Deserts and Pineapples: An alternative approach to treating "sex addiction"

​Becoming a sex therapist has been (mostly) an incredible experience. I have the privilege of walking alongside clients who are struggling with intimacy and relationships, whether it is due to trauma, poor communication, or a desire for exploration. I am honored when clients report feeling excited and empowered to engage in healthy, bountiful intimate lives as a result of their hard work. 

Unfortunately, no career is without its drawbacks. In my line of work, I am also exposed to the harmful effects of inadequate sex education, which can lead to disillusionment, fear, and shame among many other side effects. Many clients need to unlearn harmful beliefs before we have the opportunity to discuss healthy sex. While helping clients rewrite these narratives can be an incredibly rewarding experience, it also saddens me that so many of them have endured so much pain, especially since they often feel isolated or alienated. 

​One topic I encounter very frequently is that of compulsive sexual behavior, or what is more commonly coined as “sex addiction”. There is a great deal of misinformation regarding this type of behavior, but the American Association of Sexuality Educators, Counselors, and Therapists takes a firm position when it comes to the topic of “sex addiction”: 
AASECT “1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be informed by accurate human sexuality knowledge”. 

This statement, in essence, means that treating compulsive sexual behaviors as an addiction is more likely to do harm to clients. After all, who is to say what is too much sex or what constitutes healthy sexual behavior? There is no universal baseline upon which all individuals should base their sexual behavior. 
To be clear, this does not mean that sexual behavior cannot become a focal problem in a person’s life. Like any compulsive behavior (shopping, stealing, video games, etc.) sexual urges and pornography consumption can cause significant distress and are worthy of treatment. If a client is reporting significant problems in their relationships, work, or their ability to complete necessary life tasks, I am likely to label the problem as compulsive sexual behavior and treat it as such. Most compulsive behaviors create a sense of satisfaction with diminishing returns, thus leading to escalation. However, these behaviors rarely resolve the real problem. 
My outlook is that every behavior or pattern intends to meet a need or create positive outcomes. Sexual behavior is no different. There are a lot of reasons clients report turning to sex as a comfort behavior: among them are suppressive education, relational differences in desire, high stress, or deviant (i.e., atypical) desires. After normalizing that there is no “normal” way to be a sexual being, my mission becomes to identify the relevant problem or need causing the behavior. 

Consider this simple, empathetic metaphor for compulsive behavior:
“You’re in a desert,  starving. You find an oasis filled with pineapples. Any sane person would eat the pineapple, even if they are allergic to it” 

You see, compulsive behaviors are used in absence of an alternative. A person taught to feel shame related to their sexual urges may fear being honest about them. When suppressing these urges proves ineffective, they may use pornography as an outlet. Given the relief they may feel to finally have an outlet, they pursue it more and more, until it becomes a problem. Instead of treating the outlet, my job is to help the client find adaptive solutions for their distress

Among many options, these may include:
Taking ownership of sexual desires
Education about healthy sexuality
Self-soothing techniques from distress

I find that this approach produces the most effective results, especially when it comes to improving communication about sexual needs and desires. Clients often report a reduction in shame when thinking about their sexual selves. If you, your partner, or a loved one are struggling with sexual compulsivity a sex therapist, especially one certified by AASECT, may be the healthiest and fastest way to find relief!