Fundamental questions remain about the nature of sex addiction, and misconceptions abound regarding the treatments that are available for it.
The first question is: Is it actually possible to become addicted to sex or pornography? If you have surfed the web looking for the answer, you know this is the subject of a rancorous debate. One side speaks as if sex addiction is a well-established, thoroughly-investigated mental health condition, and they purport to be experts on treating it. The other group -- a relatively small number of purist academics -- adamantly denies that people can be addicted to sex or pornography. Confused?
As is often the case, the extremists at both ends of the debate are more vocal than those in the middle. In many cases, the extremists also have a financial or professional stake in the outcome (book sales, treatment programs). Here's the most important thing to keep in mind: virtually everyone agrees – including most of the experts who argue that sex cannot become an addiction -- that sexual behaviors can become compulsive or otherwise out of control, causing serious damage to the individual's relationships and career. (If you want details about the scientific debate, go to the Important Topics page and watch the video Is "Sex Addiction" Really an Addiction? It's a clip from a workshop on this topic that I did for mental health professionals.)
Finding a therapist who can assess and help you address problem sexual behaviors can be difficult because many sex addiction therapists adopt a moralistic stance and pathologize sexual behaviors and desires that are essentially normal. Moreover, they frequently pass off their personal views as expert opinion or scientific fact.
Not long ago, I attended a meeting for therapists who treat sex addiction. Many of these clinicians were "certified" sex addiction therapists, and about half were women. As I listened to the discussion, it became clear to me that most of these therapists believe that a psychologically-healthy male has sexual desires and attitudes that are fundamentally similar to most women's. Nothing could be further from the truth! Indeed, massive pornography and prostitution industries have developed in response to men's desires, but such industries that target women are virtually nonexistent. I can certainly understand why some people have strong moral objections to prostitution and pornography, but it's important for therapists to be cognizant of the distinction between what is normal (i.e., behaviors that most men find alluring) and their moral sentiments about those desires and behaviors. A lot of good science has investigated the nature of male versus female sexuality, and the differences are profound. If you'd like more information about this, a fascinating and highly-accessible book on the subject is The Chemistry Between Us by Larry Young, Ph.D., a neuroscientist at Emory University.
As I mentioned on the home page of this website, many men become increasingly isolated during their adult years, and this can lead to anxiety, stress, and depression. When any of us feel bad, it is natural to seek something that will make us feel better. Some people are lucky. As kids, they were taught healthy ways of coping with negative feelings, but most people were not so fortunate. When they feel bad, they may overindulge in food, video games, alcohol, drugs, or sex. Sometimes, these behaviors take on a life of their own – that is, they may continue long after the initial sadness or stressor has passed. For some individuals, the behaviors escalate until they are completely out of control.
Because the scientific community has yet to reach a consensus about the most accurate way to conceptualize out-of-control sexual behaviors, no published studies have compared the effectiveness of various forms of treatment for these behaviors. Unfortunately, this has not stopped programs from sprouting up to "certify" therapists in the treatment of sex addiction. These programs have been developed prematurely, to put it mildly. (As I explain below, however, I believe many therapists have a great deal to offer people who are experiencing out-of-control sexual behaviors.) The certification programs exist because many therapists don't pay attention to the state of research, and they are willing to pay large sums of money to say they have been certified in a form of therapy that was developed by an author who has a lot of name recognition.
Despite the paucity of research on the treatment of sex addiction, there are many reasons to believe that well-trained mental health professionals can help people whose sexual behaviors have gotten out of control. Psychologists frequently see clients who have unique behavior problems, ones that have not been the subject of much research. A well-trained professional knows how to analyze such a behavior to determine factors that trigger or sustain it, and how to use that information to intervene. A good clinician can, in effect, collaborate with the client to run personalized experiments to determine what works best for that individual. It's also true that most current-day therapists draw from a well-established arsenal of cognitive-behavioral techniques (CBT) no matter whom they are working with. Research has shown that these techniques are helpful in the treatment of a broad array of difficulties -- from depression and anxiety disorders to substance abuse. It stands to reason that these techniques are likely to help clients who need to control or modify sexual behaviors too.
While many therapists may use the same general approach to treatment (e.g., CBT), as I explained on the home page, I do not believe all therapists are the same. Therapists who have a Ph.D. in psychology have had far more training than other therapists in the principles that undergird specific treatments (e.g., CBT techniques), so they should be better at adapting the treatments to your specific needs.
Recommended for a General Audience
Young, L., & Alexander, B. (2012). The chemistry between us: Love, sex, and the science of attraction. Penguin Group: New York.
Cahill, L. (2006). Why sex matters for neuroscience. Nature Reviews Neuroscience, 7(6), 477-484.
Carvalho, J., Gomes, A. Q., Laja, P., Oliveira, C., Vilarinho, S., Janssen, E., & Nobre, P. (2013). Gender differences in sexual arousal and affective responses to erotica: The effects of type of film and fantasy instructions.Archives of sexual behavior, 42(6), 1011-1019.
Conroy-Beam, D., Buss, D. M., Pham, M. N., & Shackelford, T. K. (2015). How sexually dimorphic are human mate preferences?. Personality and Social Psychology Bulletin,41, 1082-1093.
Baumeister, R. F., Catanese, K. R., & Vohs, K. D. (2001). Is there a gender difference in strength of sex drive? Theoretical views, conceptual distinctions, and a review of relevant evidence. Personality and social psychology review,5(3), 242-273.
Else-Quest, N. M., Higgins, A., Allison, C., & Morton, L. C. (2012). Gender differences in self-conscious emotional experience: a meta-analysis.Psychological bulletin, 138(5), 947.
Fisher, T. D., Moore, Z. T., & Pittenger, M. J. (2012). Sex on the brain?: An examination of frequency of sexual cognitions as a function of gender, erotophilia, and social desirability. Journal of Sex Research, 49(1), 69-77.
Galperin, A., Haselton, M. G., Frederick, D. A., Poore, J., von Hippel, W., Buss, D. M., & Gonzaga, G. C. (2013). Sexual regret: Evidence for evolved sex differences. Archives of sexual behavior, 42(7), 1145-1161.
Geer, J. H., & Robertson, G. G. (2005). Implicit attitudes in sexuality: Gender differences. Archives of Sexual Behavior, 34, 671–677.
Hald, G. M. (2006). Gender differences in pornography consumption among young heterosexual Danish adults. Archives of sexual behavior, 35(5), 577-585.
Lippa, R. A. (2012). Effects of sex and sexual orientation on self-reported attraction and viewing times to images of men and women: Testing for category specificity. Archives of sexual behavior, 41(1), 149-160.
Petersen, J. L., & Hyde, J. S. (2010). A meta-analytic review of research on gender differences in sexuality, 1993–2007. Psychological Bulletin, 136, 21–38.