| CARMEN: 00:07 | Hi, everyone. I am Noelle Carmen. On behalf of Niznik Behavioral Health, I want to welcome you all to our discussion on sex and love addiction. Before we get started, let’s take care of a little bit of housekeeping. This is a very dense topic we’re about to approach, so I will try my best to save time at the end for Q&A. Go ahead and ask your questions as we go. And I, again, I’ll attempt to get to them at the end. If not, you are free to email all of your questions that we didn’t get to. Another bit of information, also tomorrow, all participants will receive an email to the address that they use to register, containing their CE certificate, and a link to satisfaction survey. And we would really appreciate your time. Just take a moment to share your feedback. If you loved it, we want to know. If you want changes or you have a topic suggestion, tell us. Our goal definitely is to continue to improve our webinars to serve your needs as clinicians. Okay. That was our housekeeping. Now, it’s time to start the actual conversation. So today, I’m so honored to introduce our panelists. We have with us Ava Profota. She is the founder and clinical director of Inner Loop Counseling in Houston, Texas. We have, soon she will be on, she will pop on. She’s having some technical difficulties, but I’m going to introduce her, anyway. Jennifer Josey, the founder and director of Clinical Pathway. She specializes in trauma, healing for families and couples who struggle with sexual addiction. Damon Dranda – oh, I’m going to say this correctly – Drandakis? Did I say that right, Damon? |
| DRANDAKIS: 01:53 | Drandakis. |
| CARMEN: 01:53 | Drandakis. My apologies. A therapist out of Pennsylvania, who specializes in substance abuse and sex addiction. And Kelli Jeray, a primary therapist at Discovery Point Retreat. Her expertise is in trauma as it relates to substance abuse. So welcome, everyone. We’ve got the introductions out of the way. So let’s just jump right into the conversation. Ava, can you go ahead and just give us an overview of sex and love addiction, so we can just start with some general definitions together? |
| PROFOTA: 02:28 | Okay. So sex and love addiction is a group of intimacy disorders that are all sort of intertwined. And the both of them are related to dysfunctional attachments and trauma around primary caregivers. So another piece I wanted to say about that was according to Pia Mellody, who’s like the grandmother of love addiction and love avoidance, that love addiction is caused by abandonment and neglect trauma, love avoidance is caused by neglect from the child’s sexual preference. So, for example, for myself as a heterosexual female, that would be my relationship with my father. For a lesbian woman, that would be the relationship with her mother. So that can at least get people sort of thinking about what that is. And a love avoidant is created by a parent who’s very enmeshing. A parent who’s very neglectful creates the love addict. Just to make that clear. So, now, sex addiction doesn’t have a really clear ideology around those kinds of things. But there’s a lot of thinking about when there’s a lack of physical nurturing in the family So a family that’s pretty disconnected, that is likely to create the child attempting to give themselves physical nurturing. And what I always say is eventually they’re going to find this or that down there. So once they start touching those places, they can be two years old or three years old. And it’s much more pleasurable to feel that part of the body than it is to feel any other part of the body. And so that very young child realizes this is a way that I can self soothe or nurture myself because the brain requires a lot of stimulation of all five senses. But primarily when it comes to self-soothing, there needs to be an intense amount of physical nurturing by the parent for the child to not start to explore areas of their body that are usually not explored until the child is 11, 12, 13 years old. I can say more about that, but I would like for Damon to step in if you have some more to share about that, Damon. |
| DRANDAKIS: 05:22 | Yes, specifically looking at sex and love addicts, one of the things I found with this population is that the– at least the male heterosexuals that I worked with that were also love addicts, they used sex addiction as a way to anesthetize their pain at what wasn’t happening in their primary relationship. So essentially, they’re in the numbing neuro pathway, compulsive masturbation, seeking out other partners because they’re not getting enough of what they need in the primary relationship. And that primary relationship, because they’re so needy is that partner’s not capable of meeting all those needs. And that’s one of the things that we have to do is get this population back to reality. |
| CARMEN: 06:14 | So let’s talk about why we’re mixing these words, sex and love when we’re talking about this addiction because there’s a lot of definitions flying around about that. So why these two particular words and why are we mixing them? |
| PROFOTA: 06:37 | So what my thoughts are about that is love and lust are so intertwined because when a person is attracted romantically to a partner, they’re going to experience some arousal at some point. And there are a lot of sex addicts that will contend that they are love addicts as opposed to sex addicts because it sounds better to them and they don’t want that label of sex addict. And then there are the sex addicts who call themselves porn addicts as opposed to sex addicts when their behavior with pornography is synonymous with addictive sexual behavior. |
| CARMEN: 07:24 | So paint the picture for us in a more granular kind of way. So what are your kind of case studies or typical behaviors that you see as you see these clients coming in so that we as clinicians can have just a more boots-on-the-ground understanding of what this looks like? |
| PROFOTA: 07:47 | So let me go down to the next point and just talking more about what happens for the addict who has lost their control so if you think about the criteria for chemical dependence, it’s really similar, except there’s loss of control. But it looks a little bit different. So the quantity of sex– the quality of sex is not the issue. What it is is that the addict has lost control. For example, they try to stop masturbation, or it’s kind of like the alcoholic who says, “I’m only going to drink beer.” And so what happens with that is they’re trying to control many different parts of their life, thinking that that’s going to stop. For example, a lot of sex addicts will get married and they think that’s going to solve the problem, but it doesn’t. So if a client is repeating a behavior that they’ve tried again and again and again to stop, loss of control. If they’ve tried to stop everything and they’re unsuccessful with either the whole thing or little pieces of it, then definitely loss of control. |
| PROFOTA: 09:07 | Another one would be a preoccupation like we think about with the alcoholic who’s always thinking about their next drink or the cocaine addict who, when they think about cocaine or they get $20 in their hand, their palm starts to sweat. So for a sex addict, what that looks like is a lot of time spent on obtaining sex, actually being in the act, and then a longer period of time than they had intended and trying to control that by either trying not to think about it, but they can’t stop. |
| PROFOTA: 09:49 | And then preoccupation with preparing, for example, I am a recovering sex and love addict and there was a huge ritual for me. My ritual was that I would have a drink, get dressed, spent hours on makeup, maybe dress several times, things like that, to go out, not to specifically have sex, but just to go out and some other person attracted by– some other persons attracted to my appearance. And so how often they engage, if they’re trying to, say, only have sex once a week or only have sex two or three times a week, and they can’t achieve that, another sign of loss of control. And one of the things we ask them is, have you stopped being social, or have you stopped having hobbies or doing social things? And some of them will say no. And then I’ll say, what are your hobbies? And their hobby is sex and love addiction. And that’s not a hobby. So they don’t understand what they are looking at. And Damon, do you have more to add to that? |
| DRANDAKIS: 11:08 | Well, just the preoccupation for clinicians to understand that the sex and love addict is going to spend an inordinate amount of hours in preoccupation and ritualization because they’re in the fantasy, and so they’re high while they’re in the fantasy. And that’s also going to involve maybe love music and the sexting, texting that’s going on with somebody that they’re trying to seduce, right? So they can spend 16 hours a day in fantasy. I’ve had addicts that come in and they’re like they spend almost the whole day. They’re losing sleep over this. So it’s beyond what most people can really comprehend. And that’s why when you’re talking with them like these things, their prefrontal cortex is not working, and they’re in la-la land, to put it mildly. |
| CARMEN: 12:08 | So it sounds like there’s this whole running away from reality and really hiding away from any kind of here and now, and that all of these rituals– so are you saying that it isn’t necessarily about the sex? Because Ava, you said it’s not really about the quantity, it’s not about the quality. Are you saying that it’s about all of these rituals and this fantasy and this hiding away kind of behavior? |
| PROFOTA: 12:41 | It’s about changing the way I feel and also, having just intense preoccupation about sex and maybe trying to force a partner to have sex when they don’t want to, feeling rejected by the partner when the partner refuses to have sex, or just says no in a kind way. And they may take that as, “Oh, you don’t love me because you won’t have sex with me.” And sex addicts and sex and love addicts have sex and love totally confused. They also have sex and love and intensity confused. For the sex addict, they want a lot of intensity around sex. They want to feel really in love and really intense sexual experience. |
| CARMEN: 13:30 | So how do you juxtapose that to what we would normally call a relationship, or love, where you have highs and lows, you have days where you’re not really engaged with your partner? Are you saying that their expectation is always to maintain this high intensity? |
| PROFOTA: 13:50 | Yes, they are trying to figure out a way to not feel. And so for a numbing neural pathway person, they’re going to use compulsive masturbation because that’s very numbing. There’s not much intensity there. If they are what we call an arousal high template, then they’re going to want to have very, very intense sex. And whereas the numbing sex addict may have just a desire to do more masturbation, and they may also use food, which is very numbing. They may do– I’m trying to think what are some of the other things. |
| DRANDAKIS: 14:34 | Work addiction. |
| PROFOTA: 14:33 | What is it? |
| DRANDAKIS: 14:34 | Work addiction. |
| PROFOTA: 14:35 | Work addiction. Yeah. Work addiction. |
| DRANDAKIS: 14:37 | Compulsive exercise. |
| PROFOTA: 14:38 | And depending on the job, it could be a numbing arousal, a numbing template, or it could be an arousal template. For example, if you’re doing a $3 billion dollar deal and you’re a work addict, then you’re probably going to use that as a way to experience high intensity. If you have a job that’s very boring, then you’ll do more work because you choose the numbing pathway. That really has to do with their experiences in childhood as well, whether they have the numbing or the arousal template. |
| CARMEN: 15:13 | Kelly, how does this jive with you when you’re looking at substance abuse? And, Damon, Ava, feel free to jump in as well. So as we’re talking about these topics, we’re talking about numbing and, of course, substance abuse plays right into that kind of behavior. Can you kind of marry those subjects for us just a little bit? |
| KELLY: 15:33 | Yes, I agree with what Ava said is that they’re very similar, although their personalities kind of look different. Basically, we’re escaping reality in some form. We want to feel okay in our skin because we don’t feel okay, the way we are. I don’t know, but maybe Ava may know better. But to me, the differences are in drug and alcohol addiction, I think there’s a bigger physical consequence with the exception of sex addiction, where you could be hurting yourself too much or you’re not having safe sex. But the idea of– I don’t know if that’s correct or not. But to me, there’s a little difference there. When I’ve dealt with clients, it takes them a long time to talk to me that they actually have sex addiction. They’ll tell me about their alcohol or drug addiction, but it’s really difficult. The shame is such a big deal, just like suicide. We’ve done a better job at communicating and being more open about suicide. But I think sex addiction carries a great deal of shame even more than drug and alcohol addiction, which we know that’s very shameful as well. I’ve known one sex addict that was kind of both love addict and sex addict. That person really was looking for acceptance. “I just want to belong. This is what I think love is.” And then I’ve known one that literally just wants to have sex. And this client told me, “I had sex with an older woman who was completely unattractive, but I didn’t care. I just needed to have sex.” I did not find this client trying to find loving relationships, or it looked different. And maybe Ava can better explain that because that was very different than some other sex addicts that were also combining love addiction. And so they come here, and they no longer can self-medicate. And we’re coed or whatever. You know what I mean. We’re finding out. Plus, we have cameras everywhere, but they don’t care. This is now coming to the surface. |
| KELLY: 18:01 | So maybe Ava can better give a difference with that type of sex addiction where they’re literally looking to feel good all the time, just like taking a drug and then sex addiction more coinciding with love addiction. Maybe you could explain that difference. |
| PROFOTA: 18:20 | Yeah, I think that’s a really good question. But I’d like to say that Jennifer’s on, and I’m wondering if we can introduce her. Let her introduce herself. |
| CARMEN: 18:32 | Jennifer, are you here? I don’t see you. |
| JOSEY: 18:34 | I am here. I don’t know. I don’t know where my picture is, though. |
| CARMEN: 18:41 | Yes. Jennifer, so welcome to the conversation. Maybe Ana can get your picture up. |
| PROFOTA: 18:51 | I see it. |
| CARMEN: 18:52 | You’re a mystery person to me right now. |
| JOSEY: 18:55 | Can you see it? |
| KELLY: 18:55 | I see it. |
| PROFOTA: 18:57 | I see her. |
| CARMEN: 18:59 | Okay, well, good. I actually don’t need to see you to continue the conversation. So I do think that getting back to this– so, we as clinicians, isn’t that a big mess in terms of having clients coming in with other addiction and then not knowing for a while that sexual addiction is really a big part? There you are. Hi. Hi, Jennifer. That sexual addiction is really a big part of this person that you’re treating. So can you also jump into these red flags as clinicians because, if we’re missing that, we’re missing a tremendous piece of the treatment process? |
| PROFOTA: 19:43 | So what you want to do is screen them for, “Are you using pornography?” That’s a good place to start. “Have you had sex outside your primary relationship?” Things like that. I wanted to say, Kelly, that the person you talked about that was only interested in sex, that is most likely what we call a severe avoidant and that comes from, usually, mother enmeshed male or mother enmeshed female, and I’m going to let Damon talk about mother enmeshed men. That is his specialty. |
| DRANDAKIS: 20:20 | Well, the mother enmeshed guy doesn’t know who he is, and as a result of losing his own life, dreams, and things of this nature, he’s entitled to act out sexually to get something back because unconsciously he’s angry at his mother and so he — |
| CARMEN: 20:45 | I didn’t mean to interrupt you, but I want to back up because this is fascinating. Talk to us about the formative stuff around this, because for us to jump to, “He’s really mad at his mom, so he’s acting out,” can you give us a broader perspective of what it is you’re actually talking about? |
| DRANDAKIS: 21:01 | Well, when you look at a young boy growing up, right, if the father is not present so this boy, as he’s growing up, if you think of it in terms of energy flow, right, mom and dad are supposed to be nurturing this young boy and instead, this boy is nurturing mom. And so he’s losing something. He’s losing energy. He’s also losing some of his masculinity. So he’s trying to get it back with all these women that he’s acting out with. And he’s not a happy person. Deep down inside, he’s angry, but a lot of times he’s out of touch. There’s a lot of displaced anger and there’ll be affairs if he’s married because he’s unconsciously married to his mother. This comes from the work of Ken Adams and since he’s unconsciously married to his mother, he can’t be 100% intimate and vulnerable with his wife. And so what does he do? He may have erectile dysfunction problems with his wife, but he can have sex with strangers. |
| CARMEN: 22:04 | Is this similar to – Ava, Jennifer, jump in on this – the enabler. So if we’re talking about a male who is taking care of his mother, who feels responsible for his mother, how is this juxtaposed to how we normally see someone who enables another person. The enabler takes care of that person, protects that person? Are these all comparable in that sense? Anyone jump in. |
| JOSEY: 22:37 | I think that they are very similar. The mother enmeshed man is enabling their mother. They’re meeting their mother’s needs over their own, and so as they were growing up, they became emasculated. I think, Damon already mentioned that and they’ve lost all their power. They’ve lost all their identity. So over time, as they’re growing up and are adults, their identity is usually completely wrapped up in their mother. So they are enabling, essentially. |
| CARMEN: 23:14 | Right. So then how does this look on the female side? So we talk about the male side of things and kind of generally what you see. Talk to us about women also in this addiction. |
| PROFOTA: 23:27 | So are you talking about the partner of the person who has sex addiction or–? |
| CARMEN: 23:33 | No, I’m I’m talking about– so we’re talking about this enmeshment with mom for the male. What does that look like on the female side for a woman who also struggles with this addiction? |
| PROFOTA: 23:46 | She is going to be enmeshed by her father, generally. So I have a few things I want to add to that. Let me take a look at my cases. So primarily what I see in females is that they’ve had a mother who was not very attentive to their needs, but expected the child to be very attentive to their needs. And that’s a huge burden on a child. A child cannot be emotional support or even physical support for a mom without having tremendous amounts of trauma that are caused in that. Now, a daughter may feel like she’s precious to mom if, let’s say, a lesbian female, that she is very special to mom and feel like she has been given a lot of opportunities to do grown-up things. And what does any kid want? They want to be a grown-up. And so they like it while they’re in their childhood. But after a while, in later childhood and early adulthood, they feel extremely burdened by that mother. And so either the male or the female may feel like they’ve been the hero child in the family, and they could be enmeshed by both parents. And for the woman who said heterosexual, she’s probably been enmeshed by her father. And so she feels like the only thing that she’s good for is taking care of people who are needy. And she extends that to her romantic relationships. And so any male that she sees that she thinks is less capable, less than, needs help, needs financial assistance, or just needs general social skill, she’s going to pick that kid up and start mothering the spouse or the partner. And the partner sometimes wants to be mothered and taken care of because they don’t feel like they’re capable. But a lot of times it’s someone who feels pretty secure in themselves. But when this partner starts working with her spouse, she is going to overwhelm the partner and he is going to feel emasculated. He’s going to feel like she’s controlling him. And his escape, again, is going to be to escape into a whole different world. And that world is going to be so secret that she has no idea that that’s what’s going on. The partners of the addicts rarely know that there’s anything going on with their addicted spouse. They are shocked when they found out about this. They’re in tense trauma. So I think it’s really important to note that you cannot treat a partner of someone with sex addiction the same way you treat the co-dependent of a chemical addict. |
| CARMEN: 26:59 | What is the prognosis for these relationships? As someone’s in treatment versus in active addiction, they’re in treatment, and you bring the partner in, is your goal as a clinician to bring this relationship back together? How do you process that, especially with a partner who now feels incredibly surprised and betrayed? |
| KELLY: 27:30 | I know when I work with couples, is that I make it clear my goal is not to make your marriage work or not work. I feel like that’s an end result that we don’t worry about. What my goal is, is to address them as individuals and see how they’re affecting each other. Now, that’s in couples therapy. I don’t know if you’re working with sex addiction. I would be working with them individually and then bringing in the partner. But I don’t know what else other people do. |
| CARMEN: 28:03 | Jennifer, this is your specialty, is it not? |
| JOSEY: 28:09 | Yes, it is. Can you repeat the question? I got a little distracted. I’m sorry. Do you mind? |
| CARMEN: 28:15 | Man, I used a lot of words. You make me go back and remember all those words. |
| JOSEY: 28:19 | Oh, my gosh. I’m sorry. |
| CARMEN: 28:21 | No. It’s definitely okay. I think I was really just talking about the prognosis of bringing in a couple. And as Evan mentioned the partners totally surprised. And so not only just the shock of it, but then the damage to this relationship, like what is your goal as a clinician as you bring people in? Is it Kelly mentioned where you’re not worried about the end goal, you’re worrying to see if we can kind of begin to communicate, to see what a healthy relationship might look like on the other end. What’s your take on that? |
| JOSEY: 28:58 | Well, I typically say that relapse usually happens, I think, like 80, 85 percent, so it’s a pretty high relapse rate. But that doesn’t mean that the relationship in the end won’t survive. I mean, Ava also has these numbers that in our long-term years of practice what I think Ava is like one percent out of like 15 years or something in private practice of no divorces. So the prognosis is really good, even if there are some relapses. But the thing is, at least in my professional opinion, is that they really have to, one, have the commitment and the dedication to their health and to healing and also, dedication to their partner and committed there, so it’s a pretty high relapse rate, but again, that doesn’t mean it’s not going to work out. It’s a pretty good chance. |
| CARMEN: 30:04 | Okay. Let’s talk diagnostic tools. Let’s talk clinical here. In terms of I’m a clinician, I have recognized sexual addiction is part of this or I need to recognize that. Talk us through what you as clinicians do to begin to diagnose and approach. |
| JOSEY: 30:27 | Typically, what we use is a reliable, validated research base assessment tool, which is called the Sexual Dependency Inventory. That’s usually extremely effective. Also, we use a short screening tool called the Sexual Addiction Screening Test that’s on the IITAP website. I think it’s iitap.com for anyone to use, but it is not diagnostic. So if a therapist uses the tool with a client to be aware that the active sex addict is mostly unaware of their behavior because their prefrontal cortex goes completely offline after the second or third time that they have watched pornography. So their ability to be objective in evaluating their sexual behavior is about 10% of the non-sex addict. |
| CARMEN: 31:25 | So that is fascinating. And, Kelly, maybe you could speak to that. If we are comparing substance use where many of those struggling with substance abuse recognize they knew it all along. Oftentimes, I talk to them. They’re like, “Yeah, I knew.” Are you saying that those that struggle with sexual addiction very much don’t understand that they are? |
| KELLY: 31:49 | I think in some cases, yes. In chemical substance addiction, I do get clients are still ambivalent. They’re being forced here due to legal motivation, family conflict motivation, or they think they’ve got a bit of a problem and “maybe just a little bit of detoxing will work, but I’m pretty sure I can drink beer on the weekends.” So I really look at the ambivalence. I like to measure where that’s at, and is it improving? And the same thing would go for sex addiction. I agree that, if we’ve been doing something for so long, it’s been a way of life, we’ve also gotten really good at pushing it down and creating more denial. And that’s just a real thing. And with the shame that goes behind it– “you’re talking to me. You’ve never met me.” And for you to even be aware of that, I think is very difficult. I think it’s our job to ask the right questions or to get them to a place of, “Wow. This really is hurting me. This really isn’t making me happy in the long run. Actually, it’s going against my entire value system because I do love my family. I do love my partner.” And that just takes time, I think, therapy to get them to the forefront of what’s going on. |
| CARMEN: 33:17 | Anyone else want to jump in on this? |
| PROFOTA: 33:19 | Yeah. I want to say that, Kelly, you are so right. When they have so much denial about their behavior, they may actually sort of know it in the back of their head, but they can’t see it. When you ask the question, “Have you struggled with repeated attempts to stop your behavior sexually?” They’ll go, “No.” And then I’ll ask another question. Ask in a different way, and they’ll go, “Oh. Well, yeah, I guess so.” So when I get the SDI back that Jennifer talked about, the sexual dependence inventory, I go over the primary criteria. And they’re 10 of them. And so they will have ticked 1 or 2, but left out the other 8. So we go over them, and I’ll ask in a different way, and they’ll go, “Oh. Yeah. I guess that’s true.” And so usually when I go back, instead of 2, they end up with 9 or 10 criteria that they actually agree is true for them. |
| CARMEN: 34:18 | So are you saying that you typically see people for other reasons? I just want to make sure that I’m understanding. And then, after these assessments, you’re like, “And by the way, you are struggling with sex addiction. We need to address this.” Is that what you’re saying? |
| PROFOTA: 34:36 | So what I’m saying is, on my assessment form, when I do the initial session with them, I ask them about chemical dependence, sex addiction, food, masturbation, pornography, trauma. All of those different things. Because all of our clients have multiple, multiple incidences of trauma in childhood. And also some of them have so much trauma that they think it’s normal. And they’ll tell you they had a wonderful household when they were growing up. And that’s as far from the truth as you can get without being off the planet. |
| CARMEN: 35:22 | Let’s jump into something you all have mentioned, which is fascinating. Let’s talk about the subject of pornography. Because there are a lot of ideas about pornography. Does it denigrate women? Does it not? If women use it, that’s their choice. How do we begin to look at pornography as clinicians to say– like, do any of you think there’s any healthy usage of pornography? Or is it– I mean, are we saying ixnay on the pornography, or? Talk to us about that. I think there’s a lot of mystery about this topic. |
| PROFOTA: 36:02 | So I’ll say something really quick, and then I’m going to let everybody else talk about it the pornography that’s on the internet today is not like the pornography that was on the internet 10 years ago, 15 years ago. It is extremely offensive toward women. There’s a lot of sex trafficking that occurs for these people to get there. And all of the credit card companies will say, “You need to put the woman on the camera and she has to say, ‘I want to do this'” before they’ll reimburse for that pornography. And so they’re all forced to stand there and say, “I really like this and I want to do this” when that’s not true. |
| CARMEN: 36:46 | So consent is not part of this industry, is that what you’re saying? Anybody else want to jump in on this? |
| PROFOTA: 36:53 | Oh, and it’s like crack cocaine because of the profound super stimulus that it is. |
| DRANDAKIS: 37:01 | Yeah. Well, also, I don’t want to lose sight of the porn-induced erectile dysfunction. That’s a huge problem that– it’s so intense that a human body live can’t compete with what they’re seeing on their screen. The other thing, going back to the sexual dependency inventory, this thing is like the George Jetson mobile that he flew around and– right? It’s like a shield. When you’re having conversations with these sex addicts, it’s like throwing a basketball at him. It just bounces off. So their insight into what they’ve done and everything is just so– they’re so off line that they need to be sober at least 15 days just to start seeing a human being in front of you. And if you gave them the same test six months later, their scores will be completely different, like double what they scored. They’ll be like, “I can’t believe I answered that question that way” because this thing is so gone. |
| CARMEN: 38:00 | You use the word sober, which is fascinating to me, under the– as we’re talking about sex addiction. Jennifer, can you speak to that a little bit? I mean, that is striking that you’re using the word sober and you’re saying clients didn’t even know what they were doing. Are you saying that, chemically, the brain is so off just naturally in terms of this addiction that we’re talking about sobriety? |
| JOSEY: 38:33 | Yeah. So that’s a great question, by the way. So, as Ava mentioned earlier, when the child is younger and they have a certain– they have a super rigid family or they have a very disengaged family or a mesh system, they begin to look for ways to escape the pain, the fear of what they’re experiencing. And so over time, they’ll end up looking to addictions. And typically, masturbation for someone that’s younger– I mean, usually they start it early is what I mean, like 11, 12, 13, 14, and so and that tends to be problematic. And so over time, though, what happens is they keep using the addiction over and over to numb out to where they aren’t able to have present relationships. And also, it’s because as they were growing up and they were numbing out, say they used pornography even earlier, they also didn’t learn how to have a healthy relationship or healthy intimacy with someone. I mean emotional intimacy. I’m not necessarily even talking sexual. And so that’s what I think of when you asked me that question. |
| CARMEN: 40:05 | So as we’re talking– so let’s talk about formative years just for a moment, because how does a kid, right–? You got two kids growing up in the same environment and having a proclivity for this addiction and one doesn’t. What are some of the triggers that we’re talking about here? Why? Is this a genetic inclination? How do you parse that out, especially as you’re talking to someone about their growing-up years? |
| KELLY: 40:44 | I think that most kids around maybe age seven are pre-wired due to their environment. They’re trying to survive, so to speak. And they’ve got to find out what feels good. That starts while they’re an infant of how to soothe themselves, or what’s going to feel good. And I think if you don’t have the correct environment to guide them, to love them in a nurturing way, then they’re going to continue that intense programming. The programming, it’s so intense, of course, during childhood. So now we’re becoming an adult, and we’re still wired this way, but now it’s causing great consequences because now we’re adults. |
| CARMEN: 41:33 | I’ve heard people who struggle with substance use say, “It was like a switch. I went into the hospital. They gave me meds, and all of a sudden, all of these addictive behaviours have came upon me.” So I guess that’s what I’m really trying to get at is, is this for some, a switch that happens in adulthood? Are we saying, “Yeah, this started when you were a kid”? Or are we seeing a variety of these kinds of experiences? |
| PROFOTA: 42:06 | I’ll answer that. So a lot of my sex addicts, most of them have started masturbation under the age of six, and it’s because they didn’t get enough physical nurturing, or they had a very traumatic event where it was extremely difficult for them to self soothe or co-regulate with the parent or another sibling. And so those guys are going to be much more apt to use sex as a way to calm themselves. And it’s not about wanting to relate to someone or wanting to connect, it is directly about changing how they feel. Now for them, the switch was on at five or six or seven years old. I had one female sex addict whose family gave her two mom’s parents to raise as an infant and then brought her back into the house at six. She was masturbating at the age of five. So before she ever came back to her actual parents’ house with four other sisters, she was already masturbating. And she’s used masturbation for 50 years to try to self soothe. |
| CARMEN: 43:29 | So do those who struggle with sex addiction think this is how everybody else is living? We talk about the fantasy that they live in. So are they walking around going, “Yeah, you’re struggling with this. You’re struggling with this. We’re all doing it. We’re just not talking about it”? |
| JOSEY: 43:50 | Well– |
| PROFOTA: 43:51 | Go ahead. |
| JOSEY: 43:52 | Do you want to go in? |
| PROFOTA: 43:53 | No, go ahead. |
| JOSEY: 43:54 | Okay. So oftentimes, addicts come from family systems – I sort of mentioned this a little earlier, but – that are highly master extremely distant. Also, toxic and boundaryless are very rigid in the sex and love arena. In that particular area, it’s never discussed. and so they’ve never learned about how to deal with love and sexuality, or what healthy sexual expression even looks like in a healthy romantic relationship. So in these situations, since they didn’t learn about the healthy intimacy they seek out, the sex and love addict will seek out false, superficial connections, leaving them empty over and over. And in these kinds of family systems, our parents are God-like idols growing up. And so we come to believe that whatever our parents were doing to us or around us is what everyone else is going through. And this type of environment really can skew the perception of the child in a dysfunctional family and as a result begins to think these types of dysfunctional relationships are normal and then become to expect them, meaning to be treated poorly, not having basic needs met, shamed, belittled, neglected. Those kinds of things. |
| CARMEN: 45:18 | I didn’t want to interrupt anyone, but is someone going to jump in here? |
| KELLY: 45:21 | I have a question real quick. Do you believe it’s abnormal for a child to masturbate at four or five. I mean, how much of that is genetic and not necessarily environment? Because I know some people develop at different ages. You know what I mean? Where someone, they can experience an orgasms late. Another one, not till they were 11. They didn’t get pubic hair till they were 12. Others, you know what I mean. I mean, hormonal changes, don’t they come at different times, different ages? Are you saying that age four or five is kind of an alert, hold up, it’s going to turn into sex addiction, or? |
| CARMEN: 46:10 | That’s a great question. |
| PROFOTA: 46:12 | So I’ll go ahead and answer that one. Normally, children don’t really start to feel sexual arousal and want to masturbate until they’re around 10-ish when puberty begins to occur. It’s an outlier when it’s under the age of eight years old generally. And it doesn’t mean necessarily that they’re going to turn out to be a sex addict. But if they’re masturbating on a daily basis or more times a day, then just– and these kids are, when they’re masturbating, they have no idea that this isn’t something that young children normally do. They’re just thinking this is how everybody operates. And I wanted to also speak to something about highly sexualized families are much more likely to create a sex addicted patient at some point. And families that are– the two things that most sex addicts have in common, by at about 70 to 80 percent, is they come from a family with rigid rules and they come from a family that’s very disengaged. And those are the two primary additional things that we notice about sex addicts who score at least a six and above on the scale for criteria for sex addiction. |
| CARMEN: 47:48 | So let me– oh, go ahead. |
| KELLY: 47:50 | Thank you. That explained a lot. |
| CARMEN: 47:53 | So a little clarity around this, because in one sense, we’re talking about highly sexualized families, which doesn’t sound like a disengaged family. That sounds like a family that is doing a lot of conversation, a lot of talk about sex in one way or another versus a disengaged family with rigid rules. Can you explain that a little better and pass that out a little bit? Because it sounds like two dichotomous things, maybe it’s not. |
| PROFOTA: 48:26 | Yeah. And so I was very confused about that myself. I used to think that my family was very warm and fuzzy. And then I realized that my mother was 12 years old, mentally and emotionally, and that parent cannot possibly engage in real intimacy with the child. And so there was tons of talk about sex. She flirted with men all over the place. She would talk about sex with my father when he was in the same room with us. That is a very immature parent. That’s not a warm, fuzzy relationship. It’s actually very disconnected. And so her ability to be emotionally present was down here while her ability to think on a sexual level was up here. And she confused those two things. I love Melody’s work because she talked so much about the definition of an enmeshed family, which is not an engaged family. It’s an enmeshed family and a family that is very disconnected. And it’s a little different from what I had heard. I’ve been sober from alcohol 32 years. That is not my definition of a warm, fuzzy family from that point. It is now. But I didn’t understand that, what a truly emotionally mature parent looked like. |
| CARMEN: 49:55 | Okay. So this segways right into my next question when we’re talking about partner profiles, because now I would like to talk about– I know we are running out of time. I knew we would. But I think this is a really important topic to talk about because this– you’re saying the addict has the inability for true intimacy. So don’t we as people attract someone at our same level of emotional health, our same level of ability to be authentic, to have intimacy? What does this say about the partner that selects an addict, a sexual addict who is not recognizing this disconnect? |
| PROFOTA: 50:45 | So you’re asking about the partner who is unaware and then suddenly discovers. So it is true that we seek– water seeks its own level. So if I’m here and my ability to be relational, I’m not going to pick somebody down here. If I’m down here and my ability to be relational, I’m not going to pick somebody in this range. However, for these folks, they’re in so much trauma that you cannot bring that topic up about what’s your part in this? Because partners are excruciatingly traumatized. They’re not in their right mind for at least probably a year to five years. That’s how long it takes for them to recover from that. Now, there are some common issues with the partner early on. And so those have to be addressed. And one is what we call safety-seeking, which means they ask 25,000 questions a day of their partner. What did you do sexually? And that just re-traumatizes them over and over and over again. And they can’t hear what your part. In fact, I’ve had people call me and the first thing they ask me, the partner, is do you make partners own their problems in this? And the is absolutely not, because you can’t– maybe in year four or five, a partner can start to see, “Oh, I think I may have had a part in that,” but you can’t go there because you will create a lot of legal liability. There are homicides and suicides that are documented from inappropriate treatment of partners. |
| CARMEN: 52:38 | And inappropriate treatment in terms of clinical, which, again, segues right beautifully into my next question. We have, what, five minutes to dive into this. So clinical mistakes. I don’t want to miss out on this part of the conversation. I know this is– we may just do a whole other segment on this. We haven’t even hit the tip of the iceberg, but we’re talking to clinicians here. Tell us our dos and our don’ts. |
| PROFOTA: 53:08 | So do focus on partner trauma. A mistake that a lot of people make is trying to treat a sex addict like the same way you would an alcoholic or a drug addict. You can’t. Putting a sex addict in group with chemically dependent clients is going to cause the addict to act out and minimize what’s going on with them, because they’ll try any way to avoid the sexual talk and in a talk with the patient in a chemical dependence group, they are never going to bring up the topic of sex. And if one does, they’re all going to freak out about that. You can’t treat male and female sex and love addicts in the same group. In fact, you shouldn’t treat them on the same campus. It is extremely important for the practitioner to wear the right clothing. You can’t wear low cut blouses, you can’t wear spike heels, you can’t wear short skirts, you can’t wear anything that is of a sexual, provocative nature. So what you wear when you walk into that room with that addict is really important. We don’t give the written formal disclosure to the partner because they will just read it over and over again and retraumatize, retraumatize, retraumatize. It can take anywhere from a couple of months to six months to prepare for the formal disclosure, and that has to be done after the addict has at least 90 days sober, if not 120 days sober. Another mistake that clinicians make is to assume that the addict is sober when they have been lying about being sober and so you can tell when an addict is sober and when they’re not sober. Damon, would you like to give some examples of that? |
| DRANDAKIS: 55:18 | Well, the examples that I have are them being in group and not participating at all. Other examples would be them trying really to get out of the disclosure. That’s one that they will often try saying that this is going to ruin this marriage, that kind of stuff. Some will start doing things like they’ll come in, and they will just tell me that they’re doing great, they’re not having any problems and then, often, when we bring in the partner, I hear a completely different story. He’s not going to any meetings, etc., etc. So you just see you don’t see any congruency in things lining up and making any sense at all. |
| PROFOTA: 56:10 | That brings up a really important point is treating the sex addict without hearing regularly from the partner, because you’re going to get a different story. And it’s really helpful just to bring that up to the client and say, “Well, your wife was telling me that you stopped going to meetings. Tell me about that,” and so that helped to bring that up. Another mistake is treating males and female sex addicts on the same campus. You can’t do that. For inpatient treatment it is– just like you search their bags when they’re coming in for drug paraphernalia and drugs, you have to search the sex addicts bag for other things, anything that might create some sexual arousal for them, and it could be something just like a woman’s dress in their bag as opposed to male clothes. It can be something like a picture, a nude picture, of one of their sexual partners, so that is really important to do. I also wanted to share a couple of questions. I think one of the things you asked us to do was examples of things that people would need to know the answer to to be able to treat an addict and I can do that now, or we can skip that. |
| CARMEN: 57:49 | I don’t want to miss out on that. Go ahead and do that, and then we will close out. |
| PROFOTA: 57:57 | All righty. So when you’re treating sex addicts– if you want to do that, it’s really important to know how do you tell if the addict is sober. What are some warning signs? We just talked about that, that they’re not sober– oh, and we need to know how many days of celibacy does it take for the prefrontal cortex and the limbic system to come back online. Should a sex addict drink alcohol or smoke marijuana or take Wellbutrin or other stimulants? They can’t do that. When is the partner ready to hear a formal disclosure? It’s not in the first week or month. Can a couple skip disclosure? Not if you want a long term sobriety and not if you want the partner to be able to renew their trust in the relationship. Does a polygraph help in the treatment of sex addiction and how? If a polygraph is done, when should it be done? There are specific types of polygraphs that are done for sex addicts and then there are general ones and having a good polygrapher is extremely important. And can a sex addict obtain long term sobriety without the first 120 days of celibacy, without a formal disclosure, and can you treat a sex addict without group therapy? |
| CARMEN: 59:29 | Well, we have, like I said, barely touched on this topic. I want to thank all of you amazing, lovely speakers for being here. Thank you, Ava, Jennifer, Damon, Kelly. I appreciate your time more than I could say. On behalf of half of Niznik Behavioral Health, thank you to everyone who took time to participate. You will be getting your CE info tomorrow in the mail, and please fill out that form where you tell us, did you like the conversation? What do you want to see more of? We want your feedback. So have a great day, and thank you to everybody for participating. |
| KELLY: 01:00:10 | Thank you. |
| DRANDAKIS: 01:00:11 | Thank you. |
| JOSEY: 01:00:11 | Thank you. |
