Tag Archives: sex addiction

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?

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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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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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Isolation

Not a good thing, we’re told, especially in the context of addiction. Isolation: has a negative connotation, don’t you think? Not like the word “alone”. In Getting Read About Sex Addiction, Joe Farley and I make several references to aloneness, isolation, or else we spin polemics about the pros and cons of doing things by oneself. Sex addiction seems like a loner’s pastime. Porn addicts do it alone, then keep what they do secret, which furthers the aloneness. Affair-seekers probably boast more about sexual conquests, just as they always have, but they’re even more secretive, or glib about their habits, for they have even more trouble to avert; more to lose, it often seems. Isolation. More than most addictions (excepting that of food, maybe), sex addiction happens in isolation, and is talked about in peer circles the least, hence the solution of groups, and of disparaging isolation, if not quite aloneness, within the milieus that treat this still-mooted condition.

             The ways to be alone, let us count the ways: well, first of all, those who wear labels like sex addiction absorb the pathology of a system. Within a family, and especially a dyad, as in a couple, the addict holds the “badness” of a relational problem. He or she is the problem, which is isolating. Our book critiques the habit of splitting as it manifests in many forms, and offers that sex addiction, while useful as a signifier of phenomena, ought to be carefully, not impulsively assigned. Furthermore, we cast doubt on terms like “perpetrator” and “victim”, which split matters into good and bad, right and wrong, which renders problems facile; histories reduced to recent events, not dense, developmental histories.  Otherwise, we refer to isolation in several other contexts, applying nuanced meanings: referring to the “incipient shame” of the addict, suggesting an early development dimension to their affective leanings; that an addict or “acting out person” isolates his or her affect, which means directing feelings towards action, not thought or feeling, which cues the therapeutic solution: let’s talk. The associated institution of 12 step recovery echoes the ethos that self-expression within a nurturing environment is an antidote to an isolationist pattern.

             Not everything that happens alone is pathologized in our writing. To be that rigid in our thinking would exhibit splitting; it would suggest a paucity of thinking. Thinking. We tend to think it happens alone, away from the noise of a crowd, but we extol its practice in collaboration. Collaboration: now there’s a loaded word, another term that casts a shadow upon aloneness. Be a team player. Don’t go it alone. Well, okay, but this paragraph is meant to represent another view, the virtues of being alone. In our first chapter, I refer to the “mischief” of breaking rules, of testing boundaries that represent authority, the group, society—all because…well, because there’s something good, something irresistible and actually worthy about going it alone. So, we thumb our noses, do our own thing at times, practice what I term (not unique to me) anodyne sexuality, like flirting, which hangs perilously close to an abyss of verboten sex, depending upon who is doing the flirting and in what context. We might agree about the new rules, or as society extols paradoxically, we might think for ourselves, do our thinking alone.

             The habit of going alone while stepping on others’ toes (Freudians take note) has been given another pathologizing label: narcissism. In sex addiction treatment, this aged construct has been co-opted by practitioners and lay observers alike, and now has the status of corollary to a sex addiction assessment. Pity, for its another saturated concept that has been reduced in the service of splitting arguments, the outrage of the betrayed or the plainly envious. It’s not that the condition doesn’t exist. Yes, narcissism is a thing. But its offhand attribution, the shoot-from-the-hip assignment to patients in sex addiction treatment bristles against conscience. I suppose Freud pathologized the condition also, by implication. Originally, as in 1914, he wrote that infants exhibit primary narcissism, a state of auto-erotic being before cathecting their sexuality to caregivers (dubbed objects, hence object relations theory), and upon resolution of Oedipal taboos, towards genital sexuality and the selection of post-pubertal partners. From this notion of auto-eroticism, many presume immaturity and pathology to the alone state, thinking it a slippery slope towards inflatedness, arrogance, and lack of empathy for others—the familiar catalogue of narcissistic traits.

             While Heinz Kohut gets much credit for having carved out a space for so-called “healthy” narcissism since the 1970s, the term has hardly left the closet of weaponized terms, thus narcissist and sex addict have become virtual synonyms in the 21st century. And remember, in the sex addiction lexicon you’re a narcissist whether you’re a habitual masturbator (being alone) or exploiting others, using others’ bodies as masturbation tools instead of practicing sexuality with an air of presence, consideration for the other, with generous attention to foreplay, emotional nurturing, passionate interplay, play of a sexual kind—all the virtues that someone has decided represents non-addictive, non-isolationist, sexual health. In this model, masturbation generally gets a bad rap, being the pastime of the anti-social if, perhaps, the socially undesirable. But not all famous theorists have denigrated the masturbatory, go-it-alone tradition. By implication, at least, psychoanalytic hero D.W. Winnicott was perhaps a champion of what he won’t have called self-abuse. Read “The capacity to be alone” from 1958. Yes, that’s right: the fifties. Not exactly the era of sexual revolution. In this paper, Winnicott writes of the capacity be alone as a developmental triumph, not a pathology. It is a signal of maturity, of what others might term secure attachment, to accept being alone, even in the presence of the other. And he was writing of a child’s experience. What’s a later version? Think for yourself while listening to others. That’s one example. Do some things by yourself. Have fantasies, even those of the so-called primal scene, by yourself, because to share on that is TMI. Even do it by yourself.

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Diversity, Inclusion, Exclusion, and dicks

*FYI: this is this blog’s 300th entry

We don’t know what we don’t know. Circular thought. It’s popular, I notice: often employed, I simply mean. Not so much by patients, or clients (guys in my groups). The latter wouldn’t employ the term because they’re not sensible to its ironic, wistful purpose; the apparent longing.

Guys in my groups, my sex addict treatment groups, tolerate my invoking the unconscious, I wrote in “The group’s the thing”. Indeed, sometimes they run with the idea, though they prefer to say subconscious for some reason none of us know, perhaps because the “sub” prefix/qualifier denotes a shred of what they’d prefer to retain: a sense that they know what they’re doing, that intentions and wishes aren’t so far down in the mind. Otherwise, it’s useful to suggest that they don’t know what’s up, as in conscious, because that appears to defer responsibility. Seriously, can’t you get away with anything if you just say that it was unconscious. I didn’t mean it: “it” being an Id-like representative; an aggregate of bad behavior blended with notions of bad self. Well, this won’t do, suggests a finger-wagging psychoanalyst, only you wouldn’t see them wagging that finger if they sat behind your prostate (I meant prostrate–now there’s a Freudian slip), on-the-couch lying figure. You’d just hear the tsk tsk in their voice, feel the eyes rolling. Analysts are human, too, despite their reputations among some. They don’t like being stereotyped, or discriminated against, and they certainly don’t like their ideas being co-opted or misused. Responsibility, they invoke, sort of. You may not know this, but it’s incumbent upon you to keep thinking about what you don’t know, and in time, like any day now (like seriously, we’re waiting!), say something…ya know, real.

Some think that it’s time for psychoanalysis to move on, and I don’t mean that it should die (actually, some might want that—un or subconsciously) like my friend Jason did recently, but rather grow, evolve, as in strike out to new frontiers, go where no man or woman or not either has ever gone before. Some refer to this undiscovered country as the analytic third, while others will rightly think that it’s a cheesy Star Trek and then Shakespeare allusion. It’s both, or all three, I guess, which suggests that my thinking is not black and white, either/or, or binary. There is a triangular reality, like that of the Oedipal situation, come to think of it. Life was once the experience of a singular figure—an auto-erotic, narcissistic trip, wrote Freud, that later undergoes a watershed of development within a fraught relational triad. Not so, rebuked the likes of Winnicott after pointing out the air raid warning amid the so-called controversial conversations of the mid-century object relations revolution. Life, or the unit of consciousness, is a dyad of mother and child from the outset (or near enough), not a singular entity, he argued. As for the Oedipal triangle? Well, that comes later, Winnicott likely conceded, while asserting that its “drama” was not a primary cause of phenomena. Sure, the relationship’s the thing, agreed some contemporaries, plus many who followed them, especially feminists. Freudians re-asserted the triangle, reminded that life really moves on when the father enters the picture, bringing his baggage of Superego, in turn inherited from the primal horde. Klein and her followers deferred once, saying this does occur but earlier than when Freud said it would, plus it manifests as a web of intertwining projections and introjections. Lacan and his people said something else that I haven’t figured out yet, often using words like indexing, or expressions like “in the register of…”.

Psychoanalysis in this mid-century era was perhaps moving between the breast and the phallus, unsure as to the nexus of development, and half-thinking that growth and evolution hinged around our relationship to sex, but otherwise thinking that something more human (as in humanistic) and less Darwinian and animal-like was the truth: that we are relational beings, seeking intimacy, attachment, someone to talk to, and even before that, developing non-verbally a proto-self with a containing other, one who provides strength in an ambient if not omnipotent fashion, not cognitive interpretations that may aim at the unconscious. Ya know, we’re not just looking for someone to…ya know. Did you get that, those of you who think Psychoanalysis is or was phallocentric? It was Klein (a woman) and then Winnicott (yeah, a white guy) who pointed us in this direction…like, seventy years ago! Anyway, this dialogue as to what’s important has been going on for some time now, air raids notwithstanding, and it’s all gotten a bit tiresome I have to say, which may be why the dialogue’s being shaken up even more recently, with added elements that have also gotten short-shrift. It won’t be a dialogue anymore, you see. It will be something like a trilogue, to indicate an analytic third, which means someone or a set of someones who have previously been excluded.

Race. See, it’s time to talk about race. Again. Wait, I mean to really start talking about it. We’re often saying, aren’t we—I mean, in whatever circles, professional and not, that we’re in—that it’s really time to start talking about race. I said it once, I think, in a blog long ago: my “token” entry about the verboten subject. Race. It is to psychoanalysis in the 21st century what sex was a hundred years ago: the thing we don’t talk about; the taboo; the thing about which we say, “we don’t know what we don’t know”. Talk about black and white thinking. We’ve forgotten the spectrum of colors in between. I won’t name them. That would be insensitive. That might cause racial injury, deliver an impact regardless of my intentions. But it is time for voices of color, people of color, and thinking in color, to have its say. They might start—indeed, they seem to start—by telling people like me, those at the top of the privilege charts (male, white, heterosexual: the anti-trifecta), that we don’t know things that others know. We can’t know things, as in the experience of people of color, of people like them, because we’re not them; because we haven’t had their experiences, and we’ve been barely aware of our own privileged experience, let alone their underprivileged existences. But we can learn and listen, even though we can’t really know the experience of the other, which shouldn’t stop us from trying to…well, we’re going in circles here, which is okay as long as we keep thinking. That is analytic thinking, I think.

In the meantime, I might continue to take refuge in the cozy bosom of universalism, the happy experience of commonality, which is what I’ve got; it’s especially gratifying when it occurs with those who are different from me in the catalogues of diversity. I have a new friend who loves soccer as much as I do, attaches meanings to its rituals that are at least analogous to my projections, and he is Portuguese, and his favorite team is a worthy institution, Benfica FC, while my favorite team is a mainstream option, the iconic Manchester United. See, sport: the universal language. I have a patient whose identities contrast with my trifecta: a woman, bisexual, and of Asian heritage, she laughs at the irony of her belief that upon several years of analytic therapy with me no one seems to understand her like I do. Or, less earnestly perhaps, I can point to the experience of a Mexican man in my practice—a tattoo-ridden, macho yet oddly genteel figure (perhaps “smooth” would be a better description) who womanizes, distances from intimacy, chases pleasure in the shadows, would bring Glock pistols to a fist-fight, drive fast cars towards cliffs if he could afford them. Regardless of where he is from, he would seem to fit the model of the libidinous, death-driven figure that Freud and others have envisioned; the kind of man who doesn’t seem “relational”. His is a decidedly male, “heteronormative” fantasy no doubt, one that is routinely castigated as toxic, narcissistic (as determined by past and present society), but he is not quite the dinosaur that many might wish him to be.

Yes, let’s not objectify him as he does others. He’s a human being, after all. He’s a sex addict as well, which is also a human being, albeit one with a lot to answer for. The latest dream he shared with me might have scared many, but it didn’t disturb him. Demons, he intoned casually. And gargoyles. Or, a kind of gargoyle, he amended with a smirk. These and other nasties had populated the fiery pit of his dream, but it didn’t rouse him. He didn’t wake up in a sweat, grabbing his nuts and looking down to see if his penis had been severed. It’s the punishment he anticipates, he smirked. But not from an afterlife. He’s got no fear of doctrinal fate; no dread of the fire and brimstone, or of sharp knives threatening an emasculating cut-off. Amid the trail of his chuckle, we let a silence settle, both of us lapsing into a still reverie. Somehow, we thought the same thing: what if the thing is not so much loss as absence, as in an absence of past as well as present. He frowned, curious about my thought. I was on to something, he figured, despite differences that were cultural, generational, and something else not easily pinned down. “You mean like no dick at all?” he asked, intuiting my thought. “Yeah,” I uttered. “Imagine there’s nothing there and you’re in the twilight zone peopled by these androgynous, phallusless creatures, and you ask, where’s my dick and they’re like, ‘what’s a dick?’ and you’re like, oh shit…”

Yeah, don’t tell me that some things don’t cut through time, differences of culture, of privilege that is legal, institutionalized and economic. Now, I know that transference and countertransference are not just dyadic phenomena, as Winnicott, Balint, Fairbairn, Benjamin, and whomever else has said. Yeah, I know there is an analytic third comprised of the separate worlds we were born into; divergent histories that preceded and steered both of our lives. But sex and addiction, two bread and butter topics in my day to day, have played reconciling agents, bridging gaps that would otherwise have created blank division. Dicks. Who knew? We knew. We knew all along, ever since the apple fell and the differences were there for all to see.  

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Intersections

A writer I like says that each page contains hundreds of decisions. A parent or an analyst might say the same about an hour in their day. Not me. Sounds like too much hard work, for the conscious mind anyway. It’s good to know that another part of me is on call, though, thinking of all the layers, making some decisions at least, mostly about psychoanalysis, lesser so about writing. They entail different relationships, you see: with live “in your face” figures on the one hand; distanced, mysterious readers—you—on the other. That’s me thinking about and making decisions about relationships, or as we say in psychoanalysis, that’s me thinking about object relations. That’s that part of object-relating, or is it object-creating? Are we still creating objects, meaning caregivers and others into which and from which we get ourselves?

According to some, D.W. Winnicott dropped a mic on psychoanalysis when he declared that a subject tests the object with his or her omnipotence; that for him the concepts of merger and fusion were not so much denoting pathological states (“stigmatizing”) as necessary stages of development. See, we need a robust figure for an object, a “rock” who can take all that we can dish, not be destroyed, and still love us. That’s right: love. That old thing. Turns out it’s all we need after all, especially when we’re at our worst, within our omnipotent, infantile fantasies. Supposedly, this message contrasted with what Sigmund had to say 40 years before Winnicott. Freud had conceptualized stages of primary process (the “id”) and primary narcissism, which he too described as necessary in the growth of human beings. This meant a movement from an infantile, auto-erotic state, to one in which we attach to an object (a mother), and then necessarily withdraw, which ultimately leads to the replacement of the mother with one based upon her model, or else we withdraw into ourselves (secondary narcissism). We cathect that libidinal energy to an ego, and from there we…wait, what was the difference?

No, No, I get it, sort of. For the likes of Freud and later Bion, the task of life is to learn reality (the reality principle) and to adapt to that reality—like not getting to have your mother (sexually), or even have her at your non-sexual beckon call. If you learn reality, it’s because of frustration (plus other frustrations derived from that) or at least the capacity to learn from frustration, or else one lapses into psychosis. That idea’s more Bion, actually. Anyway, Winnicott appeared to nuance if not quite flip the script, specifying that the “frustration” is a failure of a nurturing environment to be just that. Ah D.W., you brazen finger-pointer you. Who were you to say that a maladjusted child was one whose mother was just not strong enough—not “good enough”, as that concept was cleaned up—to settle the child’s excitable nerves, his over-stimulated, omnipotent, mother-possessing self? Wasn’t Sigmund right to assign responsibility to the innate excitability of the child, and to later place him before a righteously law-imposing patriarch at the ripe age of 3-5 and nip that object-seeking, taboo-traversing impulse in the bud? Well, who knows whether Sigmund really thought that dads were more decisive than moms in the raising of a child, but he didn’t think that omnipotence was something to caress and tolerate, like Winnicott did. And who knows whether the latter thought that parents were getting it wrong when the perversions started to happen, or when hysterias began to stiffen limbs and refrigerate the nether regions?

In treatment, this all becomes a prescriptive template for a therapeutic process. For Freud, this meant the application of what he termed an evenly hovering attention; an abstinence from gratifications of varying kinds, all derivative of sexual desire; attention to rules, the implicit validity of a Super-ego, a pathway to discontented civilization. Civilization is discontent, observe many, but we’re meant to do something about that, not just sigh, accept our lots in life and sublimate. Sigmund wasn’t much of a protester, I guess. His followers, students and so on: they weren’t activists. Now, to be fair, to be a Jewish activist, a protester against how things are in 30s central Europe would likely not have worked out. Old Siggy would have been shot or oven-roasted for saying that a harsh Superego derived from a parental template intersects with the malady of anti-semitism or fascism in modern society. Yeah, cancel culture has nothing on what Sigmund fled to London from.  

If psychoanalysis has something to say about modern society then it has extended its definition of a child. So here we (we?) introduce the concept of intersectionality to broadly declare that psychoanalysis has something to say about the state of the world, not just Oedipal triangles of children and parents—though, to be fair, Freud had been commenting on the world and not just the interior lives of his patients at least since Totem & Taboo in 1912, and later, certainly, in Beyond The Pleasure Principle, Civilization and its Discontents, and the epilogueish Moses and Monotheism. But let’s not quibble. Basically, the modern zeitgeist is to suggest that object and subject are figurative terms denoting positions of power and not having it, of being an underdog within the shadow of an institution, a “system”, etc, and within the corridors or streets of morality construction there are varying rules and therefore new Superegos. And it might take a philosophy or critical thinking expert to identify the metapsychology which declares that rage is the exclusive prerogative of the underdog, hence the progressive dislike of people who seem angry but don’t deserve to be so.

Melanie Klein, in her contributions to psychoanalysis, emphasized that the infantile fantasies of children contain states of paranoia and frustration, leading to splitting defenses, a withdrawal from “bad” objects, plus a fear that one’s own internalized “bad” object will do harm. This interweaving of introjection and projection, and attendant frustration, is a product of dependency, and so, as we extrapolate to culture, we must look at dependencies in interpersonal relationships, power dynamics between groups. In our book, Getting Real About Sex Addiction, Joe Farley and I focus our attention on the interdependence between heterosexual men and women, primarily. We do not mean to be “exclusive” of sexual minorities, but the truth is that psychotherapy is segregated by a number of demographic factors, and group identity is a factor, so we do not market to sexual minorities because we are not sexual minorities ourselves. Also, while race is of course an important—perhaps the most important cultural dimension for psychoanalysis to address in the 21st century—its intersection with sex addiction is unclear and the dependencies contained are imbalanced. People of color depend upon the justice of white people in an institutionally dominant white America. In microcosm, a person of color looking for a therapist is more dependent upon its dominantly white demographic—this is why it seems more incumbent upon white practitioners to practice “diversely” than it is for providers of color. Otherwise, in what ways are white people dependent upon people of color?

However, the thing is…we’re interested to explore in our book the ways in which men and women are dependent upon one another because—with respect to sex, at least—they are more or less equally at each other’s mercy—a unique phenomenon between social groups. Again, this is a heteronormative perspective. A gay man or woman may have numerous relationships across gender boundaries, but they do not have their intimacy needs met by the opposite sex so there is relatively little tension in such dynamics and therefore less to compel attention to the needs of the gendered other. That’s another extrapolation of the Freud-Bion axiom: it is tension, frustration, the prospect of adaptation, that informs motivated action. Yes, a rabbit hole, but if I may grab a rung on a ladder on the side of that abyss, I mean to say what numerous analysts think: that members of the gay (and perhaps transgendered communities) live in a part-object (one sex) world, which if true would be ironic given their reputation for celebrating “gender fluidity”. The LGBTQ (plus) communities may, like racial minorities, consider themselves inextricable from a dominant culture, but like all individuals to some extent, its members can indeed live or at least fashion private realities.

And a further irony is that such realities contain less widely known battlegrounds. I don’t know. Is there a battle of the sexes within the LGBTQ communities, with the notion of “sexes” as I allude to it elasticized? Are there internalized, gendered differences to contend with however much those differences have been…wait—here’s a writer’s decision, cut from the intersections—would it be cool to say cut off?

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So you’re angry…and guilty

So you’re angry. You feel entitled. You’re like Richard III with the deformity, or so wrote Freud. The world, or the microcosm in which you live, has dealt you a blow, an unfair disadvantage. You’re gonna take what you can get, not expecting anyone to do anything for you. And you extend this attitude to your sexuality, with which you play like it’s a toy; actually, like it’s a modern toy, as in some electronic goodie that merits an upgrade like, every other week or something. Meanwhile, you’re down on the old toys, and especially one toy in particular. And this toy is a she, typically (yes, I’ll be ironically sexist for a moment). She’s your wife, or your long-term partner, whatever. Long-suffering, some will opine. Deeply impacted, traumatized, abused, others will say, including her, though some of the words are borrowed. The thing is you agree. It’s not like you don’t feel bad after you’ve done your thing after the Xth time. It’s not like you don’t feel guilty. And in feeling guilty you will feel penitent, at least until resentment returns and you sort of remember why you felt the things that made it okay to act upon your fantasies which then led you to feel guilty.

Validation. See, it’s not just about sex for you. It’s about the package of emotion that you wrap around sex, which includes murky yet happy experiences of freedom, relief, the pull of seduction, of play. That sinful other offers a conflict-free experience: she’ll admire you, or at least not intrude with her own troublesome wishes. With her you’ll escape the vague feeling that you are used up, have been used up, studded and then dispatched to some figurative pasture wherein you perform tasks that are drudgery, or acts that border on the heroic but which yield little in the way of thanks. Can’t she—meaning the old toy—make a bit more effort? Lose weight, put on some make-up…ya know, act like she did before you put a ring on it. Those days are gone, it seems. Now you’re trapped, or you feel trapped, subject to daily criticisms that now far outnumber the once-upon-a-time compliments. You know what to do. It’s 2021 still (yeah, I know, wrote this a month ago), hanging on by a thread, and something that’s trending aint gonna stop anytime soon. It’s never been easier to have affairs, writes Esther Perel, a modern author on the subjects of sex and relationships. It’s also never been harder to not get caught. If you get caught you might come see someone like me. I’m paid to take your confession, and then, as far as you’re concerned, tell you what to do about the old toy that you want to keep, apparently.

You want me to validate you? Tell you what to do? Affirm that you were entitled (whenever that attitude emerges) to all the toys on the shelf because of all that you do, all that you have tried, that merits the reward of intimacy. You tried everything, didn’t you? Did you? If you’re like the average (or even the not so average) obsessive, or “addict”, then you tried everything except actually asking for what you want, regularly, in the relationships that you chose. You think you asked for it, meaning the things you want. Well, maybe you did…once or twice. Yeah, okay. She said no. Then she said no again. Then you gave up and sought out that or who that says yes.

So you’re angry. You feel entitled. You discovered that text from that someone else and it blew a fuse. You walked in while he was looking at those images with his hands down his pants and you wondered, in part because he’s usually better at hiding, how much is this going on? The first time you found evidence of this you brushed it off, thinking it was normal, for men that is. Your girlfriends said the same thing, waving their hands, moving the air, declaring it was no big deal. A dissenter is your one friend who is bisexual, or maybe she’s more gay than before, you can’t tell. Anyway, she’s woke and she tells you you shouldn’t put up with this shit. Well, you’re not gonna put up with this shit. Not anymore. Plus, this getting caught thing: it means he’s losing control, doesn’t it? It must mean he has an addiction, unless he wants to get caught. Does he? Maybe he doesn’t love you anymore and this is just his way of saying it? An avoidantly attached personality, your therapist friend said. But you’re confused on that point because he says he’s sorry, wants to work stuff out, get some help. For himself? So he says, though he keeps implying that you’re to blame for the thing that he is doing a lot—so much so that he’s calling it an addiction.

So now you’re angry. Now you’re angry? Actually, you’ve been angry, or at least tense, for quite some time, because you thought something was going on but you were brushing it off and he was saying it was nothing, and nearly everyone else was saying it was nothing, and now it’s out of the bag and the pants are down by the ankles and suddenly it’s a something. It’s an addiction? Okay, well now it’s time for all the pent up feeling that you didn’t feel justified to vent is coming out, big time—like never before, it seems, which stirs another thought: actually, getting pissed at things has never been easy. You’ve never felt entitled to vent your spleen, even though people say you do so all the time. What they don’t know is how guilty you feel afterwards; how painful it is to get angry. That’s why you do it in secret a lot, which includes speaking to confidants, people who are as secretly angry as you so they vicariously enjoy (sorry, feel) your pain. Thing is, that’s starting to ignite guilt also. These confidantes: they can take so much, or worse, they’re gonna start judging you, thinking you’re too angry. Bitter. Time to pay someone to listen to you. A therapist. Specifically, find someone who specializes in something called betrayal trauma.

Validation. You want to hear someone validate your experience, tell you that you’re entitled to your anger and, by implication, the vengeful actions that will proceed from that anger. Here’s your secret: despite what has happened, you’re not sure you’re entitled to your anger, or to that much anger. So the next bit is unconscious: you want to borrow entitlement from someone else, and specifically, an expert. This is a form of permission seeking, and guilt reduction. And this was Freud’s deliciously amoral point: righteous anger is how we soothe guilt. It’s the bone we look for to justify the diatribe, the melt-down, the action movie climax that we all want to inhabit: the one in which the hero, or heroine, gets payback! Ah, those movies! Those HBO/Netflix binge-worthy gems: don’t they trade masterfully upon our desires? Addictive, you might say. See, if you pay close attention you might notice your internal conflict is not so different from that of the addict. The problem is guilt. Guilt doesn’t quite get extinguished, even in scenarios wherein the righteousness is fever-pitched. Why? Because the capacity for guilt may be inherited. It may be part of character, part of who we are, as opposed to something stirred by circumstance, the strictly external phenomena. You wanna know what a psychodynamic or psychoanalytic treatment would “do” for a patient like this?

Well, if you’re a Winnicottian worker, your marching orders will incline you to validate the anger of the betrayed, and even the underlying disappointments of the acting out figure. You will likely think that many in our patient mist lacked an original strong parent to teach them entitlement. As a result, you’ll think that some of us are simply ill-equipped to ask for what we want, or to protest unfairness, or wrongdoing. As a result, you’ll think it your task to bolster the wounded selves of such patients, give them a hint, at least, that what they secretly or impulsively want is…dare they say…deserved—so deserved that they might integrate that entitlement into their daily lives, which leads, broadly speaking, to the likely therapeutic goal: to be entitled in a way that is honest, non-destructive; at peace with the world. Ah! Doesn’t it sound nice, like a soothing hot tea before a nice hot fire on a cold, damp night? It sounds nice, but sometimes a little condescending, when those who claim to have reached this promised land boast of the achievement.

If you’re not Winnicottian. If you are, say, a Bionian or Kleinian figure, you’ll tread a less popular path. When a patient asks you, “It’s only fair and right for me to ask him to leave, isn’t it?”, you might respond with, “what are you asking me for?” (to be fair, only if you’re prepared to piss off your patient), or—slightly less frustratingly—“well, I think we can see how you’re struggling with the question of what to do. You’re angry and you want to express that. But you’re not quite sure it will feel right, so you ask me what I think, hoping I can make it easier”. You’ll know you have an analytic patient if the person can think upon this answer; if they can, as Bion once proposed, tolerate the frustration of not knowing answers long enough so they can use their minds, think about who they are and how they relate, historically, to anger and guilt.

Whether they perceive the irony or not, the rest of the patient population will seek out that which makes them feel better. Like any addictive habit, that will feel good, for a while.

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The group’s the thing

It’s a familiar routine. Someone calls a center, a “program”, which is comprised of therapists who will talk to the afflicted, make an appointment, perhaps several, about what will variously be termed “problem sexual behaviors” or “sexual acting out”, or some other euphemism for our typically chosen shorthand: sex addiction. That’s the term that’s gained a foothold in mental health even if it hasn’t yet found a home in diagnostic standards manuals. But it’s established itself in 12-step circles, as Sex Addicts Anonymous, or Sex and Love Addicts Anonymous, and if the 12-step community says sex addiction exists, then for many that’s good enough. I cover that issue in another blog, so for now, enough said on the “is sex addiction real?” question.

Less stridently, or implicitly, 12-step programs assert something else: that addiction ought to be spoken of in groups of people whose privacy is protected via an anonymity principle; by extension, treatment ought to happen in a semi-public forum that is not shaming but does hold individuals accountable for their behaviors, amongst a peer group, not just professionals whose personal experience of addiction may or may not become known. What does this mean? Well, the meaning is ambiguous, but we may see illustrations of process, which we do see in vignettes presented via Getting Real About Sex Addictionhttps://rowman.com/ISBN/9781538158050/Getting-Real-about-Sex-Addiction-A-Psychodynamic-Approach-to-Treatment, mine and Joe Farley’s book, due to be published early next year. Anyway, many programs purport to treat addiction offering group therapy as its primary format. Being exposed to other struggling or “recovering” addicts: it will help newcomers not feel alone in their patterns of destructive behaviors and obsessive thinking; it will place them in the company of those who will not “judge” them for their habits, but rather help them set limits, be honest about problems, and above all, leave isolation behind and seek fellowship.

Such a support system, whether it is led by a professional therapist or not, should help provide a struggling addict with a consistent structure in which to learn about addiction, understand what “triggers” problem behavior, and offer real choices—perhaps the first real choices some will have ever felt—with respect to alternative behaviors. What else can an addict do to seek pleasure? Are there really other ways to cope with compulsion, or states of restlessness and anxiety? When a relapse-prone group member is “struggling with addiction”, which may include succumbing to rationalizations, justifying so-called “middle circle”, slippery, or even worst-case scenario actions, a support group may “call out” the so-called BS of the struggler and challenge him or her to not act upon impulse—that is, to not engage in the behavior that is explicitly aggressive or sexual.

The problem with groups is that they don’t necessarily help people think about how they are thinking. Despite what Kant once said about all meaning being group meaning—that an event or phenomena occurs because a community says it has, or Freud’s assertion that individuals find in groups avenues for identification and “fitting in”, the psychology of groups is suspect. Freud had in part based his thinking upon the work of a contemporary “crowd psychologist”, Gustave Le Bon, who wrote that crowds are intolerant, more irrational, more heartless, immoral, exaggerating, and uninhibited in its expression. A group protects itself and unites against outsiders. Bion later followed this line of thought, teaching that groups tend to blame, to follow messianic or “mystic” leadership, or to bond in cliques, especially against perceived outsiders. This is why couples groups or co-ed groups are fewer and riskier. But this is also the biggest problem of sex addict or impacted (or betrayed partner) support groups that are homogenous, thus protecting members from shame or guilt exposing experiences, but also shielding them from what may be the most insightful or incisive of peer feedback.

Fear of persecution is a constant subtext of the (typically heteronormative) male sex addict therapy groups that I lead, and members are quick to “act out” their defenses against such fears, which is problematic because it tends to blunt self-reflection, with members unaware that their reactions to one another’s sharing are often governed by assumptions and prejudice. A good example is a group session wherein one member shares about exchanges with impacted partners or an observably punitive authority figure, like a boss or a teacher. Everyone fears authority—spouses being a kind of authority. A man reports that in the aftermath of a computer porn binge he sat with his wife who asked him what he’d been doing with his time, seemingly with a suspicious air. The man reports feeling guilty but also resentful, to which I later offer a chestnut about guilt and anger being symbiotic, with resentment following guilt as readily as the reverse phenomenon that is more conventionally understood. Regardless, it’s not clear whether guilt is useful as a deterrent against acting out. Or, paradoxically, is it something that is reduced by a further instance of acting out? Another man relates a scene of being exposed at work for having used porn on an office laptop, and thereafter called into a manager’s office for an HR rebuke.

In both cases, the response of each man’s group peers did not surprise me. In both cases, there were opportunities to explore guilt—not because I or anyone thought the men in question ought to feel guilty—but rather simply because they reported feeling so, only to then move away from that feeling, largely enabled by group response. Curious listeners, those attentive to feelings that are defended against, which tends to result in acting out or “addictive” habits, might support the opening of space for guilt to breathe, be thought about. However, the “supportive” prejudice of groups tends to work against this possibility, substituting in its place a bias that supports and therefore perpetuates defensive thinking, unfortunately. See, in the cases indicated, fellow group members, identifying with the horror of being exposed in the workplace, or “grilled” by a suspicious spouse, moved quickly to denounce the intrusiveness of the impacted spouse; the humiliating, sadistic intentions of a punitive workplace. The result was a fueling of resentment, not a contemplation of guilt or even ambivalence (both crucial for the examination of motivational behavior so often obscured by impulse), and much less a responsibility-taking plan.

In these and other instances, I usually find it necessary to confront not just an individual’s denial, but that of a group. Among other things, I offer—okay, I come close to insisting—that “acting out” isn’t only an explicitly sexual behavior signifying a sex addiction, but rather any action or thought that supports a defensive pattern, such as deflection from feeling, the indulgence of persecutory anxiety, for example. Even the most veteran of my group members have difficulty with this notion, for despite the intentions of mine and Joe Farley’s book, my sex addiction therapy groups are not specifically framed as psychodynamic in technique. My bad, I suppose, though I may defend myself on this point: I joined this sex addiction treatment milieu/subculture years ago, knowing that psychoanalytic thought was hardly the standard brought to the field—behavioral management was and still is, mostly because of people’s fears relating to sex and intimate relationships, not anything like medical necessity. Anyway, the guys in my groups know I believe in an unconscious, and they can just about tolerate my drawing attention to it (as a concept at least) ad nauseum. But they don’t know what psychoanalysis is—not really. However, I’m no different from them in the sense that I am subject to thinking patterns, reactivity, that governs my life more than I realize. It’s just that I’m in the habit—with help, actually—of thinking about how my mind works, and where the unknowing body and conscious process will typically follow. We might offer, in principle, that a mind can take responsibility for, as in acknowledge and allow feeling about, say, binging on porn at home, or stealing time at work for the same behavior—and also have room for a little indignation for witnesses, that oppressive boss or overbearing spouse. However, some may acknowledge how they can get lost in blame: start talking about the latter phenomenon at the expense of the former; have a sort-of 90-10 split between “I shouldn’t have been doing…” versus “that was messed up that he…”.

Another example, perhaps even plainer, or certainly cruder, in its language: a man reports in group that he is dating a woman he found via a dating site (Bumble) whose rule is that women must select male partners; interested male subjects can’t “initiate”. Ostensibly, this is about protecting vulnerable women from harassment/abuse but whose implications stretch beyond that worthy purpose. On an early date, the woman (somewhat predictably) volunteers that her past dating history has been fraught with creepy men who “only want to cum on her face”. In the aftermath of that exchange, the man in my group feels stung, rejected, and has settled into what he dubs “the friend zone” thinking that sex is off the table. Now, there are several issues here, but first I’ll touch on the group’s response, which is sympathetic and sort of strategic (how to keep an open mind) but nonetheless observant of an adversarial scenario. I mean it’s implicit. So, the group offers its jargony feedback replete with questions like “well, we’re you triggered by that?” or “how did that make you feel?” about which I have no complaint. Well, I kinda do, because after all, the reason the book’s called Getting Real is that I wish the language would be a little less polite sometimes; a bit more…to the point.

So anyway, I stir a dialogue. Firstly, I point out that the woman’s expression was predictable because both the zeitgeist and the dating website implicitly decreed that it would be women’s prerogative to declare, within the dating ritual, their negative experiences of men and to serve warning to seeming nice guys that such behavior won’t be tolerated. This implicit prerogative is being imparted as early as grade school probably; is reinforced throughout the time corridors of academia, and across social media so it’s no surprise it rears its prejudicial head during a nice evening out, so men in contemporary society either have to endure this phenomenon or withdraw, simply put. If men were using the dating scene to protest against women who are typically heavier than what they show in profiles, or women who seem drawn to men who are lavish with money, then they’d be called misogynists. The analogous trend, as first described in this paragraph, might be called misandry (the analogy to misogyny) if people knew that word, but they don’t generally. People know words that are drilled into their heads by media, and less so by academia which is progressively-leaning so it doesn’t teach concepts that don’t fit agendas. It’s a big word, misandry, but more importantly, a subversive, counter-revolutionary cue. Now, you may be wondering, was I really educating my group about marginalized concepts like misandry? Was I lecturing about the zeitgeists of the 21st century that put guilty and innocent men on the proverbial witness stand? No, actually I mentally parked most of that in order to ask a more salient question: “Well, do you want to cum on her face?”

The answer and the subsequent exchange is not the point. It got a laugh. Also not surprising. It broke the ice. Yeah, we don’t notice what we don’t notice. The group, as in the microcosm of society—indeed, of democratic community, by implication—is and was meant to help us not slip into the murky abyss of isolated thought, typically a defense. Problem is, groups are people too, and as many say in psychoanalytic circles, we don’t know what we don’t know.

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That AB 1775 thing

Next, a well-trodden path of this blog: a subject that has received more ‘hits’ of interest than any other on this site—the subject of AB1775. This California law, passed in 2014, altered the 1980 Child Abuse & Neglect Reporting Act (CANRA), supposedly “merely” updating it for 21st century use, by adding language (words like “streaming”) that would require mandated reporters of child abuse to report to authorities clients/patients who disclose the viewing of sexual material depicting minors—in effect, those who view child pornography via digital media, which would include behaviors like sexting. Hitherto, it was optional to report such persons, not required. Well, as has been documented here and elsewhere, the proposed law passed easily (72-0) in the California legislature, aided in part by a demagogic political campaign that used slogans like “let’s stop child abuse”.

In our book, Getting Real About Sex Addiction, Joe Farley and I both write in opposition to AB1775, concerned primarily with the law’s chilling effect on client/therapist confidentiality. I argue that the law is grounded in a pair of dubious premises: firstly, that reporting to police authorities people who look at underage porn will necessarily prevent or reduce child abuse or exploitation (how did that rationale work out in the so-called drug war?); secondly, that those seeking help for the treatment of impulses towards child pornography (why else would they volunteer the info if seeking therapy prior to “being reported”? ) do not merit or require confidentiality rights.

Ugh

To which we tiredly ask, what kind of mental health treatment model proceeds without affording a patient confidentiality rights, as a baseline arrangement of therapist-patient care? Well, it’s clear what kind: models that contain authoritarian assumptions and methods, polished with virtue-signaling euphemisms like “limit-setting” and “accountability” to gird an approach governed by a compliance/non-compliance dynamic.

Over the last 3 years, the California Supreme Court took up the question of confidentiality rights for those implicated by the AB1775 legislation, spurred by a lawsuit brought forth by, among others, mine and Joe Farley’s colleague, Don Mathews. In January of 2020, that court suspended judgement on the issue, not affirming the law, but rather sending it back to lower courts so that its premises could be further studied.

Where does that leave us? Nearly two years later, the likes of Don Mathews, myself and Joe Farley still sit with sex addicts, would-be sex offenders, who might decide to share about impulses they at times act upon, but owing to the consequences (reporting) outlined in our informed consent documents, also might think twice about sharing what they’re most troubled by. Supporters of AB1775 don’t care about this. They’d argue that the primary task of sex offender treatment is the protection of society, not the psychological growth of offenders. They’d secondly rationalize that sex offender treatment is not effective anyway (meaning, they think it hasn’t effectively changed the behaviors or pathological inclinations of offenders). Firstly, there’s no real evidence of that claim. Secondly, even if it is ineffective, then it’s likely a circular phenomenon. I agree that orthodox sex offender treatment sucks. If it’s ineffective, it’s because its models don’t follow the fundamental ethics of psychological treatment (offering confidentiality), therefore it doesn’t consistently elicit honest, substantive disclosures of actions and fantasy that could then be examined by trained clinicians.

Duh

Did the simpletons who wrote AB1775 even consider angles like this? No. They consulted police and other lawyers, and when they finally did disclose the law to therapists, via newsletter announcements via entities like the California Association of Marriage & Family Therapists (CAMFT)—believe me, they got an earful of criticism. Also, in the rush to keep up with technology, what have they thought to do about entities like Snapchat, wherein images can be posted but then disappear without a trace—which is the point of that platform, actually. Anyway, now matters relating to AB1775 are in limbo, and so, on the eve of our publication, I propose something different, at least with respect to child abuse reporting law.

Before I share that, a bit more context: for reasons that are complex, the public at large is starting to tire of authorities overstepping in situations wherein mental health professionals ought to carry authority. With respect to other contexts, such as street interactions between police and the mentally ill, city governments are considering reducing policing involvement in situations wherein MH workers may be more effective. Why not in the context of sex addiction, or even sex offending? Perhaps it’s time to consider another amendment to the 1980 CANRA law, one that would create a special class of child abuse reporter, comprised of psychotherapists or psychiatrists—professionals who would not be “mandated” to report so much as granted latitude to decide whether a patient disclosing illegal, child abusing behavior ought to be institutionalized, or incarcerated if one prefers, or visited in the middle of the night by a SWAT team of computer-confiscating police officers (yeah, no doubt “upon consultation” with treating professionals). Otherwise, this professional might properly assess the context of a patient disclosure: determine whether there is genuine motivation for change amid an anxious presentation, for example, versus an aggressive, exhibitionistic disclosure indicating a sociopathic trait, or one of malignant narcissism. Either way, the law needs to be altered so that psychological assessment, or psychotherapeutic treatment, is given a proper chance.

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An analytic treatment of sex addiction: a basic argument

“Analyses which lead to a favorable conclusion in a short time are of value in ministering to the therapist’s self-esteem and substantiate the medical importance of psychoanalysis; but they remain for the most part insignificant as regards the advancement of scientific knowledge. Nothing new is learnt from them. In fact they only succeed so quickly because everything that was necessary for their accomplishment was already known. Something new can only be gained from analyses that present special difficulties, and to the overcoming of these a great deal of time has to be devoted”

— Sigmund Freud

One of the basic criticisms of psychodynamic or analytic treatments, particularly as they pertain to addictions, is that they don’t do enough, aren’t urgently focused enough, to arrest the escalation of problems associated with addiction. The epistemological approach (knowing, understanding) isn’t sufficiently pragmatic to halt unnecessary suffering for those directly afflicted, or their impacted others. Or, a more ontological approach, wherein emphasis lies in exploring a person’s being—discovering who they are as an emerging self—misses the severity of problems that addicted patients present.

I understand. As a patient in analysis, a past and present practitioner of analytic psychotherapy, and as a current candidate in full analytic training, I get that changes (or progress) in analytic treatment can seem “glacial”, as some put it. So, what would be the rationale for an analytic treatment of an addictive pattern, which is the matter of concern as addressed in mine and Joe Farley’s book, Getting Real About Sex Addiction. Well, sidestepping for now the questions of whether sex addiction is a legitimate diagnosis, or the linking question as to whether it merits an urgent, detoxifying focus comparable to say, chemical dependency, I’d like to offer more of a perspective than a rationale.

I’ve worked in the field of addiction, either directly in hospital-based programs, or peripherally in my private practice, for roughly twenty five years. In that time, I have, like many other psychiatric or mental health professionals, known countless individuals to go in and out of treatment multiple times, whether in rehab or therapy, upon slipping and/or relapsing, reflecting a chronic, repetitive problem. This observation is nothing new. Anyone who has ever attended a 12-step meeting will attest to hearing rhetoric asserting that addiction is a progressive, relapsing, even “incurable” disease, etc. Yet the crossover fields of addiction and chemical dependency treatment continue to offer as its dominant paradigm a short-term approach that ever treats the incoming patient as a so-called “newcomer”. Though acknowledgement of a relapsing pattern may be given by interventionists in such programs, their approaches tend to operate as if the patient is ever starting over.

I say the following: particularly when someone presents for therapy observing that their so-called addiction has lasted for years, with only sporadic interruptions due to painful consequences, followed by decisive interventions, why not suggest the following plainspoken yet analytic prescription: “Let’s explore the root of the problem. Let’s go deeper this time”. Does this proscribe some of the following tasks that are offered with virtue-signaling language: boundary-setting, relapse prevention plans, 12-step meeting attendance, medication consultation and regimens; the “inclusion” of an impacted partner in treatment? Of course not, though that last one is particularly tricky, as undue disclosures, explanations of pathology, achieved collaterally or directly, may thwart confidentiality and contaminate transference (development of a patient-therapist relationship). *Incidentally, disclosure exercises may also conflict with 12-step principles, an implicitly individualized model in which participants are typically urged to consider partners’ needs “none of your business”. Next, I hear some who suggest that a separation from the “triggering” environment is necessary for acting out persons, hence referrals to intensive outpatient programs or residential facilities. Okay, but with respect to sex addiction especially, such options are expensive and are thus available only to the wealthy. What’s that? I hear you scoff. Isn’t psychoanalysis expensive, especially if it lasts for years?

Not necessarily. Many analysts or analytically-oriented clinicians are quite flexible with those with low-fee needs, especially if they commit to multiple-sessions per week treatment. I’d be willing to bet that many such clinicians are more affordable than an average, one meeting per week, certified sex addiction specialist, and certainly more affordable than an out-of-state residential or short-term intensive program. Besides, what would you rather spend your money on? Thousands of dollars for an episode of treatment that will be over in a month, or the same amount (roughly) for something that may proceed more practically, more steadily, with more room for thought versus shoot-from-the-hip judgement, for over a year? I know. Get it over with quickly, some would counter—professional and lay-persons alike. But does anyone think it ironic that a condition epitomized by a mindset of immediate gratification would be treated with an approach that mirrors that thinking? Also, again with respect to sex addiction (versus chemical dependency), urgent, intensive interventions designed to arrest behavior ASAP are more about placating the anxiety of impacted others—not a requisite detox from a life-threatening withdrawal syndrome, or the imagined dangers of a sexual overdose.

Chill, one might say, crudely. Time to slow down, just a little at least, and think, and allow time to pass, which means space for a person’s motivation for care to intertwine with what is truly there within them: a pattern of defense that manifests habitually, often unconsciously, and sometimes dangerously. This pattern of defense is a character trait in all likelihood, not just a feature of “addiction”, and it reveals itself over time if someone is there to notice it regularly. Time. And Transference, actually. This is also why I place less stock in psychological testing, whether a comprehensive, “battery” of questions that may capture contradictions, indicating conflict, or a simple effort to elicit memory and conscious reflection, such as the HB-19 (regarding hypersexual behavior) inventory. Though I don’t have specialized training in psyche testing anyway, my basic objection is that such testing explores a patient’s mind outside of context—that is, outside of the flow of therapeutic relationship (known as Transference), and is therefore artificial. Simply put, patience and conscious witnessing are the two ingredients that counter the addict’s propensity to hide, facilitating change with lasting effect.

Consider two psychic defense concepts, one of which is decidedly psychoanalytic (displacement), while the other has a psychoanalytic pedigree but has been co-opted by other models: the aforementioned “acting out”. In sex addiction treatment, the term “acting out” denotes a sexual act, or a pattern of sexual activity, that is deemed inappropriate, exploitative, adulterous, etcetera. In psychoanalytic terms, it means replacing thoughts and feelings with action. Now consider two popular phrases whose ethos contradict each other: “actions speak louder than words” (positive connotation assigned to “action”), and “think before you act” (negative connotation assigned to “action”).

Thinking.

Analytic treatments privilege thinking, not to be confused with intellectualism, observing that addicts, in particular, act rather than think or feel, largely to their detriment. Still, they (would-be addicts) tend to enter treatment extolling the values of action in general, thinking it’s best to keep busy, don’t let idle hands…you know the rest.

Thinking

They’ve been there before. Those who have rinsed and repeated, done this cycle of keeping busy, overworking, then feeling entitled to binge on pleasure and seek inappropriate rewards may take notice. Back to that notion of “chill”, which doesn’t mean lounging on a non-analytic couch smoking something that used to be illegal. It means not acting, not acting out that is, which doesn’t just mean not looking at porn, not finding a massage parlor, or not checking out the profiles on Tinder. What next? Well, imagine you, the would-be analytic patient, are laying on an analytic couch, or (okay, let’s defer to Covid for now), speaking on the phone with an analytic practitioner, someone trained to observe the mind as it is working moment to moment, feeling it’s anxiety and restlessness, poised to act out a state of unease…about anything. You start speaking of something that, by implication, causes anxiety. But you took care of it! You paid that bill, you made that call, sent that e-mail, or said that peace to someone who was giving you grief. Next, you moved on to the next subject. Have you? Have your thoughts and feelings really moved on? And did you notice something else? The thing you were anxious about pertained to the person you were talking to, only you didn’t really go into that–that relationship with that professional who is really in your head, which is…what you asked for? You vented about someone or thing else, which is called a displacement. That means a way to avoid the conflict you are feeling, which leads to a climactic theory: addiction has two names, two categories of motive. One we know easily: pleasure seeking. The other is conflict avoidance, the escape from unpleasure, as Freud will have put it. And you know the rest.

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