Download Internet Pornogrophy Addition – Family Court Lecture

Internet Pornography Addiction
Family Court, August 20, 2009
Mark Schwartz, Sc.D.
Castlewood Treatment Center for Eating Disorders
800 Holland Road
636-386-6611
www.castlewoodtc.com
1
ALEKSANDER I. SOLZHENITSYN
If there were evil people somewhere insidiously
committing evil deeds, and it were necessary
only to separate them from the rest of us and
destroy them. But, the line dividing good and
evil cuts through the heart of every human
being, and who is willing to destroy a piece of his
own heart?
-Gulag Archipelago
2
3
COMPULSIONS (LARKIN & WHITING, 1991)
“Compulsions serve as clues to the deeper stories of
our lives, and individual’s history of emotional
woundedness.”
A compulsion covers up an interior emptiness. It
indicates the presence of a control mechanism – a
way of escaping something that is ultimately
unescapable and unavoidable.
Compulsions represent attempts to compensate for
low self-esteem and powerlessness.
4
DEPENDENCE
Addict comes to require, need or lean on
behavior for maintenance of normal functioning.
Tolerance refers to the body adapting to certain
effects of the drug.
5
REPETITION
Nevertheless, the need to repeat also has a positive side. Repetition is the
language used by a child who has remained dumb, his only means of
expressing himself. A dumb child needs a particularly empathic partner if he is
to be understood at all. Speech, on the other hand, is often used less to
express genuine feelings and thoughts than to hide, veil or deny them and,
thus, to express the false self. And so, there often are long periods in our work
with our patients during which we are dependent on their compulsion to
repeat – for this repetition is then the only manifestation of their true self.
-Alice Miller
6
SEX OFFENDERS ASCRIBING TO PAST TRAUMA
BARNARD, HENKINS & ROBBINS (1993)
Child Sexual Abuse
30
71.0%
Physical Assault
20
58.0%
Serious Accident
16
31.0%
Other Trauma
15
29.0%
Rape
9
17.0%
Military Combat
4
7.6%
Natural Disaster
1
1.9%
At Least One of the Above
40
97.0%
7
ETHNIC DISORDER


The disorder is a final common pathway for the expression
of a wide variety of idiosyncratic personal problems and
psychological distress; people who develop the disorder
can range from mildly to severely disturbed.
They utilize these cultural preoccupations as defenses that
enable them to escape from – and achieve some sense of
control over – unmanageable personal distress, most of
which revolves around issues of identity. Again, similar to
hysteria, anorexia and bulimia are socially patterned, the
fashionable style of achieving specialness through
deviance.
8
TREATMENT OF ED PREMISES PHILOSOPHICALLY

Different developmental trajectories

Symptom has developed as a survival strategy

Symptom is logical, rational and adaptive

Symptom remission is dependent on
understanding the logical development and
allowing for a more optimal solution.
9
FUNCTIONS OF EATING DISORDER SYMPTOMS

Substitute for life itself, safeguards against anxiety

Modulates anxiety, needs states, self-esteem

Sympathetic problem to mask the truth

Maintaining her false self, object self, making her real needs with
relationships with real people

Express her needs (power autonomy, comfort, soothing, recognition
connection)

Recognize control of disavow needs

Medium for relational needs
10
WEB - GENERAL
The number of people in the Unites States who use the World Wide
Web is estimated at 158.3 million, averaging six accesses per week, six
sites per visit, and spending an average of three hours and 22 minutes
per week online (Nielsen-Net Ratings, 2001). This translates into over
half of all American households and reflects a trend that grew by 58%
over a 20-month period (Department of Commerce, 2000). The
amount of information and opportunities is overwhelming, with an
estimated one billion unique web pages available in January, 2000
(Inktomi, 2000).
11
CYBERSEX




As of January 1999, there were 19,542,710 total unique
visitors/month on the top five pay porn websites, and
there were 98,527,275 total unique visitors/month on the
top five free porn websites.
In November 1999, Nielsen Net Ratings figures showed
12.5M surfers visited porn sites in September from their
homes, a 140% rise in traffic in just six months.
Nearly 17% of internet users have problems with using sex
on the net.
Severe problems with sex on the net exists for 1% of
Internet users, and 40% of these extreme cases are
women.
12
CYBERSEX, CONT.





Most e-porn traffic, about 70% occurs weekdays between
9 am and 5pm.
There are 100,000 websites dedicated to selling sex in
some way; this does not include chat rooms, e-mail or
other forms of sexual contact on the web.
About 200 sex-related websites are added each day.
Sex on the internet constitutes the third largest economic
sector on the Web (software and computers rank first and
second), generating $1 billion annually.
The greatest technological innovations on the Web were
developed by the sex industry (video streaming is one
example).
13
OVER CONTROL; OUT OF CONTROL


Some acting-in individuals will instead develop realistic
perfectionist righteousness and will channel their rage into
taking care of others. They have such a great sense of
neediness, which simultaneously evokes terror of allowing
someone close enough to meet their needs, that they solve the
dilemma by projecting their needs onto others and finding
helpless children to take care of compulsively.
Acting out individuals may move against and exploit self and
others, directly or indirectly. Often, they will physically abuse
children or neglect them, often alternating with smothering
them. They will find themselves in frequent power struggles,
insidiously directing their anger at several of their enemies,
while simultaneously feeling like the victim.
14
TEA ROOMS
Humphreys called public restrooms “sexual
marketing places” or “tea rooms.” A primary feature
of their attraction was the risk-taking nature of
sexual interactions there – the aphrodisiacal effect
of danger. The “tea room” is not an encounter, it is a
game, an adrenaline evoking adventure.
 The other motivating forces identified were:
availability, invisibility, variety and impersonality of
the “tea room” format.

15
THE NEW TEA ROOM












Curiosity explorers
Paraphiliacs
Liaison seekers
Illicit – doing something not supposed to do
Obsessing (compulsive-bind anxiety)
Bi-sexuals looking to trick
Singles looking for a partner, courtship and shyness
Re-enactment of unfinished business
Somebody wants you
Get back to your partner
Escape from boredom vs. Russian Roulette
Be young and foolish again
16
CHARACTERISTICS OF CYBERSEX ABUSE PATIENTS
Characteristic
Male
N
Percent
Female N
Percent
Total N
Percent
Married/Committed
11
57.9
2
57.2
23
57.5
Divorced
17.5
3
15.8
4
19.0
Separated
3
15.8
0
00.00
3
07.5
Single
2
10.5
5
23.8
7
17.5
19
100.0
21
100.0
40
100.0
White Collar
10
52.6
9
42.8
19
47.5
Blue Collar
5
26.3
3
14.3
8
20.0
Homemaker
0
00.0
1
04.8
1
02.5
10.5
5
23.8
7
17.5
1
05.3
1
04.8
2
05.0
07.5
1
05.3
2
09.5
72.5
Sexual abuse
11
57.9
16
76.2
27
67.5
PTSD diagnosis
6
31.6
11
52.4
17
42.5
Affective disorder
13
68.4
16
76.2
29
72.5
Chemical dep. b
14
73.7
9
42.9
23
57.5
Eating disorder c
5
26.3
14
66.7
19
47.5
Sexual addiction
17
89.5
11
52.4
28
70.0
Marital Status
7
Employment Status
Student
2
Unemployed
Disabled
Psychiatric Status a
Addiction status a
17
LIFETIME PREVALENCE OF MENTAL DISORDERS IN PERSONS WITH
COMPULSIVE SEXUAL BEHAVIOR (CSB) AND IN NORMATIVE SAMPLES (NCS)
Disorders
Black et al
Persons with CSB %
Kafka & Prentky
Normative Samples %
Total N
Percent
Mood Disorder
Major Depression
39
62
6
17
Mania
14
0
1
1
Panic Disorder
14
8
2
4
OCD
14
12
2
-----
GAD
14
12
-----
5
Phobic Disorder
42
46
9
-----
Alcohol Abuse/Dependence
58
38
16
24
Drug Abuse/Dependence
33
29
6
12
Anorexia
0
-----
<1
-----
Bulimia
11
-----
-----
-----
Schizophrenia
11
0
1
1
Somatization
11
-----
<1
-----
Pathological Gambling
6
0
-----
-----
Anxiety Disorder
Substance Abuse Disorder
Eating Disorder
Other
Key: ECA–Epidemiologic Catchment; NCS– National Comorbidity Study; OCD-Obsessive-Compulsive Disorder; GAD-Generalized Anxiety Disorder
18
SELF-REPORTED INTERESTS OF CYBERSEX ABUSE PATIENTS
Interest
Male
N
Percent
N
Female
Percent
N
Total
Percent
Paraphilias a
5
26.3
5
23.8
10
25.0
Romance/Dating
4
21.0
5
23.8
9
22.5
Swinging
3
15.8
3
14.2
6
15.0
Chat/Social Outlet
2
10.5
2
09.5
4
10.0
Homosexual
2
10.5
2
09.5
4
10.0
Bisexual
1
05.2
2
09.5
3
07.5
Gender Bending b
1
05.2
1
04.7
2
05.0
Teens/Juveniles c
2
10.5
0
00.0
2
05.0
Total
19
100.0
21
100.0
40
100.0
19
OVER CONTROL; OUT OF CONTROL 2
Typically, the disordered patient will cycle between
over-control and out-of-control cycles; acting out
and acting in cycles. The eating disorder patient acts
with a rigid sense of beliefs and boundaries. The
disorder patient acts with a rigid sense of beliefs and
boundaries which allow her to organize the world by
being angry at self and projecting and displacing the
anger onto others. The result is interpretation of all
transactions as one’s own fault, avoiding and
complying with others and a sense of helplessness
and powerlessness to solve problems or change.
20
OVER CONTROL; OUT OF CONTROL 3


Some acting-in individuals will instead develop realistic,
perfectionist righteousness and will channel their rage into
taking care of others. They have such a great sense of
neediness, which simultaneously evokes terror of allowing
someone close enough to meet their needs, that they solve the
dilemma by projecting their needs onto others and finding
helpless children to take care of compulsively.
Acting out individuals may move against and exploit self and
others, directly or indirectly. Often, they will physically abuse
children or neglect them, often alternating with smothering
them. They will find themselves in frequent power struggles,
insidiously directing their anger at several of their enemies,
while simultaneously feeling like the victim.
21
SELF-INJURY
Whenever they begin having success in life or in
love relationships, it upsets the equilibrium.
They are confronted with the reality that they
are not bad, evil or as damaged as they originally
thought. The thinking and feeling initiates an
intrusive cycle and creates anxiety, which results
in self-destructive behavior to re-establish
equilibrium. The result is a very delicate system
in which eating is used to maintain the intimacy
disorder.
22
EATING DISORDER PATIENTS’ EXPERIENCE OF RECOVERY

Ability to take responsibility for self and eschew victim mentality.

Establishment of a sense of “true self,” “real me,” or “knowing who I am.”

Capacity to formulate goals, tolerate setbacks, yet maintain positive motivation to
get better.

Reclamation of sense of one’s personal power.

Decreased emphasis on perfectionism.

Firmer interpersonal boundaries; enhanced capacitates to set appropriate
boundaries.

Cultivation of sense of purpose, meaning of life.
23
RE-FRAMING THE MEANING OF SYMPTOMS





Start with the assumption that every symptom is a valuable piece of data!
Use psychoeducational material to make educated guesses about the meaning
of symptoms, as a symptom-memory or a valiant attempt to cope.
Ask her, “How would this _____________have helped you to survive in an
unsafe world? Helped you to feel less overwhelmed? Less helpless? More
hopeful?”
Look for what the symptom is still trying to accomplish: i.e., chronic suicidal
feelings might offer comfort or a “bail-out plan;” cutting might help modulate
arousal; social avoidance could be an attempt to avoid “danger.”
Once it is clear what the symptom is trying to accomplish, then the therapist
and patient can look for other ways to accomplish the same goal in a context
that describes the patient as an ingenious and resourceful survivor, rather than
a damaged victim.
24
SHAME
Feeling of exposure inherent to the experience
that can accompany extreme amount of utter
worthlessness. Feeling exposed results in the
individual critically scrutinizing the minutest
detail, heightening the awareness of being
looked at and seen. The feeling of exposure can
produce rage.
25
26
THERAPISTS JOB WITH ATTACHMENT TRAUMA
1.
2.
3.
4.
5.
Transformation of the self through relationship.
Provide a secure base for exploration, development and
change.
Provide attunement in helping the clietn tolerate, modulate
and communicate difficult feelings.
Affect regulating interactions for accessing disavowed or
dissociated experiences strengthening narrative competence.
Deconstruct the attachment patterns of the past to construct
new ones in the present.
(see David Wallin, Attachment in Psychotherapy, Guilford Press, 2007)
27
SUBTYPES OF CYBERSEX ADDICTS AND RECOMMENDED TREATMENT
Subtype
Recommended Treatment
Male Cybersex Addicts
Chemical Dependence Treatment
Sexual Addiction Recovery
Depression Treatment
Trauma Reconstruction
Marital/Couple Therapy
Sex Therapy
Female Cybersex Addicts
Eating Disorder Treatment
Sexual Addiction Recovery
PTSD Treatment
Depression Treatment
Trauma Reconstruction
Marital/Couple Therapy
Sex Therapy
Loner Cybersex Addicts
Social Skills Training
Depression Treatment
Trauma Reconstruction
Sex Therapy
Paraphiliac Cybersex Addicts
Social Skills Training
Depression Treatment
Trauma Reconstruction
Sexual Arousal Reconditioning
28
FANTASY SATIATION THERAPY PROGRAM
Patient’s current fantasies
I.
Range of deviant imagery
Range of non-deviant imagery
a.
b.
II. Write 4-5 pages of fantasy
II.
One page including build up
a.
i.
Two pages of scene
b.
i.
ii.
iii.
c.
d.
What is he doing during the day before he exhibits
Sensory (smell, taste, hearing, touch, sight)
Thoughts
Feelings
One-half to one page of offense-activity
One page of wind-down
29
FANTASY SATIATION THERAPY PROGRAM, CONT.
III. Borderline measure of arousal
a. Verbalize each of the fantasies on audio tape
b. Play tape and have him rate his cognitive arousal on scale
IV. Selection techniques
a. Each day he will (1) masturbate to non-violent fantasy and then
(2) verbalize the most exciting component of the incest fantasy
for 30 minutes into audio tape. On Day 10, we’ll listen to the
baseline fantasies and compare arousal level.
b. If arousal to children is low or nil, the same procedures will be
used for any other deviant imagery. If arousal is not low to
children, eight more days of incest satiation is needed bfore the
next baseline measure.
30
FANTASY SATIATION THERAPY PROGRAM, CONT.
V. Patient will be instructed not to use fantasies of
illegal behavior in masturbation, intercourse or
otherwise for duration of satiation. Erotic
activity should be accompanied by fantasy or
mutually consenting fantasy.
VI. Patient will be instructed to keep an accurate
log of themes used to masturbate.
31