Cybersex Addiction: A Case Study. Dorothy Hayden, LCSW (2016)
By Dorothy Hayden LCSW 04/28/16
Intense sexual pleasure as escape from unwanted inner experiences.
Following the pattern well-established by other potentially problematic behaviors and activities (gambling, shopping, eating, drinking and using substances), the relatively new realm of sexual activity based on Internet technology has created another challenge for individuals and society. As with other behaviors, the vast majority of people who engage in “cyber sexual” activities (pornography, live webcam masturbation, sending sexual texts, interactive online sexcapades, etc.) do so occasionally, finding these activities to be enjoyable distractions that are ultimately not as satisfying as more intimate connections. For others, though, the ability to engage in cybersexual activities inexpensively and anonymously has the potential to damage lives and destroy actual relationships that is similar to other forms of addiction. Dorothy Hayden has been working with sexual compulsives for almost as long as cybersexuality has been around. Here, she presents a case study that highlights many of the key dynamics of the paradigm…Richard Juman, PsyD
When Steve arrived to his first session with me, he was markedly unkempt and underweight. With head held down, he didn’t make eye contact with me and, once sitting in the chair, was inward and lacking anything much to say. He eventually did communicate that he had received a demotion on his job and that his wife had filed for divorce. He seemed to be in a severe depression around these losses.
Steve reported that he once over-indulged in alcohol and drugs but that because of a serious accident on the job, he quit using substances. However, over the next several months, he found that his urges to masturbate increased. He found that if he did not act on these urges, he would remain “horny” all day and would be unable to focus on his work or pay attention to his wife when she spoke to him. He was constantly preoccupied with his sexual fantasies.
Steve felt lifeless and empty, devoid of energy, interest, or capacity of enjoyment. The only thing that gave him a sense of aliveness was a sexual encounter. For months after his wife declared that she was leaving, he found that his sexual fantasies and urges to masturbate were becoming more and more imperious. He realized that if he did not masturbate, he would remain “horny” all day, which would make him feel restless, irritable and discontent.
Soon enough, Steve found that pornography was not enough to sexually excite him. His use of digital devices to achieve sexual stimulation escalated. He found that being locked into the fantasies and rituals that preceded the sexual acting out were just as compelling as the actual sex act, perhaps even more so. His emotionally-charged high was maintained by the dopamine-enhanced searching, downloading, chatting, texting, sexting and other sexual-based behaviors. Every new video, picture, game, or person released more dopamine, aiding him to maintain lengthy periods of excitement through all of his looking, searching, fantasizing and anticipating.
Steve reported that he could spend endless hours feeling intense arousal without becoming physically aroused or coming to orgasm. His search for the perfect video, image or partner kept him disengaged and distracted from life’s priorities, relationships and life commitments as effectively as heroin, cocaine, or any other mood-changing substance. Cybersex was, indeed, his “drug of choice.”
After a year in treatment, Steve agreed to go to a meeting of Sex Addicts Anonymous (SAA). He found comfort there, knowing that he was not the only person in the world who engaged in such sexual behaviors. He felt supported and valued in a way he never had been before in his life. For the first time, he felt he belonged somewhere. He began to feel that he could talk to people and that people could share with him. Most importantly, he reported, he was learning how to be himself and to be comfortable with himself in social situations.
Of course, this affected his treatment. We began to do a cost/benefit analysis of his sexual behavior.
At this time, Steve made a major breakthrough. His denial broken, he saw clearly the damage he had done to himself and to those close to him. This included:
- Isolation from friends and family/reduced intimacy with one’s committed partner
- Broken trust in one’s relationships
- Increased stress from living a duplicitous life
- Loss of income from demotion at work and possible loss of job
- Partners losing self-esteem and self-worth by failing to "live up” to fantasy porn images
- Emotionally neglecting children
- Sexual dysfunction (erectile dysfunction)
- Loss of interest in hobbies and other healthy activities
- Self-neglect due to lack of sleep and exercise
Steve was the first of three children, with two younger sisters. Before he was born, his mother had a miscarriage at five months gestation. Steve described his mother as “deceitful”—warm and inviting one moment and rejecting the next. She idolized Steve. He was the apple of her eye who could do no wrong. However, she had exacting standards, and when he failed to meet them she would tell him with contempt that he was disgusting, noisy and boorish and would send him to his room for hours on end.
Steve recalled that his mother had “horrendous” attitudes toward men and would often complain that they were “beasts”—loud, rough, and only interested in sex. She would often undress in front of Steve, and would leave the bedroom door open before she went to bed. When he was afraid, he would often climb into bed with his parents. This continued until his father left the family when he was 12 years old. He recalled that he was lying in bed with her and she wore a flimsy nightgown. Steve reported that he had always had sexual thoughts about his mother.
Steve’s father was a kind, sensitive and depressive man when he was sober, but when he had been drinking, he was loud and aggressive. By the time Steve was three years old, his father was rarely sober. Additionally, he was abusive to the whole family when he was drinking, but he was particularly abusive to Steve. From time to time, he would mention that Steve’s birth was neither planned nor wanted. Steve observed that his father “always made sure that I knew what an asshole was.”
Steve’s father left the family when Steve was nine years old. Steve felt abandoned and feared that his father would never return, but at the same time he also feared that he would come back and shoot them all. He also felt responsible for the breakup of his parents' marriage.
Steve’s core affective experience was intense, searing shame from which sexuality gave him his only relief. He had failed to live up to his parents’ expectations of him and failed to live up to his own. Living in a family where he was either idolized or belittled, his shame had become internalized, that is, an essential part of his identity.
He had primary shame from living with his family and secondary shame from his addiction. Every time he had an orgasm, he was left with shame and self-hatred. It’s shameful not to be able to be in control of one’s own behavior despite one’s best effort.
Steve's low self-esteem and his vacuous sense of self, derived partly from his sense that his father neither wanted nor valued him, partly from his mother’s erratic and narcissistic responsiveness to him and partly from his split and sometimes amorphous sense of identity. Harold’s mother complicated Steve’s task of developing a healthy male identity by devaluing his father, criticizing Steve when he acted like his father and devaluing men in general.
His experience with a 12-Step program helped lessen that shame, and the empathy and understanding I offered him also helped to alleviate his shame.
Treatment was divided into “first order” change and “second order” change. “First order” change is designed to stabilize his behavior. He was sent for a psychiatric assessment to rule out co-morbid psychiatric disorders. The doctor put him on a low dose of Prozac, not for a mood disorder, but to help him manage his obsessive sexual urges.
We then embarked on a Cognitive-Behavioral regime to establish a Relapse Prevention program. He wrote out a series of “triggers”—internal and external events that preceded his sexual acting out. He learned to stay away from high-risk situations. Alternative coping strategies were then devised for each trigger. Ways to manage cravings and urges were then discussed. He saw cravings and fantasies as signals of inner distress. He could more readily observe and verbalize his inner states, rather than simply responding to them with physical action. In addition, we discussed ways that he might handle lapses and relapses.
Simple behavioral changes were put in place. He exchanged his smartphone for a regular cellphone. The computer was put in the family room. A filter that eliminated erotic material was put on the computer. He installed a family-oriented Internet service contract. When he had to use the computer, he limited himself to specific times when he checked his emails and such.
Steve and I then discussed at length his relationship to his own emotions, because negative emotions are often used as a fuel for acting out. The treatment focused on learning to tolerate negative emotions without using sex to relieve them. Knowing how to cope effectively with strong feelings is essential to sexual self-control. Coping with the issue of immediate gratification was discussed.
A critical part of a Relapse Prevention Plan is working on recognizing and disputing cognitive distortions. Sex addicts have plenty of cognitive distortions about themselves, about women and about sex. I asked Steve to write down what he thought his were and then to write down next to them an alternative, more realistic thought that he was to read a few times a week.
Because Steve had been isolated for so long, we worked on basic communication skills and he agreed to take a course in assertiveness. Both of these tasks made him feel more comfortable in the world with people.
One of the things that propelled Steve into treatment was his wife’s threat of divorce. Although their relationship was in shambles after years of his addictive behaviors, he still loved her and very much wanted her to be in his life. Sara, for her part, had become torn into pieces by Steve’s behavior. His having spent such large amounts of time in the basement engaging in “deviant” sexual behavior made her feel lonely, ignored, unimportant and neglected. Her self-esteem suffered, knowing that her husband preferred to spend his time in front of a computer screen in the company of a fantasy person with whom she could not compete.
She felt a deep sense of shame because of what was going on in the family, heightened by the fact that she was hesitant to speak to anyone about the situation or her feelings about it because she wanted to protect Steve from the humiliation of the situation.
The combination of devastation, hurt, betrayal and loss of self-esteem set the stage for Sara to begin to have an affair with another man. Her motives were both to shore up her sexual self-esteem and to wreck revenge on Steve for betraying her. Sara didn’t continue in the affair for very long, however, because she still felt devoted to Steve.
Steve’s acting out had a deleterious effect on the couple’s sex life. Sara, feeling that she didn’t “measure up” to his fantasy women, worked to make herself especially attractive and initiated lovemaking much more often than she once did. She wore sexy clothing that she thought Steve would like. On some occasions, Sara performed sexual acts that she found repugnant because she thought it would please him. She did everything she could to persuade him that he didn’t “need” to look at those “other women.”
What Sara didn’t understand was that no mortal human being could ever live up to the “erotic haze”—the dopamine-enhanced, highly aroused state that the sex addict enters into when he was acting out that really had little to do with sex with a real woman. A real-life person can never compete with a fantasy. She also didn’t understand that she held no responsibility for the situation, that Steve’s condition resulted from childhood trauma and that he carried the emotional wounds with him well before he ever met her.
In treatment, Sara relayed that it wasn’t the sexual behavior that hurt her as much as the lies and secrets that surrounded the behavior. It was that that she didn’t know if she could forgive. She doubted she could ever trust him again.
For years, Steve would tell her she was “crazy” when she suspected something. She needed to accept that she did not cause the problem and that she could not control it.
For a number of years, Sara, like so many women before her, became obsessive about “spying” on her mate; repeatedly checking computer hard drives, smartphones, texts, videos, webcams, emails, etc. to see if he was acting out. She said she felt crazy when she did this, but she continued to try to obtain more control over a situation over which she felt powerless.
Sara agreed to begin to attend S-anon, a 12-step program for partners of sex addicts where she met women who were able to give her support and empathy. At the same time, she started treatment with a therapist I referred her to, while they both continued couples therapy.
One year after treatment began, Steve announced that he was terminating treatment. I encouraged him to talk about what had led him to this decision. Our exploration revealed his fantasy that I would punish and humiliate him for having “failed” after having been so sure of himself. Further work indicated relationships between this fantasy and Steve’s shame about his fall from grandiosity and his need for help, his envy and resentment of me, and a number of emotionally significant childhood experiences with both his parents. Steve’s ability to discuss these things in a safe environment enabled him to see me less as a bully and more as a stable and stabilizing mentor who might be able to help him out of the mess that he now knew to be his inner life.
Effects of Treatment
As treatment progressed, Steve began to realize that these fantasy-based transient sexual encounters were not what he was really looking for, since they would not satisfy him or meet his needs for intimate connection.
Treatment then took the turn of addressing the damage incurred from his relationships with his parents. We looked squarely at the messages he internalized as a child that were affecting his well-being as an adult. Some of these were:
- He was not good enough, not lovable and he did not belong
- He experienced threats of abandonment, neglect and disinterest
- Parental perfectionism
After we located the most important deficiency messages he received, he went through a grieving process in his life that resulted from these messages. As an adult, he consciously challenged the messages with new messages that reflected his self-worth. Most importantly, he returned his “borrowed shame.” Both of his parents were wounded souls with their own low self-esteem and sense of shame that they gave over to Steve. Steve made a decision that the shame didn’t belong to him; it belonged to his parents and he gave it back to where it belonged—to his parents.
Steve grappled with the idea of forgiving his family. He saw forgiveness as something he did for himself because living life in resentment was too painful. This was demonstrated when he went to visit them. The visits were shorter and his interactions with them were calmer and less angry. He had accepted them as fallible human beings who did the best they could to parent him.
Three years after treatment had begun, Steve had made tremendous changes in his life. He continued to come to therapy and he worked an active program in Sex Addicts Anonymous. He had a network of supportive friends and developed new hobbies. He exercised regularly. He and Sara were doing well. They adhered to a “sobriety contract” which consisted of a list of behaviors that he would adhere to. Over time, he showed her that he could once again be trusted.
Steve did still experience cravings, but he had acquired skills with which to deal with them. On a few occasions, he lapsed. However, because of the relapse prevention work we had done, he did not move into a full-blown relapse and he understood that a lapse meant that he had to make some changes in his relapse recovery plan.
His self-esteem rose. He was no longer a victim of self-loathing and shame. He was comfortable in his own presence. Through his involvement in his 12-step program, he had the satisfaction of being a member of a caring community and of helping others.
With the help of therapy, his perspective on life changed. He moved from being an immature, narcissistic person who viewed others as “need-satisfying objects” to appreciating them as individuals with needs, thoughts and feelings of their own. He learned to be a good listener and to be empathic. As a result, he developed the satisfaction of having a network of close, supportive friends, including and especially, his wife.
Through couples counseling, bitterness and anger had been put behind them and, through their separate therapies, they learned to be “allies” in treatment. They each claimed that having gone through their crises, they enjoyed a deeper, richer and more sexual relationship.
Love and sex are part of the human condition and, as such, they are matters of concern for the clinical community. It behooves those of us who work with the clinical population, especially young people, to have some familiarity with the effects that digital technology is having on human sexuality.
Dorothy Hayden, LCSW, is a psychotherapy in private practice in Manhattan. For 20 years she has been treating sexual compulsives and their partners. She has written 40 articles about sex addiction (www.sextreatment.com) and has authored the book “Total Sex Addiction Recovery – A Guide to Therapy”. Ms. Hayden has been interviewed by HBO, “20/20” and Anderson “360” about the impact of cybersex on society.