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Book Review– Sex Addiction: A Critical History

Book Review– Sex Addiction: A Critical History

On the heels of the controversial Myth of Sex Addiction comes a new just released book entitled Sex Addiction: A Critical History by Reay, Attwood and Gooder. My colleague, Dr. David Ley, a therapist and author of several book including Insatiable Wives and the aforementioned The Myth of Sex Addiction had an extra copy laying about and I said I would be happy to receive it in exchange for an honest review of the book. Putting that piece of full disclosure out of the way, I should also mention that this is a version of a fuller review I have written that will appear in an upcoming issue of the Journal of Sex and Marital Therapy, in which I have a standing outlet for book reviews. On to the review.

For those unfamiliar with the sex addiction debate, this book is as thorough of an introduction and analysis of the key concepts as one could find anywhere. Even for those like myself, who is up on the latest in sex research, reads all the journals and is keyed in to dialogue with all of the thought leaders, there is still a significant amount of new information to be learned. Typically, when reading a new sexological book, I find myself thoroughly reading the first few chapters and then skimming the rest because either I already know most of what is being presented or the rest of the book simply repeats the ideas from the beginning but in a variety of different ways. Not the case here. The book is strong from beginning to end, and is as much a referendum on our […]

By Michael Aaron|August 26th, 2015|Sex Addiction, Sex and Culture, Sexuality and Psychology|0 Comments

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Overcoming Sexual Shame

Overcoming Sexual Shame

One of the main topics covered in my upcoming book, due sometime later next year, is the shaming effect that society has on our innate sexual selves and what we can do about it. It’s definitely not an easy subject to tackle because both sexuality and shame are extremely complex and cut right to the core of our identities. Save perhaps for urban millennials, who appear to be more sexually open than any other generation in history; it is the rare individual who has been able to escape the ill effects of the social repression of sexuality completely.

For many folks, shame may feel so pervasive that they don’t even realize how much shame they experience; they don’t have anything to compare it to. It may only come out after many years of a committed relationship, where sexual boredom and complacency demand creativity and thinking outside the box. For others, shame is so deeply felt that they enter relationships hiding their true sexual desires, fearing that they will be rejected for who they are. Some of them may believe that they are sex addicts and usually have no difficulty finding someone who will treat them from a pathology lens.

The first thing I want to do when I work with a new client is make it clear that there is no shame or judgment in my office. I’ve heard it all and there is nothing that will shock or disgust me. The books on my shelves range in topic from homosexuality to sadomasochism and I don’t hide them, I put them in full view. The implication is that […]

By Michael Aaron|July 13th, 2015|Sex Addiction, Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|1 Comment

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What is Harm Reduction?

What is Harm Reduction?

Last post I discussed some ideas around self exploration and peak experiences that strongly resonate with me. In this post, I’m going to address another issue which is just as equally important to me– harm reduction. What is harm reduction and what application does it have for sexuality in general and sex therapy in particular?
First, let me say that my introduction to the field of sex therapy was in harm reduction, so all of my work is firmly rooted through this lens. Initially I volunteered and then worked in several harm reduction facilities in the city conducting outreach to homeless intravenous (IV) drug users, street prostitutes, and transgendered individuals. For example, I would go into Tomkins Square Park in the village and trade clean needles for old, dirty ones. I always wore an ID badge to make sure I wasn’t arrested. I would go into known prostitution areas and hand out fresh condoms to mitigate the chances of them contacting STDs. If they were ready for help, I’d bring them back to the facility and connect them with a benefits counselor who would assist them with getting sober and finding housing and any other necessities they needed.
According to psychologist Andrew Tatarsky at the Center for Optimal Living, harm reduction is “a philosophy and set of interventions that seek to reduce harmful consequences of substance use and other risky behaviors without requiring abstinence.” Without requiring abstinence? What is that about? I think an important point here, and one that many harm reduction theorists and practitioners would argue, is that abstinence doesn’t work for everyone. Or […]

By Michael Aaron|February 9th, 2015|Sex Addiction, Sex and Culture, Sex Therapy, Sexuality and Psychology|0 Comments

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Sexuality and Censorship

Sexuality and Censorship

Earlier this month, UK anti-porn advocates won a monumental and far-reaching victory when the UK government passed the Audiovisual Media Services Regulations 2014, in which a whole host of sexual acts are now banned from British porn, based on what the board deems as “content that is not acceptable.” I will get into the list of taboo acts in a moment, but first I think it is important to take a look at what this ruling means. In my opinion, it sets an extremely dangerous precedent, in which some third party or government body can effectively censor anything that they may subjectively object to, even if the material is consensual and harms no one.

Avant-garde Yugoslav film director Dusan Makavejev created films in the 1970s focusing on the intersection between government, society, and sexuality. In his work, he raised a critical eye towards authority and its desire, or more like incessant drive, to eradicate and suppress all freedom and dissent. For his efforts, he was persecuted and eventually blacklisted. As Makavejev so deftly shows in his films, the first line of suppression for any authoritarian government is one of the key sources of our human creativity, inspiration, and personal sense of freedom– our sexuality. History shows that as soon as an authoritarian government rises to power, one of the first things to go is human sexual rights.

Take a look around at the world, and you can see for yourself the crackdown of human sexuality imposed by authoritarian and dictatorial regimes– Egypt’s gay community targeted by government crackdown http://www.theguardian.com/world/2014/apr/17/egypt-gay-community-fears-government-crackdown , Russia’s institutional violence and discrimination towards gays http://www.msnbc.com/rachel-maddow-show/religious-right-leader-backs-russian-cra , Uganda’s anti-homosexuality legislation http://www.bbc.com/news/world-africa-29994678 , […]

By Michael Aaron|December 16th, 2014|Sex Addiction, Sex and Culture, Sexuality and Psychology|0 Comments

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Sexuality and Self Destructive Behavior

Sexuality and Self Destructive Behavior

I’ve written many times before about all of the wonderfully positive aspects of sexuality, but I cannot examine the totality of sexual experience without acknowledging that some individuals can and do use sexuality for destructive purposes. Often as clinicians, we will see these destructive acts in the form of self-destruction– risky sexual behaviors in which the individual can end up badly hurt, dead, or in jail. Often these destructive behaviors are compulsively performed in the face of, and even due to the threat, of these dangers. In other words, the danger itself is what makes the behavior so arousing. I don’t think it’s enough though to simply understand that self-destruction is arousing. That makes it seem like any other kind of fetish or sexual proclivity. Rather, I think the other salient point to understand about this behavior, is that the individual believes that they are worthy of self-destruction. In other words, the individual may be aroused by destruction (or the “death drive” as Freud called it), but for him to continue seeking self-destruction, he must believe that this is what he deserves. So, fundamentally, if we are to try and change this individual’s self-destructive behavior, we must seek to change his relationship to himself.

Destructive behaviors of any kind, whether they are sexual or not, usually if not always involve underlying aggression. And as I’ve discussed in numerous other posts, aggression is fueled by anger and rage. So, destruction of any kind is fueled by anger, which is a simple enough observation. But it becomes an important consideration to keep in mind when understanding destructive […]

By Michael Aaron|September 19th, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|3 Comments

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Mindfulness and Sexuality

Mindfulness and Sexuality

One of the most important topics that I address with clients is the subject of mindfulness. To understand the importance of mindfulness, particularly when it comes to sexuality, let’s first take a look at what it is and what it isn’t. Many people confuse mindfulness with some sort of meditation practice, such as Zen or Vipassana. While it is true that meditation builds and fosters mindfulness, one can practice mindfulness without engaging in any of the meditative traditions. So what is mindfulness? It is defined as “the intentional, accepting and non-judgmental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment.” This can occur within a meditative practice, or just throughout the day, as one observes oneself while at work, sitting on the train, eating, or engaging in interactions with others. The most important aspect of this kind of self-observation is acceptance and non-judgmentalness. I’ll say this once more, because it bears repeating. Acceptance. Non-judgmentalness.

What does this have to do with sexuality? Everything. Often when we find ourselves struggling with some aspect of our sexuality, what is actually going on is that we are fighting ourselves. What I mean is that sexual performance, sexual desire, sexual arousal, and so on, come naturally. We don’t have to think about it. It just happens. But when we are experiencing sexual difficulties, we may be pressing too hard, putting undue pressure and stress on results, tensing our pelvis and surrounding muscles, or just fighting off the natural emotions that arise. In other words, we are going against the current, and not allowing ourselves the experience […]

By Michael Aaron|August 23rd, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|2 Comments

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Book Review: The Sober Truth and What It Means About Sex Addiction

Book Review: The Sober Truth and What It Means About Sex Addiction

I recently finished reading a fascinating book, The Sober Truth, by Lance Dodes, which focuses a critical look at the treatment of addictions, particularly inpatient rehab centers and 12-step groups. I’m sure this book will prove to be very controversial, especially in addiction circles, as its main premise is there is no evidence that 12-step groups, or inpatient rehabs (which are mostly modeled on the 12-steps) are more effective than no treatment at all in helping folks to overcome their addictions. In all, research shows that only 5% of those who regularly attend a 12-step fellowship are able to abstain fully from alcohol or drugs in the long-term, which is about the same percentage of those who quit on their own.

As a sexologist, my expertise is not in addictionology, but where my practice does intersect the addiction field is in the area of sex addiction and sexual compulsivity. There is currently tremendous debate whether out-of-control sexuality is really an addiction or a compulsion. For more on this, check out this article which covers recent research in this area. Interestingly, in The Sober Truth, Dodes states that all addictions, yes ALL addictions, and this includes all manner of drug addictions and alcoholism are really compulsions, not addictions. To illustrate his point, Dodes differentiates between physical addictions, where the human body has built up a tolerance and would go into withdrawal if the substance is removed, and the psychological or emotional aspect of the addiction, which looks very similar to a compulsion. Dodes states that it is quite possible to develop a physical addiction without emotional dependence, as well as emotional dependence without physical addiction. […]

By Michael Aaron|June 22nd, 2014|Sex Addiction, Sexuality and Psychology|0 Comments

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The Connection Between Attachment and Sexuality

The Connection Between Attachment and Sexuality

One of the subjects that I have spoken on extensively on over the last few years is the topic of attachment. By attachment, I am referring to the style of interpersonal relating that we have learned and internalized from childhood experiences. According to decades of research, started by psychoanalyst John Bowlby and extended by Mary Ainsworth, among many others, psychologists have identified four main types of attachment styles- secure, anxious/ambivalent, avoidant, and disorganized. The secure attachment style, prevalent in 65% of the population is marked by emotional stability and a childhood featuring stable and nurturing caregiving. Anxious/ambivalent attachment is characterized by obsessive preoccupations about the object of the intimate relationship and intense fear of abandonment. People with this attachment style typically have experienced inconsistent caregiving, and so have grown to feel unsafe in the stability of close relationships. Avoidant attachment is marked by the avoidance of intimacy, as well as of experiencing feeling and emotions. These folks have typically experienced more neglectful caregiving as kids. I will put aside the disorganized attachment for the moment, as it is not very common, and is typically a byproduct of more severe abuse.

At this point, I want to make an important note about what I mean by “intimacy.” I think sometimes folks get caught up in some kind of a rigid idea about what intimacy means, one that is cooked up in harlequin romance books, soap operas, and Hollywood Happy Endings. This involves the kind of romantic closeness, actually known as partner engagement, which involves the typical aspects of what we would all consider as deep and meaningful love making– the pillow talk, […]

By Michael Aaron|April 24th, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|1 Comment

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Addicted to Addiction

Addicted to Addiction

Last week, a colleague consulted with me on a challenging case in which his client cannot enjoy sex unless he is engaged in smoking. The client, who also struggles with obsessive-compulsive disorder (OCD), specifically cites the feeling of being addicted to nicotine as the most arousing aspect of this behavior. In other words, he is aroused by addiction.

In trying to make sense of this, I think the first thing to understand is the role that this person’s OCD plays in his everyday experience of life. Many would argue that OCD is some sort of inborn disruption of the neurochemicals in the brain, and maybe there’s some truth to that in some cases, but the first things that I look at are the themes of anxiety and control. Specifically, how do this person’s obsessions and compulsions help him to gain a greater sense of control over his anxiety? In my experience, an individual experiencing either obsessions (incessant thoughts) or compulsions (incessant behaviors) inevitably uses either or both of these as strategies to manage and control anxiety. Unfortunately, they often only serve the purpose of making the anxiety worse.

Often, other people will categorize those who suffer with OCD as “anal” or “control freaks,” but this controlling behavior can best be understood as an antidote to the overwhelming feeling of anxiety that these folks experience on a regular basis. The constant ruminating (obsessional thinking) and ritualized behaviors (compulsions) can come across as overly controlled, but this is the only way that these folks have learned to defend against constant and intense anxiety.

This is where I think the […]

By Michael Aaron|March 19th, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|1 Comment

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Is Sexual Compulsivity an Addiction?

Is Sexual Compulsivity an Addiction?

My colleague, Dr. Crocker, and I have given numerous presentations on the subject of sexual compulsivity and sex addiction. Whether sex addiction is a real disorder is a hotly debated topic, and just recently an effort to include sex addiction (hypersexual disorder) in the DSM 5 was rejected. I will save more complex thoughts on this topic for another post, but suffice it to say, many of the folks who seek treatment are not really sexually compulsive, they are just shamed up or have other motives for self-defining themselves as addicts. Yes, others really are compulsive and I have expertise in helping them out.

But here’s what really got me excited about writing a post– Dr. Crocker just completed a study about sexually compulsive folks that I feel is one of the most groundbreaking research projects ever in this area and once published will surely establish him in psychology as a brilliant pioneer. So let me explain what this study is all about, how it was put together, and what it uncovered.

Dr. Crocker recruited a group of over 70 compulsive guys and administered a battery of psychological tests to gauge levels of compulsivity, attachment style and childhood trauma. The tests were self-administered online and then the results were calculated with advanced statistical programs.

The results were stunning. The study found a high degree of statistical correlation between sexual compulsivity and avoidant attachment style. To understand what that means, it is important for me to provide a brief description of what attachment theory is all about. Pioneered by John Bowlby, the field of attachment studies the relationship […]

By Michael Aaron|October 23rd, 2013|Sex Addiction|0 Comments