Just Because a Client Says He’s Porn Addicted…
As digital technologies become more ubiquitous and porn usage becomes more prevalent and socially acceptable, clinicians, especially certified sex addiction therapists (CSATs), have seen a corresponding increase in the number (and variety) of people seeking help with shameful and/or compulsive porn use and related life problems. Importantly, there are multiple and often very different populations seeking such assistance. For instance, some clients seek treatment because they are addicted, while others seek treatment because they feel shame about their porn use. Unfortunately, this second population will sometimes self-diagnose as being addicted, even when they’re not.
Needless to say, these two porn-using populations have different motivations for treatment, different underlying issues, and very different treatment needs. An approach that works with one group might be harmful with the other, and vice versa. As such, it is vital that clinicians accurately differentiate between true sex/porn addicts and the people who label themselves as such based more on shame than actual addiction benchmarks.
Admittedly, both groups come to treatment unhappy about their use of pornography, often to the point where they experience significant depression and/or anxiety. And both groups are generally displeased with their sexual fantasy lives and the way they’re living them out. Moreover, both groups are usually keeping secrets and/or lying about their sexual desires, their porn use, and, sometimes, their real world sexual activity. However, shame-based clients might be utilizing a self-diagnosis of sex/porn addiction as a way of justifying sexual fantasies and behaviors about which they feel deep emotional discomfort. Recognizing this, therapists should never automatically accept any porn using client’s sex/porn addiction self-assessment. To do so would be a disservice to both the client and the psychotherapeutic community. Proper clinical assessment is always required.
Shame-Based Porn Users vs. Addicted Porn Users
There are two primary categories of shame-based porn users. First up is the person whose religious and/or moralistic belief system vilifies pornography (and, perhaps, sexuality in general). A typical client of this type is a young man with a strict religious background who looks at porn occasionally, maybe a few times per week for 20 or 30 minutes. Though porn use does not directly affect this client’s day-to-day functioning, he feels horrible about the behavior because his church, his family, and pretty much every other important person in his life has labeled this activity as sinful. Sometimes this client (or those around him) will insist that he is addicted to porn. Otherwise, why would he use it when he knows it might get him thrown out of his church and damned to an eternity of hellfire and brimstone?
The second type of shame-based porn using client is the individual with ego-dystonic sexual attractions. A typical client of this sort is a married, supposedly heterosexual man who feels great shame about his use of gay porn, which he looks at occasionally for short periods of time with no direct effects on his day-to-day functioning. However, his self-esteem is nonexistent and he’s deeply depressed. In therapy, he may blame his same-sex fantasies and behaviors on sex/porn addiction, viewing that as the lesser of two evils. This client seems to think (or wants to believe), “I only want to have sex with men because I’m an addict. If I wasn’t addicted, I wouldn’t have these desires.”
Is it possible for a shame-based porn user to also be addicted? Absolutely. But only if that person’s behaviors meet the criteria used to properly assess for sex/porn addiction. These benchmarks are:
- Preoccupation to the point of obsession with porn and/or real world sexual activity (lasting six months or longer)
- Loss of control over the use of porn and/or real world sexual activity, generally evidenced by multiple failed attempts to quit or cut back
- Real world consequences directly related to out of control porn use and/or sexual activity. These consequences may include ruined relationships, trouble at work or in school, loss of interest in previously enjoyable hobbies and activities, social isolation, lack of self-care, declining physical and emotional health, financial struggles, legal issues, etc.
The Need for Proper Diagnosis
Neither of the shame-based clients described above meets the criteria for sex/porn addiction, and no properly trained clinician would treat them as such. Instead, we would try to help them normalize, accept, and integrate their sexual desires and behaviors so they don’t feel so much shame, and to reconcile their desires and behaviors with their religious and cultural/social ideals. In other words, we would try to help these men find a sexual comfort zone, which might or might not include future porn use. Moreover, if these clients attempted to self-label as a sex/porn addict, we would educate them as to the nature of that disorder, helping them understand that addiction is not their issue.
In truth, treating either of these non-addicted individuals for sex/porn addiction, using the techniques that have proven effective in that regard, would be counterproductive, as this work would reinforce their mistaken belief that their attractions and behaviors are abnormal and wrong. In other words, to tell them that yes, their sexual desires and activities are problematic would just bolster their shame. And that in turn would deepen their presenting symptoms (depression, anxiety, lowered self-esteem, and the like).
Meanwhile, trying to treat a person who really is sex or porn addicted by “helping him feel better about his desires and behaviors” can be equally damaging, as this approach seemingly encourages more of the obsessive, out-of-control activity that’s creating the addict’s problems. It’s a bit like telling an alcoholic, “Oh, don’t worry about it. Everybody has a cocktail once in a while.” Such an approach willfully ignores the addict’s loss of control and the resultant negative consequences. So, once again, when dealing with clients seeking treatment related to porn use, proper assessment and diagnosis is a must. Without it, clinicians can do more harm than good.