Book Review: Neglect The Silent Abuser: How to recognize and heal from childhood neglect

Neglect: The Silent Abuser is a recent publication by respected psychotherapist Enod Gray.  The book seeks to provide information about the concept of neglect as well as provide some cursory steps to try to heal from the consequences of childhood neglect experienced by the readers.

Most people who come to therapy can recognize overt abuse.  Overt abuse is abuse that is obvious to the person or a form of abuse that is easily recognizable.  For example, physical or sexual abuse, though frequently minimized, are often identified as abuse.  Verbal abuse is something that people can sometimes have a harder time recognizing, but again, this type of abuse tends to be more overt.  Think of a parent who also calls their child names or humiliates them consistently.

Neglect is something that most people do have a harder time identifying.  When most people think of neglect, they think of again, more overt neglect, such as someone growing up with not enough food, safe shelter, etc.  Neglect most often brings forth thoughts of physical neglect.  Most people do not immediately think of emotional neglect when they are asked about it.  This is because, frequently, this form of neglect is not overt or consciously done.  It is also a form of neglect that is easy to minimize or rationalize.  For example, if you grew up in a household with a parent with a mental illness, you may not have received the emotional care and nurturant that you needed as a child.  However, this neglect was not consciously or intentionally done.  It would have been a consequence of the parent’s mental illness and not necessarily consciously done.  As another example, if you grew up in a household with a sibling with a physical disability, this likely took up most of the time and energy of your parents.  Likely there was some neglect in this family system, but not intentionally. One family member just needed more time and energy and the child(ren) that don’t have more overt needs are assumed to be just fine.

Neglect can also come from growing up in a family where there is addiction present in one or both parents.  If a parent is struggling with addiction, they will not be able to be fully present for their children and meet their needs for nurturance.  Frequently, we also see neglect in families where one parent is a workaholic.  Again, this neglect is not something consciously done and often justified by creating the financial means to provide the children with all the material goods and experiences they could wish for.  Unfortunately, children more often wish for  time.

This book does a nice job of discussing neglect and the effect of growing up in a neglectful environment on our adult behavior.  This is done at a cursory but understandable level.  The factual information is nicely complemented by stories of clients of the author. Often, it is these client vignettes that are most relatable to readers. 

After addressing the process of neglect, Ms. Gray provides guidelines and thoughts on how to address the struggles of adults who grew up with neglect.  In this section of the book, I found myself wishing for more “meat.”  The thoughts and ideas are brief “reader’s digest” overviews of ways to help healing such as journaling, yoga, EMDR and other forms of therapy. 

Though I found myself wishing for a bit more from this book in regard to tools for healing, it is perfectly suited for a person who is new to the idea of neglect as something they experienced in their childhood.  It feels like a primer for someone just starting their journey into recovery from neglect.  The book also provides an excellent array of resources for further investigation.  This is a book I would recommend for a client who wants a quick and easy read to serve as an introduction to the concept of neglect and the road to healing. 

Dr. Jennifer Weeks is the owner and director of Sexual Addiction Treatment Services, author and educator.

Sex, God & The Conservative Church: Book Review

Charity (The United States)’s review of Sex, God, and the ...

I was asked to teach the graduate human sexuality course last fall at the Moravian Theological Seminary. As it had been years since I taught, I was on the hunt for new books for the course.  Because this course was being taught at a seminary, we had to at least touch on religion and sex.  I found Sex, God & the Conservative Church:  Erasing Shame from Sexual Intimacy, by Tina Schermer Sellers, Ph.D. at the AASECT conference and thought it might be a perfect fit.  Once I started to read the book I thought “WHERE HAS THIS BOOK BEEN ALL MY CLINICAL LIFE?”

As someone whose primary clinical practice involves issues related to sexuality (Sex addiction, sexual offending and other problematic sexual behavior), issues of faith are frequently brought into the treatment room. It seems, that for many, faith and sex are intertwined.  As someone who is not a Christian counselor, I didn’t always have the perspective or language to help some clients work through this as much as I could have.  This book is an exceptional resource both for clinicians and clients or church groups.

Sex, God & the Conservative Church takes the reader first through a journey of the history of how sexuality and faith became derailed.  Of particular interest to me, working with sexual addiction, was her discussion of Saint Augustine, who she labeled a sexually troubled soul.  This is of interest to me as one of the main 12 step fellowship groups for sex addiction is Sex and Love Addicts Anonymous (SLAA).  This fellowship is an Augustine Fellowship, named after the saint.

“While Augustine offered much that was foundational in the formation of Christian Theology, sexual desire and his own desire for women, which he was never able to completely escape, tortured him until the end.  His legacy of shame, fear of the body, and suspicion of its desire is with us today” p 33-34

The author suggests that a great deal of the root of sexual shame that Christians struggle with is rooted in his teachings.  I find it ironic, or perhaps a bit upsetting, that one of the main 12 step fellowships for recovery from sexual addiction is rooted in sexual shame.

Once past the history, the book delves into tangible ways to help people heal from their sexual shame and pursue sex positive messages from God and a sex positive Gospel.  Dr. Schermer Sellers frames the healing of sexual shame in a four-step process which will be very helpful for all people who are struggling with sexual shame, not just those that identify as Christian.

  1. Frame – provide sexual education to a client that they did not receive
  2. Name – help the client get their story heard by someone important to them.
  3. Claim – the client works to accept and own their body as a wonderful unique thing to undo the harmful messages inherited from religion and culture
  4. Aim – help the client write a new story of what they believe and what their legacy is to become.

Another aspect of this book that I really enjoy is the authors emphasis on normalizing childhood sexuality and the need for real, accurate and frequent sexual education being taught to children.  When families do not talk about sex and sexuality to children, they often assume it is something to be kept secret.  Worse yet is when a parent or care giver overtly shames a child for expressing normal sexual behavior or curiosity.  This can create a go to thought process of sex being dirty and bad.  If I (the child) have a sexual thought or feeling, I must be bad. Those of us who do this work know that so much of the struggle is rooted in shame and secrets.  If we normalize and teach children about healthy sexuality we can erase the shame that is often at the core of sexual problems.  To again quote the author:

“A culture that shames children for normal sexual expression plants seeds that manifest themselves in adult life in the form of disturbances in relationship, libido, and sexuality.  Sexual shame can sever the experience of sensual pleasure in a deep, loving attachment because it eclipses the person’s ability to feel seen, known, loved and accepted with and through their sensual body.  “ p. 106

I don’t think I can express strongly enough how wonderful this book is.  It should be a required reading for anyone who works with clients who struggle with sexual issues, be they sex therapists, sex educators or sex addiction therapists.  One of my strongly held beliefs is that we have to be sex positive in our work and not perpetuate sexual shame in our clients (see previous writing on being a sex positive sex addiction therapist).  Learning to integrate a sex positive Gospel for those of the Christian faith will go a long way to reduce sexual shame and reduce problematic sexual behavior.

 

For more information on Dr. Jennifer Weeks and her practice, head over to Sexual Addiction Treatment Services.  

Book Review: Tell Me What You Want

Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life by [Lehmiller, Justin J.]

Earlier this year, Dr. Justin Lehmiller published his book Tell Me What You Want:  The Science of Sexual Desire and How It Can Help You Improve Your Sex Life.  Dr. Lehmiller is a researcher and writer about human sexuality. I became familiar with his work from his blog, Sex and Psychology and use his textbook in my graduate Human Sexuality Course.  I was excited to see him write something for the general public as his previous writings have been more academic.

Dr. Lehmiller wrote this book based on the results of a survey he conducted in which he asked more than 4,000 Americans over 350 questions about sexual fantasies.  He also obtained information about sexual histories, psychological profiles and demographics.  What emerged from the data is that Americans fantasize about sex a lot and many things that might not seem “normal” are quite normal after all.

When people come in to treatment for anything relating to sex, I always get questions about what is normal.  How often do people have sex? How much porn viewing is normal?  I have a fetish, does that mean I am not normal?  For some reason, we are worried about our sexual appetites and arousal templates not being normal.  I always answer that there is no such thing as normal but after reading this book, the “normal” that so many people assume about American sexuality is not terribly normal at all.

So, what are the top seven things Americans fantasize about?  The number one sexual fantasy is about multi-partner sex.  Coming in at number two is power, control and rough sex.  Third is novelty, adventure and variety.  Fourth is taboo or forbidden sex.  Rounding out the bottom three are partner sharing and non-monogamous relationships, passion and romance and erotic flexibility (homoeroticisim and gender bending).

Instead of summarizing the entire book (go read it for all the juicy details), I’ll give you some fun facts.  Men and women are different in how they fantasize.  Interestingly, Dr. Lehmiller found that when women fantasize, they don’t really fantasize about a particular person but in their fantasies, women frequently see themselves as the object of desire.  They are the focus of the fantasy, not the other person.  Men, on the other hand, tend to be the actors in a fantasy, acting on an object of desire.

What do your politics say about your sexual fantasies?  Well, if you are a Democrat, you are more likely to fantasize about things like intimacy, bonding and BDSM.  The Republicans, on the other hand, were much more likely to fantasize about things that are a bit more taboo such as orgies, infidelity and swinging.  Republicans were also more likely to fantasize about things like exhibitionism and voyeurism.  Why you ask?  Dr. Lehmiller suggest that we tend to want what those in positions of authority tell us we can’t have!!!

Dr. Lehmiller’s book is a helpful resource for both therapists and non-therapists alike.  Many Americans deal with a great deal of sexual shame.  They either have been told or believe that their sexual fantasies, desires or behavior are wrong, sinful, perverted etc.  The fact is, the opposite is quite true.  When we hold sexual shame, we tend to repress our true sexual feelings.  This can cause problems in relationships but also in our own mental health.

I will end this short review with the following quote from the book:

“What all this tells us is that we need to stop judging whether sexual desires are healthy or unhealthy based only on how many people in the population have them.  Instead, what we really need to do is look at sexual interests on a case by case basis and ask ourselves two questions that have nothing to do with how many people have them: (1) is this sexual activity consensual or non consensual? (2) does it pose an unacceptable risk of harm to one or more people that goes well beyond the usual risks of having sex?” p181

Dr. Lehmiller has a slightly different take on what I say frequently to my clients and students about sexual desires.  I don’t care what it is as long as it is consensual and legal!

I encourage you to read Tell Me What You Want:  The Science of Sexual Desire and How It Can Help You Improve Your Sex Life.  If nothing else, maybe it helps erase some sexual shame, which is something our culture needs more of!

 

What BDSM Can Teach Us About Consent

Let's Talk: Consent | Her Campus

Consent is a hot button topic today.  The #metoo movement continues to grow and the supreme court nomination brought to light the suffering of many sexual abuse survivors.  The general public is starting to realize that we do not teach consent to our children

Those of us who work in the fields of sexuality (sex therapists, sex offender therapists, sex addiction therapists) have long known that there is a lack of education about consent.  We have moved from no means no to yes means yes but that still leaves a lot of grey area.  For instance, what happens when yes turns into no?

To help learn more about consent, I turn to what some might think is a strange source, the Kink community.  The BDSM community has a lot to teach the rest of us about the concept of consent.

While there are many aspects of the BDSM world, consent lies at the heart of these communities.  Here’s how:

Negotiation:

Critical to the BDSM community is negotiation.  People who are going to play (engage in BDSM) together spend a great deal of time ahead of time negotiating what will happen during the session.  These discussions about the sex practices that will or will not be engaged in during the session are often extensive.  Negotiations include what each participant’s limits are (what they will not engage in), what types of things they enjoy as well as the discussion of the safe word.

When two people engage in extensive negotiations before an interaction it removes the grey areas that can happen when there is not good communication.  There is no room for miscommunication because it has all been talked about ahead of time.

Safe Word:

The safe word is the word that is agreed upon ahead of time which, when invoked, means the behavior that is currently happening ends immediately.  This process of safe word shows that the BDSM community understands that consent is not a broad concept.  Consent is an ongoing process that can be revoked at any time during an interaction. Just because someone says yes to something initially, it does not mean theywant the behavior to continue.  Everyone’s experience of a sexual behavior is dependent on so many things.  What they might have enjoyed engaging in during one session may not feel good in another based on many things, not limited to mood, stress level, partner and environment.

Aftercare:

Aftercare is a concept that is not often talked about in traditional sexual encounters.  The BDSM community understands that these interactions can be emotionally and physically intense.  Aftercare takes this into consideration and involves physical and emotional support for the parties involved.  This can be physical, meaning food, water, etc. or emotional, such as cuddling, holding, stroking etc.  When both parties engage in aftercare it demonstrates a mutuality in the interaction.

Traditional sexual interactions among the non-Kink community normally do not involve any of these processes.  Traditionally, there is very little discussion about what behaviors are ok between two sexual partners.  Safe words are hardly ever employed and frequently, in our hook up culture, the after-sex behavior lacks emotional and physical nurturance.

I will end this post with a quote I heard at this years ATSA conference.  “We spend more time negotiating what we want on a pizza than we do negotiating sex.”

We have a lot to learn from the Kink community and if we employed some of their practices into our own sexual practices we would be having safer and more truly consensual sex.

Reference:  “Unorthodox Rules”:  The Instructive Potential of BDSM for Consent Law.  Bennett, T (2018) Journal of Positive Sexuality, 4(1), 4-11.

 

Dr. Jennifer Weeks is the owner and director of Sexual Addiction Treatment Services.  She is a clinician and expert witness working with sexual abuse, cybersex offenders and all types of problematic sexual behavior.

Pornography Problem…. Erotic Conflict or Addiction?

Computer Key - Porn

When I started in this field, sex addiction was not a common place term.  Therapists who treated sex addiction were not that prevalent and you never heard about sex addiction on the news.  Today, it is a different story.  You hear the term sex addiction all the time, bandied about in the news every time you hear about a celebrity sex scandal.  Therapists who treat sex addiction, whether specifically trained to do so or not, are much more common now as well.

The same goes for pornography addiction.  For some reason, this feels less stigmatizing to many.  Again, there are now large numbers of therapists who treat pornography addiction (whether trained to or not) and there are also many new programs popping up to help men deal with their pornography addictions.  These are often programs not run by a therapist or affiliated with a 12-step program but instead created and run by independent agents or religious institutions.

As the visibility of pornography addiction grows, the type of clients we have coming to the office have changed.  In the beginning, over 8 years ago, the (predominantly) men who were coming in to address problems with pornography were men who had struggled for most of their lives with pornography use.  They were watching more than they wanted to. They couldn’t stop.  They were experiencing serious consequences in their work and relationships or even with the law as a consequence of their pornography use.  These were men who were what I would diagnose as pornography (or sex as a broad moniker) addicts.

Today, many of the men who are coming in with self-diagnosed pornography or sex addictions are men who look at some pornography.  They don’t look at it necessarily a lot (maybe one or two times a week or less).  They don’t look at it for hours and hours on end.  They don’t look at anything illegal.  They often don’t look at any pornography that is more “hard core.”  Often their pornography use is causing a conflict in their relationship.  These are not men that I would diagnose with a pornography addiction, but they call themselves pornography addicts.

This brings me to the title of this writing.  Are these men who come in pornography addicts?  Or are they men who are experiencing an erotic conflict?

An erotic conflict is experienced by a person who is engaging in (or even fantasizing about) a sexual behavior that conflicts with his or her moral values or religious values.  For example, a person who is attracted to sex with the same sex might experience an erotic conflict because their religious beliefs tell them that same sex attraction is wrong.  Their behavior conflicts with their religious beliefs.  A person who is using escorts might be experiencing an erotic conflict because breaking the law is against their personal moral values.  A man who is watching pornography occasionally, a few times a month, might feel as though he has a sexual addiction or pornography addiction because his religious beliefs tell him that lust and pornography are bad.  Therefore, he equates any use of pornography with addiction.

Though there is no DSM-V definition of sexual addiction or pornography addiction, we can extrapolate the criteria from drug and alcohol and gambling addictions (Use disorders in the DSM-V).  This means that someone who is a pornography addict would experience at least two of the following issues:  watching pornography more often than they intended and for longer periods of time than intended; an inability to stop watching pornography; spending a lot of time creating opportunities to watch pornography, crave pornography use; fail to fulfil obligations at work, home or school due to using pornography; continuing to use pornography even after interpersonal problems resulting from use; social isolation due to pornography use; the need for more pornography or more intense pornography to get the same feeling and difficulties when they try to stop using pornography or can’t access it.

Here is my plea to clinicians and to society as well:

CAN WE PLEASE BE MORE DISCERNING IN DIAGNOSING SEXUAL AND PORNOGRAPHY ADDICTION?

What happens when we over diagnose pornography addiction?

  1. We never get to the underlying issue.  If someone is not actually a pornography addict and is experiencing an erotic conflict, often they never get to the root of the issue.  Often, they work a 12-step abstinence model and condemn any experiences of lust as bad or problematic.  This can place moral good or bad judgements on sexual behavior that can cause more psychological harm if the client continues to engage in the behavior.  It can shame the normal biological process of attraction by naming it lust to be removed from the person’s being.  It can also prevent the client from learning about healthy sexuality and what truly arouses and attracts them.  Ultimately, they often never work through the conflict between their body and their beliefs to any healthy resolution.
  2. We cause more shame. Though being a pornography addict is less shameful perhaps than it used to be, being named a sex addict or pornography addict is often a very shameful experience for a person.  This shame must be worked through when the person truly does have an addiction.  When the person does not, the label is often causing more shame and possibly isolation than is necessary.  Often this adds to the “I’m a bad person” thoughts the pornography consumer might have, simply for looking at some pornography.
  3. We trivialize sexual addiction. The therapeutic community and often the public press hotly debate whether sexual or pornography addiction are “real.”  The con side often uses the argument that those who support the idea of sexual addiction are religious conservatives who are condemning normal sexual practices.  When someone with an erotic conflict (often based on religious beliefs) is diagnosed with an addiction, this reinforces the argument that we are trying to morally dictate sexual practices and label them addictions.

My goal here is not to condemn or judge someone’s religious or moral beliefs.  We all have our own set of values that we would like to live by.  My plea is that we, both clinicians and consumers, really look at the behavior.  Is the client presenting in your office who uses pornography an addict or someone with an erotic conflict?  The treatment is different. If they have an erotic conflict the work is to process through the beliefs, sexuality and the conflict to come to a resolution that fits the client’s moral and personal compass.  If the client is an addict, the treatment will likely follow a more traditional addiction model with 12 step attendance, abstinence from certain behaviors and recovery work.

I leave you with my plea again:  CAN WE PLEASE BE MORE DISCERNING IN DIAGNOSING SEXUAL AND PORNOGRAPHY ADDICTION?

 

Dr. Weeks is the owner of Sexual Addiction Treatment Services.

Get Paid to Watch Porn: Cryptocurrency and the Pornography Industry

cryptocurrency-predictions-2018-914087

If you are like me, you have heard of cryptocurrencies such as bitcoin, but know very little about it.  We see newspaper articles about bitcoin values going up and down and articles about how digital currency is going to eventually take over traditional banking.  Other than headlines, most of us don’t pay much attention.  However, as with any new technology, the pornography industry pays attention.

First, here is a 30 second, non-technical review of cryptocurrency.  Cryptocurrency is a decentralized digital cash system, that is kept secure by strong cryptography.  Transactions made with cryptocurrency are irreversible, untraceable to a person’s real-world identity, fast, global, secure and permissionless.  The use of this technology offers a way to pay for things or transfer money that is under the radar of governments and can be kept anonymous from a person’s credit history, spouse, etc.

Cryptocurrency can be used to pay for things but there is also a growing industry of ICOs or initial coin offerings.  ICOs are basically crowdfunding projects.  A company puts forth a white paper with their idea and then asks for investment.  The hope is that the project comes to fruition, and the coin will increase in value.

Why on earth am I talking to you (poorly at that) about cryptocurrency?  Well, it has entered the pornography industry.  On April 17, Pornhub announced that it now accepts the cryptocurrency Verge as a payment option.    The use of Verge allows a pornhub users to buy a subscription to the site in an anonymous fashion.  For those who don’t want anyone, including their credit card company, to know they have purchased a subscription to a pornography site, the use of cryptocurrency is the perfect option.

Another foray into the crypto/pornography world is the Vice Industry Token.  This new token is currently in development but has completed its ICO.  The token wants to take advantage of the attention economy.  The premise is that they wish to remonetize the industry around viewer desire and not that of paid content sponsors.  In this model, tokens will be generated and distributed based on user engagement.  All parties in the process will be rewarded.  Content producers will be rewarded for creating content that gets a lot of viewer attention and viewers will be rewarded.  The company has trademarked the phrase “Get paid to watch porn.”  See the white paper here 

The users of this system will then be able to pay for further pornographic content with the VIT tokens that they have earned by watching pornography.  Basically, someone can watch pornography (which they likely would do already) and earn digital money to do so.  They could then use that digital money to buy more adult content.

For those individuals who struggle with pornography addiction, this is something that adds even more incentive to watch pornography.  Now they can get paid to do something they already do.  For those individuals who are choosing to hide their pornography use from a spouse or partner, this offers a greater opportunity for secrecy.  There are no credit card statements to find.  There is no missing money.  There is an increased amount of anonymity which is one of the three accelerators of problematic internet behavior:  anonymity, accessibility and affordability.

 

Dr. Weeks is the Owner and Director of Sexual Addiction Treatment Services, specializing in problematic sexual behavior, and treatment and evaluation of cybersex offenders.

Book Review: Recovery: Freedom from Our Addictions by Russell Brand

A recovery book by actor and comedian Russell Brand may not be what you might be expecting in the way of a book review from an addiction therapist, but we should all have an open mind, right?

I started keeping a peripheral eye on Mr. Brand when I began focusing my clinical work on sexual addiction.  Mr. Brand made it very public (writing about it in several books) that he attended the Keystone Extended Care Unit in Chester, Pennsylvania for his in patient sexual addiction treatment.  This is what put him on my radar. I have friends and colleagues who work there and have referred many clients to treatment at Keystone ECU.  When his new book about recovery came out, I thought, “why not?”

Recovery: Freedom from our Addictions has been a pleasant surprise from the get go.  This book is a 12-step book.  The book takes the reader through the entire 12 step process, step by step.  Russell shares his own story of recovery, the good and the bad, in a very relatable way.  He also, very openly, shares his own struggles with the steps.  He has struggled with the concept of God or higher power which is a huge road block for many people who attend or think to attend 12 step meetings.  He addresses his own self-centeredness, inability to ask for help and isolation, which is very relatable to anyone who has dealt with addiction of any kind.

In addition to the book, on his website, www.russellbrand.com, he provides a supplement to the book.  He provides the reader with his own questions and worksheets to work the steps.  I have read many 12 step books and I honestly feel as though these are some of the easiest to follow and real guides I have ever seen.  They are absent the preachy vibe that can come with some 12 step worksheets.  They are also rather blunt, which is a style I prefer.  Honestly, I have printed these out and given them to clients who I know struggle with the higher power concept of the 12 steps or have some other issues with their experiences of the people in the 12 step rooms.

Of course, this is a book by Russell Brand, so it is full of obscenity.  It is not for the reader who objects to a multitude of f-bombs in every chapter.  This is part of why I really like this book.  It is real.  It is raw.  It is what actually happens when a person goes through the 12-step program, not a sanitized version of the process that makes many people feel that recovery is unattainable.

The 12th step of AA states that “After having a spiritual awakening as a result of these steps, we tried to carry the message to alcoholics, and to practice these principles in our own affairs.”  This book is Russell’s 12th step.  It is a great 12th step and one of the most enjoyable recovery books I have read in a really long time.

 

For more information on Dr. Weeks clinical work please see our website at www.sexualaddictiontreatmentservices.com 

 

 

Something’s Missing in the Current Drug Prevention Rhetoric

prevention

I have been an addiction therapist for approximately thirteen years.  While for some professions that may not seem like a long time, for a substance abuse professional, thirteen years in the trenches is a very long time. It is thirteen years of being underpaid, overworked, and underfunded.  It is also thirteen years of working with lost and often traumatized souls who may never ever get better.  Thirteen years as a substance abuse professional can make you weary.  However, you don’t end up in this profession and last for any length of time unless it is a calling.

Unless you are completely cut off from the outside world, you have seen many a news article lately about what is being called the heroin or opiate epidemic.  The apparent meteoric rise of addiction problems due to a prescription pill problem that for many turns into a heroin problem.  In March of 2016, the Centers for Disease Control issued new guidelines for doctors who prescribe opioids for chronic pain.  In 2015, hydrocodone combination products were moved to a Schedule II drug classification, indicating their highly addictive potential.  These changes were made in the hope of curbing the opiate addiction problem in our country, but with little effect.

This blog is not meant to be a discussion of anything related to why the situation continues to decline or what to do about it now.  What I want to talk about is prevention.  Most resources, even good resources like www.PASTOP.org, spend most of their page space talking about prescribing, what to do with unused medication, overdose and treatment information.  While all of this is very useful information, it is what I would call secondary prevention.  This is prevention of use by teens or adults, frequently who are prescribed medication initially by a doctor for a legitimate medical issue.  What is missing from the big picture of this prevention discussion is childhood.

Earlier this year, I finished reading both Dr. Gabor Mate’s, In the Realm of Hungry Ghosts and Dr. Bessel van der Kolk’s, The Body Keeps the Score.  Both are must reads for anyone who works in the addiction field.  I would like to share with you the line from In the Realm of Hungry Ghosts that inspired me to write the post.

“The prevention of substance abuse needs to begin in the crib – and even before then, in the social recognition that nothing is more important for the future of our culture than the way children develop.” P. 443

What is missing in almost all current talk about prevention is that, unfortunately, for all the people already addicted or prone to addiction, it is potentially too late.  Why do people become addicts?  Trust me in that no one wants to be an addict when they grow up or enjoys addiction.  Maybe, in the beginning, they liked the effect of the drug, but that quickly wears off.  What many addicts like is the escape.  The ability to take a substance that makes them not feel feelings they don’t like or can’t handle.  They like the fact that when they are taking the substance, they don’t have to sit in reality.  They like that the drug makes their flashbacks go away.  They like the fact that many drugs make them forget for a period of time.

In 13 years, I have yet to meet a drug addict who, at some point in their life, and most likely in childhood, did not suffer from at least one form of abuse or neglect.  Many drug addicts and alcoholics (gamblers and sex addicts too) endured verbal, physical and/or sexual abuse by their parents or family members growing up.  Many endured neglect in childhood as well, whether that was physical or emotional.  Many addicts were bullied in school and had no one safe at home to talk to about their experiences.  These childhood experiences mean that often, they looked for ways to self soothe, ways to cope or ways to feel better even if it was for a short period of time.

The ACE studies (Adverse Childhood Experiences) have shown scientific proof of what addiction counselors have known for years.  The more ACE events in a person’s life, the more likely they are to not only have physical issues but also mental health issues.  People with higher ACE scores are 2 to 4 times more likely to use alcohol or other drugs and to do so at an earlier age.  If a person’s ACE score is 5 or higher, they are 7 to 10 times more likely to use illegal drugs, report addiction or to inject illegal drugs.

So what do we do?  Addiction prevention starts before a child is born.  The in-utero environment of a child affects their neurobiological reaction to stress as an adult.  To stop drug addiction, we need to stop child abuse.  How do we do this?  Obviously, this is a tall order.  Make parenting classes more accessible to all expecting men and women.  Teach not only about physical care of a child but their mental health care as well.  Talk about attunement to a child and how that affects his or her ability to regulate emotion later in life.  Work to create safe spaces in a home and healthy attachment.  Teach communication skills from the start.  Teach healthy coping skills to even very young children.  Teach healthy coping skills to the adults so that they can model these for their children.  Work as hard as we can to prevent physical, sexual and emotional abuse of everyone.

I realize that my goals are idealistic.  I have always said that if the world gets healthy, I would happily change professions.

We need to start addiction prevention from the beginning by having discussions about childhood abuse, neglect and trauma.  We need to work to take away the stigma of therapy and getting help for emotional problems.  We need to teach everyone how to effectively communicate and cope.

I know that this is a tall order and that many do not have the resources to learn all these skills.  We need to work to provide these resources to everyone.  As a society, we need to do more……….

 

For more information on Dr. Weeks please go to our company website www.sexualaddictiontreatmentservices.com.

Photo credit.  The Watsons, NYC, NY.

We Are Failing Male Sexual Abuse Survivors

I specialize in working with sexual addiction and problematic sexual behavior. Most of my clients are men.  Working with male addicts for over a dozen years has taught me, in person, that many more boys are sexually abused than the numbers tell us.  These boys do not tell anyone and do not seek help.  These boys turn into men who are profoundly affected by their sexual abuse experiences as children and most of the time, don’t even know it.  They do not name what happened to them as abuse, or they don’t want to.  They feel so much shame about being abused that they lock part of themselves away so tightly it can take years (like 5 to 7 years) of therapy before they even acknowledge to a trusted therapist what happened to them.  These men who were abused as boys suffer in silence.

I realize that many people (myself included) will respond to this by saying that many girls and women do not disclose their sexual abuse and that they too live lives that are deeply affected by their abuse histories.  Having spent time working in a Women’s Trauma and Addiction PHP and IOP program, I do not dispute this.  However, I see a difference.

When women finally find the courage to come forward to seek treatment for their sexual abuse, they can find resources.  There are many group, individual and support resources for women who are survivors of sexual abuse.  Finding help is not so easy for men.  I will share an example from my practice to explain.

I have a male client who came to me last year who I will call Tom.  Tom has a pornography addiction and came to treatment after the problem began to cause a great deal of disruption in his life.  He had never gone to therapy and near the beginning of our work together, he disclosed that, when he was a boy, he was sexually abused by a neighbor boy who was near his age.  He had never shared this with anyone in his life and as soon as he acknowledged the abuse, the floodgates opened.  He started to have flashbacks and other PTSD symptoms.  Tom is a take charge kind of guy and we nearly immediately started to look for resources for him to do trauma work outside of our individual sessions.

First, we looked for men’s specific groups.  There was nothing and we are directly outside of a major east coast city.  Then we looked for trauma groups.  Tom talked to a few places that had groups for trauma survivors and was told that, as a man, he would make the women in the group uncomfortable so they could not have him join the group.  He then had an intake with a county resource for group trauma work.  After his intake, they told him that his case was too complicated and he could not join the group.  After months of looking, we literally could not find a group for sexual trauma survivors that was either all men or that would allow men into the group.

Tom continues his trauma work in individual therapy but craves the connection and understanding that one gets in group work.  He wants to know he is not alone and the therapeutic community was unable to tell him that, as a man, he is not alone.

Tom is just one example of many that I could pull from my case load.  To me, he is the loudest example of how we, as a treatment community, fail male survivors of sexual assault.  I have had other clients walk out of public events for sexual abuse survivors because, as the only man in attendance, they felt unwelcome and uncomfortable.

Why do we treatment professionals who work so closely with trauma not offer more resources to men? Are we uncomfortable?  Is there a reason we focus more closely on female survivors of sexual abuse?  These are questions to which I have no answers.  I have only heartbreak.  I can only do my part to welcome male sexual abuse survivors into therapy when they come and to start group programming for them in my practice.

I challenge other treatment professionals to process this issue and see what we can do to create more resources for men and to be more welcoming.

 

For a good online resource for male survivors of sexual abuse, please see www.1in6.org

Why is a Good Couples Counselor So Hard to Find?

179085943

I am going to start this post by adamantly stating that I am not a couples counselor. It’s not my thing and I just can’t do it. I have a great respect for those therapists who train in this area and devote their careers to helping couples find their way. Since I do not do couples therapy, I must refer my clients out to other couples therapists. You might think that this is an easy task. There are many Licensed Marriage and Family Therapists in this world. Then why do I hear so many horror stories from my clients? Why is my list of people to NOT refer to longer than my list of people TO refer to?

I will share with you the story of a newer client’s experience in couples counseling. First, I should share that I work with sex addicts and sexually addicted sex offenders. It is a rather specialized population and perhaps, a controversial one. Many of my clients are caught by the authorities for viewing child pornography. For many of them, this behavior is an escalation of their addiction to pornography.

This man and his wife, not long after her “disclosure by police”, went to see a couples therapist. This was not someone our program recommended but a therapist that they found via their insurance. The therapist had no stated knowledge or expertise in working with pornography addiction nor with offenders. This was glaringly obvious. My client reported that he was very open with this therapist. He told the counselor all about his addiction and how it led to his use of illegal images and arrest. (Let me tell you this is a big deal to share at a first session with anyone!).

When a client comes to you for this type of work, their level of shame gives them an amazing radar for judgment. They are sharing their deepest secrets with you, the therapist. If you move an eyebrow they will know it and likely interpret it as you judging them. Well, my client immediately felt as though the couples therapist did not believe that pornography addiction was a real thing. All from a vocal expression of the therapist. My client continued the session for the sake of his partner.

This therapist asked to see the partner alone during the initial session. Granted, what I relate to you is third party information, relayed from the partner to the client to me. However, even allowing for interpretation of the event, there is some truth here. That truth is very bothersome.

What the partner heard: the couples therapist thought that her husband (my client) was lying. The couples therapist felt that my client was not sorry about anything only that he was caught. The couples therapist then advised the partner that she should leave the relationship. All this assessment was garnered after only an hour intake session.

One can only imagine what this did to the partner.

What this also does is taint the idea of couples therapy for both of them.

As counselors, therapists and psychologists, we are only supposed to treat within our area of expertise. I treat sexual addiction, sexual offenders, addiction, and trauma and addiction. If someone comes to me with an eating disorder, for example, I don’t treat them. I refer them to a therapist who specializes in eating disorders. If someone comes to me with schizophrenia, I refer them to a specialist. You get the idea.

When we do not abide by this and treat people out of our area of expertise we can do damage to the client. This happens frequently when it comes to sex addiction. Sex addiction is a very controversial topic. Many people think it doesn’t exist and many people do. Personally, the label does not matter to me. For some clients, the label matters very much. If a client feels they have a sexual addiction and identifies with the label in a healthy way and a therapist tells them that it doesn’t exist or treats them in a manner biased by their own beliefs, they can do harm to the client.

If there is a stigma about sex addiction, then the stigma against sex offenders is there tenfold. Even less therapists are trained in treating sex offenders than sex addicts. There are studies that show therapists won’t treat pedophiles. In a profession where we are supposed to be open and nonjudgmental, many of us are just that, judgmental.

I do not write this to bash well-meaning couples therapists. I reiterate that I have the utmost respect for your work! My plea to couples therapists is this: If you do not believe in sex addiction, do not treat a couple where one partner feels they are a sex addict. If you do not believe in sex addiction or pornography addiction, please don’t shame the person with the addiction. If you do not want to treat sex offenders, then simply say that. Please don’t go behind one partner’s back and tell them that their husband or wife is lying and they should leave.

My advice for those seeking couples counseling (or any counseling for that matter) is to investigate your potential therapist. I understand that therapy out of network can be costly. The list of therapists you get from your insurance company means nothing other than they are in network with your insurance. It is your job to do some groundwork on us. Check out the therapist’s website. Consider what their specialties are. Call and ask if they specialize in working with couples (or individuals) who are going through what you are going through. If they don’t, then find another therapist.

Ultimately, we work for the client. Therefore I end every one of my intake sessions with a new client with one question. “Do you think that you can work with me?” I want to know if they feel comfortable with me. If not, even if I have the right training for the client, I am not the right therapist.

For more information on Dr. Weeks and her practice, visit our website:  www.sexualaddictiontreatmentservices.com