Case Study - Page 5

Long-Term Challenges

Slips continued, of course. Once Jim browsed for pornography and "accidently" took a sleeping pill, but immediately revealed these slips to the group and was able to recognize with their feedback how self-destructive he became under stress. At another point, he declared that he was finally "tired of feeling angry all the time, but not feeling anything else." Asked to sketch what this state looked like, he drew a raw picture of himself locked in a cage and, after the session, went home and disconnected his Internet.

Interestingly, Jim now began to express positive feelings as well as negative ones: gratitude for recovery and empathy for others. He met a new woman, Ann, at work. For the first time, he noticed that he'd actually chosen someone carefully and felt that she had chosen him carefully, as well. Instead of rushing into sex, he took time to get to know her, reporting weekly on this novel experience. Having learned to feel just how unloved he'd been as a child, he could now feel his heart opening as he told about his first-time experiences of honest conversation and, eventually, healthy, caring sex with a woman. His relationship with Ann hastened the maturation begun by his increasing capacity to process emotion. In fact, Jim became remarkably at ease with his feelings—in group, he could notice when his defenses were up and report it. "I'm noticing that my arms and legs are tight. I'm going to breathe and relax and see what happens." By tracking his physical sensations and recognizing them as defenses against affect, his feelings became increasingly accessible to him. The group continued to applaud his willingness to make himself vulnerable and reported feeling closer to him as a result.

The following year, Jim was fired from his job, sorely testing his new emotional maturity. His first impulse was to fire up his computer and go to a porn site. Instead, he set up a flurry of social events with friends, a successful defense against falling back into the addiction trap. A year after that, Jim graduated from group, married Ann, and was rehired by his company.

Lasting Effects of Therapy

Jim still follows his Sexual Sobriety Plan to avoid addiction-triggering behaviors. He participates in 12-step meetings and a therapy group at church to "keep me accountable, because the collection of even the smallest dishonesties will lead me to destructive behaviors. I still get angry, but I don't justify my actions with excuses and lies." For the first time, he feels active interest in the feelings of others. Instead of being driven by guilt and shame, he says, he can rely on core values and a real conscience, without feeling the need to be punitive to others when they disappoint him.

He still struggles, though. Recently he was having a hard time forgiving himself for sometimes using humor at the expense of others to ease his own social discomfort. Mostly, however, he believes honesty about himself and his feelings is a source of strength, not weakness. "And," he says with deep conviction, "I'll never say to my children, ÔDon't be sad.'"

Treating sexual addiction is difficult work because it almost always requires repairing early-childhood attachment trauma. Rarely do clients hang in there long enough to reap the benefits that Jim did. Often, people get "better enough" and move on, continuing their recovery in fits and starts. The occasional Jim stays on course, fighting for his right to feel whole and complete because he wants to be the person he knows he can be.

When clients like Jim show up ready to fight for their lives, I'm ready, too. He taught me to be patient, to slow down, manage my anxieties, and pay attention to my own body's cues. Together we found our way by trusting the attunement, misattunements, and repair work that created a crucible for us both to change through the other.

Case Commentary

By Joe Kort

Alexandra Katehakis does an excellent job of illustrating the standard treatment protocol in working with sexual addicts, including recommending a temporary period of abstinence, going to 12-step meetings, developing a sexual sobriety plan, identifying out-of-control sexual activities, and refraining from destructive behaviors. She recognizes that Jim has lost control over his pornography use and skillfully addresses his attachment disorder, with a particular emphasis on the use of body work.

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