Don’t Call It Love fame—wrote in his book The Betrayal Bond that trauma repetition is characterized by doing something over and over again, usually something that took place in childhood and started with a trauma; that it “relives” a story from the past, inclines sufferers to engage in abusive relationships repeatedly, repeating painful experiences, people, places, and things. Yes, I know. That last turn of phrase sounded familiar, didn’t it? That “doing something over and over again” bit—that sounded familiar too. You think it’s that phrase that’s quoted in 12-step meetings? Think it was something Albert Einstein said? Well, think again. It was Sigmund Freud. Repetition compulsion, it was called. He wrote about it while World War I played out and consolidated the idea around the time the so-called Spanish flu (you know, the Covid of his day) took the life of his daughter. Freud wrote of repetition that it brings mastery over trauma, unconsciously. The aspect that Freud didn’t cover was the piece about becoming like the abuser—that we credit to Ferenczi. Anyway, I’m not saying the latter-day derivative concepts are wrong, just derivative. Also, something else Carnes suggests about sex addicts likewise applies to trauma repetition. The behaviors/symptoms of trauma survivors: don’t call it love.

The concept of betrayal trauma is not difficult to accept in itself any more than the concept of addiction is hard to accept. But after we’ve duly acknowledged that betrayals are painful, and then wrung our hands dry from sympathy, it’s still necessary to think about phenomena so that platitudes or hyperbole don’t prevail. So, here’s the unusual and therefore lesser-spoken of thing: what’s difficult to digest—and this pertains to both concepts—is the back and forth between consciousness and unconsciousness that both trauma survivors and addicts tend to proclaim, at least by implication. An addict often proclaims that he/she is acting out of habit, unaware, saying things like, “I don’t know why I do this,” or “I don’t know what I was thinking”. And with respect to concrete activity (versus, says, insight into deeper reasons), we know this is BS because addicts also obsess over details, calculate their activities, and consciously lie about their behaviors, before and after their fruition. As for trauma survivors, well, we hear that they avoid painful stimuli; that they deny or dissociate awareness of betrayal because of their relational needs; that they are in shock, caught off guard by the “discovery” of the addictive pattern. Conversely, at times they are not only aware of the trauma-stirring behaviors of others, they are “hyperaroused”—that is hyper-vigilant, anything but avoidant; rather, they seem compulsively drawn to that which upsets them. Paradox? Probably. The back and forth suggests a reaction to trauma, and therefore a post (not pre) stressor response pattern. We obsess over something so as to prepare for the worst—if you like, a backwards or preemptive form of avoidance.

Then there are other seemingly contradictory presentations, like that of the so-called gaslighted partner which, if said to exist in tandem with betrayal trauma (which I often hear of), would seem to render at least one of the phenomena unlikely, at least concurrently. Why? Well, gaslighting is about persuading someone that the thing they suspect is happening is not happening, and that they are crazy for insisting that it is happening. The term comes from a 1938 play and later film about a…it doesn’t matter. It’s about lying and then pretending that the person who doesn’t believe the lie is nuts*. But the term also implies a vigilance that predates the discovery that has rendered the problem behavior undeniable, which is contrary to a pattern of avoidance of clues, including dissociative symptoms, that implicitly precede though they might not always proceed from the trauma of discovery. As observers, we can grasp how a trauma sufferer may be alternately over and under-stimulated following a crisis, just as an addict is at times deadened, unstimulated, in withdrawal or guilt-ridden following a binge, for example. But can you claim to have repeatedly not noticed problem behaviors because of dependency needs but also insist that persistent inquiries into suspect behaviors are repeatedly, and concurrently, brushed off? Again, this would only make sense if the chronology of presentations is blurred but then clarified: that a partner’s scrutiny of an acting out figure is tentative prior to discovery–in other words, primarily trusting if skeptical of the denying reports of the depended-upon figure–and then intensified into hyperaroused indignation after a discovery event.

Meanwhile, an underlying element of this issue is not clinical, much less medical. The ethical/moral dimension of the betrayal trauma concept is both subtle and not. For providers and patients, the matter of trauma is not just one of clinical presentation (i.e.: symptoms of anxiety), or of etiological (origin) theory, but also one of justice. In betrayal trauma, there is a victim and there is a perpetrator, meaning someone who has done harm. See, in our contemporary society, it’s not enough to say that a behavior is immoral or wrong. Today, we must either demonstrate or declare that we’ve been wounded, hence the necessity of attaching the word trauma to the moral construct of betrayal. In this way, sex addiction treatment, and betrayal trauma models in particular, borrow the ethos of the civil court: no harm no foul. Less subtle, however, are the concrete implications of the victim/perpetrator divide. As the identified miscreant, a perpetrator is often guilted into surrendering habitation rights, money, sometimes time spent with children or even custodial rights, or most conspicuously, the prerogative to initiate sex. The euphemisms that leverage these concessions—terms like “boundaries”—are meant to be subtle, as in genteel or discreet. They’re not. Only the words are genteel and discreet.

Further, this blending of sex addiction treatment with notions of justice has a gendered inflection, one that plays (and trades) upon our most basic suppositions about male versus female sexuality. The reason betrayal trauma models focus on betrayal is partly about monogamistic values, but it more prominently concerns feminine vulnerability. And this is true only because of the demographics of sex addiction treatment: far more men, and specifically heterosexual men, are assessed as sex addicts than are women—again, so much for the chestnut that modern psychotherapy/psychiatry stigmatizes female sexuality more than that of men (unless you’re one of those who thinks that sex addiction is a compliment, or a leniency-affording “excuse”). Anyway, female vulnerability: here I’m referring to the submission that women experience in the act of heteronormative sex; of their need to trust in the reliability of their male partner, who may also be vulnerable, but only in emotional terms, not so much physically. This point is a bullet item of so-called moral equivalency politics. Basically, the vulnerability of men does not match the vulnerability of women, therefore male sexual acting out is more oppressive, more abusive, threatening, etc., than anything women might perpetrate. In theory, men are treated as impacted or betrayed partners also when their partners have perpetrated infidelities and such, but if you read or listen carefully to most of the unctuous pundits on these matters, you might detect the whiff of bias in their jargon: the “betrayed” male is likely an abusive or possessive figure, “narcissistically wounded” by the betrayal (versus the more sympathetic “traumatized”) of his female partner, which then triggers an underlying misogyny within his subsequent anger. You get the script. From SA specialists, he might receive a subtle re-conditioning effort: a sort of half-hearted patronizing of his betrayal, coupled with a discreet shepherding from attitudes of patriarchal privilege to a woke recognition of female sexual freedom.

Interestingly, despite the possibly inadvertent influence of civil court discourse upon therapeutic interventions, the converse influence is not apparent. The impetus to punish—sorry, “hold accountable”—the wayward sexually acting out figure does not extend to the legal arena. For some time now, divorce courts have stopped punishing infidelity (whether they think it addictive, gendered, or not), instead issuing “no fault” decrees on such matters. That places the matter of crime and punishment back in privately figurative courtrooms. Mental health providers, the sex addiction specialists who in effect preside over these private disputes likely tread a line that straddles tradition and latter-day social justice principles. They “validate” the betrayal suffered by impacted partners of a sex addiction, and “educate” victim and perpetrator as to the impact of auxiliary misbehaviors like gaslighting. But they must also avoid being mere advocates of monogamy, for that might place them in alliance with the unfashionably religious, plus that dreaded system of girl-power thwarting patriarchy. This is why the progressive-leaning SA specialist speaks of violated consent rather than monogamy. In the modern zeitgeist, to consent and be honest are the moral imperatives, not the values of exclusivity.

As a result, sex addiction specialists tend to speak of betrayal while dodging the m word. Again, this is so that seemingly value-neutral concepts like honesty, or the analogy of contractual agreements (apparently an ethos that traditionalists and social justice types can both agree upon), can be invoked without provoking older Superego specters. The new Superego also prefers the term spiritual to connote a departure from the oppressive inflections of the word religion, which tends to suggest rules and dogma, things known (spiritual seems to indicate that which is unknown), not so much a connection to the divine, which is ambiguous, un-dogmatic and refreshingly new agey. The new S-ego prefers to invoke consent as the issue to supplant the concept of monogamy, but still to indicate the ethic of contracts. This, for example, features in Braun-Harvey & Vigorito’s 2016 list of ethical guidelines for sexual health, as indicated in their book Treating Out of Control Sexual Behaviors. See, then the matter is that a partner didn’t “consent” to the addictive pattern, and thus a perpetration of harm has occurred. A sound argument in itself, however much phenomena occurs in intimate relationships that would fall under the “I didn’t bargain for…” category. But most societies don’t craft marriage vows pertaining to excess shopping, hoarding, or video-game playing. And so, there’s no escaping the impression that moral tradition and developmental histories are what really drive the concept of betrayal trauma—not commonly upsetting behaviors or naturally occurring phenomena like threats to life and limb—what the PTSD diagnosis was originally meant to observe. Suggesting equivalences between traumas calls for a lot of reframing, or re-branding, designed to soothe the passage of words into the mind or down into that oft-decision-making gut. I’m not sure it’s convincing, actually, this rhetorical massage. I think we might as well add a term to the inventory of traumas. A psychiatrist and classics scholar named Jonathan Shay has termed this moral injury. How about moral trauma?

*If the reader is interested in a more artful and certainly less co-opted depiction of trauma, try Andrey Tarkovsky’s cult classic film, The Stalker. In it, characters are drawn to a mysterious zone, an area supposedly destroyed by a wayward meteor, leaving behind debris of a ruined civilization. A guide (dubbed “stalker”) leads interested soul-seekers into the forbidden area, taking them to a mythical room within the zone wherein all of the seekers’ personal needs, hopes, desires will be met. It seems a metaphor for an analytic or spiritual journey, and it is not without obstacles, including rules that the stalker appears to impose with neurotic impulsivity. This room: it cannot be approached too directly, too penetratively, he warns. Worldly goods, such as one character’s knapsack of presumedly invaluable items—an expression of his rational control—must be left behind. The filmmaker is saying something about an everyman or woman’s journey. He’s also saying something about how we must tenderly approach a scorched yet still beautiful earth.

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May 21, 2022 · 3:45 pm

Freud’s Bar

Okay, not quite. Freud’s Bar is a forum, formerly live, more recently on zoom, sponsored by the San Francisco Center for Psychoanalysis, that brings together members of that body to present and discuss matters relating to contemporary psychoanalysis. This video is a near replicate of a zoom video recorded on 4/28/2022 and subsequently made available for SFCP members but not otherwise made available because of the institute’s policies. Sorry. So, this is an encore, sans the rapturous applause of a 40-deep audience, one or two of which asked questions at the end. The reader may wonder if my oft-indicated co-author, Joe Farley, made an appearance at this event. The answer is yes. Joe appeared, looking fresh and jovial, dressed in a black robe, looking a bit like a Jedi knight, to deliver a superlative take on his case illustration of Dan and Vickie, which he wrote for our book Getting Real About Sex Addiction, which we talked about in the presentation. Sadly, Joe does not feature in this low-tech/budget re-make, but do not despair. Soon we may be podcasting or youtubing our thoughts together, and Joe’s Yeti-like elusiveness will come to an end. In the meantime, give this a listen, perhaps make a mental note or two. Thanks

Graeme Daniels, MFT

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May 14, 2022 · 7:10 pm

The sex addiction excuse: the main points

Okay, I’ll make this entry relatively short lest ideas get lost in the mix, which is naturally a problem when issues are complex, as sex addiction is. There are many sides or aspects to the “is sex addiction an excuse” question, some of which I’ve referenced in other blogs so I’ll not repeat myself here. But so far the “excuse” question has not been the focal point of any particular essay so I’ve inadvertently buried the lede on this matter. Not any longer. Today I’ll express the point that gets some print in our book, even center stage in a later chapter that is about impacted partners. The book? Yes, you know, the one you’d know about if you had read any of the other essays on this blog. There’s only just over three hundred of them, after all. Take your time. What? Just write it again so you don’t have to read all of that. Well, you can get the title on any other entry of the last six months pretty much, but on the question at hand, here’s the deal as our current president would say: the sex addiction field is divided; that is split between forces that treat or advocate for sex addicts and those who more or less do the same for impacted or betrayed partners of sex addicts. I’m somewhere in the middle, having not gone to graduate school in order to change the world—meaning, I don’t consider myself an activist because my psychoanalytic stance, contrary to my writing, is not polemical in nature, though I do hold opinions activists tend to not like so they’d stick me in camps opposite to theirs anyway.

Here’s an example: I think that the “excuse” argument/position serves the defenses of both addicts and impacted partners, though because the excuse narrative is generally deemed a protection of the sex addict figure, my positing of an analogous excuse for partners will more likely annoy them as well as their activists. See, once again, the most strident among them think that sex addiction treatment is meant to be a unilateral challenge to the behaviors, attitudes, and underlying pathology of the addict, coupled with a dominantly supportive (meaning sympathetic) hand-holding exercise for the impacted-partner. This fosters splitting, a term that means something to psychoanalytic thinkers and less so to the public at large, much of which practices splitting on a daily basis. What is splitting? It’s binary thinking. It’s good/bad, perpetrator/victim; it is simplicity. It’s popular with those who covet simplicity because they haven’t the bandwidth for thinking when they are stressed. And they are frequently stressed so that creates a circular problem. Anyway, as I’ve suggested elsewhere, the first narrative is well known, and often true I might add: a person who calls himself an addict may do so to elicit sympathy, clemency from rightful consequences of their deceitful, disloyal behaviors (Judgy? No, I think that’s fair). Again, I think this “excuse” profile is a correct call out, but only for those who truly are dodging consequences, whether they are legalistic or not, and only pretending to take seriously their problems.

Now, to that other and much lesser spotted employment of the sex addiction “excuse”: How is sex addiction an excuse for an impacted partner of a sex addict? Well, firstly, consider and compare treatment feedback that addresses affair-seeking behavior versus sexually addictive behavior. Especially when the affair seeker is female, you would hear of a space yielded for a conflict resolution that recognizes a mutuality of relationship disorder; for a therapeutic process to touch upon relational issues, which by implication, both partners are equally responsible for. For evidence of this, read authors like Esther Perel or Alicia Walker who, in the shadow of a sex addiction field that aims treatment at men, assert ironies like “women are judged more harshly for their sexuality”. When the context is infidelity instead of addiction, one hears the so-called wayward partner saying things like, “I was lonely” or “I wasn’t getting my needs met”, and don’t be surprised if such positions appear legitimized by the neutral or activist authority that is the mental health intermediary. But if the affair-seeking is cast as a feature of sex addiction then all bets are off and the question of mutuality dissolves. Then responsibility falls squarely upon the addict while the impacted partner hears admonishments like, “his behavior is not about you”. This is why the label of sex addiction might (emphasis on “might”) be attractive to impacted partners, not just the would-be targets (sorry—subjects) of clinical intervention. What? You’re telling me that betrayed figures might choose a concept the ethos of which absolves them of any mooted “part” in the development of a problem? And lastly, might this potential secondary gain be one of the reasons why sex addiction has for many bumped the concept of infidelity to the curb as a condition of clinical concern?

Graeme Daniels, MFT

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April 30, 2022 · 5:26 pm

Isolation: treatment of an impacted partner

What about the spouse or partner of a so-called sex addict? Well, what about them, said sex addiction treatment programs for many years. That’s the narrative of advocates for impacted or betrayed partners—that their clients have been ignored by sex addiction specialists who privilege attention to the acting out party, focusing upon their needs while impacted others are told to back off, not intrude upon the afflicted party’s “recovery”. Well, this is a complicated issue so the pros and cons of partner isolation, or “backing off”, as I put it, bear exploration. Firstly, as someone who has worked privately, as in individually, and as part of a collaborative team for over twenty years, I’ll admit that I have supported the segregation of a partner’s program from that of an acting out figure on many occasions. The reason: there’s too much of a rush to “do something” when you treat sex addiction with a directly systemic approach from the outset of a treatment episode. Now, a possible point of confusion: problems relating to sex addiction may be systemic—meaning, that sexually acting out behavior aside, a couple shares responsibility for relational problems.

But the problem is that since impacted partners have been integrated into sex addiction treatment as part of a “systemic” approach, the field has more recently adopted a perpetrator/victim model that addresses angry women (mostly), promising them “accountability” (as often as not a euphemism for punishment, used to disguise aggression and therefore lessen guilt), and enabling splitting defenses that lead to binary conceptions, scapegoating sexually acting out figures while their partners are given a pass on most relational conflicts because they are “betrayed”. In this model most impacted partners are treated as victimized figures, repeatedly lied to or otherwise emotionally and perhaps physically abused—basically not responsible for most if not all problems between the couple. Now, there may be some who will retort that this take is unfair; that the model in fact expresses that perpetrator/victim roles are “fluid”, implying that impacted partners become abusive and traumatizing themselves. Yes. In plain speak, this means that impacted/betrayed partners exact revenge, feel righteous when they apply “boundaries” post-discovery of sexual acting out, but don’t generally, in my opinion, accept that mutuality contributes to a pattern of acting out. That violates the “his behavior is not about you” ethos, which is then generalized, so any abuse between the sexually acting out figure and the impacted partner is presumed to be unilateral. Interestingly, this tacit heurism doesn’t apply if the acting out figure is female in a heterosexual context. Only in that scenario will you hear sex addiction or betrayal trauma specialists speculate that the impacted partner (if male) is as much the perennially “abusive” figure in the relationship, if not more so. This is probably due to what I have dubbed a feminist tautology: feminine victimization is a redundancy; unless proven otherwise, it is treated as a given—one of the tacit rules within the intersectionality ethic.

If you’re an impacted partner (especially a female one) reading this you likely won’t like the ironic tone of what I just wrote, but the non-ironic, problematic thing is this: I’ve sat with a lot of couples over a lot years (in other words, not just people like you, Heather) and—quite simply—I’ve observed or else heard about the above-described narrative many more times than I care to enumerate. Regardless, this opinion will likely be the most controversial aspect of Getting Real About Sex Addiction because it flies in the face of current political correctness. The treatment of addiction intersects with social mores, but in our progressive zeitgeist only social underdogs get to be cast as scapegoats, not heterosexual men. This is why sex addiction treatment, which is primarily aimed at heterosexual men, more recently eschews the paradigms of codependency or systemic roles like “scapegoat”, which imply that addicted individuals carry the pathology of a system and are therefore not exclusively responsible for relational disputes. Now, to complicate matters, progressive SA specialists will argue that the opposite has been long-true: that the field’s bias has actually been to employ the codependency and scapegoat concepts so as to dilute responsibility and cast unfair responsibility on impacted and betrayed partners. If this was, say, 1989, I’d say they were probably correct, but my sense is that biases have been tilted in favor of impacted partners for some time now, likely because women now represent a majority of practitioners within the field of mental health care.

Anyway, Getting Real actually begins with an exchange between myself and an agitated partner of an identified sex addict. In that illustration, I observe the frantic efforts of the angry, scared discoverer of an unacceptable pattern of behavior. Amid demands for decisive and implicitly sooner rather than later change, I outline an approach that will point her in the direction of support groups, her own self-exploration, with lesser emphasis upon what she’d prefer: an auxiliary role in the oversight of her wayward husband. In a later chapter, I devote many pages to this woman, who had attended a partners’ support group but soon dropped out, dissatisfied; she then sought a “full disclosure” in couples therapy via a sex addiction specialist (CSAT), but found that dissatisfying also, her husband merely compliant, not sufficiently earnest or candid within that exercise’s largely structured protocols. For a year she languished alone, not leaving her marriage in a practical or physical sense, but nonetheless feeling more isolated than she ever had before. In her efforts to get closer to her husband, even rebuild the shaky foundation of their twenty-year old bond, she’d tried everything she could think of—everything except looking at her anger. That she did in individual psychoanalytic therapy, or so I chronicle in the book. It played out throughout our relationship, from the tense, testy consultation we’d once had over a phone, to a later, intensive episode in which her frustration emerged in the transference of our sessions*. We met twice a week at first, then three times per week at the height of our arrangement. I know. If you don’t know much about psychoanalytic treatments then you’ll likely think that excessive, or you might not know what transference is. Think of it this way: if you want to get to know yourself with the help of a professional, it’s best they see you as often as possible, for as long as possible. You see, that way a person’s real self has less chance to hide. It simply increases the pressure to do what we call the work.

             This woman—Anne is her pseudonym—thought that the work of therapy would be “supportive”:  she supposed, largely from her prior experiences in therapy that she’d be validated in her complaints about her husband; that she’d be encouraged towards various ways to “self-care”, accompanied by the half-presumption that she didn’t do this very well. She’d be introduced to legitimate if weaponized rhetoric: terms like “perpetrator”, “victim”, “survivor”, “narcissist”, and of course “addict” were all invoked by group peers, her former providers, mostly in reference to her husband. Headlining the psychoeducation were terms like “betrayal” and “trauma”—again, legitimate constructs but often employed in a manner that externalizes problems and circumscribes meaning, blunting efforts at self-exploration. Why look at yourself if someone else is really the problem? And please, I’ve heard the expressions that feign responsibility, from the offhand, generalized, “I know I’m not perfect”, to the backhanded self-blame of “I didn’t want to believe he was an addict” or the quasi, glib self-exploration of “why am I so attracted to abusive men? I know. I know…I have low self-esteem”. At first, Anne did indeed feel validated and supported by the treatment aimed at her. But soon enough she felt patronized, and was secretly aware that the story of her marriage wasn’t as simple as some were reflecting back to her. In her meetings with me, I validated one thing: her feelings of betrayal specifically relating to the acting out of her husband. Besides that, I offered precious little of what she ultimately found precious and unconvincing. That didn’t mean she would declare herself singly at fault for a broken marriage; she wouldn’t victim-blame or otherwise split so explicitly in her thinking.

             In part due to the frequency of our meetings, she couldn’t hide the angry side of herself, even though she tried, by masking her frustration in subtle gestures of devaluation, and later—upon my interpretations of these moments—by overt expressions of complaint; her paradoxical need for an understanding beneath attempts to push me away. Part of her frustration in life was sexual. Like many impacted or betrayed partners, she hadn’t wanted a cessation or diminishing of her sex life, the semi-inevitable result of having discovered her partner’s cheating and porn-binging. Unlike some who invert the “excuse” phenomenon so often assigned to self-identified sex addicts, she wasn’t citing the sex addiction discovery as a pretext for refusing sex when loss of sexual interest was an underlying truism**. Nor was she a hypocritical monogamist, claiming betrayal while holding post-modern values that cast skepticism on the exclusivist, women-subordinating institution of marriage but still extolling the values of the white dress. Indeed, one of the feelings she wanted to explore in our treatment was her lifelong struggle with jealousy, and just as Esther Perel writes in her book State of Affairs, Anne felt that overwrought support for her betrayed experience had served to obscure this recently valid yet historically neurotic trait.

             Among the standard maxims within our profession and culture is the belief that jealousy, a derivate of hate, isolates. And we think this whether we are speaking of racism, toxic masculinity, misogyny, or its lesser observed analogue, misandry. Hate, or the perception of it, leaves us cold and distant; we lose empathy, othering the people we don’t know, or we forget the people we once knew and loved, or felt dependent on. I was reminded of this watching an old film recently in a state of unwitting jadedness. Ostensibly, I was looking for escapist fare as I selected Casablanca, one of the great romantic flicks of the WWII era, but also a story with hate and jadedness at its center. Rick, Humphrey Bogart’s character, is a cynical American expatriate wounded by, among other things, a lost love in the form of Else, played by Ingrid Bergman. When she returns to Casablanca with another love (for another man) but a lingering regret for having ditched Rick years earlier, she attempts reconciliation, only to find him bitter and drunk. In the aftermath of their tense reunion Rick asks, in effect, what did you expect? See, he felt entitled to his anger. No arguments from her—just a blank, wayward gaze. Ultimately, Else checks out, looks away, says she can’t feel anything for him in the face of his hate, even though she accepts his right to feel that way. Hate. Betrayal. Compulsion. Jealousy. Whatever it was, it had isolated them physically, emotionally. Psychologically, they were correspondingly split.

*Transference refers to feelings and unconscious thoughts that emerge in the therapeutic relationship that are based upon past relationships, especially those with primary caregivers

** I’m aware that this observation, paraphrased from one similar in the book, will be offensive to some readers. To be clear, I’m not suggesting that such ulterior wishes describe all or even most partners of sex addicts who enter treatment for themselves. But I am suggesting that this phenomenon exists, that it presents often enough, and that those who think this isn’t a thing are in another kind of denial.

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April 9, 2022 · 6:03 pm

The Sex Addiction Personality

Talk about isolation. Aren’t they all in the closet, these so-called sex addicts? What else are we calling them, by the way? Ya know, what’s the underlying sh….stuff? What’s the personality upon which this pattern of miscreant behavior lies? Well, you know what to do. Make a few calls, talk to some people who say they’re trained in sex addiction (SA) because they’ve taken a handful of weekend courses. In one of their certificate-earning workshops an instructor may have covered the topic of personality pathology, or disorder. At this point, a few stats will have been brought out. About 65% of sex addicts will have also met criteria for narcissistic personality disorder, and another 20% will have narcissistic traits if not meeting full diagnostic criteria. And those subjects will likely be male, for the most part. I don’t know if the numbers will be that high—I’m making them up, of course. Anyway, although not studied very well (we must ever be reminded of this point!), female sex addicts are more likely diagnosed in greater numbers with borderline personality disorder, which is increasingly synonymous with PTSD because a lot or most of the former have the latter syndrome also. This means that while men in SA treatment are considered self-centered, objectifying, exploitative, and suffering from much concealed personal and especially sexual inadequacy, women are treated as having abandonment issues, having likely suffered sexual abuse and general societal disregard, and in their addictions they just can’t stop “loving” people to make themselves feel better.

             There. A bit simplistic, perhaps, but then I’m taking my aim at a field that is guilty of a whole lotta simplifying in my opinion so I’m mirroring them, to use a term employed to treat narcissists, actually. But don’t listen to me. Make your calls. Read the books that represent the “gold standard” of sex addiction treatment; the blurbs on the specialist websites; the bullet points within instructive blog essays that are nothing like mine. Tell me after you’ve done all your research that the above impression doesn’t stand as the orthodoxy of this field. It shouldn’t stand, you know, and not just because the orthodoxy relies upon stereotyped profiles borne of rote personality testing, inane questions like, “do you identify with the following: if I ruled the world it would be a better place (?)”, rather than clinical impressions formed over time in intensive relationship with and by someone educated and trained in what, after all, was originally (not mythically) a psychoanalytic concept. I’m referring to narcissism and borderline personality on this point, and the concept of Transference. However, there’s another reason why the typical personality narratives of sex addiction treatment should be challenged: they’re leaving out one important category.

             In Getting Read About Sex Addiction, I actually give this matter short-shrift, this being a secondary area of interest in mine and Joe Farley’s book—personality disorder, that is. If it weren’t for the offhand assignment of narcissism to so many addicts I might not have bothered, and one view I don’t venture is that high-profile, expensive, short-term treatment programs likely do serve a lot of narcissistic men, perhaps because they have money, lots of free time, and no doubt their powerful selves have rendered them attractive to affair-available women whom we should not profile as being drawn to narcissistic, powerful men because that is a.) not de rigeur, and b.) not very nice, whether it’s true or not. But there’s a lot of people out there, men and some women I figure, who are more porn-addicted than affair-seeking; more privately fantasy-seeking in the digital age; more in the cuts of 21st century society; exhibiting less bravado, if perhaps a similar, if more intellectualized disregard of using people for sex. There’s a word for this lesser spotted bird, this unicorn in the personality mix. It is a schizoid, not to be confused with a schizophrenic, and he (or she) is a thing, believe it or not. He (I guess I’ll go with another stereotype) has been written about for years, though it’s hard to say who was first to scribe on the matter.

             The first to make a labeling stab was Melanie Klein, who offered the term paranoid-schizoid to denote a “position” of development that entailed the defense of splitting (first termed by Freud), which in turn meant the keeping separate of good and bad internal objects (internalized caregivers, or parents), resulting in split object relations, the tendency to employ “mechanisms” that projected parts of self (unwanted) onto others so as to protect the ego and the idealized object. Klein was in fact influenced by W.R.D Fairbairn, an independently-thinking Scotsman whose conceptualizing wrought an “endopsychic structure” comprised of split objects allied to a split ego, yielding a fragile personality that seeks security in an inner world. It’s likely Fairbairn, not Klein, who gives us the idea of a schizoid that is nuanced from a paranoid (Klein), who is fundamentally withdrawn socially, prone to regression and especially isolation. Following Fairbairn, the likes of Wilfried Bion, while focusing upon psychotic processes, also observed the paradoxical contact-seeking need within this isolationist figure, and indeed regarded that such needs are intensified in tension with an aggressive withdrawal. Also, figures like Harry Guntrip in the sixties and beyond supplied clinical vignettes to help us understand the dilemmas of those who experience what Fairbairn termed a “futility” that manifests as apathy yet lies beyond the affective presentations of what we term depressive.

             Why this schizoid personality develops is unknown, or at least unclear. D.W. Winnicott, not talking about schizoid personality, wrote encouragingly of the capacity to be alone, deeming it a kind of developmental achievement. Winnie thought the analytic situation a recreation of this bond, at least potentially so. It is something to learn to tolerate, this being alone thing, and he thought that mothers who weren’t “good enough” (cheesy phrase, much attributed to him whether he liked it or not) impinged upon their children with their own needs. Beatrice Beebe, a contemporary attachment researcher, called something similar the “maternal loom”, referring to mothers who get in their babies faces too much, overstimulating them (hello, future sex addict, maybe?) causing them to avert their gazes, look at…something else. Lacan’s followers, following Freud’s premises regarding infantile sexuality, and speaking of what Lacan termed the imaginary register, called this tense, overexcited state a jouissance. Bowlby’s acolytes, those who assigned attachment styles like the resistant/ambivalent category, will have known what Winnicott was on about and thought less of infantile sexuality. Meanwhile, those observing avoidant styles of attachment might have glanced at the schizoid phenomenon, or else they might have brushed up on their Meier’s Briggs material, thinking it all reminded of introversion or, if neurological tests were called for, perhaps autism. These are some of the analogue ideas. Point being, schizoid personality is something of a unicorn: a rarely seen, oft-dismissed category of human being, preferably called something else.

             And yet, the internal conflicts that the schizoid faces (or doesn’t) are not rare at all. Indeed, it might be that average human travails mirror what psychologists James Masterson and Ralph Klein termed the schizoid dilemma and the schizoid compromise. To explain these terms: the schizoid dilemma is to seek closeness with others while maintaining autonomy, bearing in mind that schizoid personalities tend to privilege the latter over the former, rendering them strange and detached. Their “compromise” is to find that which achieves human connection but doesn’t surrender autonomy, hence fantasy plus a unique affinity for the digital age. Now, there are many in our midst who would argue that species do not evolve or even survive if they don’t confront such dilemmas and discover compromises. Our growth depends upon our capacity and longing for community. At the same time, our sense of humanity, which includes a craving for uniqueness, decrees that fitting in, absorption, dilution of the one by the group leads to another kind of death.

There’s a slight hint amid theoretical thinkers that a schizoid isn’t really sexual. Perhaps they’d had too much of the maternal loom once upon a time—like, around the time that giraffes start walking in their corresponding development. Later, they (babies, not giraffes) gazed back, but only on their terms, voyeuristically we think. It’s that gaze…you know, that one. But regarding this diagnostic question, you might wonder who will care. Really, will it matter whether porn or sex addicts are secondarily tagged as narcissistic versus schizoid, or even the largely feminized category of borderline? They’re all pathologies, aren’t they? So, while I wind down my commentary on Getting Real About Sex Addiction in the dawn of its publication, I’m aware of stirring the pot on a lesser controversy.  Seriously, the parts of the book that will truly ruffle feathers are those that diss short-term treatment solutions versus psychoanalytic method; or, it’ll be the thread of dog whistling commentary about the sex addiction field’s anti-male bias. Some won’t care if the text actually contains even-handed commentary on both sexes, plus a tinge upon sexual minorities. For them, if sex addiction treatment is to be pathologizing, then it must only be so in reference to heterosexual men. Anything else is to disobey the latest memos about moral equivalence.

Not that an attention to schizoid process (or cultural messages that simulate the attention) isn’t encoded in the semi-public dialogue anyway. Consider the rhetoric that accompanies identity politics: when a person is talked about as a victim or survivor, at least in part because they belong to a marginalized group, their advocates might still reference a schizoid process by referring to denied aspects of self. These will be the split-off aspects of self, which in the case of a sympathetic figure, will be his or her denied positive or resilient qualities that have been insufficiently nurtured and are therefore insufficiently recognized by the subject, hence what they need is building up, empowerment, etc. Meanwhile, those who are cast as addicts or perpetrators or some other disparagement may be described as having a similar intrapsychic process, only their denied qualities will fall under the umbrellas of guilt and inadequacy, hence what they need is bringing down, deflation, and so on. You could call this justice if you like but you might also notice the employment of psychoanalytic thought to support whatever cause you choose. Anyway, I’ll sign off for now on a relatively benign point of interest. Sex addicts: more schizoid than narcissistic, don’t you think?

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