Tag Archives: sex addiction treatment

Sex gone sitcom

 

So, like I wrote before, I’m writing about sex. Or rather, I just got done writing about sex, only there keeps being more to say about it, kinda like there will ever be more sex to be had not long after sex is done. Sex never stops. It never really goes away.

So I invited a friend of mine, Joe Farley, a fellow therapist and “Mastersonian” (more on that…I don’t know, sometime), to write a book with me, about sex addiction (SA). I’d written about this subject before, allusively, in a novel entitled Venus Looks Down On A Prairie Vole. Not many read it so it won’t matter too much if I repeat myself, though now the context will be non-fiction, and the very non-fictional context that is my private practice work. I asked Joe to join me on this project because a year ago, as I was finishing up the Tommy book that would later win the hearts of Kirkus reviewers, he seemed to be thinking and talking a lot about how couples in his practice weren’t getting along—I mean, really not getting along: about how women were too angry and men were too detached and wounded or something. Much of this comment was tangential to the subject of sex addiction treatment, which Joe and I have a foot in the door of, sort of, and which I had been planning to write more about for some time. Neither of us are specialists in this area, which doesn’t mean we don’t know much about sex addiction, or even that we don’t know as much as anyone else in the field of psychotherapy, necessarily. It means that we don’t have the certificate one gets if taking a few CEUs pertaining to the concept of SA, which means learning some facts about widespread the problem is, plus a few strategies on how to address the matter with afflicted individuals and the loved ones that are impacted by it all—basically, how to be nicer than society generally is about the matter of sex addiction but still not nice enough so as to inform would be sex addicts how their behaviors are actually not very nice in a destructive way, and especially not nice for their long-suffering partners.

Please excuse my flippancy. Know that I’m at least sincerely flippant. My year-long toil on this project has left me feeling a bit like Stanley Kubrick as he prepared to film Dr. Strangelove: as seriously as I take this subject, I can’t stop laughing. Joe and I bring our respective attitudes to our writing, which included thinking that most of the literature we’d read over the last decade about sex addiction was dull, officiously directive, and simple-minded. Moved to draw upon our not inconsiderable experience and to offer a perspective from the psychodynamic road less traveled (at least, when addiction is being talked about, anyway), we set about the task of assembling vignettes, explications of theory that were actually represented in typical sex addiction treatment models, only they weren’t being properly credited in our view. As the sex addiction concept and label is quite controversial, we’d write from within its framework and around it, describing people who didn’t necessarily identify as sex addicts, and situations that weren’t plainly circumscribed by the sex addiction idea. I further found that the more I researched, reviewed cases, and wrote, the more I thought that the issues to be confronted were polarized around gender.

The following is a stereotypical presentation immortalized in popular culture, and after twenty years, roughly, of treating couples, I think I understand its infamy.

In this scenario we have on the one hand what I think is a woman preoccupied in her attachment style: she is clinging, fretful in relationships, and sometimes distancing in bursts. She is prone to sudden break-ups with men, dramatized by diatribes that are embroidered by quasi-feminist cant: she is “empowered” as she gets rid of the jerk who keeps hurting her feelings, whether he intends to or not. Along with him, she evacuates her feelings with the dirty bathwater, and announces an end to an affair. Only it’s not an end. It’s a time-out. Or, it’s a rupture that the unwitting partner is meant to repair. Either way, it’s simply an event within continuity, and the relationship, which hasn’t really ended as a result of this turmoil, is the thing.

The ever shrugging, baffled male partner will soon be making his stolid counter-point, re-enacting an iconic sit-com moment with the line, “We were on a break!” or the expanded incredulity of “She broke with me!” To explain away an alleged infidelity, he is uber rationalist, committed to logic and order—the common sense of his sense, that relationships end and therefore people move on. *Cue the bit where the woman responds by casting this aloof, freedom-privileging stance as that of a trauma-inducing, Gaslighting partner—a rebuke coached by her sex addiction specialist therapist. As for the man, all his commander Spock-like affectation might seem real if it wasn’t punctuated with impulsive or pleasure-seeking behaviors: clandestine hook-ups carelessly referenced on social media; altered states of intoxication, and destructive displays of temper. Ordinarily, as in by the light of day, his inner experience—his uncertainty—is concealed beneath his affectless front. It is suggested by the likelihood that aspects of his pleasure seeking, like flirting or engaging sexually with women other than his preoccupied mate began sometime before the “break up” that subsequently justified that same behavior.

In our forthcoming book, Getting Real About Sex Addiction, scenarios like these are mostly discussed in the context of addiction, and not so much the broader, protean world of sexual mores that authors like Esther Perel are commenting upon and thus stirring the modern pot. But there are passages in our text where the space opens in the treatment plan, and the conversation drifts from orthodoxy to what’s happening between people who are in intimate relationships but do not understand one another. In our view, the sex addiction concept complicates but sometimes narrows the discussion around sexual conflict, framing an issue so that sides are chosen rather than problems understood.

 

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Saturday morning sex talk

 

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

Sort of.

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

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

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

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

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

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

Graeme Daniels, MFT

 

 

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Sex addiction stigma debate (part two)

 

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

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

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

“Whereas female sex addiction is…different?”

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

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

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

I tilted my head, affecting skepticism.

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

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

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

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

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

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

“Correct,” my colleague said cautiously.

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

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

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

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

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

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

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

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

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

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

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

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

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Sex addiction stigma debate (part one)

 

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

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

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

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

“That’s right.”

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

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

“What’s your point?”

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

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

 

Graeme Daniels, MFT

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The problem of listening

 

“Thanks,” said the man in the bad shirt to his group. He kept a peripheral eye upon me, picking up my distaste in the air, my discrepant air. The process moved on, with my journeyman skills keeping things in order, neutral—not taking sides, not standing up for anything yet; not saying much of anything, even though talking’s easier than listening. Talking’s way easier, believe me. Storytelling: now that’s a cinch. Neutral is how I am, professionally and, now that I’m alone, also personally. Wanna know what listening looks like? It’s a stifled yawn pinching oxygen; a blank stare held together with tautened facial muscles, and a soft, metronomic nod providing faint reinforcement, possibly a tease, because maybe it’s a nothing, this service I give. Some really want it, and I’ve been like this for years: a cipher into which people deposit their brokenness, and then leave. Not much of a story here, you might think. If you’re a film producer, you’d say, “I’m not touching this, it can’t be done”, thinking this dull: unwatchable, or unreadable. Pornified eyes wouldn’t like it. But in the unlikely event that it hits big, is binge-read and wins awards I’ll gladly take the stage, drunk, saying “For twenty years people tried to write this script but everyone said it couldn’t be done. So and so tried it and failed. So did whatsisname, that other really famous guy.” That’s when I’d punch stuffy air; thank doting mom and rival dad, the wife and kid for their support, God for doing whatever he does, and say goodnight.

In group I became restless, started saying some things I shouldn’t have said, slipping from the listening stance: fighting with men as well as women. It’s what happens when people stop listening.

— a passage from Venus Looks Down On A Prairie Vole

Part of a polemic that runs through the novel: I set up a binary between notions of listening versus doing. Therapists don’t do anything. That’s the sometimes comic refrain that Daniel Pierce expresses, at times to punctuate a dramatic event. It’s not a popular image, this one of therapist neutrality, this sense that we sit back in our cozy offices, smugly observing pathology, remarking on it but not acting as agents of change. Not really. See, the task is to render it invisible…the change…so you won’t notice.

Not good enough, of course. For the general public, I mean: this traditional stance of not doing is not good enough.”I’M A DOER”. Isn’t someone scoring political points with this currently? When parents bring oppositional teens into therapy (as in Working Through Rehab), when wives call up and make appointments for their depressed husbands, when a couple presents for therapy needing help with a ‘crisis of communication’, and when people get out of line with respect to drugs, violence, and especially sex, people from officialdom call, asking for therapists to do something.

And so I chat the other day with an amiable lawyer, a good guy looking to represent his client and mine, someone who did something he shouldn’t have done, with a girl who was younger than she should be if doing what she was doing. But it was his fault. No argument there.It’s just that this lawyer wanted to know…what I was going to do. He knows what therapists do. He knows that we listen; that we don’t judge. But could I give him something, anything, live or in a letter, that he could share with a court and sound, ya know, convincing. He even voiced his suppositions, as if he’d hacked my association’s list-serve and scrolled through the typical ways therapists market themselves. Would I offer coping skills, he asked tentatively?  Teach ‘tools’ for affect regulation (actually, he didn’t ask that).

Empathy. Victim empathy.That’s what I offered. That plus the hope that what my client did he would not do again.

 

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The Trauma Currency, Part One

 

“You didn’t get here overnight,” writes Claudia Black in her 2009 book, Deceived. It’s a solemn lesson, aimed at co-addicts, partners of sex and porn addicts—women, mostly—who are raised in households impacted by addictions of various kinds. Their childhood histories are “training grounds” for adult dysfunctional relationships, wherein such individuals engage in so-called co-addict behaviors: tolerating hurtful behavior, avoiding conflict, taking care of others, accommodating. Black describes a woman named Katy, a “perfect candidate for partnering with an addict”, who becomes compulsive in busy behaviors, attending to her children, her job, avoiding seeing and feeling, the anticipated rejection and abandonment by her sex-addicted husband (Black, 2009, P.85-86).

Profiles like the one above seem conducive to interventions that draw attention to patterns of dysfunctional behavior; patterns that implicitly predate the discovery of addictive behaviors by sexually addicted partners—this is according to adherents of the co-addict model, which is based upon the Al-anon 12-step recovery program. Treatment based upon this model prescribes self-examination for partners of sex addicts: examination of and responsibility-taking for repetitively destructive or self-defeating behaviors; examination of trauma repetitions, reenactments of familial scripts with the unconscious hope of creating new drafts in later life. The idea recalls certain 12-step slogans, such as the supposedly Einsteinian definition of insanity: doing the same thing over and over again, expecting a different result. This too is a derivative notion, echoing Freud’s concept of repetition compulsion, first published in 1914 at the outset of the First World War. The concept of trauma has gradually merged into the lexicon of psychology since then, reaching into or underlying our understanding of several mental health disorders, including addictions.

However, some practitioners and researchers might disagree upon the premises of partners of sex addiction treatment, and therefore differ significantly in therapeutic approach. In “From Victimhood to Victorhood” (published in the March/April issue of The Therapist), Alex Katehakis writes that a “major shift has occurred in treating partners of sex addicts”. The shift she describes is towards the Relational Trauma (RT) Model, in which practitioners emphasize that partners’ relational bonds are destroyed by betrayal, as precipitated by the discovery of sexual acting out—not a historical and ongoing pattern of destructive or self-defeating behavior by non-acting out partners. In the RT approach, practitioners eschew the implication that partners contribute significantly to an addiction by an elaborate, conscious or unconscious pattern of enabling. Such suggestions are misplaced and hurtful, if sometimes accurate, assert the proponents of the RT Model, while their interventions are by contrast comforting and affirming, emphasizing the depth of betrayal by a perpetrating partner. The champions of this position are The Association for Partners of Sex Addicts Trauma Specialists (or APSATS). Their members, as well as those of the hegemonic Certified Sex Addiction Therapist (CSAT) network refer to “sex addiction induced trauma” as a specified subset of a PTSD-like condition.

PTSD-like because while discovery of sex addiction has been deemed a life altering event and has even been demonstrated to be a traumatic event for partners, according to numerous researchers (Bergner & Bridges, 2002; Glass, 2003; Steffens, 2006), each stops short of applying the PTSD diagnosis, suggesting that many or most partners of sex addicts do not meet full criteria for the condition. A resulting controversy seems partly attributable to conflicting language in the DSM-V. Psychologist David J Ley argues that typical partners of sex addicts do not meet criteria of section C of PTSD code F43.10, “persistent avoidance of stimuli associated with the traumatic event(s)”, by pointing out that these partners often demonstrate “obsessive, ruminating fixation on the details of their partners’ betrayals and actions”. He states that the essential features of sex addiction—sexual betrayal, infidelity, lying—do not constitute trauma for partners, however repetitive these behaviors may be, and that describing them as such does disservice to those who need services relating to life threatening events. With respect to the diagnostic question, I observe that language in section E of code F43.10 indicates that “marked alterations in arousal and reactivity associated with the traumatic event(s)” do meet criteria for the diagnosis of PTSD. This includes hypervigilance, which would likely describe the partners Ley discusses in his writing. Perhaps at odds with the criteria of section C, this language of section E suggests that a more concrete understanding of “avoidance of distressing memories”, versus hypervigilance, is called for; or that alternating or interwoven patterns of avoidance and hypervigilance merit further discussion as features of partners’ clinical presentations.

Ley’s position is interesting in so far as it challenges the premise of the RT model, the sex addiction-induced trauma assertion. While the assignment of trauma to sex addiction may be debatable, it might lead us to consider what life altering events are brought on for partners by other addictions. Alcoholics and gambling addicts also engage in patterns of deception and blaming alongside their destructive behaviors, yet we do not hear of “alcoholism induced trauma” or “gambling addiction induced trauma” as it might pertain to partners or families of drinkers and gamblers. With respect to sex addiction, I’d suggest that it is not so much the presentation of PTSD-like symptoms that warrants a specialized assessment label, or the pervasiveness of deception, or even the ongoing denial of partners’ assertions that sex addicts often exhibit. Rather, I think it’s the nature of the behavior, the context of the lies and deflections—sex—that hurts so deeply. After all, what is harder for our clients to talk about than problems relating to sex? What elicits shame, triggers vulnerability, rage, more than this traditionally-cited root of psychoneurosis?

At least trauma has been codified into psychiatric nomenclature. The same can not be said of sex addiction and codependency, neither of which is delineated within the DSM-V, still. While proponents of RT and co-addict models appear to accept the existence and clinical relevance of sex addiction, or Hypersexual Disorder (as it was proposed to DSM-V committees), they differ with respect to codependency. Proposal for inclusion of a Codependent Personality Disorder was originally made by Timmen L. Cermak in 1986. The diagnostic criteria for the condition then included such statements as “continued investment of self-esteem in the ability to control oneself and others”, “assumption of responsibility for meeting others’ needs to the exclusion of one’s own”, “enmeshment in relationships with personality disordered, chemically dependent, or impulsive individuals”. Cermak’s proposal also included a category which outlined other symptoms, including “excessive reliance on denial’, and “hypervigilance”, which should sound familiar, as the language of the DSM-V criteria for PTSD appears to echo this juxtaposition of ideas/symptoms.

REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

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