Sexual Expression and Sexuality: When ‘Problems’ Aren’t

Many of the people I see in my practice have come to consult with me about an issue they have with their sexual behaviors. A number of them are seeking help after violating a spousal or relationship agreement, sometimes after a partner has issued an ultimatum. I also help people who tell me they are seeking therapy to work through shame associated with (not caused by) sexuality or methods of sexual expression.

As a therapist, I am always attentive to the ways those I treat characterize the concern they are struggling with, and I aim to be particularly cautious when it comes to descriptions of “problems” related to sexual behavior. Experiences related to sexuality are often stigmatized by society, and a person’s definition and characterization of their sexual identity and expressions might be highly influenced by shame or fear, not necessarily by their own understandings of their experiences. In this article, I use the term “hyper-sexual behavior” as an example of a sexual problem or experience, as this is my professional specialization as a sex therapist.

Getting to Know the Issue

People who are experiencing a sex-related concern in their lives might form an opinion of this issue based on social stigma, but this can give the issue a level of influence that may be both unnecessary and harmful. A person’s actual experience of the issue, and the effect it has on their life, can get lost in feelings related to stigma. This can lead to feelings of powerlessness and may make it more difficult for a person to effectively address the issue.

When it comes to hyper-sexual behavior, for instance, not everyone experiencing this wants to change it. Some mental health professionals might assume an individual seeking treatment is distressed by this behavior, but this is not always the case. As health care providers, it is important for us to question our assumptions and be in touch with our own beliefs and biases. We need to understand many of our beliefs about sexuality and sexual issues have been socially constructed and reinforced.

Some people seeking therapy for hyper-sexual behavior, however, do experience significant distress with regard to this behavior, or because of it. Whether this distress is caused by the social stigmatization of their sexual identities or expressions, or by the effects of these concerns, it is our responsibility as therapists to view all people as the experts of their own experiences while remaining open, typically through curious and respectful inquiry.

In the beginning stages of therapy, it may be most helpful to work on managing the distress rather than addressing hyper-sexual behavior right away. When the therapist knows more about the characteristics of the issue, the person’s near-experience definition of the issue, and/or the impact the it may be having on a person’s life, they may then be able to assist the individual more effectively. Therapists who understand a person’s concerns on a personal level—not through a socially or scientifically constructed narrative—are likely to be able to provide the most benefit.

Personalized Conversations About Sexuality

I have found it helpful for a therapist to make space for the person in therapy to explore, through rich discussion, the effects what they are experiencing may be having on their life. As they explore their experience more deeply, it may become easier to define, and therapists can often assist individuals in therapy with the process of naming their hyper-sexual behavior in ways that fully encompass their experience. When hyper-sexual behavior is perceived as problematic, some may described it as a bad friend, reckless behavior, insidious urge, or the craving, among other things. Conversations that personalize a person’s own experience not only provide information about what the issue represents and how it manifests, but they can also open space for the identification of creative ways to overcome the negative effects of the issue. Experiences related to sexuality are often stigmatized by society, and a person’s definition and characterization of their sexual identity and expressions might be highly influenced by shame or fear, not necessarily by their own understandings of their experiences.

Tracing An Experience’s History

After a person in therapy and the therapist have collaborated on a definition or description of the presenting concern that accurately fits the person’s experience, they may also want to understand the pattern of the issue’s development across the person’s lifespan. Many individuals find this helpful when they experience issues as ever-evolving, especially those issues that are of a sexual nature.

It may be essential to understand how a person’s behavior or attitude has developed through the years, in relation to their experience. Therapists can often help those they are treating understand what patterns or trends in their lives may have contributed to the issues of a sexual nature that are now presenting challenges to daily life or function. It can also be helpful to explore times when their behavior has manifested in preferred ways, as this can provide the person and the therapist with important clues about their own resources and successful attempts to resist the behavior posing a concern.

Cultural Implications

When I refer to the experience of hyper-sexuality, I intend to use “hyper” in a way that highlights definitions such as “active” or “lively.” Some people feel quite comfortable with hyper-sexual behavior and prefer a hyper-sexual lifestyle. Their only problem may be how they are treated by others. Other people may struggle to comprehend their own behavior, whether or not the behavior itself troubles them, for a variety of reasons. One reason that stands out from my therapeutic conversations is the cultural assumption of monogamy and marriage as an institution.

Traditional conventions of living and performing in society are being widely challenged by greater recognition of diversity. This is particularly true when it comes to sex and sexuality. One can say that generalizing hyper-sexual behavior as a problem may protect some from social stigma and shame. If one’s hyper-sexual behavior is seen as an addiction or an illness, others may be more likely to view it as something they can’t control, and “relapses,” or lack of control, might be expected. From the other perspective, those who embrace this “illness” can be seen as “addicted” or “afflicted,” and consequently, their differentness can be rejected.

Sexual expressions such as hyper-sexual behavior may simply be associated with the cultural or spiritual beliefs of some individuals. In some communities, certain forms of sexual expression may be considered normal or typical, while in other societies the same behavior may be perceived and categorized as abnormal. Individuals may then take it upon themselves to turn these manners of expression or lifestyles into a public concern, and somehow, turn this into an excuse to punish and discriminate against those who engage in these expressions. Throughout history, people have used labels and medical/psychological diagnoses in such a way, or to justify horrific actions against other individuals. David Ley’s The Myth of Sex Addiction, for example, highlights the North American denial of rights to some minority groups, based on the false reporting of them as deficient or weak.

As a result of restrictive cultural views and norms around sex and sexuality, labels such as hyper-sexuality, promiscuity, or even sex addiction have often been defined in inaccurate ways that lack medical or scientific support. In therapy, however, once the therapist and person in treatment have formed a more detailed description and definition of the concern, including its historical presence in the individual’s life, they can often develop a more thorough understanding of how the issue impacts different domains in the person’s life.

Mapping the Effects

When it comes to hyper-sexuality specifically, I find that many initially describe it as a “sexual addiction,” and some psychotherapists are inclined to immediately apply “interventions” to help the person with their addiction. One problem with this approach is that we do not truly know what “sexual addiction” means to the person consulting with us. Other issues here are the controversy around this term, its authenticity, and the contradicting science and research behind it. As a therapist, I rarely use this term in my work with a person seeking treatment—unless they themselves feel this term does indeed accurately describe their experience.

As a result of restrictive cultural views and norms around sex and sexuality, labels such as hyper-sexuality, promiscuity, or even sex addiction have often been defined in inaccurate ways that lack medical or scientific support.Sexuality-related issues can have a significant impact on different areas of a person’s life. In sex therapy, I ask questions to both better understand these effects in depth myself and help the person seeking treatment understand, as well. This process, known as mapping the effects, can help people make an informed evaluation about their position in relation to the problem and its influence on their lives.

I worry about the use of terms such as “sex addiction” as I map the effects of a particular issue on a person’s life, as one’s understanding of the effects of their experience may be influenced by the sensational nature of the term, and this can prevent the work from being authentic or effective. A therapeutic conversation that maps the effects of sex addiction may be misguided by any social and moral presuppositions around the term or label.

Narrative and Supportive Conversations

All therapists (and other health care providers) working with a person who decides to share personal information about their sexuality or sexual expression should understand that this is likely a matter of great importance to that person. I respectfully ask you to resist any impulse to move to the next topic. Talking about sex and sexuality in our society is a challenging process for many, and at times, it may even be threatening. If the person you are working with brings it up, chances are they really need your support. To find out the most effective way of being supportive, it’s generally best to simply ask the person.

It is imperative we do not assume we know something is a “problem” or decide the person is bringing up sexuality because it is an issue of concern to them—they may simply want to discuss it. When a person shares intimate aspects of their experience as a sexual being, this can be seen as an act of bravery and a sign of resistance against shame and stigma. A therapist’s response to these sorts of accounts or revelations can be extremely influential in the person’s journey.

References:

1. Braun-Harvey, D., & Vigorito, M. A. (2015). Treating out of control sexual behavior: Rethinking sex addiction. New York, NY: Springer Publishing Company, LLC.
2. Freedman, J. H., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: W. W. Norton & Company.
3. Ley, D. J. (2012). The myth of sex addiction. Lanham, MD: Rowman & Littlefield Publishers.
4. Morgan, A. (2000). What is narrative therapy? An easy-to-read introduction. Adelaide, South Australia: Dulwich Centre Publications.
5. White, M. (2007). Maps of narrative practice. London: W. W. Norton & Company, Ltd.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.