The benefit of group hypnotherapy in the treatment of sex addictions.

Abstract: The purpose of this paper is to define addictions, describe the differences in the levels of sex addiction and then discuss the impact addiction has on relationships, society, spirituality, intimacy, and self-esteem of the addict. The next part of the paper will outline an eight to twelve week therapeutic group treatment utilizing different aspects of conventional talk therapy (person-centered and cognitive) and Heart-Centered Hypnotherapy[R].

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My definition of an addiction is the use of any substance or behavior to help change the way you are thinking, feeling, or experiencing emotions. The substance or behavior can also be used to avoid thoughts or feelings, in consequence the person usually experiences guilt and shame along with lowered self-esteem. Even though the behavior usually brings about more emotional pain and no resolution of the original problem, the pattern is continued with little to no positive effects. The definition of addiction according to Lycos.com is: "The state of being enslaved to a habit or practice or to something that is psychologically or physically habit forming, such as narcotics, to such an extent that its cessation causes severe trauma." Another definition given by the Ask Jeeves web site states that the word addiction derives from an old French legal procedure. "This procedure of addiction was intended when someone could not pay his debt to his creditor. So the person was addicted to the creditor. It was some kind of slavery until all the money plus interest was given back to the creditor. The creditor got the right to decide all of the addict's areas of life. Due to the raise of interest the addict stayed addicted for the rest of his life." The latter of the two definitions seems to accurately describe sexual addiction, as each time the person engages in the behavior, a loss of self occurs giving the addiction more "credit" in which it controls areas of the person's life. Patrick Carnes has defined sexual addiction as "any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one's work environment" (2001, p. 167).

Dr. Carnes will be referred to throughout this article due to his expertise in the area. His research shows that an estimated 3-6% of the population is affected by sex addiction. A survey by Dr. Carnes shows that sex addicts come from severely dysfunctional families, usually with at least one other member of these families having another addiction (87%). The dual addictions that also included sex addiction were: chemical addiction (42%), eating disorder (38%), compulsive working (28%), compulsive spending (26%), and compulsive gambling (5%). A person who is dealing with the pain from a severely dysfunctional family would be at higher risk for the development of addictive behaviors. He reports that 97% of sexual addicts reported experiencing childhood emotional abuse, 83% sexual abuse, and 71% physical abuse. Dr. Carries reports that the ratio of male to female sex addicts is three to one. One of the tools that he has developed is the Sexual Addiction Screening Test (SAST), a twenty-five item questionnaire designed specifically to identify sexual addiction.

The addict will begin acting out, usually with a pattern of out-of-control sexual behavior. Dr. Carnes listed patterns which can be indicative of sexual addiction. The patterns are as follows:

* compulsive masturbation 

* indulging in pornography

* having chronic affairs

* exhibitionism 

* dangerous sexual practices

* prostitution

* anonymous sex 

* compulsive sexual episodes

* voyeurism 

The addict begins to experience severe consequences due to sexual behavior, and an inability to stop despite these adverse consequences. The behaviors usually lead to losses in the person's life. Sexual addicts report these losses to include:

* loss of partner or spouse, 40%

* severe marital or relationship problems, 70%

* loss of career opportunities, 27%

* unwanted pregnancies, 40%

* abortions, 36%

* suicidal obsession, 72%

* suicide attempts, 17%

* exposure to AIDS and venereal diseases, 68%

* legal risk from nuisance offenses to rape, 58%

Even though the person may have the understanding that their actions can lead to severe consequences, they still engage in acting out. Addicts, in an effort to stop feeling out-of-control, will try to limit these sexual behaviors by changing their neighborhood, getting married, or religious compulsions. These attempts only serve to fuel the addiction, since the main issue underlying the addiction has not yet been addressed.

An individual starts to develop the use of sexual obsession and fantasy as a way to cope. The brain has the ability with sexual arousal to release peptides which parallel opiates and are many times more powerful, This creates a strong reward system reinforced by the brain, and causes the person to continue with the addictive cycles. The body, as with most addictions, starts to develop a tolerance. The sexual activity that the addict was engaged in is no longer satisfying and more sexual behaviors develop. Dr. Carnes points out that an addict will usually have three or more behaviors playing a key role in their addiction, such as masturbation, affairs, and anonymous sex. The nature of the out-of-control behavior of the addiction creates intense mood swings driven by the shame of the addiction. This often leads the addict to lose or give up some of himself each time he engages in sexual behavior. This loss of self adds to the addict's shame and despair.

The behaviors that are increasing due to tolerance now create a dilemma for the addicted persons. They now need to obtain more time to engage in the deeper levels of their sexual addiction. The person also begins to lead a dual life, with one part of the duality spent in pursuit of and obtaining the sexual activity and dealing with the consequences of the behavior, i.e., lying, problems with spouse, neglect of children. The second part is maintaining the facade of normalcy through repression and denial. The addicted person experiences a devastating neglect of all the things that are important, such as family, friends, work, talents, and values. The sexual addiction has now become the center point of their lives.

Dr. Carnes has identified different levels of sexual addiction that the sex addict will experience. Level one addiction deals with the "victimless" crimes such as prostitution, pornography, anonymous sex, and compulsive relationships. Level two addictions deal with the intrusive sexual acts such as exhibitionism, voyeurism, indecent phone calls and indecent liberties (unwanted touch). The third level of the sexual addiction involves child molestation, rape and incest. Dr. Carnes points out that at any of the three levels, there is an arrest in development. The damage inflicted by the addict on himself is intricately linked to those around him, and has a profound effect on relationships, self concept, and professional image.

In Dr. Carnes research, he has noted that most of the addict's behavior comes from an arousal template. The arousal template grows out of the development of neuropathways in the brain. Dr. Carnes states that the first and most primitive is the sexual arousal pathway which helps develop an attraction to others. The next neuropathway to develop deals with romance. This romance neuropathway involves developing great arousal, intensity and obsession. Dr. Carnes notes that the release of dopamine from those neuropathways actually creates a period of insanity in which dopamine levels rise and serotonin levels decrease. The last of the neuropathways is attachment, which allows us to bond with one another. All three of these neuropathways are integral for the continuation of the human species. Dr. Carnes refers to the research done by John Money regarding the "Love Map." In this love map, the child has already developed a template of what is arousing by age five to eight. Dr. Carnes notes an overlap between the sexual template and the addiction template. This arousal template and addiction template are connected to the core issue which drives the addict's acting out behavior. Each template is unique for every addict.

An example of how a template can work is provided by Dr. Carnes (2001): "A boy learns about sex looking at women wearing lingerie in a department store catalogue. He becomes fixated on lingerie and discovers lingerie websites. He also becomes sexually involved with a woman who works for a lingerie company. He is arrested for breaking into people's homes and taking lingerie."

The person's addiction was prompted by the earlier template, and the compulsion to act out prompted a violation of another person. The cycle of behavior keeps repeating itself, creating a greater downward spiral for the addict. The stages of addiction begin with preoccupation, a trance state in which the person is totally engrossed in an obsessive search for sexual stimulation. The next stage is ritualization, special routines that lead up to the sexual behavior. The third stage, the end result of the first two stages in which the addict has no control, is compulsive sexual behavior. This is in part due to the level of unconscious repression the addict is experiencing. The fourth and last stage is that of despair. This continues in a vicious cycle due to the limitations of awareness of the conscious waking mind.

The core issue still remains unaddressed in the unconscious. If one were to trace back the template to the source or core issue it would most likely reside in an unconscious and unresolved prenatal/natal/childhood issue. The benefit of talk therapy with addictions can be limited, because most unconscious behavior is not addressed through cognitive processes. The use of the subconscious and unconscious process to release the addictive patterns is integral for a person's recovery.

The next section of this paper will discuss the parameters and implications for the use of an educational/therapeutic group. The benefits of a group dynamic can at times be more therapeutic than an individual session. In the field of addictions the use of peer supports and peer identification are important in beginning to work with the addiction.

Format for a treatment group

The group is a closed group and meets weekly for 12 weeks. The group consists of both female and male addicts at levels one and two, conforming to Dr. Carnes' guidelines. Participation in the group requires taking the SAST, and then a follow-up interview with the group therapist to discuss admission into the group. Any participant considered to be level three would be given a referral to appropriate group treatment dealing with sexual perpetration. The limit of group size is eight to ten participants, with the youngest age for admission into the group being 23 years old due to maturity and cognitive skills. The group meets one and one half hours, once per week. The group participants also need to be involved in individual therapy and meeting with their primary therapist at least once every other week. The preference would be for the participant to meet with their individual therapist at least once a week for ongoing support and continued processing of the group exercises.

The group combines an education of the stages of addiction and the templates, interwoven with a group hypnotherapy exercise to help the participants become aware of their own templates. The group participants are also required to keep a log of sexual triggers and a regression template log. The purpose of the logs is to help the participant identify the current arousal trigger and then be able to map the trigger back to the original source where the template disturbance developed. An example of this is a client who was engaging in sex with women, which lead him to pulling their hair and spanking them. He reported that on one occasion he felt badly when the rough sex had hurt a female he was involved with. In his regression he was able to follow the template back to his late childhood. He reported that his stepmother would continually violate his personal space and boundaries by walking into his room when he was masturbating, and shaming him about being worthless and bad. A second regression took him back to his five-year-old who would witness his father having affairs with and mistreating prostitutes. The client was able to come to the understanding that the sexual acting out was connected to the shame he felt about himself and the anger he had toward his stepmother and women in general. He learned the anger from his father, and was acting it out now during the sexual act, where the deficit developed in the sexual arousal template.

Another example of using the template with regression is a male client who had an attraction for older females who were in power. When following the template back to its original source, he reported an incident where he was twelve and was seduced and slept with a twenty-three year old college student. The family system that he was in did not acknowledge or talk about his behavior with the older woman. He also reported that his mother was a well-liked teacher in the same school district. Until the day of this regression, he had never understood that this was a violation of his sexual boundaries, that he had been sexually abused. His awareness changed as he was able to recognize that all of the sexual relationships he had throughout middle school and high school were with older females who were in power, i.e., teachers.

The templates and arousal triggers are highly important because they lead one to the crucial developmental moments in his/her history that are in need of healing. A majority of the group time would be spent focusing on identifying and exploring participants' arousal templates and sexual triggers. (See a template arousal log at the end of this article).

The use of group hypnotherapy is focused on the sexual trigger and template logs that the participants fill out. The facilitator uses the standard induction and deepening techniques, and the group regression is focused on each individual's specific triggers. Cathartic release work can be done with the group at the discretion of the facilitator. The process can also be used as an exploratory and insight-gaining exercise, with any release work being done in their ongoing individual sessions. The level of release work needs to be determined at the facilitator's discretion. It is also important to include collapsing anchors, reframing unwanted behaviors, and formal extinguishing techniques within the group hypnotherapy sessions.

The beginning sessions consist of education and bonding/trust-building exercises. The exercises need to be neutral and non-threatening, such as "something I like and one thing I dislike." The intimacy of the exercises can then be increased to facilitate a deeper bonding within the group, e.g., the use of the blindfold process to foster trust. The participants are paired in twos, with one blindfolded and the other partner helping him/her to navigate around the room. This also essentially helps with fostering communication skills between participants. The exercise is then processed with the participants to help them understand the use of interdependence and accepting help. The blindfold can also represent and be processed as the sexual addiction and the denial. A sufficient educational foundation needs to be provided during the beginning of the group to decrease levels of denial and increase insight.

Another powerful exercise to use with the group is the "mind field relapse," which is an adventure-based exercise adapted to help participants to process their triggers to sexual addiction. The floor is set up to resemble a rectangular "mine field" with objects (facilitator's discretion) representing all the obstacles that they may be facing in their recovery from sex addiction. The group is separated into two groups and each group would have a chance to direct one of their own members to walk across the "mine field" with a blindfold on. The other team members give vocal directions as they traverse the course. The blindfold can be a representation of the addiction or the denial. As this exercise unfolds I usually bring in a drum or an object (duck whistle) to make noise and distract the person as they go through the "mine field." The drumming is a good tool and can be used loudly or softly to represent the addict's inner voice of craving as the distraction during the exercise.

I will also purposefully give wrong directions to the person navigating the "mine field" as a representation of the addict's voice that creates inner turmoil in following the inner knowing. The voices of the other participant's directions can be processed as caring friends, family, a sponsor or counselor, or their own inner wisdom. During the processing afterwards, participants are able to equate the drum with the addiction, and my experience with this process is that it elicits a deeper understanding of their addiction. I usually debrief all of the participants about all the symbolism of the "mine field." I start with the cognitive thoughts about the objects and then discuss the feelings that this exercise brought up for them. This exercise is essentially a good segue into the triggers and template logs. The exercise will bring about a deeper and more personal understanding of triggers.

The next sessions of the group work focus on addressing the shame and secrets associated with sex addiction. It is beneficial within the group process to have one or more shame/secrets exercises facilitated and processed by the participants to help deepen the regression work. The last session consists of healthy closure and completion.

I also address an integrity checklist, which is focused on healthy relationships and sexuality. This is introduced as part of the healing, to help foster the positive change in participants. This is something that can be ongoing and continued in the therapeutic relationship with their therapist. It is also beneficial to have a follow-up meeting with the group one month after the last session. A follow-up survey is sent out at the sixth month and then again at one year to measure the effectiveness of the group process.

References

Carnes, P. (1998). The obsessive shadow. Professional Counselor, 15-17, 40-41.

Carnes, P. (1999). Sex Addiction Q & A: Dr. Carnes Resources for Sex Addiction and Recovery, available at www.Sexhelp.com.

Carnes, P. (2001). Out of the Shadows: Understanding Sexual Addiction, 3rd Ed. Center City, MN: Hazelden Publishing.

Maltz, W. (1995). The Maltz Hiearchy of Sexual Interaction, available at http://www.healthysex.com/article/hier.html 1-11

Rohnke, C. (1984). Silver Bullets: A Guide to Initiative Problems, Adventure Games and Trust Activities. Iowa: Kendall Hunt Publishing Company.

Ross, C. J. (1998). Controlled by desire. Professional Counselor, 21-22, 48-51.

Twerski, A. J. (1998). When it feels good: Sex for the sake of gratification. Professional Counselor, 56.

Zimberoff, D., & Hartman, D. (1998). The Heart-Centered Hypnotherapy modality defined. Journal of Heart-Centered Therapies, 1(1), 3-49.

Arousal Trigger Log

Arousal event --

Identified Emotion --

Present Cognitive Thought --

Age Regression --

Old Decision/Behavior --

New Decision/Behavior --

Edward Millet, 162 Rowlee Road, Fulton, NY 13069 USA [e-mail]