This morning I sat in on a webinar put on by an LCSW who works at Duke University Hospital. The title of the presentation was “Sex Addiction – It’s not in the DSM-5. Does that Matter?” Having taken courses in sex theory and clinical sexology, I assumed the subtext was that it did matter. Because it is not recognized by the DSM, many clinicians with a lack of sex therapy training resort to using their own biases of what is and is not “normal” sexual behavior as a metric for deciding what constitutes a sex addiction (Braun-Harvey & Vigorito, 2016). Not long into the presentation, however, I realized that the social worker’s assumption was that the absence of sex addiction in the DSM did not matter. Citing Patrick Carnes as a “great resource,” he argued that sexual compulsive behavior was a process addiction with identical physiological effects to other widely-acknowledged addictions (e.g., alcohol, gambling, and heroin) and should therefore be a diagnosis that clinicians do not shy away from with clients. I say this as a way of getting at why I believe sexological training is of utmost importance for all practicing and future-practicing clinicians. Without sex therapy training clinicians are prone to, in some cases, pathologize diverse, healthy forms of sexuality and, in other cases, address behavioral concerns while overlooking a constellation of systems that create the conditions for problematic sexual behavior.
This is an issue near to my heart because of the ways I have been affected by a sex addiction diagnosis. Though it took me about 14 years to understand, my sexual autobiography is quite similar to many of those in my own generation who grew up in the “purity” movement (Sellers, 2017). My family and I attended a non-denominational evangelical church with a markedly conservative interpretation of the Bible. The pastor’s sermons tended to place a great deal of value around the notion of purity. This was equated with a kind of neo-asceticism that revolved around abstinence in a myriad of forms – abstaining from alcohol, abstaining from anger, abstaining from the use of curse words, and, of course, abstaining from all forms of sexuality outside of a cis-hetero marriage. Though I really loved this community and the friends I made in the church, I began to feel immense shame for my own developing sexuality.
Dating prohibitions at home were compounded with abstinence-only messages at church, which, in turn, forced my sexuality underground. Without the permission to date, I discovered porn and masturbation, which became my only outlet for sexual expression. After one traumatic incident of being found out, I vowed to never watch porn again. I made good on this promise for a good year and a half, even abstaining from masturbation altogether, but I fell into old patterns towards the end of high school, which continued well into my college years.
When I went to a counselor during my sophomore year at SPU and reported my relationship to porn and masturbation and the shame I felt about it, I was handed a sheet that detailed ways to overcome process addictions. I spent years thinking I was a sex addict and feeling such chronic shame for my inability to control my sexual desires. Interestingly, it was philosophical theology that taught me how flawed this abstinence-only treatment model was. I learned that, like the Edenic story of the forbidden fruit, prohibitions generate the very desire to transgress (Rollins, 2011). It seems to me that the Church’s strict sexual regulations repress sexual energy in a way that exacerbates desire. Because I was told I was an addict and handed an abstinence-only treatment plan, I inevitably slipped between periods of masturbatory abstinence and binge-pornography use that only fed my sexual desire and increased my religious sexual shame. My interest in sex therapy, then, stems from a desire to offer others a more holistic clinical intervention that helps usher people towards sexual wholeness, rather than repression.
Though I am quite passionate about sex therapy, I have found that when people hear the term they often hear it through a myopic lens that makes a variety of inaccurate assumptions about what a sex therapist actually does. The majority of sex therapists are not practicing like ex-Barney actor David Joyner who has unprotected intercourse with his exclusively female clients (Sager, 2018). Therapists with sexological training are legitimate clinicians committed to advocating for the well-being of their clients arguably to a greater, more holistic, extent than therapists without clinical sexology certification. The unfortunate reality is that we live in a pleasure-phobic culture that regulates the terms of desire based on the body politics of the heteropatriarchy. Such a sexual ethic places the power in the hands of men and relegates women to the receiving end of male-centric objectification; all other forms of sexuality are subject to pathologization and/or shame. At its best, sex therapy is a decolonizing practice that undermines erotophobia and advocates for a radically feminist politics where all bodies are afforded the right to pleasure and intimacy.
At the conclusion of today’s webinar 2 members of the Triangle Area Sex Addicts Anonymous fellowship in North Carolina spoke. They discussed their addictions and their sexual sobriety, all of which I found pathologically dehumanizing, not to mention sad and angering for the ways it reminded me of who I was once labeled as. What I am learning is that the (pseudo-)modality of sex addiction treatment looks at behavioral concerns, while often overlooking the systems in place that create the incubation for these sorts of behaviors (Donaghue, 2015). As clinicians and as a society, we need to talk about purity culture, transphobia, relationship issues, and abstinence-only sex education that force underground, compulsive expressions of sexuality. Sex therapists can be, and ought to be, on the frontlines of this work.
Braun-Harvey, D., Vigorito, M. A. (2016). Treating out of control sexual behavior: Rethinking sex addiction. New York, NY: Springer Publishing Company.
Donaghue, C. (2015). Sex outside the lines: Authentic sexuality in a sexually dysfunctional culture. Dallas, TX: BenBella Books, Inc.
Rollins, P. (2011). Insurrection: To believe is human to doubt, divine. New York: NY: Howard Books.
Sager, R. (2018). The guy who played barney the dinosaur now runs a tantric sex business. Vice. Retrieved from https://www.vice.com/en_us/article/zmzgbw/the-guy-who-played-barney-the-dinosaur-now-runs-a-tantric-sex-business
Sellers, T. S. (2017). Sex, God, and the conservative church: Erasing shame from sexual intimacy. New York, NY: Routledge.