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Is Sex or Porn Addiction Real?

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…
  • Dr. Suzanne Pelka

How can we truly recover from this Infidelity?

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.
  • Dr. Suzanne Pelka

Sexual Dysfunctions

Help, I’m much too young to be having ED (Erectile Dysfunction)!

Contrary to popular thought, men are not machines.  Most men do not get erections at the slightest breeze.  If a man has had a few bad experiences in which he has lost his erection during intercourse, that will usually create a lot of anxiety at the next sexual encounter.  That anxiety will often have a corresponding negative effect upon the next time he goes “to test himself,” essentially compounding the problem.  Such men – even those in their twenties – will then often turn to using popular medications – those little blue and yellow pills – to combat their erectile problem.  If their anxiety is great enough, it will override the medication and not allow the production of regular erections.  In short, anxiety is a killer in the bedroom.  For anyone.  First things first, is there much pornography use?  Whenever there is a problem in the bedroom, one of the first recommendations we make is to stop using porn during masterbation.  The regular use of porn trains the brain to need increasing amounts of stimuli to get the same effect.  And, let’s face it, there’s no shortage of novel intense stimulation online.  No real woman, no matter how outrageously gorgeous or perfect for you she is, could ever visually compete with the endless array of potential sexual stimulation from online porn.  In short, ED has multiple origins and multiple fixes.  Your therapist will start with a detailed sexual history, help you understand your erotic template as well as provide guidance regarding how to move towards a healthier sexuality and ultimately, regular, satisfying, in-person intercourse.
  • Dr. Suzanne Pelka

I’m that 40-year old virgin. How can I ever change this?

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.
  • Dr. Suzanne Pelka

Therapy Resources

Mental Health Links

The following links are listed to provide you with additional online mental health care information and counseling resources.

Addiction and Recovery

Alcoholics Anonymous

Habit Smart

SAMHSA’s Substance Abuse/Addiction

SAMHSA’s Treatment and Recovery

Web of Addictions

Anxiety Disorders

Answers to Your Questions About Panic Disorder 

National Center for PTSD

Obsessive Compulsive Information Center

Associations & Institutes

American Academy of Child & Adolescent Psychiatry

American Association for Marriage and Family Therapy

American Counseling Association

American Psychiatric Association

American Psychological Association

American Psychological Society

Canadian Mental Health Association

Center for Mental Health Services

National Institute of Mental Health

National Mental Health Association

Substance Abuse and Mental Health Services Administration

Attention-Deficit Hyperactivity Disorder

ADDA – Attention Deficit Disorder Association

Attention-Deficit Hyperactivity Disorder, NIMH

Born to Explore: The Other Side of ADD/ADHD

Child Abuse and Domestic Violence

Childhelp USA®

SAMHSA’s Children and Families

SAMHSA’s Protection and Advocacy

Questions and Answers about Memories of Childhood Abuse

The National Domestic Violence Hotline Website

Women, Violence and Trauma

Chronic Fatigue

Chronic Fatigue Syndrome


Bipolar Disorder News –

Depression and How Therapy Can Help

Depression Screening

Depression Test, Symptoms of Depression, Signs of Depression

Developmental Disorders

Asperger’s Disorder


Pervasive Developmental Disorders


DSM-IV-TR: Diagnoses and Criteria

Dissociation and Traumatic Stress

Sidran Foundation Home Page

Eating Disorders

American Dietetic Association

Something Fishy

Journals & Magazines

ADHD Report

Anxiety, Stress and Coping



Contemporary Hypnosis


Depression and Anxiety


Drug and Alcohol Review


Early Child Development and Care

Eating Disorders

Educational Assessment

Journal of Gambling Studies

Journal of Happiness Studies

Journal of Mental Health and Aging

Journal of Sex & Marital Therapy

Journal of Sport and Exercise Psychology

Journal of Substance Abuse Treatment

Language and Cognitive Processes

Loss, Grief & Care

Mental Retardation and Developmental Disabilities 

Metaphor and Symbol

Neuropsychological Rehabilitation


Personal Relationships

Personality and Individual Differences

Psychiatric Bulletin

Psychology of Men & Masculinity

Psychology Today

Stress and Health

Studies in Gender and Sexuality

Substance Abuse

Suicide and Life-Threatening Behavior

Trauma, Violence & Abuse

Medications and Health Supplements

Drug Interactions, Alternative, MotherNature

Drug Interactions, DIRECT

Medical Dictionary

Medications, FDA

Medication, Internet Mental Health

Medications, PDR

Medline, Comparison


SAMHSA’s Psychiatry and Psychology

Mental Health Care General Links

Internet Mental Health

Let’s Talk Facts, APA

Mental Health Counselor Resources,

Mental Help Net

Mental Illnesses/Disorders

University of Michigan Health Topics A to Z

Web Sites You Can Trust, Medical Library Association

Personality Disorders

Mental Help Net – Personality Disorders

Personality Disorders – Focus Adolescent Counselor Services

Suicide Awareness and Hotlines

SAMHSA’s Suicide

Suicide Awareness Voices of Education

Suicide: Read This First

Additional Mental Health Care & Counseling Resources



Interpretation of Dreams

Keirsey (Myers-Briggs) Temperament Sorter

Signs of Menopause, Symptoms of Menopause

Note: Not responsible for the content, claims or representations of the listed sites.

Treatment Specializations

My Treatment Specializations Include:

  • Individual Sex Therapy
  • Couples Counseling/ Conflict Resolution
  • Sex Addiction Treatment (using Patrick Carnes’ CSAT model and The Recovery Start Kit)
  • Love Addiction Treatment (based on Pia Mellody’s therapeutic approach)
  • Sexual Dysfunctions (Rapid or Retarded Ejaculation; Vulvadynia, Vaginismus)
  • Loss of Sexual Desire/ Low Libido
  • Sexual Trauma/ PTSD
  • Sexual Anorexia
  • Sexual Phobias
  • Erectile Dysfunction
  • Couples Sex Therapy
  • EMDR (eye-movement desensitization and reprocessing)
  • Alternative Family Planning/ Infertility
  • Surrogacy; IVF and AI Topical Specialty
  • Family Planning using Sperm and/or Egg Donation
  • Gay and Lesbian Individual, Couples and Family Therapy
  • “Coming Out” Issues/ Overcoming Internalized Homophobia
  • Depression and Anxiety
  • Major Life Adjustment Issues (Divorce, Move/Relocation, Loss of Job; New Career; Birth or Adoption)
  • Grief/Loss (of loved one or the loss of a previous romantic relationship or miscarriage/stillbirth)

Common Therapy Problems

Is therapy right for me?

Seeking out therapy is an individual choice. There are many reasons why people come to therapy. Sometimes it is to deal with long-standing psychological issues, or problems with anxiety or depression. Other times it is in response to unexpected changes in one’s life such as a divorce or work transition. Many seek the advice of counsl as they pursue their own personal exploration and growth. Working with a therapist can help provide insight, support, and new strategies for all types of life challenges. Therapy can help address many types of issues including depression, anxiety, conflict, grief, stress management, body-image issues, and general life transitions. Therapy is right for anyone who is interested in getting the most out of their life by taking responsibility, creating greater self-awareness, and working towards change in their lives.

Do I really need therapy? I can usually handle my problems.

Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you’ve faced, there’s nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting where you’re at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.

How can therapy help me?

A number of benefits are available from participating in psychotherapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:

  • Attaining a better understanding of yourself, your goals and values
  • Developing skills for improving your relationships
  • Finding resolution to the issues or concerns that led you to seek therapy
  • Learning new ways to cope with stress and anxiety
  • Managing anger, grief, depression, and other emotional pressures
  • Improving communications and listening skills
  • Changing old behavior patterns and developing new ones
  • Discovering new ways to solve problems in your family or marriage
  • Improving your self-esteem and boosting self-confidence

What is therapy like?

Every therapy session is unique and caters to each individual and their specific goals. It is standard for therapists to discuss the primary issues and concerns in your life during therapy sessions. It is common to schedule a series of weekly sessions, where each session lasts around fifty minutes. Therapy can be short-term, focusing on a specific issue, or longer-term, addressing more complex issues or ongoing personal growth. There may be times when you are asked to take certain actions outside of the therapy sessions, such as reading a relevant book or keeping records to track certain behaviors. It is important process what has been discussed and integrate it into your life between sessions. For therapy to be most effective you must be an active participant, both during and between the sessions. People seeking psychotherapy are willing to take responsibility for their actions, work towards self-change and create greater awareness in their lives. Here are some things you can expect out of therapy:

  • Compassion, respect and understanding
  • Perspectives to illuminate persistent patterns and negative feelings
  • Real strategies for enacting positive change
  • Effective and proven techniques along with practical guidance

Is medication a substitute for therapy?

In some cases a combination of medication and therapy is the right course of action. Working with your medical doctor you can determine what’s best for you. It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness.

Do you accept insurance?

While I do not accept insurance, at your request I can provide you with a monthly superbill/receipt. Patients often mail these to their insurance companies and get reimbursed the percentage of the hourly fee allowed for an out-of-network provider. Be advised however that seeking reimbursement for psychotherapy payment will be strictly between you and your insurance company and is not something that I personally facilitate. You will need to call your insurance company and as if they reimburse any percentage for an “out of network” provider, which is what I would be.

Is therapy confidential?

In general, the law protects the confidentiality of all communications between a client and psychotherapist. No information is disclosed without prior written permission from the client.

However, there are some exceptions required by law to this rule. Exceptions include:

  • Suspected child abuse or dependant adult or elder abuse. The therapist is required to report this to the appropriate authorities immediately.
  • If a client is threatening serious bodily harm to another person. The therapist is required to notify the police.
  • If a client intends to harm himself or herself. The therapist will make every effort to work with the individual to ensure their safety. However, if an individual does not cooperate, additional measures may need to be taken.