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.

No More Porn with Your Happy Meal


Last week McDonald’s announced that it will add internet filters to its WiFi in restaurants throughout the country. My first thought was, “now what about Starbucks?” as this news came literally the day after a client disclosed that he had downloaded pornography at a Starbucks. What I didn’t know is that Starbucks also has committed to providing “Porn Free” WiFi in its stores. According to news sources, McDonald’s and Starbucks already filter pornography in their stores in the United Kingdom.

Why do these announcements make me happy? There are two answers to that. The first involves recovery from pornography addiction. For those individuals who identify as pornography addicts, initial behavioral interventions to help them stop watching pornography often include internet filters or locking down their home internet connections. What we do know in recovery is that where there is a will, there is a way. This means that if someone really wants to watch pornography, they will. No filter will stop them and not having access at home won’t stop them either. Frequently, this means that they will go to a place where they know they can get access to WiFi (which is literally everywhere now) and download pornography at these locations. As more and more companies choose to filter their WiFi and not allow pornography, this open access for relapse decreases. Currently, McDonald’s, Starbucks, Panera and Chik-Fil-A provide internet filtering in stores in the U.S. or will do so soon. This decrease in access to pornography may help someone in recovery find success.

The second reason I am in favor of blocking access to pornography in public locations involves choice. I consider myself a sex positive sex addiction therapist. For me, this means that I am not anti-porn. I simply think that it can be addictive for some people. What I also truly believe is that watching pornography is a choice. A person can choose to engage with pornography or to avoid it based on their own values and personal experience. This is a very personal decision that each person makes for themselves.

When someone is viewing pornography in a public place, i.e., at McDonald’s, on the bus, on an airplane, in the library, they are making a choice to view pornography. However, what they are also doing is taking away someone else’s choice as to whether or not they wish to view the material. Anytime a person is viewing pornography in a public place on a laptop, phone or tablet, there is a risk that another person might see it. For example, the person watching pornography on the phone on the bus potentially exposes everyone else on the bus to the pornography, regardless of whether they want to see it or not. There is also a risk of exposing a young child to pornography as well.

This brings up the concept of consent that we teach both in healthy sexuality and to sex offenders we treat. For a sexual interaction to be consensual, both parties need to agree to the behavior and it needs to be free of coercion, manipulation or compliance. If a person with their two children walk by someone at Starbucks who is watching pornography on their laptop, they are exposed to sexual imagery, without their consent.

It is each person’s choice as to whether or not they wish to watch pornography. Removing access to the material in public spaces reduces the non-consensual exposure to the material, helping to ensure that each person can make their own choice about the material and that they are not exposed to pornography without their consent.

Dr. Jennifer Weeks is the Director of Sexual Addiction Treatment Services and the Author of The New Age of Sex Education: How to Talk to Your Teen about Cybersex and Pornography in the Digital Age.

Is My Husband Gay, Straight or Bi? Book Review


Where has this book been all my clinical life? Is My Husband Gay, Straight or Bi?: A Guide for women concerned about their men is a book written by Joe Kort with Alexander Morgan published in 2014. To say that this is a much needed book in the sex addiction field is an understatement. One of the hardest things to do is to try to explain to a client that just because her husband is acting out sexually with other men, he is not necessarily gay.

There are several clients I have worked with that stand out in my mind. I recall working with one man who identified as a sex addict. He came into treatment because his wife found out that he was acting out sexually outside of the marriage and he was acting out with other men. Her immediate assumption was that her husband was gay. There was little that I could say to convince her in an early joint session that her husband might be acting out with men for other reasons and that further therapy for him would be needed in order to truly find out what was going on. Unfortunately, all she had was the word of her husband’s therapist and it was a fact that, in her trauma and betrayal, she could not wrap her head around. This is one of many cases where this book might have been extremely helpful.

In this book, through case studies, Joe explains the various reasons that a man might act out sexually with another man. A man might act out sexually with another man, even though he is not aroused by men, as a trauma repetition. In fact, childhood abuse is the number one reason why a straight man will act out sexually with another man. Some men are sexual with men because they are, in fact, gay or bi-sexual and have been socialized to deny this or have denied this fact to themselves. Additionally, men may engage sexually with other men due to being attracted to various sexual kinks. In these situations, the sexual behavior may not be driven by attraction to men versus women, but to the kink itself.

In addition to discussing the various reasons why married men may have sex with other men, Joe describes many ways in which the situation may resolve itself. The key here is that if a husband is gay or bi-sexual, it does not always lead to divorce. Socially, marriage is seen as something between two heterosexual people, though thoughts and views are expanding and our culture is happily becoming much more open to same sex marriage. Joe brings to this book the reality that there may be options for mixed orientation couples to remain together and do so happily. He acknowledges that this is not easy, but it does work for some couples.

For me, this book is a must read for any woman who has found out that her husband or male partner is being sexual with another man. It provides some context for why and some helpful advice on how to handle the process. The one concern for readers I have is this: Joe comes from a sex therapy as well as a sex addiction background. He is a very sex positive therapist. This is a wonderful thing in my mind. However, his thoughts on potentially integrating kink or pornography into a marriage as part of the long term recovery process may be something that is contrary to how many partners reading the book may feel.

Is my husband gay, straight or bi? Is a must read for anyone in clinical practice who deals with sexual issues as well as any woman who finds out that her husband/partner is having sex with men.

For more information on our services for the treatment of out of controls sexual behavior, please see our website at

A Mindful Way through the 12 Steps


A Mindful Way through the 12 Steps

Using Mindfulness to Enhance your understanding of the 12 Steps

SATS is very excited to introduce our Mindful way through the 12 steps series. SATS staff member and CSAT candidate, Beth Songer will be offering a monthly meditation retreat that will combine mindfulness education and practice and periods of meditation to help attendees deepen their understanding of and connection to the 12 steps.

The seminar will be held on the 2nd Saturday of each month from 10 am to 4 pm. The cost is $150.00 per session.

This is open to participants from any 12 step tradition. Mindfulness is a great tool to help those in recovery both attain and maintain sobriety. For more information, contact the SATS office at or at 610-844-7180.

For more information please see our flyer at

We could all use a little R.A.I.N.


After a long Sunday at the office doing psychological testing for client, I came home and sat on my patio to read the Spring edition of the Tricycle magazine ( I was reminded by a great little article of a Buddhist tool R.A.I.N. I learned of it not through Buddhist teachings per se but through reading the works of Tara Brach ( who is a psychologist and proponent of Buddhist meditation. R.A.I.N, though technically from this tradition, is an amazing tool for anyone who is working to improve their emotion regulation skills. These are skills we endeavor to teach our clients whether they are dealing with addiction, trauma, anxiety, or other issues.

So what is R.A.I.N? It stands for: Recognize, Accept, Investigate and Non-Identify. I will briefly explain what that means and then discuss how it can help with someone dealing with an addiction craving. Recognize is the idea of knowing what is happening to you in the moment. It is our ability to not be immediately reactive but to see that there is something going on for us. It is the ability to know that we are triggered, feeling an emotion or feeling unsafe, in the actual moment it is happening.

Accept is the next letter in our acronym. The easiest way to explain this (as a non-Buddhist teacher) is to say that we name what we recognize. We accept that the feeling or emotion is present. We don’t have to like that it is with us and we don’t have to do anything with it. It just is. In this process, it helps to name what has happened. “This is a trigger.” “A craving is here.”

Next we Investigate. This means that we take a step into noticing. When I am investigating emotions with clients, we will ask questions like, “What does it feel like?” Where do you feel it in your body?” What is your body’s reaction to this emotion? This is the process of investigate. During the investigation process of R.A.I.N., a person breathes through the physical feeling and sits with it. Through the process of sitting with the emotion and breathing through it, the energy of the emotion dissipates. It is a skill also used in DBT, Ride the Wave of Emotions. We just sit with it until it passes.

The final letter, N, stands for non-identifying. This means that we take the “me” out of whatever it is that is happening to us. I liken this to Don Miguel Ruiz’s agreement of “Don’t take anything personally”, though it is a little different in this case. We can learn that we are not our emotions. We have emotions but they are not something we have to build an identity around. The observer mind kicks in when we can non-identify and we can see that though something is happening to me, I can watch it happen and not react.

How do we put this in action? Let’s take a scenario I have heard in my practice with sexual addiction. If an addict sees an attractive person, they may feel triggered. The R here is to Recognize that they are, in fact, feeling triggered and having a reaction to the physical cue. The next step is to Accept that they are triggered. I encourage clients to name it out loud if necessary. To simply state, I am feeling triggered, takes some power out of the trigger. From here, I ask clients to really get to know their body’s reaction. Investigate what happens when you are triggered. When we see this person who triggers me, my heart races, my breathing changes and I get mentally distracted. If the client can acknowledge that this is a trigger, it is easier for them to non-identify and manage the trigger.

I am feeling triggered and I know this based on my body’s reaction. I accept this and can ride the wave of the trigger until it’s power dissipates. I am not my triggers and not consumed by them. In my practice, clients who work to cultivate this observermind through meditation have gained a valuable tool for relapse prevention.

For more information on our treatment program please go to

The New Age of Sex Education: How to Talk to Your Teen About Cybersex and Pornography

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Yesterday I launched the indiegogo crowd funding campaign for my new book, The New Age of Sex Education: How to talk to your teen about cybersex and pornography.

I view this book as a prevention project. In other addictions, we see tons of prevention programs, advertisements and initiatives. Public education and public service announcements are very common for alcohol addiction, drug addiction and even gambling addiction. In my field, sexual addiction and pornography addiction, we have no prevention ads or programs. I feel this is a huge disservice.

The age demographic of my clients keeps getting younger. When I started in this field, most of my clients were men aged from their 40’s on up. These were mostly white collar men in relationships. As the years have gone by, the average age of my clients keeps getting younger. Young men and women are now faced with much more intense exposure to sexual imagery due to technology. These intense experiences can cause much greater problems than the print exposure of the older generations.

Most of my clients received little to no sex education from their parents. Most parents didn’t talk about sex and they surely didn’t talk about pornography. This trend continues today. The change is that today’s teens are much more knowledgeable about what goes on online than their parents. They know so much more and many adults are rather ignorant of all the realms of digital sexual media. Parents need to be proactive and prepare their children for what they will encounter on the internet so they won’t have to do damage control after the fact.

The goals of this book are multifold. First, I want to educate parents about what their children are doing online when it comes to sex. Second, we discuss the effects of exposure to digital sexual media on developing children. The book addresses the potential legal issues faced by teens who sext and look at online pornography. I address the reasons why parents don’t talk about sex. What is the baggage that parents carry that gets in the way? The New Age of Sex Education discusses how to talk to adolescents about digital sexuality and finally address what to do if the child has a problem with pornography addiction.

The book publishers I approached and everyone to whom I described the project loved the concept and felt it something that was really needed at this time. However, no one wanted to touch it due to the topic. They felt it was just too risky. I confess this makes me upset. Sex addiction lives in secrecy and shame. The entire reason that the book is needed is the reason that the publishers won’t touch it. I want to get rid of the shame about sexuality and discussing it with adolescents and I also want to get rid of the secrets. Without both, we will have a healthier generation who are in touch with healthy sexuality!

I hope that you will join me in this prevention project by supporting our indiegogo crowd funding campaign.

Click the link for more information.

Thank you so much for your support!

Is Self Care Selfish?


“Love is the capacity to take care, to protect, to nourish. If you are not capable of generating that kind of energy toward yourself, it is very difficult to take care of another person. In Buddhist teaching, it is clear that to love oneself is the foundation of the love of other people.”
Thich Nhat Hanh

Shambhala Sun

In my practice, there are some recurring themes. When they keep showing up in session or in training, it is a sign that they are of great importance. There have been a lot of signs pointing to self care lately. On the plane to the IITAP conference, the above reading from Thich Nhat Hanh struck me as rather profound and I immediately related it to many of my clients.

In therapy we often talk about the need for self care. There are certain phrases that I hear quite often from clients when we talk about the need for them to engage in more self care. The most common phrase is “I can’t.” If I had a dollar for every time I heard “I can’t” I would be able to treat everyone free of charge!

“I can’t take time to meditate, do yoga, exercise, read a book, walk the dog, have lunch with a friend. I can’t go to 12 step because I have to (insert reason/excuse here).”

Another reason that many clients in recovery don’t take or make time for self care is either the reaction of loved ones or their perception of the possible reaction of loved ones. My husband won’t be happy if I go to too many meetings in the evening and he has to put the kids to bed. My partner keeps asking why I have to go to meetings and wants me to stay home to watch a movie with her. These are two of many, many possible examples of how doing for others can become a priority instead of doing for ourselves.

This often sounds counter intuitive to someone early in recovery. “My entire addiction has been selfish and self centered. I spent my time acting out and not thinking of others and now you want me to focus on myself? Haven’t I been selfish enough?”

My fundamental answer to this is that self care is not selfish. Self care is essential. If we don’t take care of ourselves, we cannot take care of anyone else. If a person is not taking care of herself, working a program, grounded and centered, she may end up taking it out on her kids by yelling or snapping at them. If a person is not taking care of their physical and emotional health and well-being, eventually they will hit burn out and won’t be able to take care of anyone, themselves included.

I really like an exercise in an old school ACOA book called Adult Child’s Guide to What’s “Normal”. You make a circle for yourself and then surround your circle with those things in your life, such as work, husband/wife, kids, family, friends, program. Then you draw arrows from you to each circle that represent the flow of energy between you and the other circle at the present time. For example, if all my energy is going into work and I am not getting any energy back, I am out of balance with work. If all my energy is going into my friendships without getting energy back, I am out of balance. Worst case scenario, when we are not practicing self care, all the arrows point away from you and no energy is flowing into you. You can’t maintain all output and no input for any period of time. For some of us this leads to burn out. For others this leads to relapse.

When relapse is a possible outcome of lack of self care, it becomes obvious. Self care is NOT selfish. It is essential.

Integrating Mindfulness into Sex Addiction Recovery

Generally speaking, Mindfulness is the intentional acceptance and non-judgmental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment. Mindfulness interventions have been on the rise in the addiction treatment community and with good reason. It seems like each month there are more scientific studies published that support the practice of mindfulness based interventions as evidenced based practice.

The emergence of scientific data is good news for those people who have known that mindfulness is helpful all along. Though the general public, or some factions of the public might realize certain interventions are helpful, they don’t gain “credibility” (read insurance is willing to pay for them) until there is a strong body of scientific research to support their use.

A study published in 2013 by Rory Reid and associates investigated the relationship between emotion dysregulation (inability to manage or regulate emotions), impulsivity, stress and mindfulness in individuals who were diagnosed as hypersexual (sex addicts). People in this study did not engage in a mindfulness practice or therapy but were assessed based on objective tests.
The study showed that those people who were hypersexual were less likely to be mindful, or able to do things such as regulate attention, awareness and be non-judgmental of their own experiences. The author suggested that mindfulness scores uniquely contributed to the level of hypersexuality. The study also found that sex addiction is associated with unpleasant emotions, stress, and impulsivity. Dr. Reid suggests that these findings provide support for the use of mindfulness interventions to help sex addicts learn to regulate emotions and manage stress in a healthier manner.

In our practice, we are strong advocates of using mindfulness practices and integrating them into recovery. Our clients who undertake a meditation or yoga practice often begin to see impressive improvements in their ability to manage impulses to act out. The mindfulness exercises allow them to create an observer mind that can cultivate the ability to see the reality of situations in the moment. This also increases the client’s ability to act less impulsively and allows them to ride the emotional storms until they pass without acting out.

Sexual Addiction Treatment Services is honored to have Elizabeth Songer on our staff. Beth is a long term practitioner and teacher of mindfulness and meditation. In 2015, she is offering a series of mindfulness meditation seminars separately for addicts and their partners. Everyone who attends meditation with Beth loves the experience.

For more information on SATS mindfulness seminars please see our events page at

mindfulness 2-21-2015

The Marshmallow Test: What Children Have Taught Us About Willpower


Recently, a client shared that he had listened to an NPR podcast whose topic was the Marshmallow Test and the research of Walter Mischel, Ph.D. He had also watched a short youtube video that showed a modern version of children trying to resist the marshmallow. The video is cute and funny and provided him a visual cue to hold onto when he is struggling to successfully manage cravings to act out.

The marshmallow test, as it is known now, is a bit of a misnomer. The research studies looked at children’s ability to delay gratification. They let the children pick a treat that they wanted, for some this was a marshmallow and for others this was something such as an Oreo cookie. The children were then told that they had a choice. The researcher was going to leave the room and the children could ring the bell at any time to bring them back. If they waited until the researcher came back on their own, the child would get two treats, such as two Oreo cookies. If they rang the bell to bring the researcher back, they would only get one treat. The researchers then studied reaction times and the coping mechanisms of the children. Though this is an extremely simplistic overview of 40 years of research, the studies helped us learn about a person’s ability to delay gratification (get two treats) or willpower.

Through their many experiments, the researchers came to identify two systems that they called the hot system and the cool system. The hot system is our impulsive, reactionary system. Our cool system is the system that uses rational thought, including thoughts about consequences. It is postulated that there are times when the hot system simply overrides the cool system and we act impulsively or without thinking about the consequences of our actions. This framework allows us to create tools to help the cool system prevail. For example, when the researchers asked the children to think about the savory aspects of the marshmallow, such as how it would taste or feel when they eat it, they ate the marshmallow sooner. When they asked the children to think about the marshmallow in less “hot” system terms, such as focus on shape or to think of it as a cloud, the children were able to delay gratification better.

How does this apply to recovery? One thing that comes to mind is the tool that is suggested for sex addiction recovery to deal with objectification. This is called the three second rule. There are many variations on the rule, but the basic premise is: if we notice a person who is triggering, one version is to acknowledge the trigger in the first second. The second version provides the opportunity to humanize or personalize the person. For example, some people will have a mantra in their mind that states that this person is someone’s wife, sister, mother, etc. Looking at this from the marshmallow lens, the initial trigger is the hot system and the tool we use is the cool system being reinforced. The attraction to a person is reflexive but the tool use is a cognitive choice.

In truth, many of the cognitive behavioral tools that we use are trying to either engage cool system or to reinforce it. If I am dealing with a craving to drink, I can try to engage my cool system by thinking about the consequences of drinking or perhaps how bad I will feel the next day. The hope is that by engaging this rational, logic based system we will have a better chance of successfully battling the craving without a slip.

I love the marshmallow metaphor as it is really much easier for clients to relate to than the technical names of our CBT skills. Personally, I think it is so much easier to think, “don’t eat the marshmallow” than to think about what CBT skill I should use in the moment.

Don’t Expect Applause: Buddhist Slogans for Recovery


My last blog post shared the Buddhist lojong slogan, “Don’t bring things to a painful point”. Today I want to share another slogan written about in a Shambhala Sun article that I feel also really applies to recovery.

As a reminder, this article focused on using these slogans in our work life. However, we can apply them with a wide brush. The author discusses doing our work without expectation of praise or ego stroking. If we do our work just for this, we are bound to be disappointed.

In reading this, I am reminded of the conversations that happen in my therapy room about sharing feelings and healthy communication. “What’s the point of being open with my wife if she is going to freak out?” “Why bother sharing how I feel with my husband if he doesn’t know how to respond?” “I’m doing all this work in recovery and he/she doesn’t even notice!”

I hear these types of statements from clients all the time. In these moments, the “Don’t Expect Applause” slogan fits like a glove. It all comes down to motivation. Why are we doing things? Am I sharing how I feel with my partner because I want him to change his behavior or react in a certain way? Or, am I sharing how I feel with my partner because it is what I have to do in order to be healthy in my own recovery?

A larger, more fundamental question is “who am I doing recovery for, me or someone else?” If I am in recovery simply to please someone else, I am apt to feel resentments at some point in the process. If I am doing recovery to please my partner, there are going to be times when my partner is giving me the feedback, warm fuzzies or praise I need to continue recovery. This is where we are prone to build resentments and resentments can fuel relapse. Don’t get me wrong, many a person enters recovery for someone else initially but finds their own way to recovery for themselves. If we are engaging in recovery and expecting applause, we are setting ourselves up for disappointment.

I often talk to clients about motivation. What is the motivation behind what we do. What is my motivation to share my feelings openly and honestly with a partner, family member or friend? When I hear a response such as “so she will ….” or “so he will …” I know that my client is still in a place of expectation. Perhaps they are not expecting applause but they are engaging in a behavior with an expectation of the outcome. If that expectation is not met, it decreases the chances of engaging in the healthy behavior or communication in the future.

Part of long term recovery work is letting go of expectations. I try to encourage clients to embrace the goal of engaging in behaviors, such as healthy communication with a partner, for the sake of self. I am going to learn how to communicate in a healthy way with my spouse or child or boss, not because I think I can control or influence the outcome, but because it is what I need to do in order to become a healthier, more emotionally competent person.

Work to let go of expectations.