INTERNET SEX ADDICTION

1. Internet sex addiction
Clinical experience
Walid Sarhan F.R.C.Psych

2. Google search
 Sex: 3,810,000,000
 Free sex:1,200,000,00
 Group sex:761,000,000
 Child sex:402,000,000
 Anal sex:281,000,000
 Oral sex:140,000,000
 Arab sex:98,500,000

3. Internet Sex
 70% of porn traffic between 9am-5pm
 US porno revenue exceeds 6 billion
currently (3rd)
 12-17 year olds largest consumers of
internet porn
 Average first time contact is 11 years of
age
 Gender:
– 60-70% males

4. What is Going on
with These People?

5. Etiology of Sexual
Addiction
 Anyone, BUT:
More from families
multiple addictions
rigid, disengaged families
Psychological trauma common
Propensity for high-risk behavior
Onset due triggered around high stress
events
Trouble with accountability, authority

7. Prevalence
 Epidemiological estimates vary
 Inconsistent criteria for defining sexual
compulsive behaviors
– Lack of funding
– Lack of committed researchers
 Most information comes from clinical
treatment programs specialized in sexual
addictions
 Best estimates are approximately 5% of
general population Fong TW. (2006). Understanding and managing
compulsive sexual behaviors. Psychiatry, November, 51-58.

8. Demographics
 3: 1 ratio of men to women
 Younger and older persons in cybersex
 65% of sex addicts run the risk of
contracting STDs
 79% have lost work productivity
 70% severe marital or relationship due to
behavior
 65% report sleep disorder due to shame,
fear, despair

9. Pornographic internet
content
 Everything is possible
 „soft pornography“
 „hard pornography“
– „sexually explicit in the extreme, and devoid of any other
apparent content or purpose“ – including violence, sado-
maso, electroshocks, urine, feces, very fat women, pregnant
women etc., „gang-bang“, animals; even „snuff-videos“ –
killing victims in front of the camera.
 pedophile content (often with sadistic torture)
 Chat with explicit sex talk – often leading to real-life
encounters.
 Live-Video
 Mobile telephones: growing industry of short films,
pictures, explicit sounds.

10. Some statistics
 Sex Industry Statistics (2003)
– $57.0 billion revenue world-wide
– $12.0 billion of this is US revenue, more than all combined revenues of all
professional football, baseball and basketball franchises or the combined
revenues of ABC, CBS, and NBC (6.2 billion). $2.5 of the $12 billion is
related to internet porn.
 Porn on the Web
– 25% of total search engine requests are porn-related.
– 8% of total emails are porn-related. Average daily pornographic emails are
4.5 per internet user
– 12% of total websites are pornographic
 Affecting Children
– 100,000 websites offer illegal child pornography.
– Child pornography generates $3 billion annually.
– 90% of 8-16 year olds have viewed porn online (most while doing
homework).
– Average age of first internet exposure to pornography is 11 years old.
– Largest consumer of internet pornography 12-17 age group.

11. Statistics II
 Affecting Adults
– 20% of men admit accessing pornography at work
– 13% of women admit accessing pornography at work
– 53% of Promise Keeper men viewed pornography the previous week in one
study
– 10% of adults admit having internet sexual addiction.
 Business Productivity
– 70 percent of all internet porn traffic occurs during the 9-to-5 workday.2
– Nearly one out of three companies has terminated an employee for
inappropriate web use.2 (Some of this could be for liability reasons
discussed below.)
– According to Internet Data Center research 30 to 40 percent of employee
internet activity is non business-related, costing millions of dollars in
productivity.2 This does not mean all the activity is porn related. For
example, the cost to businesses in lost employee productivity from the
internet broadcasts of the Starr report and the Clinton grand-jury video was
in excess of $450 million, according to a study reported by ZDNet.2

12. Statistics
 Tracking data from 2010 by Nielsen
Online, showed that more than 25% of
those with Internet access at work
viewed pornography during working
hours. This is an increase from 2007
figures

13.  As of May, 2010, Alexa research, which
tracks Internet usage, includes two porn
sites in the top 503 for worldwide traffic.
This may not seem that impressive until
you realize that almost all of the top 50
sites are social networking sites and
that CNN.com ranks 57th

14.  25 million Americans visit cyber-sex
sites between 1-10 hours per week.
Another 4.7 million in excess of 11
hours per week.
(MSNBC/Stanford/Duquesne Study,
Washington Times, 1/26/2000

15.  everysecond $3,075.64 is being spent on
pornography. Every second 28,258
internet users are viewing
pornography. In that same second 372
internet users are typing adult search
terms into search engines. Every 39
minutes a new pornographic video is
being created in the U.S.

16.  It‟s big business. The pornography
industry has larger revenues than
Microsoft, Google, Amazon, eBay,
Yahoo, Apple and Netflix combined.
2006 Worldwide Pornography
Revenues ballooned to $97.06 billion.
2006 & 2005 U.S. Pornography Industry
Revenue Statistics, 2006 Top Adult
Search

17. 2006 Worldwide Pornography Revenues

18. Pornography in the
Workplace
 More than 75% of people at work have
accidentally visited a pornographic
website, and 15% have visited such sites
more than 10 times
Fifty Percent of Workers Spend Nine days a
Year on Personal Surfing at Work.

19.  63 percent of employees are concerned
about the ease of access to objectionable
content at work
Fifty Percent of Workers Spend Nine days a
Year on Personal Surfing at
Work. Cerberian Inc. and SonicWALL,
20 July 2004.

20.  Twenty percent of men and 13% of
women admitted to accessing
pornography at work
Internet Pornography Statistics. Internet
Filter Review, 2004

21. USA
 Out of all countries, the United States is
the top producer of both pornographic
websites and pornographic videos. In
fact, the United States has produced
89% (244,661,900) of the pornographic
web pages in the entire world. The
average age of first exposure to Internet
pornography is 11

22. Impact on the Marriage
 47% of families said pornography is a
problem in their home
 42% of surveyed adults indicated that
their partner's use of pornography
made them feel insecure
 41% of surveyed adults admitted they
felt less attractive due to their partner's
pornography use
 30% of surveyed adults said their
partner's use of pornography made
them feel more like a sexual object

23. Divorce
 350 members of the American Academy
of Matrimonial Lawyers, the nation‟s
top 1,600 divorce attorneys, met in 2002
for an annual conference. Almost two
thirds of these lawyers said that the
Internet had played a significant role in
divorces they had handled during the
last year. The problems most cited by
the attorneys were:

24.  1) Met new love interest over the
Internet - 68 percent
2) Obsessive interest in pornographic
sites - 56 percent
3) Excessive time on computer - 47
percent
4) Excessive time communicating in
chat rooms - 33 percent

25. School children
 In 2008, a Catholic high school in the
Midwest –USA. surveyed the
pornography use of 175 of their 350
senior boys, who were taking a class on
relationships. The results of the survey
indicated that 48% were viewing
pornography one or more times each
week. Out of the boys who had viewed
pornography, 36% had feelings of
addiction to pornography, and 68% said

26.  The high school also surveyed their
entire freshman class, and 29% of the
freshman boys were viewing
pornography one or more times each
week. Out of the freshman boys who
had viewed pornography, 12% had
feelings of addiction, and 74% said that
their parents were unaware of their
pornography use

27.  Almost 90% of these students were
from Catholic families, and the school
has conducted other surveys on
pornography over the last three years,
and found results that were quite
similar. Of the boys that were viewing
pornography, between 80-85%
indicated that they were accessing
pornography through the Internet.

28. Impact on Society
 Approximately 40 million people in the
United States are sexually involved
with the Internet
 25% of all search engine requests are
pornography related
 Sex is the number 1 topic searched on
the Internet

29.  15% of online porn habitués develop
sexual behavior that disrupts their lives
4
 38% of adults believe it is 'morally
acceptable' to look at pictures of nudity
or explicit sexual behavior

30. American Society of
Addiction Medicine
 On August , 2011 the statement
defining all addiction (including sex
addiction) in terms of brain changes.
"Addiction is a primary, chronic disease
of brain reward, motivation, memory
and related circuitry

31. Internet Addiction Disorder
(IAD) - Diagnostic Criteria
 A maladaptive pattern of Internet use,
leading to clinically significant
 impairment or distress as manifested by
three (or more) of the following,
 occurring at any time in the same 12-
month period:
 (I) tolerance, as defined by either of the
following:
– (A) A need for markedly increased amounts of time on Internet to achieve
satisfaction
Author: Ivan Goldberg, M.D.
– (B) markedly diminished effect with continued use of the same amount of
time on Internet.

32. Criteria – IAD II
 (II) withdrawal, as manifested by either
of the following:
– (A) the characteristic withdrawal syndrome
 (1) Cessation of (or reduction) in Internet use that has been heavy and
prolonged.
 (2) Two (or more) of the following, developing within several days to a
month after Criterion 1: (a) psychomotor agitation - (b) anxiety - (c)
obsessive thinking about what is happening on Internet - (d) fantasies
or dreams about Internet - (e) voluntary or involuntary typing
movements of the fingers.
 (3) The symptoms in Criterion B cause distress or impairment in social,
occupational or other important other area of functioning
– (B) Use of Internet or a similar on-line service is engaged in to
relieve or avoid withdrawal symptoms
 (III) Internet is often accessed more
often or for longer periods of time than

33.  (IV) There is a persistent desire or
unsuccessful efforts to cut down or
control Internet use.
 (V) A great deal of time is spent in
activities related to Internet use
 (e.g. organizing files of downloaded materials;
researching Internet vendors, trying new
browsers.)
 (VI) Important social, occupational, or
recreational activities are given up or
reduced because of Internet use.

34. Destructive consequences
 (VII) Internet use is continued despite
knowledge of having a persistent or
recurrent physical, social, occupational,
or psychological problem that is likely
to been caused or exacerbated by
Internet use
– sleep deprivation, marital difficulties,
lateness for early morning appointments,
neglect of occupational duties, or feelings
of abandonment in significant others.
– Isolation

35. Disease or behavioral
problem?
 Diagnostic Category following ICD-10
/ DSM-IV unclear
– Disorders of sexual preference
(Paraphilia)?
– OCD?
– Disorders of Impulse control?
– Non-substance Addiction?
 Internet addiction disorder – IAD
(Ivan Goldberg 1995)
 Pathological Internet Use − PIU
(Kimberly S. Young)

36. DSM
 The DSM-IV-TR still includes a
miscellaneous diagnosis called Sexual
Disorders Not Otherwise Specified

37. (ICD)
 which is not limited to mental
disorders. The most recent version of
that document, ICD-10, includes
"Excessive sexual drive" as a diagnosis
(code F52.7), subdividing it into
satyriasis (for males) and nymphomania
(for females)

38. 10 Criteria for Addiction

39. 1-Loss of Control
Clear behavior in which you do
more than you intend or want.

40. 2-Compulsive Behavior
A pattern of out of control
behavior over time.

41. 3-Efforts to Stop
Repeated specific attempts to
stop the behavior which fail.

42. 4-Loss of Time
Significant amounts of time
lost doing and/or recovering
from the behavior.

43. 5-Preoccupation
Obsessing about or because of
the behavior.

44. 6-Inability to Fulfill
Obligations
The behavior interferes with
work, school, family, and
friends.

45. 7-Continuation Despite
Consequences
Failure to stop the behavior even
though you have problems because
of it (social, legal, financial,
physical).

46. 8-Escalation
Need to make behavior more
intense, more frequent, or more
risky.

47. 9-Losses
Losing, limiting, or sacrificing
valued parts of life such as
hobbies, family, relationships, an
d work.

48. 10-Withdrawal
Stopping behavior causes
considerable
distress, anxiety, restlessness, irri
tability, or physical discomfort.

49. The Addictive Cycle
Belief
System
Unmanageability Impaired
Thinking
Addictive
Cycle
Preoccupation
Shame
Despair Ritualizatio
n
Guilt
Compulsive
Behavior

50. Cycle of Psychological Addiction
Copyright © 2010 Pearson Education, Inc.

51. Differential
 Impulse control disorders
 Bipolar mood disorder
 PTSD
 Substance induced disorders
 Dissociative disorders
 OCD
 Gender identity disorder
 Dementia or other cognitive disorders

52. Role of the Primary Care
Physician
 Most trusted relationship in healthcare
– If relationship warm and supportive, Pt
will often disclose
 Provide complete physical
 Assess, treat comorbidities
– Major depressive episode
– Sleep disorder
– Irritability
– Difficulty concentrating

53. The Ten Types
of Sex Addiction
Patrick Carnes

54. 1-Fantasy Sex
Sexually charged fantasies, relationships,
and situations.
Arousal depends on sexual possibility.

55. 2-Seductive Role Sex
Seduction of partners.
Arousal is based on conquest and
diminishes rapidly after initial contact.

56. 3-Voyeuristic Sex
Visual arousal.
The use of visual stimulation to escape
into obsessive trance.

57. 4-Exhibitionistic Sex
Attracting attention to body or sexual
parts of the body.
Sexual arousal stems from reaction of
viewer whether shock or interest.

58. 5-Paying for Sex
Purchasing of sexual services.
Arousal is connected to payment for sex,
and with time the arousal actually
becomes connected to the money itself.

59. 6-Trading Sex
Selling or bartering sex for power.
Arousal is based on gaining control of
others by using sex as leverage.

60. 7-Intrusive Sex
Boundary violation without discovery.
Sexual arousal occurs by violating
boundaries with no repercussions.

61. 8-Anonymous Sex
High-risk sex with unknown
persons.
Arousal involves no seduction or
cost and is immediate.

62. 9-Pain Exchange Sex
Being humiliated or hurt as part of sexual
arousal; or sadistic hurting or degrading
another sexually, or both.

63. 10-Exploitive Sex
Exploitation of the vulnerable.
Arousal patterns are based on target
“types” of vulnerability.

64. Signs and Symptoms:
Physical
 Carpal Tunnel Syndrome
 Dry Eyes
 Migraine Headaches
 Back Aches
 Eating irregularities (skipping meals)
 Sleep disturbances
 Failure to attend to personal hygiene

65. Signs and Symptoms:
Psychological
 Inability to stop the activity
 Craving more and more time at the
computer
 Neglect of family and friends
 Feeling empty, depressed, irritable
when not at the computer
 Lying to employers and family about
activities

66. Signs and Symptoms:
Psychological con’t.
 Problems with school or job
 Having a sense of well-being or
euphoria while at the computer
 But above all:
– A loss of control over use!!!!!

67. Why so Compelling?
In an on-line world… you can
 1. be anyone you want to be.
 2. be part of a group and play a role not
possible in “real life.”
 3. have social connections with other
gamers/chatters is highly reinforcing
 4. maintain a relationship not possible
in “real world” (romantic/sexual)

68. Associated Difficulties
 Social Anxiety Disorder
– Fear of social or performance situations that evoke
anxiety
 Avoidant Personality Disorder
– Avoidance/reluctance in interpersonal
relationships
 Depression
– Loss of interest in external world, feelings of
sadness, lethargy, appetite changes, sleep
disturbance.

69. Complications - Comorbidity
 Alcoholism: Alcohol is being used to get calmer but also to
enhance the sexual excitement.
 Substance abuse (from Cocain to Viagra)
 Depressive Episodes: caused by negative psychosocial
consequences of the cyber-addiction or the break-up of
relationships.
 Suicidal thoughts: out of despair and hopelessness.
 Obsessive-Compulsive Behavior: Online addicts develop
complex rituals to conceal their dependency and to make sure
their family, colleagues or company cannot access their “hidden
area”.
 Paranoid Thinking: Fear of being discovered and being
ashamed lets them associate even marginal observations with
personal threats. (Examples: If a police car passes: “I hope they
do not come to confiscate my computer!” – If the boss asks for a
meeting: “Does he want to confront me with my Internet
activities during last week?”)

70. Differences between men
and women
 MEN
– „Kick“ through visual material
– Sexual excitement with masturbation.
– collecting mania.
– tendency towards violent and abasing
content.
 WOMEN:
– „Kick“ through communication (Chat).
– Romantic stories and images

71. Brain functions in sexual
addiction
4 5
3 frontal
brain
2
1
Limbic
System
1. Visual Stimulus
2. Sexual Excitement
3. Dopamin – „Happiness“
4. Adaptation – Desire for more and
stronger stimuli
5. Loss of control Genital Stimulation 2

72. Biopsychosocial Model
 Why (bio), what (psycho), where (social)
 Interactionism and cycle of pain: pain and
suffering  loss  pain, stress and drinking
more pain
 Family as a system, roles
 Why need to know about addiction? 80%
behind bars, child welfare, alcoholics at work.
 Headlines:
-“Hooked on the net”
-“Girl died at poker Binge”
 Relevant movies: 28 days, Traffic

74. Prevalence, Severity, and Correlates of
Problematic Sexual Internet Use in
Swedish Men and Women
Archives of Sexual Behavior
The Official Publication of the
International Academy of Sex Research
Michael W. Ross , Sven-Axel Månsson
and Kristian Daneback
Table Percent endorsing items on Internet sexual
problems scale (n = 1,913)

75. None Few Some Big
Has sexually-related Internet use caused problems for you?
Male 79.1 15.8 3.7 1.4
Female 86.7 9.2 3.4 0.7
Do you have difficulties controlling your sexually-related Internet use?
Male 49.1 31.5 13.0 6.5
Female 74.8 17.5 5.8 1.9
I feel bad about my sexually-related Internet use?
Male 51.9 34.9 8.5 4.7
Female 60.4 28.7 7.9 3.0
I feel that I have become addicted to the Internet for love- and sexual
purposes?
Male 44.0 34.9 15.6 5.5
Female 68.2 21.8 6.4 3.6

76. Mr. M.H. is 28 years old Jordanian Muslim
single man; he is graduate of computer
science.
He presented in October 2007 with s of
Anxiety Depression with panic attacks, and
obsessional treats of personality was treated
successfully until Feb. 2009.

77. CASE M.H.
 Mr. M.H. is 28 years old Jordanian
Muslim single man; he is a computer
engineer.
 He presented in October 2007 with
symptoms of Anxiety Depression with
panic attacks, and obsessional
personality,was treated successfully
with SSRIs and cognitive therapyuntil
Feb. 2009.

78. On Jun 2011 he presented again with
relapse and revealed that he is spending
few hours at work watching
pornographic websites, and
masturbating , with religious guilt
feelings, as he prays regularly and was
very ashamed of the whole matter, was
once seen by his father and stopped
using the internet at home

79.  As he started that since the age of 18
he used the internet for sex sites but it
was only after he graduated and
started working when the use became
too much, even before his first visit in
2007 he was overusing it, but he
thought he could handle it, which
didn’t happen he got worse especially
in the last 3 years, following his first
consultation.

80.  Mr. M. never had relationship with
girls as he has been shy and religious.
He feels that not having sexual outlet
and good knowledge of using the
internet without paying money were
pushing him towards the overuse, he
was expecting the problem to be
solved after marriage,

81.  but when some of this friends couldn’t
stop even after marriage, he got scared
and realized that the problem is
serious.
 Mr. M. prefers the category of lesbians
although he has been looking at all
other categories. He is preoccupied
with the matter, on the weekends he
doesn’t use the internet but he cannot
stop thinking about it.

82.  Over the last period he has been
improving in all aspects but he was
slipping into the use every few days at
the beginning and then every few
moments.
 He feels that he missed a lot of chances
to develop himself and his career.

83. Mr. B. M.
 23 years old who has been addicted to
internet pornography sine the puberty
at age 13 with excessive masturbation,
he is an Arab American Muslim, who is
not having any relationship with girls
he developed severe generalized
anxiety and OCD, in a background of
obsessional personality disorder. His
obsessions are mainly violent sexual
thoughts and images that he picked up
from the sex websites,

84. Mr. B. M.
 he is a graduate of biochemistry
planning to join the medical school ,
 he has been advised to get married, and
not to join the medical school, he is not
using the computer or internet now
except occasionally he has been
improving, able to control his addictive
be behavior,

85. Mr. B. M.
 but he is preoccupied with sex and
masturbates daily although paroxetine
is a effecting his desire and delayed the
ejaculation he is in a crisis at home, as
the father can‟t see where is the
problem, and the mother is reading
Quran for him his mobile phone. He
has been.

86. Assalamualaikum
 He wrote: I have been experiencing
anxiety, panic attacks, depression, and
irrational/delusional thoughts. Ever
since I was thirteen years old, I was
exposed to Internet pornography. I
became addicted to it on and off for
almost a decade. One day in college, I
woke up and started getting racing
thoughts, my heart beat so fast, and I
felt like I could not make it to the

87. Assalamualaikum,
 I tried listening to Quran, being around
people, but the cerebral electricity
would not stop. It went on for many
months during the last semester of my
premedical course work in college. All
of my thoughts are extreme, like for
example, I can get AIDS from
something that is not considered a risk
factor. The "What if" questions never
stop.

88.  It's like my brain is always on
emergency mode, where I have to use
all my coping mechanisms to keep an
outside appearance of calm. These
mechanisms break down, and I feel
physically tired. It's like a hamster on a
wheel. I work as a research assistant at
a company . I got accepted to medical
school, but I cannot continue so long as
I am experiencing these symptoms..

89.  My compulsions are Prayer and
Du3aa.he says that I am extremely
intelligent, and that backfires
chemically in the form of excess
dopamine and low serotonin

90.  My psychiatrist diagnosed me with
Obsessive Personality Disorder has
been treating me since December 2009,
when all of this started. I have
fasciculation all throughout my body,
and they become more frequent when I
try to achieve a mental state where I am
at peace of mind.

91.  It always switches from thought to
thought, where I get stuck, and can only
get out of one horrible thought by
thinking about something that is
equally or even more

92.  even though I know a little spit on to
my face from somebody's conversation
is not a risk factor. I've spoken to
infectious disease experts, and they tell
me to deal with this as an emotional
issue.

93.  Right now, I am taking Paroxetine
Hydrochloride at 40mg, so I do not feel
anxiety attacks, and I do experience
decreased libido and weight gain. I am
trying to continue my studies in
medical school, but I cannot get past
these intrusive thoughts on my own.

94.  My parents, especially my mother, are
worried about me. I have put them
through so much psychological trouble.
At one time, Dr. N. suggested that I get
married. But I don't know. Will that
improve my situation, or will it make
me worse? I beg you in earnest to help
me as if I am your son. Also, when I
decreased the Paxil, and stopped it for a
few days, the pornographic

95. Addiction requires
Detoxification
 The biological component of sexual
addiction is not to be underestimated. It
can be compared to substance abuse.
 „A Sex-Addict is like an alcoholic, but it
is his own the brain which is his bar.“
 This makes decisive withdrawal
necessary.
 In contrast to substance abuse, here a
return to „controlled sex“ would be the

96. Risk factors for compulsive
sexuality
Lessons from Addiction Research:
 Personality: impulse control, self
esteem, introversion, patterns of tension
reduction,
 Disposition for addictive behavior upon
stimuli (Award-Dependence).
 Inner emptiness, isolation, emotional
burnout, neglect of rewarding
interpersonal relationships.
 Presence of harmful material (just a click

97. Risk factors II
 Dealing with hidden emotional pain.
 History of childhood trauma / neglect
 Pathological search for new Stimulation.
 Lack of inner discipline / behavioral
control
 Rationalising negative behavior: „This
helps me to relax“ – „ I owe myself a
treat“ – „It„s only pictures“ etc.
 Unrealistic expectations towards others,
sexual partners, emotional immaturity.

98. Treatment Factors
 Addiction oriented primary therapist
– 3-5 years involvement
– 1st 2 years most intensive
 12 Step sex addiction group to prevent
relapse
 12 Step for other co-morbid addictions
 Work the program, not just attend
– Find sponsor, step work, service
 Early family involvement

99. What about medication?
 Serotonin: produced as a side effect of addiction process.
Antidepressants are also elevating serotonin levels.
– Could Serotonin reduce Craving? – possibly reduce feelings of
emptiness and underlying depression.
 Dopamin (increases desire in addiction)
– No proven strategies in this area without severe side effects
(neuroleptics).
 Opiates: central in addiction, creating the feeling of being
„high“.
– Although there are opioid blockers there is no indication that they
reduce non-substance addiction.
 Conclusion:
– Medication (unfortunately) is not a solution; perhaps partially a
support for behavior therapy, where a person is additionally
suffering from depression.

100. Psychotropic Medication
 Treat for Mood, Anxiety Disorders
 “Start low, go slow” may NOT work in
most cases
 Need to target as more treatment
resistant:
– Major depressive illness
– Anxiety disorders

101. Learning from Addiction
Therapy
 The diverse evaluation of sexual
behavior in our society makes life hard
for the addicted person.
 Cybersex Dependency requires
consequent strategies of addiction
therapy.
 Detoxification: complete withdrawal.
 Removal of access to addiction.
 Working at immature expectations and

102. Eight Tipps for addicts
 Admit the fact that you are addicted.
 Realize the fact that you support sexual
abuse with your behavior.
 Use filter software (www.max.com).
 Be transparent towards your partner /
counselor.
 Be accountable to a person you trust.
 Keep your computer in an open room.
 Choose to live without a computer or
internet access for some time.

103. Psychotherapy Factors
Multi-disciplinary approach crucial!
Inpatient vs. outpatient?
Is 12 step sexual addiction group enough?
Other modalities?
Individual psychotherapy
Family therapy
Couples therapy

104. Goal of therapy: relationship
orientation
 Not secular vs. Christian
 BUT: individually centered vs.
stabilizing relationships.
 Short term satisfaction vs. long-term
integrity.
 Individual lust vs. an ecology of
relations.
 Double moral standards vs. dignity,
respect and empathy.

105. The End