Therapy for Problematic Sexual Behavior
Chapters:
- Summary
- The New Approach
- Addressing Pornography
- Excessive Online Porn Use May Cause Lots of Problems
- Porn Addiction is Not Necessarily the Same as Sex Addiction
- Typical Problems Associated with Porn Addiction
- Porn-Induced Changes Are Often Reversible Over Time
- Tips For Breaking The Porn Habit and/or Addiction
- Online Sources of Assistance for Pornography Problems
- Assistance in Asheville for Individuals Experiencing Problems with Excessive Pornography Use
Summary
Sex and sexuality is by far one of the most complex challenges we face, in part because there is so much variation in beliefs, values, and culturally accepted norms that to call a behavior “addictive” or “pathological” may do more harm than good. Fortunately, there is a new “Theory Neutral” framework for working with people suffering from distress related to their sexual behavior and habits that is non-stigmatizing, non-judgemental, and seeks to distinguish between behaviors that are merely problematic and those which are truly addictive.
This framework uses five questions to help individuals identify problematic patterns based on conflicts with commitments, values, self-control, consequences, and responsibility. This framework has been profoundly beneficial to the patients in my counseling practice, bringing more people together in a common cause of working for the same sexual health goals and narrows the distance between addicts and non-addicts, which benefits everybody.
If this new approach resonates with you I encourage you to read further as we delve into the details of how it helps those struggling with problematic sexual behavior.
The New Approach
I’ve been an Asheville Certified Sex Addiction Therapist (CSAT) and a Certified Multiple Addiction Therapist (CMAT) since 2014 and in my own recovery and discovery from all forms of “Compulsive”, “Addictive”, “Out of Control” sexual and limerence behaviors since 1990. This means I’m extensively trained in a specific form of assistance for people who have repeatedly failed in their efforts to stop engaging in sexual behavior that violates their commitments and values. It’s a powerful model that has helped many people.
And yet, for years I have been convinced that a lot of people engage in very similar behavior patterns for reasons other than sex addiction. And not everyone who comes into my office with distress necessarily has an addiction or compulsion around porn, sex, love or limerence.
I believe that people need choices in how they view their behavior and what to do about it. Sex and porn addictions are real and they impact many people. However, there needs to be a way to offer help to people even if addiction is not the primary driver. Unfortunately the therapy community as a whole struggles to venture past its own theories and methods, and I feel some people suffer as a result.
For years I struggled to articulate a way to help people understand and resolve their problematic sexual behavior patterns when addiction is not necessarily the best or only answer. Then I came across the work of a colleague in Atlanta, Bill Herring. Bill is an amazing clinician and thinker who developed a “Theory Neutral” theoretical framework for looking at all forms of problematic behaviors that is much more inclusive and non-shaming than the traditional addiction model.
Herring’s 2017 article published in the journal Sexual Addiction & Compulsivity titled “A Framework for Categorizing Chronically Problematic Sexual Behavior” describes five separate categories of what can generically be termed “problematic sexual behavior”.
These categories are:
- Sexual behavior that conflicts with a person’s commitments
- Sexual behavior that conflicts with a person’s values
- Sexual behavior that conflicts with a person’s self-control
- Sexual behavior that consistently results in negative consequences
- Sexual behavior that does not protect others from harm
These five categories yield five basic conversational questions to determine what exactly makes a sexual behavior pattern problematic for an individual. These five questions are:
- Are you keeping your promises? (Commitment violations)
- Are you ok with what you are doing? (Values conflicts)
- Are you in control of your behavior? (Diminished self-control)
- Is everything ok? (Negative consequences)
- Are you protecting others? (Lack of responsible sexual behavior)
This simple framework has many important qualities:
- These questions can be universally applied to anyone regardless of a person’s sexual, cultural, religious or moral identity and beliefs. Two people may engage in the same sexual behavior and answer completely differently to these five questions, making it very adaptable to many different populations.
- Since this framework is not tied to any specific theory it can be used by professionals who utilize different theories and work in different settings.
- The framework avoids labels which tends to reduce defensiveness and improve a person’s ability to engage in practical self-assessment of his or her behavior.
- The framework distinguishes ‘problematic’ behavior from ‘pathological’ behavior. It does not require a diagnosis to motivate behavior change and it recognizes that sexual problems don’t always need sexual solutions.
- The five questions focus on how a person’s sexual behavior conflicts with important non-sexual areas of life, such as commitments, values, self-control, and responsibility, rather than focusing on the behaviors themselves. This is important because people can engage in a wide range of sexual behaviors and the same behavior that is ok in one setting can be a problem in another.
- This framework removes the requirement for diminished control to be present for a person to be eligible to receive care and assistance. Under classic sex addiction models a person without loss of control is not eligible to receive the benefits of that knowledge base. This has the sad result of people either not seeking or receiving help for their sexual struggles, or feeling pressure to label themselves addicted in order to receive the benefits of that model.
- These categories are consistent with a general worldwide consensus of what constitutes sexual health. I consider them the essential guardrails of sexual health, meaning that they don’t dictate what behaviors a person should practice but rather insure that whatever a person does meets at least some commonly agreed-upon standards of health.
This framework has been profoundly beneficial to the patients in my counseling practice, bringing more people together in a common cause of working for the same sexual health goals and narrows the distance between addicts and non-addicts, which benefits everybody.
Addressing Pornography
In my Heart and Soul Recovery practice I regularly help people resolve problems regarding excesses in sexual behavior, including a common problem many people face, which is problematic use of online pornography.
People have created and looked at sexual images since the dawn of recorded history. However, since the advent of the Smartphone, people now have access to view a never-ending stream of every type of sexual situation imaginable. This is the first time in human history people are able to have access to an unending stream of novelty (The Coolidge Effect).
Many adolescents, young adults, and adults who look at pornography don’t have a problem with it. They enjoy what they are watching without losing control of their behavior, their time, their common sense, their morality or their ability to maintain close and intimate relationships. I don’t think that all pornography is always bad for all people. I certainly agree that much pornography is demeaning, exploitative, and harmful, and many categories of pornography are shocking to people who don’t find that particular interest to be erotic. However, I don’t condemn all pornography any more than I condemn all alcohol. It’s what a person does with it, and what it does to a person that matters. To be be clear, I’m against all rape pornography and/or any pornography that depicts non-consensual violent sexual acts.
Also, it’s important not to try to use one word “pornography” to represent the vast range of sexually explicit imagery available.
With that being said, the current terminology in most of the peer reviewed research is “Sexually Explicit Material” or SEM.
Excessive Online Porn Use May Cause Lots of Problems
Excessive use of online pornography can be a nightmare for some people. The three major categories are (a) relationship problems, (b) values-based problems and (c) addiction-related problems.
A. Relationship Problems Caused By Pornography
Since viewing pornography is typically a private matter, some issues only come up for couples. A typical problem develops when a person who views online pornography is in a relationship with a partner who is opposed to it. The trouble comes if the behavior continues secretly in an attempt to avoid a conflict.
There are lots of different ways couples handle pornography use. Some people believe that monogamy means it’s never ok to seek arousal by looking at someone else. Other people don’t feel this strongly or have an entirely different opinion on the matter. Some couples enjoy watching pornography together. What works for one relationship may not work for another.
Unfortunately many couples don’t spend enough time discussing their views about pornography as they get to know each other. Often this is because a person who enjoys looking at sexual images of other people may fear that fully admitting this to a potential partner could end a relationship before it starts.
One way that counseling can help in such situations is by helping couples address their differences. For example, if one person feels that all erotic images are inherently bad and another person does not feel this strongly then this issue needs to be addressed in order to reach some mutual harmony and understanding. Effective counseling helps a couple reach whatever healthy decisions work best for their particular situation.
B. Values-Based Problems Caused By Pornography
The second category of problems is when the enjoyment of pornography conflicts with other values. Some people “don’t like it that they like it.”
This struggle between the erotic and the acceptable is easy to understand. Society contains all kinds of conflicting messages and double standards regarding sexuality. Conversations about sex in most families are either nonexistent, brief, awkward or shaming. No wonder so many folks are sexually curious, conflicted, and confused.
Many people have some type of sexual desire that they feel too ashamed to admit. They discover that it is easier to go online than to risk saying openly “this is something that excites me.” This inability to engage in safe and affirming conversations about sex only fuels greater secrecy and shame. This causes unexamined feelings and meanings about sex to descend deeper and deeper into secret “compartments,” creating a split between a person’s inner world and outward appearance. Online pornography becomes the only way to satisfy longings that have no other outlet, which can set the stage for some deep problems to develop.
C. Addiction-Related Problems Caused By Pornography
There’s no question that an increasing number of people are overwhelmed by the easy, immediate, and endless access to online pornography. What may start as casual viewing eventually becomes more and more of a habit or dependency until it finally becomes all-consuming. Research is showing that a never-ending variety of sexual excitement can cause part of the brain to cease to operate effectively. We are just learning about all of the negative effects that can happen to a brain that is repeatedly exposed to massive levels of visual sexual stimulation. In the words of the website Your Brain on Porn, “evolution has not prepared your brain for today’s Internet porn.” The brain changing the experience some people have as a result of overexposure to online pornography is very similar to what occurs with drug addiction.
Excessive viewing of pornography doesn’t have to be addictive to be a major problem. It’s similar to the fact that it’s not necessary to be an alcoholic to have a drinking problem. What matters isn’t the label as much as whether the behavior itself is excessive and the consequences are bad. While labeling a person as a sex addict can be stigmatizing and unhealthful for many, for some relating to their issue as a “sex addict” and/or “porn addict” is a way to understand the problem that provides a pathway to real and lasting change.
Porn Addiction is Not Necessarily the Same as Sex Addiction
Is out-of-control pornography use a form of sex addiction? This is a controversial topic among experts. It’s an important question because some of the typical ways of helping sex addicts may not be necessary or even helpful to people who struggle solely with online pornography. My opinion is that many sex addicts use pornography as one of their “acting out” behaviors, but there are many other people who only struggle with online pornography and no other form of sexual behavior. These folks aren’t having multiple affairs, cruising for sexual partners, spending money for sex, or even having online sexual interactions. For these individuals, the “high” exists only on the other side of a screen.
So it is possible for a sex addict to never view pornography and for a porn addict to never interact sexually with another person. This does not minimize the severity of difficulties online pornography may cause for some people. Porn addiction can be just as detrimental as sex addiction.
As previously stated, the severity of the problem is measured by the control it has over the person and the extent of negative consequences that arise as a result.
There are important differences between people who have trouble managing their overall sexual behavior and those who only struggle with porn. For instance, it’s not unusual for a sex addict to have a history of childhood sexual trauma or a significant family dysfunction. But lots of people who struggle with pornography don’t have this kind of background.
Their problem does not come from their history as much as from the brain changes that occur when exposed to the endless variety of streaming porn.
It’s helpful to think about online pornography as visual junk food. One reason obesity is so common is that it’s easy to consume too many unhealthy calories at an all-you-can-eat buffet, even when you’re no longer physically hungry. But at least the body has a limit on how much food it can consume at one sitting. The consumption of pornography has no such limit, especially for a person who delays orgasm to keep the “high” going as long as possible.
Online porn has been called the “triple-A” engine of addiction because it is anonymous, affordable and accessible. In the days before the internet it was necessary to leave home, spend money and risk being recognized in order to get new pornographic material. Now a person can see more quantity, more intensity, and more variety of sexual content in an evening than could have been seen in an entire lifetime just a few years ago. No wonder there is a porn epidemic among people who formerly never would have had a problem.
Typical Problems Associated with Porn Addiction
While there’s no limit to the problems that can result from excessive pornography use, some issues are so common that they can almost be predicted. The negative consequences can be both sexual and non-sexual.
A. Sexual Problems Associated with Excessive Pornography Use
Many of the problems associated with chronic viewing of online pornography involve unexpected changes in a person’s sexual interests and functioning. Examples include:
- Fantasies and images that used to be very arousing can lose their appeal.
- This can lead to a never-ending search for new varieties of sexual excitement, which can result in a person becoming sexually aroused by images, scenarios and fetishes that originally held little attraction. It’s also very easy to find other people with similar interests, which reduces inhibitions and can escalate addictive processes.
- An increased need for more intense online pornography can reduce sexual interest in actual partners. This can result in increased isolation, relationship problems, and confusion for everybody.
- Excessive use of online pornography contributes to false expectations about actual sex between real people. It’s like trying to learn how to play a sport by watching highlights on ESPN: those few exciting moments don’t really teach the rules of how to play the actual game. Trying to make the transition from intense sexual videos to actually making love to a real person can be just as difficult.
- Excessive online pornography use has created a whole new problem for many men, called “porn-induced erectile dysfunction” (PIED). Some men find that chronically masturbating to pornography makes erections less reliable when attempting sex with another person. Many healthcare providers don’t yet fully understand or ask about online pornography use when their (increasingly younger) male patients come to them complaining of erectile difficulties.
B. Non-Sexual Problems Associated with Excessive Pornography Use
Many other problems associated with excessive internet pornography use aren’t sexual at all, such as the following four categories.
- Cognitive problems: excessive pornography use can lead to difficulty concentrating, “brain fog,” and memory problems.
- Emotional problems: depression, low self-esteem, mood swings, and other emotional problems can develop or worsen.
- Relationship problems: social anxiety, isolation, defensiveness, superficial connections, and reduced emotional intimacy are all common reactions to excessive porn use.
- Romantic problems: excessive pornography use can contribute to loss of romantic attraction to real or potential partners.
Of course, some of these issues may have existed before the porn problem began, but it often makes them much worse. And it can be very difficult for a person to recognize the connection between such non-sexual problems and excessive pornography use, which keeps the root of the problem from being addressed directly.
Porn-Induced Changes Are Often Reversible Over Time
The good news is that it’s possible for most people to reverse and even eliminate all of these problems. Erectile dysfunction, delayed ejaculation, loss of libido and other problems associated with excessive pornography use generally diminish over time. People often find themselves returning to the types of sexual interests they had before porn took over, including the ability to become highly aroused with a real person.
Recovery from porn addiction is generally much faster than for sex addiction. Some people bounce back in a few weeks, while for others it may take three to six months or longer to fully recover from pornography’s effects on the brain. A good initial goal is to achieve 90 days without pornography. Many people are surprised to find immensely positive effects that can take place in just a few months.
Tips For Breaking The Porn Habit and/or Addiction
Although there isn’t a one-size-fits-all model for treating excessive pornography use, some recommendations are pretty standard. The following are a few tips to help you achieve a life where pornography is not setting the terms of your day, your happiness or your relationships. For many more detailed guidelines, the links that follow will provide some of the best online sources of information and assistance.
- Accept that your goal has to be several months of full abstinence from all pornography to give your brain a chance to reboot. Simply trying to slow down the frequency of your viewing is not going to bring you the same benefits — if any.
- Be realistic that you will likely experience some challenges in your effort to be porn-free, such as mild to moderate cravings, a temporary loss of libido (i.e. “flatline“), insomnia (especially when masturbation with pornography has been a sleep aid), frequent sexual triggers, mood swings, intrusive memories of pornographic images (i.e. “euphoric recall”), and other struggles that will diminish over time.
- Get rid of any pornography collections. Don’t save a stash containing just a few images or videos. You’re either in this thing all the way or you’re not in it at all.
- Install a porn blocker on all devices you use to access the internet. The best one for your particular situation will depend on the platforms you use (whether you use a PC, Mac, iPhone, Android, etc.). Some programs simply prevent you from going to pornographic sites, while others will automatically notify people (who you choose) about the sites you went to. Here is a list of recommended porn blockers for different platforms.
- Write down your reasons for stopping porn use. You may minimize the problem and your motivation may erode when you are feeling an urge to log on for “just a look”. If you use a journal, take extra care to keep it password protected or very safe from others.
- Develop your ability to immediately recognize and respond to your triggers. Practice the Three As and other techniques to divert or redirect your attention back to your ultimate goal.
- Do what you would do when breaking any bad habit, such as: get good exercise, nutrition and rest; let someone know what’s going on; practice meditation and relaxation techniques; devote time to hobbies and enjoyable activities; find creative outlets for your newfound energy and focus; and so on.
- Remember that on the other side of an urge is a sense of well-being, victory, and confidence. Hang on, even if just a few minutes, and you’ll often find that the urge passes. Get up and move your body if an urge hits you while you are sitting or lying down.
- If you do use pornography again, don’t give up. Resist giving in to the dreaded “abstinence violation effect” where you lose all motivation if you slip.
- Don’t push yourself into actively pursuing sexual activity with a partner — keep it slow and low-key. You don’t need any performance pressure at this stage. You can make up for lost time later.
- Find and utilize a support community. Viewing porn is almost always a solitary activity, which is why a supportive network of other people who have gone through the same process can be very helpful. The resources below can give you a way to find other people who are on the same journey. There is strength in numbers. Remember that you alone have to do it, but you don’t have to do it alone.
- This may be an excellent time to seek help from an experienced and knowledgeable therapist. If you have a therapist who needs to learn more about this subject, here is some information many therapists have found helpful. This is a fairly new problem, and someone who is not recently trained in this specific topic may not be fully up to date on the latest research and understanding about this subject.
Online Sources of Assistance for Pornography Problems
Many excellent resources are available online to help people deal with internet porn problems. Here are three of my favorite resources:
- Nofap — NoFap’s humorous motto is: “Get a new grip on life!” It’s a community of people who have recognized the problems that can happen as a result of excessive internet porn. Here you will find inspiration, humor, support and a lot of useful information and assistance designed to help a person break a dependence on internet porn.
- Your Brain on Porn — The motto for Your Brain on Porn states the simple truth that, “Evolution has not prepared your brain for today’s Internet porn.” This is the premiere site for information about the effects on chronic use of online porn.
- Reboot Nation — This is another site with useful forums and other information to help provide support, education, and motivation to people working to break free from excessive pornography use.
There are also many good books about healing from excessive use of pornography.
Assistance in Asheville for Individuals Experiencing Problems with Excessive Pornography Use
I hope this information helps people seeking information about this issue. Of course, nothing is as useful as a personal consultation to help evaluate the unique needs of each specific situation. I’m available to serve as such a resource. I offer individuals and couples an emotionally safe way to address concerns about online pornography use. If you are interested in talking with me further, I invite you to contact me to schedule a time to discuss what’s going on and to chart your course of action.