As the years go on, I’ve realized that I have become a good deal more ‘myself’ as a therapist – meaning I present more of who I am, though only when appropriate to benefit the particular individual I’m working with. So I might talk about something that happened in my own past if it relates to what the client is discussing; I will generally answer questions about my own life; and generally I much more prize and focus on the actual relationship between me and my client. This has gone along with my own growth, as a person and as a therapist, in which I’ve realized clearly that what matters in the therapy is what works with the given person I’m with, and what is far less important is my trying to follow a given theoretical paradigm that I was taught years ago .
According to affect and attachment theorists, psychotherapy is essentially teaching self-observation while keeping self-loathing at bay and instead, helping the client to develop a liberated sense of free floating awareness and consciousness. In many ways psychotherapeutic work is to help our clients to trust their minds by fine-tuning the connection between affect, feelings, moods, thoughts, bodily responses and behaviors. When feelings are experienced in the body without a conscious awareness and labeling of the feeling, individuals will turn to bodily means to address the unknown feeling. This is when behaviors can get out of control.
As a certified individual and group psychotherapist I work with individuals who struggle with behaviors that they feel have gotten out of control. These behaviors can include sex, eating, substance use as well as gambling and other money-related difficulties. I believe that behaviors that feel out of control are related to feelings that are often unidentified and then turned into actions, often outside of our awareness. I believe that the affect of shame is highly related to many out of control behaviors. Shame can be conscious and/or unconscious. I help my clients to develop an awareness of their shame, as well as other feelings, in order for them to use the feeling states in the service of directing their actions consciously and purposefully.
Many feeling states that are turned into action are blends of feelings such as shame mixed with fear and/or anger. I help my clients to understand the complexity of these emotional states. I purposely collaborate with my clients to study their behaviors and decode what underlies these actions. In doing so, we are able to create the opportunity for choice and volition. This in turn enhances self-esteem and allows my clients to find for the first time or, in some cases, re-find, their connection to creativity, play and relational connectivity.
Sexual behavior is deeply rooted in the human experience. Few other forces in our lives are so closely tied to our biology, our emotions, our needs, our thoughts, and our learning history. Thus, it is not surprising that when something goes wrong in this area it can feel as if our whole world is out of control. People may find themselves engaging in abundant use of commercial sex (prostitutes, massage parlors, strip clubs, etc.), having numerous affairs or sexual liaisons, viewing pornography and/or masturbating in an excessive way, or some combination thereof. Very often, men and women find themselves lying to cover up various of these activities, or wishing they could stop or cut down but having little idea how that might happen. Sometimes, people are involved in patterns of sexual behavior that others find hurtful or problematic: They may be told, “You have an addiction,” or “That’s not normal—normal people don’t do that,” and so on. Typically, assertions such as these only add to the deep well of shame in which many find themselves. After all, what is “normal”? And what is a “problem” if a person believes what they are doing is not harmful? (Also, as of the end of 2018, “sexual addiction” was not a diagnosis officially recognized by the American Psychiatric Association.)
In the last 35 years, a great deal of thinking has gone into the assessment and treatment of compulsive and out-of-control sexual behaviors. There are various treatment models which conceive of these behaviors as addictions and thus apply a recovery/sobriety approach. Other modalities seek to discover what purpose a behavior may be serving for a person—psychologically, emotionally, etc.—so that an individual can begin to understand her or his patterns and thus let go of those patterns if they choose. There is no single approach that has been determined to be of greater efficacy than any other; what seems to be most helpful in my experience is a good and trusting fit between patient and therapist—a therapist who wants to, and sincerely believes he or she can, help because he or she has done so before.
Although I have worked with many clients struggling with sexual behaviors that are troubling them, including those who seem to have one relationship after another with “toxic” partners and those on the opposite end of the spectrum who yearn for sexual and emotional intimacy but feel paralyzed as to how to find it, I don’t believe that there is one “right” recipe for all. We are all human, with our thoughts, feelings, needs, and biological drives. I consider my job to be that of a compassionate and curious tour guide who helps a person get to know her or his mind at conscious and unconscious levels. My hope is that my office is a place where people feel safe and willing to understand themselves; to see why and how they have arrived where they are; and to begin to know a more authentic and liberated way of living that comes from within with the assistance of a beneficial client/therapist relationship.
It is challenging to modify compulsive or addictive behavior on your own or even with the help of a therapist or a program, and it may be useful to think about the differences between compulsive and addictive behavior in order to work towards change.
People who engage in compulsive behavior usually recognize it as absurd and irrational, and they feel bad about it before, during, and after engaging in the behavior. Examples of compulsive behavior are feeling you must repeatedly check to see if you locked the door or turned off the stove or wash your hands, or identifying as a “neat freak”. They are aware they are out of control in this aspect of their life.
Active addictive behavior, in contrast, usually occurs in an altered, less-than-rational state (sometimes described as a trance state or a delusional state), where a person feels they aren’t out of control, they can handle it, won’t overdo it, are just trying to get relief or escape discomfort. Once the addictive behavior is triggered the person is on a slippery slope, and turning back is unlikely without the tools of recovery. After a binge there may be feelings of remorse, shame, guilt, and anxiety, but those feelings fade when the person is triggered again.
Recovery from addiction begins with learning to recognize your triggers and having ways to help yourself avoid that slippery slope. Compulsive behavior can be modified but addictive behavior usually needs to stop. Harm reduction programs try to modify addictive behavior but in my experience they are usually not effective after the initial excitement about the notion of being able to keep your addition but not letting it get out of control.
There is a reason the 12-step programs’ focus on sobriety and community has proved to be effective for many people. My goal is to be part of the community around the addict who is trying to live a healthy life.
I find it helpful to think of addiction as a symptom, not just a problem. The problems that cause addiction are what I seek to treat.
I find it helpful to think of addictive behavior as compulsive, behavior in which we engage to relieve intolerable discomfort.
If you are engaged in compulsive, out-of-control, addictive behavior, I am eager to understand not just how you act out, but why – what it is in the moment that triggers the irresistible impulse, and what it is in your past that left you unable to tolerate your feelings without acting out.
Together, we will work to understand not just why you can’t stop, but also, what it is that you get out of your addiction.
No one wants to be an addict. Our challenge, together, is to understand your addiction as a coping strategy, and to develop alternative, less destructive coping strategies.