Tuesday, October 8, 2013

The Sex Addiction Debate- A Dialectic

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.

Sunday, October 14, 2012

Is your partner acting out sexually, with porn or with others?  

Read this letter to the wife of a sex addict who is struggling with confronting her wayward spouse:

I can see that you are in a lot of pain.  I am concerned that you are placing yourself in danger by refusing to confront your husband about his unacceptable behavior and by consenting to have unprotected sex with him, despite knowing that there is a fair degree of certainty that he continues to act out by having unprotected sex with who-knows-whom.

It sounds like he is out-of-control in active addiction and that it is escalating.  This is not good.

I urge you to be more concerned for your own health and well-being than for your marriage.  I am going to shout this next bit, so as to get your attention:





I understand that you love and care for him.  But you cannot help him.  He must help himself.  By staying with him under the present circumstances, without imposing any consequences for his incredibly selfish, insane, and hurtful behavior, you are actually ENABLING him to continue.  He is in a bubble of addiction right now.

THERE IS NO "US" TO GET BACK ON TRACK right now.  The only hope you have is to either move out or kick him out and to be ready to cut ties completely UNLESS AND UNTIL HE STOPS ACTING OUT AND GETS INTO RECOVERY.  He has no motivation to change right now.  Your pain means nothing to his addict.

He is not respecting you, because you are not respecting yourself.  YOU ARE ALLOWING YOURSELF TO BE ABUSED, hoping that it will change him.  It won't.  It only hurts you.  It will keep going as long as you will tolerate it.  What is your biggest fear?  That you will lose your marriage?  WHAT MARRIAGE?!

He does not respect or honor your marriage.  Whatever you have is not even CLOSE to what you want or deserve.  Yet you are accepting it.  GOD HELPS THOSE WHO HELP THEMSELVES.  You must take the first step.  You must love your husband enough to let him go, knowing that your action is what MIGHT motivate him to snap out of it and realize where he is and what he is about to lose.  IF and only IF he commits to REAL CHANGE can you risk staying married to him and perhaps have the loving marriage you want.  That is your only hope.

Deliver an ultimatum that you are ABSOLUTELY resolved to carry through, whatever that is.  No matter what HE does, YOU must be prepared to do what is best for YOU.  You may have to walk away from the marriage.  Paradoxically, it is only when you show this level of resolve that your marriage has a chance of surviving.  God  can and will heal your relationship but only if BOTH of you work TOGETHER to seek God's grace.

Friday, October 5, 2012

Finding Balance, a Key Recovery Skill

I just returned from a professional conference last week.  This was my first SASH (Society for the Advancement of Sexual Health) conference since becoming a member of that organization three years ago.  I have been to several similar conferences since "leaping into the void" to become a therapist specializing in sex addiction in 2009.  The great thing about attending conferences is also the most challenging thing about it for me: the people.  I really enjoyed re-connecting with friends and colleagues whom I know, and making so many wonderful new connections with some amazing people.  I am learning how good it feels to be connected to healthy others.  This is a recovery strength and resource that I encourage all of my clients to embrace and practice on a regular basis.  It feels good to connect authentically with other healthy people, and such connections feed my need for intimacy.

On the other hand, as an introvert, I know that I have a great need for internal connection to my well-spring, my source.  For me, this requires solitude and relaxed focus.  For as much as I enjoy the positive energy of intimate exchanges with others, I need to balance that with alone time for quietude and reflection - as well as to shift my mind into neutral through deep meditation.  This alone time is often difficult to carve out in the midst of all the activity.  Thus, one of the primary challenges of attending functions such as conferences and seminars is balancing this connection with others and the connection with self and with one's higher power.

In recovery, most of us struggle with balance.  The impaired brain of a person with the disease of addiction, even in recovery, tends towards extremes on either end of the spectrum.  Once I relax enough to enjoy being with others, I have a tendency to overdo it, and to challenge my perspective and balance by overstaying my welcome or by going past my healthy limits.  Or, when I return to my "nest" I tend to make up for the imbalance by isolating and avoiding contact in order to feed my inner connection.  In recovery, I am learning to be more mindful of when I am approaching my limit, and to use my self awareness and communication skills to honor the boundaries that I know are healthy for me.  That way, I can enjoy being myself, fully and completely, both in the presence of others and when alone.

If, like me, you find your ability to live in balance challenged by day-to-day circumstances, you are not alone.  There will be times you are more or less successful at finding that balance.  The key is to give yourself a break when you are less successful, and to give yourself appropriate credit when you are.  Mindful awareness - of your inner state, your limits, and your boundaries in the context of your environmental surroundings and relationships - is the key to balance.  Noticing how you are, where you are, and making the adjustments necessary to stay in balance is a fundamental recovery skill that improves with practice and determination.  Prayer and letting go of judgment about the outcome helps too!  Peace, in recovery.