In my practice, I often have patients who present for sex therapy due to compulsive sexual behavior. When they come in and sit down in my office, they usually tell me:
“I’m here because I’m a sex addict.”
As a sex therapist, I actually have a problem with the terms “sex addict” and “sex addiction.” While some people do experience psychological and health consequences due to sexual urges, using a therapy model that pathologizes consensual sexual behaviors can be damaging to the patient.
According to the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), there is insufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental disorder. In addition, AASECT has also found that sexual addiction training and treatment methods available to patients are largely not backed by accurate human sexuality knowledge.
There are many reasons why people engage in sexual compulsivity that are distinct from addictive behavior. Some of these include power struggles in their relationships (e.g. not getting their emotional and sexual needs met), shame, depression, anxiety, trauma, and (the most common of all of these) self-esteem.
Self-esteem begins in childhood. If a child has a secure attachment to their parent(s) or caretaker(s) where they are regularly validated and shown empathy, the child will feel safe and confident enough to explore their surroundings. They will have confidence in their abilities, and they can learn to be resilient. If, however, the parent or caretaker is distant, inattentive, dismissive, critical, and overly quick to punish the child, the child can develop an avoidant attachment, leading them to feel rejected, suffer from emotional isolation, and frequently feel stressed and scared.
We carry these attachment styles with us into our relationships as adults. Often people with a history of rejection who have developed an avoidance attachment style still feel a great deal of shame as adults. For some, this can cause them to act out sexually because sex provides them a form of validation.
As an example, in working with cisgender heterosexual men in treatment for sexual compulsivity, I often learn that they grew up in an environment that was fueled by toxic masculinity. They were taught not to express their emotions, and if they did, they were shamed for being weak. We discover through therapy that some of these men still feel a great deal of anxiety and shame, and they can also lack emotional awareness in relationships. Therefore, acting out sexually in order to gain a temporary sense of validation is one way that they cope with their insecurities.
Whenever I work with sexual compulsivity, I use a non-pathologizing, sex-positive, shame-free approach. I start with helping the client create an erotic template based off Jack Morin’s four cornerstones of eroticism (longing and anticipation, violating prohibition, searching for power, and overcoming ambivalence), and Silva Neves’ ten erotic boosters (visual, olfactory, auditory, touch, stress, boredom, emotional, hormonal, fantasy, and environment). This process helps the patient begin to heal from any trauma from past sex-addiction treatments and develop a template from which to seek out more deeply satisfying sexual experiences.
Once a patient has a better understanding of their erotic template, I help them look at what areas of their sexual behavior has been problematic for them. This process is guided by Braun-Harvey and Vigorito’s six-principles of sexual health (consent; non-exploitation; protection from HIV, STIs, and unwanted pregnancy; honesty; shared values; and mutual pleasure). In therapy, the patient can assess their own sexual behavior and consider where they fit in within the six principles.
Rather than pathologizing sexual compulsivity and labeling it an addiction, supporting the patient in understanding the reasons behind their patterns and helping them develop healthier behaviors is an effective, affirming therapeutic approach. Looking at sexual pleasure through a safe, consensual, non-judgmental, sex-positive lens is the foundation and motivational factor in changing problematic sexual behavior.
References:
Braun-Harvey, D., & Vigorito, M.A. (2016). Treating out of control sexual behavior: Rethinking sex addiction. Springer Publishing Company.
Morin, J. (2012). The erotic mind: Unlocking the inner sources of passion and fulfillment. HarperCollins.
Neves, S. (2021). Compulsive sexual behaviours: A psycho-sexual treatment guide for clinicians. Oxon
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