Sexual addiction treatment strategies typically mirror the techniques that have proven effective with substance abuse. Primarily, sex addiction treatment specialists rely on a combination of cognitive behavioral therapy (CBT), group therapy, and 12-step sexual recovery support groups. The primary difference between treating substance abuse and sexual addiction is that with substances complete abstinence is the ultimate goal, whereas sexual sobriety involves ongoing commitment to behavior change but not long-term abstinence. Instead, recovering sex addicts, working with their therapist, carefully define the sexual behaviors that are and are not problematic, agreeing to completely and permanently abstain from the troublesome activities and to engage only moderately and appropriately in the non-problematic behaviors. (As such, the definition of sexual sobriety differs for each client.)
When sex addicted clients first arrive, the treatment approach is twofold:
- Separating the addict from his or her harmful sexual behaviors
- Breaking through his or her denial regarding the problematic nature of those activities
Because it is very difficult for either active or newly sober sex addicts to distinguish between healthy and unhealthy sexual behaviors, a brief period of total sexual abstinence (masturbation included) is usually a good idea. Normally this lasts 30, 60, or 90 days, depending on the client. This allows sex addicts, again working in conjunction with their therapist, a sex-free cooling off period in which to fully assess their sexual behavior patterns, and also to develop some basic coping skills that can be used when the desire to act out arises. At the same time, treatment should be looking at the denial, rationalizations, minimizations, and justifications that clients are using to make their behaviors acceptable (in their own mind).
As mentioned above, CBT is the primary therapeutic modality for treating addiction. CBT looks at the emotions and events that trigger and reinforce the addict’s desire to engage in compulsive sexuality, and then identifies ways in which the client can short-circuit the process and deal with triggering emotions and events in healthier ways. In other words, CBT teaches addicts to stop their sexual thoughts and behaviors by thinking about and/or doing something else—usually a healthy behavior (coping mechanism) like going to a 12-step meeting, talking to a friend or loved one about what is going on, developing a spiritual connection, or maybe just cleaning the house, walking the dog, or cooking a nice dinner. Essentially, CBT focuses on living a sexually sober life in the here and now, rather than on uncovering and processing past traumas. As such, the therapist’s role, at least early on in sexual sobriety, is to implement a task-oriented, accountability-based methodology geared toward containment of the client’s problematic sexual behaviors. Later on, once sexual sobriety is firmly established, the therapist and client can look at other, deeper issues.
Unsurprisingly, the process of sexual recovery often presents challenges that can’t be dealt with solely in individual, one-on-one therapy. Like other addicts, sex addicts nearly always require external reinforcement and support if they want to permanently change their deeply rooted patterns of behavior. Sex addiction focused group therapy can be extremely helpful in this regard. Generally, a treatment specialist works with between six and ten same-gender sex addicts. (Co-ed sex addiction therapy groups are a bad idea!) The facilitated group setting is a great way for sex addicts to learn that their problems are not unique, which goes a long way toward reducing the shame associated with their behaviors. Group therapy is also the ideal place to confront the denial that is so integral to sexual addiction. Such confrontations are powerful not only for the addict being confronted, but for the addicts doing the confronting. As such, everyone present learns how minimizations, justifications, and rationalizations sustain sexual addiction. Clients are also able to learn which interventions and coping mechanisms work best based on other members’ experiences.
If clients are struggling with core concepts of healing, or they just can’t seem to establish a footing in sexual sobriety, they may benefit from inpatient residential or intensive outpatient sexual addiction treatment. These intensive programs can last as little as two weeks or as long as several months, depending on the program and the client. In addition to individual and group therapy (and perhaps inpatient or intensive outpatient treatment), sex addicts nearly always benefit from 12-step sexual addiction meetings. Sexaholics Anonymous (SA), Sex Addicts Anonymous (SAA), Sexual Compulsives Anonymous (SCA), Sex and Love Addicts Anonymous (SLAA), and Sexual Recovery Anonymous (SRA) are all nationwide programs for sex addicts.
Needless to say, every sex addict’s treatment arc is different. Each individual arrives with specific problematic sexual behaviors and a unique background, so each client needs an approach tailored to his or her particular needs. Some will respond best to individual therapy supplemented by group and 12-step work. Others will do best in group settings, making little progress one-on-one. Still others will struggle utterly until they are physically separated from the people, places, and things that drive their addiction by the protective walls of inpatient treatment. The most important thing when dealing with sex addicts is to recognize their individuality in this respect, and to respond accordingly rather than by attempting to force-feed any particular approach, no matter how much success you’ve had with that approach in the past.