Some thoughts on sex on a rainy Saturday from a couples therapist

I awoke this morning thinking about sex. First of all, as I write these words I am glad that my kids are no longer in middle school as they would have been grossed out and humiliated to read that opening line in a public forum from their father. Secondly, three things came together all at once to start my day off with thoughts about human sexuality, and let me be clear that I do not mean that I woke up particularly aroused, instead I found myself pondering sexuality and what I think about it.

The first factor in this confluence of events is that my wife is away for the weekend, so I woke up a little lonely on a rainy morning, but also with time on my hands.  Secondly, two days ago I read a blog entry from my mentors, Drs. John and Julie Gottman regarding pornography  https://www.gottman.com/blog/an-open-letter-on-porn/ . And finally, last night I attended a presentation by Rob Weiss, LCSW regarding his soon to be released book Getting Out of the Doghouse: How to Heal Relationships Fractured by Multiple Infidelities and Sex Addiction. 

Thanks to my association with Willow Tree Counseling (which co-sponsored Robert Weiss' presentation) I have had the privilege to work with couples in the past couple of years that are struggling to heal the their relationships from the effects of "multiple infidelities and sex addiction". I give props to all of the couples that make the choice to seek help for a troubled relationship, however, there is another level of courage necessary for the recovering sex addict and his/her partner to enter into couples therapy. First of all the recovering sex addict has a mountain of shame to overcome and secondly his/her partner typically has been traumatized by the revelation that their addicted partner not only has been unfaithful, but has lied to them repeatedly.

These couples truly need help from skilled and informed professionals, yet we practitioners of psychotherapy (including couples therapists) as a group are not even in agreement that sex addiction exists. For evidence of my assertion, the reader can look no further than the latest edition of the book that mental health professionals are required to use to diagnose psychological disorders, the American Psychiatric Association's Diagnostic and Statistics Manual (DSM). In DSM V, we find all sorts of chemical addictions and also gambling addiction, but no mention of sex addiction. 

I had the honor to sit last night with a group of colleagues including Susan Pease-Gadua, LCSW, who has written extensively about couples relationships and also works with Willow Tree Counseling. Several months ago Ms. Pease-Gadua attended a training with the esteemed couples therapist, Esther Perel (author of Mating in Captivity, which I believe is very thought provoking book ). Ms. Perel told Ms. Gadua that she believes that sex addiction is an American phenomena, meaning that it is not a brain-based addiction, but a learned behavior based upon cultural factors. Ms. Pease-Gadua also referenced this article https://www.psychologytoday.com/blog/sexual-intelligence/201506/eleven-facts-about-sex-i-wish-judges-lawyers-understood in Psychology Today by the esteemed psychologist and sex therapist Dr. Marty Klein. In the article, Dr. Klein states as fact, "Science has never shown that people who watch porn behave differently than people who don't. Science gives absolutely no evidence that 'porn addiction' exists." Although Dr. Klein does not specifically say that sex addiction does not exist, many individuals that identify themselves as sex addicts report that pornography is their "drug of choice" if you will. 

After listening to Ms. Pease-Gadua's comments about Esther Perel's statement regarding sex addiction and reading Marty Klein's statements about porn addiction, I contacted a fellow Gottman Method Couples Therapist, Dr. Robert Navarra, who is an expert on addiction and trains couples therapists about addictive dynamics. Dr. Navarra expressed the strong opinion that the underlying brain mechanism for chemically based addictions (such as cocaine addiction and alcoholism) is the same as that of behavioral addictions (such as gambling and sex addiction). He cited several studies backing this stance including one from the University of Cambridge referenced here  indicating that the brain activity of sex addicts mirrors that of drug addicts. 

My point in bringing up the conflict within the field of psychotherapy about the existence of sex addiction is that it is hard enough for sex addicts and their partners to work on healing given the inherent shame and trauma they must face without those of us who are there to help being at odds. Finally, this is where the blog entry noted above from the Gottman's ties in to my morning thoughts about sex. The Gottman's take a strongly anti-pornography stance about porn. They take this stance, not just for sex addicts, but in support of intimacy in all couples relationships. They suggest that use of pornography is bound to lead to a disconnect in intimacy for couples using it. The comments from the blog readers that follow the Gottman's "open letter" on porn are spirited and in many ways reflect the struggle that we have as a professional community and as a society in general with the nature of sexuality, sexuality in intimate relationships, and also the concept of sexual addiction. 

It is clear to me from my reading of scientific literature and my clinical experience that sex addiction exists. I agree with the Gottman's that the porn industry is largely exploitative and that the use of pornography is likely to have the effect of diminishing intimacy in couples relationship (certainly if used solely by one partner and perhaps if used by both). I trust in John Gottman's research findings that the primary predictor of good sex in a committed relationship is strong friendship, and I chuckle at the truth behind his joke that when female "Viagra" was developed he said "but it has already existed for years, it's called listening". On the other hand, before we cast out all "porn" from committed relationships should there not be dialogue between couples about what is erotic, including visual images, films, writings, and ways of being playful sexually? Despite her anti-sex addiction comments, I also think that Esther Perel has some wisdom when she says "Love seeks closeness, but desire needs distance." It is my hope that as a community we can have healthy dialogue regarding the dialectic that Ms. Perel suggests and also my wish for every couple to have this healthy dialogue. 

It is still raining, but time for me to get out of bed.

Peace, Mike Basta, LCSW, Gottman Method Couples Therapist

For more information regarding help for sex addicts and their partners, I urge interested parties to check out www.willowtreesantarosa.com .