© On Good Authority, Inc.

BAD BOYS: SEXUAL OR ENTITLEMENT?

SHARON O’HARA, LMFT, C-SAT

Interviewed by Barbara Alexander, LCSW, BCD (Edited slightly for readability)

Sharon O’Hara, LMFT, C-SAT c/o Sexual Recovery Institute 914 S. Robertson Blvd. #200 Los Angeles, CA 90035 310-360-0041 ext. 5203 www.sharonohara.com Email: [email protected]

INTRODUCTION

Welcome to On Good Authority. I‘m Barbara Alexander. You are listening to or reading an interview on the subject of Sexual Addiction.

Truth is stranger than fiction. We‘ve seen a president get impeached after having—or not having –―sex‖ -- in the Oval Office with a young intern. We‘ve seen the best golfer in a generation become a broken man after the discovery of his outrageous infidelities. His now ex-wife wound up with $110 million dollars and he hasn‘t won a tournament since. Then there‘s the now ex- governor of New York, who spent tens of thousands of dollars on prostitutes, and incredibly, his wife reportedly said, ―The wife is supposed to take care of the sex. This is my failing. I wasn‘t adequate.‖

Shall I continue? I can‘t resist. The governor of California, who has a history of groping woman, was discovered to have had a now teen-aged child by his housekeeper. And two notorious European satyrs have been in the news: one, the elderly prime minister of Italy, is said to have flown prostitutes on his government paid airplane, among other outrageous behavior, and of course, there is the Former International Monetary Fund chief who was accused of attempted . And how can we ignore the Congressman who posted photos of a key part of his anatomy, and whose unfortunate surname is also the nickname of said body part. As they say, ―You can‘t make these things up!‖

Are these men of privilege and power whose and grandiosity backfired? A dream team of lechers? Or are they tortured souls, looking for love and connection in all the wrong places?

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Here to explain the differences between the two situations is Sharon O‘Hara, Clinical Director of the Sexual Recovery Institute in Los Angeles.

Sharon O‘Hara, M.A. is a licensed & Family Therapist with 17 years of experience working with sex addicts/offenders and their families, spouses, and partners. For the past ten years, Sharon has been providing specialized treatment for sexual addiction and sexual trauma in her private practice in San Pedro and Torrance and written a monthly Q & A column on Love & Sex for the addiction newspaper, Steps for Recovery.

Sharon is the former Program Director of the Sexual Dependency program at Del Amo Hospital in Torrance, California. Sharon utilizes trauma integrative work such as EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, and Emotional Freedom Technique, in her work with sex addicts and their spouses. Sharon has appeared on a number of television and radio programs discussing sexual addiction, with a special emphasis on the problems of female sex addicts and co-dependents of sex addicts.

Now to our interview.

ALEXANDER: Well, Sharon, this rash of powerful men behaving badly has been so interesting and has provided such fodder for the late night comedians. It‘s been quite a gift to them, but it‘s also a mystery to everybody else, and I wanted to talk to you about what could these people who have everything -- they have power, they have beautiful wives, they have money …

O‘HARA: They have intelligence and yes, money.

ALEXANDER: What in the world could they be thinking that would lead them down this ridiculous path of self-destruction?

O‘HARA: Well, I do think that there‘s a large measure of entitlement. It‘s what I call the capital E word, ―Entitlement,‖ and a fair amount of what goes with that is narcissistic traits at the very least, sometimes full blown narcissism. But there is this sense of entitlement that a lot of these men have that the rules of the normal society don‘t apply to them.

ALEXANDER: So therefore the risk-reward ratio also doesn‘t apply to them.

O‘HARA: Yes, it‘s sort of like ―I won‘t be caught,‖ or ―I‘m entitled,‖ and usually people have been, because of power, getting away with a lot for a long time because power is an aphrodisiac for a number of women or if you‘re an important person and you take some liberties, often you sort of have gotten away with it. I think there were some reports about Arnold Schwarzenegger, for example, in the past when he was running for governor, where there were some reports of him inappropriately touching some people and he was kind of like, ―Well I just did it joking,‖ and then his wife came out and really said ―My husband would never really do anything seriously bad,‖ essentially. That everybody believed her was my sense of what happened around then. So you know, a lot gets swept under the rug because most of the time these kinds of men are very charming, but they have a strong sense of entitlement, and there are

2 people who say there‘s a big head and a little head and they‘re not thinking with the big head, so I‘ve heard that.

(laughter)

But I know a reporter once said to me -- he used to laugh at me because I‘ve been working in sex addiction for 20 years, and 20 years ago he thought it was laughable, but when Clinton got into trouble he said, you know Clinton is a really intelligent man; how could this person have taken these risks with a 21 year old talkative intern, which does boggle the mind? I really do think it has to do with this idea that your brain kind of gets hijacked when you have addiction going on and you just become a more clever addict.

ALEXANDER: So you really think that this bad behavior, or this sense of entitlement in this arena, is a process addiction, it‘s a sexual addiction?

O‘HARA: Well I will say that when you first started talking about men in power particularly, ―taking advantage of‖ -- there‘s little predatory feelings over into what I would call more ―sexual offending‖ type behaviors, but sex addiction definitely has what many of the characteristics that would go into other . For example, sex addicts always describe this sense of, ―can‘t stop,‖ this very powerful driven quality, and so it is chronic and is escalating, in other words it‘s not just a phase. It doesn‘t go away over time on its own.

ALEXANDER: Is it this sex drive that is over powering, or is it the compulsion to act in a certain way?

O‘HARA: It‘s a desire for a certain sensation. Sex addiction is all about wanting to medicate. Fundamentally it‘s about trying to get the brain chemicals going that are medicating to the person. It‘s a drug addiction but you‘re addicted to the drugs that your own body manufactures through intense fantasy. Literally, they‘re doing studies on this now where they‘re seeing the brain light up in certain kinds of ways, and addicts‘ brains light up differently from other peoples. They‘re doing some research on this at --- what‘s that university in Tennessee?

ALEXANDER: Oh, Vanderbilt?

O‘HARA: Yes, and some other places where they‘re really discovering that the centers in addicts‘ brains tend to, when they do it --- somebody else might look at porno and it‘s just, ―Oh, porn, ok look at that, interesting, hahaha.‖ And then they turn to something else.

But much in the same that alcoholics report their first drink as being an elixir, like there‘s something magical about it, addicts, sex addicts have such a relationship particularly with their stimulating material -- I‘m just talking porn in general here -- but often people have very specific kinds that is the key in the lock for them. What happens is they have this intensity of sensation that then blocks out any other worries, anxieties and then they can stay at it almost like a monkey tapping on a bar in a cage, wanting to get that sensation over and over and over, that intensity sensation because it blocks out any kind of negative feelings. It‘s just that of course you tend to stay up all night, and it‘s affecting your work and your wife finds out that you‘re looking at

3 porno or maybe you‘re going to see prostitutes or in escort websites, etc., etc. and it‘s going to have a lot of negative impact over time.

But in the moment you‘re in it, you‘re like in a dissociated state. It‘s like a form of self- hypnosis, and literally there are powerful drugs released in your brain and you have the sense that ―I have to have this,‖ and ―I always need more exotic, or more intensity.‖ It‘s chronic and escalating, so to get the same high you tend to want a multiplicity of images and behaviors, although people also have their favorites.

Then there are withdrawal symptoms. When you stop, people get very cranky and have a lot of sleep problems, sometimes have to go on anti-depressants. In fact, working with anti- depressants -- some of the SSRIs are helpful with treating sex addiction but this whole thing of addiction having that ―can‘t stop sensation,‖ the chronic and escalating, the withdrawal symptoms -- all of these kinds of things that mark any addiction are present in sex addiction, as is true with, for example, compulsive gambling.

ALEXANDER: Well, with sex addiction, and you talk about withdrawal, the withdrawal is not from sexual activity with their mate necessarily, it‘s from the sexual activity with somebody strange.

O‘HARA: Yes. Almost all of them do a variety of activities and since the internet -- the internet has become the crack- of sex addiction because it‘s so easily available and there‘s such a multiplicity of images with just a click or two or five or twenty, or 2,000. I mean really, when you think about it, in the history of civilization, there has never been such a multiplicity of images to tap into . I mean really, in the history of civilization.

It‘s really amazing. You used to have to wait for a new month to get a magazine and you had to go out and buy it and often spend a fair amount of money just to get a few pictures and then sit with those or have that be your masturbatory fantasy or something like that and then wait for the next month. I mean really it‘s quite amazing when you think of tapping on that button inside the human brain with all these images that are now available on the internet, and then there‘s chatting and there‘s video to watch, so there‘s the visual stimulation as well as there can be interaction through the internet, as well as the video.

ALEXANDER: Well, you spoke of the person going into almost a dissociative state.

O‘HARA: They call it compartmentalizing. When the person is there, they‘re not thinking about their wife or kids. When you get into sex addiction, typically lots of times my clients will have a willing partner in their wife but they might prefer masturbating to the intensity of the computer and often the wife feels very much left out. Sometimes the man might say, ―Well you know, I‘m getting older these days.‖ Really he‘s worn out from the computer use.

Now on the other hand, some people mistakenly believe that men masturbate to computers because their wives won‘t give them any sex -- I‘ve seen that in advice columns and things like that. On occasion, you will find sex addicts who have married what I call, ―the perfect wife for a sex addict,‖ because sex addicts rarely marry sex addict women. Usually the perfect wife for a

4 sex addict would be somebody who wasn‘t particularly interested in sex, or was angry, or controlling, or anything like that, and many sex addicts report that their wives are like that. Sometimes I‘ve thought to myself that perhaps they have an inside addict who chose this wife so as to justify their various acting out behavior.

ALEXANDER: Well, if you think about a little child approaching a jar of candy and they know they‘re not supposed to take that candy, but they on one hand -- let‘s say a three year old, and they‘re saying, ―No, no, no, no, no, no,‖ while their hand is reaching into the bowl and taking the candy. That‘s a kind of splitting. Is that what you‘re talking about? In other words, is the sex addict saying, ―Well, I really shouldn‘t go see this prostitute, I really shouldn‘t go to this bar tonight, I really shouldn‘t,‖ at the same time that they‘re driving along to get there?

O‘HARA: Typically the ―No I shouldn‘t,‖ isn‘t even there so much. They‘re so wrapped up in the excitement of what‘s going to happen: ―I‘m going to have this sensation, I wonder who I‘ll see, I wonder who‘s there I can pick up, I think I‘ll do this with the prostitute,‖ Believe me, it‘s not even in there on their wave length that ―I shouldn‘t be doing this,‖ until afterwards, when it‘s, ―Oh my god, how am I going to cover this up? Where can I hide whatever money I spent?‖ -- the record of that, or anything else -- and it goes into ―How am I going to handle this or protect this or cover up my tracks?‖ The people who are into this -- their brain is hijacked.

Now once you get into recovery and you have a sponsor, you go to or some of the other programs for compulsive sexual behavior recovery – there are five of them just for the addict -- then you might have that kind of sense of, ―I shouldn‘t be doing this,‖ because you‘re going against your recovery program. Now you‘ve actually had some practice working a recovery program and maybe you flip a or something and then there‘s that voice in your head saying, ―Uh oh, you shouldn‘t be doing this.‖

ALEXANDER: Is there any thought about ---is there any empathy for the spouse? At any point are they thinking, ―Oh, she‘d really be so hurt if she knew I was doing this?‖

O‘HARA: Not during. See there‘s a whole cycle. There‘s the cycle starts with preoccupation and and so you‘re just kind of thinking in your head and then you start clicking deep into fantasy by going online. Sometimes people also smoke pot or do some other drug or drink , but many sex addicts don‘t have any alcohol or drug problems and they just start looking at their videos or clicking on their pictures or looking at their sexual emails and they‘re off to the races. They‘re just in this trance and that‘s all that‘s on their minds and so they‘re not thinking about their spouses. If anything, they‘d be thinking (the ones who do it on the internet), ―I‘m not actually physically being with the person so it‘s not really harming my wife.‖ That‘s the justification.

There are huge amount of denial, justification, and minimizing that go into all sex addiction and then the ones who are seeing prostitutes are saying, ―Well, I haven‘t fallen in love with somebody else, there are no emotions attached to this, so therefore, I‘m not really cheating on my wife,‖ or I‘m just getting a ―happy ending‖ to some kind of hand job type massage, or it‘s which, you know, even Clinton insisted was not real sex, or at least in the beginning he did. So you have all those kinds of ways of minimizing and justifying.

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ALEXANDER: And this seems to fill something. Would you say that this is kind of a deficit model in the sense of the behavior filling some kind of a void or giving a sense of wholeness? Is that also a factor?

O‘HARA: Yes, I‘m glad you said that because I do think that often addicts describe some sort of ―black hole‖ inside themselves that they‘re trying to fill but it never gets filled. Many of them come from a variety of dysfunctional family backgrounds. Most of them have at least somebody-- one or the other parent -- with some kind of addiction. Often their fathers were what used to be called ―womanizers‖, or one or the other has a problem with alcohol or gambling or drug use.

―Rigid and Disengaged‖ is the family system that is most common among sex addicts, where it was very strict, either religious or military. Then there often isn‘t a whole lot of appropriate affection in the home. They certainly aren‘t a witness to that between the parents and they often don‘t get a whole lot of that themselves, so they are really drawn to , which they usually discover at a very young age, typically 8-10. Then they start self-soothing. The whole thing about the fantasy and the starts at a very young age. Sex addiction is what you might call ―a perfect addiction‖ for children. It requires relatively few props and for some people for whom it‘s really self-soothing, their whole fantasy world gets sexualized and then that sets up kind of a pattern where you have certain neural-pathways that get very ingrained.

ALEXANDER: Now, you‘re not talking about a teenage boy who might masturbate three times a day?

O‘HARA: Well here‘s the thing: masturbation is universal and there isn‘t anything unhealthy about masturbation for teenage boys or girls. We‘re talking about the kind of thing where hours are spent on this activity, where the ability to be appropriately social just isn‘t there, where because of whatever was going on in the family or the chaos, you have young people who discover that their sexual rituals take on a power that‘s a lot greater than for other people who are just discovering their bodies and themselves and it feels good to masturbate. This becomes a true medicator for all your problems, a medication for all your problems.

See here‘s the thing about sex addicts: sex addicts medicate all feelings. For example, some people will say to me, ―Well gee, if you act out sexually because you‘re angry, okay, we‘ll just figure out a new way to deal with your anger.‖ But see, sex addicts act out sexually when their celebrating; they want to celebrate sexually. They act out. The number one reason they act out is boredom. Another one is anger or irritation, so they act out when they‘re happy, when they‘re sad, when they‘re lonely, when they‘re hungry -- any reason at all.

ALEXANDER: What about manic, if they‘re in a manic state?

O‘HARA: There are some people who, it‘s been reported in medical literature, will act out sexually when they‘re in a manic phase. So sex addiction is thought by many , ―Oh, they‘re all bipolar,‖ but they‘re not. A very small percentage of them are bipolar.

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They‘re looking at for the DSM 5R perhaps, so it‘s not in the Diagnostic and Statistical Manual that psychiatrists use, that all mental health services use as a matter of fact, but they‘re getting closer to that, especially with the advent of so much sexual, around the internet. So I do think there‘s been a shift over the last 10-15 years on the part of the medical community thinking that sex addiction may be a real addiction. They‘re putting it under ―Impulse Disorders,‖ and things like that, at least that‘s what they‘re leaning towards; that‘s my understanding.

ALEXANDER: Yes, well, neuroscience would also, as you were saying earlier, show that it‘s a disorder. I mean, it changes your brain.

O‘HARA: Yes, that‘s why they‘re listening a little bit more but the DSM moves slowly.

ALEXANDER: Yeah.

O‘HARA: But they‘ve been working on this for a while and I‘m just telling you it‘s still considered a controversial diagnosis. When you have people show up in your office over and over again and they‘re like, ―I don‘t care what it says in the DSM, or the insurance company, or my . I can‘t stop and I‘m doing things, I went over lines. I can‘t believe that I did that. I made promises to myself that I broke. I feel like I‘m going crazy.‖ I‘ve had people who were suicidal over their behaviors and we have to have them sign no self-harm contracts. Many of them do feel really guilty and bad about their spouses but their only solution is to lie more. I have never met a sex addict who isn‘t a compulsive liar.

ALEXANDER: So it‘s not, it‘s not really sociopathic or psychopathic behavior?

O‘HARA: Most sex addicts have a lot of guilt. It‘s a range of behavior. So yes, I would say once you kind of go towards sociopathy or psychopathy, I‘m not even sure I‘d necessarily put that into the ―Sex Addict‖ category; you might be more in Offender territory. There‘s an overlap, but to me, sex addicts really have a lot of shame and guilt. There‘s an identifiable cycle of preoccupation that leads to rituals that then lead to series of acting out behaviors.

Patrick Carnes identifies Level 1, Level 2, Level 3, according to societal consequences: Level 1 being having affairs, looking at porn on the internet, things you wouldn‘t go to jail for. Level 2 is where there‘s some offending behavior but usually the person isn‘t touched, like or exposing behaviors, some frottage -- that‘s when you rub up against somebody in a bus or something like that. And then Level 3 would be really offender behaviors where there‘s an imbalance of power. It would be child molesting, it would be rape, it would be therapist–client sex where there‘s a really vulnerable person and there‘s an imbalance of power -- a priest and their parishioner. All that would be Level 3.

But after the person acts out in this whole kind of addict cycle, then they go to despair, they go to grief and shame and despair and feel badly about themselves, and then they have all these efforts to control and they have these promises that they make to themselves or whatever, and then they feel so bad about themselves that the only thing that makes them feel better… is some sexual fantasy. And then it goes around and around in this cycle.

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ALEXANDER: I really understand now what you‘re saying about the difference between the powerful, ―entitled‖ sexual acter-outers, and the sex addict who is suffering in a certain way.

O‘HARA: And there can be overlap. Actually, let‘s take Tiger Woods. From what I‘ve seen -- trust me, I never was any kind of treatment provider for Tiger Woods, but just based on what I saw in the media, I do think that he had a lot of entitlement. There he was, very well known and all kinds of people are with him, etc., etc., so I do think he had a sense that rules were for other people and that there was a little complicity kind of idea that when in Vegas, ―What happens in Vegas stays in Vegas.‖

But it sure sounds to me that he also had the capacity, after he went to treatment, to feel guilty. What you do in treatment is you try to have them rediscover their capacity for empathy, and if the person has the ability to feel remorse and be confronted and look at the damage they‘ve caused, they can often recover from this. But the ones who don‘t have any guilt and shame don‘t recover from this.

ALEXANDER: Well let‘s talk now about rehab. You said in our earlier conversation that you thought that the Addictions Model was the best way to approach this?

O‘HARA: I do, I really do because of several reasons. First of all, I think if it walks like a duck, talks like a duck, might be a duck -- it fits all these addictive definitions. Secondly, what you do to handle, to treat addiction, which is you have to interact with other people who have similar problems. Sex addiction is often very isolating behavior because there‘s a lot of guilt and shame. Who wants to talk about your dark side and your secret sexual rituals you may be doing?

So when sex addicts go to groups like Sex Addicts Anonymous, , Sex and Love Addicts Anonymous, Sexual Recovery Anonymous, Sexual Compulsives Anonymous, just to name a few… and spouses by the way, there are spouse groups too like COSA – Co- Dependents of Sex Addicts, or ASANON -- it‘s a lot like ALANON is for spouses of alcoholics. See, sex addiction is always a disorder of secret keeping. When they start to tell their secrets and they are accepted by other people, and then they work a program of the Twelve Steps, which involve inventories, facing up to your behavior, making amends, doing inventories of your anger, your excuses, your minimizing, the consequences, making a list of all those, telling them to a sponsor or your therapist, or to your recovery group -- all of these things tend to take the charge off of the urges.

Plus you build people in your recovery group that you want to please: ―I have twelve days of recovery,‖ ―I got my 30 day chip,‖ and in that bonding, there is a whole new sense of moving into integrity and having a sense of authenticity. Not having to wait for the ax to fall every minute like, ―Oh, what if they find out and then what‘s going to happen? Often sex addicts find this ability to grow what I call ―Emotional Muscle,‖ and find new coping skills, particularly if their partners are also in recovery.

Often people do need to have what I call ―a treatment piece.‖ For example, here at the Sexual Recovery Institute, we do a ―Two Week Intensive‖ and people find that easier to handle financially and time-wise than these 4-6 week programs that are in hospitals. There are several

8 of those around the country. I think that they are very good programs and would recommend them but often they are $40,000 dollars and up. But the treatment piece, where they come from 9:30-5:00 in the afternoon all day long for two weeks seems to really increase the likelihood that the client starts to get a handle on things, experiences how the Twelve Step program works.

Also there‘s a lot of lectures on trauma, and , and taking inventory, and getting to know your own cycle, and how to handle your personal triggers, If a person can go to a treatment center, whether it‘s a hospital program or an intensive outpatient, that really increases the chances as much as you can go to AA to recover from alcohol problems, or you could go to rehab. And that generally jump-starts the recovery program for alcohol and drug addicts.

ALEXANDER: You know, this is making me think about a regular traditional, say, psychotherapy, in contrast, and it sort of makes me think that a traditional talk therapy might give a person more of an ability to rationalize or find excuses, rather than really change. I don‘t know if that‘s so.

O‘HARA: I will tell you this: I do suggest that anybody who wants to recover from a sexual addiction actually find somebody who has a history of working successfully with sex addicts. There is a training now where you can become a Certified Sex Addiction Therapist, called a C-SAT. There‘s a very intensive – you have to do 5 day modules and you have to do four of them plus a lot of supervision work to be trained. I myself was trained by Patrick Carnes originally, starting 20 years ago starting at Delamo Hospital in Torrance, California and I‘ve been working primarily with sex addicts and their partners for the last 20 years. I learned a lot from my clients.

ALEXANDER: Well, what is it like for a female therapist to be working with men with these problems?

O‘HARA: Well that‘s a really good question. It‘s interesting. I got into this because I was married to an addict and I, first of all, was really interested in addiction recovery, and then I heard um Patrick Carnes who really wrote the first book on sex addiction called, Out of the Shadows. Back in the 1980‘s he started giving workshops, and I thought, ―Oh my god, this is why everybody‘s relapsing with alcohol, drugs, and . It‘s their relationships and their compulsive sexual problems and their problems with sex and relationships – this is it!‖ And I immediately went for one of his weeklong trainings and then I found that they were just starting a treatment center in California and I applied and they said I had more training than anybody else, and so I got the job starting in early 1992. I just thought this is cutting edge, and I do still think that that‘s largely true, so I just thought it was really interesting and exciting and was going to be particularly useful for all these other addictive behaviors.

Then I discovered that I seemed to have some capacity to listen to what people have to say around really shameful behavior, and I seem to have some ability to be ―a container‖, and not have a strong reaction. I just seem to have that. I have therapist friends who say, ―I could never do that work‖, or ―How do you work with those sex addicts?‖

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Of course, I think there‘s so many sex addicts who aren‘t talking about it with their therapists because if they sense their therapist can‘t handle it, they won‘t go there, and there‘s a lot of unrecovered sex addicts who are showing up at alcohol and drug treatment centers, for example, but if you don‘t know what to do with it, you‘ll kind of just gloss over it. Meanwhile they keep relapsing because if you have a cocaine problem, but it‘s strongly connected -- if you get your cocaine from the prostitutes – you‘re driven to see the prostitutes; you can‘t stop one without getting a handle on the other. Just to name one example, crystal meth and sex is another one that is really joined at the hip, so to speak.

I‘ll tell you this – I used to work a lot with women with eating disorders and when I started specializing in sex addiction, most of the sex addicts were men, although there are some women sex addicts, in fact probably a lot more than we currently realize – but it gave me a sense of compassion for the pain that they were in. Once you could get below some of the entitlement or whatever, there‘s such a black hole inside of them. They‘re medicating for a reason and it‘s often connected to a lot of pain about dysfunctional families or a lot of unresolved trauma. Over 50 % of them have those kinds of issues.

So I found myself being in the interesting experience of having been a young woman in our culture thinking, ―Men get all the breaks and they can do anything they want,‖ to ―Oh my god, a lot of them are really hurting.‖ I found that when they actually started to find ways to lower their shame, set some appropriate boundaries, bond with other recovering people, they also got better fairly quickly. Real recovery takes 3-5 years generally speaking, but if you‘re working with for a chronic depressed client for example, you‘re not seeing them get better very quickly.

So just in terms or working with people who often have a fair amount of intelligence, the hardest thing is getting them to come into treatment in the first place. But once they‘re here, they‘re almost like sponges and really wanting to find some way to be. They just didn‘t think it was possible. They tell me that all the time: ―I just thought I was stuck like this. I didn‘t really think there was any recovery from this, ―I‘m just like this,‖ so I just looked for ways to cover it up.‖

ALEXANDER: What would you say would be the first thing you would want to accomplish, I mean once you get the person into treatment and you have established a relationship so the person knows you can listen to these thoughts and feelings? What would be the first thing that you would hope the person would be able to do?

O‘HARA: Well, first of all, like with any therapeutic experience, I want to work on the rapport and the therapeutic connection so that the person might start to feel that they could reveal some things, because as I said, there is a whole long history of lying and covering things up. People generally find me pretty easy to talk to and I can show them that there‘s very little that can shock me anymore because I‘ve been doing this for 20 years. If you‘re an addict, you‘re looking for somebody that you feel there‘s some good rapport with and that they‘re not being judgmental with what you‘re talking to them about.

And by the way, before I go into the next thing, I want to say that I think there‘s a huge difference between a Sex Addiction Therapist and a Sex Therapist. Sex therapists are trained mostly to help people who have loss of desire, or they can‘t get it up, or they have some sexual

10 dysfunction along those lines. There is no such thing as ―sex addiction‖ in the training for . In fact, for example, looking at porno is often prescribed as a way to increase your sense of eroticism; there is no idea that there could be too much masturbation or too much porn. It‘s a really different world view.

ALEXANDER: That‘s an excellent, excellent point.

O‘HARA: Yes, I always have to tell people that, even insurance companies. I‘ll say, ―Do you have any Sex Addiction Therapists that we can send this client to?‖ and they‘ll all say, ―Oh yeah, we have lots of sex therapists,‖ and I‘ll go ―Uh oh, they don‘t know the difference.‖ No matter how much I try to educate them they have, ―No, no, that can be handled by a sex therapist,‖ but that‘s not often the case.

So in terms of somebody coming in, what I usually like to do with them is hear their story and then they can tell that I haven‘t fainted. Also, I‘m a little older than some of the folks who are out there so I would say that I‘m not too scary for a lot of the sex addicts. Sometimes I‘ve had interns here who are rather young and attractive and a couple of them have gotten tired of treating sex addicts pretty quickly because they do tend to sexualize you. So I always am very nonchalant if anybody does anything like that: ―Thank you for telling me, I really appreciate that. That‘s called ‗telling the truth and telling it faster.‘ There of course isn‘t going to be any sexual behavior in this room and I care much more about you than to be able to let anything like that happen, because I‘m much more interested in you being able to grow and to be the kind of person that is somebody you can stand to live with.‖ So I say things like that.

ALEXANDER: That‘s terrific, that‘s really good.

O‘HARA: Then, what happens is I start to have them do behavioral inventories of several hundred questions. I work with them on timelines to try to get a sense of the history of their behaviors since mostly they‘ve put it out of their mind. They always minimize when they first come in. So there‘s a thing called a ―Sexual Dependency Inventory.‖ You can even do it online, and there are printouts showing you categories of sex addiction and the strength of certain kinds of behaviors and how strongly addicted a person is by how many things they‘ve marked, for example, and we‘ll maybe go over them.

I‘m also looking for what‘s the motivation of the client. In other words, many of my clients are what you might call, ―Wife Referred,‖ and so, are they here only to please, to get their wife off their back? And ―How can I get away with doing the least amount so I can just say, ‗Oh yeah, I went to therapy,‘‖ Or, does this person say, ―You know I‘m just so tired of this.‖

Usually what happens is people got caught at something: the wife found the numbers or they saw something on the internet or something in the billing or something like that. Then there‘s a big blow up and the wife feels hurt and threatens divorce and then the guy comes in. That‘s a typical scenario. So I‘m okay if you‘re wife referred but I always want to work with them to move towards -- it won‘t be successful unless I can, over some time, move them towards wanting to do it themselves. So that‘s a process.

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I try to work with them on recognizing their denial, their minimizing, their justifying, and claiming their behavior. If possible, I do think it‘s really useful to do at least the Two Week Intensive. I think it jumps them 6 months to a year ahead of everybody else who‘s trying to be in recovery and builds up their support networks. I just don‘t think recovery from sex addiction is something you can do all by yourself, or even just one on one with a therapist; it takes a long time. If you didn‘t go to Twelve Step programs, it‘s just about as difficult as trying to recover from alcohol or drug addictions without going to AA, for example.

Then you also want to also get to their family dynamics and work on their trauma issues because you want to help rebuild them from the inside out, have them feel better about themselves. Then the urge lessens.

ALEXANDER: Why are there trauma issues? Where does trauma come in?

O‘HARA: Well, their trauma issues -- they either don‘t think there is something wrong with them or they have a feeling or belief about women: ―The ones that I like, they wouldn‘t like me,‖ or ―Women are always controlling and they‘re going to own me so I better just go and see these prostitutes or these women on the internet because then I can have the kind of intensity or the feeling I want. I can be in control and I have perfect sexual equipment and I can do all these strange things that I want to do and nobody can tell me I shouldn‘t.‖ Then it feels very liberating and freeing and intense, except that it takes over your life and it causes you negative consequences and there‘s no freedom in it at all, but you have to work with people to have them get to where there‘s some negative consequences. I mean the true addict is somebody who does a compulsive behavior where there are negative consequences and you can‘t stop despite the negative consequences. That‘s the primary working definition for any kind of addict.

So, many of them have these trauma issues and that feeds either their low self-esteem or their need to constantly self-soothe because they have post-traumatic symptoms: startle reactions, trust issues, scanning the environment, not being able to feel their feelings.

ALEXANDER: So you‘re not suggesting some sort of in their childhood?

O‘HARA: Often, often.

ALEXANDER: Often, oh?

O‘HARA: Yeah, over 50% have sexual abuse in their childhood. Patrick Carnes did a survey some years ago and it was 80%. With women sex addicts, it‘s virtually got to be 99%. I personally have never treated a female sex addict who was not sexually abused as a child.

ALEXANDER: I want to go to another subject because we had talked some before about EMDR, and how that‘s helpful.

O‘HARA: Okay. EMDR is Eye Movement Desensitization and Reprocessing. It‘s a trauma recovery method that was invented by a , Francine Shapiro, back in the 1980‘s and it‘s kind of a power tool in trauma recovery. It involves bilateral stimulation, either

12 tapping alternately on the knees or hearing sounds alternately in your ears, beep beep beep, either ear, or having your eyes go back and forth. Originally Francine Shapiro would wave her hand back and forth in front of the person‘s face and have their eyes go back and forth. There‘s something about the bilateral stimulation -- right left right left -- that accelerates information processing and helps the trauma to be more integrated, so it will lower or stop the symptoms that the traumatized person has. She had video and many examples of this and I took this training. I also did another three year training in something called ―Somatic Experiencing,‖ which is another trauma treatment which I think is a little more gentle, so I like to use Somatic Experiencing and EMDR combined in trying to help my clients with these trauma issues, because I do believe if you have a lot of unresolved trauma, it‘s much harder to deal with your ongoing addiction recovery.

I try to help clients set boundaries and go to their meetings and do all the kinds of things that you do in any kind of AA program, very similar things in an SAA program. Often the unresolved trauma causes them to blow up, for example, in anger, and then they march out and go act out sexually, and or in some other kind of way where they have emotional reactivity that‘s often connected to early trauma. It can really trigger sexually acting out episodes.

ALEXANDER: Well, in the few minutes we have left, Sharon, this has just been so informative. What would you have to say to your everyday therapist about work with this population?

O‘HARA: Okay. What I would say to the everyday therapist is that it‘s really a good idea to read Out of the Shadows, at a minimum, and for spouses, there‘s a book called, Mending a Shattered Heart, that I particularly like, written by Patrick Carnes‘s daughter, who is a therapist herself, Stephanie Carnes. Out of the Shadows is Patrick Carnes.

There are workbooks you could use to educate yourself to be able to be open to the idea of recognizing sex addiction in your clients. There is something called the Sexual Addiction Screening Test, SAST, and there is a revised edition. That‘s kind of like the Twenty Questions of AA, and it‘s useful to ask your clients about these questions because they won‘t bring it up if you aren‘t willing to ask.

Then refer them for something, at least for some kind of intensive work as you‘re educating yourself in how to work with them or with the coupleship in terms of getting them back on track. Many therapists who aren‘t trained in sex addiction have used me, for example, or some of my peers as consultants to their therapy.

I would say to other therapists that you might want to see if you could consult with, get supervision from a sex addiction trained therapist like a C-SAT for example, because it really is a specialty and I just don‘t think you can just ―Oh, now I‘m treating sex addicts,‖ when you haven‘t really had any training in it.

I will tell you also that working in sex addiction brings up all of your unresolved personal issues.

ALEXANDER: I bet it does.

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SHARON: As a therapist, if you have any unresolved personal issues, this work will bring them up. I think that‘s probably true for most addictions but I think when it comes to sex addiction, that‘s very powerful. And you know, the first time clients sit in front of you and they‘re crying or they‘re this or that but then they tell you about how they‘re looking at child porn, I mean you can definitely have a feeling about that.

So I do think that it‘s good for all therapists to understand the limits of their expertise and at the very least, to call in some consultation and to get themselves educated, at least enough that they‘ve read a couple of books, some of the ones like by Patrick Carnes that can help them to at least be able to recognize sex addiction.

I would always tell people to ask if anybody has compulsive gambling, compulsive eating, compulsive alcohol or drugs -- I would be asking the questions about possible sex addiction.

ALEXANDER: Oh that‘s very important, not just to forget about that but make sure that‘s a part of your initial assessment.

O‘HARA: Yes, yes.

ALEXANDER: Very good. Sharon, this has just been terrific and I very much appreciate your time and your great energy and enthusiasm.

O‘HARA: Yes. Let me just say that where I‘m working now at the Sexual Recovery Institute, there is a website, www.sexualrecovery.com, and there are some tests that you could use for sex addiction tests, like, ―Am I an addict?‖ There‘s like 20 some questions, one for men and one for women, so go online and look them up and that might be a place for people to start.

ALEXANDER: The internet has a lot to offer, both good and bad, I guess. Thank you again.

O‘HARA: Thank you so much for asking me.

ALEXANDER: It‘s a pleasure, really a pleasure. Bye, bye.

This concludes our interview with Sharon O‘Hara. We hope you learned from it and that you enjoyed it. You may contact Sharon O‘Hara at the Sexual Recovery Institute, 310-360-0041 ext. 5203.

I need to say here that the views expressed by our speakers are theirs alone and do not necessarily reflect the views of On Good Authority.

Until next time, this is Barbara Alexander. Thank you for listening.

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