Untangling the Web:

Treating Sex and Porn Addiction

Robert Weiss LCSW, CSAT
Executive Director
The Sexual Recovery Institute
www.sexualrecovery.com

What Do These Men Have

In Common?
Fmr.PresidentBillClinton
Fmr.SenatorLarryCraig
Fmr.GovernorElliotSpitzer
Theyaremenwhosesexualbehavior
MORTALLYWOUNDEDtheirabilityto
lead...butwhatiftheirproblemhadbeen
drinkingordrugse.gPatrickKennedy?

Our Typical Client

38 year old married working male
Wife found extensive porn or hook-ups in computer
- says get help or youre out.
Married 7-10 years
One or more children under age 6
Acted out with sex prior to marriage, then slowed or
stopped - never informed wife

Why did he return to acting out?

Sex Addiction is Not

A Moral or Religious Stance
A Symptom of Underlying Axis I Illness
Fun
Same Sex Interest or Activity
Sexual Offending
Fetish / Paraphilia
Sociopathy
Crystal Meth Addiction
The End of a Relationship

Sex addiction can be

A Stand Alone Diagnosis

The Diagnosis Follows the

Characteristics of All Addictions
Criteria for assessing Sex Addiction closely
parallels guidelines for assessing Substance
Dependency, Alcoholism, and Compulsive
Gambling:
Loss of control
Continuation despite adverse
consequences
Obsession or preoccupation
The presence of all three criteria operationally
defines addiction to any drug or behavior

Typical Sex Addict

Behaviors
Compulsive Use of Porn (with or without masturbation)
Anonymous Sex (met online or in sex clubs etc.)
Adult Bookstores and Strip Clubs
Sexual Exchange (i.e. Drugs or Favors for Sex)
Prostitutes and Massage Parlors
Cruising, Intriguing, Objectifying, Seduction
Boundary Violations, Sexual Harassment
Multiple Affairs / Anonymous Infidelity
Abusing Power Relationships for Sex - Predatory

QuickTime and a
decompressor
are needed to see this picture.

QuickTime and a
decompressor
are needed to see this picture.

Addicted to sex?
Increased Heart Rate
Shallow Breathing
Perspiration- palms, underarms, etc.
Reduced Intellectual Functioning
Rush or Intensity Feeling

Substances of Mood
Serotonin
Dopamine
Adrenaline
Endorphins
Oxytocin the

cuddle chemical

ADDICTS CALL IT
The Bubble
The Trance
Spaced Out
Think ...
Dissociative State
Mood Alteration
Trauma

In 12-Step Language ...

POWERLESS!

Sex Addiction is not

about sex, its about
the search for sex and
desire for orgasm. Its a
process addiction.

Sexual Addiction Symptoms in

Residential or Outpatient Clients
In the Clients Behavior

Seductive Dress (especially after it is pointed out)

Seeking out special relationships with other attractive clients or
staff for advice, friendship and direction

Giving the stare.

History of CD relapse especially females
Encouraging Dependency as a form of seduction
Sneaking Porn into treatment - sharing porn in treatment.
Consistent sexual references in jokes and conversation
Consistent sexual objectification.
Lack of empathy about how their sexual behavior affects others.
Having sex while in treatment

Sexual Addiction Symptoms in

Residential or Outpatient Clients

In the Clients History

Multiple abortions (females), multiple STDs (both sexes)

Previous arrest or major life consequences related to sex
Drugs/Alcohol used to help tolerate or enhance sex
History of previous sexual acting out in treatment
Drug use fused with sexual behavior
Multiple past failed relationships due to affairs or
infidelity
Chronic or Compulsive Masturbation

What makes online sex so

popular and so exciting?

ACCESSIBILITY
AFFORDABILITY
ANONYMITY
Adapted from the Triple-A Engine
Al Cooper PhD. 1998

Online sexual content,

chats and interaction has
forced us to reassess
sexuality in our culture.
For example, today what
do you consider to be

Infidelity?

Cybersex Addiction/Compulsivity:
Range of Online Sexual Activities
in 1999 ...
View and download pornography with or without masturbation
Visit sexually-oriented chat rooms to voyeur or hook up with

someone
Exchange sexually explicit e-mails
Belong to online sex clubs, sex organizations or hooker review
sites
Engage in real-time one-on-one masturbation
Plan ahead to sexually act out on the road
Offender / Predator Behaviors
Hire prostitutes to perform live sexual acts on command
View and download illegal or deviant sexual images

And in 2009..
All of the above, only faster. on cell phones, laptops, social
networking (yelp, twitter etc.) and dont forget

SEXTING

Whats the big deal

Its just a guy thing

Consequences of
Compulsive Cybersex

Loss of time for work, family, recreation

Family violence / relationship loss
Loss of job because of cybersex at work
Guilt and shame due to keeping secrets
Decreased interest in sex with spouse
Increased preoccupation with sex
Increased overall sexual objectification
Children potentially exposed to porn
Increased interest in deviant sex
Potential arrest for illegal online sex
Escalation to off-line sex

And now a word or two

about ...
...Spouses and Partners

Treatment
is the Reclaiming
of Reality

Please find a partner to your left

or right, decide which of you will
ask questions and who will
answer and then ask the
following:
1- How often you drink alcohol and how
much do you drink.
2- How often you masturbate and what
fantasies you use when doing
masturbating?
3- How often do you pay for sex ...

Initial Sexual Addiction

Treatment is ...
Cognitive Behavioral
and Task Oriented

Initial Focus of Sex

Addiction Treatment
Stop the acting out ASAP by making contracts

and plans
Confronting denial and teach relapse prevention
Carefully reviewing a sexual history Providing Appropriate Tasks and Interventions
Spouse, job & family crisis resolution
Shame reduction
Holding the client accountable!
12-step, therapy or faith-based group referral

And Sexual Sobriety is

A clear and well defined written plan
Based on client goals
Mutually agreed upon
Signed
Sobriety plans are behavioral in nature
Sobriety plans flow from the goals of
the client
Doesnt change without prior
agreement

Simple Sexual
Sobriety Plan
List of Behaviors
I Want to Stop

A
B
C
D
E
F

List of Behaviors
I Want to Add

A
B
C
D
E
F

Treatment Error
Inadequate or poorly detailed history
(Not asking about prior arrests/offending behaviors etc.
Unfamiliarity with resources (porn blockers, 12-step)

Normalizing problematic sexual behavior

Initially employing Psycho-dynamic, Analytic, Jungian
and other non-cognitive behavioral method
Not identifying triggers, patterns, rituals and
behavioral escape methods (relapse prevention
planning)
Focusing too early on trauma

Treatment Error
Not addressing the sexual behavior as the primary
initial treatment focus
Not properly understanding and/or pathologizing
the depth of the betrayal, grief, loss and rage
of the partners and spouses
NOT HOLDING CLIENTS ACCOUNTABLE
Not getting supervision / consultation
Not utilizing 12-step programs, faith based support
groups, group therapy and psycho-education
Not processing countertransference.

12-step Groups for

Sexual Addicts and Partners
Sex Addict Support
SAA
SA
SCA
SLAA-Women
SRA

Partner Support
S-Anon
Alanon
COSA
CODA
RCA - Couples

Treatment and Training

Information
The Sexual Recovery Institute

www.sexualrecovery.com
IITAP - International Institute for Trauma, and
Addiction Professionals
www.iitap.com
SASH - The Society for the Advancement of
Sexual Health
www.sash.net

Untangling the Web:

Treating Sex and Porn Addiction
Robert Weiss LCSW, CSAT
Executive Director
The Sexual Recovery Institute
www.sexualrecovery.com