Blog

Articles by David H Jacobs Ph.D

Sex Addiction Treatment

The goal of diagnosis is to formulate a realistic and adequate statement of what is the matter. Treatment has no direction without a grasp of what is ailing an individual. I have discussed my view of what is going on in sex addiction in a companion piece. As with all addictions, what is the matter in the case of sex addiction treatment must refer to what is actually driving the person’s insatiable need for the addictive activity and all the fantasizing, planning, arranging, plotting, and scheming that goes along with it. I discussed two prominent legacies of an oppressive and/or neglectful upbringing in a companion piece that I believe are highly pertinent to sex addiction: a dysphoric baseline feeling state that motivates seeking strong distraction and titillation, and a shallowness in feeling about and caring about another person that derives from fundamental distrust and wariness of people.

Crisis and threats put a halt to the sex addict’s usual habits, but crisis and threat will not bring about a real change in a person’s desires, values, sensibilities, preferences, and so forth. Positive change can only be achieved if there is a softening of what drives the addiction, if the background dysphoria is reduced and if the ability to turn to, trust, and enjoy relationships with people is enhanced. This is the task of therapy with or without the aid of some kind of supportive and connecting group experience. Malaise and distrust were originally created in the experience of disappointment, frustration, and otherwise inadequate or worse relationships with caregivers growing up; in the present, only a quite different relationship experience with someone emotionally important can to some extent remold basic feeling states and expectations.

Why not the spouse? I should say, why hasn’t the relationship with the spouse repaired old wounds? This hasn’t really been much of a possibility because the spouse has only been allowed to know what is compatible with maintaining a marriage, so all of the old feelings of having to hide to be safe have been continuously reinforced in the marriage. Post-exposure, the spouse is injured and outraged, not a favorable emotional position from which to extend acceptance, nurturance, affection, and so forth. Either way, the spouse has her own needs. Marriage requires mutuality and not one-sided unconditional acceptance and care-giving (too much and too continuous frustration heralds divorce). Parenting is different: parenting requires giving; there is realistically no expectation or demand for mutuality. Parenting is one-sided, in contrast to friendship and marriage. Ideally. In reality, the person who is now a sex addict got gypped. For whatever reasons, his parents were unable to give him the one-sided attention, care, nurturance, and so forth that he needed to live life as an adult without being tormented by bad baseline feelings, bottomless needs, and basic mistrust. The spouse cannot realistically be expected to supply what he failed to get from parents. A spouse is a spouse, not a parent.

The bad real news is you don’t get another set of parents when you are an adult. The window is closed. But the job/profession of psychotherapy is to provide a one-sided relationship in the present. Unfortunately there is a cost for getting help because therapists live in the same money economy as everyone else and have to make a living. Because it’s a professional job and payment is required, the psychotherapy relationship is inherently somewhat artificial as a relationship. Nonetheless, the therapist’s job is to enter into the client’s subjective and emotional world in an empathic and caring manner, and, if you’re a secretive, distrusting person it’s not likely you have anyone else in your life to whom you can unburden yourself. The therapist is bound ethically and legally to maintain confidentiality, so you can unburden yourself without fear of worldly consequences. You don’t have to worry that your therapist won’t like what you say and won’t like you (I am referring to secular therapy) and will shame you and tell others. Therapy is about listening and understanding, not judgment. Above all else, therapy is confidential.

I emphasize experience as mutative, not practical advice, information, moral suasion or exhortations, tips on how to delay gratification, learning to breathe in a certain manner, learning to meditate, and so forth. Only experience, not information or thought, can impact deep and long standing sentiments, beliefs, desires, convictions, and so on. The intellect is the wrong approach. Conscience or appeal to moral or religious beliefs is the wrong approach. Threat and shame just drive people underground and make them cunning. It would be a different world if information could alter deeply held beliefs and feelings. In some ways, people are rational and act in a rational means-ends manner; in other ways, people are profoundly emotional and act on the basis of emotionality, needs, and desires. With regard to sex, anyone who watches TV or reads newspapers has to be impressed with what even very prominent people in the public eye will risk to divert themselves with sex. We read about it or see it on TV precisely because so many people find it impossible to keep their activities a secret indefinitely .

What can be game changing about therapy is not what the therapist advises or the insights the therapist may have about you, but rather the reliable and unchanging attitude of interest, acceptance, desire to understand without judgment, and the like. Based on their personal experience growing up, sex addicts have no reason to regard the interest of another person as benign. They have had to dissemble with their wives. Therapy is an opportunity to speak honestly without fear of reprisal. It is not necessary for the therapist to have brilliant insights; what is important is that the therapist reliably demonstrates that he is an ally, wants to understand your point of view, wants to understand how it was and is for you, and so on. The therapist is not much interested in giving advice. Anyone can give advice. A common expression is very revealing about advice: ‘What I would do is…” But the topic is not what the therapist imagines he would do in your situation; the topic is endeavoring to grasp and put together into words what the client is facing. I might give advice if asked, but it’s not my first choice and I definitely have to be asked. The point of therapy is not to impart what I would do. Usually, what I am inclined to do is not really even relevant because only the client is fully in his position and only he has to live with the consequences of what he does or does not do.

Therapy for sex addiction must address what has been driving the addiction. What has been driving the addiction is not so baffling (although the addict has no doubt developed cunning). People get desperate, afraid, and insatiable when basic needs are unfulfilled for too long during the formative years growing up. Therapy has to explore and acknowledge the needs that were frustrated growing up. In the course of this work, the client experiences a relationship with another person that has heretofore been unknown. The experience of this relationship over time ameliorates a variety of basic injuries. The client little by little is in a different position in living: less desperate, more connected. Marriage in more than name becomes possible.

How Does Change Occur in Psychotherapy?

I think it will be helpful to me and to prospective and beginning clients to try to provide an overview of how I think about …

Make-Believe in the Addiction Treatment Industry

Therapists shouldn’t be in the business of make-believe. There is a great deal of make-believe in the addiction treatment …