Sexual Desires and Behaviors

Sadly, some counselors and therapists have not learned current clinical understanding, best practices, and the latest research regarding the assessment and understanding of human sexual arousal. Nor have they learned to leave their highly personalized moral, religious, and ethical judgments at the door when they walk into the therapy space. Sadly, these men and women can and do cause considerable harm when they label and pathologize a client’s sexual desires and behaviors simply because the client’s urges and activities don’t mesh with their own (personal, not clinical) value system.

In truth, nearly always the behaviors in question are, clinically speaking, perfectly normal and acceptable – even if they are ego-dystonic for the client, as sometimes occurs with things like fetishes and same-sex attractions. Typically in these situations, the client and/or the therapist decides that certain attractions and activities are unacceptable – immoral, deplorable, gross, etc. – and no person would desire or engage in those behaviors if he or she did not have a serious psychological issue. Then they grasp at the “sexual addiction” label, hoping to use that as a way to alter the client’s arousal template and sexual behaviors.

Below are three examples of this misguided thinking, all of which I’ve encountered on multiple occasions in real life.

  • A man in my church has been looking at porn, even though we believe it’s a sin and grounds for excommunication. He must be a sex addict.
  • She gets into BDSM and other kinks. I bet she’s sexually addicted. Otherwise, she wouldn’t be doing those things.
  • He’s married, but he’s been sneaking around and having sex with men. Obviously he’s a sex addict.

I find this demonization of nontraditional sexual behaviors incredibly upsetting, primarily because it fails to consider two very basic and important facts.

  • Sex that seems abnormal, wrong, or weird to one person can be perfectly normal for another. There is absolutely no reason to pathologize a sexual behavior simply because it doesn’t appeal to you or mesh with your highly personalized system of values (provided the behavior is consensual and does not victimize or harm anyone).
  • Sexual addiction is unrelated to a person’s sexual arousal template. In other words, sex addiction has nothing whatsoever to do with who or what it is that turns a person on. Instead, sex addiction is defined by obsession, loss of control, and directly related negative consequences. (These are the same criteria we use with all addictions, including substance use disorders.)

I especially take umbrage with the idea that a person should be diagnosed as sexually addicted simply because he or she is engaging in same-sex behaviors. Sex addiction as a diagnosis was never meant to be used in this way, and doing so is both homophobic and unethical/unprofessional. Even worse, therapists who foist this idea on their homosexual and bisexual clients can do a great deal of emotional and psychological damage in the process.

As mentioned above, the underinformed and/or misguided counselors who equate things like fetishes and same-sex attractions with sexual addiction typically tell their clients that they are only desiring and doing these things because they are sexually addicted. And then they try to stop these behaviors through all sorts of ineffective and potentially harmful “treatments,” including things like aversion therapy, directed prayer, and gay conversion therapy (also known as reparative therapy). Basically, these clinicians tell a client that he or she is sexually addicted, and then they try to change that person’s sexual arousal template.

Interestingly, misguided counselors will try this even though sexual orientation is fixed and immutable, as are fetishes. Put very simply, the sexual arousal template is what it is. Gay men are sexually and romantically attracted to other men, lesbians are sexually and romantically attracted to other women, bisexuals are sexually and romantically attracted to both genders, heterosexuals are sexually and romantically attracted to the opposite sex, and people with kinks are turned on by their kink. End of story. Sure, a person can choose to not act on his or her desires, but that doesn’t make those desires go away.

Regarding sexual orientation, the American Psychological Association states this rather clearly, writing:

[People] cannot choose to be either gay or straight. For most people, sexual orientation emerges in early adolescence without any prior sexual experience. Although we can choose whether to act on our feelings, psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed.

Importantly, every major medical and psychiatric professional organization is solidly in agreement on this point. These organizations also agree that attempts to change a person’s sexual orientation can be detrimental, especially to adolescents, who are typically subjected to these efforts involuntarily. (For the most part, this damage is wrought by the deeply shaming reinforcement of societal prejudices against homosexuality.) In one study looking at the effects of social, familial, and clinical beliefs and behaviors, researchers found that gay and lesbian kids who experience significant feelings of rejection because of their sexual orientation – such as what occurs with attempts at gay conversion therapy – are three times as likely to use illicit drugs, six times as likely to report high levels of depression, and eight times as likely to attempt suicide. Recognizing these dangers, virtually every major medical and psychotherapeutic professional organization has issued a statement condemning gay conversion therapy. And two states, California and New Jersey, have passed laws outlawing the practice on minors.

NOTE: If a client is ego-dystonic related to sexual orientation, the therapist’s job is to focus on acceptance and shame reduction, helping the client understand and accept that his or her sexual orientation is perfectly normal and nothing to be ashamed of. Under no circumstances should a clinician ever attempt to change a client’s sexual orientation.

So, once again, sexual arousal patterns and sexual addiction are unrelated. Neither sexual orientation nor kinks are factors in the diagnosis of sexual addiction. Being gay, lesbian, bisexual, and/or having a fetish does not make a person sexually addicted any more than being straight and vanilla makes a person sexually addicted.

Robert Weiss

American Psychological Association Help Center. Sexual orientation and homosexuality

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