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Erapists Must Be More Skilled and Adept at Identifying When The University of Alberta Can Psychologists Identify When the Problem is Cybersex Addiction?: An Exploratory Study by Easter Samir Yassa A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Counselling Psychology Department of Educational Psychology ©Easter Yassa Spring 2014 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission. CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Dedication I dedicate this research study to all individuals with cybersex addiction who have searched unsuccessfully for a clinician who can truly understand and help them. I hope this study goes a little way towards increasing the odds of finding one. CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Abstract Clients with cybersex addiction (CSA) are a growing challenge for mental health practitioners. Therapists must be more skilled and adept at identifying when the core issue is cybersex addiction in spite of client denial and potentially confounding symptoms. The main purpose of this exploratory research was to determine whether psychologists can identify when the presenting problem is cybersex addiction among non-disclosing clients. A pilot was conducted with 10 doctoral-level graduate students in psychology and three Expert Validators to evaluate the construct validity and internal reliability of the Client Vignette Scoring Instrument (CVSI) created for this study. The CVSI provided participants with three fictional case vignettes which each incorporated a specific number of CSA criteria. The case of “Jeff” included no CSA symptoms, “Sophie” included the minimum required for diagnosis, and “Bill” included the maximum. Psychologists were then recruited via the CPA and the PAA online and by mail, resulting in a final sample of 93 participants. Three surveys were administered: the CVSI, a Modified Sexual Opinion Survey-Revised (SOS-R-M), and a demographic survey. Alpha was set at .10. Results of a chi-square test for goodness of fit indicated that a significant proportion of psychologists missed correctly identifying CSA as the primary presenting problem in the case of both Sophie and Bill, but correctly avoided identifying CSA as the primary presenting problem in the case of Jeff. Results of a multiple linear regression found no significant predictive model in any of the three cases for the IVs age, number of years in practice, Internet familiarity, sexual attitude and amount of training in CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? CSA/SA on the outcome variable perception of CSA symptoms. Neither age, sexual attitude, gender, nor province of registration had a significant effect on perception of CSA symptoms in any of the cases. Doctoral level psychologists had significantly lower scores on the outcome variable than Master's level in all cases. Implications of the findings are discussed. CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Acknowledgement In so much as it takes a village to raise a child, and in so much as the experience of writing a dissertation is like birthing a child into the world, it takes a village to help birth a dissertation. There are so many people to thank for helping me complete this part of my Ph.D. requirements. I want to thank Gretchen Hess, who was in the role of my supervisor up until my candidacy and challenged me to write with clarity and concision. George Buck, my supervisor from candidacy till the completion of this document, has been encouraging, respectful, supportive and kind and for his understanding I owe him a great deal of thanks. The rest of my committee members – Dr. William Whelton, Dr. Shaniff Esmail, Dr. Sophie Yohani, Dr. Jim Eliuk, and Dr. Maryanne Doherty-Poirier – I thank you for your thoroughness in reviewing my research and your patience as I worked through what was a tremendous undertaking for me. To Dr. Derek Truscott, my gratitude for taking the time to consult with me as I tried to make sense of my findings. I want to thank Mary Roduta Roberts for her patience and calmness in the face of my myriad of emails and phone calls about yet another statistical question. You always explained clearly and kindly and I always felt a little smarter after talking to you. To my dear, dear friend and colleague Sherry Antonnucci I extend the warmest thanks for the many kindnesses and the gentle way with which you nudged and encouraged me and told me you had faith in me when I really thought I couldn’t write or read one more sentence. To my parents and my whole family, I thank you for your endurance as I plowed through foreign sounding doctoral requirements and avoided your inquiries into when I would be done. To my sister CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Eanas, my sincerest thanks for your support through the roughest parts of this journey. To my husband, Chris, I thank you for hours of listening to me talk about statistics and for your encouragement and belief in me that I could indeed “get it done.” This process has, just like raising a child, changed me, and I am grateful. CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Table of Contents Chapter 1 – Introduction................................................................................. 1 Problem..................................................................................................... 3 Purpose...................................................................................................... 5 Overview of Study and Research Questions............................................. 6 Definitions................................................................................................. 9 Chapter 2 - Literature Review........................................................................ 14 Sexuality.................................................................................................... 14 Sexual Attitudes........................................................................................ 20 Sexual attitudes to erotica................................................................... 22 Correlations with sexual attitudes....................................................... 23 Sexual attitude and gender............................................................ 25 Sexual attitude, age and socioeconomic status............................. 26 Cybersex Addiction................................................................................... 27 What is cybersex?............................................................................... 27 Pathological or adaptive?.................................................................... 28 What is Cybersex Addiction?............................................................. 30 The biopsychosocial model........................................................... 31 Previous findings........................................................................... 36 The cycle of Cybersex Addiction.................................................. 38 The four stages of Cybersex Addiction......................................... 39 Three types of cybersex users....................................................... 40 The Triple-A Engine of cybersex.................................................. 42 Levels of problematic sexual behaviour....................................... 43 Telltale signs................................................................................. 44 Naming and categorization................................................................. 44 Addiction, compulsivity or impulsivity?...................................... 45 Internet Addiction or Sex Addiction?........................................... 48 A note about Hypersexual Disorder.............................................. 50 Differential diagnosis.................................................................... 54 Treatment............................................................................................ 54 Challenges..................................................................................... 56 CAN PSYCHOLOGISTS IDENTIFY CYBERSEX ADDICTION? Putting It All Together.............................................................................. 60 Chapter 3 – Phase I: Creation and Pilot of the Client Vignette Scoring Instrument (CVSI)........................................................................................... 63 The Client Vignette Scoring Instrument (CVSI)...................................... 63 The Purpose of the CVSI.................................................................... 63 The Need for the CVSI....................................................................... 63 Client Vignette Scoring Instrument - Version 1 (CVSI-V1)............. 64 Structure........................................................................................ 64 Cases......................................................................................
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