SEXUAL ADDICTION AND MARRIAGE AND FAMILY THERAPY: FACILITATING INDIVIDUAL AND RELATIONSHIP HEALING THROUGH COUPLE THERAPY

Journal of Marital and Family Therapy, Jul 2006 by Bird, Mark H

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). This article (a) presents a synthesis of the research on the impact of sexual addiction on the addict, the partner, and the couple; (b) outlines the process of healing for each based on the research synthesis; and (c) discusses the role of marriage and family therapy in facilitating both individual and relationship healing from sexual addiction. Implications for future research in sexual addiction, generally, and in marriage and family therapy, specifically, are presented.

The publication of the book Out of the Shadows: Understanding Sexual Addiction (Carnes, 1983) marked a significant increase in the recognition of the term now called sexual addiction as well as the theoretical and empirical literature surrounding the concept. The explosion of the internet has provided a new arena for potential sexual addicts, offering easy access (see Griffiths, 2001, for a review of avenues available), affordability, and anonymity (Cooper, 1998). Young, Griffin-Shelley, Cooper, O'Mara, and Buchanan (2000) suggest that these factors may open the door to sexual addiction for individuals who previously did not express vulnerability, or push mild addicts toward more severe addiction. It is estimated that there are now between one-half and two million sexual addicts (Delmonico & Carnes, 1999).

Despite increased awareness of sexual addiction, as well as an increase in avenues by which many can become sexually addicted, many therapists still experience uneasiness about or lack knowledge of sexual addiction. This may cause therapists to miss many important cues and/or completely fail to address sexual addiction in therapy.

Because couples experience intense emotional reactivity, particularly during early stages of recovery, many therapists who are knowledgeable about sexual addiction prefer to offer treatment for sexual addiction without the spouse, at least initially. However, many of the conceptual and etiological explanations (i.e., past relationship degradations, Bergner, 2002; a subjectively high degree of life stressors, including relationship difficulties and social isolation. Carnes, 1983) suggest that marital therapy might be more helpful than group or individual therapy for facilitating healing with couples (and particularly for monitoring emotional reactivity early in the recovery process). Although the role of marital therapy in helping individuals and couples heal from sexual addiction has been sparsely discussed in the literature (Carnes, 1986; Corley & Schneider, 2002; Earle & Crow, 1998; Laaser, 1996; Schneider, 1989; Sprenkle, 1987; Young et al., 2000), those articles that do address marital therapy suggest the following themes: restoration of trust, improved awareness of individual issues and emotions, improved communication and assertiveness, forgiveness, dealing with sexual problems, establishing boundaries, improving intimacy (positive interactions, activities together, etc.), reducing defensiveness, and reducing shame. Despite the increased recognition of the role of marital therapy in healing sexual addiction, marital therapy still is considered primarily an addition to individual and/or group treatments.

EMPIRICAL REVIEW

Because of the lack of conceptual congruency among authors and the relatively small role marital therapy plays in the current conceptual literature, I conducted a systematic research synthesis (Rothman, Damron-Rodriguez, & Shenassa, 1994) to understand more fully the trends and limitations in the empirical literature with relation to (a) the impact of sexual addiction on the addict, the partner, and the relationship; (b) the healing process for the addict, the partner, and the relationship; and (c) the possible role of marital therapy in facilitating healing from sexual addiction.

For the purposes of the critique of empirical literature, I only examined peer-reviewed journal articles. Although there is an abundance of books (Carnes, 1983, 1991; Earle & Crow, 1998; Milkman & Sunderwirth, 1987; Schneider & Schneider, 1990a) and non-peer-reviewed projects on this topic, I did not include these in the review. The articles chosen are a culmination of all empirical articles that have been written since the inception of the concept of sexual addiction. Because the bulk of research draws a distinction between the nonparaphilia and paraphilia sex addictions (Kafka & Hennen, 1999; Kafka & Prentky, 1992), I also eliminated the articles addressing paraphilia.

METHOD

The articles selected are the results of an extensive literature search in several databases, including Psychlnfo, Google Scholar, and ERIC. The keywords utilized in the search include the following words and their possible combinations: "sexual addiction," "compulsion/compulsivity," "impulsive/impulsivity," "sexual fantasy," "sexual risk taking," "study," "empirical," "qualitative," "quantitative," "comorbidity," "relapse prevention," "love addiction," "dependence." "marital therapy," "couple therapy," "therapy," "internet addiction," "pornography," "cybersex," and "masturbation." In addition, I reviewed the reference lists of all articles collected in the search in an attempt to find any other empirical articles related to the topic that did not appear in the database searches.