Psychoanalysis for the Treatment of Sex Addiction

It is my belief that sex addiction requires a contemporary psychodynamic approach. Psychoanalysis changed drastically in the 1970's with the work of a prominent psychoanalyst who rejected the Freudian approach and established a kind of treatment that is particularly useful in treating sex addiction. Contemporary analysts no longer conduct treatment three-times a week on the couch. They do not unearth hidden meanings, or remain silent, or put themselves on a "thrown" as being the "One Who Knows". The process is a shared one and the relationship between patient and therapist is co-created and mutual.

Some contemporary psychoanalysts use the concept of a vertical split in treating the addict. The split exists from inadequate parenting which results in structural deficits in the personality. Patients often report that they feel fraudulent, living two separate lives with two different sets of values and goals. They feel they're acting out a version of "The Strange Case of Dr. Jekell and Mr. Hyde."

One sector of the personality, the one anchored in reality, is the responsible worker and partner. This part of the person is conscious, adaptive, anchored in reality, structured, and often successful in business. This is also the sector that experiences guilt and shame about his sexual behaviors and ultimately drives him to seek therapy to ease his misery.

The "Mr. Hyde" side of the vertical split has a completely different set of values and seems to be impervious to his own moral injunctions. "Mr. Hyde" represents the unconscious, split-off part of the personality. It is impulse-ridden, lives in erotic fantasy, and is sexualized, unstructured and unregulated. This side of the vertical split seems to be incapable of thinking impulses through, and thus is oblivious to the consequences of his behavior. This is the part of the self that is hidden, dark, driven and enslaved.

A comprehensive discussion of the actual process of therapy is beyond the scope of this paper. Suffice to say, the therapist uses him/herself as an instrument in integrating the split which results in personality structure building. Treatment bridges the gap of the split. Its aim is the establishment of a relationship with the therapist that regulates emotional states, to be used as a "laboratory" to bring to consciousness maladaptive relationship patterns, provides empathy and understanding and reconstructs the childhood origin of the addiction. The goal is an integrated self that is able to merely experience a sexual fantasy without being preoccupied with it and without acting out a damaging sexual scenario. The patient achieves some ability to self-regulate moods, and to seek out adequate and sustaining available supportive relationships both in and out of treatment. He is then free to put sexuality in its proper place and free up energies to gain satisfaction from real relationships, pursue creative or intellectual goals, obtain pleasure from hobbies and activities, and have a heightened sense of self-esteem, thus enabling him to end his isolation. He is then free to love, to have deeply satisfying, self-affirming sex, work to his potential, and experience being a valued member of the human community.

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Last reviewed: By John M. Grohol, Psy.D. on 7 Sep 2004
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