Tannia Los – June 29, 2013
Hypersexual behaviour can have a devastating impact on relationships and the attachments formed between partners (Reid & Woolley, 2006). Engagement in hypersexual behaviour can cause negative feelings such as anger, shame and resentment, and ultimately cause an attachment rupture within the relationship (Johnson, 2005). This rupture can make healing and forgiveness very difficult, if not impossible, until the rupture is addressed. It is very important that a couple is able to discuss their emotional responses to hypersexual behaviour in a safe and controlled environment (Reid & Woolley, 2006). Emotion Focused Therapy (EFT) provides that environment and is an effective theoretical framework that can help to repair attachment ruptures between partners using specific interventions (Johnson, 2003). The purpose of this paper is to first define hypersexual behaviour and discuss the impact it has on the individuals involved. Next, provide a description of how to use EFT to help couples dealing with hypersexual behaviour and the process of reparation of attachment ruptures, and finally, offer recommendations for future research.
A Behaviour Addiction?
There is some controversy over whether hypersexual behaviour is an actual addiction. Kaplan and Kreuger (2010) stated that sexual behaviours are very culturally bound and question how the limits of sexual behaviour turn to sexual addiction and who gets to decide when this shift has taken place. Giles (2006) furthered that criticism by stating that the term sexual addictions are an attempt to stigmatize the types of sexual behaviour that are not morally approved of within the context of culture. Although there are some controversies, hypersexual behaviour is becoming accepted by the psychological community as an addiction (Johnson, 2005).
The term hypersexual behaviour is often used interchangeably with sexual addictions. Reid and Woolley (2006) defined hypersexual behaviour as a difficulty in regulating sexual thoughts, feelings, or behaviours. The behaviours lead to significant levels of interpersonal distress and may include activities that are incongruent with the individual’s beliefs and values. Birchard (2011) defined sexual addiction as behaviour that an individual has little control of, becomes preoccupied with, and partakes in to release anxiety; not to achieve sexual satisfaction. The behaviour’s associated with sexual addiction make an individual feel bad, they become compulsive, and the behaviour causes problems in other areas of life such as: physical health, cognition, impulse control, mood, intimacy, and attachment (Karim & Chaudhri, 2012; Sex Addictions, 2013).
The field of addictions recognizes that there are two types of addictions. The first is a substance addiction, in which an individual relies on the consumption of a stimulant or depressant in order to achieve a change in affect. The other type of addiction is a process or behavioural addiction such as gambling, overeating, and hypersexual behaviour (Smith, 2012). Smith (2012) described how process addictions can occur through the medical model. First, engaging in a pleasurable behaviour, such as having sexual intercourse, causes the brain to release a chemical called dopamine. Dopamine gives the individual a feeling of happiness and well-being and a continued increase of dopamine to the brain can cause the brain’s neurotransmitters to become out of balance. Some individuals are more prone to a loss of brain chemical homeostasis than others through factors such as genetics and previous addiction problems. Once this disruption to the brain occurs, the brain requires more of the behaviour to produce the same levels of well-being and happiness. This increased need causes the individual to crave the behaviour and starts the process addiction.
Sexual addictions have a 3-6% prevalence rate in United States, consisting of mostly males (Kaplan & Krueger, 2010). It is often comorbid with depression, ADHD, Bi-Polar Disorder, and Eating Disorders (Birchard, 2011). Although sexual addiction and hypersexual behaviour have been used interchangeably, the term hypersexual behaviour will be used throughout the rest of the paper as it is more inclusive of behaviours other than just sexual intercourse as implied by sexual addiction.
Effect on Individual
Hypersexual behaviour highly affects the individual who is struggling with it (Corley & Kort, 2006). Hypersexuality is often described as an invisible problem because there is a high amount of shame and guilt that come from this behaviour and it is therefore often hidden and rarely talked about (Hall, 2011). The individual dealing with hypersexual behaviour is bombarded with constant, intrusive thoughts that disrupt other areas of life (Schaeffer, 2009). There are physical changes in the brain to the areas which control emotions and cause the addict to feel emotions in the extremes. The individual must live with relentless emotional loneliness from fear of intimacy and extreme guilt from living a double life (Schafer, 2009). . Often the individual will only see others as sexual objects that may potentially fulfill the hypersexual behavioural needs. There is a constant fear of STD’s, public humiliation should they be found out, loss of employment from the way these behaviours consume the individual causing decreased productivity, and fear of economic hardship (Reid & Woolley, 2006). The hypersexual behaviour leaves the individual in a cycle of addiction that is hard to break; the behaviour causes shame, shame causes the need to cope by engaging in the behaviour, and the cycle continues (Birchard, 2011).
The individual gains a love-hate relationship with the hypersexual behaviour (Reid & Woolley, 2006). They love and are dependent on the euphoria the behaviour brings, but hate the destruction they know it is causing in their lives. Reid and Woolley (2006) discussed how the deception that the individual uses causes shame and guilt which take away from the individual’s ability to remain available and open to their partner. These feelings also take away time and commitment that could be invested into the relationship.
Effect on Relationship and Family
Effects of hypersexuality can be severe for partners and can accompany feelings of shame, distrust, betrayal, and negative self-esteem (Kaplan & Krueger, 2010). Partners of individuals with hypersexual behaviours often are codependent and use a pattern of denial to try to reason with the addict (Tripodi, 2006). The partners feel a tremendous amount of self-blame and may try to self-manage the hypersexual behaviour. The partner can experience severe isolation because of the social stigma attached to this behaviour (Schneider & Schneider, 1996). Schneider and Schneider (1996) detailed the most prevalent problems for partners of hypersexualized individuals were trying to rebuild trust, lack of intimacy, and setting limits or boundaries.
Hypersexuality has devastating impact on a relationship and undermines a healthy expression of sexuality by threatening emotional and physical intimacy. It can become a competing attachment that overrides the attachment to the partner as it can be used to feel safe and soothed (Reid & Woolley, 2006). Individuals with hypersexual behaviour often manipulate and use guilt to get what they want from their partner. These self-serving behaviours make a relationship volatile and susceptible to dissolution. Both partners may be ambivalent about staying in the relationship because of the level and amount of hurt they both feel.
Children who are in a family with an individual with hypersexual behaviour may be exposed involuntarily or voluntarily to sexual behaviours (Reid & Woolley, 2006). They may be at risk of abuse. Matheny (1998) stated that a child’s self-confidence can be eroded, along with their emotional well-being, sense of security, and a healthy sense of sexuality.
Emotion Focused Therapy
What is EFT?
Emotion Focused Therapy is a brief therapy (8-15 sessions) which stems from attachment theory. It emerged after Johnson (2003) noticed that most theories focused on behavioural change and did not consider the emotional aspects of change. EFT assumes that people have a primal need for closeness and comfort in the face of threat and danger. They require secure attachments to others to fulfill this need. The focus of this therapy is to look at negative emotional patterns, reframe them into terms of attachment theory, and help the partners move towards a secure attachment bond. EFT repairs negative, hard emotions, such as anger and frustration, and replace them with softer emotions, such as vulnerability, to create new patterns of interaction (Johnson, 2005).
Why Use EFT?
Emotion Focused Therapy attends to growth over pathology (Reid & Woolley, 2006) and helps couples restructure both their emotional experience and their interactional patterns towards a secure attachment (Johnson, 2003). Hypersexual behaviour is already stigmatized in society so placing the emphasis on growth instead of blame can help the couple be successful in therapy. Shame plays a large role in hypersexual behaviour and needs to be addressed in order to heal; something that would not happen in behavioural-type therapies (Reid & Woolley, 2006). It is important to include family members in the treatment of sexual addictions as often they are co-addicts/co-dependent and also require therapy to stop reinforcing the addict’s behaviours (Matheny, 1998). EFT stresses soothing, comforting interactional patterns to create stability within the relationship through emotional engagement and good communication (Johnson, 2003). It examines and deconstructs the ineffective dependency of maximized attachment (co-dependency of the partner) and minimized attachment (withdrawal of the addict from the relationship) by investigation a couple’s level of separation distress. EFT employs the concept of the attachment injury to help the couple heal from the incident (perhaps infidelity caused by hypersexuality) and have the ability move forward with the rest of the healing process. Finally, the bonding interactions that happen during therapy continue on after termination and the couple continues to improve. Hypersexual behaviour is never cured, but rather enters into recovery or remission. Using EFT, with its ability to have sustained improvement, can help guard against relapse (Reid & Woolley, 2006).
Emotion Focused Therapy is highly empirically supported as a very effective therapy for helping couples in distress (Johnson, 2003). Johnson (2005) described how a meta-analysis of 4 rigorous studies on EFT found that 90% of clients experience significant improvement and 70-73% recovered fully from distress. Using EFT to help a couple with an emotional injury has shown significant changes in that couples are able to forgive the violating spouse, reduced distress levels, and begin to trust again (Greenberg, Warwar, & Malcolm, 2010). Forgiveness of the offenses was sustained two years after termination of therapy.
When and How Does EFT Work?
Emotion Focused Therapy can be used with couples who are experiencing distress in their relationship (Johnson, 2005). For hypersexual behaviour, both partners may need individual counselling first before they can come to a place where they can work on their relationship (Reid & Woolley, 2006). The hypersexual behaviour is best to be treated before the commencement of marital therapy otherwise the partner will experience reoccurring attachment injuries and will not be able to engage in the healing process. The addict may also benefit from some individual EFT to gain an emotional vocabulary as there is often disconnect from emotion.
EFT examines the negative interactional patterns of criticize/demand followed by defend/distance and look for the patterns within the couples interactions that maintain these negative interactions (Johnson, 2003). It is a structured therapy that that is composed of nine steps broken into three stages. Johnson (2003) explained the stages. In stage one, de-escalating, a working alliance is formed, a pattern of interaction is discovered along with the underlying emotions surrounding the pattern as it is reframed into attachment needs. For instance, with hypersexual behaviour, the partner may interrogate the addict about their behaviour, which may lead to the addict withdrawing from their partner out of defense. This withdrawal may cause the partner to feel insecure about the relationship so they again interrogate the addict, starting the cycle over. The partner may express anger and frustration with the addicts retreat, and the addict may express frustration and anger with the lack of trust from the partner. The cycle may be reframed into attachment needs by stating that the partner loves the addict enough that the partner would like to have a secure attachment to the addict. The interrogation techniques are an attempt to achieve a more secure attachment between the partners.
Once the pattern is reframed and accepted by the partners, stage two, restructuring interactional patterns/positions begins. The therapist helps to promote interaction of disowned attachment needs and integrates emotions into the couple’s interactions. Acceptance of the other partners new construction of the problem is facilitated as are the expression of self-needs and wants within the attachment. The couple’s expression of the hard emotions such as anger and frustration may be undone by incorporating the underlying softer emotions such as sadness (Davidson, 2000). The partner may express anger from the withdrawal of the addict, however looking into their more vulnerable, softer emotions, may reveal that the partner is saddened by the lack of connection they have to the addict. Once the alternate emotion has been accessed it transforms or undoes the original state and a new state is forged (Greenberg, 2010). The addict’s anger may shift to shame and guilt as they soften to their partner. As these new emotional experiences of the hypersexual behaviour emerge the therapist facilitates interactions between the partners using this new awareness of the problem.
In stage three, consolidation, the therapist fosters positive cycles of bonding, caring and comfort (Johnson, 2003). Once the softer feelings and new experience of the problem are embraced by both partners, the therapist helps the couple use this new perception to interact and sooth each other. The partners are encouraged to use emotional language and acknowledge each other. The addict may apologize for causing their partner to feel sad and rejected. The addict may also attempt to soothe and care for their partner. In turn the partner may apologize for the constant questioning and accept responsibility for their part in the pattern. Before a couple is able to move forward to this stage, the couple must first trust each other enough to be vulnerable and enter into their softer emotions. This becomes impossible if there is an attachment injury, which is very likely with hypersexualized behaviour (Reid & Wooley, 2006).
What is an Attachment Injury?
Johnson (2005) described an attachment injury as a trauma or wound; a violation of trust that brings the nature of the whole relationship into question and must be dealt with if the relationship is to survive. This injury acts as a betrayal of a person’s attachment bond with their partner. For many individuals, affairs constitute an attachment injury (Johnson, 2002) because the emotional threat is serious enough (such as repeat infidelity in hypersexual behaviour). The hurt partner may have hyper-activated attachment anxieties and try to numb out fear and anxiety by pushing the partner away thus moving in and out of anxious and avoidant responses (Corley& Kort, 2006). For example, the partner of an individual with hypersexual behaviour may try to keep their partner by acting desperate and needy out of fear of being alone. Once the hypersexual individual reengages in the relationship, the partner pushes the addict away to stop from being hurt again (Johnson, 2005). These strong emotions and negative cycles must be dealt with because the injured partner cannot forget the attachment injury (Greenberg, Warwar, & Malcolm, 2010).
The goal of repairing an attachment injury is to make sense of the injury, deal with the accompanying emotions, forgive the offending partner, gain back trust, and start to move towards a secure attachment bond (Johnson, 2005). Partners must experience a softening, where each spouse can comfort and sooth each other and provide the antidote to hurt and pain caused from the injury. A secure attachment is based on the idea that you matter and are prized. Your spouse will protect you and be dependable (Johnson, 2005).
Hypersexual behaviour can create an attachment injury that must be dealt with specifically (Johnson, 2005). The attachment injury that occurs during this behaviour represents a violation of trust or abandonment at moment of deep need or vulnerability. For example, the partner of the individual with hypersexual behaviour took a risk by staying with addicted partner with the promise of working towards recovery. The partner placed themselves in a place of vulnerability and had a deep need for the addicted partner to gain recovery. If a relapse occurs trust can be severely damaged and the partner can even suffer from post-traumatic stress disorder. The partner re-remembers the trauma and enters into a belief that they will never be able to trust the offender again (Reid and Woolley, 2006).
Attachment injuries are addressed by heightening the emotions, framing attachment needs, shaping emotional engagement (Johnson, 2005). Johnson (2005) described the process that the therapist must employ in order to repair the attachment injury. A fictional example is provided to illustrate the steps of repairing an attachment injury caused by hypersexual behaviour (adapted from Reid & Woolley, 2006):
- The partner tells the story of the betrayal and how it affected them. The violator will brush aside their partners hurt emotions, experiences of the trauma, and become defensive. Mary describes her experience of learning of her husband, Joe’s, hypersexual behaviour, how it affected her, and how she reacted to it. She says she no longer trusts him and feels betrayed and angry. Joe becomes defensive and minimizes Mary’s experience stating that his behaviour is not that bad and Mary is overreacting.
- The therapist helps injured spouse stay with the injury and explore emotions more deeply. The connection of injury to present negative cycles becomes clear. Mary discusses, with the help of the therapist, how her anger actually stems from fear of being abandoned by her husband. She is also hurt from the betrayal of trust and feels like this problem will not be able to be fixed. The therapist may reframe Mary’s emotions as an attempt to show Joe that she loves him because if she didn’t she would be ambivalent in the situation.
- The violating partner beings to actually hear the injured partner, starts to understand the wounds, and how they contributed to the injuries. The violator expresses their own feelings about the event and acknowledges injured feelings/experiences. The violator describes their own experience so the injured partner can better understand why the injury occurred. Joe begins to understand that Mary’s pain stems from her love of him and her need and want of secure attachment to him. He begins to see that Mary is not personally attacking him, but rather his hypersexual behaviour. He opens up to Mary and describes how his behaviour started in childhood as a way to relieve anxiety.
- The injured partner gains a more articulated version of events and the narrative is made clear and becomes organized. The injured partner becomes vulnerable and expresses the softer feelings (loss, hurt) surrounding the event. Mary begins to sympathize with how Joe’s behaviour started and allows Joe to see her be vulnerable as she begins to understand how this new understanding of the trauma affects her.
- The violating partner becomes more emotionally engaged and takes responsibility for their part. Joe expresses empathy, regret, and remorse for his past hypersexual behaviours. He acknowledges how he has caused Mary to feel unsecure in their attachment.
- The injured partner looks for caring and comfort from the violator partner. Mary asks Joe to give her a hug. She states that she appreciated him sharing his past history with anxiety. She tells Joe that she needs him to be open and honest with her from now on, and that will help her feel more secure in their relationship.
- The violating partner responds and offers comfort and caring and acts as an antidote to the trauma event and attachment injury. This creates a new narrative of the injury for both partners and a new pattern of interaction has emerged. The injured partner is the able to forgive and move on. Joe lets Mary know that he is happy that she knows more about his past and now that it is in the open he feels more confident discussing his emotions with her. Joe also expresses his need to continue to use other coping strategies and requests that Mary support him in this. Joe comes to the realization that Mary can meet his needs and the attachment they share is a safe place.
Hypersexual behaviour is a relatively new concept that is missing a solid definition and research (Kaplan & Krueger, 2010). There is a significant lack of theoretically driven recommendation for how to treat individuals with hypersexual behaviours (Ford, Durtschi, & Franklin, 2012). It has many hurdles to overcome to be recognized as an actual disorder and not just a culturally created problem (Reud & Woolley, 2006). Therefore, a consensus of the problem, a definition and criterion for diagnosing hypersexual behaviour, and research into effective theoretical frameworks to treat this disorder must all take place.
Emotion Focused Therapy is empirically validated by the American Psychological Association and bridges the gap between practise and research (Johnson, 2003). It is integrative, respectful and humanistic in nature. EFT is effectively used with a wide variety of clients including gay partners, low SES, people with depression, and those suffering from post-traumatic stress disorder (Johnson, 2003). As a young therapy, EFT has room for growth. EFT interventions need to be refined and elaborated on, the application of EFT to depression and PTSD needs to continue to be researched, sequencing of events of repairing an attachment injury needs to be validated, and impasses need to be further defined and understood (Johnson, 2003).
Hypersexual behaviour can have a devastating impact on relationships and the attachments formed between partners (Reid & Woolley, 2006). Before a relationship suffering from a partner with hypersexual behaviour can enter into marital therapy, they should first attend therapy separately to deal with the addiction and co-addiction. EFT can then be used to assist the distressed couple to reframe their experiences and emotions into attachment theory and explore deeper, softer emotions. With the help of the therapist, this softening brings the couple closer to a secure attachment bond. Before a secure attachment can be formed, attachment injuries and ruptures must first be addressed using seven stages of EFT to assist in healing and moving on of the injured partner. Both hypersexual behaviour and EFT are newly emerging concepts which both require further definition, refinement, and research.
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