I had the pleasure of hearing Dr. Fawcett give a presentation on Sex Under the Influence at the 2023 IITAP conference. 

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It was one of the more enjoyable discussions I caught while at the conference. He has a vast amount of experience working with dual chemical and sexual addictions. He is very clearly passionate about helping people work through these issues. 

So, when he published a book on the subject, I was eager to read it.   

Sex Under the Influence is aimed at Individuals

While this book’s target audience is individuals who are struggling with sexualized drug use, it will also be useful to clinicians who are not as familiar with the pairing of sex and drugs in a compulsive manner. 

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Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.

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The first chapter does a nice job with the following points:

• What sexualized drug use is
• How people use sex and drugs together and why
• The biology of the addictive process and the consequences when pairing sex and drugs gets out of hand

Chapter 2 is either a nice primer or recap about what addiction is and how it can be experienced by people. 

Chapter 3 looks at addictive behaviors in a variety of demographic groups. 

I really enjoyed this chapter. It did something few books on addiction do: it discussed what addiction can look like for men, women, and transgender individuals. 

We know from the scientific literature that men and women experience addiction differently both socially and biologically. Dr. Fawcett also discussed how addiction may differ based on one’s sexual orientation. 

An entire chapter looking at the diversity of the addictive process was appreciated.  

Recovery Tools from Sex Under the Influence

Starting in Chapter 5, the book provides tools and information for recovery. For clinician’s reading this book, particularly those who are trained in treating problematic sexual behavior, a lot of this work will be familiar. 

For people struggling with addiction who are thinking about or entering into recovery, the second half of the book provides valuable tools such as:

• The three-circle exercise
• Emotion regulations tools
• Relapse prevention planning

Subsequent chapters delve into the long-term process of recovery. It implicitly and explicitly acknowledges this is a long-term or lifelong process. 

Recovery, particularly from issues with sexuality, require us to deepen connections. It requires us to delve into intimacy and our own sexuality.   

Are you a professional looking to stay up-to-date with the latest information on, sex addiction, trauma, and mental health news and research? Or maybe you’re looking for continuing education courses?

Stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

My Favorite Part

One of the things I particularly like about Sex Under the Influence is the author’s discussion of harm reduction. 

So often, recovery is seen as an abstinence-only model and harm reduction is not discussed. 

Abstinence-only models can drive away those thinking about recovery but feel full abstinence is impossible. 

Additionally, abstinence-only models often are not realistic for problematic sexual behavior. Sexuality is part of who we are as humans. 

The author spends a chapter discussing harm reduction and how it can be applied to sexualized drug use.

This post contains affiliate links. The author or blog owner may earn a commission if you make a purchase using these links.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

The post Book Review: Sex Under the Influence first appeared on Dr. Jen's Recovery Readings.

We all have known a villain or two. Even the sex addiction treatment community has villains. Why are these people villains?

Because they question the validity of sex addiction.

Two, in particular, come to mind, though upon reflection they are not the same.

Villain Introduction

The first villain, Dr. David Ley, is a rather publicly outspoken opponent of the idea of sex addiction. He is a clinician, writer, and sometimes public debater of Dr. Rob Weiss.

The second villain is Dr. Prause. She is an academic and researcher from the University of California with a prolific CV. Her publications appear in peer reviewed scientific journals. Her argument against sex addiction as a concept is more theoretical and based on the scientific concept of validity.

Listening, Not Just Hearing

Imagine my surprise, after spending three hours in an Association for the Treatment and Prevention of Sexual Abuse (ATSA) training on Compulsive Sexual Behavior Disorder (CSBD), that the first plenary speaker of the ATSA conference was Dr. Prause making her case against sexual addiction.

To be completely honest, I have not read much of her scientific work.

My knowledge of her is second hand from a community that does not consider her a friend.

I had two choices:

1. Sit and listen to the talk from a position of defensiveness based on my belief in CSBD.
2. Sit and listen from a place of openness and process her information with an open and clear mind.

Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.

Giving the Villain a Chance

I put on my open-minded researcher hat and listened to her talk entitled Psychophysiology and the Failure to Discriminate Sexual Compulsion as a New Disorder. Her talk focused on two key components of proving the construct validity of a theory.

Particularly, she focused on convergent and discriminant validity.

Research Methods

As a recap for those who did not endure lots of research methods in school:

• Convergent validity is a type of construct validity that tests whether things that should be related are related.
• Discriminant validity, on the other hand, tests whether constructs that should not have a relationship do not have a relationship.

In looking at these two types of construct validity, Dr. Prause is addressing whether our measures of assessing sexual addiction are related and whether sexual addiction is different than other things such as depression.

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As professionals, our time is valuable. Dr. Weeks created the Mitigation Aide Research Archive because there isn’t enough focused, data-backed research available in easily digestible formats.

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Determination of a New Disorder

We often point to Voon et. al (2014) as a neuroscientific study that lends support to sexual addiction because the results of the self-determined sex addicts in the study had similar results to those of substance abusers.

Prause argues that when you look at the brain imaging studies of sexual desire you see the same reactivity, suggesting that Voon et. al very possibly just studied sexual desire as opposed to sexual addiction.

In terms of discriminant validity, Dr. Prause looks to the many studies that look at sexual addiction and its comorbidity with other mental health issues like major depressive disorder, obsessive compulsive disorder, alcohol use disorder, etc. The point she made is that if a diagnosis has so much overlap with other diagnoses, it is likely not its own separate diagnosis but symptoms of some other construct.

The Villain May Not Be a Villain After all

What I found most interesting: despite not believing that sexual addiction is its own separate diagnosis, she treats people who come in with problematic sexual behavior similarly to a clinician who does believes sexual addiction is valid. For example:

• Assess for other mental health conditions
• Engage in behavioral analysis of the sexual behavior they are concerned about
• Then treat them with shame reduction work and ACT

Final Thoughts

She agrees that people struggle with sexual behavior sometimes.

Dr. Prause thinks we should help them get a handle on the things they find to be a problem.

She does not believe in using a 12-step model or forced abstinence.

My personal take is that she believes that what some of us would call compulsive sexual behavior disorder is not its own thing but that the same behaviors are likely a symptom of some other mental health issue.

My other take away… I don’t think she is a villain at all. She is just someone who wants us to really think critically about our work.

Are you a professional looking to stay up-to-date with the latest information on, sex addiction, trauma, and mental health news and research? Or maybe you’re looking for continuing education courses? stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

The post How to Un Villain: Listening with an Open Mind first appeared on Dr. Jen's Recovery Readings.

I remember, vaguely, the first time I saw Love, Sex & Eating the Bones. I may have been twelve or fourteen years old at the time.

The only memory I had was of the last scene where Michael cuddles next to Jasmine around a fire pit with pornography films engulfed in flames. Obviously, at the time I had no understanding about the film, other than a guy throwing porn tapes in a fire. 

New Eyes

Years later, I revisited this film with “new eyes” (which is going to be a theme here) and realized not only is it a film about porn addiction.

It is a film about black people with porn addiction.

Research with this specific population is non-existent. I think that this film is one of the most important, if not the only, film with people of color dealing with porn addiction. With the lack of research aside, I think this is a great film that needs more recognition for individuals in recovery.

I feel this film could be used to help others articulate their relatability to Michael and his issues. 

Synopsis of Love, Sex & Eating the Bones (Spoilers!)

The issues Michael encounters are similar for all individuals addicted to porn such as:

• Erectile dysfunction
• Having sexual attraction to your partner but not being able to perform due to sexual desensitization
• Performance anxiety
• Frustration
• Decrease of quality in relationship
• Guilt and shame

In the start of the film, we can see that Michael is a young man in his mid- to late-twenties. He is employed as a security guard. We also find out he is an aspiring photographer.

We see a collection of women’s pictures he taped to the wall at work like a generic teenager’s celebrity crushes.

This shows that he does objectify women to a degree. The wall of women serves as foreshadowing for the variety of porn that he consumes. 

Aside from the mundane security job, Michael seems to be struggling with finding love and motivation for his photography. But when he meets Jasmine, things take a turn for the better. After a few dates with Jasmine, they attempt to have sex and he could not get an erection.

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

After they both become frustrated, Michael proposes to try to get an erection and have sex while porn is playing in the background.

The Low Point

This makes her uncomfortable and she then leaves Michael.

This is a common issue with some partners of porn addicts. They would have low self-esteem or personalize the fact that the addict can only have an erection by watching porn. This comes from a feeling that the addict is not stimulated or aroused by the partner. If the use of pornography continues the addict could form an intimate relationship/connection with pornography instead of the partner.

Such realizations could be devastating and sever the relationship. 

This was the moment when he realized that the porn is not “real.” It’s different from watching from the couch. Porn itself is just a fantasy and not a real human sexual connection.

Throughout the film we could see his addiction manifest itself as his favorite porn star.

She would come out of the screen while he would be watching porn or occupied with processing film. She would ask him to “spend time” with her.

Personification

This is an accurate representation of how a personification of the addiction would be.

Personification is a great tool that I use with my clients. I ask them to put the addict-self outside of themselves. I then explain how to make the addict-self a conduit to refuse the behaviors that the addict desires.

This could also be looked at as a personification of a trigger or urge being that voice in the mind triggering/urging the addict to act out or masturbate. 

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

Sexual Addiction Treatment Services has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7250. Programs that do not qualify for NBCC credit are clearly identified. Sexual Addiction Treatment Services is solely responsible for all aspects of the programs.

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The Turning Point

There is a scene where Michael wins a chance to record a porn scene with the same porn star. He, ironically, plays a security guard in the scene.

As she pins him against the desk and attempts to go down on him, the porn actress’s face suddenly warps into Jasmine’s. He panics, yells “cut!” and runs off the set.

This was the moment when he realized that the porn is not “real.” It’s different from watching from the couch. Porn itself is just a fantasy and not a real human sexual connection.

It also looked like he was experiencing performance anxiety and/or erectile dysfunction while on set. Similar to what he experienced with Jasmine. Perhaps, he had to think about Jasmine in order to get an erection and have sex with the porn star.  

After all the pornographic media he’s consumed, he decides, at that moment, to seek out an organic sexual connection/relationship that isn’t influenced by pornography.

The Conclusion

In the next scene, he’s siting in a chair talking to a counselor saying, “I just want my eyes back”. This was a great metaphor for reclaiming his vision for photography and his view of healthy relationships.

Michael and Jasmine end up getting back together after he professes his love for her and wants to commit.

Finally, we see them having sex and both climaxing at the same time as they ironically turn to the camera and say, “What are you looking at?” This showed the rewarding effects of rebuilding the intimacy and abstinence from pornography in order to facilitate a deeper intimate connection. 

As a therapist, I wish the rebuilding process for intimate connections was this fast but, in the real world, it takes time.

The Takeaway from Love, Sex & Eating the Bones

In therapy we would recommend abstinence from sex with the partner, in addition to abstinence from porn, for a significant amount of time. Typically anywhere from 30-90 days. This process helps reset dopamine levels and time to work on rebuilding the other intimacies of the relationship. This may be alien to our hypersexualized culture in which intimacy does not always mean sex.

Just to be clear: intimacy also refers to emotional, physical and mental connection.  

Originally appeared on EliIrving.blog on December 6, 2021

Guest Post by Elijah Irving

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Are you looking for more reputable, data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post Love, Sex & Eating the Bones (2003) Review first appeared on Dr. Jen's Recovery Readings.

For many people in early recovery from pornography addiction, a behavioral intervention they entertain is getting rid of their smart phone and going back to the dumb phone. This has caused some consternation when shopping for an old school flip phone. 

Do they even make them? If they do are they in stock or does it have to be ordered. Then, some of them still have some access to the internet. 

Update: To learn more about ways to restrict access to pornography, see the series on Blocking Porn.

The Dumb Phone in the News

In the past month, there have been a few articles in the Wall Street Journal about simple phones. 

The first article targeted parents who were not sure about getting their tween a smartphone. It is now the norm for a tween to have a smartphone and those that don’t may face some social pushback from their peers. 

Several newer phone companies have stepped up to address this gap. 

The first is the Light Phone II. This phone runs on the AT&T network. It looks like a smartphone but only allows calling and texting as well as some basic apps such as music and an alarm. 

The second option is the Gabb. This phone mimics the look of an iPhone but does not have any access to the internet, games, or social media. 

A third option is Pinwheel this phone also looks like a traditional smart phone but does not allow access to the internet or social media. In contrast, this company does allow age appropriate, nonaddictive apps. 

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

The second article targeted adults who wanted a minimalist phone.

The MuditaPure is a cellphone that can call and text but cannot access the internet, email, or take picture. The phone does not even have a color palate and is monochrome. This device will be available in November. Another option is the Light Phone that uses black and white to avoid blue light. 

Conclusion

With these new developments, there are now many more phone options for those in recovery. If you want, you can have a phone that looks like your peers’ so you can avoid the inevitable questions that come when you pull out a flip phone. 

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Do you feel your sexual behavior, or that of someone you love, is out of control? consult with a professional.

The post Who Uses a Dumb Phone? first appeared on Dr. Jen's Recovery Readings.

One of the unfortunate, but predictable, outcomes of the horrific Georgia shooting at the massage parlors is the rash of news articles talking about how Sex Addiction isn’t real. Most of what people are saying tends to focus on the lack of inclusion in the DSM-V. It never occurs to many how sex addiction can be confused with moral incongruence. What we need is a thorough discussion of the massive body of sex addiction research.

A full blown narrative of the research on sexual addiction conducted since the publication of the DSM-V in 2013 would be beyond the scope of this blog. I will, however, leave you with a few paragraphs regarding the topic that I recently included in a sentence mitigation report.

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

Sexual Addiction Treatment Services has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7250. Programs that do not qualify for NBCC credit are clearly identified. Sexual Addiction Treatment Services is solely responsible for all aspects of the programs.

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Diagnostic and Statistical Manual of Mental Disorders– V: (DSM-V)

In the current edition of the DSM, there is no stated mental disorder that encompasses the concept of sexual addiction. Be that sexual addiction, sexual compulsivity, hypersexual disorder, etc. To simply negate a mental health phenomenon because it is not in a version of the DSM that is currently almost 8 years old is to negate both the history of the disorder with the DSM and the body of research that has been conducted since the DSM-V work group decided against including Hypersexual Disorder. 

Prior to the publication of the newest edition of the DSM-V in 2013, the Sexual and Gender Identity Disorders Workgroup (Kafka, 2014) considered the inclusion of Hypersexual Disorder into the upcoming edition of the DSM. The suggested diagnostic criteria were as follows:

The “Almost Officially” a Disorder

1. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following criteria:
   1. Excessive time is consumed by sexual fantasies and urges and by planning for and engaging sexual behavior.
   2. Repetitively engaging in these sexual fantasies, urges and behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, and irritability).
   3. Engaging repetitively in these sexual fantasies, urges and behavior in response to stressful life events.
   4. Repetitive and unsuccessful attempts to control or significantly reduce the sexual urges, fantasies, and behavior.
   5. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.
2. There is clinically significant personal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of sexual fantasies, urges or behavior. 
3. These sexual fantasies, urges and behavior are not due to the direct physiological effects of exogenous substances (e.g., drugs of abuse or medication), a co-occurring general medical condition or to a manic episode.
4. The person is at least 18 years of age.

Specify if masturbation, pornography, sexual behavior with consenting adults, cybersex, telephone sex and strip clubs.

It was ultimately decided that Hypersexual Disorder would not be included into the DSM-V. The main reasons cited for the lack of inclusion were concerns around diagnostic accuracy, moral and cultural confounds and a lack of research supporting the concept (Kafka, 2014).

Do you believe you have an online pornography addiction? Take the free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

What’s changed in Sex Addiction Research since 2013?

In the nearly 8 years since the publication of the DSM-V, a vast body of scientific research in peer reviewed journals has been published seeking to understand the concept of sexual addiction and compulsivity which has also been termed hypersexuality.

A recent metanalysis was published by Grubbs et. al. (2020) that systematically reviewed the scientific research on the topic. Research on the topic, alternatively called sexual addiction, sexual compulsivity, hypersexuality, and compulsive sexual behavior began in the mid 1990’s. Research increased during the time that the DSM-V was in development. Knowledge on the topic continues to expand. The Grubbs et. al. (2020) metanalysis included 371 papers published in peer reviewed scientific journals documenting the results of 471 individual scientific studies. 

The Grubbs et. al. (2020) meta-analysis yielded several findings. On the negative side, the study found that there was a lack of rigorous outcomes studies for the treatment of Compulsive Sexual Behavior. Therefore, to date, there is no gold standard approach to treating the issue. The study did reveal that the Hypersexual Behavior Inventory (Reid et. al., 2011) is a well validated and clinically useful tool to assess Compulsive Sexual Behavior. The main finding pertinent to this case is that there is “clear evidence that CSB is a real phenomenon with clinical implications.”  (Grubbs et. al., 2020, p 11)

Are you a professional looking to stay up-to-date with the latest information on, sex addiction, trauma, and mental health news and research? Or maybe you’re looking for continuing education courses?

Stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

International Classification of Diseases – 11 (ICD-11) and Sex Addiction Research

The ICD-11 is the international equivalent of the DSM-V in the United States. The International Statistical Classification of Diseases is published by the World Health Organization and its most recent version was published in 2019 (WHO, 2019). Like the DSM, prior to any condition being accepted into the ICD there is a process of extensive debate and consideration. The ICD-11 does include a diagnosis of Compulsive Sexual Behavior Disorder (CSBD) which is classified under impulse control disorders. The diagnostic criteria share some traits with the proposed DSM-V diagnostic criteria for Hypersexual Disorder.

The Diagnostic criteria for Compulsive Sexual Behavior Disorder (ICD-11)

            Essential (required) features for compulsive sexual behavior disorder:

1. A persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior, must be manifested by one or more of the following:
   1. Engaging in repetitive sexual activities has become a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, or responsibilities.
   2. Person has made numerous unsuccessful efforts to control or significantly reduce the repetitive sexual behavior.
   3. The person continues to engage in repetitive sexual behavior despite adverse consequences (repeated relationship disruption, occupational consequences, negative impact on health, etc.).
   4. Person continues to engage in repetitive sexual behavior even when the individual derives little or no satisfaction from it.
2. The pattern of failure to control intense sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more.)
3. The pattern of repetitive sexual behavior causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning   NOTE:  Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges or behaviors is not enough to meet this criterion.

The inclusion of the rule out relating to erotic conflict or moral incongruence is a necessary criterion to address historical concerns about pathologizing sex with a label of addiction or compulsivity. Simply engaging in a sexual behavior that is non-normative or outside of a person’s religious or moral belief is not sufficient to diagnose Compulsive Sexual Behavior Disorder according to the ICD-11.

Check out my more recent article about Compulsive Sexual Behavior Disorder for more information about CSBD and its classification.

Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.

References

Bothe, B., Potenza, M.N., Griffiths, M.D., Kraus, S.W., Klein, V., Fuss, J., & Demetrovics, Z. (2020). Journal of Behavioral Addictions 9(2), 247-258.

Gola, M., Lewczuk, K., Potenza, M.N., Kingston, D.A., Grubbs, J.B., Stark, R. & Reid, R. (2020). What should be included in the criteria for compulsive sexual behavior disorder. Journal of Behavioral Addictions published online November 25, 2020.

Grubbs, J.A., Hoagland, K.C., Lee, B.N., Grant, J.T., Davison, P, Reid, R.C. & Kraus, S.W. (2020). Sexual Addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clinical Psychology Review (82), 1-15.

Kafka, M.P. (2014).  What happened to hypersexual disorder?  Archives of Sexual Behavior, 43(7), 1259-1261.

Reid, R.C., Garos, S. & Carpenter, B.N.  Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men.  Sexual Addiction and Compulsivity, 18(1), 30-51.

Are you looking for more reputable, data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

Do you feel your sexual behavior, or that of someone you love, is out of control? consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

The post The Importance of Sex Addiction Research first appeared on Dr. Jen's Recovery Readings.

Last night, after my final session ended at 8 pm, I looked at the news quickly before I packed up to leave the office. The biggest piece was the horrific murder of eight people in a massage parlor shooting. Many of the victims were women of Asian descent. 

These stories were followed by news that the shooter said he did this because of his sex addiction.

In a moment of full transparency, I will acknowledge that my thought after seeing sex addiction being brought up as a motive for a mass shooting was, “oh no, we don’t need this.” 

The legitimacy of sex addiction continues to be hotly debated in some circles and when horrible things happen and sex addiction is spoken about in conjunction with these horrific acts, it can add fuel to the debate fire.

Condolences

I would like to start this post by saying that I am deeply saddened for the victims and their families. The tragedy is compounded by the fact that many women who work in these massage parlors are victims of sex trafficking. I am also very sorry that the man who committed these crimes felt such despair. This extreme violence shouldn’t ever be the only option.

Much of my work is in forensic psychology, that is the lens through which I am viewing this. When a person commits a crime, there are both aggravating and mitigating factors. As I have no knowledge of the specifics in this case, I am going to speak in generalities. 

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

Mitigating Factors

Mitigating factors are things that may influence the person to commit the act. They are in no way, shape or form an excuse for the commission of the crime. They are the things that can explain the underlying factors that drove the person to the final criminal act. 

It is well established that addiction is frequently a mitigating factor in many crimes. We know that there is an association between drug addiction and crimes such as forgery, theft, etc. Other crimes may be influenced by a person’s untreated mental health issues.

In this case, it may well be that a mitigating factor was sexual addiction. 

This would mean that the perpetrator felt he had an addiction to sexual behaviors and that he could not control them.

Per newspaper reports, he sought treatment for these issues. At some point, his behavior continued to feel out of control and he likely had deep feelings of shame around his sexual behavior; news reports have claimed that his religious beliefs fueled this shame. 

Obviously, there may be other mitigating factors as well.

Aggravating Factors

On the other side of mitigating factors are aggravating factors. These are issues that make the crime particularly heinous. 

Again, not having reviewed the case, I can speculate that an aggravating factor here is the fact that many women who work in massage parlors are victims of sexual trafficking. Research from many nonprofit advocacy groups that work to stop sex trafficking has shown that many of these women  are often from China or South Korea. These women are often under extreme financial pressure, have limited resources and are recruited to work by fraudulent means and often do not know that they will be expected to perform work of a sexual nature. 

If the victims in this case were also victims of sexual trafficking, it makes them even more of a vulnerable population.

Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.

The Realities

In this case, we can speculate that this man’s feelings of despair over his inability to control his sexual behavior overrode his sense of right and wrong. As I stated before, mitigating factors are explanations and not excuses. A person who has been to treatment has knowledge of coping skills and resources that could have been used instead of resorting to an act of violence. 

There were other options. 

There are two major takeaways from this horrible act of violence in Georgia. 

1.  Sex trafficking is a major problem in the United States.  If you are unaware of this, please do some research on the topic.  Please also support the many great nonprofit organizations that work to stop the trafficking and help the victims of sex trafficking. 
2. Problematic sexual behavior is treatable.  Violence is NEVER an acceptable answer. 

If you feel that you are suffering from a sexual addiction or are having difficulty controlling your sexual behaviors, please reach out to our office. We will be happy to direct you to treatment in your area.

Resources to learn about Sex Trafficking

Office of Juvenile Justice

Human Trafficking Hotline

Minnesota Coalition Against Sexual Assault

Valley Against Sex Trafficking

Resources for Treatment

Sexual Addiction Treatment Services

International Institute for Trauma and Addiction Professionals

Society for the Advancement of Sexual Health

The post Georgia Massage Parlor Shooting first appeared on Dr. Jen's Recovery Readings.

Rob Weiss’s latest contribution to the recovery community is his book, Prodependence: Moving Beyond Codependency. 

This book, and the philosophy of prodependence are an alternate take on the idea of codependency that has been rampant in the addiction recovery movement for decades. 

What is Codependency?

Codependence has been defined as “a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, such as an addiction” (Merriam-Webster). 

In the recovery community the spouse, partner or family of someone suffering from an addiction is often labeled a codependent. 

This term came into the recovery lexicon in the 1980’s and became part of everyday language. 

A codependency diagnosis was rejected by the APA for the inclusion into the DSM but the “diagnosis” has persisted and there are 12 step meetings for Codependents (CODA). 

Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.

How is Prodependence Different from Codependency?

Rob Weiss proposes the the concept of Prodependence. He, and other therapists, believe codependence is not helpful to family members. 

Family members, loved ones, or care givers of addicts, in the codependency model, are often told they’re part of the problem. However, they’re just trying to cope with a very difficult situation. 

Prodependence is a term to describe “attachment relationships that are healthfully interdependent, where one person’s strengths support the vulnerabilities of another and vice versa, with this mutual support occurring automatically and without question.” (p53.) 

Rob prefers this concept as it celebrates a loved one’s desire to help the addict in their life without shame or blame.

Distancing from the term ‘enabling’

Prodependence looks at the behaviors of those around the addict as attempts to maintain or restore healthy attachment.

Not as enabling. 

Treating prodependence is similar to treating co-dependence in terms of encouraging healthy boundaries and self care. 

However, it differs by being a strength based, attachment driven model that values loved ones of an addict.

Are you a professional looking to stay up-to-date with the latest information on, sex addiction, trauma, and mental health news and research? Or maybe you’re looking for continuing education courses?

Stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

Kindness and Empathy, Not Shaming

Another key idea behind prodependence, is that an addict has an attachment disorder and needs healthy attachment to truly heal. 

Encouraging prodependence, treating addicts and their loved ones with kindness, empathy and respect, can help repair attachment traumas. 

Intimacy Versus Codependency

Another difference between prodependence and codependence is looking at addiction as an intimacy disorder. In opposition to tough love, intimacy disorders are treated with the pursuit of healthy, intimate and ongoing connection.

While suggesting that codependence may be an outdated concept is risky, it doesn’t feel groundbreaking. Prodependence feels like the natural conclusion when you consider what we’ve learned about attachment, intimacy and shame.

As Johann Hari suggests in his TED Talk, “What if all we were taught about addiction is wrong?” 

Perhaps, instead, we should treat addicts and their loved ones without shame and blame. We might get farther modeling healthy attachment, boundaries, compassion, and empathy instead.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

The post Prodependence: Moving Beyond Codependency – Book Review first appeared on Dr. Jen's Recovery Readings.

As a therapist, how do we determine whether a pornography problem is erotic conflict or an addiction?

When I started in this field, sex addiction was not a common term. Therapists who treated sex addiction were not that prevalent, therefore you never heard about sex addiction on the news. 

Today, it’s a different story. 

You hear the term sex addiction all the time, bandied about every time there’s a celebrity sex scandal. Therapists who treat sex addiction, whether specifically trained to do so or not, are much more common now too.

The same goes for pornography addiction.

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

The Impact of Media Discussion of Addiction

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
• Couldn’t stop
• Were experiencing serious repercussions in
  • Their work
  • Their relationships
  • The legal system 

I would diagnose these men as pornography or, more broadly, sex addicts.

The Changing Face of Sex and Pornography Addicts: The Pornography Problem

Today, many of the men who are coming in with self-diagnosed addictions are men who look at some pornography. 

They don’t:

• Look at it a lot; once or twice a week, sometimes less
• Look at it for hours and hours on end
• Look at anything illegal
• Often look at any pornography that is more “hardcore” 

Their pornography use is usually causing a conflict in their relationship. These are not men that I would diagnose with a pornography addiction, but they call themselves pornography addicts.

So, are these men who come in pornography addicts? Or are they men who are experiencing an erotic conflict?

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

Sexual Addiction Treatment Services has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7250. Programs that do not qualify for NBCC credit are clearly identified. Sexual Addiction Treatment Services is solely responsible for all aspects of the programs.

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What is an Erotic Conflict?

And how do we know what type of pornography problem it is

An erotic conflict is experienced by a person who is engaging in, or 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. Therefore, their behavior conflicts with their religious beliefs. 

A person who uses 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.

What does the DSM-V say about the Pornography Problem?

There is no DSM-V definition of sexual addiction or pornography addiction but we can extrapolate the criteria from drug and alcohol and gambling addictions. These are all 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
• Craving pornography use
• Failure to fulfill 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 actually experiencing an erotic conflict, they may never get to the root of the issue. They may work a 12-step abstinence model and therefore condemn any experiences of lust as bad or problematic. This can place moral good or bad judgements on sexual behavior, in other words more psychological harm if the client continues to engage in the behavior. It can shame the normal biological process of attraction by labeling it as lust. It may prevent the client from learning about healthy sexuality and what truly arouses and attracts them. Ultimately, they may never work through the conflict between their body and their beliefs to a healthy resolution.
2. We cause more shame. Though being a pornography addict is less shameful than it used to be, being named an addict will create very shameful thoughts for most people. This shame must be worked through when the person actually has an addiction. When the person is mislabeled, it can cause more shame and isolation than necessary. This adds to the “I’m a bad person” thoughts the pornography consumer might have for looking at pornography.
3. We trivialize sexual addiction. The therapeutic community and, often, the media hotly debate whether sexual or pornography addictions 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

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

The Takeaways

My goal here and in my practice is not to condemn or judge. 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?

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Are you looking for more reputable, data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post Pornography Problem: Erotic Conflict or Addiction? first appeared on Dr. Jen's Recovery Readings.

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 12^th 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 12^th step.  It is a great 12^th 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 

The post Book Review: Recovery: Freedom from Our Addictions by Russell Brand first appeared on Dr. Jen's Recovery Readings.

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 

The post Why is a Good Couples Counselor So Hard to Find? first appeared on Dr. Jen's Recovery Readings.