Sexual compulsion and the internet

As a mental health therapist working in the community mental health system, I'm constantly challenged by a myriad of presenting problems clients would like to work on in therapy. While I've been working in the field of co-occurring disorders (ie, addiction and mental health) since 2005, there are certain disorders I'm very skilled in and others I have very little knowledge or experience to draw from.

I'd venture to guess that an individual presenting to therapy is confident that their therapist can help them tackle any and all presenting clinical problems. Unfortunately, this is not always realistically possible. Sometimes the problem is totally out of the scope of a clinician's educational or professional competence. In these instances, referral to a more appropriate professional specialist is warranted. In a majority of cases, however, it is important for clinicians to take the initiative to seek either (or both) supervision, case consultation with trusted colleagues, and self-motivated professional development via continuing education classes/workshops or reading professional literature on the particular subject.

With that said, I was recently presented with a case involving compulsive masturbation and addictive online sexual behavior. I found myself (internally) floundering within this extremely sexually revelatory session with my client....not out of discomfort of the subject matter being discussed, but out of not knowing how to specifically help someone with this particular issue. Especially given how vulnerable my client felt telling me and wanting the client to continue feeling confident or courageous enough to proceed with treatment.

I found myself both intimidated and intrigued by this newfound clinical challenge, that of sex/cybersex addiction. Immediately and somewhat ironically, I searched various sites online for well-written and highly rated professional books on the topic. Much to my surprise, it was a disappointing and difficult search. While there are a plethora of books promoting "healthy" sexuality and how to explore one's sexuality in healthy/safe ways, books on sexual addiction are few and far between. The book I ended up getting wasn't even one I thought would be very helpful, but it ended up being decent.

"In the Shadows of the Net" by Carnes, Delmonico, and Griffin explores and analyzes the dangerous allure of the Internet on one's sexual proclivities, especially given the technologically dependent society we live in. Although certainly not to be used by any means as an excuse to act out compulsive sexual behaviors, the availability of sexual content and ease of anonymity online makes it that much easier for an individual to get sucked into a downward spiral of unhealthy and unmanageable sexual behavior. Chapters in this book include identifying problematic behavior ("Do I Have a Problem with Cybersex? and "Understanding Problematic Sexual Behavior on the Internet"), analyzing sexual arousal and intimacy ("What Turns You On? The Arousal Template" and "Courtship Gone Awry"), and how to change/recover from sexually addictive behaviors ("Boundaries," "Taking That First Step," "Changing the Way You Live," "Preventing Relapse: Maintaining the Changes You've Made," and "Family Dynamics and Cybersex"). I found "Understanding Problematic Sexual Behaviors on the Internet," "What Turns You On?," "Courtship Gone Awry," and "Boundaries" to be most helpful.

Upon reading the second half of the book, I realized recovery for sex addiction is very similar to alcohol and drug addiction. The author posits that there is a stronger propensity for relapse with sexual addiction than other addictions. Not sure I agree with that, though the relapse prevention model is very much akin to those used in alcohol/drug recovery programs and seeing that made me feel more confident in my professional capabilities to help a client seeking recovery for sexual addiction. I might even take it one step further and pursue a training to become a Certified Sex Addiction Therapist.

Who can say their work is never boring or that they're always learning more about the human condition?

Therapists.

The stigma of (not drinking) alcohol

How often do you drink alcohol? Daily, weekly, a few times a month, a few times a year, not at all? When you drink, how much do you consume? Is there a pattern to your drinking (ie, have a beer or glass of wine to "relax" after work, go for a night on the town with friends, partying till all hours of the early morning, special occasions,etc.)? How many years have you been drinking? Can you remember what your life was like before you first drank alcohol? Can you imagine what your life would be like without it? Do you feel (or act) differently when you drink than when you're sober? These are but a few questions I asked myself recently.

In recent months, I have become increasingly aware of how frequently alcohol and drug addiction is mentioned in the media. Of course, I realize that the media is built upon the idea of sensationalism (the nice word for "drama" if you will), as well as exploitation...but given how working with addicts has been a large part of my professional career the last five years, it is very real and very accurate. In fact, I would go so far as to say it's even more rampant than what we even see in the media...but I digress.

Coupled with the aforementioned questions that have run through my head, I also had a growing awareness that alcohol is everywhere. If people aren't drinking, they surely will be soon. They talk about looking forward to drinking. They joke about needing a drink. They talk about how much they drank last night or last week, and with whom. They plan happy hours. They bar hop. They talk about their favorite alcoholic beverage. They mention alcohol as a reward for having to endure something crappy or stressful that's going on. They use it as a social lubricant, to feel that somehow they are more confident, fun, and interesting than they are sober. They are consumed by it and god forbid the response you get when you challenge this mindset by stepping outside the norm. Stigma for drinking? Think again. Stigma for NOT drinking: Katie's social experiment.

It has been 30 days so far that I have abstained from alcohol. Go ahead, ask "Why?!?!" with a very frantic, disturbed look on your face. This is the typical reaction. It's funny (ironic, not haha); I've had clients who struggle with addiction and/or are in recovery who have told me negative experiences they have had in regard to not feeling supported in their recovery as far as others not respecting their sobriety or even sabotaging their sobriety by offering them alcohol,or ridiculing their sober efforts, etc. A part of me wondered if they were full of it, like they were just making up some excuse as to why they relapsed....but now I'm seeing a different perspective. There's something about alcohol (because it's such a mainstream socialization behavior?) that really provokes a reaction in people. I'm not even bringing the topic of religion into the picture, because that carries its own separate factors that aren't relevant to what I'm discussing here. What I'm talking about is a sociological epidemic. There seems to be a stigma against NOT choosing to imbibe.

You tell someone you're on a diet, so you're not eating cookies or carbs. End of story. People generally understand and respect your efforts to exercise willpower, work on being healthier, etc. That's usually the end of it; there's no Spanish Inquisition around your decision and most people wouldn't judge you as being weird/abnormal for not devouring an Oreo's cookie with them. You tell someone you aren't drinking for awhile (note: I didn't even say completely, just for an unspecified length of time) and there's that strange look, followed by jokes like "What, are you in recovery?" or "Well, what do you do for fun then?" (followed by laughter). And of course there's the peer pressure with justifications attached. "What about if you just have (such and such a drink)? It only has such and such amount of calories..."

A little about me for anyone in cyberworld that might be reading this that doesn't know me personally:
1. I'm not in recovery/an alcoholic (but I'm beginning to empathize with how my clients must feel...that there is some truth to what they have shared with me about relapse issues in social environments)
2. I'm pretty damn fun sober (if I do confidently say so myself!) and don't "need" alcohol to enjoy my own company or the company of others.
3. I'm not doing this for religious or puritanical reasons (here I told myself I was going to stay away from bringing religion into the mix of this blog!), so no...I haven't given up alcohol for Lent or anything like that.
4. I don't need the mask of alcohol to have social relationships. Frankly, as I grow older I'm growing tired of that world/culture. I want meaningfulness with people and when alcohol is involved, many times I question how "real" my interaction is with someone. Is it deep or is it superficial? Is it all an illusion? I'm pretty sure you know what I mean. The conversations you had or the chemistry you felt while drinking with someone. Was it real or just "beer goggles", I or they were too drunk to know/care/remember? Would I have had these same interactions sober? Would they with me?

If alcohol represents the primary cultural mechanism in which we express our identity and carry ourselves in social situations, what does this really reflect about ourselves as a society? And as separate individuals that comprise that collective whole?

I'm not sure how long I will continue my non-drinking stint, but it has been an eye-opening experience. Responses from people have been more challenging to face than the actual substance itself. It's just that powerful. An addicted nation?