Friday, April 20, 2018

A Look at Hypersexuality: Treatment and Assessment



The classified advertising site, Backpages.com, was recently shut down by the United States government, thereby making it inaccessible in Canada as well.  The website, which hosted everything from child care to real estate ads, was recently suspended by U.S. law enforcement due to activity stemming from the “adult” sections on the site.

Many essential political and societal discussions have transpired following the decision to close the site, including debates about whether the intention to prevent sex trafficking will benefit from this action. 

Amid these discussions, some of my clients who use the internet to access sex services, and who identify as having problems regulating their sexual behaviour feel a sense of relief.  Some are experiencing an unexpected external control over their response, albeit temporary, now that Backpages.com is no longer accessible.

What is hypersexuality?


Problematic sexual behavior is referred to using a variety of labels – from sex addiction to compulsive or impulsive sexual behaviour to hypersexuality.  Societally, this is commonly labeled as sex addiction, but there remains little scientific evidence to support sex as an addiction.  There is also some suggestion that perceived addiction to pornography can contribute more to psychological distress than pornography use itself (Grubbs, Volk, Exline, & Pargament, 2013). 

Many of my clients seek out therapy for problems managing their sexual behaviours, sexual interests or both. Regardless of the label, many men (and it is mostly men that seek treatment for this in my practice) are struggling with a variety of sexual behaviours, from anonymous sexual encounters to frequent masturbation and pornography use.  Some men also experience distress related to the content of their sexual thoughts, or pornography use (versus the frequency of their sexual behavior).  In other words, they experience a sexual interest that is atypical or less common; the inclination could turn illegal if acted upon and/or it contributes to significant moral distress. 

Assessment


Research has been conducted to identify the characteristics of individuals who seek out help for hypersexuality, along with related treatment targets (Cantor et al., 2013; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2014). The paths leading people to engage in hypersexual behaviour are varied and beyond the scope of this current blog, but there are more common ones I see in my clients.  Clients often use sexual behaviour as a way of procrastinating, avoiding, and escaping stressors.  Many of my clients struggle with identifying, labeling, and expressing their emotional experiences (preferring instead to ignore and suppress). This is even more common with emotions experienced as being more challenging to manage (i.e., frustration, anxiety, anger, disappointment), and they seek out a distraction, and a way of temporary escape, through sexual behaviour. 

Other clients have varied sexual interests that are explored through pornography or sexual activity with another, that they may not feel comfortable talking about or exploring in their partnered relationship.  At times there is a mismatch in sexual drive or interests in a relationship, but what is often apparent is a lack of healthy communication between partners about their needs and experiences in their sexual relationship.

What is essential when seeking support is finding a mental health clinician who will engage in a detailed assessment to understand the nature of the problem and the contributing factors.  It is also essential to determine if there are other mental health concerns (i.e., depression, anxiety, bipolar disorder to name a few) that are influencing the behaviour and also require intervention.  There is no ‘one size fits all’ approach to treating individuals who struggle with sexual behaviour. As a result, an assessment helps to determine the most relevant treatment targets to assist those seeking help to achieve their goals.

Treatment


A therapist assists clients in understanding the origins and development of their behaviour.  Clients are offered support through their journey to develop and refine skills to live a life that is more in line with their values.  This path is often challenging and filled with a range of emotions, and mistakes and a return to old patterns may occur.  With the guidance of a therapist, these challenges can be navigated and explored in a safe and supportive environment. The client can take steps they feel are necessary to define and live a more fulfilling and value driven life.

Often when a man is in a partnered relationship, couples therapy is recommended, mainly when the sexual behaviour of concern involved infidelity.  In these situations, the sexual behaviour that occurred happened in the context, and with all the relevant dynamics, of a relationship.  If the couple desires to remain together, at the very least, the rebuilding of trust occurs again in the context of the couple.  With that in mind, many men still seek out therapy on their own, either at the insistence of their partner or without their partners’ knowledge that there is a problem. 

If you can identify with these struggles, there is help and support.  Individual and couples therapy is available at the Centre for Interpersonal Relationships (CFIR).


References


Cantor, J., Klein, C., Lykins, A., Rullo, J., Thaler, L., & Walling, B. (2013). A treatment-oriented typology of self-identified hypersexuality referrals. Archives of Sexual Behavior. 42. 10.1007/s10508-013-0085-1.

Grubbs, J., Volk, F., & Exline, J., & Pargament, K. (2013). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2013.842192.


Sutton, K., Stratton, N., Pytyck, J., Kolla, N., & Cantor, J. (2014). Patient characteristics by type of hypersexuality referral: A quantitative chart review of 115 consecutive male cases. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2014.935539.