Sex Addiction, the Twelve Steps, and Therapy (Summary)

Summary of the chapter written by Timothy D. Stein, MFT and Patrick Carnes, Ph.D. published in The Routledge International Handbook of Sex Addiction.
April 19, 2018

Rex had consistently avoided 12 step meetings. When he reluctantly walked into the room for the first time, he found a room of men who shared his struggle. He listened to readings, hearing numerous phrases that described his pain, his fear, and his situation. He heard men share their experiences while others nodded their heads with understanding and support. He realized that no one at the meeting was interested in who he was outside of the room. No one was interested in “outing” him or his behaviors. Instead, they were focused on changing their lives and helping others do the same.

During the meeting, Rex mustered up the courage to share about his struggle with pornography and masturbation. He talked about his desire for things to be different. He talked about how he had tried to “control” and “manage” his life unsuccessfully. And then, when he started to talk about his wife and kids and the impact his behavior had on them, the walls came down. Tears streamed down his face. His voice cracked. His words came out in choppy and difficult to understand bursts. He dropped into the pain he had been avoiding for so long. The façade he had unconsciously created decades earlier, to show the world a strong, capable, successful, handsome, “got his shit together” image of a man, cracked.

The men in the room created a safe place and allowed Rex to be vulnerable. They became his community; the community that helped him stop isolating and open up to a solution larger than himself.

Rex’s therapist took advantage of the acceptance Rex began to feel in his new community by integrating the principles of the 12 steps as a way to create traction in Rex’s therapy. She supported Rex’s 12 step work and used it as a springboard into the deeper issues and patterns in his life. She was able to intertwine the work done in therapy sessions with the 12 step work Rex was doing in the recovery community, and this intermingled process of recovery became a gestalt, a process for change larger than the sum of its parts.

The steps do not focus on stopping the problematic behavior. Instead, the message embodied in the 12 steps is that by focusing on something larger than yourself and trusting something larger than yourself, change and healing can happen. In fact, the only step that mentions the behavior is step one, and then only to admit powerlessness over it. Steps 2 through 12 do not mention the addictive behavior or even an attempt to stop or change the behavior. Instead, those steps focus on spirituality; they guide addicts into connecting with their Higher Power and allowing that Higher Power to heal them.

Because of this, the 12 steps are often referred to as a spiritual solution to a behavioral problem. Carl Jung, the well-known psychiatrist, influenced this idea. In correspondence with one of the co-founders of AA, Bill W, he suggested that an alcoholic’s “craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God” (Jung, 2001).

Critics sometimes cite a low percentage of consistent sobriety by members of 12 step groups as evidence that they are ineffective. However, research that culminated in the book “Don’t Call It Love” (Carnes, 1991) shows that the 12 step process is a significant piece of the long-term sobriety puzzle. According to this research, sex addicts who have the most success with sobriety have a number of factors in common, three of which are:

  • They worked with a primary therapist
  • They were involved in group therapy
  • They attended 12 step meetings.

More recent research also supports the 12 step model of treatment. Hartman et al. (2012) tell us that sex addicts in residential treatment who also participate in 12 step programs show improved sexual impulse control and self-reported quality of life at six months follow up. Plus, they are more likely to attend aftercare. While there currently is a paucity of research in this area, these studies show that incorporating the 12 steps as an adjunct to therapy can lead toward positive client outcomes.

In the 1970’s, problematic sexual behavior was hitting a saturation point, and 12 step organizations addressing this issue started to spring up. Currently active “S” programs include Sex and Love Addicts Anonymous (SLAA), Sex Addicts Anonymous (SAA), Sexaholics Anonymous (SA), Sexual Compulsives Anonymous (SCA), and Sexual Recovery Anonymous (SRA). These programs have adapted the 12 steps of Alcoholics Anonymous so they can address problematic sexual behavior rather than alcoholism.

Step work and therapy are both powerful processes. Rob Weiss, a noted sex addiction expert, has said, “The 12 steps are where I grew up. Therapy is where I went to school” (Weiss, 2012). With an understanding of the 12 steps, weaving 12 step ideas into therapy is only limited by the therapist’s willingness to discuss these concepts and their creativity.

In chapter 4.4 Sex Addiction, the Twelve Steps, and Therapy of the Routledge International Handbook of Sex Addiction we highlight a variety of ways step work can be integrated into therapy.  We also discuss significant milestones that sex addicts in recovery will face during their step work and explain how therapists’ awareness of these milestones can be beneficial to their clients’ recovery and work in therapy.