Another Guy Who Isn’t a Sex Addict

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He was 50, married, and he had all the symptoms of “sex addiction.” Let’s call him Joe.

As he travelled the country lecturing (he was a pioneering ear surgeon), he’d hire an escort to spend the night with him. He’d lie about it to his wife, of course. He became a regular—or rather he had a few “regulars”—in cities he visited frequently, such as Chicago and St. Louis. What had started 12 years ago as an occasional treat eventually became a virtual necessity.

While he wanted to be an attentive father and husband, he worked long hours and was emotionally distant from his sons and his wife. His sexual desire for her was erratic—sometimes overwhelming her, other times leaving her disappointed and confused. Always a frequent masturbator, he became a devoted consumer of online pornography. He put up a profile on and OkCupid, although it was only to cruise, never to actually hook up.

He eventually got caught. The escorts were the big headline of course, an institutionalized, long-term infidelity that completely outraged his stunned wife. But once the matter was opened, his over-involvement with porn, the mercurial desire for his wife that seemed not quite personally connected to her, his periodic inappropriate comments to waitresses, flight attendants, and baristas, all became fair game for her angry and frightened outbursts.

“I love you, which for me is simple,” she said bitterly. “What’s wrong with you?” For once, he told the truth: “I love you, but for me, that’s complicated,” he said.

He promised he’d stop with the escorts, but didn’t. He agreed to share his online passwords, but simply opened new accounts. He took down his profiles on Match and OkCupid, but found other websites on which to cruise.

And that’s how it was when they came into my office. Two years after he’d been caught cheating, they were trapped in a cycle of his promising, her believing, and him lying and getting caught again.

Over and over. She was terrified of losing her marriage, and outraged at the repeated humiliation. He was tired of her monitoring him, of her “still processing her feelings, after two whole years,” and of her periodic suspicions.

When they came to me they were getting “sex addiction” treatment, which their individual therapists had both encouraged. As the spouse of an “addict,” she was in S-Anon, endlessly talking about her trauma and her “co-dependence.” He was going to Sexaholics Anonymous meetings, but not regularly, and he was reading about the 12 Steps, but not quite enthusiastically.

She wanted me treat his “sex addiction,” and he was willing to do almost anything to end their nightmare of mistrust and chronic conflict.

But in the very first session, I told them that I don’t use the category of “sex addiction.”

“You don’t treat cases like this? You won’t see us?”
“I do treat cases like this, all the time, actually. I just don’t use the ideas around sex addiction to explain people’s behavior, or to make treatment decisions.”
“What do you do instead?”
“I do therapy. Couples counseling or individual therapy, as seems appropriate.”

Although they were skeptical, they decided to see me anyway.

And that’s what we did—therapy. During the course of our work, here’s some of what Joe realized:

* He turns to sex when he feels lonely.
* Because he knows his wife loves him, there’s a limit to how proud he feels when she tells him he’s great. He gets more emotional value from strangers’ appreciation than from his family’s. And sex workers are the perfect strangers.
* He makes promises about calling or texting his wife when he travels for work. But then he feels so controlled when it’s time to contact her that it’s a struggle to keep his promises. For him, not calling is a small adolescent rebellion that feels oddly satisfying. But her experience is that for him, giving into these feelings is more important than their marriage or his commitment.

In fact, we talked about what other non-sexual feelings he has that are so strong he finds it difficult to keep his commitments. It was eye-opening for both of them.

Mostly Joe talked about these things–with his wife. She didn’t like some of what she heard. I gently encouraged her. When she tried to avoid or limit conversations by saying she was “being triggered,” I gently insisted the conversation continue. When he tried to avoid or limit conversations by referring to her obvious discomfort, I wouldn’t let him.

And so they talked. They fought, but they were fighting about new things, and eventually they were fighting in a new way—as partners attempting to find truths, rather than as adversaries trying to persuade each other about who was wrong.

I didn’t tell Joe what he couldn’t do (like use pornography), so he didn’t have to defend his autonomy with me. Of course, he got defensive anyway, periodically feeling misunderstood and judged.

We talked about that as part of our relationship. She observed us. He thought about it. They talked about it. They were watching intimacy in action. They practiced it. They cautiously liked it.

He backslid, hiding a few inconsequential things for seemingly no reason. Of course. I interpreted this: yes, he was wrong, but he wasn’t bad. This was big news for both of them.

He voluntarily disclosed more about what he had done in the bad old days—months after he had supposedly told her everything. She wailed about him victimizing her again. I reframed this, encouraging them to celebrate it. Backed by her therapist, she once again insisted on “full transparency.” I suggested something slightly more modest, so he could succeed and she could enjoy it.

She’s still waiting, I think, for the “full transparency.” Do grownups really provide that to each other about important topics? Your favorite flavor of ice cream, sure. But your sexual fantasies, your sense of guilt for not being a better spouse, your secret flirtation at the airport? It isn’t easy, and if it comes, it rarely comes all at once.

Therapy continued, all three of us working our butts off. He developed a new standard of sexual behavior for himself, which he’s been living up to—at least, that’s what he says, and I believe him. She’s still waiting for the other shoe to drop. Her therapist says she has PTSD. That strikes me as a heavy burden to place on this woman, who is still upset, maybe a little too upset, almost three years after her husband’s betrayal with professional escorts.

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