Sex Addiction: Interview with Chris Wolf

[Episode 24] Sex addiction has been defined as "engaging in persistent and escalating patterns of sexual behavior despite increasingly negative consequences to self and others" (Ewald, 2003). In today's podcast I talked with Chris Wolf, a licensed marriage and family therapist and a certified sex addiction counselor. She received her masters in counseling psychology from the University of Pennsylvania, and trained with pioneering sex addictions researcher, Patrick Carnes. She currently works at Gateway Rehabilitation Center in Pittsburgh, Pennsylvania and has a private practice where she works with primarily with couples dealing with sex addiction. Our interview covered a broad range of topics, including how sex addiction is similar to and different from substance use addiction, common characteristics of sexually addicted clients, basic skills and competencies clinicians need when working with sexually addicted clients, and some resources for further study or learning.

Download MP3 [52:22]


As with the podcast with Jody Bechtold on pathological gambling, this interview is intended to be an overview and introduction to the topic of sexual addiction. It is not intended to be used as a substitute for supervision or clinical training.

Transcript

Interview
Jonathan Singer: What is a sex addiction?  For example, how do you know when your client has a sexual addiction?

Chris Wolf: Well, addiction, in general, is about compulsivity, continuation despite consequences, and obsession.  Sex addiction is about the loss of the ability to choose freely whether to stop or continue to a behavior.  It is an out of control, addiction means loss of control and sex addiction, it would a sexual activity of some kind or a preoccupation or obsession.

 Jonathan Singer: Since sex addiction is not a DSM diagnosis, how do you bill for it?

Chris Wolf: It has to be diagnosed under the heading of Impulse Control or OCD, Obsessive Compulsive Disorder, or sometimes it’s under Depression or Anxiety Disorder.

Jonathan Singer: How is sex addiction different from and similar to substance use addiction?

Chris Wolf: Well there’s a lot of similarities so let’s start with the differences.  Sex addiction involves the brain, they all involve the brain really, but sex addiction, they are creating the substance through the arousal template, and through the fantasies or sexual activities.  And so they can’t just walk away from the drug and be away from it, they carry it with them.  There’s often a secret life, and they use all three neuro-pathways in the brain, whereas some other addictions use one or another, but sex addiction uses all three.  And usually there’s other addictions, there’s often trauma as the basis, or oftentimes, sexual abuse as the basis for a large percentage of people who have a sexual addiction.  So you have similar things that you have with an adult child of an alcoholic that’s also a drug addict or an alcoholic, once they stop using the drug or the alcohol, you have all of this trauma to deal with, where you’d really like them to just stabilize before you have to deal with that, and the same is true with sex addiction.  It’s not that easy to compartmentalize or just say we’ll wait a year with that.

Jonathan Singer: I assume that the treatment process for sex addiction is similar to treating other types of addiction, for example, there’s a lot of challenging, breaking through denial, understanding the clients readiness and willingness to change.  I also assume that there’s some unique features in treating sex addictions, could you talk about some of those?

Chris Wolf: Well the one I just mentioned about the trauma and abuse issues that are underlying, so since addiction is a way to medicate and you take away that medication, you oftentimes have to deal with those issues immediately.

Jonathan Singer: Or else those issues will come back up and perhaps trigger your patient?

Chris Wolf: I would say the triggers are very intense.  For example, I had a patient, and it’s not unusual to describe, he could not watch television, he could not read a newspaper, he could not open a magazine, he could not go to a movie, it was just all around him, as you know in our society, and when he got triggered it would send him on a binge that could last for several weeks, and that’s how the addictive cycle works for sex addiction.  The unmanageability of that, they continue to go until they crash, just like with drugs, and then they have so much shame that they feel the need to go act out again to medicate the shame.

Jonathan Singer: I also know that sex addiction is very similar to gambling addiction, it’s a process addiction, since it doesn’t require any external substance, so what do you mean when you say there are triggers?  What would be an example of a trigger?

Chris Wolf: Visual, because oftentimes people get aroused by an image.  Summers are very difficult for sex addicts, where women are walking around in shorts and halter-tops.

Jonathan Singer: So what are some of the other approaches for treating sex addiction, perhaps that might be different than for treating other types of addictions?

Chris Wolf: One of the things is there aren’t as many meetings.  There may be four or five meetings in the whole city, where drug and alcohol addicts can find one wherever they need to be, morning, noon, or night, seven days a week.

Jonathan Singer: What are those meetings?

Chris Wolf: There’s SA for married people, you have to be in a committed heterosexual relationship to be in SA.  So there’s SLA for Sex and Love Addicts Anonymous, and SAA for Sex Addicts Anonymous, which have a little different requirements.

Jonathan Singer: Are those meetings available across the country?

Chris Wolf: It’s getting so that they are pretty much, though there aren’t as many meetings.  We’re also talking about little support group for spouses, there aren’t any, we’re trying to get some started.

Jonathan Singer: That sounds like a really valuable service, does it have a name?

Chris Wolf: COSA

Jonathan Singer: COSA, so what does that stand for?

Chris Wolf: Co Sex Addiction.  The spouses need to be brought into the treatment, and early, and that’s different, well we’d like that with all addictions, but with this because of the trauma and the shame that it triggers in the spouse, it really is very helpful if we can get the spouse involved right away.  And therefore, get them involved in their own recovery.  Sex addiction is similar to eating disorders in that you can’t live without food, and certainly you cannot imagine a life without sex for the rest of your life.  Like with food addiction, they say it’s like taking a tiger out and walking it three times a day, well you have to find a way over the recovery time to slowly build back a healthy sexual relationship.  They also need to go through a period of abstinence sexually, they have a sexual withdraw, they have a physical withdrawal, and a lot of people do not understand that.

Jonathan Singer: So what qualifies as abstinence, when you’re talking about sexual addiction?

Chris Wolf: Abstinence would be the absence of those bottom line acting out behaviors.  The period is 60 days, no sex whatsoever.

Jonathan Singer: And so that would include solitary activity, such as masturbation or looking at porn?

Chris Wolf: Right, anything, because if you ask well where does this take you?  If that behavior, let’s say it was even petting as we might say it with the wife, if that triggered these old behaviors, then they have to have a period of abstinence to calm that all down.

Jonathan Singer: What are the most common characteristics of your sexually addicted clients?

Chris Wolf: Distrust or trust issues, accountability problems, inability to be intimate is a big one, just because they’re a sex addict you might think they’re really good at this thing called sex, but the truth is they do have a problem being truly intimate.  Family issues are usually at the core, family of origin issues, oftentimes abuse is an early factor, they may be attached to persons they don’t know aren’t looking out for their best interests, so boundary issues, trauma issues, abandonment, or at least a perceived loss is oftentimes some of the issues that are in all addicts.  As far as their personalities, there is no image that fits all, there’s no personality type that fits all, but a lot of shame, secret life, isolation.  They often times come from rigid or disengaged families, where there was a lot of extreme control and then the need to assert yourself independently against that and in creating a secret life, and that rigidity oftentimes, addiction is a way to try to manage the chaos.

Jonathan Singer: Chris, as you’re talking, it seems pretty clear that people with sexual addictions are as multifaceted as just about anyone else that we might see in therapy.  What’s the first thing a clinician should do when a person with an acknowledged sex addiction comes through the door?

Chris Wolf: I think the very first thing is that you should not see a sex addict if you don’t feel comfortable extremely important, because they pick it up.  You have to examine your own sexual issues in order to work with sexual addicts.  If you have any kind of bias, if you have any kind of chuckling under your breath when they’re telling you about their sexual behavior, then you really shouldn’t see them.  So that’s the first thing.  Second thing is that you need to assure them of what training you have and background, and that you are comfortable with whatever they need to say, so of course like in any therapeutic endeavor, you have to form an alliance, but the fact that their coming in with such shame, you have to start with that I believe.

Jonathan Singer: Are there any confidentiality issues when working with a client with sexually transmitted infection who’s engaging in unprotected sexual behavior?

Chris Wolf: I tell my clients before they ever have any disclosure to know that if they are going to share anything illegal, I would have to report them, I just let them know that at the very beginning, so if they don’t want me to know that, they better not tell me because I have to act upon what the law has told me I have to as a therapist.  So we’ve come back to another very important point in terms of your question, and that is to know the level of your competency, and that is part of our ethical standards, and to know where you need to refer to somebody else, and as I said to you before, I work with Eric Deck and Christine Cook, and I have a man come to see me, I want him in a men’s group, immediately, as soon as possible.  So Eric runs some men’s groups, we want to have that couples support, and so we need a place for that, I do that, and Christine also she doesn’t have any groups, she sees individuals a lot, so we really try to find what’s really the best and most effective and efficient treatment that we can give the client.  And that should be what our discernment is.

Jonathan Singer: What are some short-term and long-term treatment issues that are common with sex addiction?

Chris Wolf: First point, stabilization, getting them so that they don’t get triggered quite so easily, helping them establish network of support, meetings, sponsor, relapse prevention, we have certain things that we like them all to learn.  Like we do the three circle exercise, so that they know what their bottom line acting out behaviors are, and that’s also what they have to disclose to their spouse.  Then we have them know what people, places, and things will trigger those acting out behaviors, so that they really have that clear, and then that’s what their supposed to try not to relapse from that.  Whether there’s addictive interaction disorder, whether there are multiple addictions, and therefore, if you don’t have them assessed you’re looking at the sex addiction, but there might be a cocaine addiction because 57% of cocaine addicts also engage n sexual behavior.  Oftentimes a sex addict also has food addictions, gambling addictions, high-risk behaviors, financial, we try to look at all of them and make a proper assessment.  Addiction is a disease of emotions so I do a lot of work with my clients helping them learn a comfortable way to experience emotions, release emotions, I do a lot of teaching around that and give them self-supportive tools.  They have to change people, places, and things, just like other addicts, they have to face the pain and the damage that goes to the core of their being, because oftentimes as I said, there’s sexual abuse in their own childhood or abuse issues, abandonment issues, a trauma.  Shame reduction is another thing that we have to really focus on in the sex addicts, because it is the shame that triggers the addictive cycle.  Disclosure with their spouse, and there’s some differences in opinion on that but we really tend to believe, the people I work with, as soon as they can disclose to their spouse and get their spouse involved, we want that to happen.  Trauma is another thing, I do a lot of trauma work, I teach them what to do when the trauma is triggered and how to recognize that because oftentimes that is the basis of what’s triggered the sexual acting out anyway.  Because addiction is a response, it’s a repressive mechanism, it’s to try to medicate, to alter the state of mood, to escape, but to escape what?  So we have to deal with those core issues as part of their therapy.  Intimacy issues is another big things because addicts, sexual addicts, do not even know what real intimacy is and so over the period of years that’s what we teach them.  Trauma bonds are different than trauma, it’s when they can’t stop behavior when they actually speed up in that behavior, there’s evidence then of a trauma bond that we need to deal with.  That behavior they speed up with stacked against a moral code that they have that says they don’t want to be doing it but they can’t stop.  Long-term goals are to learn how to manage their anxiety by teaching them self-supported tools, to teach them how to manage reactivity and some of the things that I just said previously are for that, acquiring the ability to withstand discomfort for personal growth, and the 12 steps oftentimes is a good tool for them to hang on during a crisis and work through something in that regard.  They have to learn how to change their distorted thinking because that is one of the problems with any kind of addiction, and as I said, teach them a lot of self-supporting tools, boundaries, it’s about intimacy. 

Jonathan Singer: I’d like to follow-up on this idea of boundaries.  You’ve mentioned that people with sexual addictions cross boundaries when they act out in sexually inappropriate ways, for example, extra-marital affairs, but there are behaviors such as voyeurism and pedophilia that cross sexual boundaries and break laws, so what’s the difference between say sex addiction and sexual offense, and when do the two overlap?

Chris Wolf: Someone who creates a sexual offense is not necessarily a sexual addict.  A sex offense would be something that is illegal.  Flashing, voyeurism, exhibitionism, prostitution, where the person is a prostitute because they’re actually a sexual addict and it is the sex for money or sex for pay that is the arousal.

Jonathan Singer: In preparation for this interview I came across a couple of terms that I thought our listeners might not be familiar with.  I was wondering if you could explain what is meant by sexual sobriety and sexual health, and also how you might explain these concepts to clients?

Chris Wolf: Sexual sobriety is the ability to stop the bottom line acting out behaviors.  Just like an alcoholic does not drink anymore, they do not engage in those bottom line acting out behaviors anymore.  Sexual health is the goal of becoming sexually intimate and understanding what true intimacy is, and changing from sex being simply recreational activity or something that you really don’t even need to know the other person, it’s anonymous, to only feeling aroused because there is the respect, and the trust, and the commitment, and safety involved.

Jonathan Singer: In drug and alcohol treatment, clients are often asked to go to 90 meetings in 90 days, is there a similar expectation when treating sexual addictions?

Chris Wolf: We would certainly like the 90 meetings in 90 days but there aren’t the 90 meetings, so we ask them to go to at least three to five meetings per week, to get a sponsor, in fact we ask that they get three sponsors.

Jonathan Singer: Really, why three sponsors?

Chris Wolf: Because they need someone to call and if that one sponsor isn’t available they need to develop a group of people that are in the program that they can call when they feel like acting out and talk to.  Sadly to say, there are not a lot of people in the programs that have a lot of years of sobriety, and those that do get asked to be a sponsor by a lot of people.  And interestingly, after 90 days, the brain seems to repair itself to a degree that it starts to make it easier, but 90 days truly is a magic amount of time, it’s really what we would like for that reason.  But whatever the behavior was once they start to engage in it again, even after they’ve had the period of abstinence, they have to notice, and where does that take you, does that start the preoccupation again, does that start the obsession again, does that start them to having cravings again, and then we have to back up.  Not for another 90 days, but that’s what we always watch for.

Jonathan Singer: How do you address transference, for example how do you respond when a client says they’re sexually attracted to you?

Chris Wolf: If there’s transference we like just to use it and really it can be very effective in helping them, to just get a lot of information out there in the conscious, which was in the unconscious, and teaching them about the appropriate boundaries, and just so much.  But we do need to be aware of it and interact very openly with the client about that.

Jonathan Singer: Well, transference is certainly a 20th century concept, still applicable today, but I am going to jump right in to the 21st century and ask you what is cybersex?

Chris Wolf: Cybersex is sex on the internet, now that can be a lot of different types of sex, it can just be viewing but it can also be talking to somebody online and a lot of other things.  But yes it can be an addiction, and in fact Pat Carnes, who really brought the publics awareness to sex addiction believes that we are going to have a tsunami of cybersex and one of the quotes that he gave the last time I was with him said that in the work place for example, they did a research of online porno sites from 9 to 5 which meant it had to be during the workday, 40% of those were women.  And that’s the other that we haven’t talked about and that is that women are also sexual addicts but the shame around that is so much higher that we really don’t see as many of them in treatment.  Two thirds (2/3) he said of our children are watching porno sites as they are doing their homework, and there is no age discrimination, there are people who have never had any addiction or any compulsivity behaviors before that are becoming addicted.  Like say a man after he retires, or the loss of a spouse, or just a lot of different things.  It’s very serious.

Jonathan Singer: Chris, you’re obviously passionate about your work, and I can relate to that.  When I was working with kids who were suicidal people always said how can you do that, and for me it was really that I saw kids at their lowest point, and when we were done with services they were better, they weren’t perfect, but they were better than they were when they came in.  And so I guess my question is for you, what is it you like about working with people with sexual addictions?

Chris Wolf: Well, a lot of things.  It’s a life and death matter I think, it’s really serious, and if you can help a sexual addict, you can stop the damage for more than just one person.  You can oftentimes not just help a family, their family, but you can stop a generational pattern, because there usually is a generational pattern.

Jonathan Singer: What do you recommend for social workers who are interested in learning more or who are currently seeing clients with sex addictions?

Chris Wolf: As I said before, they need to receive specific training for it, not just think all addictions are the same.  They have to examine their own issues very thoroughly.  I would suggest that they read “Out of the shadows” by Pat Carnes and “Don’t call it love” by Pat Carnes.  That they understand trauma and know how to work with trauma because it’s a big part of working with sexual addictions.  Of course not always, and I also wanted to say that because one of the things that I failed to say is that the male scripts are also a bearing on what brings about sexual addiction, and I’ve found it to be tremendously helpful to really understand those.  So somebody could be, could engage in sexual addiction as a start because the male script says they have to be really good at this and they’ve got to know how to get themselves aroused by themselves, and it really isn’t about the partner, which I find also, girls now, or women now, in this open generation of sexuality or sex, are starting to fit under the same sexual myths as men, it’s an interesting thing.  And for example, if they, their arousal template got started because they met people at the bars because that was the only place for people to meet, and they had sex the first night they met them, then their sexual template gets to be because it’s new, because it’s somebody they don’t even know, and then when they fall in love with that person, they don’t know how to be aroused, so it caused a problem.  Another thing is after people have been in recovery for about two to three years, then we need sex therapy as part of what is needed to help them through the entire journey.  And a lot of people are trained in sex addiction but not in sex therapy.  Wendy Maltz wrote a very good book called “Healing sexual trauma” that’s excellent for that. We also have SASH which is our certification organization, and they can get on the website and find out about that, attend conferences.  Another thing, David Delmonico is from Pittsburgh, he does a lot with cybersex.

Jonathan Singer: You’ve mentioned Patrick Carnes a few times, can you say a bit more about him?

Chris Wolf: Pat Carnes was the person who brought the publics awareness to sex addiction.  He wrote a book called “Sex addiction” it was a green book with the words sex addiction on the front and when I was at Gateway  Rehabilitation Center, people would come to me maybe the last day or the last week and put a little not on my door that they were having sexual problems or were a sex addict, I would give them that book and they would have to put a brown manila paper around this book so he renamed it “Out of the shadows” and he’s an excellent author, he’s a researchist, and a good clinician, so all three of those, he’s a wonderful source.

Jonathan Singer: Well Chris thanks for being on the podcast today and for sharing your clinical wisdom about the treatment of people with sexual addictions.

Chris Wolf: Thank you, I appreciate being with you, hope it’s helpful.

-- End --

Internet Resources

The Society for the Advancement of Sexual Health (SASH)
http://www.sash.net/

Lists of cybersex addiction, internet addiction, and related resources may be useful to a variety of helping professionals, parents, and others. Resources include website links, self help tests, articles, books, and other materials. Issues addressed include cybersex addiction, internet addiction, sex addiction, computer addiction, among others.
http://www.internetbehavior.com/services/resource_center.htm

Tests for Internet Addiction
http://www.netaddiction.com/resources/iaindex.htm

Simon, S. (2009, March 14). A comedian's memoir of sex, drugs and stand-up: Interview with Russell Brand. National Public Radio
http://www.npr.org/templates/story/story.php?storyId=101881014&ft=1&f=1032


The following annotated bibliography is excerpted from an excellent chapter on sex addiction by Jennifer Schneider: Schneider, J. P. (2004). Understanding and diagnosing sex addiction. Coombs, Robert Holman (ed.). Handbook of Addictive Disorders : A Practical Guide to Diagnosis and Treatment. Hoboken, NJ: John Wiley & Sons.

Carnes, P. J. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare. The classic book about sex addiction is written for people with the problem.

Carnes, P. J. (1991). Don't call it love: Recovery from sexual addiction. New York: Bantam Books.Written for professionals, this book describes the results of research on a large number of sex addicts treated in an inpatient setting.

Carnes, P. J., & Adams, K. M. (Eds.). (2002). Clinical management of sex addiction. New York: Brunner-Routledge. The latest and most complete guide for clinicians on treatment of sex addiction, including special populations (women, pastors, gays, homeless, etc.).

Carnes, P. J., Delmonico, D. L., & Griffin, E. (2001). In the shadows of the Net. Center City, MN: Hazelden. A book for people who are hooked on Internet sex.

Cooper, A. (Ed.). (2002). Sex and the Internet: A guidebook for clinicians. New York: BrunnerRoutledge. An up-to-date scholarly text for understanding Internet sex, both healthy and problematic.

Corley, M. D., & Schneider, J. P. (2002). Disclosing secrets: When, to whom, and how much to reveal. Wickenburg, AZ: Gentle Path Press. Information and exercises for all types of addicts who are keeping secrets from spouses and families.

Earle, R., & Earle, M. (1995). Sex addiction: Case studies and management. New York: Brunner/ Mazel. An excellent guide for clinicians who treat sex addicts and their families.

Schneider, J. P. (1988). Back from betrayal: Recovering from his affairs. Center City, MN: Hazelden. (Second edition, 2001, Tucson, AZ: Recovery Resources Press.) The classic book for spouses of sex addicts. It describes the steps of recovery for the partner.

Schneider, J. P., & Schneider, B. H. (1991). Sex, lies, and forgiveness: Couples speak on healing from sex addiction. Center City, MN: Hazelden Educational Materials. (Second edition, 1999, Tucson, AZ: Recovery Resources Press.) Based on research with many couples who have dealt with sex addiction, this book describes how to rebuild trust, forgive, and rebuild the relationship. Written for couples who are going through the process.

Schneider, J. P., & Weiss, R. (2001). Cybersex exposed: Simple fantasy or obsession? Center City, MN: Hazelden. This book provides an explanation of how and when computer sex becomes an addiction, and the steps to recovery. (p. 229-30)

APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, September 17). Sex Addiction: Interview with Chris Wolf. [Episode 24]. Social Work Podcast [Audio podcast]. Retrieved from http://socialworkpodcast.com/2007/09/sex-addiction-interview-with-kris-wolf.html