“I have a 12-year-old client who is completely out of control sexually on the internet. How do I treat him?” asked a colleague. Even though I had treated sex addicts for over 20 years, I was taken aback by the age of her client. The description “completely out of control” had, in my experience, been used to describe adults.
Psychologists today are facing clients with out-of-control or compulsive sexual behaviors not previously seen in such depth and scope due to the addictive “high” created by cybersex. Like many crack cocaine users, those individuals who may have not fit the typical profile of an addict are getting “hooked.”
Referred to as the “Triple A Engine” – affordable, accessible and anonymous – by the late sex researcher Alvin Cooper, Ph.D. (1997), cybersex offers users an array of options that can quickly produce serious negative consequences from high risk behaviors. In a survey of 9,265 internet users, 17 percent reported problems due to cybersex activity. One percent of these users, 40 percent of which were women, reported severe consequences (Cooper, Delmonico and Burg, 2000).
Individuals who may have never developed sexual problems requiring treatment now find themselves in trouble. According to Patrick Carnes, Ph.D. (2005), the cybersex world offers individuals an assortment of opportunities to “access the unresolved.” Those sexual fantasies that might never have led to sexual behavior now become entrenched in the sexual template of the user.
With new sexual freedom and a trance-like state produced by the internet, a novel rush of “sexual highs” occurs. Obsession, preoccupation and compulsion quickly follow. Once addicted, the brain escalates its search for novelty. The risk for acting-out high risk sexual behaviors increases dramatically.
Carnes points out the following patterns of cybersex addicts:
- Rapid escalation of amount and variety.
- Escalation becomes obsessive with new, specific behaviors becoming quickly fixated.
- Relational regression occurs (withdrawal from and loss of sexual interest with partner).
- Acceleration of existing addictive and compulsive behaviors and precipitation of new off-line sexual behavior.
Further complicating the treatment picture is the fact that many partners of cybersex addicts are coming into therapy feeling betrayed, depressed and confused. No partner can compete with the internet. Detection of online infidelity includes:
- Change in sleep patterns and demands for privacy.
- Responsibilities ignored.
- Lying and personality changes.
- Loss of interest in sex within the relationship (Young, et al, 2000).
Their children may also be negatively impacted by exposure or subsequent neglect. The challenge for psychologists is to find the most helpful treatment model and techniques for cybersex addicts and their families.
So what are the critical treatment considerations with this population? The first is conceptual. Even though it has been debated for years that sex can become addictive, it is hard to deny that clients “hooked” on cybersex look like addicts. Treating it as a deficit in the couple’s relationship or turning only to “insight-oriented” treatment can result in frustration for the client and therapist.
Even when cybersex use begins as a couple’s issue, its escalation largely reflects addiction, not dynamics. It is critical that if you are going to treat cybersex problems that you understand sex addiction and its corresponding treatment.
Sex addiction is not addressed in the DSM-IV. However, there is general consensus that individuals sexually addicted evidence a loss of control, negative consequences and continuation of the behavior in spite of the consequences. Sex addiction treatment typically includes:
- Assessment of sexual history.
- Challenging the denial system, distorted thinking and blame projection.
- Twelve-step program attendance e.g., Sex Addicts Anonymous (SAA).
- Abstinence definition.
- A written relapse plan.
- Shame reduction.
- Affect regulation.
- Addressing other addictions.
Dealing with the underlying intimacy problems most cybersex and sex addicts present with is necessary as well. Healing the effects of childhood trauma is critical in preventing relapse. Sex addicts have reported high incidents of childhood abuse: physical (72 percent), sexual (81 percent) and emotional (97 percent) (Carnes, 1991).
Involvement of family members in treatment is positively correlated with a favorable treatment outcome for the addict. Partner’s participation in a twelve-step program, like Co-Sex Addicts Anonymous (COSA), is helpful.
Psychologists who take the time to become familiar with sex addiction treatment strategies will find themselves more comfortable in dealing with the growing problem of compulsive cybersex use.
Kenneth M. Adams, Ph.D., is a licensed psychologist practicing in Royal Oak, Mich. He is a certified sex addiction therapist and the author of three books, including The Clinical Management of Sex Addiction. His web page is: www.drkenadams.com.