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.

Therapist to therapy?

Every so often (increasingly so lately) I contemplate whether to seek a therapist and start my own process of psychotherapy, especially the more I talk to my my coworkers about it (one of which told me today that every therapist should/would greatly benefit from having their own therapy). The more questions that flood my mind, however, the longer it takes me to make a decision....

I've been in therapy, but not since I've actually become a therapist myself. I've often wondered what it would be like to be on the other side of proverbial couch/chair, wondered mainly if it would feel any different or better than my experiences as the client throughout my childhood and adolescence. I vaguely remember my mom taking me to see a counselor when I was between 8-10 years old. Looking back, I don't remember what I talked about with the counselor....but I do remember feeling comfortable and emotionally safe in the therapist's office.

I don't think I saw another psychotherapist again until I was in my late teens...a hypnotherapist actually. I think that was a one-time visit...hypnosis to help me work through a traumatic experience from my childhood that was still bothering me. I was skeptical at first, but it was quite powerful and helpful.

There was also family counseling in my teens and a few times in my early 20's, with my parents and stepparents. I absolutely loathed the family counseling sessions. I always felt more angry and frustrated after a family therapy session than I ever did before stepping into the therapist's office. I never felt heard or understood. I was the 'scapegoat.' It was like one big bitchfest, going around in circles arguing with no resolution.

I had my share of shitty therapy experiences (ie, family counseling) and yet instead of turning me off to therapy, it steered me in the direction (ie, MA degree in Marriage and Family Counseling) of wanting to help people with the very issue no one could help me (in an intelligent and compassionate way) during those years. I remember one time a therapist even subtly questioned my sexual orientation simply because I wasn't dating anyone. Really?!

I've always been one (from a very early age) to overanalyze, question everything, reflect, stretch myself to learn/grow and aim for self-awareness...to reach my full potential. Fortunately for my nerdy and curious personality, I've become my own therapist in some ways by reading things or pushing beyond my comfort zone with situations that are conducive to awareness....to change things about myself that are keeping me stuck. Most of the time this has been tremendously beneficial to me. With where I'm at in my life right now though, I wonder if I need more than that.

Not too long ago I asked one of my clients how she would know when she was done with therapy (ie, how would she know that she was better/reached her potential and thus not need therapy anymore). Her response? "When I no longer need to ask a question that I wouldn't ask a friend." There was something I found interesting and true about that response. I find myself contemplating this, yet on the other end....do I need therapy because I have questions that I can't ask (and get insights/solutions from about my problem) a friend? Maybe. Do I have a need to divulge some issues that are troubling me on a regular basis that I can't figure out how to change? Absolutely.

I have made positive changes in myself this year of which I'm proud and confident. A part of me wants to go even further with this possibility of therapy, yet another part of me is hesitant. What if no matter how much self-awareness I have and how much effort I put in to change my men/relationship/heartache challenges....and I'm still in the same boat (single and alone) as I am now?

My biggest concern is disappointment....disappointment that perseverance won't bring me any further to a better place than not trying.

Is it better to try therapy with the possibility of no positive tangible results? Or is it better to keep questioning things and doing the best you can with no help from anyone (ie, no therapist) other than your own self-improvement sensibilities?

Hmmm. Decisions, decisions (says the therapist to herself)....

Working with Polish Clients in therapy

I'm not quite sure why, but over the years I have had a particular intriguing fascination with multicultural issues/aspects of people. I think it's because one's differences seem more interesting than similarities, culturally speaking. Funny enough, I went into a seminar on "Working With the Polish Client" expecting to leave with more clinical insights/techniques geared towards counseling with Polish clientele....and left with no more than when I arrived (in that regard). I did, however, enjoy learning more about the historical roots of Poland and the understandable link between addiction and its people.

Presented by a Polish native, the seminar focused on how the social and political climate (particularly 1793-1918 being the worst, as Poland didn't even exist on the map during this time....territorial wars taking place with everyone wanting a "piece" of Poland) contributed to its inhabitants "adapting" to the stress in escapist ways (drugs and alcohol, especially vodka). In the past I remember wondering why many Poles would make a decision to immigrate to the US, of all countries. With all the deep seated mistrust and hopelessness of communist rule, the speaker pointed out that Polish people tend to admire other countries (like America) who fight for freedom and have a more free economy.

Interestingly, as much as I learned about historical stuff from the seminar, I was surprised to discover I already knew a majority of the things discussed from talking about these very specific cultural issues with one of my Polish clients I have been working with since Dec. 2005. A very interesting and intelligent guy, he has educated ME on his culture....by MY asking him questions. While it's great for clients to learn from me/what I can offer them in counseling, I'm also very humbled to say I learn very valuable things from some of them as well.

Challenging racial tendencies

(Note: The name of the following client has been changed to protect confidentiality)

I just had a very interesting session with one of my clients, the kind of session where I am reminded just how fascinating my job can be at times. I get the opportunity to talk about things with people that in most work situations would be frowned upon, possibly even deemed "politically incorrect." Yes, that's right....I'm talking about race. After my session was over, as I reflected on the discussion I had with one of my favorite clients, I was reminded of another favorite of mine....the phenomenal movie "Crash." A movie that aims to expose the shadowy, dark side of many different races, it also sets the stage for viewers to take a look at their own idiosyncratic prejudices....including taking a look at negative stereotypes perpetuated by one's own race. I won't go into the plot of the movie because if you haven't seen it, you must see for yourself.

What I would like to articulate, however, is the topic of discussion I had with my client. For the sake of making this easier to convey, let's just call my client "Jane." I have been seeing her for two years now. I don't think she even needs a counselor, as she has been clean for as long as I have known her!! A 44 year old strong minded and independent black woman, "Jane" is perhaps my most put together, intelligent, honest, witty, insightful, and articulate clients out of the about 50 clients on my caseload. Sometimes we will talk about what's going on with her work situation, other times it will be about her family relationships, her husband,etc. Whatever it may be, sessions with her always flow very easily and to be honest, I look forward to sessions with her! My coworker Carol and I joke off and on that if all our clients were like "Jane," our jobs would be so easy. Hahaha. Anyway, just giving a little background info on her and our rapport to set the scenario for what I'm about to describe as our discussion.

Somehow, and I'm trying to remember how this came up (this tends to happen...I usually can't remember how topics are broached...just happens with my magical therapist-like powers to get others to open up I guess...hahaha!) she brought up things she doesn't like about her race. She mentioned how she had once watched comedian Bernie Mac's standup show in which he talked about stereotypes of African Americans, which Jane listed aloud as she spoke to me: "that they can be lazy, will show up for a job at whatever time they want to, and that they don't seem to take care each other as a race." She told me that she tended to agree with him, based on experiences she has had. I questioned my client on the generalizations, challenging her perspective on her experiences...."Maybe it was just a particular person's personality, not really a race issue" I suggested. But Jane gave me a handful of examples to back up her belief that her race is "divided." She tells me one time when she got on the bus, a black male driver was very friendly and overly talkative with a white well-to-do Gucci bag carrying female in front of her. When Jane gave a cheery "Hello" to the driver too, however, according to my client, his demeanor changed to that of abrupt unfriendliness. Another example involved Jane going to McDonald's to get something to eat. She described being in line amongst 2 or 3 other people that were white and/or hispanic. Jane went to order with the young, black woman behind the counter, who Jane adamantally says saw Jane and overlooked her to take the order for the person after her. It also extends to Jane's experiences at work, where she has observed her black coworkers clocking in/returning from their break whenever they want to.

I looked quizzically at Jane, as it was clear to me that surely it wasn't anything she could have possibly been doing in all these scenarios (if you recall how I described her earlier: sociable, kind, intelligent,etc) to repeatedly keep experiencing such things. I asked her "If this is true, as you believe it to be (in your experience), why do you think your race doesn't want to help each other/take care of one another....a fear of success?" Jane wasn't entirely sure, though she did wonder whether children who grow up in ghettos really know much better/different if it's all they have experienced in their reality. Her bringing up the topic brought me to ask her something I had been pondering when I stumbled across a segment on "60 Minutes" Sunday night. It's rare that I will talk about things I have seen, read, watched,etc with my clients, but if I feel it is relevant to a session I am having with a client, once in awhile, I will add my own thoughts and observations on something. I told Jane that she brought up an interesting theory, though I wondered what she would think about this, as it seemed opposite of what I saw on the "60 Minutes" segment. Anderson Cooper was interviewing a few different people regarding why it is that hip hop/rap artists will not cooperate with police in capturing someone the artist may know have killed another musician in the industry, such as the late TuPac or Notorious BIG. He had asked one rapper (I can't remember the guy's name) that if he knew a serial killer was living next door to him, would he then be inclined to talk with police? The rapper said he would probably move, but would not go so far as to be a "snitch." I couldn't quite wrap my head around it and curiously asked Jane what she thought about that. Jane seemed to believe the hip hop/rap artists are just "covering their own ass" and that while they put on a tough front, are in actuality afraid someone will come after/kill them if they were to tell police, especially since they are more vulnerable targets as celebrities/performing concerts in public forums,etc. I thought it made sense, when Jane framed it that way. While race issues are definitely prevalent in society, when it comes to fears, vulnerabilities, and protecting oneself, we are all simply of the human race in that department.

After Jane left my office nearly an hour later, I thought about how refreshingly open and honest it was talking with her. I'm not sure whether her feelings and experiences on relations with her race will become more positive for her in the future, but what I do appreciate is the fact that a middle aged black woman and a young white woman can have such an open-minded discussion in a society where the media likes to sensationalize prejudice BETWEEN races. Maybe what makes us different on the outside has a powerful way of reminding us how much we are actually alike on the inside. It just goes to show that when you think you really know something, you really know nothing...and that is the greatest lesson to be learned.