This week I'm in Washington, DC giving very different presentations to two very different groups. I'll be giving Congressional briefings on science-based sex education. And I'll be giving a half-day webinar for the American Psychological Association on couples counseling & psychotherapy around pornography. These two subjects might seem unrelated, but they aren't. Consider:
If young people were taught media literacy and porn literacy, they'd understand that porn relies on editing, lighting, makeup, and modern digital techniques. And they'd understand that porn isn't a documentary, it's more like a highlight reel.
If young people were encouraged to communicate with their partners about sex, they'd notice how much it's missing in porn—especially the part about "Wait, I'd prefer it this way," or "Y'know, I'd rather not do that."
If young people were taught that contraception is a normal part of intercourse, they'd understand that its lack in porn is just part of the fantasy.
If young people were taught empathy and respect for others in sex ed class, they'd notice when it's missing in porn—and not expect that selfishness or disrespect would work in real sex.
If young people were taught about male and female anatomy, they'd understand that the porn version of women climaxing from intercourse (in about 2 seconds) is inaccurate. And they'd understand that lube is almost always a good thing to add to sex, although it's typically missing on-screen.
If young people were taught decision-making skills, they wouldn't assume that the "spontaneous" sex shown in porn is a good idea.
If young people were taught about the reality of sexual fantasy, and told that fantasy does not necessarily reflect desire, they wouldn't feel so guilty about their sexual curiosity and fantasies, which drives a lot of porn-viewing.
I'm always trying to teach adults that "Sex is not about what the bodies are doing, it's about how the people are feeling." If we successfully taught that to young people, we wouldn't have to teach it to adults.
Happily, everyone at the Congressional briefing will be getting a copy of my current book, Sexual Intelligence. I hope they see the summary: "Sex is more than an activity—it's an idea."
Maybe you think about sex a lot, maybe even all the time. Perhaps you masturbate every day. And maybe you do it with lots of pornography.
Maybe you want sex more than your partner, maybe a lot more. Perhaps you wish your partner were more sexually adventurous.
Maybe you make terrible decisions about sex. Maybe you take risks, and in the process maybe you've acquired a disease, lost a precious relationship, even been arrested.
Maybe you desperately want to change your sexual behavior, have tried, and have failed. Perhaps more than once.
None of these makes you a sex addict.
"Sex addiction" is a newfangled category that was invented in 1986 by prison addictionologist Patrick Carnes. The criteria for this disease are either hopelessly vague, moralistically specific, or subjectively applied—typically by anguished spouses, decency crusaders, or "addicts" themselves who are in genuine pain.
As a psychotherapist and sex therapist for over thirty years, I just don't see the value of the "sex addiction" diagnosis. It assumes that people who FEEL out of control ARE out of control. It assumes that the only kind of healthy sex is wholesome and intimate sex. It assumes that any self-destructive use of sexuality is pathological—while ignoring the fact that most of us periodically abuse every activity we really value, whether it's working, eating, playing golf, reading romance novels, surfing the web, or volunteering at our Church.
And the sex addiction "treatment" can be a nightmare. Again, like the diagnosis, the standards and rationale are all over the map. Some programs insist that "sobriety" means no casual sex, while others ban pornography or even masturbation. Some sex addiction counselors are ignorant or judgmental about non-traditional activities like S/M, non-monogamy, internet role-play, swing clubs, even sex toys. Most sex addiction programs and counselors see no legitimate value whatsoever in massage parlors, escorts, or other commercial venues.
Millions of men and women are in real pain about sexuality out there: I've seen them in my office every single week since 1980, before "sex addiction" was even invented. When my hate mail on the subject speculates that I clearly have never spoken to people in pain about their compulsive or destructive sexual behavior, I shake my head ruefully. I've spent tens of thousands of hours working with people who could be (or are) labelled sex addicts. I don't deny their suffering at all.
I just think there are better ways to conceptualize these peoples' problems. That leads to better ways to treat them—because it aims toward more positive, more adult outcomes.
When sex addicts complete their treatment, they're still addicts, facing a lifetime of recovery. When someone completes sex therapy, psychotherapy, or couples counseling—really completes it—they've changed. They still have their biography and vulnerabilities, but they've resolved the problems that brought them into therapy. Sex is not dangerous—it's a grand opportunity for self-expression and celebration.
Later this week I'll describe the specifics of an approach to sexual compulsivity and self-destructiveness that doesn't depend on lifelong recovery.
Meanwhile, if you're wondering about whether sex addiction exists, take the Sexual Addiction Screening Test. I can almost guarantee you'll discover that you're a sex addict, or at risk. The test primarily measures guilt, shame, secrecy, and experimentation—that is, standard American sexuality.
By the way, my last teleseminar of 2013 is November 4. The topic is "If It Isn't Sex Addiction, What Is It? And How Do You Treat It?" For more information, click here.
Earlier this week, I discussed some of the many reasons that "sex addiction" fails as a helpful clinical diagnosis. It's a popular term, with vague, intuitive criteria. Every week, some person comes into my office saying his (non-psychologist) wife or girlfriend has diagnosed him as a sex addict. And every month or two, a celebrity gets caught with his hand in some sexual cookie jar, and the airwaves are filled with psychologists diagnosing him as a sex addict.
If you don't even have to meet the person in order to diagnose this disease, if you don't need to be a psychologist to diagnose this disease, how clinically robust can the concept be? That's the sex addiction movement for you—it makes clinical training, skill, and experience superfluous. All you need is a strong opinion of "right" and "wrong" sex and a willingness to condemn someone else's reality.
What pundits, spouses, and movement spokespersons call "sex addiction" can be many different things. For some people, it can be an expression of anxiety or depression. For some, it can be obsessive-compulsive disorder. For some, it can be a reflection of Asperger's Syndrome, mild autism, or borderline personality disorder. And for some, what looks like sex addiction is actually the behavior of someone filled with hostility, loneliness, despair, or desperation to connect. Or it's the behavior of someone who can't communicate with their mate, deal with the aging process, or handle being in a relationship with little or no sex.
For some, "sex addiction" is part of a larger internet entanglement. After all, the human brain isn't wired for the unlimited hunting that the internet offers, whether on eBay, NFL.com, or buttbustersUSA.
Not insignificantly, what looks like "sex addiction" to some is often a matter of sexual tastes that others don't share—S/M, multiple partners, casual or anonymous sex, commercial sex workers.
So how do we treat "it"? Obviously, it depends on what "it" is. Here are some of the approaches I use with various versions of "it":
- Ask what kind of sex life the patient wants; either help them negotiate it, or accept that they won't get it with their current mate (or anyone they'd like to be with).
- Resolve the guilt and shame someone feels about their sexual desires. Guilt and shame can fuel repetitive, compulsive behavior, and make it difficult to connect with someone authentically.
- Medication when appropriate: anti-depressants, anti-anxiolytics, perhaps stronger drugs like mood stabilizers.
- Sex therapy to investigate and resolve possible sexual dysfunction, chronic need for risk-taking or breaking taboos, or rigidity in preferences, such as cross-dressing (not to eliminate paraphilias like cross-dressing, but to help someone integrate it into his/her life, and possibly expand their sexual interests).
- Serious couples counseling: hopelessness about serious discrepancies in desire or preferences is often the fuel for serial affairs, inappropriate flirting, or involvement with sex workers.
- Cognitive or other behavior therapy for internet disability or other phobias.
- Psychotherapy to enhance self-esteem and the ability to soothe oneself when frustrated; and to reduce fear of intimacy or pleasure, self-loathing, and self-defeating narratives.
Notice that a lot of these treatments don't center on sexuality. That's how we're able to resolve a lot of the behavior that sex addiction programs can't. Such programs aim far too low—to create life-long recovery rather than resolution and permanent change—and they focus way too much on sex. Which is ironic, since most sex addiction programs are run not by sex therapists, but by addiction specialists. I guess with only minimal training in sexuality, they get distracted by their clients' sex lives.
Finally, let's not forget that some "symptoms" of sex addiction don't need treatment at all. They need a better understanding of the broad range of human sexuality, a bit of tolerance, and a culture that's far less suspicious of eroticism. And a willingness for couples to confront their actual relationship (and for people to confront their actual desires), rather than taking the easy way out and demonizing sex.
There’s still time to register for my last teleseminar of 2013. The topic is “If It Isn’t Sex Addiction, What Is It? And How Do You Treat It?” For more information, click here.