Building sexual integrity. Healing minds and hearts.
Randy Flood and Charlie Donaldson have for many years provided treatment for men who struggle with sexual addiction and the use of pornography. Randy’s program at the Men’s Resource Center, Transformations Toward a Healthy Sexuality, and Charlie’s protocol, the Specialized Program for Relational Health, use this six-part treatment program.
I. Creation of a safe environment and development of a trusting therapeutic relationship in which clients tell their stories of sexual addiction and use of porn, gain greater understanding of their addiction, and recognize that, with honest personal investment, they can overcome their addiction.
Our primary treatment goal is to help men develop sexual integrity. While some sexually-addicted men can escalate to acting out in coercive, intrusive, or abusive ways, most are not “bad people.” It is in this arena where they have lost their ethical moorings. Our program targets men who are good fathers, responsible partners, hard-workers, and good citizens, but who have lost their sense of integrity about sexual behavior. They engage in an activity over which they have become powerless, one that’s created unmanageability and is destructive of their lives and hurtful to their families.
Men in individual and group sexual addiction counseling learn that their sexual activities meet the criteria for addiction:
- Preoccupation: obsessive thinking about sexual behavior, opportunities, and fantasies
- Loss of control: inability to stop behavior despite problems resulting from such behavior, and failed commitments to self and others to end the behavior
- Relationship disturbance: sexual behavior has created significant relationship problems
- Affect dysregulation: significant depression, despair, or anxiety over sexual behavior
- Continuation of behavior despite adverse consequences.
Men in our programs also recognize the pernicious process of sexual addiction. They learn that sexual addiction often results from men’s deficits in intimate primary relationships and inadequate connections with others; that they have poor emotional regulation; that feelings of hurt, fear, shame, and loneliness drive the addictive process; and that their errant sexual behaviors are an analgesic for their psychic pain. They also realize that they have experienced increased anxiety and shame over their behavior because they live in constant fear of being discovered. In counseling, they recognize that they have lost control of themselves and cannot stop their behavior, no matter how self-destructive and potentially devastating the consequences may be.
II. Assessment and treatment planning.
After the initial sessions, clients continue to tell their stories, including their perception of cravings, rituals, triggers, warning signs, and consequences. Client self-disclosure is healing in itself, but it also helps to develop an individualized program to achieve abstinence and prevent relapse. Along with clients’ narratives, the administration of self-inventories provides additional information for the therapist to develop treatment plans which, beyond sexual addiction itself, often focus on childhood trauma and family of origin attachment disturbance, as well as present relational issues.
Treatment goals include:
- Greater understanding of their personal addictive process, especially powerlessness over the addiction
- Increased awareness of consequences of the addiction
- Enhanced awareness of triggers, opportunities for use, and emergency steps (such as phone calls to accountability partners) to avoid addictive behaviors
- Adoption of replacement behaviors—healthy intimate relationships, meditation, prayer—in place of addictive activities
- Development of more effective self-regulation tactics to avoid using addictive behaviors to escape dark feelings and to retaliate against partners who they perceive as uncaring about their needs
- Development of more open, gratifying, and intimate relationships both with partners and other people in their lives
- Creation of, and commitment to, a deeper spiritual or religious life.
III. Cognitive-behavioral change including the understanding and incorporation of 12-step programs, use of the CBT disputation model, and psychoeducation about male socialization and behavior to create greater understanding of men’s issues, the role of toxic masculinity, and how to overcome any misogynist thinking and abusive behavior.
Sexual addiction treatment has conventionally used cognitive-behavioral therapy and the Alcoholics Anonymous 12-step model. Our programs start with these approaches but add psychoeducation about male socialization which provides men with insight into themselves and their errant thinking. Clients are challenged to examine and release destructive beliefs about sexuality: (1) that “real men” prove their masculinity with sexual conquests; (2) that they are entitled to sex from their partners; that if their needs aren’t met, they are justified to get sexual gratification elsewhere in spite of consequences for themselves and their relationships; (3) that it’s acceptable to be demanding of women and abusive to get their way; (4) that sexual acting out is an appropriate means of self-soothing and stress management.
IV. Emotional self-regulation.
Our sexual addiction protocols use trauma-informed therapy to heal family of origin issues such as attachment disorders stemming from child abuse, neglect, or sexual assault with the goal of ameliorating the use of sex and porn as an analgesic for psychic pain.
Recent advances in understanding the impact of trauma and attachment disorders suggest that childhood abuse, neglect, or inadequate nurturing result in children growing into adults who have inadequate emotional regulation, especially of the dark emotions: hurt, fear, or shame. Men who engage in sexually-addictive behaviors frequently do so to quell and calm their pain.
In treatment, many men find a sense of relief and increased self-control when they recognize that their fears, depression, anxieties, neediness, isolation, shame, and anger are not because they are bad people but frequently are instead a product of childhood trauma and toxic male socialization which inhibits healthy human development. They also learn that, while they are not to blame, they are responsible for their dark feelings and acting out behavior. Over time, they learn to experience, identify, express, and manage their feelings as well as manage “trauma attacks” when they relive harrowing events from their past.
V. Creation of healthy relationships including more effective communication and intimacy and use of therapist-client transference and counter-transference in individual counseling as well as participant relationships in therapy groups to experience and practice healthy relationships.
Some women struggle with sexual addiction and use porn, but they are often less vulnerable than men because many possess larger powers of self-observation, greater resources for mindful problem-solving, and more ability to ameliorate bad feelings through self-disclosure.
Manliness—being tough enough, strong enough—undermines men’s ability to be relational. Many men have been socialized to shut down their hearts, to avoid intimate communications, to fear the vulnerability that makes for healthy relationships. Unable to achieve the human connection that human beings need and covet, these lonely, angry, hurt, and shamed men turn to sexual acting out to meet their needs, and some develop an addiction to sex.
Most men, when they come to understand that their toxic masculinity fosters bad behavior and undermines good behavior, shuck off the mantel of damaging masculinity, recognizing for the first time that they can be different; finding a softness and compassion for others and themselves.
In our individual and group therapy, men frequently find a personal connection previously unknown to them, and they are able to carry that newfound capacity for intimacy into their primary relationships, learning to meet their needs through emotional connection and sexual intimacy with their partners, decreasing or eliminating their desire for sexually-addictive behaviors.
Specifically, men learn the fundamental components of healthy relationships−respect, empathy, shared meaning, conflict resolution. They come to understand that relationships are a continual process of harmony, disharmony, and repair; they learn the skills to prevent disharmony and to repair the fabric of their connections. In individual or group sessions, men report on situations from the past week with their partners, assess their behavior, and get feedback from the therapist and/or men’s group members. Over time, their new insights and emotional intimacy with other group members frequently improve their primary relationships so they no longer seek the pseudo connections of sexual addiction.
VI. Development of an enhanced spiritual or religious life.
Robert Johnson, a Jungian psychologist, has argued that our culture so glorifies romantic love and sexuality that they dominate our thinking and behavior, overwhelming and superseding spirituality and religion. Then there’s this: Beyond the cultural influence, on a personal level, when men live in fear and shame because of their behaviors it’s hard to make a healthy relationship with God or a higher power. This blockage obstructs the gratitude, humility, and compassion that are foundational to a healthy connection with the world beyond the self.
Most men do have some spirituality in their lives. They find meaning in nature, teamwork with other men, in the joys of fatherhood. And many have faith in God. Our protocols help men broaden their spirituality to inform their relationships and sexuality. More specifically, men are taught the importance of seven values to ward off their addiction: gratitude, compassion, intimacy, respect, accountability, trust in a higher power, and willingness to work on spirituality.
Whether men learn to pause or pray, whether they practice a secular spirituality or more traditional religion, they will, as Bill W. promises, get a daily reprieve from addiction contingent upon their spiritual condition.