Alexandra Katehakis, PhD, LMFT, is founder and Clinical Director of the Center for Healthy Sex in Los Angeles, CA. She is a clinical sexologist, certified sex addiction therapist/supervisor, and AASECT certified sex therapist/supervisor. Dr. Katehakis is a Senior Fellow at The Meadows, AZ, faculty member of the International Institute of Trauma and Addiction Professionals, and the 2012 recipient of the Carnes Award. She is author of Erotic Intelligence: Igniting Hot Healthy Sex While in Recovery From Sex Addiction (Health Communications Inc., 2010), Sex Addiction as Affect Dysregulation: A Neurobiologically Informed Holistic Treatment (Norton Series on Interpersonal Neurobiology, 2016), and The Katehakis Integrative Sex Therapy Model: A Workbook Companion That Celebrates Healthy Sexuality (forthcoming); co-author (with Tom Bliss) of the award-winning Mirror of Intimacy: Daily Reflections on Emotional and Erotic Intelligence (AASECT, 2014), and contributing author to Making Advances: A Comprehensive Guide for Treating Female Sex and Love Addicts (Society for the Advancement of Sexual Health, 2012, edited by Marnie C. Ferree).
NPT: Can you tell us a little about the theories and philosophies that have most impacted your work?
AK: I’ve always been interested in a synthesis of theories and philosophies, taking the best aspects and melding them together. I’ve never been satisfied with following “one way” since I seek a holistic view of things in life. Affect regulation theory is where I hang my hat today because it acknowledges and includes multiple areas of science. Given the evolutionary underpinnings of the theory, and its rich complexity of ideas, it crystalizes the genesis of all forms of psychopathology. In other words, its neuropsychobiosocial approach makes therapy make sense! Early mother/infant regulatory interactions set the stage for how a child develops over time. Knowing that a combination of genetics and epigenetics are at play in forging who we are, and who we are to become, allows me to see the intricacies of the adaptive strategies my patients recruited for survival. With a psychobiological map, I’m better equipped to move patients out of dissociation and back into their mind/body.
NPT: What are you working on currently?
AK: I’ve just completed a workbook—The Katehakis Integrative Sex Therapy Model: A Workbook Companion That Celebrates Healthy Sexuality—for people who are in recovery from sexual addiction or compulsive sexual behaviors (whatever term the patient is most comfortable with using). The workbook arose naturally from the research study I conducted for my dissertation. Specifically, I titled my thesis, A Conceptual Model of Healthy Sexuality for Male and Female Clients Who Identify as “Sex Addicts”, and on the day I sat down to design and write my research study, the model sprang forth with such ease it surprised me! I wrote for about six hours straight that day, and another six the following day. I was in a highly creative flow state that unlocked my intuition, allowing ideas and concepts to emerge without judgment. After two days in this play state, the result was an amalgam of my years of clinical experience, my personal therapeutic journey, theoretical study, and my own beliefs.
NPT: If there was one thing you would like to impart to a new psychotherapist what would it be?
AK: For starters, I think it’s imperative—a requirement even—for clinicians to spend a significant amount of time in personal psychotherapy. Without going through deep, affective, psychotherapeutic work that includes a body-oriented process, I don’t think therapists have the necessary experience to take others through a depth process. At the very least they’ll be limited, especially if they hang everything on a theory without lived experience—in short, we are our own best laboratories! Through present-day reactions to our early beginnings, childhood experiences, adolescent tribulations, entrance into young adulthood and so on, we form ourselves, change our capacity for self-compassion and empathy, and become more capable of self-regulation, and therefore regulation of others. Recall the old adage that goes something like you can only take your patient as far as you’ve gone yourself. Next, I suggest new clinicians follow their passion, which usually has personal meaning driving it. Many therapists embark on their journey into the field of psychotherapy in an effort to heal themselves; this gives them a distinct advantage since they have personal experience related to the area of study they choose. Finally, they should be encouraged to be a good listener, and to drop interpretations and listen instead to the inherent wisdom of the mind/body. By wondering aloud with patients, disclosing their felt sense, and being willing to sit in the unknown without answers as they walk side-by-side with patients in search of their truth, safe surprises and moments of joy and play will emerge.
NPT: In your experience, how has an understanding of neurobiology helped you in your practice/research?
AK: Over the past ten years I’ve had the privilege and good pleasure of learning neurobiology directly from Dr. Allan Schore, which has fundamentally changed the way I think and practice. Dr. Schore reminds us that the psychobiological substrate of the human unconscious is the right brain. This notion alone focuses me when I’m with my patients on the primacy of affect rather than on cold cognition. I have the experience over and over again of what happens when a deep resonance occurs between my patient and myself when we’re engaged in a nonverbal, intersubjective “conversation”. Through rupture and repair – by “listening” with my right brain and to my bodily-based cues, and following my intuition – the right amygdalae of both parties activate, uncoupled circuits start to kindle, and a whole host of other co-regulating processes engage, potentially moving the patient toward neural integration. These implicit exchanges appear to be the key to healing both the structure and function of the central and autonomic nervous systems. The simple practice of staying present with myself and with my patients has created a stillness in me that allows for an intimate connection where both of us feel seen and known.
NPT: So what’s ahead for you in the next 12 months?
AK: I will continue with my mission of working with patients who struggle with sexuality issues and educate professionals on the notion of sexual addiction as a problem of trauma repetition and, therefore, affect dysregulation (Sex Addiction as Affect Dysregulation: A Neurobiologically Informed Holistic Treatment, Norton, 2016). Additionally, since 2017 ended with the most talked about topic in the U.S. being sexual harassment, I’ll be thinking more about what comprises healthy sexuality. I’m looking forward to my workbook coming out in the spring of 2018 and plan to create an online platform to train therapists on how to use this simple, affectively based model with their patients. Overall, I’d like to inspire more critical thinking and conversations about what healthy sex is and how we can begin to change our definitions of masculinity and femininity toward a more sexually healthy and respectful world.
We also have some exciting directives at the Center for Healthy Sex this year including a women’s weekend workshop for those struggling with sex and love addiction, a topic I’ve written about extensively via my contributions in Making Advances: A Comprehensive Guide to Treating Female Sex and Love Addiction (Society for the Advancement of Sexual Health, 2012). And for those of you who prefer to just read one chapter on the topic, I recommend my chapter entitled “The Female Face of Sex Addiction” in the International Handbook of Sex Addiction (Routledge, 2017).