Masturbation can be thought of as a form of self-soothing. I have heard clients talk about growing up without enough love and support and connection, and discovering masturbation once they hit puberty. They describe their first experiences with it as being very soothing, and report engaging in it when they are sad, upset, or bored. In this context masturbation is being used as a form of emotion regulation.
This is a great question. As I understand it, the creators of the DSM have tried to steer clear of pathologizing any sexual activities, given their history of having included homosexuality in the manual and the subsequent backlash they faced against this. However, The International Classification of Diseases – 11 (ICD-11), an alternative classification system published by the World Health Organization and preferred by many researchers, does include it, under the title of ‘Compulsive Sexual Behaviour Disorder’.
There is no easy answer for this. This is why aftercare is so important. Before leaving treatment, clients are encouraged to identify their bottom-line behaviours: the sexual behaviours they are committed to abstaining from for the time being. Whenever they feel they are ready to reintegrate sex or masturbation back into their life, they are encouraged to go over this with their therapist and group members: What would it look like? What limits are you going to set around it? What will the signs be that it is causing you harm?
Typically, male clients with attachment issues report compulsively meeting their attachment needs through sexual gratification primarily. Conversely, female clients often report being more compulsive relational connections. A good place to start for female clients with compulsive love and relationship issues is Ready to Heal, by Kelly McDaniels. There are inpatient treatment programs specifically for women as well.
There is a distinction between sex offenders and sex addicts, although there can be overlap. For example, someone with a sex addiction can become a sex offender if they’re behaviours cross certain legal thresholds. But the distinction lies in understanding the behaviour of sex addicts as a progression of an addiction, as secondary to it, as opposed to being a primary form of sexual orientation. There are entirely separate programs for sex offenders.
A big part of the training for CSATs focusses on the experience of the partner and how traumatic their experience can be. Connecting the partner with a CSAT for their own therapy process can be helpful. I also recommend a workbook for partner’s of sex addicts, entitled Facing Heartbreak: Stepts to Recovery for Partners of Sex Addicts, by M. Lee, S. Carnes, and A. Rodriguez.
Voyeurism is just one of many possible paraphilic behaviours which often become incorporated into the sex addiction, particularly as the person becomes habituated to certain stimuli and need even greater levels of risk to achieve excitement. Other paraphilic behaviours include: pain exchange, exhibitionistic sex, anonymous sex, paying for sex, seductive role sex, among others. What’s helpful clinically is investigating with the client why they have chosen that specific behaviour. What is it doing for them? What developmental experiences is it attempting to rebalance or address?
We have a 7-week long inpatient program where clients are in group with each other every day. Clients are also encouraged to attend a year of weekly SA-specific aftercare group, which is included in the initial cost of the inpatient program.
This is an excellent question and one that is hard to answer. One of the benefits of the pandemic is that many therapists have been required to broaden their practices through digital technology, therefore making more formerly geographically constrained CSATs easier to access.
Absolutely. This is also in keeping with Patrick Carnes’ model as well. Most of our clients tend to prefer Sex Addicts Anonymous, and Sex and Love Addicts Anonymous.
Out of Carnes’ 30 steps to recovery, the first is Break Through the Denial. There are several written tasks the clients can do to work on this. However, perhaps the most important and powerful method for breaking through denial and encountering shame and guilt is the presence of other group members. Peers who have already done some work and gained some ownership over their actions can invoke a client to look inward in ways that a therapist can’t.
Short answer: it depends. As clinicians, we are not invested in pathologizing any particular behaviours. The way we perceive these behaviours is: is it working for you? The main thing that drives the addiction cycle is shame. If people feel shame after a certain sexual activity, then we need to ask why? Is it because you have internalized certain cultural norms and need to fly your freak flag? Or is because what you are doing is out of your control and against your own value system?
A good place to start is with a Certified Sex Addiction Therapist (C-SAT). There are a limited number of them in Canada, unfortunately, but it seems that the pandemic is pushing many therapists in the direction of offering virtual care, extending their geographic range. Click on this link to find a therapist in your area; https://iitap.com/search/custom.asp?id=4662.