Seattle Relationship & Couples Therapy: On Sex Addiction

‘Sex addiction’ is now a commonly used term; sex has seemingly joined chocolate, gambling and shopping as pleasurable activities to which people can become ‘addicted.’ The term ‘sex addiction’ trades on a longstanding model of chemical dependency treatment, and how it understands and treats repetitive, compulsive behavior.

In this post, I outline some basic questions about what sex addiction might mean for a couple. First, let’s briefly review the latest psychiatric/medical diagnostic thinking.

New Diagnosis

The official diagnostic reference, the Diagnostic and Statistical Manual (DSM), will introduce ‘sex addiction’ in 2013 (DSM-V) in a brand new diagnosis, “Hypersexual Disorder”. It posits “normal” sexual behavior – coitus and pornography/fantasy – which is “repetitive, excessive, or disinhibited”.

This last part is derived from diagnosis of chemical dependency, even though the overall diagnostic category is a sexual disorder. The behaviors must occur despite “adverse consequences” (also a chemical dependency criterion) to either individual health (higher risk of STDs and sex offenses), relationship/marriage and employment. Yet research is not conclusive on the neuro-science behind this proposed diagnosis, specifically whether the brain can become dependent on dopamine produced by orgasm.

Labeling A Sex Addict

In everyday reality, when couples begin therapy where sexual problems are prominent, one partner may declare that the other is a “sex addict”. Or, they agree that one of them is a sex addict. It’s very rare that both acknowledge ‘sex addiction’.  The sexual history of each partner, of the relationship (including who has been the higher/lower desire partner), past relationships, the partners’ parents’ relationship, the role of pornography, sexual contact with third parties, alcohol or drugs – all of this information and more factor into the big picture. A loss of credibility/integrity overarches everything when the sexual activity was covert. Divorce may be imminent, or, a confused, ambivalent period of healing looks like the only option for the future.

Shame Game

Labeling a partner as a ‘sex addict’ confers shame on him or her, while reducing or eliminating therapeutic flexibility. Curiously, it reduces responsibility for that partner, since many question whether addiction can be ‘cured’. Telling one’s partner that they will be in perpetual recovery certainly affects desire in the relationship. But labeling someone a ‘sex addict’ also expresses the intense pain, betrayal, sudden loss of intimacy & integrity. Past deprivation is re-experienced.  The labeling can begin a cycle: 1) immediate relief or “improvement”; 2) relapse; 3) further shame.

What The Behavior Means

I think that ‘sex addiction’ is one way to construct what the behavior means for a couple. That isn’t ‘right’ or ‘wrong’;  partners ultimately decide how they make meaning and attribute motives.  But in a case where progress is stalled, couples look for a way in therapy to have things develop further. As always, the questions that get asked are more influential than the answers (advice) I might provide.

Pornography & Questions

Does pornography/fantasy content represent the setup to the addiction, or the addiction itself? Can the ‘addict’ permanently help him/herself? Is he/she out of control?  Is the ‘addict’ truly responsible, truly choosing the behavior(s)? If the ‘addict’ stopped the behavior(s), would the partners resume wanting each other and would sexual relations re-commence? These and other questions may begin to develop progress when the recovery process has stalled.

No Scapegoat

There may ultimately be a painful acceptance that there is no scapegoat, be it a partner or the internet; in a committed relationship, every meaning is co-constructed. The ‘addict’ partner often claims that they themselves were deprived by the other. It  may become possible for partners to see the covert, repetitive sexual activity for what it says about them both, not just one partner. And then real couples therapy can begins, as distinct from one partner anxiously witnessing the other’s recovery from ‘addiction’.

I’ll close this long post by thanking Esther Perel, who gave me a long answer to a question I asked her about working with the idea of ‘sex addiction’. When I finally de-constructed her response, it was both empathic and observant and clearly the result of long work and clear thought.

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