Proper Training for Professionals
Be a Part of the Solution
As our sexually saturated culture brings the problem of pornography and other forms of sexual acting out into the public eye, more people and their partners are seeking help for sex addiction. As a clinician, pastor, physician or support group leader, you are uniquely positioned to guide or assist the healing process. Are you equipped?
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Bethesda Workshops provides training for clinicians, pastors and lay helpers. Our Therapist Observer program allows professionals to sit in on an actual treatment workshop. We also offer teaching conferences, CEU events, and church seminars.
Unfortunately, many Christian helpers are ill-equipped to address sexual addiction or to help partners of sex addicts. Standard approaches like cognitive-behavioral therapy and using scripture alone are rarely effective. In fact, uninformed Christian counseling often adds to the sufferer’s shame and makes the problem worse. Appropriate training is vital.
The field of treating sexual addiction is still relatively young and competent training isn’t widely available. The other Bethesda Workshops Position Papers outline an appropriate clinical approach for numerous topics. This Paper takes the opposite slant and details typical mistakes made by untrained professionals.
Most often – and most damaging – is the error of addressing only the sin component of sexual addiction. Sex addicts already know their behavior is wrong, and they’ve already prayed to be free. Motivating addicts through guilt never works long-term. Exhortations to “Just stop!” or “pray more” only add to the person’s shame. Shame, in turn, further fuels the addiction. Helpful professionals understand that sexual addiction is a complicated issue. It is multi-faceted problem requiring a multi-faceted approach that covers all the components of this disease: physical, mental, emotional, and relational, as well as spiritual.
Next, untrained helpers often only focus on the specific acting out behavior(s) and ignore the deeper issues. Arresting behavior is the first treatment task, but it’s only the beginning. The sex or relationship addict must uncover, understand, and heal from the underlying issues that drive the behavior. A trauma-based approach (one that examines woundedness and false core beliefs) is essential.
Without adequate training, Christian helpers also often fail to identify co-existing conditions that complicate recovery. Most sex addicts and partners of addicts are depressed at some level. Many have an anxiety disorder or another behavioral or chemical addiction. Attention deficit disorder and eating disorder often are concurrent with the issue of sex addiction.
These co-morbid conditions often require medical attention in addition to psychotherapy. Although the Christian climate is changing, some pastors and clinicians still discourage the use of psychotropic medications.
These Christians are also likely to be suspicious of a so-called secular 12 Step recovery group and to discourage attendance. While a healthy faith-based support group is ideal, they aren’t widespread. And even if a Christian group (like Celebrate Recovery or a L.I.F.E. Group or similar program) is available, recovering people need meetings more frequently than once a week, which is the norm for faith-based groups. The Twelve Steps are firmly rooted in Scripture and active participation is vital for healthy progress in recovery.
Christian helpers also may discourage full disclosure. Instead, they advise “what she doesn’t know won’t hurt her” and thus let the addict avoid the painful necessity of telling the truth.
Too often, untrained pastors and counselors are especially off target in working with partners of sexual addicts. Standard marital therapy approaches don’t work and are often harmful. Sadly, partners are sometimes blamed for the addiction, are encouraged to continue enabling the addict in some way (like by being more sexual), and aren’t pushed to pursue personal healing.
Finally, Christians often believe that someone must get help only from a Christian practitioner. We recommend that strugglers find the person who best understands sex addiction and helping partners of addicts, regardless of that helper’s religious beliefs. A responsible counselor respects a client’s faith and does nothing to alter it. Just as you’d seek the best cardiologist for a heart condition, sex addicts and partners need the best clinical help possible. They can turn to the church for spiritual guidance and comfort, but they need competent clinical help in order to recover.
4NOTE: These Bethesda Workshops Position Papers offer a brief overview of our approach and isn’t meant to be a comprehensive treatment of the subject. Clients will cover this topic in more depth at a Bethesda Healing Workshop, and clinicians may receive more information from the writings of Marnie Ferree, M.A.
Few things in recovery are as difficult for the sex addict as disclosing the secrets about his or her acting out, and probably nothing is as hard for the co-addict to experience. After disclosure, everything changes. The co-addict’s world shifts, and life will never be the same. The pain on both sides is nauseating and at times feels unbearable.
These hard realities about disclosure make it one of the most difficult therapeutic challenges – and perhaps the most important part of a couple’s recovery.
At Bethesda Workshops we believe that full disclosure is absolutely necessary. The non-negotiable truth is that restoration within a relationship is impossible without the foundation of honesty. There can never be marital healing and true intimacy unless there’s complete disclosure.
“Full disclosure” means that the addict volunteers the truth about his or her acting out. The addict shares the nature of the behavior, meaning the broad categories such as viewing pornography, engaging in other Internet sexual activity, patronizing strip clubs, masturbating compulsively, or crossing the flesh line by having affairs, one-night stands, anonymous sex, visiting prostitutes, etc. The addict should provide a timeline of the acting out and disclose financial and other consequences. The addict must also provide the identity of any acting out partners that the co-addict knows.
Full disclosure does not mean telling graphic sexual details, which is often information the co-addict insists on. Specific details are rarely necessary and more often harmful. That kind of information feeds the co-addict’s obsession and further erodes her sense of self. A clinician should steer her away from those demands into the deeper issues, which is her desire to be wanted and to be enough.
Ideally, disclosure is a one-time event, where the addict tells the whole truth at once. Unfortunately, it rarely happens that way, and this on-going string of disclosures only increases the co-addict’s pain and mistrust. Especially when the addict has mishandled disclosure in this way, we recommend an additional, formal disclosure session that provides full information in one sitting.
The professional should be prepared to spend additional time with the co-addict after disclosure to provide support and resources. These sessions are extremely painful and draining, but they also open the door for unbelievable healing.
Disease Model of Addiction
Is this sin or is it an addiction? That’s one of the most frequently asked questions about sexual addiction. Our immediate answer is “Yes!” Sexual addiction is both.
At Bethesda Workshops, we unequivocally identify inappropriate sexual and relationship behaviors as sin. We don’t sugarcoat that reality. At the same time, we believe the “sin model” as it’s normally understood is inadequate – too simplistic – to describe this problem and its solution.
Sexual addiction is a multi-faceted problem with physical, mental, emotional and relational components as well as a spiritual aspect. Sex addiction begins with the choice to commit some kind of sexual sin. Over time, though, as the behavior is repeated, it can cross the line from sexual sin to the point of addiction.
An addiction is the use of any substance or engagement in any behavior that is obsessive, compulsive, and continues despite adverse consequences. The apostle Paul well describes addiction (though probably unintentionally) when he writes in Romans 7, “I don’t understand what I do. The good that I want to do, I don’t do; and the evil I don’t want to do, I keep on doing. What a wretched one I am!” (paraphrased). The “simple” sexual sinner can “Just stop!” when he or she decides to; the sexual addict cannot.
We believe the disease model of addiction is most appropriate to the solution for sex addiction. Unfortunately, too many Christian professionals instruct the addict to pray more or read the Bible more or commit to Christ as the answer to sex addiction. While we agree those spiritual disciplines are important, sexual addiction recovery requires a more comprehensive approach. Similar to addressing the problem of diabetes, sex addiction demands a clinical as well as spiritual approach.
When we use the disease model, we in no way absolve individuals of responsibility for their sin and their healing. We simply mean that there are many components to sexual addiction, and it’s necessary to tackle them all through wide-ranging tactics.
Program of Recovery
Attending a treatment program, including one more long-term than a Bethesda intensive workshop, is only the beginning of the journey of transformation. Getting help is an important first step, but if that’s all someone does, he or she won’t recover successfully. Genuine, lasting transformation requires more.
The Twelve Step tradition refers to this “more” as “working a program of recovery.” That means a person consistently takes specific action steps such as:
– Attend 12 Step or faith-based meetings (ideally at least 3 times a week)
– Daily connect with other recovering people (by phone preferably or email)
– Use a sponsor as a guide for recovery
– Solicit daily accountability from multiple people who know your story
– Cultivate community
– Use an Internet filter
– Practice healthy boundaries
– Read recovery literature
– Practice emotional presence
– Practice healthy self-care
– Receive counseling as needed
– Use medication when appropriate
– Cultivate a deeper relationship with God
Taking these actions is crucial, and a recovering person must be willing to “go to any lengths” to work a program, especially in the early stage until sobriety has been well established for a number of years.
As the 12 Step slogan says, recovery “works if you work it.” Then some groups add, “And it won’t if you don’t.”
Sobriety and Abstinence
In simplest terms, Bethesda Workshops defines sexual sobriety as no sex with self or with anyone other than a legally married spouse. A fuller definition of sobriety includes freedom from fantasy (including viewing pornography even without masturbation), freedom from sending out sexual energy (including flirting and sexual humor), and freedom from inappropriate emotional relationships. Sobriety is deeper than mere physical activity.
We believe that sobriety is the foundation for the rest of recovery. Nothing good happens without sobriety, but it’s only the beginning of the process of transformation.
Abstinence is the practice of sexual and emotional sobriety. For the single person, abstinence means refraining from all the behaviors and thoughts previously described. For the married person, abstinence means refraining from everything mentioned, including a mutually agreed on sexual time-out within the coupleship.
Bethesda recommends an intentional period of marital sexual abstinence early in the process of recovery. Complete sexual abstinence accomplishes a drying out period for the addict and uncovers deeper layers of issues for both partners. Abstinence removes sex as the barometer of the relationship and as a reward, punishment, proof, control or manipulation. Facing these relational issues around sex is just as critical for a co-addict’s recovery as sexual sobriety is for an addict
This marital abstinence period should be a conscious, mutual decision based on full disclosure and a commitment to individual recovery. (As a healthy boundary, a co-addict may refuse to be sexual with an active addict or during a period of grieving and rebuilding trust. That’s a different issue.) We recommend marital abstinence for a minimum of 90 days, though many couples extend that time.
It’s vital that couples use the abstinence period for intentional work as individuals and as a couple. Simply refraining from sex falls far short of the benefits abstinence can achieve. The clinician must guide the couple in creating safety within the relationship and in building non-sexual intimacy. Many couples need help structuring this period and navigating through all the issues it surfaces.
Couples also benefit from a specific plan for reintegrating sexual activity into the relationship. Even if a couple chooses to resume intercourse immediately after abstinence, it’s wise to also go through a slow, guided process of learning to be emotionally and spiritually present during sex.
While sexual abstinence is hard for many couples, if done properly with accompanying mental, emotional, relational and spiritual work, most couples find it a significant piece of their healing process. Indeed, frequently couples report that their sexual re-engagement is like nothing they’ve ever experienced in their coupleship. Sex becomes an act of emotional and spiritual intimacy – which is exactly God’s intention for the one-flesh union of marriage.
Statement of Faith
Bethesda Workshops is a distinctly Christian program. We believe that Jesus is Lord, the son of the Living God, and that He died for the sins of the world. We believe in Christ’s virgin birth and His bodily resurrection. We affirm the Bible as the inspired Word of God provided for our instruction, example and encouragement. We believe individuals are saved by grace through faith and that baptism is the outward sign of one’s acceptance of the free, undeserved gift of salvation. No sin is so deadly as to separate us from the love of God, and forgiveness is offered to all who accept Christ as their personal savior. We believe Christians are called into personal relationship with God the Father, God the Son, and God the Holy Spirit, and that they live out their relationship in daily transformation into closer likeness of Christ.
We believe God created people for relationship and established the church as a community of faith. We encourage authentic relationships rooted in integrity, brokenness, and realization of our deep need for God and for each other. As a program, we seek to be Jesus in our world.
Bethesda specifically takes a non-denominational, grace-based approach in our Healing Workshops. We enjoy times of worship, prayer, and Scripture reading and weave Christian principles throughout the entire program. We welcome anyone regardless of his or her faith beliefs and show respect to those who hold different religious views.
We use an eclectic theoretical approach which draws on the best of several treatment modalities. In simplest terms, we use a trauma-based model, which means that we believe trauma (in its broadest sense) is the root of compulsive sexual and relationship behavior. Simply stopping the problematic behavior isn’t enough without healing the woundedness that drives it.
Because we conceptualize sexual addiction as an intimacy disorder, we view the sexually addictive behaviors as merely symptomatic of deeper issues. Thus, our primary theoretical approach is to uncover and address those roots. In this sense, we use a psychodynamic, Bowenian model that considers family of origin as crucial in the development of adult beliefs and behavior.
We also come from a family systems approach, which is the foundation for our treatment of co-addiction and couples recovery. We believe each spouse is equally responsible for the dynamics in the marriage, and each partner must address his or her own patterns of relating. Further, in this systems perspective both partners are roughly equal in their emotional health or ill health. In other words, “Water seeks its own level.” (This concept, of course, is an extremely hard sell to the spouse who has been wounded by a partner’s infidelity.)
Cognitive-behavioral therapy also has its place in addiction recovery. It’s a behavioral approach that insists on attendance at Twelve Step groups, the achievement of physical sobriety, or the maintenance of healthy boundaries. Cognitive therapy examines the false core beliefs of addicts and co-addicts – the damaging messages received from their families of origin and the culture.
We’ve found that bibliotherapy is an extremely helpful adjunct to what happens in counseling sessions. We encourage clients to read recovery literature about addiction, codependency and woundedness. This material often generates insight and speeds progress.
We insist that addicts and co-addicts both participate in a support group. (This step is especially hard for co-addicts, who tend to isolate.) In addition to breaking isolation and reducing shame, group offers a fertile practice field for learning intimacy.
We also believe that healing happens in relationship, and therefore, the therapeutic relationship is key. Although we’re only with workshop participants a short time, we seek to establish a caring, supportive connection. We also are willing to speak the truth in love and aren’t afraid to challenge a client for the purpose of his or her growth. We seek to model God’s unconditional love and grace, while at the same time inspire the development of a more holy character.
An effective treatment plan for addiction and co-addiction is a dual-track approach. The first rail is arresting the problematic behaviors and creating a healthy lifestyle of accountability and community. The second rail involves healing from the woundedness that fuels the unhealthy coping methods of addiction and codependency. Both tracks are addressed simultaneously, though in the beginning stage, more emphasis is given to achieving and maintaining sobriety.
In this early stage, we believe it’s important to evaluate a client for mood, attention and anxiety disorders, as well as other co-morbid conditions such as another addiction. Some addicts and co-addicts suffer from an Axis II personality disorder (or traits) that require attention. See the section on dual diagnosis for more information.
We’ve found a variety of techniques are helpful in treating trauma. In addiction to traditional talk therapy, EMDR (eye movement desensitization and reprocessing), neurofeedback, and experiential approaches are especially effective. We believe group therapy is the treatment of choice for addiction and trauma, and at some point, every recovering person benefits from participation in a therapy group.
For the co-addict, it’s important to hear the pain of the betrayal and allow the client a period of grieving. In those raw early days of discovery or disclosure, a co-addict needs support and understanding before she can make the paradigm shift to focusing on herself instead of on the addict.
We believe engaging the co-addict in treatment is one of the best predictors of marital success. When the spouse refuses to get help, it’s much harder for the addict to achieve lasting sobriety. And without recovery on the part of the co-addict, the marriage relationship can never achieve the transformation both spouses deserve.
While we strongly insist that both partners do their individual work, we also introduce couples therapy early in the process. The addict/co-addict marriage is in extreme crisis, and we believe couple’s sessions can help the partners stop the bleeding in the relationship. We advocate a marital time-out where both spouses agree to postpone any major decision (like divorce) for 6-12 months while they both work on their individual issues and begin to examine patterns in their coupleship.
Early couple’s work is more to stabilize the relationship than to specifically address significant issues. Some couples structure a therapeutic separation, which gives them some breathing room and lowers the reactivity. We strongly encourage an in-house separation if at all possible, instead of an out-of-home separation. A period of sexual abstinence is vital.
This beginning stage of couples counseling is often more like doing individual therapy with the spouse in the room. A couple’s session informs the mates about each other’s process and progress. It also provides a forum to put out any fires that flare in the relationship. Our Healing for Couples workshop is designed for this early stage of couple’s work.
Length of Treatment
Recovery from sexual addiction and co-addiction is a lengthy process. Short-term therapy is insufficient, for sure. Patrick Carnes, Ph.D., asserts it takes three to five years to fully recover. At Bethesda Workshops, we’ve found that those who come through our whole program – an individual workshop for each spouse plus the couples workshop – cut that time in at least half. We often tell couples, “You can do this the hard way or the harder way – there’s not an easy way.” The Bethesda program greatly accelerates the recovery process, and most people find significant improvement, both personally and within their coupleship, within six to twelve months if they’re willing to do the work.
Life-Long Recovery Plan
Recovery is a forever process, ongoing and unending. It’s like our spiritual journey of transformation, which certainly doesn’t stop when we accept Christ as our personal savior. Recovery becomes a way of life, which again, is like our spiritual walk.
Many people find benefit from life-long attendance at recovery groups, at least occasionally. It’s like church attendance, where someone goes for fellowship with other Christians as well as worship. Going to a Twelve Step or faith-based recovery group becomes a tool for healthy living instead of a safeguard against acting out.
Giving back is an important activity for someone in recovery. Offering help and hope to someone new on the journey is an act of gratitude and redeems the pain of sexual addiction and co-addiction.
Twelve Step Recovery
Bethesda Workshops strongly supports the Twelve Step program of recovery, and we believe is is vital to an individual’s success. These programs are rooted in Biblical principles and dovetail cleanly with Christian faith practices.
Alcoholics Anonymous, the original 12 Step program, grew out of the Oxford Group, a Protestant movement that started in England in the early 1900s. The group met in houses and encouraged members through testimonies, Bible study and informal talks.
Bill Wilson, the founder of Alcoholics Anonymous, traced his journey of sobriety back to the Oxford Group. They emphasized deflation of pride, dependence on God, moral inventory, confession, restitution, and working with other suffering people – all clearly Biblical principles.
Eventually, Wilson broke away from the Oxford Group because of its rather aggressive evangelism. Still, the group’s principles and Scriptures remained the foundation for AA and the Twelve Steps. Today, a number of Bibles incorporate recovery principles and match Steps to specific Scripture passages. We especially like Serenity: A Companion for Twelve Step Recovery, which includes the New Testament, plus Psalms and Proverbs, along with extensive material about the Twelve Steps.
Sometimes religious people are concerned about the use of “Higher Power” terminology in the Twelve Step programs and fear they are contrary to faith. Nothing is farther from the truth. Inclusive language was adopted to create a welcoming environment for people of all faiths (or no faith). Bill Wilson, Dr. Bob Smith and other early AA leaders also realized that it was easy for recovering people to get fragmented by issues of doctrine, and thus to miss the bigger picture of surrender, grace, responsibility and redemption. Sadly, many in the church today make the same mistake when they mistrust the Twelve Step program of recovery.
Bethesda Workshops encourages people to take advantage of a Christian-based recovery program (like Celebrate Recovery or a L.I.F.E. Group) if one is available. Many of these programs are loosely based on the 12 Steps, which often have been adapted to the group’s specific use. Often, though, a faith-based group isn’t available, or more unfortunate, the group is rigid, dogmatic and shaming, which is exactly why many people turn to addictions in the first place.
We insist that recovering people need a 12 Step program as part of a healthy aftercare plan. If a sex addiction or co-addiction fellowship isn’t available, we suggest attending AA or Al-Anon, which is widespread. The principles of recovery are the same, and these fellowships are blessed with many who have long-term sobriety and can provide guidance for those early in the process.