Treatment approaches for sexual addiction and family counseling

Sexual Addiction and Counseling

There is an assortment of well-researched treatments for sexual addicts and their partners. The facts are that, like all other addictions, the sexual addiction is rooted in a complex web of family and marital relationships. The prospects for the addict, his or her partner, and the family are at best difficult. Recovery is complicated and the work that must be done is not easy. This paper explores some treatments and their ramifications.

Sexual Addition and Marriage, Couple and Family Counseling

Sexual Addition

Patrick Carnes (2001) defines sexual addiction as any sexually-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one's work environment.

Sexual addiction is a compulsive behavior that completely dominates the addict's life. Sexual addicts make sex more important than family, friends, and work. Sex becomes the organizing principle of addict's lives and they are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior.

Sexual addiction is defined by no single pattern of behavior. Compulsive masturbation, compulsive heterosexual and homosexual relationships, pornography, prostitution, exhibitionism, voyeurism, indecent phone calls, child molesting, incest, rape and violence can all be manifestations of sexual addition. The healthiest forms of human sexual expression can turn into self-defeating behaviors.

It is estimated there are now between one-half and two million sex addicts (Bird, July, 2006). According to Carnes (2001), sexual addiction is rooted in a complex web of family and marital relationships. Sex addicts can rationalize their behavior, believing it does not adversely affect other relationships, especially a marriage. A common justification for a married addict is, "I do it in order to stay in the marriage." In truth the marriage is often beset with a lack of intimacy, sensitivity, and sexuality. Many sex addicts also believe the family does not know about their secret sexual life. But at some level family members, even children, are always aware that something is amiss.

Carnes (2001) explains the addictive experience for the sexual addict is a four step cycle that intensifies with each reoccurrence. The first step is preoccupation where the addict becomes totally engrossed with sexual thoughts. This state of mind induces an obsessive search for sexual stimulation. The next step is ritualization where the addict performs his own special routines that intensify the preoccupation increasing arousal and excitement. The third step is the manifestation of the compulsive sexual behavior; this is the culmination of preoccupation and the ritualization. Sexual addicts do not have the capability to control or stop this behavior. The final step is despair where the sexual addict experiences profound hopelessness about their actions and their inability to control their behavior.

Typically it takes a major crisis where the consequences are so great, or the pain is so bad, that an addict must come to terms with his or her addiction. Carnes (1983) lists some of these events: when the squad car pulls into the driveway and you know why they've come, when you break off yet another relationship you never wanted to be in, when your spouse announces the end of your marriage because of the latest discovery, when your daughter's friend sees your photo in the mug shots at the police station and no one in your family knew, when the school councilor calls to inform you that your daughter does not want to come home because, after eight years, she no longer wants to be sexual, and you are being reported to child protection, when you have a car accident while exposing yourself. The consequences for the addict his or her spouse, and his family are devastating.

Marriage Couples and Family Counseling

Doss, Thum, Sevier, Atkins & Christensen (2005) did a study comparing traditional behavioral couple therapy (TBCT) with integrative behavioral couple therapy (IBCT). They reported that approximately one third of the couples who enter therapy fail to improve by post treatment. Furthermore, 38% of couples who enter TBCT are divorced after four years. The findings indicated that TBCT creates a more significant change in targeted relationship-related behaviors early in the therapeutic process while IBCT led to acceptance of targeted behavior both early and late in the relationship.

The researchers note that as therapists consider the two findings from this research they may conclude that treatments should begin with TBCT and end with IBCT. However, they point out "a focus on acceptance might not follow easily from an emphasis on making change -- if change is successful, why focus on acceptance? If change is unsuccessful, then acceptance comes on the heels of failure," (Doss, Thum, Sevier, Atkins & Christensen, 2005). The implications for modifying treatment are unclear.

It is not surprising that children are alert to their parent's marital tension. Balswick & Balswick (2006) report martial conflict increased the risk of children developing a variety of difficulties. Children are not only negatively impacted by the frequency and duration of their parents' conflicts, they are acutely aware of, and stressed by, conflict between their parents. Research shows that a highly conflicted marriage is not a good environment for children. Chronic unresolved conflict between spouses leaves children feeling insecure, unable to regulate their emotions and hypersensitive. Hostility and anger between parents is associated with withdrawal and avoidance in children. Children can become emotionally invested in parent's unresolved conflicts and tend to blame themselves for the problems between parents.

The wisdom of conflictive couples staying together for the sake of the children has been debated for years. Balswick & Balswick (2006), report that the dissolution of low-conflict marriages appears to have negative effects on children's lives, while the dissolution of high-conflict marriages appears to have beneficial effects. It is important for couples to take seriously their responsibility to deal with their conflicts, not only for the sake of their marriage, but also for the well-being of the children.

Laaser (2006) advocates working with couples from a spiritual perspective. He asserts that when a sex addict commits a violation of the vows he or she made to a partner, the violation is spiritual, and the pain of it is experienced on a deep emotional level. It is necessary for the therapist to be willing to understand and treat the spiritual beliefs of both partners.

According to Laaser (2006) counseling from a spiritual perspective begins with three questions. The first question, are you willing to get well?, reveals if the addict wants to be free of the addiction and is willing to surrender to a higher power. When couples seek counseling the questions are the same, do you want to heal your relationship?, are you willing to do the hard work?, are you willing to stop blaming each other and take your own inventory? The partners need to stop being enemies and begin being companions in the journey toward recovery.

The second question, what are you thirsty for?, deals with seven universal desires. They are the desire to be heard and understood, affirmed, blessed, safe, touched in non-sexual ways, chosen and passionately desired, and be included in fellowship with God and with others. If these desires are not met in healthy ways, expectations are developed of others to give them to us. This can cause problems in relationships. The solution is not for couples to strive to serves each other's desires better, it is to find the desires of our heart in our relationship with God and our community of family and friends.

The third question is, are you willing to die to yourself and, therefore, what are you willing to die for? Addiction is selfish and during recovery the addict needs to die in their arrogance and sense of control. During the recovery process the non-addicted partner is encouraged to establish healthy boundaries, but there can be a danger that if carried too far this can also lead to selfishness. Laaser (2005) counsels that it is through selflessness, putting your partner first, and a sense of spirituality, that people become willing to die to yourself and for your partner. He asserts that when this attitude is adopted in a marriage arguments are virtually non-existent.

Successful couple's counseling can only proceed where both partners are willing to seek individual healing for their trauma. Laaser (2005) says couples must find meaning in suffering and pain. By this he means that couples who have suffered a trauma together have an opportunity to for greater insight, healing and empathy for and with each other. When this takes place partners become companions.

Helping couples rebuild trust is a vital part of repairing the relationship after the sexual addiction has been disclosed. Laaser (2005) believes the spiritual tradition encourages couples to find forgiveness in their hearts. "Christian tradition tells us that we must forgive others as God has forgiven us."

Vision determines what we see and is based on what we desire. For instance, sexual fantasy leads to the belief that the love can be found in sexual activity. Any fantasy according to Laaser (2005) can be a false solution to desires that only God or deeper spiritual understanding can provide. The trouble for some couples is that each partner may have a vision, but they don't match up or complement each other. The couple that has two different visions really experiences division. Couple's counseling must facilitate the development of a vision that both partners can embrace and pursue.

Couples who don't have a vision, will do only what they think they have to in order to survive, while couples who do have a vision will do whatever it takes to fulfill that vision.

Sexual addicts and their partners may be reluctant to delve further into this area due to the potential negative consequences, trauma for the partner and the loss of the relationship for the addict according to Bird (2006). Nevertheless, research indicates that discloser is necessary and helpful in the long run in improving the relationship and recovering from the addiction. It is important to keep in mind that partners who are further along in therapy report that learning more about the addict's behavior does not give them the power to control the addict or the situation. In fact, too much detail can be more traumatic the helpful. The revelation of certain details may possibly cause, or enhance, PTSD symptoms; therefore the therapist must consider the potential negative consequences of collecting too much information.

If disclosure of inappropriate sexual behavior is prior to therapy most spouses have already dealt with threats to leave and other ineffective and often harmful problem-solving behaviors. Bird (July, 2006) states that research indicates such behavior does not preclude relapse and often induces the addicted partner to withhold important information for fear of losing the relationship. At this juncture the role of the therapist is to assist partners in setting appropriate boundaries, up to and including separation, which will allow the addict to feel more open. It is further noted the trust in the relationship will increase over time and consistency in the addict's behavior. By helping couples become more aware of their own feelings, learn to share these feeling with each other, set boundaries and manage future disclosures, the therapist can support them while they work at redeveloping lost confidence in each other.

In terms of general treatment approaches therapists recommend contracting, anger management, cognitive restructuring, confrontation, defining sexual sobriety, defining behavioral boundaries, empathy, and grief counseling as treatments. Prayer and scripture study are also useful.