1. Lauren Bierman, MC, LAC, NCC, CSAT Candidate

2. Sex Addiction: Defined “A pathological relationship with a mood altering experience” © Patrick Carnes, PhD,

3. “Sex Addiction” is an umbrella term for a number of compulsive behaviors Sex Addiction

4. It is not all about SEX At the core of it, sexual compulsivity is an intimacy and/or attachment disorder ▫ False sense of “connecting” which in actuality disconnects from the self and others ▫ Compensating for a feeling of inadequacy ▫ Fear of true intimacy and attachment to a primary partner Attempting to get non-sexual needs met through sexual behaviors

5. “I thought that sex was love and love was sex” “It was the only coping skill that was always there for me, even if only in my head” “It filled the deep hole in me, momentarily, and then after acting out I felt even worse. “I had sex to escape my shame, then I felt shame because I had sex, then I again had sex to escape my shame” (vicious cycle)

6. The Making of a Sex Addict

7. 10 Criteria for Sexual Addiction

8. Compulsive Behavior A pattern of out of control behavior over time. © Patrick Carnes, PhD/

9. Loss of Control Clear behavior in which you do more than you intend or want. © Patrick Carnes, PhD,

10. Efforts to Stop Repeated, specific attempts to stop the behavior, which fail. © Patrick Carnes, PhD,

11. Loss of Time Significant amounts of time lost doing and/or recovering from the behavior. © Patrick Carnes, PhD

12. Preoccupation Obsessing about or because of the behavior. © Patrick Carnes, PhD

13. Inability to Fulfill Obligations The behavior interferes with work, school, family, friends, hobbies, and spirituality. © Patrick Carnes, PhD

14. Continuation Despite Consequences Failure to stop the behavior even though you have problems because of it (social, legal, emotional, financial, and physical). © Patrick Carnes, PhD

15. Escalation Need to make behavior more intense, more frequent, or more risky. © Patrick Carnes, PhD

16. Losses Losing, limiting, or sacrificing valued parts of life such as hobbies, family, relationships, and work. © Patrick Carnes, PhD

17. Withdrawal Stopping behavior causes considerable distress, anxiety, restlessness, irritability, or physical discomfort. © Patrick Carnes, PhD

18. Case Example: “Ted” Ted is a 55-year-old, white male who is a lawyer by profession and has two adult children and has been married to his spouse for 22 years. Ted started to engage in pornography and masturbation at the age of 12 and this has been a constant for him throughout his life up to 7 days a week, for hours at a time. At the age of 25 he started to use cybersex with online services and also went to massage parlors. He hid this from his soon to be wife when they started dating and promised himself that he would stop once they were married. They did wed and had two children and he still continued to act out and had now escalated into actually seeing escorts for sex. His job was impacted due to not being able to concentrate and eventually his partner realized he was using company funds for his sexual acting out.

19. Addiction Cycle and Template

20. The Addictive Cycle Belief System Impaired Thinking Unmanageability Preoccupation Ritualization Compulsive Behavior Addictive Cycle Despair Guilt Shame © 2008

21. Arousal Template One’s psychosexual history that establish patterns and connections which have formed neurochemical and emotional templates related to sexuality.

22. What contributes to the Arousal Template? Biology: Some of our desired parameters are simply given by genetic encoding. Family: Parental interaction with child and the parents with each other has a profound effect. Early sexual experiences: Child abuse can have a profound effect on the template. Adults who were trauma victims often repeat their abuse because the abuse has become eroticized. Sexual history: Personal experiences that shape one’s sexual beliefs and behaviors. Sexual Addiction History: Acting out behaviors that become obsessive.

23. Components of the Arousal Templates Feelings Personality types Objects Processes Patterns or situations Body types Characteristics Vulnerability Stages of courtship

24. The 10 Types of Sex Addiction

25. Origins of the Ten Types A total of 10 “types” of sexually compulsive behavior emerged in the sex addicts surveyed by Patrick Carnes, Ph.D. Don’t Call It Love (1992) In the original research conducted for Don’t Call It Love (1992), a series of 114 sexual behaviors was statistically analyzed. © Patrick Carnes, PhD/

26. Fantasy Sex Sexually charged fantasies, relationships, and situations Arousal depends on sexual possibility. © Patrick Carnes, PhD/

27. Seductive Role Sex Seduction of partners. Arousal is based on conquest and diminishes rapidly after initial contact. © Patrick Carnes, PhD/

28. Voyeuristic Sex Visual arousal. The use of visual stimulation to escape into obsessive trance. © Patrick Carnes, PhD/

29. Exhibitionistic Sex Attracting attention to body or sexual parts of the body. Sexual arousal stems from reaction of viewer whether shock or interest. © Patrick Carnes, PhD/

30. Paying for Sex Purchasing of sexual services. Arousal is connected to payment for sex, and with time, the arousal actually becomes connected to the money itself. © Patrick Carnes, PhD/

31. Trading Sex Selling or bartering sex for power. Arousal is based on gaining control of others by using sex as leverage. © Patrick Carnes, PhD/

32. Intrusive Sex Boundary violation without discovery. Sexual arousal occurs by violating boundaries with no repercussions. © Patrick Carnes, PhD/

33. Anonymous Sex High-risk sex with unknown persons. Arousal involves no seduction or cost and is immediate. © Patrick Carnes, PhD/

34. Pain Exchange Sex Being humiliated or hurt as part of sexual arousal; or sadistic hurting or degrading another sexually, or both. © Patrick Carnes, PhD/

35. Exploitive Sex Exploitation of the vulnerable. Arousal patterns are based on target “types” of vulnerability. © Patrick Carnes, PhD/

36. Other behaviors that have been added through more recent research: Broken Down:Added: Paying for Sex- ▫ Power ▫ Commercial Exploitive Sex ▫ Trust ▫ Force ▫ Child Pornography Drug Interaction Internet Sex Paraphilia Masturbation © Patrick Carnes, PhD/

37. Does it lead to powerlessness? Does it lead to preoccupation?

38. Case Example: “Sheila” Sheila is a 32-year-old, female, of Native American decent. She is recently separated and has a small child. Sheila’s husband left her due to her drug use and severe rage issues. Sheila was molested by a neighborhood boy when she was 12-15. Since the separation from her husband, she has been inviting men over to her place via the internet and will exchange sexual acts for drugs. Sheila will often post pictures on the internet of herself naked or in vulnerable positions to men. Before the men come over, she will fantasize about how this next one will be “the one” for her and will sweep her off her feet. When they arrive, Sheila will suggest that the men to do almost anything sexually to her including humiliating and degrading behaviors.

39. Love Addiction and Love Avoidance

41. Cybersex

42. What is Cybersex? Accessing online pornography and audio, video, and text stories. Real time with a fantasy partner. Other cybersex venues (social networking sites, and portable devices such as Blackberries and iPhones). Multimedia software.

43. Internet Pornography Statistics A total of 4.2 million websites contain pornography. That is 12 percent of the total number of websites. There are 100,000 websites that offer pornography and 1 in 7 youths report being solicited for sex on the internet. Average age of first exposure to internet pornography is 11-years-old. http://internet-filter-review.toptenreviews.com/internet-pornography-statistics-pg4.html

44. Why Sex on the Net?

45. The Three A’s Accessibility Anonymity Affordability Al Cooper, PhD

46. Ten Criteria for Problematic Online Sexual Behavior  Preoccupation with sex on the Internet.  Frequently engaging in sex on the Internet more often or for longer periods of time than intended.  Repeated unsuccessful efforts to control, cut back on, or stop engaging in sex on the Internet  Restlessness or irritability when attempting to limit or stop engaging in sex on the Internet.  Committing illegal sexual acts online (ex: sending or downloading child pornography).

47. Ten Criteria cont.  Jeopardizing or losing a significant relationship, job, or educational or career opportunity because of online sexual behavior.  Incurring significant financial consequences as a result of engaging in online sexual behavior.  Using sex on the Internet as a way of escaping from problems or relieving feelings such as helplessness, guilt, anxiety, or depression.  Returning to sex on the Internet day after day in search of a more intense or higher-risk sexual experience.  Lying to family members, therapists, or others to conceal involvement with sex on the Internet.

48. How does SA impact the Family? Dishonesty and secrets throughout relationships or the entire family system Overwhelming sense of betrayal “Shattered” world Covert/ Overt Sexual Energy/ Behaviors Risk of disease and consequences (STI’s, divorce, violence, loss of job, or jail time, etc.) Financial loss Passed down through generations

49. Treatment Plan

50. Building a new relationship with self Building a new relationship with sex

51. Treatment tools:  Individual Therapy  Group Therapy  Twelve Step Meeting  Sponsor  Steps One through Nine  Family Participation  Family Recovery  Couples Recovery  Exercise/Nutrition

52. Intervention and Plan Break through denial Understand the nature of the illness Become willing to surrender to the process Limit damage from behavior Establish sobriety Ensure physical integrity Participate in a culture of support- 12 Steps Shame reduction work Grief work Acknowledge cycles of abuse Commit to recovery for each family member

53. For the Addict Out of the Shadows- Dr. Patrick Carnes Facing Love Addiction- Pia Mellody Don’t Call it Love - Dr. Patrick Carnes In the Shadows of the Net - Dr. Patrick Carnes Ready to Heal - Kelly McDaniel Women, Sex, and Addiction - Dr. Charlotte Davis Kasl For the Family Deceived - Dr. Claudia Black Mending a Shattered Heart - Dr. Stefanie Carnes A House Interrupted - Maurita Corcoran