Book Review: Sex Addiction As Affect Dysregulation

I have been in the addiction field for decades now and can say that defining what an addiction is has been a constant issue in the profession. Recognizing addiction can be very intuitive and people often feel like they know it when they see it, but coming to a universal agreement as to just how to define it is almost impossible.

Alexandra Katehakis does one of the best jobs I have seen of describing what addiction is, how it comes to be, and how to work with an addicted person. Her holistic approach is called the Psychobiological Approach to Sex Addiction Treatment, or PASAT. Katehakis is a licensed marriage and family therapist, a certified sex addiction therapist/supervisor, and a certified sex therapist/supervisor.  She is the founder and clinical director of the Center for Healthy Sex in Los Angeles. She has authored other books and articles on sexual addiction, provided a wealth of workshops, and is on the faculty of several organizations and treatment facilities. She brings an enormous amount of knowledge, wisdom, and experience to this work.

Katehakis draws from attachment theory, trauma, neuroscience, emotional regulation and more. She draws on the work of Porges, Schore, Seigel, Carnes, and many others. The depth of her knowledge, research and her ability to draw it altogether into a coherent, logical, and understandable theory with practical applications is amazing. She also talks about trauma in her own life, and in the lives of her family. Trauma affects the individual, and also the children and subsequent generations through our stories (even if untold but acted upon) and epigenetics.

Katehakis shares her work with clients, including her sessions. She is courageous in her sharing. She includes learning experiences with transference and counter transference. She listens to her own body in therapy and that helps guide the way in what she calls right brain to right brain communication. She listens for meaning without making assumptions. I appreciate that she shares not only what works, but times when the outcome was not what she hoped for. She writes with both wisdom and courage, two qualities which she brings to her work as a therapist.

Katehakis also addresses the current culture with the ready availability of Internet porn, and likens Big Porn to Big Tobacco and Big Gun, with its enormous profits and its rather perverse use of the Constitution to protect profits despite “evidence of devastating harm particularly to youngsters.” She has ideas on how to address this using a model similar to that of second hand smoke. She advocates “wise and workable policies [which] support adults’ and children’s relational and sexual health by valuing connection and self-confidence over competition and self-criticism.” She devotes an entire chapter to cultural factors, including the rise of narcissism, addiction, sexual stereotyping, sexualization, the prescribed roles of gender, and “the falsity of commodified, competitive, shame-based sexuality” and “its damaging effects of relentless, soul-crushing self-critique and relational chaos.” So much is sexualized these days that with the sex addicts I work with, triggers can lurk everywhere, even presidential campaigns.

I appreciate how she explains the system of addiction — any addiction, whether chemical or actions such as shopping, gambling, sex, etc. — the etiology of the addiction, and how individuals come to rely on the addiction as a means of self-soothing and emotional regulation in an escalating feedback loop of pain mitigation and its consequences. She then goes on to explain how to diagnose and work with the person using a combination of CBT, psychodynamic therapy, twelve-step programs, clinical intuition, and an empathetic relational way of being with a client that helps the person on their journey to establishing a healthy trusting attachment, perhaps for the first time in their lives. She provides treatment guidelines for use throughout therapy and includes teaching self-compassion and addressing your own shame issues as a therapist. She also acknowledges that the DSM does not recognize sexual addiction (among other behavioral addictions) and helps to look at possible diagnoses for use with clients, since payment for services requires a diagnosis.

The Guide to Abbreviations is very useful for keeping track of which parts of the brain Katehakis is referring to. The appendix has many resources useful as a quick reference when evaluating an individual for addiction, includes a listing of support group organizations, PASAT goals and recommendations, and much more. She addresses both sexual addiction and love addiction, which is very useful. Her website has love and sex addiction questionnaires for people who are questioning whether they are addicts. If you want to further your knowledge in this area, she also has a list of suggested readings.

I think Katehakis’ book is one of the best I have read in the addiction field in quite some time, and I highly recommend it to anyone with an interest in or whose life has been touched by addictions, and that includes just about everyone to some degree.

Sex Addiction As Affect Dysregulation: A Neurobiologically Informed Holistic Treatment
W. W. Norton & Company, September 2016
Hardcover, 416 pages
$42.50