As many of the readers here had cheaters who were diagnosed SAs (and probably have the thousands of wasted therapy dollars to prove it), I thought you would appreciate Dr. Ley’s sex positive but own-your-shit perspective.
CL: Do “sex addiction” therapists have to have any particular sort of licensing? Who can call themselves a sex addiction specialist?
DL: Sex addiction “treatment” is an unlicensed, unregulated industry. Some sex addiction therapists are licensed mental health professionals, such as counselors or social workers. Mental health licensing boards have not yet come down on these therapists for practicing an “experimental,” unsupported, undiagnosed treatment, but they might. Especially as many such therapists are engaged in treating “same sex attractions” as a form of addiction.
In other words, some of these patients’ sexual behaviors include homosexual activity, in video stores, etc. Sex addiction therapists often characterize such homosexual desires as a form of illness, and work to suppress it. This is a form of conversion or reparative therapy, banned by most professional associations. Licensed therapists doing this are likely to start seeing licensing complaints and malpractice suits.
But, most sex addiction treatment occurs in unlicensed settings, from:
- “Coaches” who are former sex addicts who have embraced the model of sex addiction treatment to help themselves, and now sell that service to others, often online. There is no regulation of these folks. They often have no liability insurance, supervision, and have no requirements to protect confidentiality or treat people ethically.
- 12-step groups – including SA, SLA, SAA, etc. There’s a proliferation of these. These are peer-led. There’s no regulation or monitoring of them. Each varies significantly, in theory and practice. Some ban anything except heterosexual monogamy, including masturbation. Other groups are more “flexible” about what constitutes unhealthy sexual behaviors.
- Residential treatments – these are residential recovery centers, which charge cash for sex addiction treatment. They often claim to bill insurance, but because sex addiction is not a recognized disorder, such treatments aren’t covered by insurance. Such centers are rarely closely regulated. Recent exposes about such rehab facilities are proliferating in the media, for good reason. Typically, they provide 12-step based treatments.
It’s incredibly important to know that there is absolutely NO evidence that any of these sex addiction treatments are effective, in reducing sexual behavior problems, improving relationships, etc. So, it’s unethical in my opinion for any of these folks to provide or charge people for such services, without making it clear to the patient that these treatments are unsupported by literature or medicine. They are “experimental” and frankly, comparable to treatments such as homeopathy. These treatment providers are usually well-intended, and genuinely are trying to be helpful. But that doesn’t prevent them from causing therapeutic harm.
CL: Is there a connection between sex addiction and personality disorder? Instead of I’m a poor sausage who is a slave to his urges, how about I’m an entitled horndog who is fully cognizant of what he’s doing and lacks empathy for his partners?
DL: There’s a really strong connection here, in two ways:
- Substantial research has demonstrated that as many as 30-70% of alleged sex addicts may have a diagnosable personality disorder such as Narcissistic PD, Antisocial, or Borderline. You can imagine how such problems could have a sexual component, in a variety of ways. It raises the very real problem of diagnosing/treating sexuality as the problem, when the reality is, the problem is the person themselves. These people don’t behave selfishly just in sex. They have lots of other problems. Diagnosing sex addiction in such cases is the equivalent of diagnosing “sneezing disorder” in someone who has a cold. It’s dangerous, and distracting, and reflects our society’s fear and mistrust and obsession with sex.
- Secondly, it’s important to know some of the numbers here. Roughly 90% of sex addicts are males. About half of these males in treatment are white men who make over $85k a year. What does that mean? It implies the strong possibility that in these men, what we are seeing is a form of sexual privilege. Wealthy, powerful men have always had the privilege to engage in infidelity, have a harem, etc. But, starting in the 80’s we started applying the same rules to men as we do for women, as a result of the feminist revolution. And suddenly, we have a “disorder” that explains and excuses these selfish sexual misbehaviors.
CL: Does it matter what flavor of fucked up it is? If someone is behaving this destructively and risking your health and emotional well-being, isn’t the healthy thing to get away from it? Does it need a name? (Or does giving it a “syndrome” keep partners stuck?)
DL: I’ve heard from many wives and partners who stayed with spouses who treated them dishonestly around sex, in part because the wives bought into the sex addiction excuse. One woman told me, “it was easier to believe he had a disease, than to believe he was merely treating and my safety in such selfish ways.” I’ve seen countless other women who told me that the “sex addiction identity” became their husband’s justification and explanation for all their sexual choices, and that it became impossible to get their husbands to assume responsibility for their behaviors or their consequences.
However, and this is the one caveat I will really give to the sex addiction model – it does give people who are struggling some sense of peace, resolution or mastery, to be able to “name their problem.” For some people, saying “aha, that’s my problem, I’m addicted to sex,” gives them a way to begin working on their behaviors or problems. Unfortunately, in my view, it’s a deceptive and not very effective strategy, that depends on externalizing one’s sexual desires, rather than increasing one’s personal understanding and acceptance.
CL: Let’s say SA is an addiction — then why doesn’t the same advice apply to partners of other addictions? In addiction literature, you are taught the 3 C’s — didn’t cause it, can’t control it, can’t cure it. But partners of sex addicts are encouraged (guilted?) into owning their part (“colluding”) and supporting the SA through expensive therapy. Why is that?
DL: Well, few things I’ll say:
- There is NO evidence that such men cannot control their sexual behaviors. In fact, there’s a wealth of research showing that they have as much self-control as any other person, even though they often believe they have difficulty controlling themselves. I think this is evidence of a disturbing self-fulfilling prophecy. They present themselves as people who have difficulty controlling their impulses and desires, but there’s no evidence that they actually do.
- There’s a radical difference between “choosing not to exert self-control,” and “being out of control.” Most sex addicts appear to be people who choose not to exert control over their sexual behaviors. I believe that’s a problem of personal responsibility and understanding of one’s sexual desires/needs, not an addictive disorder.
- Much research indicates that so-called sex or porn addiction is most often an indicator of high libido. Sex/porn addicts “look” just like high libido people in much of the good experimental research. But, many of these self-identified addicts also have moral/religious/family/social conflicts about sexuality. So, they are people who grew up in an environment where sexuality is shamed and suppressed, but they are a person who responds strongly to sex. It makes sense that they would identify and understand that as an addiction, because they haven’t been taught to understand and accept their own sexuality. (As said before, they are often also bisexual men, who treat their homosexual desires as an addictive impulse to be suppressed.)
- This libido mismatch/conflict appears to often be at root of wives labelling their husband as a sex addict. I saw one man who was married three times. First two wives, and the couples’ therapists they saw, all labelled him as a sex addict. He really, really wanted to be a swinger. His first two wives refused, and said his obsessive interest was an addiction. Third wife cured him. How? She was a swinger. So, the point is, “too much sex” is a relative term, which varies by social and relational context.
- Finally, there is a group who advocate for something they call “Sex Addiction Induced Trauma” where they are literally trying to diagnose PTSD in the wives of these men who’ve been treating. While I understand and empathize with the devastation and emotional pain that comes from such a revelation and the dishonesty of one’s partner, calling this trauma, or a disorder, is disturbing. So, now, a person with a fictional disorder has created another fictional disorder in other people, as a result of their behaviors. Where does this stop? We don’t get to just make up a disorder to label every problem out there, especially when there are already really good explanations and labels out there.
- I encourage husbands and wives to sit down and have a really good discussion about infidelity, sexual desires, libido, etc. Unfortunately, in our heteronormative, monogamy-idealizing society, these people with high libido have no real room to say, “Hey, I’ve got a high libido, and sometimes sex with one person might not be enough for me. Is that something we can deal with?” This is where porn, open relationships, fantasy, role play, etc., can all come into play, to help partners resolve these issues from a place of understanding, mutual respect, compromise and personal responsibility. Personally, I think that’s a lot better than saying, “It’s not my fault, my sexual desires are an addiction and I can’t control them.”
CL: PTSD is a real thing, isn’t it? It seems to be recognized by therapists as a legitimate reaction to discovering infidelity. Having experienced the discovery of a disordered person’s double life I had the shakes, nightmares, intrusive thoughts, vomiting, triggers. Honestly, I don’t know many people who discover infidelity that don’t experience major trauma from it for months. I can’t speak to SAIT, but it would stand to reason these people do a lot of damage to their spouses and then they’re encouraged to stay with them and take more abuse.
Why do you think their partners don’t have PTSD? My advice would be, whatever its label, recognize the situation isn’t good for you. If staying with this person makes you physically sick? Get far away from it.
DL: PTSD is defined as trauma and lasting impact (over 3-6 months) from a life-threatening situation, rape, death, etc. The emotional devastation from infidelity is real. But it’s not a disorder. As hard as it is, it’s a normal reaction to an awful situation, just like grief is a normal reaction to a normal, but devastating loss. We shouldn’t medicalize this.
I think we’re mostly in agreement on the character issue. I believe that character and personal responsibility comes from acceptance and understanding of one’s own needs, including sexual, and treating others with respect — not treating others as though their needs matter less than our own.
But, I often point out that the character/moral issue of infidelity is one that is heavily influenced by social standards. In the US, we’ve identified infidelity as an overriding moral/character issue. Once a person cheats, it becomes the overriding variable regarding their morality. Other cultures take different views of infidelity. Some ignore it, some don’t like it, but accept it as one of the many human flaws. The big point for me here though, is these are moral issues, not medical ones. Society and morality can oppose infidelity, and define it as overriding. That’s fine, I’m not arguing it. But they shouldn’t be allowed to pretend that these moral issues are actually medical issues.
On that – there are many religious groups, like the LDS, the XXX Church, Focus on the Family, who use addiction language to masquerade their moral attacks against porn, masturbation, and homosexuality. It conceals their true intentions, and conveys a sense of altruism and beneficence, and confuses people into thinking they are getting healthcare, when actually they are getting moral preaching.
CL: I think we are in complete agreement on personal responsibility and communicating your sexual needs. Especially the “I can’t do monogamy” talk.
However, you’re making an argument a lot of people make on infidelity, that it is a “monogamy” problem or a high sex drive problem. I argue cheating is a character problem. It’s an entitlement problem.
Swingers get cheated on too. Every arrangement has boundaries. The whole “he married a swinger and everything was fine” narrative might work for that guy, but it ignores the major problem with cheaters — they violate agreed upon rules.
By your own writing, you say 40-70 percent of SAs are personality disorders. These are people who get high off deceit. They PREFER the un-level playing field.
I fear we do great damage to chumps when we focus on the sex drive and monogamy issue, and avoid the character problem. If the chump stays stuck on upping their bedroom skills or winning back the cheater by “improving” their “inadequacies,” they’re playing a rigged game.
DL: Relationship issues involved in infidelity, around honesty, communication, respect, boundaries and negotiation are absolutely real, important issues. I wouldn’t like to be cheated on, deceived, or treated as though my feelings or needs don’t matter. I see such people in therapy and support them in dealing with it. But, those feelings aren’t inherently a disorder, and the “bad actors” in these situations aren’t necessarily mentally ill. I think at some point the mental health profession has to stop labeling as a disorder all the things that hurt and cause problems. Pain is a normal part of life. Getting rid of pain leaves people more vulnerable. The pain of being cheated on and hurt, teaches people to try to avoid that in the future, with that person or others. If we treat this as a disorder, we’re saying that pain is abnormal, and we should get rid of it. A life without pain sounds ideal, until you realize that getting there involves some dystopian science-fiction story, where we all take “Soma” and live numb and placid lives. Unfortunately, medicine and mental health become the “arm” of society enforcing moral rules. This is how homosexuality was called a disease, and women who liked sex as much as men, were called nymphomaniacs. Bad things happen, people get hurt, when we let morality dictate medical treatment.
CL: How do people complain about sex addiction “treatments”? To what authority would you report a quack experience?
DL: Complaints should go to: state licensing boards if they are licensed clinicians; also to groups like IITAP if they are a “Certified Sexual Addiction Counselor” or SASH if they’re a member of that (Society for the Advancement of Sexual Health — they used to be the National Council on Sexual Addiction and Compulsivity and renamed themselves in a pretty transparent ploy to pretend they are something they’re not.) It’s a problem that there is no oversight of many of these sex addiction coaches and 12-Step groups.
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Dr. David Ley is a clinical psychologist in practice in Albuquerque, New Mexico and the author of The Myth of Sex Addiction. He is the Executive Director of New Mexico Solutions, a large outpatient mental health and substance abuse program in Albuquerque, NM.
Dr. Ley has been treating sexuality issues throughout his career. He first began treating perpetrators and victims of sexual abuse, but expanded his approach to include the fostering and promotion of healthy sexuality, and awareness of the wide range of normative sexual behaviors. The Myth of Sex Addiction challenges the concept of sexual addiction and exploring a different model of male sexuality. Since it was released, The Myth of Sex Addiction has triggered a firestorm of debate, allowing people to finally challenge the media hype of this pseudo-disorder.
Dr. Ley is on Twitter, at @DrDavidLey