Teen Internet Pornography Addiction: A Three-Part Treatment Plan

Client Profile and Presenting Concerns

The client is a 17-year-old white male high school sophomore from a middle-class background. He lives at home with his mother, father, and two siblings. He identifies as heterosexual and Catholic. He is intellectually gifted, ranking in the top five of his class, and is physically active — thin and energetic, playing sports casually with friends though not on a formal team.

The client presents with concern about what he describes as a strong sexual addiction that conflicts with his religious beliefs. He reports struggling to resist internet pornography and fears the impact this behavior is having on his life. He describes feeling isolated, preferring to stay home and view pornography rather than socialize, even though he finds the behavior deeply unsatisfying and morally repugnant. He expresses a desire to have a girlfriend and eventually marry, but reports that after a few days of attempting to change, he returns to the behavior and then feels too embarrassed to pursue romantic relationships.

The client also reports depression stemming from his sense that there is no one he can speak to about this issue. He feels embarrassed and stigmatized, and is fearful that others will discover what he is experiencing. He expresses a strong desire to change his behavior but feels unable to do so on his own.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) focuses on treating the thinking (cognition) and actions (behaviors) of the individual. It does not seek to probe subconscious desires or engage in psychoanalytic methods, but instead looks to identify problematic thinking and actions and implement new habits, new modes of responding to triggers, and a new behavioral direction. CBT is a very effective and commonly used approach in treating addictions.

This intervention is particularly well suited to the client because it specifically addresses the thoughts and actions he wants to change. It can help him identify the thinking patterns he wants to avoid and the behaviors he wants to modify. It can also help him recognize high-risk environments — situations in which he is more likely to engage in the target behavior — and develop strategies to avoid or manage those environments. Triggering thoughts can be countered through new behaviors that redirect his attention.

Young (2011) developed a CBT approach — CBT-IA — that focuses specifically on internet addiction. It combines CBT with harm reduction therapy in order to address the underlying issues that may accompany the addiction. The first step is behavior modification to reduce the amount of time spent online; the second involves cognitive therapy to address the denial and rationalization that often accompany addiction; and the third involves harm reduction therapy to address co-existing issues.

Group Therapy

Group therapy promotes interpersonal healing and peer support. Participants share their stories, concerns, and struggles, and provide mutual encouragement because they are all navigating similar experiences. This process removes the stigma and shame associated with a given issue and helps normalize it, making individuals less afraid to confront their problems directly. Group therapy would be particularly beneficial for this client because he feels isolated and wants to talk about his situation but is afraid to do so. Exposure to the support of others — including those who may be older and further along in recovery — could boost his confidence and help him break out of his social isolation and depression.

McKeague (2014) notes that "shame is the core affect of sex addiction" (p. 203), and so it can be helpful for the client to realize that his experience is not abnormal — and this is precisely where group therapy can play a critical role: it brings people with similar issues together so that they can speak openly and support one another in confidence (Park et al., 2016). Group therapy also helps reduce the stigma of addiction and supports individuals in overcoming the depression associated with it (Pluhar et al., 2019). Haney (2006) likewise stresses the importance of normalizing pornography addiction for teenage clients, as "many teenagers who are developing compulsive pornography problems do so in agonized isolation, often believing that they are perverts and alone in their actions" (p. 50). This description closely matches the way the client describes himself. It is therefore important that he not feel so alone or isolated. Group therapy could, for this reason, be a tremendous aid in helping him confront this issue directly.