Our therapeutic approach
This brief article has been written to provide clients and health professionals with an overview of our therapeutic approach when working with, and delivering training on, sex and porn addiction. Whilst some people still dispute the existence of sex and porn addiction, it can be helpful to understand why the controversy exists and where the Laurel Centre sits within the debate.
Sex Addiction and Porn Addiction are controversial. Whilst ‘addiction’ is the term most commonly used and accepted by the general public, some health professionals, mostly in the US, but also some in the UK, object to the label ‘addiction’ because they believe it pathologises human sexuality.
The latest version of the International Classification of Diseases (ICD-11), which is run by the World Health Organisation, accepts the term “Compulsive Sexual Behaviour Disorder” (CSBD). The ICD is a manual that health professionals use to diagnose a condition. Currently sex addiction and porn addiction have not been accepted as terms by professionals because there hasn't been sufficient evidence demonstrating the condition is the same as chemical addictions, or behavioural addictions such as gambling and gaming. However, there is currently a lot of new research being undertaken and this recognition by WHO was seen as a significant and positive step, acknowledging for the first time that this needs to be recognised by health professionals. Currently, CSBD is listed under ‘Impulse Control Disorders’, but the Laurel Centre, like many others within the academic and therapeutic communities, believe that when the research catches up with client experiences, CSBD will be moved to ‘Addictive Disorders’, which is exactly what happened with ‘compulsive gambling’ some years ago.
So why does it matter what it’s called? Broadly speaking it’s because some therapists who claim to help people with sex and porn addiction are either not trained in addiction, or not trained in sexuality which means the treatment they offer is ineffective, or even damaging. Inadvertently, these people maintain the controversy of the label - we will look at each of these groups in turn.
Regrettably many people who are not trained in the field of addiction believe that there is only one ‘addiction model’ and anyone who uses the term ‘addiction’ must therefore use one single treatment approach. The addiction model that is objected to is the ‘disease’ model, sometimes referred to as the ‘medical’ model. This model of addiction was first coined many years ago to explain alcohol and drug addiction. The belief was that addiction caused irreversible brain damage that results in a life long struggle with addiction and the addict needs to accept the reality of their condition and maintain total abstinence. With the advent of neuroscience we have learned that this is not the case. We have learned that whilst addiction most certainly does ‘change’ the brain, it is not always in a damaging way, but more importantly, the brain can change again and develop new circuits (do look at my Road to Brighton video for a layman’s explanation). What we also know is that there are significant psychological and emotional contributions to the development and maintenance of addiction and that all of this happens within a social context. For example, someone who is addicted to alcohol will have experienced biological brain changes, but there will also be psychological or emotional reasons why they have become addicted, and/or struggle to stop, such as a history of trauma or an ongoing struggle with stress or depression. Furthermore, their social context will also influence the addiction, and the meaning of the addiction, for example if they work in a bar or have a belief system that alcohol consumption is a sin, or essential for an enjoyable life. Now that more research is available, more and more addiction professionals have adopted what is known as a BioPsychoSocial Model of Addiction. However, some therapists who are not trained in addiction are not aware of this and hark back to an outdated view of addiction which maintains the controversy of the ‘addiction’ label.
Unfortunately, there are still a few addiction professionals working in sex addiction who do use a disease model of addiction and often they have received little or no training in human sexuality. In the UK, this is relatively rare as all of the UK training in the field of sex addiction originated from psychosexual therapy, but there are some therapists in the UK who are either untrained in sex addiction or attended training abroad that focusses on the disease model. If you use a pure medical, or disease model of addiction with sex or porn addiction then it may be difficult to fully explore what positive sexuality means to the individual. And without this knowledge and experience, sexual boundaries may be established that are either inappropriate or damaging. It is understandable that people who call themselves ‘sex addiction therapists’ who work with a disease model of addiction, and only treat it from this perspective without an understanding of sexuality, continue the controversy – just like those with no training in addiction at all.
The BioPsychoSocial Perspective
As explained earlier, most addiction professionals now use a BioPsychoSocial model of addiction to both understand and treat addiction. In the field of sex addiction, the Laurel Centre believe this is absolutely essential and indeed we have taken the model further to include client’s cultural and relational perspective. The BERSC Model of Addiction was first developed by Paula Hall in 2012 and was published in her first edition of Understanding and Treating Sex Addiction. The BERSC Model includes understanding the Biology of addiction, but also the Emotional and Relational influences. Like the BioPsychoSocial model, it also encompasses the Social context, but goes further by adding the Cultural dimension. The cultural dimension includes those factors we use to define our sense of identity, such as our gender, sexual orientation, race and faith. It also includes the cultural groups that we identify with, such as kink, poly and open communities.
Unlike any other addiction, abstinence is not the goal of sexual addiction recovery, but rather, reclaiming sexuality from compulsivity. That means that a therapist working in sex or porn addiction needs to be comfortable, and experienced, in exploring a client’s sexual template and helping them navigate the nuances of desire within their cultural context. Our goal at the Laurel Centre is to help clients enjoy their sexuality more, not less, and that’s why all our associates are trained in the BERSC model of addiction and sexuality.
As a society our understanding of addiction has changed, and so have our treatment approaches. Within the field of sex addiction and porn addiction, our approaches continue to evolve as more and more research is undertaken. But one thing that has not changed is the importance of understanding both sexuality and addiction. If you’re exploring either therapy or training in this field, ensure that your provider is up-to-date with the research from every perspective and is able to provide a client-centred, integrative and sex positive approach.