Sex Addiction 2/7: Treatment
Psychosexual therapist Dr Thaddeus Birchard founded the first UK centre for sex addiction treatment, and pioneered training for therapists working with compulsive sexual behaviour. In the second part of his blog series on this still stigma-ridden issue, he outlines his treatment programme for sex addiction, and emphasises the importance of ‘restoring the self
Last week we looked at the definitions and characteristics of compulsive sexual behaviour, and discussed addiction as an, ‘escape from the burden of selfhood’. This week I want to outline the components of our treatment programme.
Mohammed (not his real name) was a businessman who rang me up from Saudi Arabia to say he had a problem. He said that his sexual behaviour was ‘out of control’. He was coming to London for a couple of weeks, and could he see me and possibly do an intensive treatment programme? While I always prefer for men to come into the group programme, this was clearly not possible. I took him individually through the interventions that we use in the group programme, along with carefully directed reading. His problem concerned the use of sex workers and some alcohol fuelled parties (yes, in Saudi Arabia). A year later he wrote to me to say he had done well, and had left the behaviour behind. I lay out the overall content of the treatment programme below.
Our treatment programme at The Marylebone Centre is divided into three 12-week sections. We have outcomes studies on the success of the treatment, and it creates a high level of change. In Part One, we use a variety of Cognitive Behavioural Exercises to intervene in the behaviour. Part Two was designed by an art therapist, and uses drawing exercises to go deeper into causation. Part Three returns to CBT, and we call this section ‘Restoration of the Self’. In this final part of the treatment programme, we work on creating a more robust sense of self. The group programme meets one evening a week.
Intervening in the behaviour
In this initial phase of treatment, we do a CBT formulation of the individual, and the Young Schema Questionnaire. This is followed by ‘Harmful Consequences’. It is important that men confront the losses caused by the behaviour – time, money, employment, family neglect, exposure to sexually transmitted infection, to name a few.
They are then asked to do a Sex Plan, which helps set goals for recovery. We explore traumatic events in each individual background. Perhaps most important is that we establish that compulsive behaviours follow repeating behavioural patterns, and are signalled by precursors. There is an evening of assertiveness training.
The culmination of the 12-week programme is the penultimate weekend session. On this weekend, each man is given 45 minutes to make a personal presentation. The personal presentation includes their history of trauma, sexual history and compulsive behavioural patterns. It ends with their hopes for the future. Each group member gives feedback to the person doing the presentation. The weekend is filled with emotion. There is much sadness for
the situation of the other. Part One concludes with Relapse Management and an individual exercise in affirmation.
Drawing exercises and ‘Restoration of the Self’
In the second part of the treatment programme, each evening is devoted to a different drawing exercise. The drawings are shared and feedback given. These drawing exercises include ‘worst case scenario’ (if you don’t stop), ‘the museum of loss’ (losses caused by the addiction) ‘message in a bottle’ (a farewell letter to the addiction), ‘snakes and ladders’ (things that lead you into addiction and things that help you out of addiction) and ‘the gift box’ (about making amends to self and others).
In the final 12-week set of sessions, we use straightforward CBT exercises to strengthen the internal sense of self. Most addicts have a ‘blame self’ response to shame. This persecuting voice derives from childhood and is contradicted by the asset list. We use exercises like ‘good news diary’, anxious predictions, old system-new system, and thought records to help build a more robust sense of self.
The importance of group work
Most effective addiction treatment takes place within a group format. The group is the agent of change. Groups provide a place for catharsis, a positive recapitulation of family life, universality (‘I am not alone with this’), vicarious learning, and a place to reach the elusive answers to existential questions. While our programme is different from the Twelve Step Programmes, the group experience is common and effective in both.
Next week, we will look at paraphilias and at how they fit – or do not fit – into the landscape of addiction.