♂️♀️Sexual Addiction
Here is a summary of the “Sex addiction as Affect dysregulation” book by Alexandra Katehakis, focusing on the most practical aspects for both individuals seeking recovery from Sex Addiction (SA) and the professionals who treat them.
Understanding and Treating Sex Addiction: Practical Guidance
The sources present Sex Addiction (SA) as a complex disorder stemming from affect dysregulation and early relational trauma, impacting the body, brain, and mind. Treatment, particularly through the Psychobiological Approach to Sex Addiction Treatment (PASAT), integrates various modalities to address both symptoms and underlying causes, promoting holistic healing.
For Individuals Seeking Recovery from Sex Addiction
If you are struggling with problematic sexual behaviors, understanding the nature of SA and the steps to recovery can be profoundly helpful.
Understanding SA:
1. What it is:
SA is described as a "pathological relationship with a mood altering experience", a chronic disease of brain reward, motivation, memory, and related circuitry. It's characterized by an inability to consistently abstain, impaired behavioral control, craving, diminished recognition of problems, and dysfunctional emotional responses.
2. Its Roots:
SA often originates from early developmental and relational trauma, such as abuse, neglect, or shame-humiliation, leading to deficits in affect and self-regulation. The seeking of sexual experiences becomes an attempt to manage intense emotional pain or numbness that you may not even consciously recognize.
2. The Cycle:
You might experience a repetitive cycle where shame leads to fantasy, ritualized sexual acting out, followed by sadness, despair, or guilt, which in turn perpetuates the cycle. This continuous seeking of arousal can eventually lead to dysphoria, where once-thrilling experiences become mere necessities, overshadowing other joys in life.
4. Your Internal World:
You might have core beliefs rooted in shame, such as "I am basically a bad, unworthy person" or "My needs are never going to be met if I have to depend on others".
5. Initial Steps in Recovery (PASAT Approach):
A. Admitting the Problem:
Often, the motivation for seeking help comes from being "caught" or experiencing significant negative consequences like job loss or relationship damage. Recognizing the impact your behavior has had on yourself and others is a critical first step.
B. Initial Abstinence (Celibacy): A mandatory period of abstinence from destructive sexual behaviors is usually the first step to ensure your safety and begin uncovering the issues driving the addiction.
This period, whether seen as agonizing or liberating, helps your brain recalibrate and heal. You might experience withdrawal symptoms like depression, anxiety, and irritability.
C. Joining a 12-Step Program:
This is a vital component for sexual sobriety. The community and shared experiences in these groups significantly reduce shame and help challenge those core negative beliefs. You are encouraged to find a sponsor (a mentor) and make outreach calls to other members.
D. Creating a Targeted Plan for Sobriety:
Work with your therapist and 12-step sponsor to explicitly list behaviors you must stop, triggers to watch for, and new healthy behaviors to pursue. This plan is personalized to your unique situation.
E. Understanding the Neurobiological Basis:
Learning that SA is a neurobiological disorder, rather than a moral failing, can be a great relief, helping you understand your struggles are rooted in brain function rather than simply being "insane or evil".
F. Practicing Self-Compassion:
Learn to treat yourself with kindness, acknowledge your pain as a universal human experience, and practice mindfulness. This helps to manage difficult moods and encourages self-improvement.
6. The Treatment Process and Long-Term Healing:
A. A Holistic Approach:
PASAT combines Cognitive-Behavioral Therapy (CBT), which is a "top-down" approach focusing on changing negative thoughts and behaviors, with relational psychotherapy, a "bottom-up" approach that focuses on healing the underlying trauma through your relationship with the therapist.
B. Deeper Healing:
As you maintain sobriety, the focus shifts to addressing the deep-seated emotional wounds and affect dysregulation. This involves reconnecting with your bodily sensations and feelings, learning to recognize, track, and tolerate them in a safe therapeutic environment.
C. Long-Term Stages:
Recovery is a process with stages including Crisis/Decision, Shock, Grief, Repair, and ultimately, Growth. Full recovery, leading to neural and psychological integration, can take 3 to 5 years.
D. Restoring Your Life:
The ultimate goal is to restore social, sexual, and spiritual relationality.
This includes developing a healthy sexual self, rooted in acceptance, attachment, responsibility, and emotional empathy, rather than using sex for self-soothing or escaping pain.
You will learn to redefine your sexuality positively, free from shame and compulsion.
For Treatment Professionals
Treating Sex Addiction requires a nuanced, holistic, and relationally informed approach that addresses the intricate interplay of psychological, neurophysiological, and social factors.
1. Conceptualizing Sex Addiction:
A. Chronic Brain Disorder:
Understand SA as a dysfunction involving reward, motivation, memory, and related brain circuitry, similar to substance addictions.
B. Affect Dysregulation and Attachment:
Recognize that SA is fundamentally a disorder of affect dysregulation stemming from early, often traumatic, attachment experiences that have misshaped the developing brain, particularly the emotion-processing right brain.
C. The Primacy of Shame and Seeking:
Trait shame (deeply ingrained and dissociated shame) is a bedrock of SA, perpetuated by the addictive cycle. The seeking system, driven by dopamine, is the true force behind the compulsion, often overriding rational thought.
D. DSM-V Context: While not officially listed as a disorder in the DSM-V, SA presents with criteria mirroring other addictions. It can be conceptualized as an impulse-control disorder.
E. Assessment (Collaborative Assessment Method - PASAT):
First Intervention: The assessment itself is a powerful intervention. It should be collaborative, immediately offering the patient a sense of control and reducing shame.
Therapist's Self-Awareness: As a clinician, you must be highly attuned to and reflective of your own bodily sensations and emotional responses (somatic countertransference). This internal sensing provides crucial clues to the patient's implicit (unconscious) experience.
Comprehensive Inquiry: Go beyond surface behaviors. Ask explicit questions about sexual activities, types of pornography, frequency, triggers, and the affective context of their behaviors. Use scaling questions to help patients locate and describe physical sensations and emotional arousal.
Partner Involvement: Encourage partner involvement from the initial assessment, if safe. Partners of SAs often experience significant trauma reactions (acute stress, PTSD-like symptoms) that need to be acknowledged and validated, not pathologized as "codependency". Early joint sessions should be structured as "strategy sessions" focused on concrete concerns and stabilization.
F. Identifying Underlying Dynamics: Look for evidence of shame, rage, core beliefs, insecure/disorganized attachment styles, and co-occurring disorders. The absence of guilt or remorse can indicate deeper narcissistic or antisocial traits.
2. Treatment Protocols (PASAT):
A. Integrated Approach: PASAT seamlessly blends CBT (a top-down, left-brain approach for symptom reduction and challenging cognitive distortions) with relation-based psychotherapy (a bottom-up, right-brain/body approach for healing underlying trauma and affect dysregulation).
B. Initial CBT Phase: Focus on directive, task-oriented work to establish sexual sobriety through abstinence and strict adherence to a Targeted Plan for Sobriety (or "Circle Plan"). Utilize 12-step programs to foster community and address distorted thinking ("stinkin' thinkin'").
C. Relational Psychotherapy Phase: Once behaviors are contained, shift to deeper, affectively focused work. This involves:
Coregulation: Actively engage in a "dyadic dance of feelings" with the patient, providing interactive regulation through your presence, empathy, and attunement. This helps the patient develop their own self-regulatory capacities.
Pure, Present Awareness: Maintain a nonjudgmental, moment-to-moment presence to perceive and respond to the patient's implicit, nonverbal communications (gaze, tone, posture, facial expression).
Therapist's Use of Self: Be willing to disclose your own affective experiences in the moment (affective self-disclosure) to deepen connection and make the patient's implicit feelings explicit. This models vulnerability and trust.
D. Managing Transference and Countertransference: These are inevitable, especially erotic transference and countertransference, given the nature of SA. Do not ignore them; instead, process them openly and constructively, using your own reactions as valuable clinical data. Acknowledge and explore these dynamics while maintaining therapeutic boundaries. Be mindful of potential "seduction" (emotional or professional idealization) that can derail treatment.
E. Rupture and Repair: Recognize that therapeutic ruptures (enactments) are inevitable and can be powerful opportunities for growth and healing if acknowledged and repaired collaboratively.
Mindful Body Awareness: Guide patients to focus on their bodily sensations to access dissociated affect and integrate mind and body.
Amplifying Play States: Introduce elements of play and vitality into therapy to help patients reconnect with spontaneous, joyful experiences outside of their addictive patterns.
Working with Partners: Refer partners to qualified specialists and support groups. Acknowledge their trauma, normalize their reactions, and facilitate a structured disclosure process (including impact letters and letters of atonement) before considering couples therapy.
Addressing Comorbidities: Be aware that SA rarely occurs in isolation and often co-occurs with depression, anxiety, personality disorders, and other addictions (e.g., gambling, eating, drugs). Chemical dependency should be addressed first.
- Avoiding Iatrogenic Harm: Do not dismiss SA as "not a real addiction" or minimize its impact. Avoid judgmental, shaming, or blaming attitudes, which can damage the therapeutic alliance. Be aware of your own biases and triggers.
By understanding these practical aspects, both those seeking healing and those providing it can navigate the challenging, yet ultimately transformative, path of recovery from Sex Addiction.