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• Outpatient Treatment of Sex and Love Addicts, |
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CHAPTER 1 Introduction
Eric Griffin-Shelley
Sex and love addiction is a relatively new conception for understanding and treating compulsive sexual behavior and relationship dependency. This approach to obsessive, driven sexual acting out and intensive, unending, and unhealthy romantic attachments has grown out of addiction recovery and treatment. The founder of the Augustine Fellowship of Sex and Love Addicts Anonymous (SLAA) discovered that his sexual compulsivity did not settle down (as he anticipated it would) when he established sobriety from alcohol with the help of Alcoholics Anonymous (AA). Consequently, in 1976 he began meetings for people with obsessive relationship and sexual acting-out problems based on the Twelve Steps of AA. His ability to deal with one compulsion through the support and direction of a Twelve Step program led him to believe that the same principles and practices might work for difficulties with sexual activities that were out of control and relationships that were unmanageable.
Other recovering people had the same idea, and other Twelve Step programs grew up in different sections of the United States. The Midwest saw the development of Sex Addicts Anonymous (SAA). On the West Coast, Sexaholics Anonymous (SA) was founded. Sexual Compulsives Anonymous (SCA) was started in New York City. Each of these separate fellowships applied the Twelve Steps of AA to problems with compulsive sexuality.
At the same time that recovering people were applying the lessons of Twelve Step recovery to sex and love, professionals who work with addicted clients began to think and write about sex and love as addictions.
CHAPTER 2 Sex and Love Addiction: Definition and Overview p5
Eric Griffin-Shelley
Professionals and recovering people have struggled with definitions of addictions for years. The root of the word "addiction" is ad dictum ("to the dictator"). When people were conquered long ago, they were sent ad dictum (to the dictator), where they were slaves without freedom or any control over their lives. Addiction, then, means slavery. Addicts themselves identify with this loss of choice or freedom. When they are "hooked," they are not free to choose to stop whatever addictive behavior they have. Alcoholics are not free to stop drinking. Gamblers feel they have no choice but to gamble. Sex and love addicts feel compelled to act out in sexual or romantic ways as if they had lost their freedom of choice.
This question of whether an addict really has a choice, is really free, is the crux of much of the debate about how the addict can change. In Twelve Step recovery programs, the First Step is to "admit powerlessness" over the drug or activity to which one is addicted. Many people find this troubling because there appears to be a clear choice by the addict to engage in the addicting activity. No one can force someone to drink, eat, spend, exercise, or make love to excess unless there is some willingness on the part of the individual. The subjective experience of most addicts, however, is quite the opposite. They may have had a choice early in their abuse of the chemical or the activity, but as their addiction has progressed, they feel less and less in control and able to say "no" to the urge to participate in the activity. Addicts feel like slaves to drink, drugs, food, sex, money, or whatever their individual demon is.
CHAPTER 3 A Diagnostic Proposal with Neurochemical Underpinnings p21
Lord William
Sexually transmitted disease rates are continuing to rise in the United States (Centers for Disease Control, 1989). A dramatic illustration is the number of reported cases of early syphilis in Philadelphia, which increased 551% from 1985 through 1989 (Centers for Disease Control, 1991). The practice of safe sex, to avoid transmission of the AIDS virus, is declining (DeBuodo et al., 1990; Centers for Disease Control, 1990; Handsfield & Schwebke, 1990). Sexually related exposts and arrests are increasingly making local and national headlines. A flourishing pornography business, estimated at over $8 billion (Attorney General's Commission on Pornography, 1986), is spreading into every community. Phone sex is readily available even to young children through 900 numbers. Attendance at Twelve Step groups such as Sex and Love Addicts Anonymous (SLAA), Sex Addicts Anonymous (SAA), and Sexaholics Anonymous (SA) is steadily growing. SLAA meetings in the United States grew from 445 in 1989 to over 900 in 1991, SAA increased from 150 meetings to 378 in the same period, and SA reported a similar growth. CHAPTER 4 Using Individual and Group Therapy in Recovery
Eric Griffin-Shelley and Helen Griffin-Shelley
Outpatient therapy of sex and love addictions involves a variety of components including individual and group psychotherapy, psychoeducation and bibliotherapy, and self-help work. After initial diagnostic formulations have been made by the therapist and the patient, a treatment plan is needed to guide their work. A key element in this plan is the role of individual and group psychotherapy. In this chapter, we will address the value of each of these therapeutic approaches, with special emphasis on the potential for healing the sex and love addict. Then we will examine the different ways that these two therapies can be used alone or in combination. Finally, we will discuss some of our failures as indicators of the limitations of our therapeutic endeavors.
Many of our initial contacts with clients are initiated because of a crisis or extremely stressful event in the sex and love addict's life. Someone, something, or some event has compelled the person to seek help. For one client, it was a confrontation with the police over sexual acting out in exhibitionistic ways. For another, a spouse had threatened him with divorce if he did not do something about his "sexual problem." A woman felt near the verge of suicide because her sexual behaviors seemed out of her conscious control and likely to cause her to violate her most sacred beliefs and commitments. Another client sought help because she found that she could not break away from a drug-addicted boyfriend who was becoming more paranoid, jealous, and physically dangerous.
All of these clients came to us for help, and most of them wanted to be
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Unfortunately, the medical profession continues to debate the diagnostic terminology to be applied to individuals who are powerless over their sexual and love pursuits and, consequently, find their lives unmanageable. Various labels are applied to this disorder: "compulsive sexual behavior" and "sexual addiction" are used interchangeably by Carnes ( 1983), Qualand ( 1985), and Schwartz and Brasted ( 1985). Coleman ( 1990) prefers to call these problems of "sexual compulsion." Oxford ( 1978) uses the term
CHAPTER 5 Group Process Issues in Men's Groups
Jeffrey Kaufman
This chapter is based on my experience over the past several years conducting a weekly outpatient psychotherapy group for sexually addicted men and supervising other therapists conducting similar groups. The psychotherapy group is part of a recovery program for persons who have identified themselves as sex- and love-addicted. My approach to group therapy is rooted in psychodynamic psychotherapy and a group-as-awhole perspective on groups. A good example of the integration of these two ways of thinking elaborated into a general theory of group psychotherapy is Ashbach and Schermer Object Relations, the Self and the Group ( 1987).
Early in my practice I had heard that Freud said he learned the most by listening to his patients. I have placed listening to patients above all other sources of learning. This chapter owes most to the men in the sex and love addicts group. The shame, the pain, the persistent yearning for recovery, and the courage of the men in the group have infused the group process and have guided my therapeutic understanding. I have also learned about sex and love addictions from the writings of Patrick Carnes ( 1989) and Eric Griffin- Shelley ( 1991).
GROUP MEMBERSHIP AND IDENTITY
The group is specifically for men who have self-identified as sex and love addicts. Identification with and participation in a sex and love
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CHAPTER 6 Women's Issues in Addiction Recovery
Linda Dubrow
My observations on women's issues in recovery from sex and love addiction are based on my work with female clients in individual therapy in my private practice, and in group therapy, which was part of the intensive, outpatient therapy program described in Chapter 2.
I led two groups in the intensive, outpatient therapy program. A longterm therapy group was offered for women without making a distinction between who was sexually addicted and who was love or relationship dependent. A short-term group was offered for women emotionally involved with sex/love-addicted people. I will refer to the long-term therapy group for sex and love addicts as "the group," and will specify when I am referring to the short-term group for co-addicts.
Mental health professionals have tried to distinguish between sex addiction and love or relationship dependency. This has typically resulted in men being diagnosed as sex addicted and women as love or relationship dependent. This dichotomy is well entrenched in cultural norms, in which women are often defined according to their relationships with men, and men are seen as preoccupied with sexual conquest. Carnes ( 1991) reported that women felt they had learned as children that "A woman simply is no good without a boyfriend" (p. 157), and referred to the cultural expectation that "boys will be boys" (p. 29). At times, when some men express interest in committed relationships, or some women express sexual interests outside the context of committed relationships, people greet these nonstereotyped responses with ridicule or derision.
CHAPTER 7 Integrating Sex Therapy and Addiction Recovery
Stephen Heilakka
In sexual expression, the human being can experience a breaking down of physical, spiritual, and emotional barriers individually or with his or her partner. When the barriers are let down, at least three primal needs are being met. First, the inner child is reminded of nurturing received in infancy from primary caretakers. If that nurturing was not present in infancy, the inner child has the experience of having an unmet need fulfilled through the experience of being held and caressed as an adult. Second, the adult experiences a sense of confidence and well-being. There is a sense that a partner has been found with whom one can share the self and life experiences. Third, the soul is able to experience a moment of grace and unity that speaks to its desire to be reunited with its Creator.
It should be no wonder that sex is so powerful. At any given moment during sexual expression, the past (the inner child's needs), the present (the adult's needs), and the future (the soul's needs) are being expressed and met. At the same time a terror can emerge, due to the possibility that these needs cannot and will not be met indefinitely. This terror is the driving force in the sex addict's urge for sexual contact. This same terror drives the American culture's obsession with sex.
American culture is in search of an ethical and moral value system regarding sexuality. At the simplest level, the sex addict is expressing that cultural trait. Intuitively, the culture knows that sexual expression can be a healing experience. Intuitively, the sex addict knows that sexual expres-
CHAPTER 8 The Cultural Context of Sex and Love Addiction Recovery
Steve K. Dubrow-Eichel
They must needs go whom the Devil drives. Cervantes
In retrospect, I have always obsessed over my relationships. My own growth, both as a psychologist and as an individual, has involved years of work on basic relationships. I never thought the content of my personal therapy sessions was terribly "unordinary." I also thought, over the years, that I had encountered all the major surprises my unconscious had to offer. About the first belief, I eventually discovered I was right, although not in the way I thought. About the second belief, I would find out that I was wrong.
Personal facts do not have to change; shifts in the way we perceive the context of these facts can bring complete redefinitions of specific aspects of personal history and identity. I spent years of my early adulthood searching for what I thought was the "perfect woman." My feelings about this search ranged from frustration to pain to humorous self-recognition. It took years of later self-exploration before I recognized what I now believe was my first experience with obsessive love and sex.
I met Karin (not her real name) in my senior year of college, toward the end of 1975. Our meeting seemed, at the time, unplanned and spontaneous. But I was far more "ready" to meet her than I ever imagined. Just before meeting her, I wrote in my personal journal: "Passion, that is the crux of the matter. . . . If anything, I feel ready, now more than ever, to find a real lover, to find a real passion" ( Dec. 5, 1975). Karin and I fell quickly and
CHAPTER 9 Conclusions
Eric Griffin-Shelley
The exciting and insightful contributions to this book reflect the developments being made in the areas of sex and love addiction, sexual compulsivity, relationship dependency, sexual trauma and shame since 1987. The first ten years after the founding of the Augustine Fellowship of Sex and Love Addicts Anonymous in 1977 were highlighted by Patrick Carnes Out of the Shadows ( 1983), Robin Norwood immensely popular Women Who Love Too Much ( 1985), the Fellowship's Sex and Love Addicts Anonymous ( 1986), and Susan Forward Men Who Hate Women and the Women Who Love Them ( 1986).
Since then, there has been an ever increasing amount of literature available, such as Hope and Recovery ( 1987) and Brenda Schaeffer Is It Love or Is It Addiction? ( 1987). The next year saw Jennifer Schneider Back from Betrayal and Stephanie Covington and Liana Beckett Leaving the Enchanted Forest. In 1989, Patrick Cames Contrary to Love, his Gentle Path Through the Twelve Steps, and Ralph Earle, Gregory Crow , and Kevin Osborn Lonely All the Time came out. The first book for codependents, Mic Hunter and Jem The First Step for People in Relationships with Sex Addicts, also appeared in 1989. A companion piece, Hope and Recovery: The Workbook, came out in 1990. In 1991, Carnes Don't Call It Love and Eric Griffin-Shelley Sex and Love: Addiction Treatment and Recovery were published.
The books that have been published only begin to tell the story of the exciting and explosive developments in the field of sex and love addiction treatment and recovery. Twelve Step programs continue to grow and