Addiction is medicating underlying shame with entitlement and grandiosity. –Terry Real
Many people seek recovery for compulsive sexual behavior or sex addiction. As much as ten percent of men and seven percent of women suffer from distress due to their sexual behaviors. The Karuna Healing approach is to focus on the healing that is required in sex addiction recovery.
For the person struggling with their sexual behavior, distress over their acting out can cause depression, anxiety, toxic shame, and even suicidal thoughts. Many feel like they continue to act out against their values and can’t seem to stop no matter what they do. Frequently if there is a spouse or partner involved, sex addiction can cause significant relationship stress and trauma experienced by the partner.
I acted out in sex addiction and created chaos for my family for many years. I know that depression, shame, and suicidality. After many unsuccessful attempts to quit, several rounds with 12 Step groups, expensive outpatient programs, and shuffling through many different therapists, I finally found an approach that led to the deep healing I needed for long lasting recovery from sex addiction.
Traditional sex addiction recovery treatments didn’t resonate with my experience. Twelve Step Groups. Cultivating motivation. CBT (cognitive behavioral) therapy primarily centered on navigating triggers. Periods of sobriety would intersperse my journey, occasionally spanning several months or even surpassing a year during moments of heightened motivation. Nevertheless, I’d invariably stumble.
I use a metaphor of someone standing on the ocean floor some distance out from the shore where the water is up to his neck, jumping waves to stay above the water line. Traditional sex addiction recovery methods strengthen the ability to jump. But eventually the person will get tired or a wave will come that’s just too strong. Treating the trauma and attachment insecurity will help a person grow so much that the waves become small. They splash harmlessly at your knees.
After I found long lasting healing, I became obsessed with developing the optimal approach to sex addiction recovery. I read every book and journal article on sex addiction, listened to every podcast, then expanded it to addiction in general, then to other psychology fields, and finally decided to go back to school and get the formal training to understand all the mental health, brain science, and addition recovery principles involved in sex addiction recovery.
These are the components of the Karuna Healing approach to sex addiction recovery, which incorporates my personal experience with the best practices in the industry:
Psychoeducation around Trauma, Brain Science, and Neuroplasticity
Healing trauma is vital to long term success in sex addiction recovery. Trauma is stored in the parts of the brain and body that are below are pre-frontal cortex and our ability to understand it consciously. Trauma shows up in those struggling with sex addictive behavior as automated thoughts and emotional triggers that are happening sub-consciously, driving us to act out sexually. Traditional CBT often is successful in making short term change, but it’s very difficult to translate that to permanent change, because CBT involves the pre-frontal cortex only. I can tell my brain all day long that “sex is not my most important need” and that “I’m a worthwhile, lovable person”. But the parts of the brain where those trauma messages are stored are not easy to access with traditional therapy. Our therapy is aimed at trauma recovery. It’s not the talk therapy where we talk about our childhood endlessly and nothing gets resolved and we feel worse.
Trauma results in our brains being disintegrated (meaning compartmentalized, ie not integrated). Trauma results in neural pathways that block mental flexibility making it very difficult to think through a trigger and act according to our values instead of acting out sexually. The brain and body has a remarkable self-healing ability built in to heal this trauma, called neuroplasticity. EMDR is a powerful therapy modality for trauma processing.
Neuroplasticity is our brain’s ability to build new neural pathways that undo the damage of trauma. All of our approaches: mindfulness, self-compassion, IFS, attachment repair are aimed at building these neural pathways that heal trauma. We use guided meditations to access the limbic brain and somatic experiencing to feel the therapeutic healing not just talk about it where it remains “all in our head”.
Mindfulness, Mindfulness-based therapies (ACT, DBT, Tara Brach’s MBCT)
Mindfulness is the most important piece of our approach and building block of all the other components. Mindfulness is the ability to sit still, focus on an object like the breath, and note when your brain starts to wander, bringing it back to the breath. This simple skill is so powerful. It helps increase the “window of tolerance”, the time between a trigger and acting out. Mindfulness is the most proven way for neuroplasticity to take place, literally healing our brains that have automated responses to deal with triggers.
ACT, Acceptance and Commitment Therapy, is the only approach to sex addiction recovery that has proven, clinical results. Put simply, CBT (the most popular therapy modality) therapy would be to explore why I think I need to act sexually. ACT therapy would be to build the skills to simply acknowledge the distress I have of wanting to act sexually and sit with the distress knowing it will go away. It’s not as difficult as it sounds. And it works.
Mindfulness and meditation skills are the building block of all the other Karuna Healing methods.
IFS — Internal Family Systems
IFS therapy is especially good in clients who have internal conflict or compartmentalization issues. Part of me wants to watch porn. Another part of me wants to keep my promise not to watch porn. You may think you have decided once and for all. No more porn. But there’s a part in you, underneath your conscious awareness, that didn’t buy in. He’s saying nope, no, I didn’t agree to that. And you’re doing well for a few days or a few weeks and then something happens to trigger that part to come out, and good game, it’s over. You’re acting out again.
In IFS therapy, we isolate each part and work with it. The goal is not to get rid of the “bad” parts. There are no bad parts in IFS. Each part is doing a job that it thinks is good.
We get to know our parts, listen to them, validate them, love them, show them compassion, show them we are more mature and capable than they might have assumed, and over time the parts naturally become less extreme and easier to work with.
IFS is absolutely ground-breaking in sex addiction recovery. I highly recommend IFS therapy, especially if you have tried therapy before or you are on your second or third unsuccessful attempt to quit your unwanted sexual behaviors.
In the 1970’s, John Bowlby and Mary Ainsworth did the research and created the Attachment Theory in psychology. The basic idea is that we attach as babies to our mother and father. If everything goes well, you become, with 60% of Americans, a securely attached adult. If it doesn’t, like the other 40%, you have insecure attachment.
Insecure attachment causes problems with emotion regulation, impulsivity, and stability in relationships. Though it accounts for 40% of the total population, if you look at populations of those with addictions, severe depression or anxiety, or personality disorders, it accounts for 90% of those populations.
But the good news is that you can heal your attachment insecurity—called earning secure attachment. The traditional approach to heal attachment insecurity is the therapeutic relationship. The therapist acts as a proxy to the parent and models healthy attachment: empathy, attuning to needs, expressing delight in successes, soothing, teaching healthy boundaries. This takes a long time and doesn’t always work.
I trained in and teach the method IPF (Ideal Parent Figure Protocol) from the late Harvard Psychiatry Professor Dan Brown. I use IFS, this IPF method, and principles from Kristen Neff and Tara Brach’s compassion-based techniques to teach the client to take the therapist role to reparent himself.
Insecure attachment is generally caused by trauma. And though trauma can sometimes be very difficult to treat, one can essentially heal the effects trauma through attachment repair.
Psychoeducation in sex addiction models
I am trained in the Carnes CSAT (certified sexual addiction therapist) model. I am also trained in the Douglas Braun-Harvey OCSB (out of control sexual behavior) model. I take the best of both models.
We should not minimize the serious consequences sexually acting out can cause self and partner and family. Partner empathy is critical. However, some people have more distress due to sex addiction recovery than sex addiction. Sexually acting out is a symptom of trauma and other issues like anxiety and attachment insecurity. Therapy and recovery should be focused more on healing the underlying issues than over-focused on the outward symptom of sexual acting out.
Many people have a moral conflict over their sexual behavior, and that moral conflict needs to be worked out in therapy. The client working together with their partner sets their sexual values and agreements. The focus is on healthy sexual expression that avoids an addictive or dependent element. When our client is in a relationship, we work out sexual agreements and those are kept. If there is a breach, that must be communicated to the partner within certain time.
It is said “addiction is an intimacy disorder”. I would change that to “addiction is an attachment disorder”. There are two really important factors involved in sex addiction recovery when it comes to someone in a relationship.
- Partner Empathy. The deeper a person in recovery from unwanted sexual behavior can feel for their partner’s pain over his or her sexually acting out, the better their recovery prospects are. In order to do this, we first must work on shame enough to have the ability to do that. Our compassion-based ACT exercises and IFS work are instrumental in developing that ability to face the huge impact our sexual acting out has caused without being consumed by the shame.
- Relationship Skills. Understanding boundaries, mastering communication and conflict management skills, bolstering attachment security to avoid relationship sabotage. It’s offensive to the betrayed partner to imply their relationship was the reason the betrayer is acting out. It’s not. But if the betraying partner can have a more mature ability to be in a relationship, it will help the magnitude of daily triggers to feel more like a 4.0 than a 7.0 on the sex addiction trigger Richter Scale.
The goal of a therapist should be to get himself fired. We teach you the methods that over time, you can become your therapist. Therapy is a life-long venture, but you’ll become that therapist for yourself eventually.
Karuna is the Buddhist word for compassion. Compassion is a theme in every approach we take. Compassion, compassion, compassion. Compassion for ourselves. Compassion for others.
How do I know if I’m making progress?
How many weeks or months of sobriety is a poor indication of long-lasting healing and recovery.
My clients experience healing as a reduction in reactiveness, increased calmness and inner peace. They have increased empathy for their partners. They have compassion for themselves and others. They are kinder, gentler people. When cut off in traffic, they are chill. When the amygdala response comes and the heartbeat starts to elevate, they can slow down, breathe, look inside and see what their parts are doing, breathe compassion and soothe themselves. That’s the healing you can find.
Progress like this can be found in as little as a few months with some good work. This kind of work will help us “stay sober” when triggers come that tempt us to go against our sexual values, even if those triggers are coming fast and furious.
Healing our attachment wounds and undoing the negative core beliefs that determine how strong and how often those triggers come is deeper work that might take more time. Six months to a year for some is a good timeline for this. For others, the work may be several years or more. But this does not mean you are doomed to hell (you or your partner) until that work is complete. You can feel a lot better within a few months. This is the “icing on the cake” kind of healing that will help the addiction fade away.