Fantasy and action

Josh Wolf-Powers

I have worked with a wide range of adults with a wide range of sexual fantasies and behaviors. I have worked with neurotic or depressed or anxious people, people with tremendous shame about their desires, and with people whose sexual behavior has led to arrest (“sex offenders”).

Sexual fantasies and sexual behaviors are different. We know this, intuitively: monogamous married people may fantasize about sex with people other than their spouses, but most of us do not imagine such fantasies necessarily must lead to action. That doesn’t, however, stop many of us from feeling guilty for our fantasies – or from judging others, for theirs.

Many people fantasize about being raped, but almost no one wants to be raped.

Many straight-identified women enjoy pornography depicting lesbian – or gay male – sex, but do not even fantasize about having, let alone actually participate in, sex with other women or with gay men.

Many gay men enjoy pornography depicting straight sex, but have no interest in participating in it.

Many straight men enjoy viewing bisexual or gay porn, but have no interest in participating in sex with other men.

And many of us have been surprised by sexual situations in dreams in which we were aroused by situations we never would seek to replicate, or even would find repugnant, in waking life.

In short, what turns someone on, or the pornography they seek, is not necessarily the same as what they do, sexually.

Neither our fantasies nor our dreams necessarily reflect our actions or behaviors.

Among the people with whom I have worked, some have been habitual viewers of child pornography who never touched a child, and who never would. Others were attracted to minors but repulsed by child pornography. Some were aroused by graphic, violent depictions of rape, but never harmed a human, sexually or otherwise. And some were aroused simply by transgression – the “wrongness” of whatever they view, rather than the people and actions depicted – and were obsessively rule-following in their actual lives.

We often use our sexual fantasies to feel safe, and to heal childhood wounds (Stoller, 1975).

For people whose sexual behavior causes problems – relational, financial, criminal or otherwise – psychodynamic psychotherapy, when successful, leads to a substantial reduction or elimination of the problematic behavior. It enables patients to develop an interest in and understanding of the meaning of their  desires, and to develop less maladaptive, more healthy, strategies for addressing the underlying psychological wounds in response to which they have developed.

Particularly when it comes to stigmatized, or criminalized, desires – like pedophilia – it is an understandable but unfortunate error to conflate pornographic viewing habits with behavioral risks. Many of us intuitively understand that this is erroneous, but because of the fears, shame, and disgust attached to child sexual abuse, we do not permit ourselves to think logically in the face of it.

As a clinician, I understand sexual fantasy and sexual behaviors to be two entirely separate, and often unrelated, categories.

Citation:
Stoller, R. J. (1975). Perversion: The Erotic Form of Hatred. Karnac Books.

Stigma of Sexual Addiction

Liz Lacy

One of the reasons I started treating sexually compulsive behaviors is because at the age of 26 I had a close friend who suffered with them. He was a guy with masters degrees, commitment to his community and a very loving heart yet he felt such shame about what felt to him like an unforgivable compulsion to be sexually stimulated. The pain and shame I saw in a man I respected and loved made me want to learn more effective methods of treating the pain and shame of sex addiction. I don’t think any other addiction is hidden as much as this one. 

What still bothers me after 20+ years in the field is how much stigma is still involved in people seeking treatment even within the field of psychotherapy. I was recently struck by how difficult it was to find a trauma group for one of my patients who was not yet entirely sober. He had come a long way but a few self destructive behaviors hung on due to his history of sexual abuse. He needed an additional support through trauma work with others. After three calls with colleagues who ran trauma groups and an in patient program for trauma, I still hadn’t identified one where I wasn’t being told ‘ think his addiction could be triggering (upsetting) for the other members’. I began to wonder if I would find a group that would accept him. This is New York City…I had hoped for more enlightened treatment. Luckily the fourth call was to a colleague who understood the compulsion which like other addictions was just another way of reenacting trauma, difficulty with intimacy and/or avoiding painful feelings (in this instance). 

As in eating disorders and other process addictions, I’m looking forward to the day where assessing for and treating this compulsion becomes routine in mental health assessments and treatment so that people can get what they truly need to heal. People should not have to live with this shame especially when talking to providers.

Meanwhile, we in the SAT Network try to educate, treat and inform people as we are able. For me, it’s always been more than just a career… it’s a calling.

My experience and approach

Christine Chapman

I work with all types of people; many of them are perfect… or so it appears. But, we all have challenges. How we choose to deal with them is what varies. So, if you’re looking to make a change I offer my expertise and support. Together, we’ll explore why things are, or are not happening for you, how to apply coping mechanisms to everyday living, and what it takes to experience a more loving relationship, a satisfying job, to heal from trauma, or control your impulses.

What you need to know about me

Richard Olson

As an out therapist who has worked extensively with gay men for over thirty years, I bring cultural awareness, compassion and empathy to the therapeutic relationship. As a graduate of one of the earliest  LGBT psychodynamic training programs designed for LGBT therapists, I operate from an informed theoretical perspective as well. I am flexible and eclectic in approach. I am committed to providing the individualized course of treatment you are entitled to, maximizing your unique strengths while shoring up areas of deficit.

Working through and altering OCSB requires commitment and tenacity. Developing insight, working through shame and anger, exploring the effects of childhood sexual abuse or developmentally pre-mature sexual acting out are pivotal.  So is recognizing that lasting change requires action. Together, we will formulate a treatment plan utilizing external resources when appropriate, as well as in depth therapy. Progress towards meeting treatment goals will be re-assessed and reformulated on a regular basis. We will work together to achieve maximum contentment and authenticity.

Barbara’s first post

Barbara Mazzarella

Good mental health is a precious commodity. It is also essential if you’re to have a fair shot at living a fulfilling and satisfying life.      The kind of life, I believe, is every human being’s natural birthright.

The kind of psychodynamic psychotherapy I provide is collaborative, interactive and timed & tailored to your specific needs.

Drawing upon a foundation of postgraduate psychoanalytic education & clinical training, along with over 20 years of treatment experience, I feel truly privileged to “join” with my patients on their individualized paths of self discovery and psychological growth. 

The working alliance we build together in our therapeutic relationship is what becomes the tool for healing old traumas, negative core-self beliefs, and problematic behaviors. Beliefs and behaviors that might be holding you back in life, in your career and in your close and intimate relationships. 

In addition to my general practice, I  specialize in the treatment of those struggling with out of control, compulsive, shame-based and often secretive sexual activities. At first we work to contain and reduce the painful behaviors. As healing and recovery grow deeper, the work grows deeper too. Treatment may focus on recognizing one’s unconscious motivations, attachment patterns and increasing the capacity to identify, tolerate and regulate one’s varying emotional states.  

In conjunction with psychotherapy, I have found that many patients accelerate their healing by attending 12-Step recovery programs for sex & love addiction, substance abuse and codependency.  While attendance is definitely encouraged, it is by no means mandatory–the meetings work extraordinarily well for many, but not necessarily for everyone.

I also work with the partners of those with sexually compulsive behavior.  If you have recently discovered that your partner has been compulsively unfaithful, then you have experienced a disorienting, relational trauma–a rupture in your perception of what you thought was your reality. Psychotherapy can help you regain your emotional “footing” and improve upon your existing and future relationships, including the most important one of all–the relationship you have with yourself.

My treatment approach

Gail Appel

For over 35 years, I have been treating people with Out-Of-Control Sexual Behavior (OCSB)/sex addiction, alcoholism, substance abuse, love addiction and co-dependency. I provide individual, couples and group therapy. As we work together, in your most personal moments, when its just you and me, there is freedom to share your most vulnerable concerns. I provide a safe, therapeutic space, with caring, humor and respect where you can explore your deepest issues.

Initially, we may be working on attempting to reduce or eliminate out-of-control behavior. Often as we do that, intense feelings emerge. We will explore these emotions together. Childhood trauma often underlies addictive/out-of-control behaviors. I am trained in doing EMDR, which is very effective in treating childhood trauma.

There is something profoundly healing about sharing your most personal truths with a trusted witness. I would feel privileged if you allow me to go through this healing process with you.

An Integrative, Personalized Approach

Nathan Rice

I’ve worked with hundreds of individuals attempting to regain control over problematic sexual behavior. Although I can recognize similar patterns across the board, every individual is unique and requires personalized treatment. Some of my aims are to help people cultivate a sense of curiosity and acceptance toward themselves, teach people how to survive urges without acting on them and to help people identify and pursue goals that are meaningful. I use a mixture of hardcore behavioral principles, motivational enhancement and deep listening, all guided by my ongoing close study of cutting-edge, contemporary psychoanalytic theories. 

I worked at a sex addiction treatment center for more than four years, where I provided individual, couples and group therapy. I served on the committee for psychoanalysis and addictions treatment (COPAT) and have presented on the topic of problematic sexual behavior at conferences and universities. Currently, I am completing the last year of an 8-year training program in psychoanalysis and psychoanalytic therapy. My ongoing interests include therapeutic mechanisms of change, the role of emotional intelligence in healing and the latest developments in how we understand unconscious forces. 

How I work

Ali Shames-Dawson

Drawing on principles and techniques from relational psychotherapy and mindfulness practices, I aim to strengthen my client’s self-understanding and sense of control over their choices. My first objective is to create a space where people may feel safe to speak about experiences, thoughts, and feelings that may feel dangerous, shameful, or unacceptable. When we can access the personal meaning of problematic behaviors, then we can work with limiting beliefs about the self and the world that may keep people locked into patterns of behavior that disrupt their capacity to seek and maintain fulfilling, sustainable relationships and lifestyles.

At the root of much of my work is a sense of urgency about the primacy of self-expression for psychological health. But life experiences can lead to conflicts that stifle our capacity to be truthful with ourselves about who we are and what we want. This often results in great confusion, because we may act in ways that lead us astray or damage the commitments that matter most to us. Whether these conflicts manifest in out-of-control sexual behavior, substance use, problematic relationship styles, or harmful habits of thought, they serve a purpose that often has to do with running from ourselves.  Therapy is unique in that it provides a nonjudgmental relationship in which an individual can engage in careful observation of their thoughts, feelings, and habitual ways of relating to others that may help them step outside of these painful patterns and experience relief. The only way out is through.

My Treatment Approach

Stephen McFadden

Since I began my professional practice in the 1980s, I‘ve been treating men with Out-of-Control Sexual Behavior (OCSB). How this is named and treated has changed over time – sexual compulsivity, sex addiction, etc.  But whatever it’s called, the men who come to me feel that sex is not in a balanced place in their lives and often has disruptive consequences. They haven’t been able to make changes on their own and keep slipping back into the same patterns, in spite of repeated efforts.

My treatment approach always has a dual focus: (1) teaching direct tools and skills that clients can use in managing and changing the problematic patterns in their thinking and behavior, and (2) understanding the underlying issues and needs that drive the OCSB.  

I’ve been trained in Somatic Experiencing, EMDR and Clinical Hypnosis, all of which can help clients better regulate the feelings, urges and fantasies that feel out of control. These become part of the skill set clients use to make changes in their sexual patterns. They also are helpful in working through early traumas or sexual conflicts that can play an underlying role.

Over the past six years, I’ve been working within the new OCSB model, which is based on sexual health principles and is also sex-positive.  I directly trained and continue to consult with the developers of this model, which is increasingly recognized by both the sex addiction and sex therapy communities as one that incorporates a broader understanding of sexual behavior and takes an individualized rather than a “one size fits all” approach.    

I currently provide individual and couple therapy for OCSB.  I will be starting a group in the spring of 2019. Further information is available at my website.

My Approach to Treatment

Kelly Moylan

Therapy can help you uncover and remove obstacles that may be keeping you from enjoying your life. We can work together to identify solutions that will reduce anxiety, lift depression, improve your self-esteem and relationships. 

I specialize in helping patients recover from codependency in relationships. 

Codependency can manifest as a pattern of enmeshed or abusive relationships, preoccupation with the needs of others, self-neglect and obsessive thinking.  Partners of addicts or alcoholics and people raised in families affected by alcoholism or addiction often develop codependent habits.  Identifying and transforming these potentially self-destructive patterns of thinking and behaving is extremely difficult to do alone.  I can offer my empathy and experience to guide my patients to insight and relief from the distress associated with these experiences.