February 2018

After people learn that I am a therapist that specializes in sexuality and addictions they often ask me if I think sex addiction is real.  It’s now in the media pretty frequently and many folks wonder if it’s just an excuse for cheating behaviors.  There is a big difference between infidelity or cheating and truly sexually-addicted acting out behaviors.  Both are very real.  At the worst, I’ve seen sex addiction ruin lives and, at the least, temporarily ruin “normal” sexual functioning and deeply scar relationships.  What we call it doesn’t matter one bit.  I tell clients rather inelegantly, “A problem is a problem.  If you know it’s a problem, it doesn’t matter what we call it, you have a problem, let’s deal with it.”  Addictions hijack the rational brain.  Something that is addictive is something you’ve tried to stop, made many promises to yourself that you would indeed stop, and, for one reason or another, you’ve been totally unable to stop on your own.  You find yourself back online, scrolling sexual message boards, back at that “massage” place or the strip club, back on the webcam after your partner has gone to sleep… Your rational self wants you to stop this madness.  Your addicted brain proves powerless.  This is a problem.  You don’t want to or physically can’t seem to have decent sex with your partner anymore.  You’d much rather have the kind of sex you have in your private, secret life.

Food can be addictive in the same way sex can be.  Food can be misused, abused, something you are dependent on (used in a binging way to numb yourself) and finally, used addictively – something you use to self-soothe even though you promise yourself you will indeed stop.  Food and sex are what we therapists sometimes call process addictions.  They are complicated because you need to figure out a way to have a healthy relationship with them.  You can become sexually abstinate but that won’t really provide you the most well-rounded, healthy life.  If you can’t figure out a way to have a healthy relationship with food, that can be lethal.  People that really wind up with problematic sexual behaviors can ultimately put themselves in potentially lethal situations too.  They can contract sexually transmitted diseases, be the victim of blackmail or violent sexual crimes.  They can disrupt their families, children and relationships in devastatingly traumatic ways.  Yes, problematic sexual behavior can be a huge problem.  For some, it is an addiction.  It hijacks the brain and very similarly to cocaine.  Just like a cocaine addict experiences withdrawal symptoms once quitting, there are often many physical withdrawal symptoms when stopping a sexual addiction.  There can be headaches, body aches, intense irritability, depression, anxiety, even stomach upset.  And just like quitting any other drug, huge positive shifts are noticed physically and mentally at the 30 day, 60 day and 90 day markers.  Sex addiction lights up the same areas of the brain as does opiate addiction.  Somehow the neurochemicals activated by these two “substances” are encoded by the brain very similarly.  An active cocaine user shows a very different brain scan from a healthy brain using MRI technology.  A sexually-addicted brain looks similar to the cocaine addicted brain.  When that same cocaine addict hits 90 days of sobriety, his or her brain scan once again resembles a healthy, non-addicted brain.  My clients sober from their sexual acting out behavior similarly feel a huge shift at 90 days of sobriety.  Yet, now comes the truly tough part — maintaining healthy sobriety and gaining recovery…

Couples sometimes come in to see me after truly devastating infidelities.  Often one partner has engaged in serial infidelities (sometimes sexually addictive in nature) and his or her partner has been totally unaware and is utterly traumatized by the discovery.  Though it is not always the case (and although I treat many gay, lesbian and non-traditional couples) for the sake of this blog, let’s assume that we are talking about a heterosexual, married couple in which the husband has engaged in multiple infidelities while his wife was completely unaware.  Some people will argue, how could she not have known anything?  Trust me, it’s very possible.  And if she may have suspected something, she might have even broached the topic with him and he may have gaslit her – acting totally offended and simultaneously hurt at the implication, even turning it around on her – enough to throw her off and make her question her intuition.  Of course there are usually problems in these relationships outside of the infidelity but most long-term relationships have problems and many people aren’t unfaithful.  So let’s get back to my typical couple in which there have been many grave infidelities.  The woman often exhibits PTSD-type symptomology.  She has trouble sleeping and nightmares imagining her husband cheating on her, she has similar types of flashbacks during the day and many easy triggers through everyday events.  She’s having a hard time eating, feels too ashamed to talk to her friends or family about what has happened and often fears if she confides in these people, they won’t ever be able to forgive her husband.  So, she starts to isolate.  She cries often and sometimes rages at her repentant husband.  After a few weeks of the same, and many tearful apologies later on his part, he starts to feel utterly hopeless that she will ever be able forgive him.  At this point he calls me on the phone and soon thereafter the couple is sitting on my couch.  Not every couple makes it through this.  But if both can really reach down deep and start to do things differently, they can.  Healing from infidelities takes a heck of a lot longer than a few weeks or months.  Yet, the couples who hang on, have a relationship worth fighting for, a connection or family they want to save, come out on the other side of intense therapy with the strongest most enviable marriages that I have ever seen.   That is truth.  We at Psychotherapy Works have many concrete helpful tools for couples in this situation.  I’ll give you my starting advice free of charge here.  For the betraying partners: don’t minimize and don’t rationalize whatever it was that you did to hurt your marriage – big or small.  Whatever you do, do not call her crazy.  Validate that your past actions caused the extreme hurt and anger she is now re-experiencing.  Own it.  Apologize most sincerely again.  Let her know you are currently 100% faithful right now (if indeed you are) and ask her if there is anything you can do to help her in this moment.  Listen to her answers and respond accordingly.  If she is angry and yelling, don’t slink away, but instead, move towards her (and this is very hard because like a deer in headlights you will want to avoid her pain and avoid this conflict).  Avoiding conflict is part of what got you into this mess.  Come into therapy, I or another talented therapist on my team can truly help you.  One book (out of many excellent others) that I often recommend is After the Affair by Janis A. Spring, Ph.D.  Check it out.  And, take heart; there truly is hope if you just hang on.

Not everyone magically loses their virginity in their teenage years or college.  I have had many clients that, for various different reasons, have just not had regular or even any intercourse.  They often feel humiliated about this fact and so painfully alone in their experience.  This is a great reason to seek out psychotherapy.  We have helped many people in exactly this situation – male and female.  Often there is a lack of self-esteem, a sense of not being entitled to a sex life.  Sometimes there was a dominating parent in the picture.  For others, they never wanted to be “that guy” that seemed to only want sex from women.  They tried to be respectful and they were, but now to a fault of not being able to get from life what they want.  Sometimes women experience painful penetration (vulvodynia) or, even more upsetting, vaginismus – in which the vaginal muscles tense up so much out of conscious or subconscious fear and anxiety that penetration of any kind is not possible.  This makes her feel like an outsider – so painfully different than her girlfriends.  This can be a very lonely experience.  Women with vaginismus are often unable to have a gynocological exam.  Her vagina will not allow it.  There is real hope for all people who find themselves in these situations.  A trauma inventory, careful trauma-releasing work with a modality like EMDR (eye-movement desensitization and reprocessing), psycho-education and loving, compassionate encouragement will go a long way toward helping such clients.  Many negative cognitions block our clients from living the lives they want including having the sexual experiences they want.  Change is truly possible with commitment and a wrap-around therapeutic approach.  We are expert at helping even the toughest cases of ED, premature ejaculation, vulvodynia and vaginismus.