AS I read and re-read the exchanges
that occur around the topic of the intersection of sex addiction
research and practice, within the community of therapists and in the
public sphere, I find myself drawn to what I have learned in
Dialectical Behavior Therapy (DBT) training. Before I dive into
that, I have another observation to make.
One of the primary draws I had to this
work is the pioneering work of Dr. Patrick Carnes, whose genius, in
my estimation, lies in his ability to synthesize concepts and models
from various, and apparently disparate, disciplines in attempt to
understand and explain the patterns of human behavior we have come to
call "sex addiction" (which is only a label, not the thing
it points to). In doing so, he has constructed a model that looks at
these patterns from various perspectives or lenses. I find this
particularly helpful as a practitioner, as it helps me in my attempts
to explain to folks ways to look at their own behavior that helps
them figure out how to change. The intellectual openness and
flexibility required to maintain, juggle, contrast, and synthesize
multiple views of the same issue or set of issues helps me to be a
more balanced and humble human being, and a more effective therapist.
All of the theories that we use to describe, represent, and
interpret the complex dynamics of human behavior are only arbitrary
mental constructs at best. As such, they are subject to all of the
flaws to which any human behavior is subject, despite our best
efforts to prevent such flaws. History is replete with examples of
"scientific truth" that has later been revealed to be less
than accurate, despite the intensity of belief or numbers of
"experts" who subscribed to that “truth”. Similarly,
many "proven" theories have later been disproved upon the
development of more accurate or detailed measures and/or concepts.
What I make of the recent exchange is
that, as in any arena of human endeavor, it is probably unwise to
cling rigidly to any position regarding theories that attempt to
interpret, analyze, or explain human behavior, including sexual
behavior. Depending upon one's vantage point, or the lens through
which one is viewing the behavior, it may look completely different,
and our interpretations might (and do) appear to be contradictory at
times. This does not invalidate any particular point of view. As
the dialectic suggests, it is NOT "either/or", but
"both/and". Applied to the recent exchange, I believe it
is possible to hold all positions simultaneously without invalidating
any of them. Looked at from the lens of a particular neuroimaging
study, it appears that there is no correlation between "compulsive
sexual behavior" and the markers we know to correlate with
substance abusing behaviors. AND, viewed from the lens of a
practitioner with a despairing man and his traumatized partner in the
office, there is absolutely something that LOOKS a lot like addictive
behavior occurring, and something needs to change. Stated another
way; on one hand, we don't know very much about WHY or HOW this is
occurring in the brain. And, on the other hand, we know quite a bit
about interventions that seem to be effective in helping folks who
want to stop their problematic behavior.
One of the things I tell my clients is
“Understanding that you desperately want to know WHY you act the
way you do - and in agreement that knowing why might even be helpful
- the fact remains, if you continue to act that way, it will continue
to have a negative impact on your life. Regardless of whether you
are able to completely understand WHY you acted that way, the most
important thing to acknowledge is that you must do things differently
from now on.” Let's look at what has helped other people, who are
not so different from you, change their behavior and improve their
lives. I invite you to consider doing those things to see if they
might work for you. Along the way you might get some answers to the
question, “Why?”
Is it important to figure out what is
going on so we can devise more effective interventions/treatment?
Absolutely, more awareness and understanding is usually better than
less awareness and understanding. If something works and we don't
know why it works, should we stop doing it because we don't know why?
Of course not. We don't know why electricity works, but we know that
it works and we use it. A lot. Are diagnostic categories and
concepts helpful and necessary? Certainly, we need language to talk
about what we are dealing with. And it is also dangerous to
over-focusing on this to the extent that we forget that we are
dealing with human beings, not “diseases”. Words matter. And
they are often superfluous. Getting hung up on the diagnostic
labels, or any other labels, strikes me as similar behavior as many
of our clients who are hung up on the label “God”, therefore
reject any spiritual concept that uses that term to describe it. To
gleefully mix metaphors: Sometimes we are so focused on the trees
that we miss the forest. Sometimes we are so focused on the forest
that we miss the tree. Our challenge is to find the middle path –
avoid running headlong into the tree while we're trying to find our
way in the forest.
