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For some years now a fight has been going on between those who ascribe to the notion that people struggling with “out of control” sexual behaviors should be labeled “sex addicts” (and treated under the same protocols as other types of addicts), and those who believe such people must be understood and treated in a more psychotherapeutic way—one that is more sexually informed.
Recently, the American Association of Sexuality Educators, Counselors and Therapists (AASECT), founded in 1967, released a historic statement about sex addiction asserting that it:
1) Does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and
2) Does not find the sexual addiction training, treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.
As the leading national body of sexuality educators, counselors and therapists, AASECT does, however, recognize that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. How to help clients deal with and manage and characterize these inclinations is at the heart of the dispute mentioned above.
I was a certified “sex addiction therapist” for many years before I began discovering that there were other ways of understanding sexual behavior, mainly through the sex therapy training and supervision I received in my involvement with AASECT. This is where I began to see the importance of labels in how we treat clients.
Let me offer some examples of how my views evolved from the sex addiction model into what I now believe to be a more nuanced and realistic view of sexual behavior, and how labels—words—make a difference.
* Progression vs evolution. The sexual addiction therapist would likely label a person’s growing sexual desires as “progression,” that is, like the person who progresses from the occasional beer in a night to four beers to a keg, and so on. He would try to raise a sense of urgency in the client by convincing him that he is moving to the next level, a more dangerous entrenchment of the client’s pathological addiction.
The sex therapist, on the other hand, would more likely call this “evolution,” that is, the natural tendency to explore and include further sexual practices as the client delves more deeply into their core sexual script. Rather than pathologizing the behavior as addiction, something to build a bulwark against, the therapist helps the client by helping to lessen the stigma he may feel around his behavior, and help him to accept it as part of himself and manage the behavior so that it doesn’t become destructive in his life.
We need to understand that everyone’s sexuality evolves. For instance, I have had women clients who have discovered their husband’s hidden sexual urges and behaviors tell me that they would rather think of their husband as a “sex addict” rather than a “pervert” (Men have told me the same thing). As a sex therapist, I help them understand that just because a behavior wasn’t part of the original marriage contract, it doesn’t make it wrong or perverse. In truth, we all need to make room for the reality that our erotic desires evolve. Quite frequently as we grow, we experience changes in what arouses us, that what turned us on as a teenager or as a newlywed has lost a bit of its sparkle. We may see something in online porn or read something in a book that we never knew was so erotic, and we feel the urge to experiment with it.
* Loss of control vs feeling out of control. Whereas a sex addiction therapist may talk about the client’s dangerous “loss of control,” and lead him down the path of addiction treatment (admitting inability to control, abstinence, etc.), the sex therapist would lead the client to explore the behavior—why it is there, what are its roots, and if his “feeling out of control” is due to not understanding or accepting that it may just be another erotic part of his life that is wanting expression.
* Failed attempts to stop or cut down vs not wanting to stop. In the addiction model, not being able to stop the behavior, or returning to it after trying to abstain, is considered backsliding, proof of pathological dependency, a moral failure, or character weakness, and efforts to fight the addiction are redoubled. The client is told, “Once an addict, always an addict,” and made to believe that he must never give in to the addiction, and make every effort to cut out the offending part of his psyche or starve it to death by not feeding it. This is what
Doug Braun-Harvey and Michael Vigorito, psychotherapists and co-authors of Treating Out of Control Sexual Behaviors: Rethinking Sex Addiction, call “eroticectomy,” a label I can agree with.
In sex therapy, on the other hand, we must consider if the client really wants or needs to stop the “unwanted” behavior or if it is coming from from something or someone else. Maybe they are fighting an inner battle against how they see themselves or how they think they need to be because of their religion or culture. Maybe they are attempting to expunge urges that are quite normal for them, such as if they are kinky or sexually fluid but have inner or outer restraints against such expression due to a partner, family, religion or their society.
It is not, “Once an addict …” but rather letting the client know that he or she may always have this erotic interest, that it is part of their core sexual script. Then it becomes the therapist’s task to help the person be honest with himself and his partner, to take responsibility for his sexuality, to own it, become a changed self, and not place the blame on, or surrender authority over his sexuality to, his partner, religion or culture.
Though it has become deeply imbedded in our culture, the “sexual addiction” label tries to be an easy answer to a complex problem of human sexuality. The term is a cultural myth, a convenient and superficial term to describe disapproved sex, a way to put the behavior in a pathology box and proceed to a push a standard treatment method that has largely proven effective for chemical dependencies such as alcohol or drug addiction.
However, it is clear to me and to other sex therapists—as well as other therapists in general-- that the label is outdated, and should be relegated to history.
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