Treatment Approach with Sexual Addiction
Written by Katie Whiting, MS, LMFT, July 10, 2021
Abstract Summary
Treasure Valley Therapy, LLC, has therapists who specialize in treating sex addicts. No matter where a client is on the continuum of severity for sexual addiction, Treasure Valley Therapy, LLC, treatment approach is applicable. We utilize psychological education, trauma work, and real-life application to help clients with compulsive sexual behavior. We integrate 12-step addiction work with Eye Movement Desensitization and Reprocessing (EMDR) treatment protocols and other therapeutic interventions to guide clients toward living a life of recovery and healing their relationships.
Psychological education
The more knowledge and understanding clients have, the more capable they are to heal and change their lives. Spending time learning about the addiction cycle, their personal triggers, and relapse-prevention plans will equip clients with tools to add to their toolboxes. When they are able to apply the knowledge gained, they aid themselves in successful lifelong recovery.
Trauma work
Addiction recovery focuses on trauma. Clients sexually act out to escape current and historic points of pain and shame. Completing a full disclosure, addressing experiences from childhood, and working through shame is the next phase of therapy work after psychoeducation. Utilizing the knowledge gained, clients heal from the traumas that have kept the addiction alive.
Real-life application
It is vital that clients leave therapy with life skills and resources they can lean on to live a life of recovery. Personal boundaries are vital to an addict’s recovery as well as knowing how to honor the boundaries of those around them. Clients are highly encouraged to attend a 12-step group outside of therapy and work the steps alongside what they experience in session. The most important tool and skill clients walk away from therapy with is the stronger ability to empathize with those around them and have healthy connections that are not based in sexuality.
The sexual addiction work we offer is thorough. Often for the client, it can feel like a second job, requiring lots of time outside of therapy to accomplish goals established. When clients fully apply themselves to the process, lasting change can be experienced. Ultimately, it is up to the client and how much they invest. We feel honored to be a part of clients’ healing journeys and know it is possible to live a life of recovery, constantly striving one day at a time to overcome lust and experience change.
The following provides a more in-depth look at the treatment of sexaholics.
Sexual Addiction Treatment
Treasure Valley Therapy, LLC, has therapists who specialize in treating sex addicts. No matter where a client is on the continuum of severity for sexual addiction, Treasure Valley Therapy, LLC, treatment approach is applicable. We utilize psychological education, trauma work, and real-life application to help clients with compulsive sexual behavior. We integrate 12-step addiction work with Eye Movement Desensitization and Reprocessing (EMDR) treatment protocols and other therapeutic interventions to guide clients toward living a life of recovery and healing their relationships.
Psychological Education
The more knowledge and understanding clients have, the more capable they are to heal and change their lives. Spending time learning about the addiction cycle, their personal triggers, and relapse-prevention plans will equip clients with tools to add to their toolboxes. When they are able to apply the knowledge gained, they aid themselves in successful lifelong recovery.
Addiction Cycle
At Treasure Valley Therapy, LLC, we use the following addiction cycle to bring awareness to the client. Real life involves pain and shame. Addicts have not learned healthy ways to cope with pain and shame. In order to avoid the triggers, addicts enter preoccupation, which is “I don’t like how this feels; I want to escape it.” In this stage, clients preoccupy their mind with T.V. shows, video games, and other mind-numbing activities. Preoccupation only lasts so long before it leads to rituals that are permission-giving thoughts and slipping behaviors, ultimately setting the stage to act out. Acting out the high-inducing behavior is the paramount momentary escape. This is unique to the client including many potential unhealthy sexual behaviors from masturbation to paying for prostitution. Hiding and secrecy follows acting out. Shame keeps the addict isolated. They fear being discovered. Hiding includes deleting web history, making up stories for their time, and other secrecy behaviors. Which brings them right back to pain and shame. The original pain had a temporary release through sexual behavior. When the high wears off, the pain and shame is greater.
Therapeutically assisting clients in understanding how the addiction cycle has played out specifically in their life is one of the first steps taken in therapy. Arming them with this knowledge challenges the denying and hiding they have done with themselves. Being able to recognize when they are in the beginning stages is empowering to stop and turn toward healthy coping before reaching another relapse. Thus, familiarity with how the stages look for them is vital for recovery.
A common goal for addicts is to establish exits with their cycle before reaching pain and shame squared. Clients master how to stop themselves and apply the exit strategies, which often involve emotional regulation skills. These skills are used outside of therapy to cope in healthy ways and inside of therapy when trauma work becomes the focus.
Emotion and Sexual Triggers
Earnestly coping with triggers is another important recovery milestone. Emotional triggers are often negative core beliefs (I am inadequate, I can’t do anything right) that are provoked in everyday situations. Being exposed to a sexual situation (finding someone attractive at the grocery store, watching a sexually suggestive T.V. scene) is a sexual trigger. Both types lead to emotional pain and shame or lust, inviting clients back into their addiction cycles.
Spending multiple sessions identifying what these triggers are for each individual client provides more empowerment towards healing. Once awareness is increased and clients can understand what is happening, they can respond to the triggers in healthy ways. There are three core coping skills we teach: the surrender process, engaging mindfulness, and wholesome self-talk.
As clients create new habits of responding to triggers in a healthy way, the rate of being triggered frequently decreases. They are able to work through the pain and shame instead of getting sucked into their addiction cycle of escape. Consequently, they progress on their recovery path.
Relapse Prevention
It is rare that an addict stays completely sober the day they decide to start working recovery. Relapse is often part of recovery work. We consider unhealthily coping with triggers to be a slip and a relapse to be crossing the bottom line clients establish. Here are a few examples of bottom lines: lying to a partner, viewing pornography, having sex (including masturbation) outside of a committed monogamous relationship, etc.
When a slip or relapse happens, the information is used to further explore and fill in the client’s addiction cycle. The experience is also examined thoroughly via our relapse prevention plan. This plan looks at the triggers and emotions involved with the relapse before outlining what the acting-out ritual and behaviors were. Shame is challenged through acknowledgment. The client challenges the permission-giving thoughts with alternative mantras to apply in the future. Recognizing where points of intervention could have been taken is also vital to prevent another relapse. Gaining more awareness of risky behaviors provides a chance to establish personal boundaries that will redirect clients toward recovery.
Working through relapses provides more information for the client and therapist. This knowledge commonly identifies points of healing to focus on during the trauma work phase. These plans provide space for addicts to learn more coping skills and practice accountability.
Trauma Work
Addiction recovery focuses on trauma. Clients sexually act out to escape current and historic points of pain and shame. Completing a full disclosure, addressing experiences from childhood, and working through shame is the next phase of therapy work after psychoeducation. Utilizing the knowledge gained, clients heal from the traumas that have kept the addiction alive.
Full Disclosure
Whether a client comes in with their partner or individually, at Treasure Valley Therapy, LLC, we have all addicts complete a full therapeutic disclosure document. A disclosure is a written narrative of the client’s life of addiction, including compulsive sexual behaviors, lying habits, trauma experiences, and emotional regulation patterns. This process takes many weeks. The content is edited and processed with the therapist throughout.
With the document are accountability statements, recognition of core beliefs, emotional triggers, denial forms, and negative experiences. All of which have contributed to the addiction. It is an honest and accurate account. Disclosures give space to empathize with their partner and commit to recovery. At the end addicts also answer questions that the partner previously prepared. The full disclosure is shared in a two-hour session after a preparation session.
Creating the full disclosure is hard therapeutic work. Clients learn how their addiction started, progressed, and fluctuated. There is a clear picture of the real problem: lack of connection. With this understanding, clients move to a space where they can foster real relationships. Having taken accountability for all they have done, the disclosure can serve as a reminder and motivation to live a life of recovery.
Addressing Childhood
Not everyone experiences big “T” trauma in their life (sexual/physical abuse, parents’ divorce, severe car accident, etc.) Everyone does experience little “t” trauma in their life (peer insults, internalizing a parent’s bad day, experiencing rejection, etc). If someone experiences no big “T” traumas but is exposed to repeated small “t” traumas, this can create the same emotional harm as a big “T” trauma, sometimes more.
When any kind of trauma is experienced in childhood, it has the potential to create unhealthy or maladaptive coping mechanisms. As similar events are experienced, the maladaptive coping is reinforced. Sometimes innocent childhood curiosity leads to the discovery of pornography and masturbation. Other times it is emotional distress. If acting out continues, it is the emotional distress that sustains the use of pornography and masturbation for addicts. This is a maladaptive coping mechanism frequently learned in childhood from either small “t” or big “T” trauma. As clients work on their disclosure and make other discoveries in session, emotionally charged experiences will come up. This creates the foundation to start EMDR work for addicts.
EMDR can be implemented to help release the emotional charge from different events and help the brain heal through digesting the experience in an adaptive way. Accessing the youngest memory can cause a chain reaction of healing. We use EMDR after a client has gained a certain level of sobriety and is confident in using coping skills already retained to help with emotional distress outside of session. EMDR is also utilized earlier to help build other resources to aid addicts in using recovery tools instead of slipping or experiencing another relapse.
Shame Work
Guilt and shame are often misunderstood. Shame is felt when an experience causes one to withdraw, isolate, and hide. Guilt is felt when an experience causes one to seek connection, forgiveness, and make amends. Shame drives disconnection where guilt seeks to repair connection. Shame is “I am bad” where guilt is “I did something bad.” Shame enables trauma where guilt empowers rebuilding. Addicts are often stuck in shame with things that can be healed with guilt. Helping clients see the difference is a vital part of recovery.
All addicts have specific acting out experiences that are accompanied with overwhelming shame. Additionally, shame finds its way into other areas of clients’ lives. Present shame is given power through damaging labels that are often self-given (I’m a freak, pervert, gross, bad etc.) Clients hide this shame through addict behavior, which often looks like pride, gaslighting, avoidance, denial, and ultimately acting out.
The biggest way we challenge shame is to let it be seen and not judged. This is accomplished by speaking it out loud in a therapeutic space. Seeing and speaking the shame can help transform it into guilt where it is needed. Clients are taught to practice self compassion and let go of the shame that does not serve an adaptive purpose. Healing shame from the past with EMDR while learning healthy ways to work through present shame teaches clients that they don’t need to escape these feelings through acting out. Thus, allowing themselves to turn toward connection instead of isolation.
Real-Life Application
It is vital that clients leave therapy with life skills and resources they can lean on to live a life of recovery. Personal boundaries are vital to an addict’s recovery as well as knowing how to honor the boundaries of those around them. Clients are highly encouraged to attend a 12-step group outside of therapy and work the steps alongside what they experience in session. The most important tool and skill clients walk away from therapy with is the stronger ability to empathize with those around them and have healthy connections that are not based in sexuality.
Boundaries
A beautiful way to create safety is through the help of healthy boundaries. We use two analogies to help illustrate what boundaries are. The first is that of a fence protecting a yard. Working in session, the yard will be defined (relationship, recovery, purpose of sex, etc.), and a fence (a boundary such as: I will work on the 12-steps daily, I will be transparent about slips) will be built around the yard to help keep it safe. The second analogy is that of a mountain road. There are guard rails to help prevent cars from going places they don’t want to go (repeating past mistakes such as: having an affair) and the road guiding them to where they want to be (becoming their ideal self such as: becoming physically active three times a week).
We utilize S.A. Lifeline Foundation’s 10 basic principles of healthy boundary setting, which are:
Good, decent people set boundaries.
Generous people set boundaries.
Boundaries allow others to grow.
Boundaries allow you to get more of what you want and less of what you don’t.
Effective people set boundaries.
You must stick to your guns.
Practice makes perfect.
Boundaries are about creating safety, not controlling others.
Boundaries are most effective when they are God-centered.
Boundaries need to be written down.
Addicts start with creating personal boundaries focusing on their behavior and what they need to do to protect and strengthen their ability to work recovery. Having personal boundaries creates more safety for the addict and provides space for them to rebuild trust with themselves. If the client comes in with a partner, the partner takes the lead with establishing relational boundaries. This helps build a foundation of trust and creates safety for both people to be present and emotionally invest in the relationship. The therapist takes the role of helping the couple follow through, adjust, and understand boundaries as it is needed.
12-Steps
In session we only briefly check in to see how the client is progressing with their 12-steps. Sometimes we will focus on the 12-steps when they are working through amends or if the client is struggling with a step. We allow outside groups to provide the support and direction that comes with working the steps. We want clients attending group right away as it is often a huge part of a successful recovery process. We also encourage working with a sponsor to encourage accountability and provide connection.
When clients work the 12-steps, attend a group, and work with a sponsor, they gain a support system and know they are not alone. They practice and learn connection and empathy with themselves and others in non-sexual ways. Connection with a Higher Power is another role the 12-steps and group provide. Without the help of a Higher Power, clients’ lives will continue to be unmanageable, as the first step references. Clients can define what their Higher Power is, whether that is God, Heavenly Father, Buddha, Mother Nature, Karma, Humanity, or the Cosmos. Having a connection with something that is bigger than oneself provides motivation, power, and humility.
Even after therapy is completed, the client’s sponsor, the 12-steps, the connection with group members, and the addict’s Higher Power will stay with them. Clients discover they can do the 12-steps continually to support their daily recovery and commitment to live a life of recovery. Our goal is to not have clients in therapy for the rest of their lives. We want them to gain the tools they need to live a happy, healthy, recovery-filled life. Utilizing groups and the 12-steps is part of what makes that possible.
Empathy and Connection
Subconscious isolation and narcissistic tendencies are a result of an addict’s inability to empathize and connect with other people. Empathizing is accessing emotions inside ourselves that another person is communicating they are experiencing. Empathy is not taking responsibility for another’s emotion nor is it trying to change what is being experienced. When we are able to put ourselves into someone else’s emotional perspective, we experience empathy. Truly taking the time to understand another’s emotional experience leads to connection, which is often called the opposite of addiction.
To truly be seen by another person and understood with compassion enhances the natural connection we all have with each other. Addicts offer false connection due to the fear of being discovered and underlying shame in who they are. They are often seen doing good or being extra nice after acting out. Gaslighting and manipulation are other behaviors used to distract from real connection. These addict behaviors often enhance a sense of pain and shame in clients. When on the road to recovery, addicts can set aside their unhealthy behavior. This gives space for them to enter vulnerability, which can be terrifying at first. If at this time they can be seen, not judged, and understood, they start to experience real connection again.
Using the therapeutic relationship, from the very beginning, we teach clients what real connection feels like without a sexual lens, hiding, or manipulation. After fostering safety and rebuilding trust, couples who come into therapy for sexual addiction and betrayal trauma have the opportunity to empathize with what the other has experienced because of the addiction. They can find true healing connections within their relationship, sometimes for the first time. This is one of the biggest gifts a couple can gain from therapy work as they strive to overcome the addiction and stay together. Throughout writing the full disclosure addicts spend significant time empathizing with those they have hurt or included in their acting out. Connection and empathy go hand in hand in the biggest and smallest of moments.
Conclusion
The sexual addiction work we offer is thorough. Often for the client, it can feel like a second job, requiring lots of time outside of therapy to accomplish goals established. When clients fully apply themselves to the process, lasting change can be experienced. Ultimately, it is up to the client and how much they invest. We feel honored to be a part of clients’ healing journeys and know it is possible to live a life of recovery, constantly striving one day at a time to overcome lust and experience change.
