Sex Addiction: Holistic Treatment Goals and Protocols for Body, Brain, and Relationship (Part 1)
Since a host of psychological, neurophysiological, and cultural factors conspire to create and maintain sexual addiction (SA), only an equally holistic integration of addiction treatment and trauma recovery interventions can heal it. The most successful model for repairing SAs’ affect dysregulation and relational deficits blends a 12-step addiction recovery protocol with one that develops affective powers through the therapist’s coregulatory engagement with the patient to create a mutual, if “asymmetrical” (Benjamin & Atlas, 2015, p. 50) dyad.
But effective, lasting treatment of SA needs to be holistic in more than its recipe of interventions. Clinicians must not only tolerate, but treasure, the paradoxes or seemingly contradictory truths that such patients exhibit and experience daily. For SAs harbor dramatic conflicts in their selves. Shameful secrecy splits the self into public bravado and private panic. Desperate thirst for connection sports with utter incapacity for relationship. And every addict both bears pitiable injuries and perpetrates horrendous hurt. As a result, therapists must—paradoxically—confront and deconstruct the patient’s defenses while simultaneously tending to the equally hidden, equally powerful underlying dysregulation. Unless the therapist engages a “doubly double” approach—one integrating both left-brain and right-brain powers, and both the patient’s and the therapist’s experiences—even proven treatments will fail.
The Stockdale Paradox, named after the American general captured and tortured by the Viet Cong, exemplifies the dual vision therapists must carry. Refusing the role of “model prisoner” for his captors’ propaganda, Stockdale survived his POW experience through his ability to embrace the paradox of knowing he might die at any minute and concurrently imaging his eventual release (Grosser, 2013, Loc 68). Likewise, clinicians must recognize that SAs could lose their sobriety at any time, and simultaneously must visualize their recovery. Patients, on their part, must trust the therapist enough to sacrifice sexual pleasures while experiencing desperately feared pain—no easy feat when the frontal lobes that teach trust have been damaged, and instead predict only betrayal (McGilchrist, 2009). If the therapist and the patient learn to tie such paradoxical truths together, they can brave the terrain of treatment by letting their genuine, gloriously imperfect human relationship unfold.
Overall Treatment Goals Require a Holistic Healing Model
In the 1960s and 1970s, the medical community finally embraced practitioners’ use of an AA-style, abstinence-based, behavioral approach to addiction (Flores, 2003). While chemical dependency counselors borrowed from cognitive psychology (“stinkin’ thinkin’ ”), they still worked primarily from a mechanistic CBT model focusing on maladaptive behaviors and thoughts, while “real” therapists kept to an analytic or psychodynamic model. In isolation, neither modality healed addiction: CBT helped reveal, then change, the negative cognitions and behaviors maintaining addiction (Potenza, Sofuoglu, Carroll, & Rounsaville, 2011, in Thomsen, Fjorback, Moller, & Lou, 2014) but ignored the underlying trauma and bodily based emotions driving it; classic psychotherapies provided insight but lacked effective interventions....
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