Does sexual addiction therapy work?
No evidence-based treatment exists to curb the misconduct seen in the news, experts say
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 behaviour.
“My journey now will be to learn about myself and conquer my demons,” the producer Harvey Weinstein said in a statement in October. The actor Kevin Spacey announced that he would be “taking the time necessary to seek evaluation and treatment.”
Whatever mix of damage control and contrition they represent, pledges like these suggest that there are standard treatments for perpetrators of sexual offences. In fact, no such standard treatments exist, experts say. Even the notion of “sexual addiction” as a stand-alone diagnosis is in dispute.
“There are no evidence-based 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 said — powerful urges that cannot be turned off.
Still, there is reason to think that these therapeutic approaches can be adapted to treatment of the men accused of offences 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 behaviour. The other is reserved for people committing non- consensual acts — sex offenders.”
The first group includes the college student failing out 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 counselling sessions, and by teaching classic impulse-control techniques, such as avoiding friends, social situations and places like bars that put them at high risk of repeating the behaviour.
The services offered resemble those for other kinds of compulsive behaviour, such as gambling and drug use. There are life coaches, couples counsellors and hypnotherapists, as well as residential clinics with names like Promises and Gentle Path at the Meadows.
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 behaviour 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 Centre.
When confrontation is not enough, the therapist has alternatives. People who commit sexual assaults often minimize their behaviour. One way to counter this is by having patients be more accountable and adopt appropriate language describing their offence, Reid said.
For example, a perpetrator needs to describe acts as an assault — to say “I forced my hand down her pants,” rather than “I went a little too far.”
Reid helps patients cultivate victim empathy by having them attend court-sentencing hearings, where victims read detailed accounts “and the impact isn’t sugar-coated” 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 potential 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.”
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.”
From there, the playbook is similar to that used to treat men with more severe disorders, Seto said. Amplify the person’s motivation to change by, say, getting them to describe the loss they face in their work, their family, their reputations.
Build awareness of what triggers the bad behaviour — that is, not merely the presence of an attractive target, but the setting in which this occurs.
Distraction, relaxation, meditation: these techniques can help, too, in the person who takes them seriously, as ways to offset bouts of anxiety or despair that can make willpower go right out the window.
Serial harassers, though often caricatured, do not fit any personality type or types.
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 said.
Having a measure of power can turn such long-standing 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,” Cantor said. “And we certainly don’t have a treatment.”