SEXUAL ADDICTION AND MFT: THERAPISTS - Virginia Tech

211 Pages·2009·0.82 MB·English

SEXUAL ADDICTION AND MFT:
THERAPISTS’ PERSPECTIVES ON FACILITATING INDIVIDUAL AND
RELATIONSHIP HEALING
by
Mark Hilton Bird

Dissertation submitted to the Faculty of the
Virginia Polytechnic Institute and State University
in partial fulfillment of the requirements for the degree of

Doctor of Philosophy
In
Human Development

Scott Johnson, Ph.D., Chair
Lenore M. McWey, Ph.D.
Anna Beth Benningfield, Ph.D.
Fred P. Piercy, Ph.D.

April 24, 2009
Blacksburg, Virginia

Copyright 2009, Mark Hilton Bird
SEXUAL ADDICTION AND MFT:
THERAPISTS’ PERSPECTIVES ON FACILITATING INDIVIDUAL AND
RELATIONSHIP HEALING
Mark Hilton Bird
Abstract
In recent decades there has been an increase in literature regarding sexual addiction as
well as a growing number of clients presenting in therapy with problems related to their
sexual behaviors (including internet sexual addiction). More recently, the impact of
sexual addiction on couples has been noted, but little is known regarding how couples
can be assisted in the recovery process. In this qualitative study, I explored in depth the
critical change processes in couple therapy for sexual addiction from the therapist’s
perspective, including the therapist’s role in that process. The findings suggest that
couple recovery from sexual addiction includes (a) individual responsibility in recovery
(which includes themes of trauma, family-of-origin, emotional reactivity,
depersonalizing, and utilizing other resources), (b) couple recovery (which includes the
themes of family-of-origin, communication, empathy, intimacy, trust, and sexual
intimacy), (c) balancing individual recovery with couple recovery in the process of
healing (which includes the themes of education, accountability, and couple perspective)
and (d) distinguishing affairs from sexual addiction. I discuss the implications of study
findings, offering a sequential outline of the process of therapy with couples who are
struggling to recover from sexual addiction, including therapist interventions that may
assist in that process. Limitations to the study and implications for future research in
sexual addiction generally and MFT specifically are presented.
Acknowledgments
I first want to thank my Father in Heaven for his loving watch over my family
during the past seven years. I have attempted to honor all He has blessed me and my
family with by trying to put Him first in my life. I know my sacrifices to do so were
honored by the blessing of being able to complete this dissertation.
Next I want to thank my sweet, wonderful wife, Stevie, for being so amazingly
patient as, year after year, I struggled to be a husband, father, provider, and dissertation
writer. Thank you for the extra time you dedicated to caring for the children during the
time I worked on my dissertation. Thank you for your encouragement. Thank you for the
nights you did not get to spend time with me because I had to go to sleep early to get up
by 4 a.m. to write some more. Mostly, thanks for your patience and love for me since the
day we married (and even before). I love you very much, and will always work to make
sure you know that.
Mom and Dad: I truly was born of goodly parents. I doubt you could ever have
imagined that I would make it through so many years of school as you struggled with me
through elementary, middle, and high school (although maybe it was because you could
see past the struggles to a brighter time that I have been able to accomplish all that I
have). Thanks for teaching me about my loving Heavenly Father and modeling for me
what that kind of parent might be like. Thank you for teaching me the value of learning,
to always value myself, and to love and care for others as Jesus would. Much, if not all,
of what I have become in life has been because of what I was taught in our home. Thanks
for your support, encouragement, and love. I will be forever grateful for both of you, and
I love you.
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I also want my committee and chair to know how grateful I am for their efforts to
support me over the long haul. I also know that for several of you it was outside of your
current responsibilities, and I appreciate your sacrifices. I also want to thank Mark Butler
for offering a listening ear and feedback as I asked for it throughout the process (and I
know it was several times). I appreciate your friendship, Mark, and your willingness to
take time you didn’t have to take to help me.
I want to express my thanks to the other three analysts who voluntarily
participated in the study. Rick, Kate, and Susan, I am grateful for your willingness and
insights. I certainly believe you helped mold the findings into something greater than
each of us could have done alone. I also appreciate your friendships that have formed as a
result of our work together.
Finally, thank you to all the therapists who were willing to be interviewed and
share of your experiences to help provide a greater foundation for helping those who
struggle with sex addiction (including couples). I thoroughly enjoyed the interview
process, and you have infinitely increased my therapeutic awareness and abilities in
helping those who struggle with sexual addiction to find greater individual and relational
healing.

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TABLE OF CONTENTS
CHAPTER I........................................................................................................................1
Introduction.....................................................................................................................1
Early Conceptual Evolution: Struggling for Definition..............................................2
Etiology of Sexual Addiction......................................................................................4
Family of Origin.....................................................................................................5
Culture.....................................................................................................................6
Trauma and Abuse..................................................................................................7
Psychological/Emotional........................................................................................7
Summary.................................................................................................................8
CHAPTER II.......................................................................................................................9
Literature Review............................................................................................................9
The Sexual Addict: A Theoretical Review.................................................................9
Faulty Core Beliefs.................................................................................................9
Shame....................................................................................................................10
Isolation/Loneliness, Relationship Problems........................................................11
Ineffective Coping................................................................................................11
The Cycle..............................................................................................................12
Treatment Approaches..............................................................................................13
Marital Therapy....................................................................................................14
Empirical Review......................................................................................................16
Method..................................................................................................................17
Review of Studies.....................................................................................................18
Addicts..................................................................................................................18
Sampling...........................................................................................................18
Design...............................................................................................................22
Results...............................................................................................................23
Discussion.........................................................................................................28
Spouses (Co-addicts)............................................................................................30
Sampling...........................................................................................................30
Design...............................................................................................................30
Results...............................................................................................................31
Discussion.........................................................................................................33
Couples.................................................................................................................35
Sampling...........................................................................................................35
Design...............................................................................................................35
Results...............................................................................................................36
Discussion.........................................................................................................37
Conclusions...............................................................................................................38
Discovery and Trauma..........................................................................................38
Role of the Therapist in the Process of Healing...................................................39
Marital Therapy....................................................................................................41
CHAPTER III...................................................................................................................44
Methodology.................................................................................................................44
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Design.......................................................................................................................44
Participants................................................................................................................45
Procedures.................................................................................................................46
Measures...................................................................................................................47
Analysis.....................................................................................................................50
Phase 1..................................................................................................................51
Phase 2..................................................................................................................51
Phase 3..................................................................................................................52
Phase 4..................................................................................................................52
CHAPTER IV...................................................................................................................54
Findings.........................................................................................................................54
Individual Responsibility in Recovery......................................................................56
Trauma..................................................................................................................56
Interventions.....................................................................................................58
Family-of-origin....................................................................................................59
Interventions.....................................................................................................60
Emotional Reactivity............................................................................................62
Intervention.......................................................................................................63
Depersonalizing....................................................................................................72
Intervention.......................................................................................................73
Other Resources....................................................................................................77
Intervention.......................................................................................................81
Boundaries............................................................................................................82
Interventions.....................................................................................................83
Couple Recovery.......................................................................................................91
Family-of-Origin...................................................................................................91
Intervention.......................................................................................................92
Communication.....................................................................................................94
Interventions.....................................................................................................94
Empathy................................................................................................................98
Interventions...................................................................................................101
Intimacy..............................................................................................................104
Interventions...................................................................................................108
Trust....................................................................................................................109
Intervention.....................................................................................................110
Physical Intimacy................................................................................................112
Interventions...................................................................................................114
Balancing Individual Recovery with Couple Recovery in the Process of Healing 118
Intervention.....................................................................................................124
Recovery as a Process.........................................................................................128
Intervention.....................................................................................................136
Education............................................................................................................138
Accountability.....................................................................................................142
Couple Perspective..............................................................................................148
Intervention.....................................................................................................151
Addiction versus Affairs.........................................................................................155
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Intervention.....................................................................................................159
CHAPTER V..................................................................................................................162
Discussion...................................................................................................................162
Assessment..............................................................................................................162
Appropriate care..................................................................................................164
Alliance...............................................................................................................166
Couple Perspective..................................................................................................168
Intervention: Transitions in the Change Process....................................................170
Crisis Stabilization..............................................................................................171
Road map........................................................................................................172
Emotional awareness......................................................................................173
Depersonalization...........................................................................................173
Disclosure.......................................................................................................175
Boundaries......................................................................................................175
Accountability.................................................................................................177
Creating positive experiences.........................................................................179
Individual Recovery............................................................................................180
Couple Recovery.................................................................................................181
Communication...............................................................................................181
Empathy, intimacy, and trust..........................................................................182
Empathy..........................................................................................................183
Intimacy..........................................................................................................184
Trust................................................................................................................184
Physical intimacy............................................................................................185
Addiction Versus Affairs....................................................................................185
Limitations and Recommendations.........................................................................187
References.......................................................................................................................189
Appendix A.....................................................................................................................197
Appendix B.....................................................................................................................200

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LIST OF TABLES
Table 1 Overview of Addict (Individual) Studies..............................................................20
Table 2 Central Research Questions and Related Interview Questions...........................49
Table 3 Methods of Improving Credibility, Trustworthiness, and Transferability...........53
Table 4 Sections and Related Themes...............................................................................55

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CHAPTER I
Introduction
The publication of the book Out of the shadows: Understanding sexual addiction
(Carnes, 1992) marked a significant increase in the popularity of the term now called
sexual addiction as well as the theoretical and empirical literature surrounding the
concept of sexual addiction. The explosion of the internet (with ease of access to all types
of information) has provided a new arena for potential sexual addiction because it offers
increased access to online sex, pornography, sexual chat rooms, and various other sexual
avenues (see Griffiths, 2001 for a more complete list of internet sexual behaviors).
Cooper (1998) also points out that the internet offers easy access (24 hours a day, seven
days a week), affordability (low-priced or free), and anonymity (people perceive that
their communications are unknown, contributing to reduced sexual inhibition). Young,
Griffin-Shelley, Cooper, O’Mara, and Buchanan (2000) suggests that the ease of access,
low cost, and anonymity provided by the internet may open the door to sexual addiction
for individuals who previously did not express vulnerability to sexual addiction or push
mild addicts toward more severe addiction. It is estimated that there are between one-half
and two million sexual addicts (Delmonico & Carnes, 1999).
Despite the increased awareness of sexual addiction, as well as the increase in
avenues by which many can become sexually addicted, many therapists still experience
discomfort towards or lack knowledge about sexual addiction. This may cause therapists
to miss many important cues and/or completely fail to address sexual addiction in
therapy. Because many couples experience intense emotional reactivity, particularly
during early stages of recovery, some therapists who are knowledgeable about sexual
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addiction prefer to offer treatment for sexual addiction without the spouse. However,
many of the conceptual and etiological explanations (see below) suggest that couple
therapy might be as effective or more effective than group or individual therapy for
facilitating recovery from sexual addiction (for individuals and couples). In this chapter I
review the early conceptual evolution of sexual addiction (the struggle for definition) as
well as the proposed causes (etiology) of sexual addiction.
Early Conceptual Evolution: Struggling for Definition
Much of the early clinical literature about sexual addiction focuses on whether or
not the label of sexual addiction is appropriate. In contrast to those authors who believe
that a person can become a sexual addict, some authors argue that it is better termed an
obsessive-compulsive disorder (Fischer, 1995; Quadland, 1985; Weissberg & Levay,
1986) or an impulse-control disorder (Barth & Kinder, 1987; Coleman, 1991, 1992;
Quadland & Shattls, 1987). Levine and Troiden (1988) argue that the label of sexual
addiction or compulsion is not appropriate. Goodman (2001) and Gold and Heffner
(1998) offer in-depth synopses of the sides of each argument.
Since its origin, the concept of sexual addiction has received much criticism.
Although several authors have expressed concerns about the use of the term sexual
addiction (see Goodman, 2001), only a few of the most cogent concerns are mentioned
here, along with the improvements in the conceptualization of sexual addiction that have
occurred as a result. One major criticism of the term sexual addiction is that it is too
vague and allows for overdiagnosis. Much of the confusion with regard to sexual
addiction occurs due to the lack of a measurable assessment of the condition. While the
Diagnostic and Statistical Manual (DSM) III-R (American Psychiatric Association
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