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Written in the Scars: Sex Addiction as an Attachment Disorder

John Beveridge (UKCP, ATSAC) discusses how disrupted attachment impacts core beliefs and sexual behaviours associated with sexual addiction, and how this manifests in the therapeutic realm.  

Having trained in attachment theory, when I assess sex addicts coming into therapy, I look for experiences of early relational trauma, abuse, and abandonment.

‘Attachment Theory is in essence a spatial theory: when I am close to my loved one I feel good, when I am away I am anxious sad or lonely’ (Holmes 1993: 67). There is a biological imperative for animals to stay attached to the herd, and so it is for humans. Mitchell and Black (1995) write that John Bowlby recognised that babies come pre-programmed with attachment behaviours including: sucking, smiling, clinging, crying, and following.  These are designed to elicit an emotional response so that caregivers form relationships with us, upon which our survival depends.

If parents do not attach, unattended children are naturally at risk of accident or predation, and, since this knowledge is wired into us, fear of abandonment persists across the lifespan. We do not like to think of the emotional damage that might result from different kinds of abuse and parental neglect, ranging from the abandonments of emotional absence, to the gross impingements of physical and sexual abuse. Ronald Fairbairn, a contemporary of Bowlby, recognised that children who are abused need to cling to the belief that their parents are good people.  In order to preserve this illusion, they must develop a ‘moral defence’, which Greenberg and Mitchell, describe thusly, ‘The child separates and internalises the bad aspects of the parents – it is not they who are bad, it is he. The badness is inside him; if he were different, their love would be forthcoming’. (Greenberg & Mitchell 1983: 170).

This raises an important question for our work, namely why are unpleasant experiences, early conflicts, not dropped and forgotten, but instead become restructured systematically throughout life? Mitchell and Black write that: ‘The child bonds to the parents through whatever forms of contact the parents provide, and those forms become lifelong patterns of attachment and connection to others’ (Mitchell & Black 1995: 115).

Relational bonds can be broken through disaster, accident or misfortune, such as; parental death, adoption, separations through hospitalization, operations, and illness, or children being born prematurely. When these events occur at a pre-verbal age, it can make later historical description of distress in therapy impossible because it is inconceivable in language and may only be retained as body memories. The most sacred bonds of trust are always broken when children are sexually abused. In families where there are powerful sexual secrets caused by incest, or illegitimacy, or the raising of a sibling’s child by the parents as their own, or adults having affairs and secret addictions to porn, then atmospheres are created where nothing is really as it seems.

Core beliefs are formed in infancy which affect how people see themselves and how they believe they are going to be responded to in relationships. For addicts, the knowledge of their separation anxiety and the risk of losing their original caregivers has to remain out of awareness, so distractions have had to be intense and dramatic. In a sex addict’s early life, engaging in sexual activities, which bring escape, intensity, numbing, and distraction, might seem like a creative solution to emotional problems, but the relief it provides only approximates to the advantages of being held in a secure attachment. To avoid feeling vulnerable, which is inevitable in relationship, many sex addicts retreat from intimate involvement with family or friends who they see as impediments to their secret lives. Sexually addicted people are attracted to all-or-nothing thinking and the excitement of high-risk behaviour. I keep telling my patients, “Exciting does not always mean pleasant”.

Sexual acting out is often used by people who feel shame around having any emotional needs. Addicts survive in the present, by literally, ‘making a drama out of a crisis’. They can then be in a state of powerlessness over their addictive behaviour, believing that they have only themselves to blame, particularly when damaging and self-defeating consequences become apparent. This seems baffling, masochistic, and perverse, even to those engaging in it. The wells of self-hatred, fear, and self-loathing run deep. Sometimes therapy becomes necessary when the client may have an experience with loss, or they encounter an external crisis, which provides an emotional ‘live link’ to the place in their relational history where they felt most helpless and vulnerable. This can be caused by; the threat of separation, or divorce, or illegal activity, or public disgrace, and, in some cases, all of the above.

As animals, we are conditioned to react to threat by fighting, fleeing, or pretending to be dead. In recovery we are dealing with the depressive effects of low self-esteem, which has deepened in the addictive vortex of trying to recover alone and failing to make progress.

It has to be recognized that, under threat, just thinking about sex produces dopamine which has an immediate sensory payoff. Because acting out to regulate unwanted feelings has become a ‘default setting’, recovering addicts will experience stress when they are expected to be intimate, open and honest. There has to be a desire to relinquish intensity and excitement, which is a big ask in an instant culture where waiting, being still and holding on to feelings which offer no ‘quick return’ is actively discouraged. Psychodynamic support is needed to find the dysfunctional relational dynamics which continue to trigger anxiety when the addictive payoffs no longer work.

People feel at the mercy of their emotions if, when growing up, their feelings were not explained to them. Now, in therapy, the addict might revisit their traumatic relational past which, as an infant, they had to survive alone. The field of addiction therapy is largely populated by therapists who are recovering addicts themselves and I believe that we cannot take people to, or be with them in, places we have not been willing to visit ourselves. If a therapist has not encountered this experience then, triggered by the client’s emotional vulnerability, they might behave in the same way that the original caregivers did, who abandoned or abused the child. Therapists can be drawn into present day problem-solving, feeling under pressure to help the client escape their terrifying feelings and they might try to hurry the patient through this process.

IMG_4857  John is an attachment based Psychoanalytic psychotherapist working in North and Central London in private practice. Trained at the Bowlby Centre London and in Supervision at SAP (Society of analytical psychology) John has also trained at The Institute for Group Analysis (IGA) He has studied PIT Trauma Reduction and Sex Addiction at the Meadows Arizona, trained in sex addiction with Paula Hall and with Thaddeus Birchard.  He teaches therapists in training at and runs groups for sexually compulsive men at The Marylebone Centre.  John enjoys spreading understanding about Sex addiction through writing and public speaking. He is the author of ‘The Exclusion Zone’ chapter to The Therapeutic Frame in the Clinical Context.  (2003, Maria Luca Ed.), and ‘The Tangled Web’ in  Love in the Age of the Internet. Attachment in the Digital Era. (L. Cundy, Ed.) re-edited for The Politcal Self: Understanding the Social Context for Mental IIlness. 2017 (R. Tweedy, Ed.)  John can be contacted via the ATSAC website, via telephone (+44 (0)7979 862 765) and via email john50beveridge@gmail.com

 

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Working with Female Partners

Joy Rosendale (MA (Dist) Cert Ed, Accredited with COSRT, UKCP, ATSAC) writes about interventions used in group programmes for female partners of men with sex addiction and sexually compulsive behaviours. 

Although there has been a rise in understanding and treatment of sex addiction over the past few decades, the situation of partners of sex addicts has not been given a similar degree of attention. Most partners are traumatised by the revelations of the sex addict, yet historically they have been omitted from the treatment processes and so suffered from losing the relationship they thought they had, and then losing their spouse to recovery.

My experience has been that most women feel ambivalent when deciding to join a group offering support and education about sexual addiction and its impact on partners. Feelings of isolation, powerlessness, shame, sadness, fear and indignation that it is not their problem, all feature in the often desolate emotional landscape.

All addictions make a couple dynamic problematic, but when sexual energy is diverted compulsively outside of the relationship, it strikes at the heart of femininity. Some members think their partner’s acting out is just bad behaviour, using expressions such as ‘he can’t keep his trousers up’. However, increasingly, since 2013 especially, participants are reading more of the literature and recognising that it may be worth exploring the concepts of an intimacy disorder, a generational addiction pattern or frozen early emotional development.

Sue arrived in the office, white with fatigue and with the shocked, traumatised appearance sadly familiar to me from other partners in a similar situation. She had discovered more pornography on her husband’s computer that morning, despite a showdown three days earlier when her partner, Doug, disclosed a secret life of visiting dominatrix sex workers. Doug had become careless of late and had left a mobile phone in a jacket. Sue had taken to checking his things routinely as she had felt his absence from the relationship in the last year but had not been able to make her intuitions concrete. There had been some missing time in his work schedule and she had once found a stocking in his suitcase.

In this initial session I reassured Sue that, as her life committed to reality again, rather than existing in the denial of addictive patterns, she would be in a place to make decisions about whether to stay in or leave the marriage, and that in six months it might be time for some evaluation.

Sue felt extremely apprehensive before the first group meeting and almost couldn’t get in the car to drive there. She paired up with Sarah for the introductions and was shocked to hear that Sarah’s husband, a city lawyer, went ‘dogging’ frequently, sometimes disappearing for days and returning dishevelled, with his shoes muddy and ruined. Sarah’s baby was only 18months old. When Sue though of this back at home after the meeting she cried for Sarah, for herself and for all the women who had been humiliated and exposed.

My observation, anecdotally, is an outcome of ‘thirds’: in a typical group, one third will leave the relationship, one third will ‘stay stuck’ (remain together but with problems unresolved) and one third go on to have a different and often improved closeness with their partner.

A therapeutic modality that I have to be of benefit when facilitating partner groups at the Marylebone Centre is Transactional Analysis, which is humanistic in its philosophy, believing we all have worth and value (I’m Ok, You’re Ok). The three main TA concepts I explore in this chapter are Ego States, The Drama Triangle, and Life Scripts, all of which I find help partners better understand and shape the dynamics of their own relationships.

The group facilitator will need to be willing and able to sit with the profound trauma, anger and sadness in the room and should never accept the invitation to join the ‘aren’t men awful’ game. Finally, hope must always be held for the future for partners. This is a learning that would never had been chosen, but whether going forward in the couple, or continuing alone, it can be a positive wake-up call for one’s life.

joy-rosendale_500  Joy specialises in working with partners of those struggling with sexually compulsive behaviours www.joyrosendale.comShe initiated the Partners’ programme at the Marylebone Centre in 2005 and the groups continue, offering support and education. She also teaches on the Sex Adddiction Training Diploma and has contributed to books on the subject including being a contributing author to the Routledge International Handbook of Sexual Addiction.  Joy has been practising psychotherapy for 27 years and trained with Relate as a relationship and sex therapist, and with Patrick Carnes in Arizona for sex addiction.   She likes Transactional Analysis as a modality (I’m ok, you’re ok) and offers a kind and holistic approach to self development.  

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Group Cognitive Behavioural Therapy for Compulsive Sexual Behaviour

From The Routledge International Handbook of Sexual Addiction, Dr Thaddeus Birchard shares his clinical experience of using CBT-based activities in group therapy for compulsive sexual behaviours.

Cognitive Behavioural Therapy (CBT)

Modern Cognitive Behavioural Therapy (CBT) has emerged since the publication of Cognitive Therapy of Depression (Beck et al., 1979). It combines behaviour therapy and cognitive therapy, with its emphasis upon understanding and changing the meaning of events. It is our interpretation of an event, rather than the event itself, that gives it its character and determines its impact upon our feeling states. Introductory textbooks on CBT are fond of quoting Epictetus (AD55-135), who said that ‘Men are disturbed not by things but by the principles and notions that they form concerning things’.

CBT always locates itself as an evidence-based methodology. There is evidence of the effectiveness of CBT for depression, panic, phobias, post-traumatic stress and personality disorders. CBT is the psychological therapy with a wide evidence base for efficacy and effectiveness’.  Some authors contend that CBT is currently the psychotherapy with the best documented efficacy for sexual addiction. The sexual addiction programme used in our clinic is CBT, as is the content of the training programme that we have developed to train therapists to work with compulsive sexual behaviours.

CBT-based Activities and Compulsive Sexual Behaviours in Group Therapy 

In the early stages of the work at The Marylebone Centre for Psychological Therapies, we use an exercise called ‘Values Clarification’. This exercise requires individuals to think about their values – things that they feel strongly about – and then consider whether their sexual behaviour contradicts or confirms these values. Although an uncomfortable task, we ask participants to make a list of all the harmful consequences of their compulsive sexual behaviour. The next stage of the treatment process is to ask individuals to draw a ‘trauma egg’. We ask participants to draw a large egg, inside which they note down events in their life history that were traumatic, non-nurturing or shaming. This is followed by a general share on the ‘trauma egg’ exercise. Shame is reduced when exposed in the presence of an understanding and ‘non-shaming’ other. This exercise encourages men to reflect on their history and to come to see that, while the behaviour exists, it did not come into being wilfully. Shame is thus reduced. Next we present a generic ‘cycle of addiction’, take people through it and then ask them to personalise it by analysing a recent or significant acting-out experience. The cycle has precursors, seemingly unimportant decisions, triggers, build up and the point of inevitability. Towards the end of the treatment programme we focus on cognitive distortions. These are thinking errors that are very common for all of us.

An immensely important part of our group treatment programme is the personal presentation. Drawing on the trauma egg, we ask each participant to prepare a presentation of a personal life story, with an emphasis on past events that were shaming and/or non-nurturing, the sexual history and the history of the sexual addiction, with an emphasis on any rock-bottom or crux point that caused them to pursue recovery. The personal presentation is normally followed by a teaching evening on sexual health.

We give patients a relapse prevention and recovery worksheet. The worksheet includes questions about their distinctive cycle of addiction. This includes questions about the individual precursors to their sexual acting out, as well as their distinctive cues and triggers. The worksheet closes with a section on relationships and how these can be improved. It also includes a section on making amends. This includes making a list of people to whom one owes amends.

The treatment plans outlined above fit well with any type of sex addiction, including internet pornography addiction. As far as I can determine, all effective programmes for the treatment of sexually-compulsive behaviour are, in fact, cognitive behavioural. They normally include a didactic element, homework exercises, a treatment plan, organised sessions and should, at least, have some way of measuring outcomes. Our treatment programme is such a programme.

Dr. Thaddeus Birchard

dr_birchard

Clinical Director, Marylebone Centre for Psychological Therapies

C0-Editor:  The Routledge International Handbook of Sexual Addiction (2017)

Author:   Overcoming Sexual Addiction: A Self Help Guide (2017) , CBT for Compulsive Sexual Behaviour: A Guide for Professionals (2013)

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The Routledge International Handbook of Sexual Addiction – NEW!

The Routledge International Handbook of Sexual Addiction

Each chapter in this comprehensive reference guide is written by leading international experts in the field of sex addiction, compulsive sexual behaviours and out of control sexual behaviours.  Complimentary and contrasting views both for and against the concept of sex addiction are included.  Multiple chapters on sex addiction presentations, aetiology, and treatment of sex addiction are written by researchers, theorists, and clinical practicioners.  Additional chapters highlight sex addiction in specific populations (MSM, adolescents, women, female partners, sex offenders, religious sector, and in professional misconduct).   This research-based collection covering diverse aspects of sex addiction includes the views of experts who challenge and present alternative clinical and social views to ‘sex addiction’.  Link to our Blog to gain more insight from our highly esteemed colleagues and handbook authors.

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Virtual Reality (VR) – Questions re Compulsive Sexual Behaviours

I’ve been discussing with my therapeutic colleagues whether virtual reality (VR) cybersex provides a medium for compulsive sexual behaviour akin to forms of online pornographic content.   Or whether VR can, as has been done with nicotine and gambling, be used therapeutically with problematic sexual behaviours, (Park, et al. 2015).  Since no academic literature yet exists on VR cybersex, it would be premature and irresponsible to associate it with a ‘next wave’ of compulsive sexual behaviours.   Yet, there are similarities in the mediums.  So how does VR compare to the 24/7, on demand, stimulatory experience of internet pornography, a current online medium that for some becomes compulsive and problematic?  This is an exploratory article designed to raise questions for therapists working in the field of compulsive sexual behaviours.

Shifting Towards a Virtual World

Some of us may remember when cybersex gave us one (visual) or two stimuli (auditory) by looking at pornographic images or sexually explicit videos.  Cybersex now provides ‘engagement’ opportunities, e.g. conversations, interaction of sexual avatars,  remote teledildonics, etc..  Yet much of cybersex’s medium takes place on a ‘flat’ screen, and stimuli from the ‘real’ world (location, touch,pressure, peripheral vision, sound, smell and taste) remind us it isn’t ‘real’.  

VR provides immersion into a reality so that the user “feel[s] like they are experiencing the simulated reality firsthand.” (Augment.com).   Some VR experiences are more ‘passive’ taking the point of view (POV) of a participant, like riding a roller coaster.  Other VR media allow three dimensional movement of the participant within a new reality; good for fighting zombies in an apocalyptic world, or dinosaurs in a Jurassic forest.  Whether passive or active, VR completely replaces visual and auditory cues.  As a result, one’s sense of position and balance becomes congruent with the virtual, rather than the real world.  The real world shifts a little further away, akin to what Milgram envisioned in 1994 as a shift on a continuum from ‘real’ to ‘virtual’ environments.

VR Cybersex – What’s Different?

The first wave of VR pornography has been ‘point of the view’, i.e. the experience of inhabiting another’s body.  The VR user sees, as if with his own eyes, everything its new ‘body’ is doing and with whom it is doing it.  Even though the user has no ability or choice in interacting with this body or the other people in the experience, the stimulus cues provide a sense of integrating with the body and of being ‘in’ the virtual world.  

Though there are no published studies on the VR pornographic experience, first hand accounts are available.  They convey something ‘different’, a more ‘real’ experience than 2D pornography.  This shift in experience is reminiscent of Naughty America’s goals, “Our customers want to get as close to reality as they can get, without reality getting in the way,” (Hamill, 2015).  Users trying virtual pornography for the first time similarly report, “I underestimated how realistic it would be because they got very close to me,  It felt pretty real,” (BuzzFeedBlue, 2016).

Is VR pornography as easily accessible ?

With a VR headset (now free with some pay subscriptions), a virtual pornography experience is just a headset, headphones, and mobile phone away.  For those trying to overcome the technological ‘how to’, YouTube videos are already available to help the viewer get their phone VR porn ready.  For a better quality stimulatory, immersive experience, high end headsets with a higher price tag are available.  Yet, the bulky headset and the need for headphones make it unlikely VR technology at present will be easily accessible and hidden in a work or home environment.  Still, the technology does provide the opportunity for instant sexual, 24/7 access, anonymity, and the potential in the near future to be more affordable and provide a variety of sexual genres.

What issues does this raise of a partner’s experience of VR pornography?  Again, the research is yet to be carried out.  Harrison (2016) raised this issue with a non-scientific sample of couples’ perspectives of how they would feel if their partner were engaging in pornography.  I was struck by one respondent who felt that it was the interactive component of VR that made it different from 2D pornography.  Regarding VR pornography, he/she replied, “I guess it makes me uncomfortable because it’s so close to just having sex with me yet they’ve decided to do it on their own.  It’s something we could be doing together and they choose the VR.”

What does the future of VR cybersex hold?    

VR porn designed for two people is a predicted future feature, as well as watching one’s adopted body engage in sexual activity that may be controlled remotely, (Sloat, 2016).  Motion sensitive suits and teledildonics (dildonic devices synced to the virtual experience) open this field.  CIO of Naughty America, Ian Paul thinks the VR version of pornography will shift from the passive, depersonalised version to a more intimate one. (Lee, 2016).  Albeit, this could be seen as “an extremely isolating way of experiencing intimacy…and can function to reinforce unrealistic norms around bodies and sex,” (Core 77, 2016).

A therapeutic thought…

I linger with something I read by Weisel (2015) discussing media addicted (not pornography addicted) clients.  Weisel proposed that the person “immerses” himself into an alternate reality, to attempt to self heal “into new forms of being or onto another stage-set, in order to prevent the return of the trauma” (p. 205).  What the computer programme creates are symbols in the fantasy experience that become ‘relational artefacts’, i.e. virtual objects upon which the client creates an attachment.  It is this attachment, Weisel believes, that gains power because the relational artefacts “facilitate a sense of continuity which is endlessly renewed without any need for separation”, (p. 209).  A media-addicted client shows one of two defenses:  phantasy and reality are kept separate (rather than integrated into a triangular experience), or extinction of connectedness and a staying in a state of ‘non-experience’.  Rather than connecting with real-life relationships, the person develops a safe, separate, fantasy existence that becomes a repetition compulsion, and creates greater isolation from connection from self and others.  I wonder how this matches the therapist’s experience of working with problematic sexual behaviours particularly given we often see trauma and attachment issues driving management (with pornography) of negative feeling states.  

Still, without valid and reliable research, it is only conjecture that VR technology may provide a medium for compulsive sexual behaviours akin to what we see with internet pornography. There are distinct similarities in terms of accessibility and engagement.  By hijacking additional senses, VR takes the user into feeling the fantastical is “real”.  And how could we use the technology to provide therapeutic support? The psychology and neuroscience of our experience in VR is an exploration that is just beginning.

Author:  Cecily Criminale, MS, MEd, MA, MBACP (Reg)

Bibliography

Augment.com (2015). Virtual Reality vs. Augmented Reality. [Blog] Available at: http://www.augment.com/blog/virtual-reality-vs-augmented-reality/ [Accessed 25 July, 2016].

BuzzFeedBlue. (2016) People Try Virtual Reality Porn. YouTube. Available at: https://www.youtube.com/watch?v=gVatvg_UyEA/ [Accessed 3 July, 2016].

Core 77. (2016) Will Porn Finally Make Virtual Reality Popular?  Available at:  www.core77.com/posts/47529/Will-Porn-Finally-Make-Virtual-Reality-Popular? [Accessed 3 July, 2016].

Milgram, P., Takemura, H., Utsumi, A., & Kishino, F. (1994). Augmented Reality: A Class of Displays on the Reality-Virtuality Continuum. SPIE, 2351, pp. 282-292.

Hamill, J. (2015). ‘World’s First’ Virtual Reality Porn Flick Invites Men to Take part in a Simulated ORGY. The Mirror. Available at: http://www.mirror.co.uk/news/technology-science/technology/worlds-first-virtual-reality-porn-6017946/ [Accessed 24 July, 2016].

Harrison, J. (2016). How Will Virtual Reality Porn Affect Our Relationships? TechRadar.com. Avaialble at: http://www.techradar.com/news/wearables/how-will-virtual-reality-porn-affect-our-relationships–1323577/ [Accessed 24 July, 2016].

Lee, S. (2016). Virtual Reality Porn Lands in E3 with a Bang.  Newsweek. Available at: http://europe.newsweek.com/virtual-reality-porn-lands-e3-bang-470888.  [Accessed 23 July, 2016].

Park, C-B., Park, S. M., Gwak, A. R., Sohn, B. K., Lee, J-Y., Jung, H. Y, Choi, S-W, Kim, D J, Choi, J-S. (2015). The Effect of Repeated Exposure to Virtual Gambling Cues on the Urge to Gamble.  Addictive Behaviours. 41, pp. 61-64.

Sloat, S. (2016). Why Virtual Reality Sex is More Likely to Kill Pornography than Monogamy. Inverse.com. Available at: https://www.inverse.com/article/16154-why-virtual-reality-sex-s-more-likely-to-kill-pornography-than-monogamy/ [Accessed 24 July, 2016].

Weisel, A. (2015) Virtual Reality and the Psyche. Some Psychoanalytic Approaches to Media Addiction.  The Journal of Analytical Psychology. 60(2), pp.198-219.

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Sex Addiction Treatment in the UK – New article in “Sex Addiction & Compulsivity: The Journal of Treatment & Prevention”

A Paradigm Shift…Again?

We are living in the time of a ‘paradigm shift’ when one all-embracing framework moves on towards another framework.  During such times there can be considerable disagreement.  This paradigm shift has largely emerged from advances in neuroscience.  The term ‘addiction’ can now apply to repetitious behaviours as well as substances.  Disagreement is evident from the email circulation of the Society for the Advancement of Sexual Health and, in particular, the recent conflict with the American Association of Sex Educators, Counsellors and Therapists.  These conflicts happen during a paradigm shift and remarks can be intemperate.  In all cases, I urge courtesy and respect for all points of view.

Media and Sex Addiction…the impact on awareness

For some years now, the media have been discussing the concept of sexual addiction. My practice, and the practices of colleagues, have seen an increase of referrals drawn from a wide public acceptance of the reality of sexual addiction.  Of course, the newspapers like to report in ways which are designed to focus on anything to do with sex.  Sexual addiction has been highlighted by the release of films like Weiner and Shame.  Just yesterday, I was interviewed by a journalist working for Vogue, on the psychology and motivation of couples who have live sex on the internet for the benefit of on-lookers.  So the media, newspapers, magazines, television and film have all contributed to the dissemination of an understanding of sexual addiction and the corresponding issues of treatment.  From so much press exposure, many people may now self-identify as sexually addicted.  Many of the patients who came to this clinic self-refer and come through the internet.

A Story of Sex Addiction Therapy in the UK

This brand new article, published in full in The Journal of Sexual Addiction and Compulsivity, (2017, Volume 24:1-2) is a personal story but one made richer by the attentive and devoted work of many other clinicians.  Although I was the not the first person to work in this field, in the early days mine was and continues to be a commitment to this important work.  As times have moved on, more individuals have joined me in the development of sex addiction work in the UK.  It is right that all their efforts and creativity are celebrated and acknowledged.  In this article, I name names as it is proper that these men and women should be acknowledged and often, against the odds, have sought to promote the concept of sexual addiction in the face of indifference and sometimes animosity.  This is a story of people and personalities that have shaped the public acceptance of the concept of sexual addiction in the UK.

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