Getting Real about Sex Addiction

As the controversial field of sex addiction treatment reaches for legitimacy across the disciplines of medicine, psychiatry and psychotherapy, Getting Real about Sex Addiction: A Psychodynamic Approach to Treatment applies psychoanalytic framework to concepts of addiction and sex, as well as related concepts of personality and attachment development. Authors Graeme Daniels and Joe Farley explore the intersection of sex and culture and address social undercurrent relating to gender, such as objectification and sexual aggression and how those influence conceptualization goals and procedures in treatment. Through a number of case illustrations and vignettes, this text demonstrates psychodynamic method across treatment contexts, in formats of individual, couples, and group therapy. The result is a work that critiques theoretical, intervention, and gender biases that have infiltrated this important yet embattled field, and provides a fresh, alternative approach from a source with the oldest pedigree in modern psychology.

Graeme Daniels, MFT, has been a practicing psychotherapist since 1996, is an instructor at the East Bay Year Long satellite program of the San Francisco Center for Psychoanalysis (SFCP), and is a post-seminar analytic training candidate at SFCP. He has written several novels, as well as three non-fiction works, including Getting Real About Sex Addiction: A Psychodynamic Approach to Treatment, co-authored with Joe Farley (Rowman & Littlefield, 2022). He has provided annual trainings at San Francisco Bay Area mental health agencies and is a former faculty member within the West Coast Masterson Institute.

Table of Contents
Preface
Joe Farley, MFT
Introduction: What are we wearing?
Graeme Daniels, MFT
Chapter One: Trends and Norms in Sex Addiction Treatment
Graeme Daniels
Case Illustration: Rick and Anne
Where Sex Addiction Fits in the Mental Health Industry
Motivational Interviewing, 12-Step Programs, and Initial Assessment
Money, Time, and Shame: Three Indices of Assessment
Female Sex and Love Addiction: The Under-Researched and Under-Treated
Sex Addiction, Personality and Attachment Disorder
Splitting, "Excuses", and Keys to Therapy
Case Illustration: Not Thinking (Mr. A)
A Comment on Psychoanalytic Approaches to Treating Sex Addiction
Chapter Two: Sex and Intersectionality
Graeme Daniels
Sex Addiction: A Cultural Controversy
Sex Addiction and Social Class
Sex Addiction and Gender
Mythological Perspectives: The Swine, Virginity, and Scopophilia
Case illustration: Voyeurism (Mr. B)
Hate, Objectification, Exploitation, and Male Sacrifice
Case Illustration: Jill and Ray
Chapter Three: Individual Therapy with the Sex Addict
Joe Farley
A Psychodynamic Approach
Efficacy of Psychodynamic Approaches
Revisiting the Definition of Sex Addiction
Patients Mandated for Treatment
Legal Issues
Standardized Treatment Models
Discovery
Developing a Therapeutic Alliance
Therapeutic Neutrality
States of Mind
Implicit Memory
Procedural Memory
Case illustration: Tony
Therapeutic Frame
Unconscious Process
Empathy and Empathic Failures
Countertransference Reactions
Early Attachment Issues
Chapter Four: Treatment of an Impacted Partner
Graeme Daniels
Co-Addict, Relational Trauma, and Psychoanalytic Models of Trauma
Trauma Profile and the Reconfigured Environment: Labels, Boundary Agreements, and "Full Disclosure"
Alternative Profiles of Impacted Partners
The Anti-honeymoon
Forgiveness, Mindreading, and Rebuilding Trust
Case illustration: The Return of Anne
Chapter Five: Sex Addiction and Group Therapy
Graeme Daniels
A Problem of Thinking: Internal Process and Defenses in Group Therapy
Group Needs, Community Virtues
Group Therapy Versus 12-Step Participation
Groups Discussing Sexual Fantasy, Sexual Abuse, and Violence
A Sex Addiction Superego: Group Conscience and Purpose
Case Illustration: A Women's Group Experience
Groups as Microcosms of Commitment and Conflict Resolution
Case Illustration: Eric, Stu, and a few supportive men
Chapter Six: Collaborative approaches: working with a treatment team
Joe Farley
Splitting of the Treatment Team
Splitting in Everyday Life
Competition Among Therapists
Case illustration: Kevork and Shannon
The Blind Men and the Elephant
Physician Heal Thyself
Professional Burnout
12-Step Programs and a Higher Power
Freud's Views of God and Religion
Chapter Seven: Couples and Family therapy
Joe Farley
Providing a Non-judgmental Therapeutic Experience for Both Addict and Partner
Case Illustration: Dan and Vickie
Therapist Neutrality in the Face of Pressure to Take Sides
Countertransference Reactions of the Couples Therapist
Case Illustration: Mary and Stan, a Therapeutic Failure
Case Illustration: Dan and Vickie (continued)
Helping each partner understand the other by supporting the emergence of real selves in a relationship