It is becoming increasingly important for counsellors and psychotherapists to educate themselves about the issue of Sexual Addiction, which can be defined as out-of-control and damaging sexual behaviour in relation to Internet sex, prostitution, telephone sex, multiple affairs etc. Modern society provides a huge range of options for artificially enhanced, relatively impersonal sexual stimulation, and in our counselling practices we are more frequently meeting clients who may be addicted in some of these areas.
I recommend this new 2nd edition of Carnes' book as an introduction to the subject. Carnes has been the field leader in Sexual Addiction counselling since publishing "Out of the Shadows" in 1983, and the present book accessibly summarises his thinking about the problem, along with approaches for helping those who may be struggling with it. The main addition since the 1st edition is a more detailed exploration of the growing phenomenon of Cybersex (Internet sex) addiction.
Having been involved in the development of addiction treatment/recovery in the USA for many years, Carnes' thinking is a blend of influences taken from 12-Step programmes such as Alcoholics Anonymous and Sex & Love Addicts Anonymous, from Cognitive-Behavioural techniques such as written inventories and challenging core beliefs, and from relevant neurobiological findings. He has a deep understanding of the nature of Addictive Behaviours over and above the familiar example of Chemical Dependency, and his key contribution to the field may be his description of the Sexual Addiction Cycle, where Preoccupation leads to Ritualisation, which leads to addictive Acting Out behaviours; the Pain arising from this acting out can then be numbed by further Preoccupation, which closes the self-perpetuating cycle.
Carnes is also known for his Tasks approach to recovery. In this book he focuses on what he sees as the first 7 recovery tasks:
1. Breaking through denial
2. Understanding addiction
3. Surrendering to the process
4. Limiting damage
5. Establishing sobriety
6. Ensuring physical integrity
7. Participating in a culture of support
In earlier books he included Reducing Shame, which he now leaves until the second phase of recovery. My own experience, and those of many other therapists working with the Centre for Sexual Addictions, is that it is important to address the issue of shame and self-hatred at an early stage. Clients may see themselves and their sexuality in a very negative light, perhaps partly due to the negativity towards sexuality which has been a part of Irish culture, and may be in danger of trying to force themselves into the opposite extreme of complete avoidance and denial of sexuality (Carnes is alert to this danger, calling it Sexual Anorexia, and he has written an important book on the subject, entitled "Sexual Anorexia: Overcoming Sexual Self-Hatred").
Perhaps the main strength of this book is that it can be useful to both therapist and client alike, and while I have never worked through the whole book with any client, we can together make productive use of some of the handouts/exercises/inventories (for instance, the Consequences Inventory).
Eoin Stephens is Director of Education & Training at PCI College, and at the Centre for Sexual Addictions ([...] a division of the Institute for Behavioural & Mental Health ([...]