Tag Archives: trauma

June 24, 2025 · 1:41 am

You want honesty?

“I don’t feel like I can be honest”

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

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

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

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

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

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June 1, 2025 · 6:29 am

Adam is in charge

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

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

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

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

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

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February 23, 2025 · 8:30 am

Bumper sticker treatment

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

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

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

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

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

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

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

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

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

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

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March 26, 2023 · 7:54 pm

Treatment of hoarding induced trauma

The American Psychiatric Association’s Diagnostic Standards Manual, Edition V (2013) reports that between 2 and 6% of the general population have a hoarding disorder. Once considered a type of obsessive compulsive disorder (OCD), hoarding is now regarded as a serious clinical condition co-morbid with diagnoses of depression, social phobia, generalized anxiety disorders, attention deficit disorder, and sometimes psychosis given the delusional levels of denial that hoarders often present (Frost, Stekelee, Tolin, 2011). Hoarders engage in excessive acquisition of items, whether those items have real world value or not, as well as excessive shopping. This behavior often results in living environments that are seriously compromised, if not uninhabitable: blocked entrances and exits, leading to fire hazards; hygiene and safety problems resulting from the acquisition of consumer products, items of supposed sentimental value, plus a plethora of strange items, including trash and feces.

           Imagine the life of someone living with a hoarder. Imagine what it must be like to live in perpetual squalor, or to fear being trapped in the event of a fire or some other emergency, or more commonly, to lack space for one’s own personal belongings. Other consequences include: sleeping in beds that double as storage areas, or losing valuable items because they are buried or crushed beneath a hoarder’s accumulated belongings; discovering beloved animals neglected or deceased, or the discovery of unwelcome creatures, such as rodents.  Imagine having one’s entire household space or the interior of vehicles rendered unusable, unsafe or unhygienic. Partners and other family members are the invisible and sometimes buried victims of hoarding behaviors. Invisible because while traditional treatments for hoarding behaviors have focused clinical attention upon the perpetrators of hoarding, they have focused much less so upon supportive or instructive interventions for or on the behalf of impacted loved ones. Within existing treatment models, there is no established diagnostic criteria nor intervention strategy for the treatment of hoarding induced trauma (HIT), a condition based upon discovery of PTSD symptoms related to similar acting out disorders, such as sex addiction, leading to treatment models like sex addiction induced trauma (SAIT) (Minwalla, O., 2012)

This is a serious omission in the field of obsessive compulsive disorder treatment. Treating the problem of hoarding simply as an obsessive-compulsive disorder, or even as a disorder co-morbid with mood, anxiety or psychotic disorders, while avoiding the proper diagnosis and treatment of the accompanying abuse of others, constitutes a significant area of clinical neglect. The perpetration of hoarding behaviors entails much more than the pathologically excessive acquisition of items. The condition further entails the maintaining of an elaborate thought system that compartmentalizes a protected reality, a routinized impingement upon a partner or family member’s living space, plus a manipulation of such victims’ reality. Hoarding perpetrators hide belongings in obscure or secret spaces, deceiving others as to the extent of their hoarding behaviors. They make false promises about cleaning unhygienic surfaces, or tidying cluttered spaces, without follow-up on such promises. Alternatively, perpetrators invoke false rationales, such as casting spilled garbage as ‘compost’ merely awaiting appropriate elimination, or normalizing lack of hygiene by comparing the accumulation of feces in common areas to implicitly virtuous, eco-friendly ‘dry toilets’ such as those prominent in emerging world economies. Or, they declare disingenuously that items unused or placed in inaccessible areas will be “used at some point in the future” and must therefore be kept in their existing, congested spaces. However, when real attempts are made by others to tidy or clean household areas, perpetrators regress from glibly-stated organizational goals, are prone to bullying behaviors, which they subsequently deny and indeed project onto their plaintive loved ones, ever assuming the role of victim rather than accepting responsibility. These calculated rather than compulsive tactics result not only in frustration for others, but also a sense of betrayal and confusion, plus a feeling of being gaslighted in a world of relational danger.

Meanwhile, if the rationales employed by perpetrators seem bizarre, the underlying motives for hoarding behaviors may seem entirely inexplicable. This is another area of clinical neglect in the treatment of hoarding behaviors. Though Cognitive Behavioral Therapy has been shown to reduce symptoms of hoarding behavior (Gillman et al, 2011), there is little evidence that such approaches unearth the compartmentalized realities protected by perpetrators. These realities include deep feelings of emptiness that are self-medicated by excessive accumulations; distorted and excessive self-identifications with personal belongings, or the behavior of clinging to objects as a symbolic substitute for unresolved abandonment depression. Existing treatment models do little to explain such dynamics to either perpetrators or their impacted loved ones. Instead, partners and other family members are told they have “enabled” perpetrators, become “co-hoarders” by providing or perpetuating the kind of living environments that make possible accumulating behavior. This is like telling a burglary victim that he or she has enabled a thief, become a “co-thief”, via the practice of homeownership and consumerism in a capitalist society. Otherwise, partners and family members are simply encouraged to be patient with hoarding perpetrators, or they are coached to not yell at or criticize them, as if protecting the hoarder from feelings of shame or decompensation were the paramount, if not exclusive purpose of treatment.

Such approaches fail to address the hoarder’s lack of awareness about the real-world impact of their behavior. They express little about the intrapsychic, familial and social underpinnings of hoarding behavior, such as anal personality structure, or gender-based subversive/oppositional reactions to patriarchal norms of property ownership. Perpetrators erect alongside their hoarding behaviors a complex conscious and unconscious system of relational reality that perpetuates a pattern of abuse upon loved ones that is tantamount to human rights violations. A perpetrator’s interior/exterior reality is translational, crosses physical and symbolic relational boundaries in a manner that Laplanche (2005) describes. Living in a psychic vacuum, needing a vacuum of another kind, they induce a like interior/exterior reality in others. Their system of behavior and psychic manipulation denies fair allocation of space to others, not to mention filling space that could be made available to visitors, resulting in social isolation plus the exclusion of outsiders, potential residents, immigrants. It places loved ones in danger while imposing upon overpopulated or housing-limited communities a cruelly ironic waste of personal and collective space.

The hoarding induced trauma (HIT) model is a directive, didactic, and intensive clinical method designed to galvanize awareness in a perpetrator of a complex and destructive pathology. Coordinated clinical intervention with individuals and families, coupled with psychiatric intervention to contain psychotic symptoms, is designed to outline thirteen different areas of distinct trauma suffered by victims of hoarding behaviors, and to confront the intersection of hoarding, personality disorder and distorted social constructs that perpetrators typically exhibit. The hoarding induced trauma (HIT) model aims to comprehensively address and treat the abusive impact of that pathology upon all who live with this terrible disorder. 

REFERENCES

American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Arlington, VA. American Psychiatric Publishing.

Frost, A., Stekelee, G., Tolin, A. (2011). Comorbidity in Hoarding Disorder. Depression and Anxiety. October 3: 28(10). 876-884.

Gillman, C.M., Norbury, M.M, Villavicencio, A., Morrison, S., Hannan, S.E., Tolin, D.F. (2011). Group Cognitive Behavioral Therapy for Hoarding Disorder: an open trial. Behavior Research and Therapy, 49 (11), 802-807.

Laplanche, J. (2005). Freud and the Sexual: Essays 2000-2006. Transl. J. Fletcher, J. House, and N. Ray. New York: International Psychoanalytic Books, 2011.

Minwalla, O. (2012, July 23). Partners of Sex Addicts Need Treatment for Trauma. The National Psychologist.

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September 26, 2022 · 5:40 am

Fire in the hole

Recommendations for technique. That’s what Freud called his paper on the matter. A bit plain, don’t you think, rather like ‘psychology in everyday life’—another good one. Took him a while, it seems, to gather his thoughts and give some tips on how to do things his way. Can’t believe he wrote it after Totem and Taboo (1912), or Three Essays (1905), or his first big splash into big, meta-thought, Interpretation of Dreams (1900). That’s where he laid out the big ideas**, suggesting that we all have an unconscious that surreptitiously guides the mind; that children have sexual fantasies; that humankind acquired guilt feelings more or less biologically, from a prehistoric moment in time when an incest occurred and a tribal elder was murdered and then cannibalized.

Oops!

Yeah, back to the present day, to the plainer task of sitting with a troubled person looking for guidance, thinking that an analyst might have answers. Sigmund eventually suggested that his acolytes (meaning his proteges) assume a position of medical authority, with the authority and spirit of a scientist gathering evidence. Worthily, he suggested that analysts keep a relative distant, listen with “evenly hovering attention”, encouraging free association though anticipating resistance, and above all, maintaining a neutral stance. That meant, roughly, not imposing beliefs onto a needy patient. There’s enough of that in religion, Sigmund thought. Others elaborated the idea: don’t gratify, we’re told in training. Don’t assume the expert stance with reassurances, with advice, or even what we might preciously call affirmations. If a patient says, “I went to church and said my prayers” in a cheerful, relieved voice, there’s no need to say, “good for you”, as if they’d otherwise feel guilty about the pronouncement. We’re not behaviorists looking to reinforce what people already think is a sound, healthy way to live. What are they hiding, or even reversing? Freud would have wondered. Sex and aggression. That’s what he was listening for. Of course, people have other needs, but sex and aggression are what people inhibit, or repress, as he termed it. He was right.

Indifference was another word he used to describe an analyst’s stance. A lot of people don’t like this suggestion. Taking him a bit literally, I think. I think my couples’ therapist is bought into this indifference thing, though not in the way Sigmund recommended. Indifference. Damn right she is. Doesn’t give a shit, I mostly think. Caught her looking at the clock after ten minutes in our last session. Can’t say I blame her. Sometimes, when Liz is bending my ear, I’m gone after a minute and a half—sometimes under thirty seconds. The therapist and her get on like a house on fire, like they could give or take me being there. I half expect them to go out for coffee afterwards—that’s when they’d really sort things out. In the meantime, the therapist has got to play her part, which means pretending that she cares about the two of us and that I have a legitimate point of view. A fair amount of nodding conveys this. Not very neutral, an analyst would say. Sometimes, there’s much effusion in the room: arms wave about, moving the air, performing an illusory expansion of otherwise benign principles. Yes, we should have boundaries. We should come up with a pros and cons list about our relationship. There’s so much to unpack here, this woman exudes with tired eyes and a fiercely contained sigh.

She was fascinated by our first visit, and by the “uncanniness” of the situation that brought us to her. Unpacking is right. Packing too, and packing quickly. Funny also, that thing I said about a house on fire, for it was a literal fire in our quite material home that nearly went up in flames because of nearby wildfires that penetrated our indifferent, ungratifying life and upset the homeostatic deadness. Liz and I: we knew we’d get little familial sympathy should this happen. Sure enough, everyone who had an opinion about our woodsy home on the lake warned us of the danger ages ago. Since the evacuation, they’ve not been so much indifferent as smug, though most don’t the half of it. Right now, I’d take indifference or smugness about our current state of transiency, especially as we can go back soon because the fire actually stopped short of our place, but mainly because the fire’s not the real reason we’re seeing a therapist.

But it is an interesting metaphor for your relationship, that therapist observed. A disaster, or a disaster averted, which means an opportunity. I think that’s what she meant, plus the fact that the approaching threat of fire caused an ironic discovery. See, if it hadn’t been for the fire then Liz wouldn’t have been packing things up in a hurry (packing things in a hurry and Liz are not words that go together) and therefore finding photos and letters from an old relationship that I was keeping from her. Very sentimentalist of me, not to mention careless. But I had my excuses, which cued my counter-complaint, which has to do with her cluttering, not my pre-digital era affair-seeking behavior, which—as the discovered ephemera suggests—is not even an up-to-date thing anymore. In that sense, I’m as dead as our marriage. She doesn’t even think I’m having an affair. It’s that I hold on to things, but not her. So, nothing like a disaster to shake things up, some might say. Damn right, I say for a second time. Liz half thinks that I started the wildfire as an attempt to leverage a clean-up; as a protest against her indifferent, cluttering habit. I didn’t, of course, but it’s not a bad idea, I’ve since quipped. In fact, I’m surprised no one has thought of it, or that it hasn’t been mooted as a common arsonist’s motive. When we get like this the therapist’s eyes glaze over, like she’s had enough of us. Her interest in the uncanny, near cosmic events that bring patients to her office isn’t sufficient to help her endure the prosaic disputes of everyday life. There’s little hope for us, I think she thinks. What’s your plan? She drones wearily.

Or, she’s invigorated by an inspiration, thinks there’s something in these metaphors that keep popping up, especially fire. It happened towards the end of that last session. She reached out her arm, like she was prying her way between us, but also aping a movement Liz assigns to me: that of a football player stiff-arming an opponent while in full flight, like the figure frozen on that famous trophy, the Heizmann. It’s what I do to Liz, I guess: I stiff-arm. Anyway, this therapist’s gesture looks like this, so it drew a burst of sniggers from my beloved. Fire. What had we been talkin’ about? The woman asked. What is the meaning of this crisis? Liz held her hand over her mouth, clearly holding something back. I held mine slightly open, as if tentatively waiting for something to enter me: a fire in the hole, so to speak. Fire in the belly, the woman translated, as though reading my mind. And where is the fire between us? Liz and I glanced at each other, at once knowing where this was going. On that we were on the same page. We got it: fire, as in passion, needed to be rekindled. That’s what the fire was really about. That’s what this disaster really means, and so we have a choice. We’re at a crossroads. Jesus, how many metaphors are we gonna stick in this thing? Do we burn still for each other. Gotta stick in this thing. Speaking of which, should we try that again? Liz and I thought. Better tidy things up first, she said.

** yes, yes, Freud’s first major model of the mind was called Seduction theory, and it was a trauma model grounded in the idea that not everyone had an unconscious—only those suffering from reminiscences, meaning sexual traumas that will have been enigmatic originally, subject to repression because they are impossible to understand, but later activated and understood thru secondary sexuality. Are we all traumatized in childhood in this way, to one degree or another? Do we all get messages in infancy that are eroticized in nature, that we simply can’t take in?  

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July 24, 2022 · 4:34 pm

Female Sex Addicts: the protected species

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

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

                                                                 —from London Fields, by Martin Amis

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

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

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

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

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

Okay, stop it now

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

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

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

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

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

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

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July 9, 2022 · 10:14 pm

Betrayal Trauma

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

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

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

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

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

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

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

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

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

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

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May 21, 2022 · 3:45 pm

Freud’s Bar

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

Graeme Daniels, MFT

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April 9, 2022 · 6:03 pm

The Sex Addiction Personality

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

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

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

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

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

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

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

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

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March 26, 2022 · 3:51 pm

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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