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What the Heck Is Sex and Relationship Rehab?

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It seems like every time I turn on my television, open a newspaper, or go online, I'm hit with yet another story about a secret, problematic pattern of sexual misbehavior and/or multiple infidelities acted out by a major politician, sports star, actor, religious leader, teacher, coach or whomever. Sometimes these men and women might well qualify as sex addicts; other times not. When their behavior does meet the definition of sexual addiction, they sometimes, either on their own or at their lawyer's behest, enter a sexual addiction treatment facility. The general public is usually unimpressed with this, seeing it as a cop-out, primarily because most people understand neither sex addiction nor the addiction treatment process.

Yes, most people know about drug and alcohol rehab. If they haven't been to one themselves, they're familiar with someone who has had to face those demons in a residential setting. At worst, most people understand that you "go to rehab" because you need a time out from drugs and alcohol. At least that's what it looks like if you watch ABC's Nashville any episode, any week. But sex rehab? That's a joke, right? Nope. No joke. Sexual addiction (also known as hypersexuality) is a very real thing with consequences that are every bit as devastating as those of heroin, cocaine or alcohol addiction. And sex addiction treatment is equally as real and as serious.

In many respects, sex rehab mirrors drug and alcohol rehab, relying on the same basic structure and techniques. The main differences between sex addiction recovery and substance abuse recovery are the level of intimacy in the work being done, the subject itself, the fact that the majority of clients have had significant early life trauma, and the way in which "sobriety" is defined. Whereas lasting abstinence from mood-altering chemicals is the goal in nearly all forms of chemical dependency treatment, sexual sobriety involves an ongoing commitment to behavior change but not long-term abstinence. In sexual addiction recovery, the goal is learning to engage in and be satisfied with non-compulsive, non-compartmentalized, relationship-focused sexuality -- not to abstain from sex. This is much like an eating disorder, where the person with an eating problem still needs to eat. Essentially, recovering sex addicts and their treatment team must determine what sexual behaviors are healthy and acceptable, and which are destroying their relationships, career, family and life. Addicts then commit to engaging in only the identified healthy sexual behaviors, eschewing the problematic ones and calling it a "slip" or "relapse" if one of those problem behaviors is repeated.

Of course, the definition of "problematic sexual behavior" varies from person to person based on the individual's life circumstances (married/single, gay/straight, religious background, community standards, etc.) Thus, the definition of sexual sobriety also varies from person to person. But in all cases, sexual sobriety is defined as the elimination of sexual behaviors and patterns that diminish the addict's life functioning, sense of self and relationships. It is important to note that the patterns of sexual behavior to be eliminated never involve trying to change one's sexual identity, sexual orientation, or fetish/kink arousal patterns -- none of which are considered sexual addiction, per se.

Inpatient (Residential) Treatment: Sex Rehab Basics

A common misperception about residential rehab facilities (of all types) is that the addicts who complete these programs will have their problems resolved when they leave treatment. This is not the case. We don't expect any addict entering rehab to be cured when he or she leaves treatment; rather, we hope that the addict leaves better prepared -- with greater emotional strength, social support and shame resilience -- for the longer-term, ongoing process of addiction recovery.

The primary goals of sex rehab are:

  • To temporarily separate the addict from the people, places and things that trigger addictive sexual behaviors
  • To clearly delineate, in writing, which sexual behaviors are problematic
  • To confront and address denial about the danger/harm/losses related to the addict's problematic sexual and romantic behavior patterns (past, current and future)
  • To help the addict gain insight into the consequences of his or her sexual behavior, thereby gaining empathy toward those he or she has harmed (self and others)
  • To provide clear, workable, relapse-prevention tools
  • To encourage participation in lifelong, ongoing recovery from sexual addiction, which often includes long-term individual therapy, group therapy, and/or 12-step involvement

Essentially, residential treatment is a first step on the pathway of lasting sexual sobriety and a satisfying life of personal integrity. Treatment seeks to interrupt long-established compulsive sexual and/or relationship behavior patterns while providing a safe, structured opportunity for building both the awareness and the coping mechanisms required for healing.

What Happens in Residential Sexual Addiction Treatment?

Many people enter sex rehab expecting that the identification and resolution of childhood trauma will be their primary focus. However, this traditionally useful therapeutic approach is often counterproductive at such an early stage of addiction treatment. Helping addicts gain insight into their childhood trauma, while serving to reduce shame, does not provide the concrete tools needed to cope with life on life's terms without returning to sexual acting out as a way to self-soothe and self-medicate. So, first things first. And the first thing to do in sex rehab is to identify and stop the problematic sexual behaviors. Later, after the addict has established a modicum of sobriety, a therapist can help the patient deal with childhood trauma and other underlying psychological issues. Usually this occurs in a longer-term outpatient treatment setting.

The rehab process starts with a thorough psychological assessment. Careful evaluation explores and evaluates nearly every aspect of the addict's life. After that, treatment typically focuses on three main issues:

  1. Separating the addict from his or her harmful sexual behavior
  2. Breaking through the denial used to make that behavior acceptable (to the addict)
  3. Raising awareness of when the addict is most likely to act out, and offering concrete coping mechanisms to use instead

Recovering sex addicts nearly always require external reinforcement and support if they wish to eliminate deeply ingrained behavior patterns. Group therapy, begun in residential rehab, starts this process. It is in these settings that addicts are able to clearly see, often for the first time, that their problems are not unique and they are not alone. This helps to reduce the guilt, shame and remorse that sex addicts experience in relation to their behaviors. The group format is also ideal for confronting the denial that all sex addicts develop. Group level confrontations are powerful not only for the person being confronted, but for the addicts doing the confronting. Through these interactions, everyone present learns how rationalization and justification sustain addiction. Last but not least, addicts are able to learn from and reinforce with one another which interventions and coping mechanisms work best, based on their own and other group members' experiences.

What Defines a Good Sex Rehab?

For the last 25 years or so, there have been a relatively consistent number of U.S.-based residential and intensive outpatient treatment centers specializing in sexual addiction and related intimacy disorders. These facilities have routinely provided useful, accurate care. At the same time, the number of individual clinicians treating sexual and romantic addiction has increased significantly, mostly related to the escalating numbers of people self-reporting problems with Internet porn, webcam sex, and similar tech-driven sexual/romantic behaviors. Similarly, many generalized addiction and mental health treatment facilities now list "sexual addiction treatment" as a specialty -- even though it really is not. Yes, it makes for good marketing, but very often these facilities are not set up to treat sex and relationship addictions. In reality, the number of facilities that are able to effectively treat sex and relationship addiction is limited.

So how can one distinguish a solid, useful residential sex and love addiction treatment center from all the rest? Here are a few clues:

  1. The treatment center should have a dedicated, separate treatment program for clients who have sex and relationship addiction problems. This should not be a track in a larger behavioral or substance addiction treatment program, nor should it be a mixed group with other kinds of addicts. To be effective, a sex and relationship addiction facility needs a dedicated treatment group and program.
  2. At least 75 percent of the staff providing treatment should be certified in the treatment of sexual addiction -- not as sex therapists, but as sexual addiction specialists.
  3. The program should have a proven track record of success, including former clients who are willing to anonymously speak about their experience receiving treatment there.
  4. The treatment program should have both addiction and mental health specialists on staff.
  5. The program should be gender separate.
  6. There should be a strong treatment component in support of spouses, family members and caring others.

If a sex and relationship addiction/intimacy disorders treatment program meets all of the above criteria, it is likely you are on the right track as far as finding a good program for yourself or a loved one.

It is important to note that after completing inpatient treatment, most sex addicts need continued work with a sex addiction treatment specialist, including both individual and group sessions, if they plan to maintain sexual sobriety over the long haul. For these individuals, it is essential that a personalized aftercare plan be formulated and implemented before the addict leaves the treatment center and the temptations of home can take effect. After all, once the addict returns home, he or she will inevitably be confronted with the same temptations that led to treatment in the first place. So putting an external safety net in place before the person goes home is essential. This is a standard component of any good treatment center, regardless of the addiction being treated.

Robert Weiss LCSW, CSAT-S is senior vice president of clinical development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded the Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Sex, Intimacy and Relationships, along with numerous peer-reviewed articles and chapters.