In early May, I was in Phoenix for the annual symposium for therapists who treat individuals struggling with problematic sexual behaviors and their partners. I was presenting on harm reduction at the conference on a panel discussing alternative paths of recovery that may not include 12-step recovery groups. I was thrilled to bring harm reduction to the field of sexual addiction and recovery.
While I was there, I spoke further with Jackie Pack, the facilitator of our panel. She invited me onto her podcast Thanks for Sharing to talk more about harm reduction. A couple of weeks ago, Jackie graciously hosted me and we talked about harm reduction, its benefits and rationale, and how it can help those struggling with addictive behavior and those who love them.
We covered a lot of ground, but there are some things we didn’t get to or that I wish I’d said more clearly. Here’s the rundown.
As a psychotherapist for about 7 years now, I’ve had the profound privilege of helping many couples move from conflict, anger, and pain and toward deeper, more conscious intimacy. But it doesn’t always go this way.
Indeed, sometimes couples realize in the course of our work together that their relationship, for whatever reason, needs to end. Many partners view the end of the relationship as a personal failure, blaming themselves. Others wallow in anger and resentment, sometimes lashing out in destructive ways.
Tragically, in these instances the circumstances that bring about the end of the relationship can have the power to redefine a couple’s entire story together. This is especially true with cases of sex addiction, porn addiction,infidelity, or some other form of intimate betrayal. Partners carry with them the pain, loss, heartache, and anger about the relationship long after it ends and can even carry it over into their next one.
It doesn’t have to be this way. There’s another path. That’s where Conscious Uncoupling, a method pioneered by psychotherapist Katherine Woodward Thomas, comes in.
This month was the 25th anniversary of the death of Nirvana frontman Kurt Cobain. I loved Nirvana as a teenager (sorry Mom) and still enjoy “Heart-Shaped Box” whenever I hear it over the airwaves. I remember his tragic end after a long bout with heroin use. It had been quite a while since I’d thought about his story.
Now, after all these years and working so closely with addictive behaviors and substance use, I felt sad as I read stories like this one about how loved ones tried to help him. They did their best, as we all do, in a difficult situation, and they were listening to the professionals guiding them.
Still, they can’t help but wonder today: What might they have done differently? How could they have reached him? How could they have helped? Could his story have ended in another way?
Of course, everyone affected by addiction—including those struggling with addictive behaviors and substance use themselves—asks similar questions not in retrospect but every day they live with their using or acting out.
Those struggling with substance use or problematic, compulsive sexual behaviors want to understand how they could possibly return to their addictive behavior of choice, sometimes even after a long period of abstinence. “Why do I keep doing this?” they ask. “And how can I change?”
Family and friends want to understand helpful ways to support their loved ones. They’re often desperate to help the loved one find healing and become hurt, angry, frustrated, and exhausted trying to understand his or her behavior.
A sound understanding of how people change can provide the foundation for answering both of these questions. If we understand the stages of change, we can give ourselves a bit of grace as we struggle with our addictive behavior. And family members can learn how to better support their loved ones and promote their healing.
Recently, I’ve been wrestling with a business decision. I was unclear about what to do and decided to ask some trusted colleagues about their thoughts. So yesterday, I hopped on a phone call and talked for a few minutes about my quandary. I wasn’t ready for what happened next.
Because of the nature of the decision and my history with similar decisions, I felt very vulnerable. And to my colleagues, it seemed clear that my fears and “not enough-ness” was showing up in my waffling.
And suddenly, there is was. A big, fat helping of shame with a side of inadequacy.
It was like a sucker punch. I admire my colleagues and looked up to them, and suddenly I felt so small. I felt so foolish. So silly. So exposed.
“Why? Why do I keep doing this?” I get this question a lot, especially from new clients who are struggling to comprehend why they keep engaging in an addictive behavior they don’t want to keep doing. They struggle in understanding addiction.
I get it. I’ve been there. I wondered the same for a long time. I couldn’t understand why I continued to drink when I felt as ashamed about it as I did. Eventually, I came to understand why I started to drink and why I continued to need to drink.
Eventually, I came to understand that I drank to alleviate my own shame and anxieties. Understanding what alcohol was doing for me helped me learn to be more authentic and manage my feelings differently. When I didn’t need alcohol anymore, I spontaneously stopped when I got tired of how much it was taking from me.
Maybe you’re trying to understand your drinking, gambling, sexual behaviors, or other addictive behaviors. Really, you’re asking about what you don’t understand about yourself. That’s where looking at a few models of understanding addiction can help.
Recently, I collaborated with Evo Health and Wellness in Venice Beach to talk about sex and porn addiction and how we might think about addiction. Evo asked me a few questions, which I respond to below, and they answered a few of my questions about addiction.
Should he have any contact with the affair partner now that the affair is over? Shouldn’t she cut her affair partner out of his life and stop talking to him altogether? How can I get him to stop talking to her?
After an affair, the couple is in crisis. They’re struggling to adapt to their new reality now that the affair has been exposed.
The hurt partner is reeling from this world-shattering news. She’s often traumatized and angry, while also struggling with the desire to scour phone records, check his phone, and other responses intended to help her feel safe after a massive betrayal.
The partner participating in the affair is often remorseful and desperate to save the relationship.
In instances like this, it’s a matter of course that the affair is over, that contact with the affair partner will not continue, and that both partners are all in the save the relationship.
This week, I received the exciting news that I’ll be participating in a panel discussion about sex addiction, approaches to treatment, and how best to help clients needing support with these issues. I’ll be talking about treating sex addiction with harm reduction psychotherapy.
The conversation will take place at the conference for the International Institute for Trauma and Addiction Professionals in Phoenix in May. It’s going to be a great chance for mental health professionals on the front lines of out-of-control sexual behavior treatment to compare treatment options and philosophies.
But this panel is so important and exciting because it’s evidence of a growing number of voices in the addiction field who think a bit differently about how to help those struggling with addictive behaviors, including sexual behaviors.
I thought I’d briefly compare the traditional approach and the harm reduction approach as I consider my remarks for the panel. I’m very much thinking out loud here as I continue to evolve and grow, so I invite you to be a part of the dialogue in the comments below.
Shame. Shame is pervasive these days, as are our attempts to banish shame from our existence. We try desperately to rid ourselves of shame and will sometimes to anything for a moment’s respite from that awful, heavy feeling.
Just for a moment, consider what comes up for you when you read this word.
Maybe you’re concerned about someone you love. Maybe you’re curious about your own shame and what to do about it. Maybe you’re even now trying to put out of your mind what you tell yourself when you feel shame so you can read this post.
If so, you’re not alone. Shame sucks. I would know; it’s a part of my story too. And I often get asked about how shame can be healed. It’s a good question, and one I’ve never quite felt I can answer fully in sessions.
While healing is never easy, finding your way out of shame is possible. Before we dive into that topic, though, we need to understand what shame is and how it affects us.
So you’ve started therapy, and it’s actually going pretty well. Maybe you’ve been going for just a couple of months or a few years. You’re working well with your therapist feel you’re making good progress. The counseling seems to be helping. Things are humming along.
Then, whether gradually over time or all of the sudden, there’s a shift. Life gets really hard. Almost unbearable. And so does therapy.
Wait a minute. Weren’t things supposed to get better? Why now is the terde hitting the ventilateur?
It’s important to understand that I’m speaking in generalities here, and painting with broad strokes.
But often there’s a really good reason why therapy gets hard. It means you’re doing the work. Here’s what I mean.