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How Do We Treat Sex Addiction if It Isn’t Real?

It’s heartbreaking, as a therapist, to see multitudes of patients walk into my office thinking they’re sex addicts, often led by the hand of an angry partner, sometimes having just run away from years of pricey sex-addiction treatment that’s based on nothing more than the sex phobia and the miseducation of its founders and practitioners.

In our horrendously hyper-sexualized yet sex-negative and suspicious culture, few people have done the work of untangling their sexuality and sexual judgments, so a term like sex addiction makes a lot of sense. But the larger problem is that many people in the mental health field (therapists, psychologists, psychiatrists, etc.) are no healthier — and often even worse.

Academia has done a poor job of educating mental-health students in sexology, sex therapy and human sexuality, with either no class requirements or sometimes only a pass/fail one-off class. Any training for sex-related therapy tends to be via specialized programs outside of the university system. Some it is good, some of it isn’t. All of it puts the onus on the practitioner to work rigorously for years to get an actual certification.

In total, there are only about 500 of us certified in sex therapy across the world. This leaves the rest of the mental-health world undertrained and riddled with the standard cultural anxiety and miseducation around sex. Case in point: I’ve worked in offices and group practices where other therapists were upset with the promotion of my clinical services or the visibility of my book (Sex Outside the Lines: Authentic Sexuality in a Sexually Dysfunctional Culture) because they’re both sex-centric. And generally speaking, they were uncomfortable with my healthy use of sex terms, open discussions of sexual anatomy and ease around sexuality.

On the flip side, I was horrified at their inability to do the same, wondering how they could possibly model healthy sexuality and clinically address sex-related issues (which all couples and marital therapy mandates) if they couldn’t discuss these concepts confidently and openly with me and their other colleagues.

That said, I’m not going to break down all that’s wrong with the mainstream mental health community when it comes to sex addiction — that work exists in my book and all over my social media. Instead, I want to present a solution for how someone who feels they relate to the term “sex addiction” should go about addressing it.

This work requires a sexual re-education and unlearning of all that you’ve been told in your life about sex. I had to do the same. Like most, I was taught that the majority of us are heterosexual; that sex was about penetration and always between only two people in a monogamous relationship; and that the main goal was to build toward marriage and reproduce subsequent generations of the human race.

Sadly, all of this is wrong — pathologizing anything different, and not actually relevant to anyone’s real life. Sadder still is that most therapists reinforce these notions as the only way to have a healthy sex life and relationship.

Meanwhile, good therapy for those struggling with issues that many place under the sex addiction label preaches the exact opposite. Healthy relationships can be open or poly. They can be short-term or long-term. And most importantly, sex with their many partners — potentially of various gender presentations and diverse bodies — can be non-penetrative. In short, healthy sexuality is about a variety of options and full confidence in the diversity of sexuality.

Shame is the common theme here. The suspicion of anyone who openly enjoys sex, has a lot of it or prioritizes it is so great that most of us immediately problematize it without any critical exploration. While it’s okay to watch football all day Sunday or binge-watch The Real Housewives in a single sitting, the idea of spending the same amount of time having sex or watching porn is viewed as an immediate issue — or even an “addiction.”

But that’s wrong. This isn’t about wasted time or “checking out”; it’s about a fear of sex.

So first things first: We need to embrace those who love sex — and thereby lessen their shame and boost their confidence in the values they place on sex and pleasure. After all, sex is one of the best ways to self-soothe, cope with stress and entertain oneself. If it’s healthy to read a book, do yoga or play basketball, it’s the same for sex. Most of all, remember: Your calling someone a sex addict (or slut) says everything about you and your anxious sexuality and nothing about them. It says you’re uncomfortable with what you’re hearing, so the work falls on you to process and unpack why sex scares you, and to not project your immaturity onto others.

This is where we need to fix the literature on the topic, too. There are very few resources psychologically and therapeutically where someone interested in nontraditional sex can find support. There are, however, many where they can get shamed or pathologized. I was once pulled aside at a drug-and-alcohol addiction center I worked at to consult on a case because I was “the sex guy.” The lead therapists wanted to know how to work through the following issue with one of their clients: “He was having sex and hanging out with a transgender girl.” They’d been trained to believe that this might be the sign of a sex addiction; that being cisgendered is the only healthy way to be; and that heterosexuality should always be centered in a definition of “health.”

After my shock, horror and disgust at the question, I was able to explain that the real issue was their transphobia and that the gender of their client’s partner was far from the problem.

In that way, good therapy confirms and supports dating and sex with all genders, bodies and sexualities. I frequently work with clients who need confirmation that it’s okay that they’re asexual, solo sexual (interested in masturbation only), pansexual, fluid, into objects rather than people.

My main message to them: Difference isn’t a disorder.

I also prescribe porn to many patients and couples as a therapeutic treatment. Porn, like all forms of art and film, has many different capacities, and its healing benefits are vast — despite what many miseducated “experts” have written about its “dangers” and “addictive” qualities. Many studies show, in fact, that cultures with more permissive attitudes toward sex and porn have less sex crimes, lower rates of teen pregnancy and lower rates of STDs. And so, I prescribe all kinds of porn to patients to help normalize diverse sex acts and to increase body esteem for non-normative bodies.

After all, the needed work isn’t more shaming of individuals’ sex lives and psyches; it’s more liberation and comfort with diversity.