In my opinion, long-term psychodynamic therapy is the most efficient way to cultivate healthy personality development. The most comprehensive treatment combines the empathy, insight and relational abilities of a psychodynamic psychotherapist with the 12-step orientation and cognitive-behavioral strategies of an addiction specialist.
What IS Psychodynamic Psychotherapy?
The primary focus of psychodynamic treatment is on patients' internal structural deficits rather than on their addictive symptoms. Besides compensating and repairing deficits in the self stemming from childhood misattunements with early caretakers, it may also be the most appropriate treatment to help individuals cope with life stressors and painful emotional states that contribute to urges to engage in addictive sexual behavior.
The focus of this type of therapy is to enhance individuals' self-regulation and self-care, and to foster their capacity for meaningful interpersonal connections. Psychotherapy serves these goals by facilitating the development of healthy ways to regulate emotional self-states, for getting appropriate needs met in reality, for resolving inner conflicts, and for taking care of oneself in a spectrum of areas.
Integration of the patient's personality is an important element of psychodynamic therapy. Sex addicts live in two worlds; the "normal" world of work and love and the "secret world" of sexual acting out. This split in the personality results in the addict having different value systems and goals for each part of the personality. Psychodynamic treatment promotes personality integration by bringing together under the light of consciousness the split, denied, dissociated and repressed aspects of the person's mental functions. Dr. Jekyll and Mr. Hyde finally become one.
Some General Principles of Psychodynamic Therapy
Focus is on affect and expression of emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are threatening, and feelings that the patient may not initially be able to acknowledge.
Exploration of attempts to avoid distressing thoughts and feelings.
Knowing, but not knowing at the same time is the result of various defenses the person uses to remain unaware. One aspect of this type of therapy is actively focusing and exploring these avoidances. Patient and therapist chip away at defenses so unconscious material can be brought to consciousness where there is a chance of changing and adapting to reality.
Identification of recurring themes and patterns. Self-defeating patterns in patients' thoughts, feelings, self-concepts, relationships and life experiences are put under a microscope.
The past is alive in the present. Past experience, especially early family-of-origin issues, affects our relation to, and experience of, the present. The goal is not just to dwell on the past for its own sake, but rather to help people free themselves from the bonds of past experience in order to live more fully in the present.
Focus on interpersonal relationships
Psychodynamic therapy emphasizes patients' interpersonal experience. Problematic interpersonal patterns interfere with a person's ability to meet emotional needs.
Exploration of the entirety of mental life. Patients are encouraged to say whatever comes to mind. Thoughts can range over various aspects of mental life, including desires, cravings, fears, fantasies, dreams and daydreams. All of this is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interfer4es with potential capacity to find greater enjoyment, ease and meaning in life.
The goals of this type of therapy extend beyond healing the symptom (compulsive sex) but also foster the positive presence of inner capacities and resources. These might include more fulfilling relationships, more effective use of one's talents and abilities, maintain a realistic sense of self esteem, tolerate a wider array of strong feelings without acting out, have more satisfying sexual experiences, greater understanding of self and other and face life's challenges with greater freedom and flexibility. These goals are explored through self-reflection, self-exploration and self-discovery that take place in the context of a safe and deeply authentic relationship between therapist and patient.
Personality Factors Common to Sex Addicts
Treated in Psychodynamic Therapy
- Sexually compulsive behavior helps one manage fluctuating affects, self-sooth, and maintain self-esteem. Sex distracts from painful feelings and thoughts, counteracts inner emptiness, replaces feelings of fragmentation with an illusion of control, and temporarily bolsters self esteem.
- Sexual activity is a form of self- medication, used to make unbearable feelings and self-states bearable. Addiction furnishes externally what can not be provided internally.
- Sexually compulsive individuals often have personalities with narcissistic features.
- Poor capacity for self-regulation, self-efficacy and self-care
- Sex Addicts tend to have difficulties sustaining relationships and feeling close to others.
- Problems in family-of-origin where their individuality and needs were often ignored or punished.
- In childhood, the true, authentic personality needed to go "underground" to please narcissistic parents; parts of the personality were then "split off" and are enacted through sexual activity as the adult.
- The person affected alternates between deprivation of needs / feelings and unrestrained indulgence. This state is marked by significant splitting and minimal integration. (The Dr. Jekyll / Mr. Hyde Syndrome)
- Deviant sex provides a much-needed connection with another without the "danger" of relatedness.
- Brief sexual encounters are seen as emotionally safe. They have a fixed ending point, no strings attached and have little room for conflict. Furthermore, anonymous partners can not readily reject the addict upon the discovery of his real or perceived flaws.
- Many sex addicts have a strong wish for control and a fear of vulnerability. They feel internally fragile and prone to fragmentation.
- Sexual behaviors allow a feeling of control, power, triumph or omnipotence that compensates for early-life feelings of helplessness and powerlessness. Most likely a ritualized sexual enactment turns trauma into triumph and is a repetition compulsion with the unconscious aim of repairing the original childhood trauma. Dysfunctional relationships developing out of the trauma are enacted through sexual activity.
- The details of a sexual enactment, and the fantasies that fuel it, are laden with symbolic meaning and are an aid in understanding the themes of inner conflict driving the behavior.
The Fruits of Treatment
Psychodynamic therapy can help sex addicts to develop:
- An understanding of the internal factors driving their sexual behavior;
- Better self-regulation through internalization of the nurturance, containment and structure of the therapeutic environment;
- Improved capacity for interpersonal relationships and healthy sexuality;
- Improved capacity for working at an optimal level;
- Improved access to creative inner resources;
- Improved capacity to reflect on thoughts and feelings, with a resulting increase in inner control and a decreased need to act out unwanted mental states;
- Integration of the private and public selves: Dr. Jekyll and Mr. Hyde become one;
- The therapist explores the client's sexual behaviors and fantasies in detail. Like dreams, they have symbolic meaning and aid in understanding the structure of the personality as a whole.
Shedler, J. (2011) "The Efficacy of Psychodynamic Psychotherapy"
Goodman, A. (1998) "Sex Addiction"
Bean, M. and Zinberg, N. (Eds) (1981) "Dynamic Approaches to the understanding and Treatment of Alsoholism"