Silva Neves Online Specialist Psychotherapy for Central London,
Mayfair W1

Compulsive sexual behaviours. CSB

Compulsive Sexual Behaviours: Important information before starting treatment

The field of 'Sex addiction' emerged in the 80’s with Dr Patrick Carnes' publications and treatment centres in the USA. The films Shame (2011), Thanks For Sharing (2012), Nymphomaniac (2013) and Don Jon (2013) brought 'sex addiction' to the awareness of the public.
More recently, the public scandals in the Hollywood film industry brought the 'sex addiction' treatment field into questioning and scrutiny. The field has been criticised to be an easy and comfortable ‘get-out-of-jail’ card for white, rich sexual offenders.

'Sex addiction' is currently the most widely used term describing sexual behaviours that have gone out of control. At the moment, many people are confused as to what 'sex addiction' actually is. If you think you are having problems controlling your sexual behaviours, you might call yourself a 'sex addict'.

There are a few important things for you to know before you engage in treatment:

  • 'Sex Addiction' is only a term coined by some treatment centres in the USA in the 80’s. It is not an approved or recognised mental health diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). It is not a recognised condition in the field of psycho-sexology either. The reason for this is that robust clinical research in the field is poor, despite what many books are preaching. These books are based on clinicians’ opinions, not clinical research. Many of these well-meaning clinicians and authors are not adequately trained in the field of human sexuality.
  • The clinical term that has been agreed by ICD-11 (International Classification of Disease) is Compulsive Sexual Behaviour Disorder. Its classification is under Impulse Control Disorder, not Addiction. The clinical criteria to meet the diagnosis for the disorder are very specific: it is rare for people to meet the disorder. Therefore, most people who struggle with their sexual behaviours do not suffer from a disorder, but they struggle with a sexual health behaviour problem.
  • I think that most people who struggle with compulsive sexual behaviours do not qualify for the disorder diagnostic, yet they still need help to address the sexual behaviours that cause them problems. My opinion is based on my extensive knowledge of human sexuality and my experience of working with many clients who present with compulsive sexual behaviours.

    Some of the issues people with compulsive sexual behaviours have are:
  • Using sex as a primary way of coping with the unpleasant feelings of life: feeling sad, feeling angry, feeling tired, feeling bored, etc…
  • A sexual behaviour that is compulsive and repetitive. They cannot stop their sexual behaviours despite negative consequences. They feel their sexual behaviours are out of control.
  • It makes the person feel bad. Clients often report that the sexual behaviours they engaged in was unwanted by them, and they feel bad and shame afterwards. They can also feel depressed or worthless.
  • Engaging in sexual behaviours that is against their own values and integrity. For example, having sex outside of the marriage, even though they love their spouse.
  • It is a condition that brings a lot of despair and suffering for the people with compulsive sexual behaviours, and it has a tremendous traumatizing impact on their partner.

Compulsive sexual behaviours. loneliness

The diagnosis of 'sex addiction'

Although the term ‘sex addiction’ is the most widely used term to describe compulsive sexual behaviours, it is vital for you to understand the implication of a ‘sex addiction’ diagnosis so that you can make an informed choice on your treatment options:

If a clinician diagnoses you with ‘sex addiction’, you are likely to be offered an addiction treatment, which rests upon the assumption that sex is addictive and it is a chronic illness. As mentioned above, there is no clinical evidence to support this assumption, despite many books and websites that claim otherwise.
The typical 'sex addiction' treatment will encourage you to attend SAA meetings (Sex Addicts Anonymous) or SLAA meetings (Sex and Love Addicts Anonymous). The addiction clinician will base their treatment plans on addiction-focused treatment which will include a ‘sobriety contract’ and other addiction behavioural interventions. A sobriety contract and addiction interventions work very well for alcohol and drug addiction. However, in my clinical experience, the addiction model is not efficient with sexual behaviours because human sexuality is a completely different physiological and psychological system. In my professional opinion, in order to treat ‘sex addiction’ effectively, the clinician must have a thorough and specialist training and understanding of human sexuality.

AASECT (American Association of Sexuality Educators, Counselors and Therapists) issued the following statement:
1- There is no sufficient empirical evidence to support the classification of 'sex addiction' and 'porn addiction' as a mental health disorder.
2- The sexual addiction training and treatment methods and education pedagogies are not adequately informed by accurate human sexuality knowledge.

"Although the term 'sex addiction' has been taken up by the popular media, the Working Group concluded that available evidence did not support this conceptualisation." ICD-11. World Health Organization.

"Materials related to the ICD-11 make very clear that CSBD is not intended to be interchangeable with 'sex addiction', but rather is a substantially different diagnostic framework." ICD-11. World Health Organization.

Based on my clinical experience, compulsive sexual behaviours are real problems which bring a lot of distress in people's lives. But it is not an addiction or a chronic illness. You can re-organise your sexual behaviours and your relational self in a way that is fulfilling for you, permanently.

Compulsive sexual behaviours. iceberg

My treatment of compulsive sexual behaviours: a psycho-sexological, holistic and humanistic approach

My treatment for compulsive sexual behaviours is based on specialist psychosexual training and experience, clinical research on human sexuality, clinical evidence on brain functions and neuropathways, and human psychology. I do not offer an addiction treatment to ‘sex addiction’. It means that I do not encourage clients to attend SAA or SLAA meetings. I do not ask clients to be ‘sober from sexual behaviours’. I do not prescribe clients a ‘right’ way to be sexual.

Instead, I help you understand where your sexual behaviours come from, explore your sexual and relational landscape to gain a better understanding of your own individual sexual and relational system. Together, we make sense of your sexual urges and desires, your needs, your wanting, your longing. We also explore values and what your integrity is made of. With this deep understanding, you can then change many different areas of your life to support a fulfilling and vibrant sex life in stable relationships. My approach is humanistic and holistic: it is a non-shaming, respectful and sex-positive approach. In my clinical experience, this approach is very effective, and supports a sustainable long-term fulfilling lifestyle.

My treatment of compulsive sexual behaviours includes:
  • Behavioural approach to help identifying the sexual behaviours that are wanted from those that are unwanted.
  • Learning new ways to self-soothe and cope with the negative feelings about life: stress, anxiety, feeling low, feeling bored, feeling unfulfilled, feeling bad.
  • A deep exploration of the sexual landscape.
  • A deep exploration of the emotional world and core beliefs.
  • An examination of cognitive processes.
  • An examination of sexual urges and desires.
  • Behavioural, psychological and emotional interventions to manage impulse control.
  • Re-instating balance in life: hobbies, positive connections with friends and loved ones, a deep sense of self, finding meaning, higher self-esteem.
  • Healing the possible trauma(s) underlying the roots of out-of-control sexual behaviours.
  • Treating the possible psychosexual dysfunctions underlying the roots of out-of-control sexual behaviours.
  • Healing the relationship that has been devastated by hypersexual behaviours, if appropriate.
  • Re-integrating vibrant, diverse and fulfilling sexuality with self and others.

    My approach of the treatment of compulsive sexual behaviours is non-moralistic, non-judgmental, empathic and holistic.

    The treatment for compulsive sexual behaviours is challenging. But I do not believe in ‘once an addict, always an addict’. Using specific classic humanistic, evidence-based psychological interventions and modern psychosexual interventions, people can truly leave their out-of-control sexual behaviours behind and change their lives positively and permanently.

    The aim of the treatment of compulsive sexual behaviours is based on the six principles of sexual health (Pan America Health Organisation):
    1- Consent
    2- Non-exploitation
    3- Protection from HIV, STI and unwanted pregnancy
    4- Honesty
    5- Shared values
    6- Mutual pleasure

    Sexual Health is the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. (WHO 2006)

Compulsive sexual behaviours. Sex addiction

Therapy for partners

The discovery or disclosure of compulsive sexual behaviours brings devastating and traumatizing consequences to the partner.

The most common impacts on the partner are:
  • Emotional turmoil, depression and feelings of despair
  • Acting like a detective
  • Obsessing about the sexual acting out which can make like hard to manage
  • Avoiding thinking or discussing the traumatizing consequences
  • Sleeplessness and nightmares
  • Feeling stupid for believing the addict's lies
  • Emotional numbness
  • Feelings of victimization
  • Fear about future relapse
  • Trust is shattered
  • Anger and hostility
  • Loss of the dream of the relationship
  • Loss of self
  • Loss of emotional and sexual safety

    It is important for the partner to engage in therapy to help with healing the trauma of compulsive sexual behaviours and the restore balance in the emotional and practical life.

    I do not offer therapy for both the person with compulsive sexual behaviours and the partner. If I engage in therapy with the partner, I refer the person with compulsive sexual behaviours to one of my trusted colleagues, and vice versa.
    I do offer couples therapy for couples who have been wounded by compulsive sexual behaviours.

Compulsive sexual behaviours. Eye EMDR

Treatment of Compulsive Sexual Behaviours with EMDR.

In addition to the psycho-sexological treatment, I offer a treatment using the standard EMDR protocol as well as the Feeling State protocol.

The Feeling State Protocol is a modern, cutting-edge treatment that has been shown to be efficient treating compulsive sexual behaviours.

The treatment is non-shaming, non-moralistic and sex-positive.

EMDR is a clinically proven and evidence based psychotherapy which has shown successful outcomes.

For more information on this treatment, do not hesitate to contact me:

Compulsive sexual behaviours. Road to recovery

LOW COST therapy for compulsive sexual behaviours

Low cost help is available!

I have a team of therapists whom I trained offering low cost therapy for people struggling with sexual compulsivity.
Our approach is sex-positive, non-pathologising and informed by sexology.

Get in touch for a low cost referral:

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