What is a Sexual Addiction powerpoint 06052012

Yvette Gates, Mdiv, LPC & Nadia G. Barnett, LPC
PhD students in Counselor Education & Supervision
Mercer University
College of Continuing and Professional Studies
Department of Counseling and Human Sciences
Created by Nadia Barnett & Yvette Gates 4/2012

Overview
 Introduction
 How sexual addictions can progress
 Types of sexual addictions: non threatening vs
threatening
 Types of current effective treatment options
 Recommendations for future research & counselor
education
 Conclusion

 Sexuality is dependent on many factors, including
individual and relationship variables, societal values,
cultural [morals], ethnic and religious beliefs (Kaplan
& Kruegar, 2010).

What comes to mind when you think of
the following?
 “sexual addiction”
 “hypersexuality”
 “problematic sexual behaviors”
 “sexual behavior disorder”
 “sexually compulsive behaviors”
 “sexual compulsivity”
 “out-of-control sexual behaviors”

Lacks of categorization of sexual behaviors

DSM-IV-TR contains …
 Current available diagnoses under the section of
“Sexual Disorders”
 Sexual dysfunctions
 Sexual desire disorders
 Sexual arousal disorders
 Orgasmic disorders
 Sexual pain disorders
 Sexual dysfunctions due to a general medical condition
 Paraphilias *

 In any discussion of whether a sexual behavior is
problematic or not, it is critical to attempt to define
what constitutes [a sexual addiction] problem for self
or others (Kaplan & Kruegar, 2010).
 For the purpose of this presentation, the term ‘sexual
addiction’ will be used and has been defined as:
 A progressive compulsive or obsessive behavior that
occurs in response to an increase in anxiety,
characterized by an indirect or direct sexual act.

Academic literature connects sexual
addiction with …
 Childhood attachment trauma on sex addicts
(Katehakis, 2009)
 Direct or witnessed sexual, physical, or emotional abuse
(Katehakis, 2009)
 Poorer ability in self regulation (Billingham, Finn,
Monahan, Perera, & Reece, 2009)
 Sexual behaviors that may place one at high risk for
contracting HIV/AIDS or a sexually transmitted
disease (STD) (Cole, Dogde, Reece, & Sandfort, 2004)
 Food addiction (Power, 2005)
 Substance and/or alcohol addiction (Katehakis, 2009)

 The literature regarding sexual addiction indicates
that a person’s particular sexual addiction type can
manifest, change, and progress through three
phases.
 Obsessions
 Compulsions
 Impulsions

Obsessions
 One has “persistent ideas, thoughts, impulses, or
images that are experienced as intrusive and
inappropriate and that cause marked anxiety or
distress” (Giugliano, 2009)
 The individual with obsessions usually attempts to
 ignore or suppress such thoughts or impulses
 to neutralize them with some other thought or action
[such as masturbation, voyeurism, or the use of
pornography]

Compulsions
 One is demonstrating “repetitive behaviors or mental
acts of which the goal is to prevent or reduce anxiety or
distress” (Giugliano, 2009).
 The person is driven to perform the compulsion to
reduce the distress that accompanies an obsession
[which may manifest in either nonthreatening, such as
masturbation, fetishism, voyeurism, or the use of
pornography; or threatening sexual addiction types
such as frotteurism]

Impulsions
 “the failure to resist an impulse, drive, or temptation to
perform an act that is harmful to the person or others”
through physical contact (Giugliano, 2009).
 These characteristics may fit individuals who are child
molesters or serial murderers; examples of the
threatening types of sexual addiction are
exhibitionism, frotteurism, pedophilia, and rape

Nonthreatening Types
 Defined here as a sexual addiction that either has no
physical contact with any person(s) regardless of age
or physical contact with persons of sexual consenting
age.
 Types:
•masturbation
•pornography
•frequent visits
to strip clubs
•cyber sex
•phone sex
•simultaneous
or repeated
sexual affairs
•fetishism *
•Voyeurism *

Nonthreatening Types (cont.)
 Masturbation, Pornography, Frequent visits to strip
clubs, and Phone sex – (in this context) cause clinically
significant distress or impairment in social,
occupational, economical, or other important areas of
functioning (Kaplan & Krueger, 2010).
 Cybersex - users report getting further and further into
the bizarre, losing interest in their previous sexual
activities and partners, and seeking more and more
unusual experiences (Schneider, 2000).

 Simultaneous sexual affairs
 a sexual interaction with more than one person at the
same time
 Repeated sexual affairs
 sexual interaction that occurs at different times but on a
frequent basis
Both of the above can occur with known partners and
unknown partners (through the use of escort services,
massage parlors, prostitutes, or some other anonymous
person)

 Defined by the DSM-IV-TR:
 Fetishism – over a period of at least 6 months, recurrent,
intense sexually arousing fantasies, sexual urges, or
behaviors involving the use of nonliving objects (e.g.,
female undergarments) (American Psychiatric
Association (APA), 2000)
 Voyeurism - over a period of at least 6 months,
recurrent, intense sexually arousing fantasies, sexual
urges, or behaviors involving the act of observing an
unsuspecting person who is naked, in the process of
disrobing, or engaging in sexual activity (APA, 2000).

Threatening Types
 Defined here as a type of sexual addiction that involves
physical contact with a child, adolescent, or non-
consenting adult.
 Types
•Rape
•Exhibitionism *
•Frotteurism *
•Pedophilia *
•Sexual sadism *
•Sexual masochism *

Threatening Types cont.
 Rape - defined as “the crime of having sexual
intercourse with a person forcibly and without
consent” (Agnes, 1996).
 The DSM-IV-TR defines exhibitionism, frotteurism,
pedophilia, sexual sadism, and sexual masochism as
the following:
 Exhibitionism - over a period of at least 6 months,
urges, or behaviors involving the exposure of one’s
genitals to an unsuspecting stranger (APA, 2000)

 Frotteurism - over a period of at least 6 months,
urges, or behaviors involving touching and rubbing
against a nonconsenting person (APA, 2000).
 Pedophilia - over a period of at least 6 months,
urges, or behaviors involving sexual activity with a
prepubescent child or children (APA, 2000).

 Sexual sadism - over a period of at least 6 months,
urges, or behaviors involving the act (real, not
simulated) in which the psychological or physical
suffering (including humiliation) of the victim is
sexually exciting to the person (APA, 2000).
 Sexual masochism - over a period of at least 6 months,
urges, or behaviors involving the act (real, not
simulated) of being humiliated, beaten, bound, or
otherwise made to suffer (APA, 2000).

Treatment Options
 CBT
 Affective Neuroscience
 EMDR
 Medication
 Brief Multimodal Experiential Group Therapy
 Motivational Interviewing

CBT
 Cognitive Behavioral Therapy has the following
characteristics
 Collaborative relationship between client and therapist.
 Premise of psychological distress as a function of
cognitive processes.
 Focus on changing cognitions to produce desired
changes in affect and behavior
 Generally time limited and educational treatment that
focuses on specific and targeted problems.

CBT cont.
 When looking at CBT, Carnes (2005) believes long
term success is linked to behavior. He designed
experiences and assigned them as tasks to recovering
patients. When patients finished each assignment, it
signaled they had completed the task, grasped its
concepts, and made progress toward recovery.

CBT cont.
 The tasks were specific competencies (skills) that
individuals in recovery from sexual addiction could
use to manage their illnesses. The skills were divided
into thirty recovery tasks.
 Each task consists of performables and life
competencies. Performables are smaller tasks
individuals in recovery complete that make up the
larger recovery task. Life competencies are what the
recovering addict learns as a result of completing the
tasks.

Affective Neuroscience
 Affective Neuroscience is the study of the neural
mechanisms of emotion. This interdisciplinary field
combines neuroscience with the psychological study
of personality, emotion, and mood. By understanding
the impact of early childhood attachment patterns on
the neuropsychobiology of sexual addicts and their
partners, we can create a more effective model for
recovery(Katehakis, 2009).

Affective Neuroscience cont.
 Neuropsychobiology elucidates how affective
disturbances in the central nervous system (CNS)
autonomic nervous system (ANS) and the
hypothalamic-pituitary-adrenal system (HPA axis)
causes neurobiological deficits in infancy, and how
these deficits undermine both emotional and
intellectual growth, and how such damage may
manifest as sexual addiction (Katehakis, 2009).

Walking in Your Shoes
 Empathically relates to the client.
 Integration of the body and the mind.
 Observing, tracking and pointing out signs of anxiety
as defenses against deeper affect.
 Asking about bodily functions.
 Tracking affect
 Client attending to therapist prosody and body
language.
 Enabling insight and tuition.

Walking in Your Shoes cont.
 Client awareness of physical signs of anxiety is
encouraged by the therapist.
 Indicates client ability to move to deeper feeling states
without decompensating.
 Therapist monitor signs of anxiety that may not be
noticed by the client.

EMDR
 EMDR (Eye Movement Desensitization and Reprocessing)
 Phases of EMDR:
 client history and treatment planning,
 preparation,
 assessment,
 desensitization,
 installation,
 body scan,
 closure
 reevaluation

Client History and Treatment
Planning
 Obtaining client history and preparing a treatment
plan.

Preparation
 Establishing rapport.
 Explaining the process of EMDR and outcomes/effects
that could be expected.

Assessment
 Client assesses where they are regarding emotional
distress.

Desensitization
 The client processes distressing image(s) using EMDR
and emotions that came with the image(s). It also
involves processing the images while confronting and
challenging the irrational beliefs and faulty cognitions
that accompanied them

Installation
 This phase describes the therapeutic objective of
replacing negative cognitions with positive cognitions.

Body Scan
 The client is asked to visualize the traumatic memory
and also perform a mental scan of his/her entire body,
identifying areas where he/she experiences any kind of
unusual sensation

Closure
 The client returns to a calming, relaxed state through
the use of relaxation techniques such as guided
imagery.

Reevaluation
 This phase is conducted to determine the effectiveness
of EMDR after each session.

Medication as an Intervention
 Non-paraphilic sexual addiction (NPSA) was treated
successfully with psychotropic medication.
 According to Elmore (2005) NPSA is defined as
distress about a pattern of repeated sexual
relationships involving a succession of lovers who are
experienced by the individual only as things to be used
(APA, 2000).

Brief Multimodal Experiential
Group Therapy
 Both genders had
 significant reductions in psychological distress from
pretreatment to posttreatment.
 Significant reductions in depression symptoms.

Group Therapy, Cont’d
 Men had significant reductions in obsessive
compulsive-symptoms.
 Stable at six-month follow up.
 Women had reductions but they were not significant.
 Both genders reported significant reductions in their
preoccupation with sexual stimuli and difficulty with
controlling impulses.

Group Therapy, Cont’d
 Discordant Scale
 significant reductions in discordance scores were
obtained from post treatment to follow-up

Motivational Interviewing
 Motivational interviewing is defined as appreciation of
client strengths and simultaneous de-emphasis on
pathology, which creates the establishment of a
relational blueprint characterized by clarity, support
and respect instead of criticism, ambiguity or
dependence.

Motivational Interviewing cont.
 Primary focus on the individual instead of the disease
(Del Giudice & Kutinsky, 2007).
 The shame and relational deficits common to sexual
compulsivity and addiction seem most logically
addressed by an approach that makes unconditional
acceptance of clients a centerpiece of the therapy itself.
 Advantageous to the client’s internal locus of control
and discourages dependence on the therapist.

Recommendations for Future
Research
 Comparative Studies measuring the effectiveness of
CBT, EMDR, medication treatment, and motivational
interviewing.
 Outcome measures could focus on the quality of the
therapeutic alliance, session attendance rates, long
term group cohesiveness, mood state and relapse
frequency.

Recommendations for Future
Research
 The study by Hagedorn (2009) found that future
research could also focus on identified competencies
of family, pre-treatment, sexual addiction assessment
interventions, sexual addiction specialty counseling,
treatment planning, and professional practice being
given to a wider clinical sample (other than addiction
counselors) to determine their perceptions of
importance.
 Although treatment interventions mentioned
previously are promising, research participation is
limited.

Recommendations for Counselor
Education
 Crucial that counselors are adequately trained.
 Paucity of therapist trained in this area which could be
due to differing societal views about sex and the nature
of the addiction.
 More dialogue is needed to assist counselors in
exploring their feelings about sexual addiction and its
influence on their clients.
 Modeling acceptability in talking about sexual
addiction is imperative.

Conclusion
 Sexual addiction is a challenging topic because of
differing societal views about sex. Because of this,
individuals suffering from this addiction feel shame
and embarrassment which makes it difficult for them
to seek treatment. It is hoped that this literature will
add to the growing awareness and affirm the need for
more treatment in this area.

What is a Sexual Addiction powerpoint 06052012

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