Treatment of Sex Addiction: What is a Sex Addiction?
Case Study
Steve is a professional musician. A man in his 50's, virile yet sensitive, he is sexually compulsive around fetishistic sex. Since his early teens, Steve had masturbated nearly every night before going to sleep. As he matured, his need for masturbation increased until he was masturbated five or six times a day. He found that if he did not act on these urges, he would remain "horny" all day, which would make him restless, distracted, and irritable. When asked about his masturbatory fantasies, he related that they centered on feet, stockings, worshiping at the feet of a dominant woman to whom he would avow love, and visiting professional sex workers to whom he would also confess love.
By his mid-twenties, he was routinely acting out on these fantasies. Again, if he did not act out his sexual fantasies, he would become very uncomfortable and would be unable to focus on anything except playing music during the day. When the Internet became available, he started spending multiple hours each day surfing the net, looking for fetishistic images to which he would masturbate. Stating that he was never interested in "fucking real women", he was eager to view websites that featured feet, legs, stockings, heels and dominatrixes.
When he would begin a romantic/sexual relationship with a woman, he would vow to stop acting out with aberrant sex to devote his attention to the girlfriend. He could, however, never bring himself to tell the "real girlfriend" he loved her. Within a few months after he began a relationship, he would lose sexual interest in his partner and the relationship would fall apart.
At some point, he started using telephone sex services. He would enjoy having elaborate fantasy relationships with the workers and would often "fall in love" with one of them. When he had "maxed out" his credit cards, he applied for new ones and then ran them up their limits. He got behind in the rent, and the power company threatened to cut him off unless he paid his bill. Socially isolated, deeply in debt, and about to lose his job, Steve realized his preoccupation with sex was ruining his life, but he felt powerless to change his behavior. Moreover, he was fighting the urge to visit a dominatrix/transvestite which he felt was a significant increase in the level of deviance he required to achieve sexual satisfaction.
He also was beginning to sense that pornography and phone sex no longer excited him as much as they used to. He was tired of having to always increased levels of novelty, excitement and risk that were required to achieve orgasm. At the same time he had met a woman whom he greatly admired, but for whom he had no sexual feelings despite her very real physical attractiveness. When he lost interest in her sexually and episodes of emotional intimacy would provoke anxiety, he began to examine his relationship patterns. Fearful that he was perpetuating his life-long pattern of not being able to be sexual or to have loving feelings for a real woman, he was concerned that yet another relationship would painfully fall apart. This, combined with persistent job jeopardy and chronic debt, propelled him therapy for sex addiction.
Personal History
Steve was the youngest child in the family, with a sister who was five years his senior.
His sister was a bit sadistic, tormenting him with teasing when he began to develop sexually. He relayed an incident wherein he had given an ID bracelet to a girlfriend and his sister confronted him about the missing bracelet at the dinner table which incited fear in him about his projection of his mother's enmeshed and hysterical reaction.
His mother, it seemed, was the stereotypical "Jewish mother." She was adamant that he not see girls who were not Jewish (and most of his girlfriends were not). When starting treatment, Steve relayed that he had a very "loving" relationship with his mother. She would tell him that she loved him "every 10 seconds" and would incur his guilt about abandoning her whenever he made an effort to explore his interest in girls. As treatment proceeded, he began to realize that a fear of engulfment was an underlying factor about his anxiety about true intimacy and was able to connect this to his relationship to a mother who was too insecure to allow him to become his own person. He spent his childhood feeling that he could not retain a sense of himself and still maintain his relationship to mother, whom he put on a pedestal. Unable to risk his mother's emotionally abandoning him, he clocked himself in an armor of a "false self", which was a people-pleasing self. Constantly seeking validation from the outside, sexual approvable and acceptance from sex workers made him feel real, vital and alive. It defined his identity.
