What is Sex Addiction?  A sex addiction is similar to most other addictions – it is either used to medicate or manage trauma, or it is a control issue – an issue where a part of a person is able to take control or take over for a time and make the person do some kind of sex addiction behavior.  The general criteria I use to determine if someone has a sex addiction are:  1. Is the behavior out of control? – the person cannot control it.  2.  Are there negative consequences?  3. Is there denial in place; denial usually blocks the reality of the negative consequences.  Some people have all three of these, and some people just have the first 2 but still cannot stop the behavior.  One of the big differences between a sex addiction and other addictions is some good news – with most other addictions you just need to quit, with sex addiction you have two very powerful things to replace it with, healthy sex and healthy intimacy, so doing this work has some very good rewards in the end, and something very positive to move towards.

How do you assess – is it a sex addiction or is it an intimacy disorder?  A sex addiction has out of control behavior and negative consequences.  An intimacy disorder has negative consequences but not really out of control behavior.  For example, a man age 40 is married with 2 kids and is doing paid phone sex, online porn and occasionally sees a prostitute.  His wife has left him and he is still doing the behavior.  This is clearly a sex addiction.  Another example, a 47-year-old man is married with 2 grown kids.  He has an affair and feels like he’s falling in love with this woman.  His wife finds out and labels him a sex addict.  But then he has no further slips and he wants to work on his relationship with his wife.  This is much more in the category of an intimacy disorder – where either this man, or his wife or both have trouble with intimacy.  This kind of assessment is very helpful to know where to work – if it’s a sex addiction, that’s the thing to work on; if its an intimacy disorder either the relationship needs work, or one or both partners need work on how to develop and sustain intimacy and connection in their relationship.
What’s at the root of the behavior?  The sex addiction is most often a symptom of something deeper.  For example, consider the first client I cited above who has porn use, phone sex and sees prostitutes.  His father was an alcoholic and died when he was 10, and at that time his mother fell apart and he was pretty much on his own through his teen years.  The trauma is neglect and abandonment and this is what is at the root of the sex addiction.  In the second example I gave where the man had the affair, the relationship was the problem and it turned out that the main problem was that his wife had intense fears of intimacy and so he had to face that and deal with it (in my work with men with intimacy disorders, its more often the man who has the trouble with intimacy in this kind of situation).   One of the ways I am able to tell what is at the root of the behavior is by the type of porn or sex most desired by the person.  Take for example, a man who looks at porn of older women and feels no sexual passion with his wife.  His mother abandoned him at age 11.  The type of porn use tells me what he’s really looking for – his lost mother; so this is where we focus in the work.  Another example is of a man who engages in sex with bondage.  He had a father who was a tyrant who controlled the family with verbal and physical abuse.  The bondage behavior shows that the extreme control by his father is what is at the root of the behavior because to feel safe having sex, this man needed to be in control during it.  Or another example of a man who is addicted to porn with submissive women had a similar situation – a controlling father and looking at submissive women for sex was a way to feel safe while imagining being sexual with them.  Often the type of porn or sex a person is engaged in with a sex addiction is like a key that unlocks the lock that has a hold on their sexual inhibition so they can feel free to be sexual for that time.  Another way to say this is that most people with a sex addiction have a negative belief that locks up their sexuality and makes it very difficult to be sexual with their partner.  For example, a negative belief that says “I’ll be taken over if I let myself be that close with my wife” – can lead to a sex addiction of looking at porn of submissive women because this can feel like the solution to feeling OK and free to being sexual with a woman.  The problem is it doesn’t dissolve the negative belief; it only works for that short time.  In summary of what is at the root of a sex addiction, it is usually some type of trauma – such as sex abuse, neglect, physical violence, power/control/autonomy issues, loss, feeling not responded to – or selectively responded to, negative boundary issues, codependent issues (i.e. a weak parent that the person took care of), or dysfunctional relationship issues.
I have four ways I work with sex addiction issues.
1.  Intimacy work if the problem is more of an intimacy disorder than a sex addiction:  I work with clients to educate them about what creates intimacy – emotional and sexual intimacy combined.  I work on communication skills and how to connect with one’s partner.  I recommend the book “Non Violent Communication” because I think its one of the best books written on communication.  I teach that sexual chemistry is all about emotional safety – in other words, people feel sexual chemistry when they feel safe with someone, and when they don’t feel safe, its very difficult to feel chemistry – so we work on anything in the way of feeling safe with their partner.  I explain that it is the attachment between them and their partner that is the most important need we have as adults and therefore it’s one of the most important things in a relationship to improve and maintain.  People with an intimacy disorders and sex addictions usually have an attachment issue and working through this with a partner is a great way to heal it.
2.  Sex Addiction and Trauma work:  If the person I’m working with has a sex addiction and there is trauma in their background that is what I focus on.  I often use EMDR to do direct trauma work and sometimes this will completely resolve the addiction.  There is a new EMDR tool out called the Feeling State Addiction Protocol – FSAP (http://www.fsaprotocol.com/multiple_baseline_study.pdf) that works directly on the addiction.  This method works by taking out the feeling or emotion that is driving the addiction.  The theory in this is that an intense positive emotion has become connected with the behavior and it is this emotion that is driving the addictive behavior.  For example, if someone has had a very powerful – exciting feeling while having sex with a prostitute, this feeling could get stuck in the person because it is so intense.  And then this intense positive emotion could get triggered by anything sexual and motivate the person to repeat the behavior.  The problem is similar with trauma, but with a negative emotion – a very powerful negative emotion gets stuck in someone because of a traumatic event and that negative emotion is what keeps causing the problems for the person – the nightmares, or the high anxiety or disruptive negative symptoms.  Because the emotion is so intense sometimes a person’s psychological and emotional mechanisms cannot process it and so its get stuck inside, and this is what traditional EMDR processes out of one’s system.  The Feeling State Addiction Protocol works to process the intense positive emotion out of a person’s system.  It usually takes several months and a number of sessions to do this but this is usually much faster than any other method for ending the addiction.  In each session the intensity of the emotion driving the behavior usually goes down a notch.  Often when the emotion has been processed out, there is a negative belief underlying the whole thing, which made the person vulnerable to the emotional high forming in the first place.  For example, for a person who had a very high and positive experience with a prostitute, they may have been vulnerable to this happening because they had an unconscious negative belief that said, “I’m unattractive”, or a deeper negative belief of “I’m un-loveable”.  In this kind of work, once the emotion is processed out, then the negative belief is worked on and transformed so the person is not vulnerable to the same thing forming again.  
3.  Behavior Work:  For people with a sex addiction, I often use behavioral interventions to help with the recovery process.  For example, the 12-step programs for sex addiction, Sex Addicts Anonymous, or Sex and Love Addicts Anonymous can be very helpful and have a lot of behavioral tools.  I help people set up porn filters on their computers and phones, teach them about the “bubble” and how making phone calls can get you out of it.  And other tools such as the 3 circles to define what is healthy sex, what is iffy, and what is negative.  The 5-question tool when triggered –  What is this about? Do I need this? What do I really need? What am I feeling?  What can I do now?  The 3-second tool – if you see someone you’re triggered by, after 3 seconds you need to move back to your life and your reality.
4.  Couples Therapy:  After 3 – 6 months of doing individual therapy with someone with a sex addiction, usually that person and his partner are ready for couples therapy.  It usually takes at least this long for the person to do enough of his personal work so that he can really show up for couples therapy and work on the relationship.  This is not true however if the addiction is still going on – then he needs more individual work.  The partner usually needs about 5 – 6 months to stabilize and recover from the trauma of the betrayal before she is ready for couples therapy.  Once I begin couples therapy with 2 people I tell them that we have 2 main goals; first to recover and heal from the crisis of the sex addiction or betrayal, and second to work on the relationship and get it to the place where it is healthier and stronger than it was before the addiction/betrayal came to light – this is usually the imperative for the relationship.  In my experience in working with close to 1000 people with these issues, I’d say that about 90% of the couples work through the crisis, improve their relationship and stay together.  And this is in large part determined by the person who has been addicted or cheated – doing his work and being serious about repairing the relationship.
by Mark Robinett, MFT  415-221-3182  mrobi@sonic.net