Presentation on theme: "The Clinical Assessment and Treatment of Sex and Porn Addiction"— Presentation transcript:
1The Clinical Assessment and Treatment of Sex and Porn Addiction Robert Weiss LCSW, CSAT-SFounding Director - The Sexual Recovery InstituteDirector of Sexual Disorder Programs, Elements Behavioral HealthPromises, The Ranch & The Sexual Recovery InstituteNote: 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.
3Fmr. Congressman Anthony Weiner Fmr. President Bill ClintonActor David DuchovneyActor Jesse JamesFmr. Governor Elliot SpitzerFmr. Governor Mark SpencerFmr Sports Hero Tiger WoodsFmr. Chief Dominique Strauss-KahnFmr. Governor Arnold SchwarzeneggerFmr. Congressman Anthony WeinerAll 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?
4Is Sexual Addiction A Mental Health Diagnosis ? Was in the DSM IIIWas out of the DSM IVNow being considered for the DSM V (Hypersexuality)
5Sex Addiction is not Axis I Symptom- we r/o out ADD/OCD/Bipolar A Moral or Religious StanceFunFetish / ParaphiliaSame Sex Interest or ActivityCrystal Meth AddictionSexual Offending - non consensual
6Sexual Addiction Symptoms Follow the Characteristics of All Addictions Criteria for Sex Addiction parallels guidelines for assessing Substance Dependency, Alcoholism, and Compulsive Gambling:Loss of controlContinuation despite adverse consequencesObsession or preoccupationThe presence of these three criteria operationally define addiction to both substances and behaviors
7Typical Sex Addict Behaviors Compulsive Use of Porn (with or without masturbation)Anonymous Sex (met online or in sex clubs etc.)Adult Bookstores and Strip ClubsSexual Exchange (i.e. Drugs or Favors for Sex)Prostitutes and Massage ParlorsCruising, Intriguing, Objectifying, SeductionPushing Boundaries, Boundary ViolationsMultiple Affairs / Anonymous InfidelityGPS SmartPhone Hook-upsSexting / Abusing Social Networks
8Addicted to sex? Increased Heart Rate Pupils Dilate Hearing More Acute Shallow BreathingPerspiration- palms, underarms, etc.“Rush” or “Intensity” FeelingReduced Intellectual Functioning!
9Sexual Addiction is the use of Intense Fantasy to Induce Neurochemical Release Serotonin - mood stabilityDopamine - pleasureAdrenaline - energy, joltEndorphins - calmOxytocin - love/jealousy
10ADDICTS CALL IT… The Bubble The Trance Spaced Out Think ... Dissociative StateTraumaSelf Soothing
12Sex 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.
13The Process Addictions GamblingInternet GamingWorkaholismBinge EatingSexExerciseReligionSpendingHigh Risk Behavior
14Sexual Addiction Symptoms in Residential or Outpatient Clients By HistoryMultiple abortions (females), multiple STDs (both sexes), repeated unprotected sexPrevious arrest or major life consequences related to sexDrugs/Alcohol used to help tolerate or enhance sexHistory of previous sexual acting out in treatmentDrug use fused with sexual behaviorMultiple past failed relationships due to affairs or infidelityChronic or Compulsive Masturbation with or without porn
15Sexual Addiction Symptoms in Residential or Outpatient Clients By BehaviorSeductive Dress (especially after it is pointed out)Seeking out “special relationships” with other attractive clients or staff for advice, friendship and directionGiving “the stare”, being sexual in treatmentHistory of CD relapse – especially femalesEncouraging Dependency as a form of seductionSneaking & using porn in treatment - sharing porn in treatment.Consistent sexual references and objectification in jokes and conversationLack of empathy about how their sexual behavior affects others.
17Initial concern for this spouse is physical and emotional safety Physical health -STD’s, PregnancyFamily safety - Children at risk?Specific betrayals that might overwhelm or undermine later
18Diagnose this clientActs 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 stalkingOften 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.
19Which 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 ...
20We believe she is on an Emotional Roller-coaster
21How 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.
22The 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 feelingsDisclosure and clarity regarding their unknown historyPEER SUPPORT as well as support by professionalsStructure toward moving forwardHope
24Online sexual content, chats and interaction has forced us to reassess sexuality in our culture. For example, today what do you consider to be…Infidelity?
25Access Affordability Anonymity What has changed in our experience of sexual content & sexual contact over the past 20 yearsAccessAffordabilityAnonymity* Cooper, Del Monico et al
26How long did it take for the following technologies to reach 50 million participants following public introduction?Radio - 38 yearsTelevision - 13 yearsInternet - 4 yearsSocial 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.
27Sexual Access Timeline 1.0 Pre-history - 1890 Recreational and Intimate SexualityCave, drawn and painted pornographyAffairs & InfidelityPublic BathsProstitutes & HaremsMasturbation to fantasy
28Sexual Access Timeline 2.0 1890 - 1970’s All of the above plus ...Photographic PornPorn Movies (XXX)Adult Bookstores, Porn shopsBath-houses & Strip clubs
29Sexual Content Access 3.0 1977 - 1990 All of the above plus ...Video = VCR and BETAPhone SexSoftcore on cable TV- at home“Adult” and “Escort” Sections in Yellow Pages, magazines and newspapers
30Sexual Content Access 4.0 1990 - 2004 All of the above plus ...BBS - Online bulletin board systems (BBS)Websites for porn and prostitutionOnline Porn and file transfer sitesChat RoomsOnline Hook-ups - i.e. craigslistWebcams and interactive live sex
31Sexual Content Access 5.0 2004 - Present All of the above plus ...Sexting and live video streaming from your smart phoneSmart Phones with GPS hook-up appsSocial Networks (facebook, twitter, mySpace)Virtual World Sex (2nd-Life, virtual games etc)3-D Imagery and Teledildonics
32And some are using it to offend ... About SextingTell story about young offender at SRI - Exhibitionist/VoyeurEewwwwwwwww!And some are using it to offend ...
33facehooked?“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
34About SmartphonesGPS 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 historyLive video streaming to phones and pads-Let’s look at this more closely ...
35There’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 phoneSex apps are the same - loaded from to your phone to help find sexual partners.
37Apps you should know about Ashley Madison - for married men and womenGrindr - for gay men
38About Ashley MadisonStarted as a website - now also a mobile app - perfect example of content access progressionAM 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 internationallyIn May 2011 – 1,3 million men and women used the service to contact a sexual partner in that single month92% of males on the site sign in as married68% of female members sign in as married
39Teledildonics 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.
41Initial Sexual Addiction Treatment Is Cognitive BehavioralBehavioral 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 minimumIn 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
42Required Treatment Steps When Working with Sex Addicts Do a thorough psycho-sexual history/assessmentIdentify 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 denialEducate and teach relapse preventionGet them into a sex addiction group therapyFind support for the spouseDirect healthcare, family and crisis resolutionRefer to long-term 12-step, therapy or faith-based group support
43Elements 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.
44What is Sexual Sobriety? Rarely complete abstinenceA mutually agreed upon clear, written and signed, behavioral contract based on client goals.Sobriety plans don’t change without prior discussion.
45Sexual Sobriety Contract List of Behaviors I Want to StopABCDEFList of Behaviors I Want to AddABCDEF
4612-step Groups for Sexual Addicts and Partners Sex Addict SupportSAASASCASLAA-WomenSRAPartner SupportS-AnonAlanonCOSACODARCA - Couples
47Want to Learn More?The Sexual Recovery InstituteThe RanchIITAP - International Institute for Trauma, and Addiction ProfessionalsSASH - The Society for the Advancement of Sexual HealthE-summits Online and Video learning with available CEU’s
48The Clinical Assessment and Treatment of Sex and Porn Addiction Robert Weiss LCSW, CSAT-SFounding Director - The Sexual Recovery InstituteDirector of Sexual Disorder Programs, Elements Behavioral HealthPromises, The Ranch & The Sexual Recovery InstituteNote: 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.