What makes Sammy Run?
The Psychodynamics of Sexual Compulsion
by Dorothy C. Hayden, LCSW
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It is well known among people in the 12-step sex programs say that of all the
addictions, sex is the most difficult to master. Compulsive sexuality, which
includes phone sex, the use of prostitutes, massage parlors, “dungeons” and
dominatrixes, as well as the burgeoning of cybersex addiction, is overwhelmingly
compelling for those enslaved by it. The reason for its compelling appeal is
that sexual addiction, deviant sexual fantasies, and acting on a “perversion” is
often the addict’s only source of safety, pleasure, soothing and acceptance. For
the addict, it vitalizes and connects. It relieves loneliness, emptiness and
depression. Sex addition has been called the athlete’s foot of the mind: it is
an itch always waiting to be scratched. The scratching, however, causes wounds
and never alleviates the itch.
The majority of sexual compulsives live in isolation filled with feelings of
shame. Almost 100% of the people who come to me for an initial consultation,
whether it be for compulsive use of the baths, public bathrooms, prostitutes,
phone sex, a fetish, cross dressing, or masochistic encounters with dominatrixes,
relay that beneath the shame they feel in telling me their story, they also
experience a sense of freedom that comes from finally being able to share with
another human being the secretive, shameful, dark world that imprisons them.
This “dark side” gradually bleeds away everything the person holds dear. The
life of a sex addict gradually becomes very small. The freedom of self is
impaired. Energies are consumed. The rapacious need for a particular kind of
sexual experience drives the addict to spend untold hours in the world of his
addiction. Inexorably, the compulsion begins to exact higher and higher costs.
Whether it be on the internet indulging in sexual fantasies with fantasy people,
being on the phone to the sex hot-lines, or frantically searching the net and
the S&M clubs for someone who will act out a particular, ritualized fetish
fantasy with them. Perhaps the addict cruises the bars searching for the “one”
who will have sex in a public toilet, or go to dungeons to be whipped, flogged
and humiliated. Whatever for it takes, sex addiction is a devastating illness
that takes an enormous toll. Friends slip away. Hobbies and activities once
enjoyed are dropped. Financial security crumbles as sums as high as $40,000 or
$50,000 a year are spent on sex. Then there is perpetual fear of exposure.
Relationships with partners are ruined, as the appeal of intimate sex with a
partner pales in comparison to the intense “high” of indulging in the dark and
devious world of sexual compulsion.
The effect on the addict’s partner is one of the most pernicious consequences of
sexually acting out. A female patient of mine, the wife of a sex addict, claims,
“I used to be married to a drug-addicted man who beat me so as to fracture my
skull. But, frankly, his sexual addiction was more painful.” Sexual addiction
hurts both the addict and the addict’s loved ones. It tears apart families and
destroys lives, striking at the core of human relationships and intimacy. When
sex addiction is active, it usually hampers and disturbs intimate relationships.
It is hard to spend the time that the addiction requires and still maintain the
level of attention that a close personal relationship requires.
For the relationship partner of a sex addict, it can be a painful process
experiencing the powerlessness of the addict’s out-of-control behavior. The
partner may not know what the addict is involved in, but she does know something
is amiss. She may increase her attempts to “keep her man happy”, a strategy
motivated by fear. Some of the common fears the partner may experience may
include: I was afraid I wasn’t woman enough for him; I was afraid I could never
please him sexually; I was afraid there was something wrong with me; I was
afraid I was a pervert; I was afraid that I couldn’t protect my kids if they
were being hurt by him; I was afraid of his anger; I was afraid he would give me
a disease. Couples treatment for the addict and his partner is a mandatory part
of recovery. Family therapy may be needed because in the tornado of the
sex-addiction dance between partners, children may go unnoticed and unattended
to.
So, what is a sex addict? Sex addiction, of course, has nothing to do with sex.
Any sexual act or apparent “perversion” has no meaning outside of its
psychological, unconscious context. A simple definition of sex addiction is not
dissimilar to definitions of other addictions. But a simple definition of this
complex and intractable condition doesn’t suffice. What makes sexual compulsion
so intractable and sets it apart from other addictions is the very real fact
that sex and sexual fantasies touch on our innermost unconscious wishes and
fears, our sense of self, our very identity.
Current treatment might include participation in a 12-step program, going to an
outpatient clinic, working with the Patrick Carnes material, aversion therapy,
or the use of medications to stave off hypersexuality. Most therapy is
cognitive-behavioral, designed to help the patient to control or repress the
instinct for a period of time, usually out of a desire to comply with the group
norms of their 12-step meeting or a need to please the therapist. While I
recognize the efficacy the 12-step programs to provide structure and support, in
my opinion, the reason that relapse is so prevalent is that these treatment
modalities do not effect long-term structural personality change that modifies
the compulsion at its roots. Current psychoanalytic treatment aims to transform
psychic energies, enabling the reality sector of the mind dominates the
personality so that the impulse to act out can be understood, controlled, and
ultimately eliminated.
Sex addiction is a symbolic enactment of deeply entrenched unconscious
dysfunctional relational patterns with self and others. It involves a person’s
derailed developmental process that occurred as a result of inadequate
parenting. Hence, permanent growth and change are most likely to occur in the
arena of contemporary psychodynamic therapy, which seeks understanding and
repair of these unconscious dysfunctional relational patterns along with the
development of a more unified and structured sense of self. This new personality
restructuring can better self-regulate feeling states without the use of a
destructive defense like sexualization and can find meaning, enjoyment,
intimacy, meaningful goal setting and achievement from attainable and
appropriate sources in life.
Freud formulated that sexual deviance occurs due to an incomplete resolution of
the Oedipus complex, with its concomitant castration anxiety. Unconscious
anxiety occurs in the person’s present-day consciousness in the form of fear of
confrontation, retaliation, or rebuke, a sense of inadequacy, and perhaps doubts
about gender identity. Sex addiction, according to Freud, is a defensive way to
cope with a tenuous sense of masculinity combined with unrelenting anxiety about
sex, women, intimacy, aggression, and competition. Analysts that followed Freud
held varying views. Sexual compulsions derive from an insatiable need for
approval, prestige, power, bolstering of low self-esteem, and the love and
security which are experienced as being necessary for survival. The addict
experiences the absence of sexual acting out as a threat to his very existence.
Characteristic of any addict is a long history of a disturbed mother-child
relationship.
An unempathic, narcissistic, depressed or alcoholic mother has low tolerance for
the child’s stress and frustrations. Nor is she able to supply the empathy,
attention, nurturing and support that foster healthy development. The gay sex
addict is particularly traumatized by hostility and abandonment of the father
and the internalization of societal homophobia. The result in later life is
separation anxiety, fear of abandonment and a sense of imminent
self-fragmentation. This anxiety sends the sex addict running to his eroticized,
fantasy cocoon where he experiences safety, security, a diminution of anxiety
as well as the quelling of an unconscious wish to establish and maintain the
missing, yet essential tie to mother/father. Typical of this person is the hope
that he can find an idealized “other” who can embody, actualize and make
concrete the endlessly longed for nurturing parent. This approach is doomed to
failure. Inevitably, the other person’s needs start to impinge on the fantasy.
The result is frustration, loneliness and disappointment.
On the other hand, the sex addict’s mother can be overly intrusive and
over-attentive. She may be unconsciously seductive, perhaps using the child as a
replacement for an emotionally unavailable spouse. The child perceives the
mother’s inability to set appropriate boundaries as seductive and as a massive
disillusionment. Later in life, the addict is hypersexual and has trouble
setting boundaries. Real intimacy is experienced as an engulfing burden. The
disillusionment of not experiencing appropriate parental boundaries is acted out
later in life by the addict’s unconscious belief that the rules don’t apply to
him with regards to sex, although he may be regulated and compliant in other
parts of his life.
A major theme for all addicts is that they have experienced profound and chronic
need deprivation throughout childhood. Intense interpersonal anxiety is the
result of early-life emotional need deprivation. In later life, the person
experiences anxiety in all intimate relationships. Because the sex addict has
anxiety about being unable to get what he needs from real people and because his
desperate search for the fulfillment of unmet childhood needs inevitably end in
disillusionment, he invariably returns to his reliance on sexual fantasies and
enactments to alleviate anxiety about connection and intimacy and as a way to
achieve a sense of self-affirmation.
Sex, for the addict, begins to be his primary value and a confirmation of his
sense of self. Feelings of inferiority, inadequacy, and worthlessness magically
disappear while in the “erotic haze”, a highly focused state of sexual
preoccupation that may last for long hours, depleting energy and time that could
be used for more productive endeavors. In addition, using sex to meet
self-centered needs for approval or validation precludes using it to meet the
intimacy needs of a cherished other. Characteristic of this kind of narcissism
is the viewing of other human beings not as whole people who have their own
feelings, wants and needs, but rather as deliverers of desperately needed
satisfaction that shores up a fragile sense of self. This sets up a cycle
wherein the addict prevents himself from deriving satisfaction from mutual,
reciprocal relationships in real life. Sexualizing, once again, is returned to
as a magical elixir wherein his needs are magically met without having to
negotiate the very real conflicts of intimate relationships.
A client of mine, a 48-year-old attractive gay man, is in the process of the
breaking up of yet another relationship. After spending years of living a
noxious childhood household, he went into his own world of fantasizing and
masturbation as a way to soothe and protect himself.
“When I was a kid, I was obsessed with beautiful men in the magazines. When I
was able to have sex, I went through one man after another. In adulthood, I knew
there was sadness and anger stemming from my childhood that I didn’t want to
face. To evade them, I had a steady stream of men who worshipped me, soothed me,
paid attention to my needs. I went to peep shows, to the clubs, to the baths.
Many a night I would spend hours in my car circling the block looking for a call
boy to give me oral sex in my car. Often, after these encounters, I’d cry all
the way home.
He met a man whom he designated as “perfect – my redemption, my salvation.” He
moved in but soon lost interest in the sex, which he described as “boring”.
While still living with his lover, he started picking up men in bars, going to
the baths and the pubic toilets. He felt most comfortable with strangers who
didn’t make demands on him.
Another client of mine, a 38-year-old married man, has a compulsion to visit
prostitutes. Three years into the treatment, he was finally able to talk about
his anger towards his mother for depriving him emotionally through neglect and
for never touching or caressing him. He can now make a connection between visits
to the prostitutes and his hostility against mother for depriving him of sensual
pleasure.
“When I was very young I would put a blanket on my genitals as a kind of
soothing which I wasn’t getting from my parents. The rest of my life was a
struggle to find other ways to soothe myself. When I discovered prostitutes, I
thought I was in heaven. I can get sex now and be in total control. I can have
it immediately, any way I want it, whenever I want it. I don’t have to concern
myself with the girl, as long as I pay her. I don’t have to concern myself with
vulnerability and rejection. This is my controlled pleasure world. This is the
ultimate antithesis of the deprivation of my childhood.”
The use of sexualization as a defense is a common theme that runs through the
psychoanalytic literature. A defense is a psychological device the young child
devises to emotionally survive a noxious family environment. While this way of
protecting himself works well for a period of time, the continuous use of it as
an adult is destructive to the person’s ongoing functioning and sense of well
being. By losing himself in sexual
fantasies and constantly seeing others as potential sex partners, or by erotic
internet enactments, the sex addict is able to significantly reduce and control
a wide variety of threatening and uncomfortable emotional states. Diminution of
depression, anxiety and rage are some of the pay-offs that operate to facilitate
and maintain life in the erotic cocoon.
I quote another patient which illustrates a case of narcissistic personality
together with the use of sexualization (internet fetishes) as a defense against
unwanted feeling states and as a way to maintain the search for perfection. He
is a 52-year old attractive, successful single man.
“I went on a date the other night. She wanted sex. I didn’t. It’s predictable. I
don’t think I can even maintain an erection anymore. While a spend untold hours
compulsively websurfing to live in my erotic fantasies, when it becomes real,
when you find someone who seems to be the embodiment of your sexual
pre-occupation, interest soon wanes as her wants and needs come into the
picture. Sometimes, I don’t even bother with the pursuit of real women, because
I know the inevitable result is disillusionment. I’m simply not prepared to meet
somebody else’s needs.
Oddly enough, my life is still dominated by sex. It becomes the lens through
which I view everything. I go to a family gathering and get lost in sexual
fantasies about my teenage nieces. I live in constant fear of being found out to
be a “pervert”. I see a woman on the train dressed in a way that triggers me,
and I’m ruined for the day. Regular sex just doesn’t do it for me anymore. It’s
got to be bizarre or forbidden or “out of the box”. I arrive at work in an
erotic haze. Women around me are all objects of sexual fantasy. I’m distracted;
not focused. If something requires my attention, when real life intrudes and
yanks me out of my sexual preoccupation, I get angry. Real life is so boring.”
.
This patient uses sexualization as a defense. He uses his sexual pre-occupation
as a way to ward off chronic feelings of loneliness, inadequacy and emptiness
born of a childhood deprived of nurturing from a withdrawn, depressed mother.
When stress or anxiety begins to overwhelm him, sexualization becomes his
standard way of managing feelings that he feels are intolerable as well as a way
of stabilizing a crumbling sense of self-worth.
It is my belief that sex addiction requires a contemporary psychodynamic
approach. Psychoanalysis changed drastically in the 1970’s with the work of a
prominent psychoanalyst who rejected the Freudian approach and established a
kind of treatment that is particularly useful in treating sex addiction.
Contemporary analysts no longer conduct treatment three-times a week on the
couch. They do not unearth hidden meanings, or remain silent, or put themselves
on a “thrown” as being the “One Who Knows”. The process is a shared one and the
relationship between patient and therapist is co-created and mutual.
Some contemporary psychoanalysts use the concept of a vertical split in treating
the addict. The split exists from inadequate parenting which results in
structural deficits in the personality. Patients often report that they feel
fraudulent, living two separate lives with two different sets of values and
goals. They feel they’re acting out a version of “The Strange Case of Dr. Jekell
and Mr. Hyde.”
One sector of the personality, the one anchored in reality, is the responsible
worker and partner. This part of the person is conscious, adaptive, anchored in
reality, structured, and often successful in business. This is also the sector
that experiences guilt and shame about his sexual behaviors and ultimately
drives him to seek therapy to ease his misery.
The “Mr. Hyde” side of the vertical split has a completely different set of
values and seems to be impervious to his own moral injunctions. “Mr. Hyde”
represents the unconscious, split-off part of the personality. It is
impulse-ridden, lives in erotic fantasy, and is sexualized, unstructured and
unregulated. This side of the personality split seems to be incapable of
thinking impulses through, and thus makes the addict/deviant oblivious to the
consequences of his behavior. This is the part of the self that is hidden, dark,
driven and enslaved.
A comprehensive discussion of the actual process of therapy is beyond the scope
of this paper. Suffice to say, the therapist uses him/herself as an instrument
in integrating the split which results in personality structure building.
Treatment bridges the gap of the split. Its aim is the establishment of a
relationship with the therapist that regulates emotional states, to be used as a
“laboratory” to bring to consciousness maladaptive relationship patterns,
provides empathy and understanding and reconstructs the childhood origin of the
addiction. The goal is an integrated self that is able to merely experience a
sexual fantasy without being preoccupied with it and without acting out a
damaging sexual scenario.
The patient achieves some ability to
self-regulate moods, and to seek out adequate and sustaining relationships. He
is then free to put sexuality in its proper place and free up energies to gain
satisfaction from real relationships, pursue creative or intellectual goals,
obtain pleasure from hobbies and activities, and have a heightened sense of
self-esteem, thus enabling him to end his isolation. He is then free to love, to
have deeply satisfying, self-affirming sex, work to his potential, and
experience being a valued member of the human community.
Dorothy Hayden, LCSW, is a New York-based psychotherapist who specializes in the scene, fetishes and sexual addiction. She received her M.S.W. from New York University and her psychoanalytic training at the Post Graduate Center for Mental Health. She can be reached at
dhayden@nyc.rr.com
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