Therapists with Limited Knowledge of Sex Addiction

From Corley & Schneider, 2002.

In our research with couples dealing with sexual addiction, the primary complaint was that the therapist was unfamiliar with sex addiction and that the therapist’s approach prolonged the addict’s denial about the extent of the problem. A therapist who has little or no experience with sex addiction needs to let the couple know this.

Therapists with inadequate knowledge of sex addiction may fall prey to the error of premature diagnosis. When a client presents with a sexual problem, ferreting out its cause may require some detective work. An all-too common therapist mistake is to diagnose without obtaining an adequate sexual history of both the addict and the partner. For example, a client who complains that her husband is not interested in sex with her may indeed be married to someone who has a sexual desire disorder or sexual dysphoric disorder, but alternatively, he may be an active sex addict who is spending hours every night downloading pornography and masturbating. If a client describes her own loss of interest in sex with her husband, she may have sexual anorexia, but alternatively she may be reacting appropriately to living with a spouse who has disclosed that he spends hours masturbating on the computer, and who after 10 years of marriage suddenly wants her to participate in unusual sexual practices with which she is uncomfortable. Therapists need to take the time to ask enough questions to get a full understanding of what is happening in the relationship.

Another type of premature diagnosis is to attribute the cause of any sexual problem to the partner. For example, years ago a woman wrote to Dr. Ruth Westheimer (1987), who had a sex therapy newspaper column, complaining that her husband could hardly wait for her to leave the house so that he could begin watching pornographic videos, and that several times she had returned home early and found him masturbating to a porn movie. Meanwhile, her husband was rarely interested in sex with her. Dr. Ruth’s diagnosis was that the wife was sexually boring, and she recommended the wife work on becoming more exciting sexually by dressing more provocatively and increasing her sexual repertoire and her sexual availability. Another therapist, upon hearing a woman’s complaints about her husband’s interest in pornography, told her that all she needed was a more enlightened attitude about pornography, including joining her husband in viewing the pictures and films. Meanwhile, her husband’s preferred sexual outlet, one he spent engaged in for may hours a week, was masturbating to pornography. The wife had, in the past, agreed to experiment with various sexual activities with her husband, but he was not particularly interested in relational sex (Schneider et al., 1998).

In both of the cases, the underlying problem may have been a compulsive or addictive sexual disorder involving pornography and masturbation. Rather than looking to the partner to change, it is better to obtain a thorough history about addictive or compulsive patterns.

In other cases, the diagnosis may be correct, but the labeling may be premature. Partners are very sensitive to being labeled along with the addict. Labels such as “coaddict” or “codependent”, while they may appropriately describe the partner, rarely are the best path for helping the partner begin to see her part in the couple’s relational dance. After the chaos begins to subside, it is easier for the partner to see that some of her behaviors have contributed to the situation with the couple. Early on, it is preferable that the partner hear those labels at support group meetings from other partners in similar situations.