Sex addiction: Is it a valid diagnosis with treatment?
The recent surge in accusations of sexual harassment and assault has prompted some admitted offenders to seek professional help for the emotional or personality distortions that underlie their behavior.
“My journey now will be to learn about myself and conquer my demons,” movie producer Harvey Weinstein said in a statement in October. The actor Kevin Spacey announced the same month that he would be “taking the time necessary to seek evaluation and treatment,” after he was accused of sexually assaulting several men, including a 14-year-old boy.
Whatever mix of damage control and contrition they represent, these pledges suggest that there are standard treatments for perpetrators of sexual offenses. In fact, no such standard treatments exist, experts say. Even the notion of “sexual addiction” as a diagnosis is in dispute.
“There are no evidencebased programs I know of for the sort of men who have been in the news recently,” said Vaile Wright, director of research and special projects at the American Psychological Association.
That doesn’t mean that these men cannot change their ways with professional help.
The evidence that talk therapy and medication can curb sexual misconduct is modest at best, and virtually all of it comes from treating severe disorders, such as pedophilia and exhibitionism, experts say — powerful urges that cannot be turned off.
Still, there is reason to think that these therapeutic approaches can be adapted to treat men accused of offenses ranging from unwanted attention to rape.
“You’re really looking at two categories of people,” said Rory Reid, an assistant professor of psychiatry at UCLA, who has a clinical practice focusing on sexual problems.
“One is what I call sexually compulsive behavior. The other is reserved for people committing nonconsensual acts — sex offenders.”
The first group includes the college student failing classes because he spends all his time surfing porn sites, or the man who is visiting prostitutes so often it’s threatening his livelihood and health.
Therapists treat these types much as they would substance abusers: with 12-step programs, group counseling sessions, and by teaching classic impulse-control techniques. Among those: avoiding friends, social situations and places that put them at high risk of repeating the behavior.
It is not at all clear how well such addiction-based approaches work — if at all. And that’s especially true for men in the more serious offender category, who are more likely to respond to confrontation, experts said.
“Confrontation itself — being busted or outed, as so many are now publicly — is enough to curtail or end the behavior in many cases,” particularly when the offender has a lot to lose in terms of money and standing, said James Cantor, director of the Toronto Sexuality Center.
When confrontation is not enough, the therapist has alternatives. People who commit sexual assaults often minimize their behavior. One way to counter that is by having offenders be more accountable and adopt appropriate language describing their offense, Reid said.
Reid helps offenders cultivate victim empathy by having them attend court-sentencing hearings, where victims read detailed accounts “and the impact isn’t sugarcoated” so offenders can “start to understand how an assault forever changes lives.”
The evidence is weak for
empathy training in offenders, through techniques such as role-playing and taking a victim’s point of view, said Michael Seto, director of forensic rehabilitation research at the Royal Ottawa Health Care Group.
“It’s hard to teach empathy,” he said. “Accepting responsibility is often done confrontationally instead of collaboratively.”
Some well-known men who recently were named as offenders have offered apologies and admitted to some or all of what their accusers say they’ve done. Among them: NBC’s Matt Lauer, who lost his job with the “Today” show this past week; Democratic Sen. Al Franken of Minnesota; and Charlie Rose, who was fired in November from “CBS This Morning” and his show on PBS.
Wright, of the psychologists’ association, said repeat offenders’ social assumptions are often worth challenging in therapy as well.
“This is worth trying if, for instance, the serial harasser has these assumptions that, for instance, ‘Well, I’m not hurting the person, because I’m not touching her or I’m touching gently — that’s not a big deal,”’
Wright said. “Those are simply inaccurate thoughts, and it is possible to break them down.”
Serial harassers do not fit any personality type. There’s the brash executive who gets what he wants; the doe-eyed guy with the man-bun in a loft; the nerdy good listener who likes to give shoulder rubs.
To the extent that their misdeeds are at least partially rooted in unacknowledged feelings of inadequacy or abandonment, traditional psychotherapy also has a role, experts say.
Having a measure of power can turn such longstanding psychological wounds into surreptitious excuses for exploitation. “It’s my turn now; all those women who ignored me in high school have to line up at my door.”
But only if the harasser is willing, committed and genuinely humbled is therapy likely to be anything more than a ruse to buy some sympathy — and worse, perhaps an eventual return to the field.
What to make of the harasser who is entirely unrepentant?
“I don’t think we have a diagnosis yet,” said Cantor. “And we certainly don’t have a treatment.”