Saturday, December 5, 2015

Understanding Sexual Health

How Sexual Addiction Treatment Fails When Working With Gay and Bisexual Men
Joe Kort, Ph.D.
Psychotherapist, certified sex therapist, and relationship therapist at Joe Kort & Associates, PC
Posted: 12/02/2015

I thought I was done with the coming-out process, but I am coming out again, only this time on Psychology Today as a former sex-addiction therapist. Today I treat those struggling with out-of-control sexual behaviors much differently and more successfully with my current education and understanding about what sexual health is, and tailor it to each individual. 
The reason? The longer I was in the field of sex addiction treatment the more I found both the label and many of the interventions antiquated, limiting and sometimes even harmful -- especially when working with gay and bisexual men. Sex addiction treatment began to reveal itself to me as simplistic, moralistic and judgmental rather than truly diagnostic. The more I learned, the more I saw a number of problems embedded in the interventions within the model -- negative messages of shame, erotophobia and homophobia -- which were inextricably entwined in the treatment. Over the last 10 years I have become an AASECT (American Association of Sex Educators, Counselors and Therapists) certified sex therapist and supervisor, and have learned a great deal more about helping people with problematic sexual behaviors from an informed sexual-health model, which is lacking in the sexual addiction field.
Sex Addict or Homosexual?
I know of clients telling their therapist, "I would rather be a sex addict than a homosexual." Some sex addiction therapists, especially those who have a religious influence to their work, admittedly believe that homosexuality is not an "authentic" identity, particularly for those who do not want it. Calling such sexual interests a "same-sex attraction" and an "acting out" of the client's sexual addiction, these therapists then treat the client as a sex addict, and send him to Sexaholics Anonymous, which is overtly anti-gay. This type of sex-addiction treatment becomes, at times, the new "reparative therapy," which is widely considered unethical and, in some states, illegal. It might be coming from a well intended therapist, however it is still treating same-sex attractions as pathology rather than exploring the various ways sexual orientation can manifest, or helping gay or bisexual men come out of their shame into their true sexual identity.
It implies that being sick and a sex addict is better than being a gay or bisexual man. I have had clients who are clearly homosexual, but because of their culture -- such as Arab or Indian -- they cannot come out and never will. I will never tell them that they are sex addicts or can change from gay to straight, or that they should manage their feelings because they are sick. Instead I help them to accept that they are homosexual, but don't have to embrace the "gay lifestyle" or a gay identity -- only if this is what they choose. This supports a position of sexual strength and health rather than pathology or sickness and keeping them ashamed.
Sex Addiction Treatment Should Not Endorse Sexaholics Anonymous
Sexaholics Anonymous (SA) remains on all the national sex-addiction websites as a resource, ultimately endorsing the program. SA is one of a number of 12-step fellowships dealing with recovery from compulsive sexual thinking and behavior, and it views LGBTQ behavior and relationship as pathological, unhealthy and not a true identity. It believes that sex should only be in the context of a marriage, which it defines as "one man and one woman." While other fellowships may make no distinction between same-sex and opposite-sex behavior, SA explicitly defines sexual sobriety to exclude same-sex behavior. 

Listing SA as a resource is not in keeping with values for an LGBTQ-affirmative sexual health affirmative therapy. It also in not in keeping with the values of any professional mental health organization such as National Association of Social Workers, American Psychiatric Association, or American Psychological Association, to name a few. It also goes against current scientific and professional views of human sexuality.
Because the label "sex addiction" contains the word "sex," understanding and training is required for cultural competency of the various manifestations of the sexual and relationship lives of LGBTQ, and how we differ from our heterosexual counterparts. Currently it is glaringly lacking.
How I Became a Sex Addiction Therapist
I became a sex addiction therapist in the late 1980s. At the time, it seemed like a hopeful means to deal with out-of-control behaviors, especially in the gay male community. The specter of AIDS had descended on the gay community, and AIDS was considered in the broader culture to be divine judgment on gay sexuality. Gay men grew increasingly ashamed of their unbridled desires (the '70s had seen an explosion of open sexuality in the gay community), and terrified that they would contract the disease, God's punishment for their actions. I was one of them, and was grateful for the hope I could change my behavior.
Anything that didn't involve heterosexual, normative, monogamous sexuality was seen as behavior having the potential to contract and spread HIV. Blame was falling on anyone having promiscuous sex outside of a committed and married relationship. Not surprisingly, numerous 12-step programs, like Sexaholics Anonymous, sprang up to help those who sought to change their behavior. Sex-addiction therapy became the go-to means to address the fears, and we frequently referred our clients to such groups.
However, gay men soon found that they were in the minority in these sex addiction settings, and were expected to think and act like their heterosexual counterparts -- for instance having only monogamous relationships and taking time before having sex. Meeting someone and and having sex right away was common in the gay community. Such behavior was -- and still is -- labeled as a pathological and as a "courting disorder." In the gay community it is also common to have open relationships, which is frowned upon by too many sex addiction therapists. BDSM and fantasy sex is quite open and normalized in the gay community, and yet sex addiction therapy targets those behaviors as problematic. What straight couples fight about around sexuality, gay male couples don't. Thus sexual addiction lacks cultural competency on LGBTQ sexual behaviors and pathologizes non-heteronormative sexuality in general.
From Sexual Despair to Sexual Health
Referring a gay or bisexual client to Sexaholics Anonymous as part of a treatment plan is irresponsible and will only contribute to more despair. He is at risk for aligning himself with internalized homophobia by sitting in a room filled with rules and individuals believing that gay sex and gay relationships are wrong.
Instead, I refer gay and bisexual men to Sexual Compulsives Anonymous (SCA). This 12-step group was started by gay and bisexual men who needed a safe, judgment-free space to address their out-of-control sexual behaviors. On their national site they state, "SCA is a 12-Step fellowship, inclusive of all sexual orientations, open to anyone with a desire to recover from sexual compulsion."
Clients come into therapy with many issues around sex. We need to help them manage their issues through the lens of appreciating this as part of themselves. It is important to see the distinctions between sexual health versus out-of-control behaviors. For example, understood in the context of the gay culture, when a gay man first comes out he often experiences a period of hypersexuality -- a delayed gay adolescence, which is completely normal. It is inaccurate to label him a sex addict as he would be labeled in the SA model. Many straight men enjoy watching gay porn, and this speaks to the sexual fluidity of many straight men. Without a therapist understanding sexuality it can be easy to pathologize such behavior.
I am now revising an entire chapter I wrote on sexual addiction in my first book, 10 Smart Things Gay Men Can Do to Improve Their Lives. I am removing references to sex addiction treatment, and changing it to help gay men understand their sexual lives and problems from a strength-based, informed position. In my revisions I am referring more to the model and book, Treating Out of Control Sexual Behaviors: Rethinking Sex Addiction, by Doug Harvey-Braun and Michael Vigorito, focusing on the treatment of men struggling with problematic sexual behaviors, and using a strength-based and sex-positive approach.

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