It’s difficult to find a good online sex addiction therapist. Sex addiction, also known by the diagnosis compulsive sexual behavior disorder (CSBD) included for the first time in ICD-11, is defined as compulsively engaging in sexual behavior despite negative consequences often accompanied by repeated, failed attempts to stop.
About 4% of the population meet the criteria for CBSD—about 8% of men and 2% of women. Consequences of sex addiction can be serious: relationships, financial and career, and psychological distress including suicidal ideation. Since sex addiction was popularized by Patrick Carnes in the 1980s, we still know very little about effective treatment. According to a meta-analysis, only 3.5% or 15 of 415 peer-reviewed articles on sex addiction in the previous decade focused on treatment.
What to call this condition and whether to allocate a diagnosis to it has been a politically charged notion for the past several decades. The International Institute of Trauma and Addiction Professionals (IITAP), the governing body for the popular CSAT (certified sex addiction therapist) certification favors the term sex addiction. But this term has not been well received by the medical community. Ley in his book “The Myth of Sex Addiction”, representing many in the American Association of Sexuality Educators, Therapists, and Counselors (AASECT) promoting a more sex-positive culture argued that sex should not be considered an addiction and that sex addiction therapists were unnecessarily shaming clients in treatment. Various alternative frameworks for sex addiction have been explored but none seem to be perfect: hypersexuality disorder (this implies a high level of frequency of sexual behavior which is not always the case), compulsivity disorder (not perfect because compulsion is usually reserved for behaviors that are not pleasurable), impulsivity disorder, “problematic” sexual behavior, or “out-of-control” sexual behavior.
Comorbidities in sex addiction
Similar to Tolstoy’s famous description of families, “All happy families are alike; each unhappy family is unhappy in its own way,” sex addiction clients are all different in their own way. Common themes are prominent, but sex addiction counselors should resist the temptation to apply a “one size fits all” approach to sex addiction recovery.
Sex addiction is often conceptualized as a symptom of another underlying mental health disorder. Comorbidity with other mental disorders is common in sex addiction. A study found the following comorbidities in those seeking treatment for sex addiction:
Any mood disorder: 41% (major depression 43%, bipolar 7%)
Any anxiety disorder: 40% (GAD 13%, PTSD 13%, panic 6%)
Any substance-abuse disorder: 41% (alcohol 33%, marijuana 10%)
Other impulse-control disorder: 24% (gambling 20%)
ADHD: 19% – 27%
An effective treatment plan should include assessment and treatment of a wide variety of mental health disorders, especially depression, anxiety, ADHD, and substance abuse.
Braun-Harvey and Vigorito (2015) emphasized the importance of addressing three aspects in the treatment of out-of-control sexual behavior: emotion regulation, moral incongruence, and attachment insecurity.
Emotion regulation is the most common and most immediate issue to treat in sex addiction. Most sex addiction counselors do a pretty good job handling this. Sex addiction is most often conceptualized as an attempt to self-medicate negative emotions. Most of the research has focused on this aspect. ACT and CBT (especially mindfulness-based CBT) are proven therapy modalities for emotion regulation.
There have only been two randomized studies proving a successful approach to sex addiction recovery in the last 10 years. One of them was a study by Crosby and Twohig that showed the effectiveness of the therapy modality Acceptance and Commitment Therapy, which is heavily based on mindfulness. Their participants experienced a 93% reduction in porn viewing and significant improvement in mental distress. The second study showed positive results for group-administered cognitive behavioral therapy (CBT). Much of their material overlapped with the Crosby and Twohig ACT group (mindfulness, urge-surfing, values work, etc) , but also included CBT related to understanding behavioral patterns and cognitive distortions. Their participants showed a 20% reduction in symptoms and 23% decrease in sexual compulsivity measures compared to a waitlist group.
Mindfulness and ACT or mindfulness-based CBT should be an essential element of every sex addiction counselor’s treatment plan.
Despite CBSD only affecting 4% of the population, Joshua Grubbs found that 18% of men self-identify to some degree as suffering from sex addiction, despite not engaging in behaviors considered to meet the CBSD threshold. This gap is explained by the concept that many suffer intense psychological distress and relationship consequences related to conflict over moral and religious values and one’s sexual behaviors, resulting in the concept of a “perceived sex addiction”.
This concept of moral incongruence might explain the findings of Rory Reid. In his study, 70% of men seeking treatment for sex addiction had high rates of ambivalence, meaning they expressed both the desire to quit sexual behaviors and a desire to continue to engage in the behaviors.
This dovetails nicely with the founder of the therapy modality Internal Family Systems (IFS) Dick Shwartz’s view of the human psyche being comprised of “parts”. We commonly use language like “part of me wants to do this while part of me wants to do that”. Sex addiction patients often describe their internal mental landscape in that way, citing a struggle between a part of them that wants to be “good” and a part of them seems to take over and indulge in problematic sexual behavior. They often say they compartmentalize their feelings for their partner while acting out. This is a mild form of disassociation. In Cece Sykes groundbreaking book “Internal Family Systems Therapy for Addictions: Trauma-Informed, Compassion-Based Interventions for Substance Use, Eating, Gambling and More” she illustrates the process of using IFS in an addiction setting. The client may understand the goals as “killing off the bad part and keeping the good part”, but the more effective method is to befriend, listen to, validate, nurture, heal, and integrate these parts.
This is an area that’s a blind spot for many sex addiction therapists. Most of us are trained effectively how to treat a patient suffering with sex addiction who is highly motivated. But many of us are not equipped to work with clients experiencing a high degree of ambivalence. Especially when this ambivalence manifests itself through “parts” where the “good” acting part is the one that shows up for therapy while the “bad” acting part lurks inside. I use square quotes for these, because I believe there are no bad parts. Our “bad” parts mean well, but they are misguided and acting from trauma.
Another construction of sex addiction is that it can be described as a coping mechanism for insecure attachment. Attachment insecurity affects only 40-50% of the general population, but 88-95% of sex addiction clients have insecure attachment. This is another area where a person looking for a good online sex addiction counselor might struggle. A very good sex addiction therapist will treat trauma and attachment but it’s not common or always done effectively.
This statement from Patrick Carnes’ core beliefs of a sex addict is especially applicable “No one could love me as I am.” But you might feel like you’re constantly looking for reassurance that someone will. The sexual behavior or pornography consumption is likely an attempt to satisfy that need.
An important finding of Kotera and Rhodes is that to date, sex addiction treatment has been focused on CBT, which has little emphasis on attachment security. Their study explored the relationship of sex addiction, attachment insecurity, self-compassion, and narcissism. Clients that improved scores in attachment security and self-compassion were associated with decrease in sexual compulsivity and narcissism. Therapeutic interventions that address attachment security could be added to increase the effectiveness of sex addiction treatment. I use IFS and a resourcing mentalization common in attachment-based EMDR, the Ideal Parent figure protocol, (Parra et al., 2017; Wesselmann et al., 2012) to heal attachment wounds and help sex addiction patients move to earned secure attachment.
Shame is a huge aspect of sex addiction. Reid et al. found that shame more than other negative emotions like depression, fear, or boredom was the biggest factor in men turning to sex addiction behaviors or relapsing after recovery started. They studied the effect of self-compassion and found that self-compassion was a mitigating factor for shame, and that men with high levels of self-compassion were more able to manage their sexual compulsivity. An effective treatment plan should have reducing shame and increasing self-compassion as a core element.
In conclusion, finding a good online sex addiction therapist can be a challenging task, as the field is still developing and the understanding of the condition is constantly evolving. Sex addiction affects a significant portion of the population and can have serious consequences on relationships, finances, careers, and mental health. It is essential for therapists to address the various aspects of the condition, including emotion regulation, moral incongruence, and attachment insecurity, in order to provide effective treatment. Mindfulness and Acceptance and Commitment Therapy (ACT) or mindfulness-based Cognitive Behavioral Therapy (CBT) have proven to be effective in treating emotion regulation, while Internal Family Systems (IFS) therapy can address moral incongruence and ambivalence.
Additionally, focusing on attachment security and self–compassion can help clients manage their sexual compulsivity and reduce shame. As the field of sex addiction therapy continues to grow and evolve, it is crucial for therapists to stay informed about the latest research and treatment modalities in order to provide the best possible care for their clients. By addressing the various aspects of sex addiction and tailoring treatment plans to each individual‘s unique needs, therapists can help clients overcome their struggles and lead healthier, more fulfilling lives.
Why Sex Addiction Therapist Online?
In today’s digital age, seeking an online sex addiction therapist has become not only more accessible but also a necessity for many. The very nature of sex addiction, often shrouded in secrecy and shame, can make the idea of in-person counseling intimidating for some. Opting for online therapy offers a level of discretion and privacy that can’t always be achieved in traditional settings. Furthermore, it eliminates geographical barriers, granting access to top-tier therapists regardless of one’s location. This virtual approach is especially relevant given the global nature of the internet where many of the addictive behaviors can manifest.
Moreover, online therapy presents a cost-effective option, often requiring less overhead and potentially reducing transportation and time-off costs for clients. The digital platform also provides a permanent record of therapy sessions, allowing clients to revisit and reflect at their convenience. In addition, the flexibility of online sessions allows for tailored scheduling, making therapy more adaptable to individual lifestyles and reducing the likelihood of missed appointments.
With the increasing efficacy of online therapeutic modalities like ACT, CBT, and IFS, digital platforms are proving just as impactful as in-person sessions. Lastly, the online environment may foster a greater sense of safety, enabling clients to open up more freely about their struggles, ensuring a deeper and more holistic healing process. As the realm of sex addiction therapy evolves, online counseling is solidifying its role as an indispensable tool for comprehensive recovery.
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Rob Terry is a therapist for clients in Utah and coach for clients outside of Utah and across the globe. He specializes in sex addiction recovery for individuals and couples. He integrates the CSAT, OCSB, and Minwalla models for individual recovery and Gottman Method, RLT, and ERCEM for couples recovery. He is betrayal trauma informed. His therapy modalities are IFS, ACT, CBT, EMDR, and Attachment Theory.