Bad things happen to good people

Posted on December 31, 2011 by Robert Odell

The title of this post derives from a well-worn and somewhat corny phrase. Yet I admit it captures a simple overall view about my experience working with people involved in “critical incidents” (for background on that term, you can view my site’s critical incident webpage which describes this part of my practice.)

I am dedicating my year end post to this part of my practice, to express my gratitude and deepest respect to the men and women who I met in this work in 2011 (and really, everyone over the last 12 years). They show me what people are like at their best. Many times, that “best” comes forward not just as deeply sympathetic, supportive or honest grief, but also as startling and even anxiety-provoking honesty.

Even in the midst of expressing the shock and grief from directly witnessing and responding to fear, grief and close proximity to losses of life or health, people can be very honest. They say what’s true about their feelings, the complexity of the situation they face, and their feelings toward those who were imperiled, injured or killed. Within the circle of people who are closest to who was endangered, injured or killed, the honesty is healing, just like the many kind and supportive acts that are performed for families and co-workers.

The humor that people are capable of is also healing and profoundly human; within the immediate group affected by the loss, the humor is always appropriate, without any specific effort to make it so. And that humor, expressed by those further removed from the most immediate group, is either less meaningful, or worse. It’s often put forward by those who thoughtlessly try to make themselves feel better.

To those who suffered and lost, thank you for letting me “in”, and teaching me again and again what’s best in the human spirit. After I left you that day, I believe you continued to develop and respect the grief process that causes us to grow, mature and appreciate the life and health we have.

On (sex) addiction

Posted on December 26, 2011 by Robert Odell

‘Sex addiction’ has entered everyday language, joining chocolate, gambling and shopping; pleasurable activities to which people can become ‘addicted.’ These transformations all trade on a longstanding model of chemical dependency treatment, and its particular way of constructing repetitive, compulsive behavior.

Apart from the current state of psychiatric diagnosis, I outline some basic questions about what sex addiction might mean for a couple. First, let’s briefly review the latest psychiatric/medical diagnostic thinking.

The official diagnostic reference, the Diagnostic and Statistical Manual (DSM), will introduce ‘sex addiction’ in 2013 (DSM-V) in a brand new diagnosis, “Hypersexual Disorder“. It posits ”normal” sexual behavior - coitus and pornography/fantasy - which is “repetitive, excessive, or disinhibited”. This last part is derived from diagnosis of chemical dependency, even though the overall diagnostic category is a sexual disorder. The behaviors must occur despite “adverse consequences” (also a chemical dependency criterion) to either individual health (higher risk of STDs and sex offenses), relationship/marriage and employment. Research is not conclusive on the neuro-science behind the diagnosis, specifically whether one can become dependent on dopamine produced by orgasm.

In everyday reality, couples begin therapy, and either one partner says the other is a sex addict, or, they agree that one of them is a sex addict (it’s very rare that both acknowledge ‘sex addiction’.) The sexual history of each partner, of the relationship (including who has been the higher/lower desire partner), past relationships, the partners’ parents’ relationship, the role of pornography, sexual contact with third parties, alcohol or drugs – all of these and more factor into the big picture. A loss of credibility/integrity overarches everything when the sexual activity was covert. Divorce may be imminent, or, a confused, ambivalent period of healing looks like the only option for the future.

Labeling a partner as a ‘sex addict’ confers shame and a simultaneous reduction of choice and responsibility for that partner. Many people question whether addiction can be ‘cured’, and telling one’s partner that they will be in perpetual recovery has consequences. Labeling someone a ‘sex addict’ expresses the intense pain, betrayal, sudden loss of intimacy & integrity. Past deprivation is re-experienced. The labeling can begin a cycle: 1) immediate relief or “improvement”; 2) relapse; 3) further shame.

I think that ‘sex addiction’ is one way to construct what the behavior means for a couple. That isn’t ‘right’ or ‘wrong’; partners ultimately decide how they make meaning and attribute motives for what’s happened. But in a case where progress is stalled, couples look for a way in therapy to have things develop further. As always, the questions that get asked are more influential than the answers (advice) I might provide.

Does pornography/fantasy content represent the setup to the addiction, or the addiction itself? Can the ‘addict’ permanently help him/herself? Is he/she out of control? Is the ‘addict’ truly responsible, truly choosing the behavior(s)? If the ‘addict’ stopped the behavior(s), would the partners resume wanting each other and would sexual relations re-commence? These and other questions may begin to develop progress when the recovery process has stalled.

There may ultimately be a painful acceptance that there is no scapegoat, be it a partner or the internet; in a committed relationship, every meaning is co-constructed. The ‘addict’ partner often claims that they themselves were deprived by the other. It may become possible for partners to see the covert, repetitive sexual activity for what it says about them both, not just one partner. And then real couples therapy can begins, as distinct from one partner anxiously witnessing the other’s recovery from ‘addiction’.

I’ll close this long post by thanking Esther Perel, who gave me a long answer to a question I asked her about working with the idea of ‘sex addiction’. When I finally de-constructed her response, it was both and empathic and observant (and so clearly the result of long work and clear thought).

Who’s Afraid Of Couples Therapy?

Posted on December 21, 2011 by Robert Odell

This attention grabbing title (at least for couples and therapists) is for my current continuing education program. It’s a group of eight interviews, with Q&A, with some of the top practitioners in the couples therapy field, with some emphasis on sexuality. The series is sponsored by Psychotherapy Networker, to whom I give credit for innovative professional education offerings.

Topics include: “Confidentiality, Secrets, and How to Deal with Affairs” (Esther Perel); ”Taking Off the Masks: Truth-Telling in Couples Work” (David Schnarch) and “The Logic of Eroticism” (Marty Klein). In addition to working with the latest material from both Perel and Schnarch, my two greatest clinical influences, this series also gives me a chance to listen and direct questions to some top practitioners who practice and think quite differently than they or I might.

I am just finishing my review of tapes from the series of six hours that I took from Tammy Nelson and Esther Perel. They are brilliant and deeply encouraging people. I will blog some of the thoughts that stand out for me from that work shortly. [UPDATE: My first blog post directly stemming from this series is titled "On (sex) addiction" Your comments are very welcome!]