Treatment For Sexual Addiction A Psychoanalytic Approach It is well known among people in the 12-step sex programs that

t of all the addictions, sex is the most difficult to master. Far from the notion that sex addiction is the fun one, the suffering of dealing with this affliction is enormous. The compulsion is so compelling that it is common for members of the sex recovering groups to be unable to maintain any continuous time of sexual sobriety, giving way to despair and hopelessness. Before treatment, sexual enactment is the addicts only source of safety, pleasure, soothing and acceptance. It vitalizes and connects. It relieves loneliness, emptiness and depression. Sex addition has been called the athletes foot of the mind: it is an itch always waiting to be scratched. The scratching, however, causes wounds and never alleviates the itch. Furthermore, the percentage of people who go to therapy or a 12-step program is quite small. The majority of sexual compulsives live in isolation filled with feelings of shame. Almost 100% of the people who come to me for an initial

consultation, whether it be for compulsive use of prostitutes, phone sex, a fetish, cross dressing, or masochistic encounters with dominatrixes, relay that beneath the shame they feel in telling me their story, they also experience a sense of freedom that comes from finally being able to share with another human being the hidden, shameful, sexually compulsive acts that imprison them. This is a condition that gradually bleeds away everything the person holds dear. The life of a sex addict gradually becomes very small. The freedom of self is impaired. Energies are consumed. The rapacious need for a particular kind of sexual experience drives the addict to spend untold hours in the world of his addiction. Inexorably, the compulsion begins to exact higher and higher costs. Whether it be on the internet indulging in sexual fantasies with fantasy people, being on the phone to the sex hot-lines, or frantically searching the net and the S&M clubs for someone who will act out a particular, ritualized fetish fantasy, or cruising the bars searching for the one who will have sex in a public toilet, or going to dungeons

to be whipped, flogged and humiliated, sex addiction is a devastating illness that takes an enormous toll. Friends slip away. Hobbies and activities once enjoyed are dropped.Financial security crumbles as sums as high as $40,000 or $50,000 a year are spent on sex. Then there is perpetual fear of exposure. Relationships with partners are ruined, as the appeal of intimate sex with a partner pales in comparison to the intense high of indulging in the dark and devious world of sexual compulsion. What is a sex addict? Sex addiction, of course, has nothing to do with sex. Any sexual act or apparent perversion has no meaning outside of its psychological, unconscious context. A simple definition of sex addiction is not dissimilar to definitions of other addictions. But a simple definition of this complex and intractable condition doesnt suffice. What sets sex addiction apart from other addictions and makes it so persistent is that the subject of sex touches on our innermost unconscious wishes and fears, our sense of self, our very identity.

Current treatment might include participation in a 12-step program, going to an outpatient clinic, working with the Patrick Carnes material, aversion therapy, or the use of medications to stave off hypersexuality. Most therapy is cognitive-behavioral, designed to help the patient to control or repress the instinct for a period of time, usually out of a desire to comply with the group norms of their 12-step meeting or a need to please the therapist. While I recognize the efficacy the 12-step programs to provide structure and support, in my opinion, the reason that relapse is so prevalent is that these treatment modalities do not effect long-term structural personality change that eliminates the compulsion at its roots. Current treatment does not aim to transform psychic energies so that the reality sector of the mind dominates the personality so that the impulse to act out can be understood and controlled. While the definition of sex addiction is the same as that of other addictions (recurrent failure to control the behavior and continuation of the behavior despite increasingly harmful

consequences), sexual compulsion is set apart from other addictions in that sex involves our innermost unconscious wishes, fears and conflicts. Sex addiction is a symbolic enactment of deeply entrenched unconscious dysfunctional relational patterns with self and others. It involves a persons derailed developmental process that occurred as a result of inadequate parenting. Hence, permanent growth and change are most likely to occur in the arena of contemporary psychoanalysis, which seeks understanding and repair of these unconscious dysfunctional relational patterns along with the development of a more unified and structured sense of self. This new personality restructuring can better self-regulate feeling states without the use of a destructive defense like sexualization and can find meaning, enjoyment, intimacy, meaningful goal setting and achievement from attainable and appropriate sources in life. The remainder of this paper will give a brief overview of the historical psychoanalytic views about sexual deviance, and will then articulate the current analytic understanding about the

dynamics and treatment of sexual compulsions. Any discussion of historical psychoanalysis must, ipso facto, begin with Sigmund Freud. Freud formulated that sexual deviance occurs due to an incomplete resolution of the Oedipus complex, with its concomitant castration anxiety. Unconscious castration anxiety occurs in the persons present-day consciousness in the form of fear of confrontation, retaliation, or rebuke, a sense of inadequacy, and perhaps doubts about gender identity. Sex addiction, according to Freud, is a defensive way to cope with a tenuous sense of masculinity combined with unrelenting anxiety about sex, women, intimacy, aggression, and competition. Analysts that followed Freud held varying views. Sexual compulsions derive from an insatiable need for approval, prestige, power, bolstering of selfesteem, love and security which are experienced as being necessary for survival. The addict experiences the absence of sexual acting out as a threat to his very existence. Dorothy Hayden LCSW About the Author:

Dorothy Hayden, LCSW, (www.sextreatment.com) is a New York-based psychotherapist who specializes in sex therapy and sexual addiction. She received her M.S.W. from New York University and her psychoanalytic training at the Post Graduate Center for Mental Health. She can be reached at http://www.sextreatment.com Tags: Author Dorothy Hayden, New York University, Patrick Carnes,Sigmund Freud