The Clinical Assessment and
Treatment of Sex and Porn
Addiction
Robert Weiss LCSW, CSAT-S
Founding Director - The Sexual Recovery Institute
Director of Sexual Disorder Programs, Elements Behavioral
Health
Promises, The Ranch & The Sexual Recovery Institute
Note: This presentation will demonstrate methods utilized to
access online sexual experiences. Explicit images will not be
shown, however please carefully consider if learning such
information might prove harmful to your personal recovery.
The Problem
Fmr. President Bill Clinton
Actor David Duchovney
Actor Jesse James
Fmr. Governor Elliot Spitzer
Fmr. Governor Mark Spencer
Fmr Sports Hero Tiger Woods
Fmr. Chief Dominique Strauss-Kahn
Fmr. Governor Arnold Schwarzenegger
Fmr. Congressman Anthony Weiner
All are men whose sexual behavior MORTALLY
Is Sexual Addiction A Mental
Health Diagnosis ?
• Was in the DSM III
• Was out of the DSM IV
• Now being considered for the DSM V
(Hypersexuality)
Sex Addiction is not
‣Axis I Symptom- we r/o out
ADD/OCD/Bipolar
‣A Moral or Religious Stance
‣Fun
‣Fetish / Paraphilia
‣Same Sex Interest or Activity
‣Crystal Meth Addiction
‣Sexual Offending - non consensual
Sexual Addiction Symptoms Follow the
Characteristics of All Addictions
Criteria for Sex Addiction parallels guidelines for
assessing Substance Dependency, Alcoholism, and
Compulsive Gambling:
‣Loss of control
‣Continuation despite adverse consequences
‣Obsession or preoccupation
The presence of these three criteria operationally
define addiction to both substances and behaviors
Typical Sex Addict Behaviors
• Compulsive Use of Porn (with or without
masturbation)
• Anonymous Sex (met online or in sex clubs etc.)
• Adult Bookstores and Strip Clubs
• Sexual Exchange (i.e. Drugs or Favors for Sex)
• Prostitutes and Massage Parlors
• Cruising, Intriguing, Objectifying, Seduction
• Pushing Boundaries, Boundary Violations
• Multiple Affairs / Anonymous Infidelity
• GPS SmartPhone Hook-ups
• Sexting / Abusing Social Networks
Addicted to sex?
‣ Increased Heart Rate
‣ Pupils Dilate
‣ Hearing More Acute
‣ Shallow Breathing
‣ Perspiration- palms, underarms, etc.
‣ “Rush” or “Intensity” Feeling
‣ Reduced Intellectual Functioning!
Sexual Addiction is the use of
Intense Fantasy to Induce
Neurochemical Release
‣Serotonin - mood stability
‣Dopamine - pleasure
‣Adrenaline - energy, jolt
‣Endorphins - calm
‣Oxytocin - love/jealousy
ADDICTS CALL IT…
‣The Bubble
‣The Trance
‣Spaced Out
‣Think ...
‣Dissociative State
‣Trauma
‣Self Soothing
In 12-Step Language ...
POWERLESS!
Sex Addiction is not
about sex or orgasm.
It is about the search for
sex and desire for
orgasm.
It’s a Process Addiction.
The Process Addictions
• Gambling
• Internet Gaming
• Workaholism
• Binge Eating
• Sex
• Exercise
• Religion
• Spending
• High Risk Behavior
Sexual Addiction Symptoms in
Residential or Outpatient Clients
‣By History
• Multiple abortions (females), multiple STDs
(both sexes), repeated unprotected sex
• Previous arrest or major life consequences
related to sex
• Drugs/Alcohol used to help tolerate or
enhance sex
• History of previous sexual acting out in
treatment
• Drug use fused with sexual behavior
Sexual Addiction Symptoms in
Residential or Outpatient Clients
By Behavior
• Seductive Dress (especially after it is pointed
out)
• Seeking out “special relationships” with other
attractive clients or staff for advice, friendship
and direction
• Giving “the stare”, being sexual in treatment
• History of CD relapse – especially females
• Encouraging Dependency as a form of
seduction
• Sneaking & using porn in treatment - sharing
porn in treatment.
The Betrayed
Spouse
Initial concern for this spouse is
physical and emotional safety
• Physical health -STD’s, Pregnancy
• Family safety - Children at risk?
• Specific betrayals that might
overwhelm or undermine later
• Acts out in angry, vengeful, acts superficially
Diagnose this client
supportive of treatment while actually undermining
it.
• Often shifts from idealizing her spouse, therapist
and treatment - to devaluing and dismissing them.
Can be demanding and boundary-less.
• Expresses feeling “out of control.” Can engage in
compulsive behaviors such as ‘detective work’ or
stalking
• Often seems to be on a mood ‘roller coaster’.
• Mistrustful, suspicious, at times can be rageful
and verbally abusive. Can ‘act out’ by overeating,
spending and other compulsive behaviors.
• Inconsistent and uncommitted to looking at her
Which one is (s)he?
1.An Axis II Diagnosis -Borderline, extreme
Codependency etc.
2.Profoundly Co-dependent. “poor dear, she
lost her ‘self’ to him”.
3.A client who suffering from a profound life-
trauma and grief reaction without meaningful
support or direction.
•It might take a while before you know ...
We believe she is on an
Emotional Roller-coaster
How long can it take to
get off this ride?
• 9-18 months, post-discovery/disclosure.
Provided there is an active recovery
process in place in place for both.
The clinical needs of this spouse.
• Direction regarding self-care, health issues,
talking to family etc.
• Education about addiction, disclosure, family
dynamics, support.
• Holding and Validation of her reality and her
feelings
• Disclosure and clarity regarding their unknown
history
• PEER SUPPORT as well as support by
professionals
• Structure toward moving forward
• Hope
Sex and Tech
Online sexual content,
chats and interaction has
forced us to reassess
sexuality in our culture.
For example, today what
do you consider to be…
Infidelity?
What has changed in our
experience of sexual content &
sexual contact over the past 20
years
•Access
•Affordability
•Anonymity
• * Cooper, Del Monico et al 1998 - 1999
How long did it take for the
following technologies to reach 50
million participants following public
introduction?
•Radio - 38 years
•Television - 13 years
•Internet - 4 years
•Social Networking - 16 months!
•Whatever comes next will happen close to
instantaneously. It will be in our lives
before we know it our fully understand it.
So get ready.
Sexual Access
Timeline
1.0 Pre-history -
• Recreational and Intimate
Sexuality 1890
• Cave, drawn and painted
pornography
• Affairs & Infidelity
• Public Baths
• Prostitutes & Harems
Sexual Access
Timeline
2.0 1890 - 1970’s
• All of the above plus ...
• Photographic Porn
• Porn Movies (XXX)
• Adult Bookstores, Porn shops
• Bath-houses & Strip clubs
Sexual Content Access
3.0 1977 - 1990
• All of the above plus ...
• Video = VCR and BETA
• Phone Sex
• Softcore on cable TV- at home
• “Adult” and “Escort” Sections in
Yellow Pages, magazines and
newspapers
Sexual Content Access
4.0 1990 - 2004
• All of the above plus ...
• BBS - Online bulletin board systems
(BBS)
• Websites for porn and prostitution
• Online Porn and file transfer sites
• Chat Rooms
• Online Hook-ups - i.e. craigslist
• Webcams and interactive live sex
Sexual Content Access
5.0 2004 - Present
• All of the above plus ...
1. Sexting and live video streaming from
your smart phone
2. Smart Phones with GPS hook-up apps
3. Social Networks (facebook, twitter,
mySpace)
4. Virtual World Sex (2nd-Life, virtual
games etc)
5. 3-D Imagery and Teledildonics
About Sexting
Eewwwwwwwww!
And some are using it to offend ...
facehooked?
• “Before entering treatment I was
spending up to 5 hours a night some
nights cruising facebook for sex.
Well, not for sex exactly, it was more
cruising for faces and profiles I
thought might respond to me. I was
looking for friendly, engaging women,
then leaving messages, poking them,
trying to get a response from
someone who cared. Then we would
take it from there ... ”
•GPS locators mean immediate live
About Smartphones
access to sexual partners and sexual
content-
•Universal Internet access anywhere -
to porn, to sexually oriented
environments (strip clubs, adult
bookstores, etc)
•Not ‘trackable’ like a computer
history
•Live video streaming to phones and
pads-
•Let’s look at this more closely ...
There’s an app for that!
So what’s an app?
• Apps are applications that you load from the
Internet onto your smart phone or ‘pad’ to
perform specific functions. For example - if
you load a dictionary app onto your phone-
you can then use your phone to look up
words and spelling from your phone
• Sex apps are the same - loaded from to your
phone to help find sexual partners.
Apps you should know
about
• Ashley Madison - for married men and
women
• Grindr - for gay men
• Started as a website - now also a mobile
app - perfect example of content access
About Ashley Madison
progression
• AM Slogan: “Life is short, have an affair.”
• AM Mission Statement: “To provide an
interactive way for like-minded users to
explore whether they wish to meet each
other, chat with each other and/or explore
extra-marital relationships”
• Over 9-million members internationally
• In May 2011 – 1,3 million men and women
used the service to contact a sexual
partner in that single month
Teledildonics with your Wii...
By hooking up the hardware components up to the two
Wii-motes, wiggles and thrusts on the first Wii-mote are
detected and sent via Bluetooth to a nearby computer.
From there this information is sent over the Internet and
reproduced by the other Wii-mote which acts as a Wii-
brator on the other end, allowing remote partners to
Treatment
Initial Sexual Addiction Treatment
Is Cognitive Behavioral
• Behavioral disorders require behavioral forms of
treatment -not Jungian, Psycho-analytic, Somatic
Narrative etc.
• In Outpatient- we don’t delve deeply into trauma
or transference until 90-days sober at minimum
• In Residential - we can delve into deeper issues
sooner and more directly - but still stay focused
on the primary goal which is always establishing
sobriety and relapse prevention
Required Treatment Steps When Working
with Sex Addicts
Do a thorough psycho-sexual history/assessment
Identify the treatment goals of the client and then co-
create a sexual sobriety contract aligned with those
goals.
Hold clients accountable to all their agreements!
Confront denial
Educate and teach relapse prevention
Get them into a sex addiction group therapy
Find support for the spouse
Direct healthcare, family and crisis resolution
Refer to long-term 12-step, therapy or faith-based group
support
Elements Behavioral Health
Assessment & Treatment Options -
• The Sexual Recovery Institute (SRI) - Los Angeles- 2-
weeks of Intensive Treatment- Structured, manualized
programming. Clients stay at a men’s recovery residence -
• Psycho-sexual and Fitness for Duty Assessment,
www.sexualrecovery.com
• The Ranch in Tennessee - 35 Days of Residential Sexual
Addiction Treatment with Extensive Trauma and Family
Component - www.recoveryranch.com
• Promises Malibu or West Los Angeles- Primary CD
Treatment with a focus where needed on Sexual Disorders
and access to SRI clinicians or full IOP where needed.
www.promises.com
What is Sexual Sobriety?
• Rarely complete abstinence
• A mutually agreed upon clear, written and
signed, behavioral contract based on client
goals.
• Sobriety plans don’t change without prior
discussion.
Sexual
Sobriety Contract
List of Behaviors List of Behaviors
I Want to Stop I Want to Add
‣A ‣A
‣B ‣B
‣C ‣C
‣D ‣D
‣E ‣E
‣F ‣F
12-step Groups for
Sexual Addicts and Partners
Sex Addict Support Partner Support
‣SAA ‣S-Anon
‣SA ‣Alanon
‣SCA ‣COSA
‣SLAA-Women ‣CODA
‣SRA ‣RCA - Couples
Want to Learn More?
‣The Sexual Recovery Institute
www.sexualrecovery.com
‣The Ranch www.recoveryranch.com
‣IITAP - International Institute for Trauma, and
Addiction Professionals www.iitap.com
‣SASH - The Society for the Advancement of
Sexual Health www.sash.net
‣E-summits www.e-summits.com Online and
Video learning with available CEU’s
The Clinical Assessment and
Treatment of Sex and Porn
Addiction
Robert Weiss LCSW, CSAT-S
Founding Director - The Sexual Recovery Institute
Director of Sexual Disorder Programs, Elements Behavioral
Health
Promises, The Ranch & The Sexual Recovery Institute
Note: This presentation will demonstrate methods utilized to
access online sexual experiences. Explicit images will not be
shown, however please carefully consider if learning such
information might prove harmful to your personal recovery.