The Sex Addiction Debate--A Dialectic

As I read and re-read the exchanges that occur around the topic of the intersection of sex addiction research and practice, within the community of therapists and in the public sphere, I find myself drawn to what I have learned in Dialectical Behavior Therapy (DBT) training. Before I dive into that, I have another observation to make.

One of the primary draws I had to this work is the pioneering work of Dr. Patrick Carnes, whose genius, in my estimation, lies in his ability to synthesize concepts and models from various, and apparently disparate, disciplines in attempt to understand and explain the patterns of human behavior we have come to call “sex addiction” (which is only a label, not the thing it points to). In doing so, he has constructed a model that looks at these patterns from various perspectives or lenses. I find this particularly helpful as a practitioner, as it helps me in my attempts to explain to folks ways to look at their own behavior that helps them figure out how to change. The intellectual openness and flexibility required to maintain, juggle, contrast, and synthesize multiple views of the same issue or set of issues helps me to be a more balanced and humble human being, and a more effective therapist. All of the theories that we use to describe, represent, and interpret the complex dynamics of human behavior are only arbitrary mental constructs at best. As such, they are subject to all of the flaws to which any human behavior is subject, despite our best efforts to prevent such flaws. History is replete with examples of “scientific truth” that has later been revealed to be less than accurate, despite the intensity of belief or numbers of “experts” who subscribed to that “truth”. Similarly, many “proven” theories have later been disproved upon the development of more accurate or detailed measures and/or concepts.

What I make of the recent exchange is that, as in any arena of human endeavor, it is probably unwise to cling rigidly to any position regarding theories that attempt to interpret, analyze, or explain human behavior, including sexual behavior. Depending upon one’s vantage point, or the lens through which one is viewing the behavior, it may look completely different, and our interpretations might (and do) appear to be contradictory at times. This does not invalidate any particular point of view. As the dialectic suggests, it is NOT “either/or”, but “both/and”. Applied to the recent exchange, I believe it is possible to hold all positions simultaneously without invalidating any of them. Looked at from the lens of a particular neuroimaging study, it appears that there is no correlation between “compulsive sexual behavior” and the markers we know to correlate with substance abusing behaviors. AND, viewed from the lens of a practitioner with a despairing man and his traumatized partner in the office, there is absolutely something that LOOKS a lot like addictive behavior occurring, and something needs to change. Stated another way; on one hand, we don’t know very much about WHY or HOW this is occurring in the brain. And, on the other hand, we know quite a bit about interventions that seem to be effective in helping folks who want to stop their problematic behavior.

One of the things I tell my clients is “Understanding that you desperately want to know WHY you act the way you do – and in agreement that knowing why might even be helpful – the fact remains, if you continue to act that way, it will continue to have a negative impact on your life. Regardless of whether you are able to completely understand WHY you acted that way, the most important thing to acknowledge is that you must do things differently from now on.” Let’s look at what has helped other people, who are not so different from you, change their behavior and improve their lives. I invite you to consider doing those things to see if they might work for you. Along the way you might get some answers to the question, “Why?”

Is it important to figure out what is going on so we can devise more effective interventions/treatment? Absolutely, more awareness and understanding is usually better than less awareness and understanding. If something works and we don’t know why it works, should we stop doing it because we don’t know why? Of course not. We don’t know why electricity works, but we know that it works and we use it. A lot. Are diagnostic categories and concepts helpful and necessary? Certainly, we need language to talk about what we are dealing with. And it is also dangerous to over-focusing on this to the extent that we forget that we are dealing with human beings, not “diseases”. Words matter. And they are often superfluous. Getting hung up on the diagnostic labels, or any other labels, strikes me as similar behavior as many of our clients who are hung up on the label “God”, therefore reject any spiritual concept that uses that term to describe it. To gleefully mix metaphors: Sometimes we are so focused on the trees that we miss the forest. Sometimes we are so focused on the forest that we miss the tree. Our challenge is to find the middle path – avoid running headlong into the tree while we’re trying to find our way in the forest.