1. The Clinical Assessment and Treatment of Sex and Porn Addiction
Robert Weiss LCSW, CSAT-S
Founding Director - The Sexual Recovery Institute
Director of Sexual Disorder Programs, Elements Behavioral Health
Promises, The Ranch & The Sexual Recovery Institute
Note: This presentation will demonstrate methods utilized to access online sexual experiences. Explicit images will not be shown, however please carefully consider if learning such information might prove harmful to your personal recovery.

2. The Problem

3. Fmr. Congressman Anthony Weiner
Fmr. President Bill Clinton
Actor David Duchovney
Actor Jesse James
Fmr. Governor Elliot Spitzer
Fmr. Governor Mark Spencer
Fmr Sports Hero Tiger Woods
Fmr. Chief Dominique Strauss-Kahn
Fmr. Governor Arnold Schwarzenegger
Fmr. Congressman Anthony Weiner
All are men whose sexual behavior MORTALLY WOUNDED their ability to lead. But what if their problem had been drinking or drugs like Congressman Patrick Kennedy?

4. Is Sexual Addiction A Mental Health Diagnosis ?
Was in the DSM III
Was out of the DSM IV
Now being considered for the DSM V (Hypersexuality)

5. Sex Addiction is not Axis I Symptom- we r/o out ADD/OCD/Bipolar
A Moral or Religious Stance
Fun
Fetish / Paraphilia
Same Sex Interest or Activity
Crystal Meth Addiction
Sexual Offending - non consensual

6. Sexual Addiction Symptoms Follow the Characteristics of All Addictions
Criteria for Sex Addiction parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling:
Loss of control
Continuation despite adverse consequences
Obsession or preoccupation
The presence of these three criteria operationally define addiction to both substances and behaviors

7. 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
Pushing Boundaries, Boundary Violations
Multiple Affairs / Anonymous Infidelity
GPS SmartPhone Hook-ups
Sexting / Abusing Social Networks

8. Addicted to sex? Increased Heart Rate Pupils Dilate Hearing More Acute
Shallow Breathing
Perspiration- palms, underarms, etc.
“Rush” or “Intensity” Feeling
Reduced Intellectual Functioning!

9. Sexual Addiction is the use of Intense Fantasy to Induce Neurochemical Release
Serotonin - mood stability
Dopamine - pleasure
Adrenaline - energy, jolt
Endorphins - calm
Oxytocin - love/jealousy

10. ADDICTS CALL IT… The Bubble The Trance Spaced Out Think ...
Dissociative State
Trauma
Self Soothing

11. In 12-Step Language ...
POWERLESS!

12. Sex Addiction is not about sex or orgasm
Sex Addiction is not about sex or orgasm. It is about the search for sex and desire for orgasm. It’s a Process Addiction.

13. The Process Addictions
Gambling
Internet Gaming
Workaholism
Binge Eating
Sex
Exercise
Religion
Spending
High Risk Behavior

14. Sexual Addiction Symptoms in Residential or Outpatient Clients
By History
Multiple abortions (females), multiple STDs (both sexes), repeated unprotected sex
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 with or without porn

15. Sexual Addiction Symptoms in Residential or Outpatient Clients
By 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”, being sexual in treatment
History of CD relapse – especially females
Encouraging Dependency as a form of seduction
Sneaking & using porn in treatment - sharing porn in treatment.
Consistent sexual references and objectification in jokes and conversation
Lack of empathy about how their sexual behavior affects others.

16. The Betrayed Spouse

17. Initial concern for this spouse is physical and emotional safety
Physical health -STD’s, Pregnancy
Family safety - Children at risk?
Specific betrayals that might overwhelm or undermine later

18. Diagnose this client
Acts out in angry, vengeful, acts superficially supportive of treatment while actually undermining it.
Often shifts from idealizing her spouse, therapist and treatment - to devaluing and dismissing them. Can be demanding and boundary-less.
Expresses feeling “out of control.” Can engage in compulsive behaviors such as ‘detective work’ or stalking
Often seems to be on a mood ‘roller coaster’.
Mistrustful, suspicious, at times can be rageful and verbally abusive. Can ‘act out’ by overeating, spending and other compulsive behaviors.
Inconsistent and uncommitted to looking at her part or her issues - tends to externalize and blame.

19. Which one is (s)he?
An Axis II Diagnosis -Borderline, extreme Codependency etc.
Profoundly Co-dependent. “poor dear, she lost her ‘self’ to him”.
A client who suffering from a profound life- trauma and grief reaction without meaningful support or direction.
It might take a while before you know ...

20. We believe she is on an Emotional Roller-coaster

21. How long can it take to get off this ride?
9-18 months, post-discovery/disclosure. Provided there is an active recovery process in place in place for both.

22. The clinical needs of this spouse.
Direction regarding self-care, health issues, talking to family etc.
Education about addiction, disclosure, family dynamics, support.
Holding and Validation of her reality and her feelings
Disclosure and clarity regarding their unknown history
PEER SUPPORT as well as support by professionals
Structure toward moving forward
Hope

23. Sex and Tech

24. 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?

25. Access Affordability Anonymity
What has changed in our experience of sexual content & sexual contact over the past 20 years
Access
Affordability
Anonymity
* Cooper, Del Monico et al

26. How long did it take for the following technologies to reach 50 million participants following public introduction?
Radio - 38 years
Television - 13 years
Internet - 4 years
Social Networking - 16 months!
Whatever comes next will happen close to instantaneously. It will be in our lives before we know it our fully understand it. So get ready.

27. Sexual Access Timeline 1.0 Pre-history - 1890
Recreational and Intimate Sexuality
Cave, drawn and painted pornography
Affairs & Infidelity
Public Baths
Prostitutes & Harems
Masturbation to fantasy

28. Sexual Access Timeline 2.0 1890 - 1970’s
All of the above plus ...
Photographic Porn
Porn Movies (XXX)
Adult Bookstores, Porn shops
Bath-houses & Strip clubs

29. Sexual Content Access 3.0 1977 - 1990
All of the above plus ...
Video = VCR and BETA
Phone Sex
Softcore on cable TV- at home
“Adult” and “Escort” Sections in Yellow Pages, magazines and newspapers

30. Sexual Content Access 4.0 1990 - 2004
All of the above plus ...
BBS - Online bulletin board systems (BBS)
Websites for porn and prostitution
Online Porn and file transfer sites
Chat Rooms
Online Hook-ups - i.e. craigslist
Webcams and interactive live sex

31. Sexual Content Access 5.0 2004 - Present
All of the above plus ...
Sexting and live video streaming from your smart phone
Smart Phones with GPS hook-up apps
Social Networks (facebook, twitter, mySpace)
Virtual World Sex (2nd-Life, virtual games etc)
3-D Imagery and Teledildonics

32. And some are using it to offend ...
About Sexting
Tell story about young offender at SRI - Exhibitionist/Voyeur
Eewwwwwwwww!
And some are using it to offend ...

33. facehooked?
“Before entering treatment I was spending up to 5 hours a night some nights cruising facebook for sex. Well, not for sex exactly, it was more cruising for faces and profiles I thought might respond to me. I was looking for friendly, engaging women, then leaving messages, poking them, trying to get a response from someone who cared. Then we would take it from there ... ”
- A 32 year old married SRI-IOP client

34. About Smartphones
GPS locators mean immediate live access to sexual partners and sexual content-
Universal Internet access anywhere - to porn, to sexually oriented environments (strip clubs, adult bookstores, etc)
Not ‘trackable’ like a computer history
Live video streaming to phones and pads-
Let’s look at this more closely ...

35. There’s an app for that! So what’s an app?
Apps are applications that you load from the Internet onto your smart phone or ‘pad’ to perform specific functions. For example - if you load a dictionary app onto your phone- you can then use your phone to look up words and spelling from your phone
Sex apps are the same - loaded from to your phone to help find sexual partners.

37. Apps you should know about
Ashley Madison - for married men and women
Grindr - for gay men

38. About Ashley Madison
Started as a website - now also a mobile app - perfect example of content access progression
AM Slogan: “Life is short, have an affair.”
AM Mission Statement: “To provide an interactive way for like-minded users to explore whether they wish to meet each other, chat with each other and/or explore extra- marital relationships”
Over 9-million members internationally
In May 2011 – 1,3 million men and women used the service to contact a sexual partner in that single month
92% of males on the site sign in as married
68% of female members sign in as married

39. Teledildonics with your Wii...
By hooking up the hardware components up to the two Wii-motes, wiggles and thrusts on the first Wii-mote are detected and sent via Bluetooth to a nearby computer. From there this information is sent over the Internet and reproduced by the other Wii-mote which acts as a Wii-brator on the other end, allowing remote partners to simultaneously enjoy each others stimulations.

40. Treatment

41. Initial Sexual Addiction Treatment
Is Cognitive Behavioral
Behavioral disorders require behavioral forms of treatment -not Jungian, Psycho-analytic, Somatic Narrative etc.
In Outpatient- we don’t delve deeply into trauma or transference until 90-days sober at minimum
In Residential - we can delve into deeper issues sooner and more directly - but still stay focused on the primary goal which is always establishing sobriety and relapse prevention

42. Required Treatment Steps When Working with Sex Addicts
Do a thorough psycho-sexual history/assessment
Identify the treatment goals of the client and then co- create a sexual sobriety contract aligned with those goals.
Hold clients accountable to all their agreements!
Confront denial
Educate and teach relapse prevention
Get them into a sex addiction group therapy
Find support for the spouse
Direct healthcare, family and crisis resolution
Refer to long-term 12-step, therapy or faith-based group support

43. Elements Behavioral Health Assessment & Treatment Options -
The Sexual Recovery Institute (SRI) - Los Angeles- 2- weeks of Intensive Treatment- Structured, manualized programming. Clients stay at a men’s recovery residence -
Psycho-sexual and Fitness for Duty Assessment,
The Ranch in Tennessee - 35 Days of Residential Sexual Addiction Treatment with Extensive Trauma and Family Component -
Promises Malibu or West Los Angeles- Primary CD Treatment with a focus where needed on Sexual Disorders and access to SRI clinicians or full IOP where needed.

44. What is Sexual Sobriety?
Rarely complete abstinence
A mutually agreed upon clear, written and signed, behavioral contract based on client goals.
Sobriety plans don’t change without prior discussion.

45. Sexual Sobriety Contract
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

46. 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

47. Want to Learn More?
The Sexual Recovery Institute
The Ranch
IITAP - International Institute for Trauma, and Addiction Professionals
SASH - The Society for the Advancement of Sexual Health
E-summits Online and Video learning with available CEU’s

48. The Clinical Assessment and Treatment of Sex and Porn Addiction
Robert Weiss LCSW, CSAT-S
Founding Director - The Sexual Recovery Institute
Director of Sexual Disorder Programs, Elements Behavioral Health
Promises, The Ranch & The Sexual Recovery Institute
Note: This presentation will demonstrate methods utilized to access online sexual experiences. Explicit images will not be shown, however please carefully consider if learning such information might prove harmful to your personal recovery.