Last week, AASECT announced a new
advocacy position regarding sex addiction passed by the its Board of Directors
at their Fall Meeting on November 15 in Chicago. That
statement reads:
AASECT Position Statement — Sex Addiction
Founded in 1967, the American Association of Sexuality
Educators, Counselors and Therapists (AASECT) is devoted to the promotion of
sexual health by the development and advancement of the fields of sexual
education, counseling and therapy. With this mission, AASECT accepts the
responsibility of training, certifying and advancing high standards in the
practice of sexuality education services, counseling and therapy. When
contentious topics and cultural conflicts impede sexual education and health
care, AASECT may publish position statements to clarify standards to
protect consumer sexual health and sexual rights.
AASECT recognizes that people may experience significant
physical, psychological, spiritual and sexual health consequences related to
their sexual urges, thoughts or behaviors. AASECT recommends that its
members utilize models that do not unduly pathologize consensual sexual
problems. AASECT 1) does not find sufficient empirical evidence to support the
classification of sex addiction or porn addiction as a mental health
disorder, and 2) does not find
the sexual addiction training and treatment methods and educational pedagogies
to be adequately informed by accurate human sexuality knowledge. Therefore,
it is the position of AASECT that linking problems related to sexual urges,
thoughts or behaviors to a porn/sexual addiction process cannot be advanced by
AASECT as a standard of practice for sexuality education delivery, counseling
or therapy.
AASECT advocates for a collaborative movement to establish
standards of care supported by science, public health consensus and the
rigorous protection of sexual rights for consumers seeking treatment for
problems related to consensual sexual urges, thoughts or behaviors.
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This position statement is, in my
view, a crucial and inevitable step AASECT has taken at the time given the
characteristics of the clinical and social environment. This, indeed, is why I agreed to participate
with Michael Aaron, Doug-Braun-Harvey, and Michael Vigorito, in creating it at
the behest of Ian Kerner, the AASECT Public Relations, Media, and Advocacy
Steering Committee Chair. The statement
purposes are also consistent with my work as Kink-Aware Professionals Advocate
for The National Coalition for Sexual Freedom, (NCSF) a position I accepted
shortly before receiving the invitation to participate in constructing the
statement.
Context:
Elephant is all about context,
and like kink, therapy, and so many other things in social life, it is easy to
misunderstand this statement without appreciating the context from which it
arose. So that is going to require
excursions into organizational history, some discussion of the contemporary socio-political
landscape, and AASECT’s history as an advocacy organization for fuller
understanding. But let’s talk a little
bit about what the statement might or might not be intended to accomplish.
One important caveat: While I
speak as an author, and the document I helped create was adopted by AASECT, I do
not speak for AASECT, or even the other members of the task force that created
this language. The history I shall
present is as factual as I can make it, but the views are my own. I am urging readers to view my observations
critically in the interest of better therapy and social policy towards sexual
variability, but it would be naïve to assume that all readers will share the
values and assumptions that characterize this blog.
The AASECT Position Statement is
an assertion that the best scientific studies do not currently support the
theory that sex can be an addiction directly analogous to cocaine, heroin,
alcohol or nicotine. That similar neural
pathways may sometimes be shared by sexuality and other sources of pleasure and
reward, including those involved in true addictions, reflects correlation, but
does not establish causation. The
scientific evidence is also weak that one will lose erectile function or
partner desire from over-use of erotica.
These claims are the modern equivalent the 1880’s shibboleths that one
will grow hair on one’s palms or go blind from masturbation. Just last month a new study was reported that
failed to replicate the long-touted study that partners who used high levels of
erotica were more likely to divorce than those who did not. The evidence is clear that clients sometime
have problems with excessive and non-consensual sex behaviors, but not that they are ‘addicted’ to sex.
The statement is also an attempt
to reframe the inept social language that defines sex problems such as excessive
use of erotica or intimacy difficulties as ‘addictions’ because they are best
treated by the same techniques as alcohol and recreational drug dependencies. Neither is there scientific basis for claiming
we are in a public health crisis caused by erotica use that requires emergency
governmental intervention.
The position statement also
states that it is not reasonable for the public to expect high quality
treatment for sexuality problems from addiction specialists certified by
addiction specialty organizations unless those professionals also have special
training and certification in professional sexology. The clear majority of sexual problems do not
belong to the class of addictions, but are in the domain of the human sexuality
professionals.
The position statement does
confront the practice of using shame as a mechanism of social control for human
sexuality generally, and specifically and directly opposes it as a therapeutic
technique to attempt to change sexual behavior.
We made this statement confidently and assertively given the poor
scientific track record of therapies relying on shaming techniques and the
ubiquity of sexual shame in society generally which greatly risks over
diagnosis of sex as the root cause underlying presenting complaints about a
client’s sexual and intimate relations.
Thus, the position statement is
not a blanket condemnation of all certified addiction specialists, some of whom
already have, and others who are seeking, advanced competence in treating the
problems of human sexuality.
While it is criticizing the use
of the term ‘sex addiction’, it is not a blanket condemnation of all ‘sex
addiction’ treatments. Therapists, both
sex therapists and so-called sex addiction therapists, use a great variety of
techniques, and there is overlap between what good therapists of differing
theoretical orientations do. In fact, we
are confronting the use of shaming and the uncritical defense of sexual
conventionality, not specific theoretical orientations.
Neither is it an attack on other
certifying organizations, especially SASH and IITAP, which are nowhere
mentioned in the document, except in so far as they teach their memberships
based upon unsound scientific principles, and fail to require adequate human
sexuality training, or advocate for under-trained individuals to practice as if
they were certified and licensed professionals.
It is anticipated that our opposition to the use of shaming behavior in
therapy would be a bone of contention for some members of other organizations
that deem shame to be condign.
It is not an attempt to expel
persons seeking expertise in the field of human sexuality from our AASECT
community because they hold certification in other organizations whose ideology
we do not share. That not only includes
professional organizations like AAMFT, IITAP, or SASH, but religious
organizations, or diverse minority communities some of whom hold sexual views
with which we might disagree.
Immediate Context:
The immediate impetus to the
AASECT PRMA Steering Committee soliciting this advocacy document and passing it
was two-fold. AASECT evaluates the
educational programs of other organizations in the field to determine which of
our education requirements outside providers might fulfil. This work is conducted by the CE Approval
Committee led ably by Sally Valentine, which, late last year, stopped approving
sex addiction programs because they were not adequately sexologically
grounded. This raised the issue that if
we had a principled reason to this, we had an educational responsibility to
communicate to the Membership and public about it. At
around the same time, Susan Stiritz chair of the, AASECT Summer Institutes Committee, decided
that years of controversy on the AASECT listserv about sex addiction might
indicate an excellent programing opportunity. If Members wanted to talk about it so much on
the list, maybe they would pay to attend quality intensive training about
it. This simultaneously made for
excellent opportunity to teach about the change in the CE Approval policy. The Summer Institutes Committee assembled such
a great line up, I coughed up the money to go and it was the best AASECT
program I have ever attended. PRMA Steering
was moved to action because of discussion generated by the resultant program: ‘Revisiting
“Sex Addiction”: Transformative Ways to Address Out of Control Sexual Behavior’. It included a wide slice of AASECT
participants, including many who held SASH and IITAP memberships. Presenters included Eli Coleman, Joe Kort,
David Ley, Nicole Prause, Rory Reid, Neil Cannon, Ruth Cohn, Dalychia Saah and
Rafaella Smith-Fiallo, Michael Vigorito, Doug Braun-Harvey and Susan Stiritz.
Also influential in the timing of
this position statement was the deteriorating social discourse associated with
the then-current US Presidential Campaign.
Comment trolls and political flaming did not originate with this
campaign, but it is highly significant that in it, blatantly false discourse
and the promotion of strongly-held opinions as the equivalent of facts crossed
the line from internet anonymity to daily public speeches by the candidates
before thousands of partisans. In this
climate, organizations like “Fight the New Drug” have been spreading ideology
that porn is the equivalent of heroin.
The Republican National Committee put a plank in their platform that
erotica constitutes a public health crisis in defiance of STI rates, unequal
access of poor and ethnic minorities to sexual healthcare, and sexual
transmission of the Zika virus which constitute genuine public health crises. It is the professional responsibility of
AASECT to defend the practice environment in which quality sexuality education,
counseling and therapy might take place.
The position statement is part of AASECT’s response.
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| How big was the lie, Donald? "It was this big. You should have seen the one that got away"! |
AASECT History:
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| AASECT Founder Patricia Schiller, JD. Photo taken by AASECT around 2008. |
This year AASECT will celebrate
its 50th anniversary. It was founded by Patricia Schiller with the
express goal of supporting high standards in the field of sexuality
education. It was not until 5 years
later that AASECT’s mission was expanded to cover training psychotherapists and
physicians in sex therapy. Schiller
founded AASECT because, despite social changes in the 1960’s that made for increased
social discourse about human sexuality, academic institutions failed to provide
adequate graduate and undergraduate programs to train in human sexuality. The contemporary political environment made
it extremely hard for colleges and universities to secure funding and
legislative support for academic programs involving sex. That sad reality remains true even today
despite a handful of quality programs at Morehouse University, University of
Minnesota, University of Michigan, Guelph and Widener University. Sexuality education, sexuality counseling and
sex therapy remain post graduate specialties to this day, and are marginalized
and diminished as academic disciplines relative to supply chain management and
forestry because of social stigma surrounding human sexuality.
So AASECT took up the task of
certifying competence in the sexual health professions outside of traditional
medicine. This is the basis for its Continuing
Education Approval Committee needing to make decisions about what programing
has AASECT-approved sexuality content.
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| Although ratified by 35 states, the Equal Rights Amendment failed in 1979 sparking debate in AASECT about boycotting Colorado. No permanent advocacy mission was established in AASECT until 2004. |
Until 2004, AASECT had no official
advocacy function. Great controversy had
attended AASECT’s decision to hold a conference in Denver Colorado about the
time of the defeat of the Equal Rights Amendment in 1979. But efforts to officially incorporate an advocacy
function were deterred by three factors. Tax-exempt educational associations like
AASECT are strictly limited in their ability to lobby governmental officials,
and cannot generally afford to do so and simultaneously fulfil their other
responsibilities to their memberships. Because of those regulations, AASECT existed
in an agreement to carve up the domain of professional sexology with three
other organizations. The Society for the
Scientific Study of Sexuality (SSSS) handled research, The Sexuality
Information and Education Council of the United States (SEICUS) handled
advocacy, the Foundation for the Scientific Study of Sexuality did fundraising,
and AASECT was responsible for certification of professionals. In that arrangement, advocacy was another
organization’s job. Third, these
arrangements were mostly fine with sex therapists, who made up most voting
members in AASECT and were reluctant to advocate, seeing it as a role conflict
with their clinical work and a diffusion of scarce organizational resources.
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| The ACT UP die-in at The National Institutes of Health over experimental treatments for AIDS. |
But in the late 1990’s NCSF
formed and, along with the Victoria Woodhull Foundation, started exhibiting at
AASECT Conferences, gently advocating for kink and consensual
non-monogamy. GLBT members became increasingly
influential in AASECT Membership. Many
had learned that collective action and advocacy were essential to surviving the
HIV epidemic. And the practice
environments of sex educators were steadily deteriorating due to the onslaught
of abstinence-only education funded by the states and federal government. At about this time, the World Health
Organization and World Congress of Sexology (now named The World Association of Sexual Health) adopted advocacy platforms,
legitimating the argument that AASECT should advocate for sexual health too.
In this new environment, Barnaby
B Barrett, then AASECT President-elect, persuaded the 2004 AASECT Board of
Directors to create a Public Relations, Media, and Advocacy Committee with the
tasks of amending the AASECT Mission to permit sexual health advocacy, and writing
the AASECT Vision of Sexual Health. In
2006, the Board was reorganized and the advocacy function was made a permanent Board-level
position to support other initiatives that fell within the scope of the AASECT
Vision of Sexual Health. Since then, AASECT
has passed statements opposing abstinence-only education, opposing reparative
and conversion therapies, and supporting scientifically sound ideas of healthy
sexual variability. Because sex
addiction therapies have been used reparatively against gay, lesbian,
gender-nonconforming and kinky clients, these efforts involved intense
discussion whether sex addiction should be specifically named in our statements
against conversion therapies. I opposed
this as misplacing our focus: we are
against reparative therapies because they are a violation of human rights and
scientifically ineffective regardless of the treatment methods involved. But these earlier advocacy efforts were yet
another source of impetus for AASECT to address sex addiction explicitly. The formation of the AASECT AltSex Special
Interest Group in 2009 became yet another focus for some of this advocacy
discussion.
Hypersexuality , Sex Addiction, OCSB or Problem Sexual Behavior?
I will not review here the long
history of the various theoretical constructs that have been offered to the American
Psychiatric Association's Diagnostic and Statistical Manual revision
efforts. Back in the 1960’s with the
publications of DSM – II, one set, ‘nymphomania’ and ‘satyriasis’, were
mentioned in DSM – II. Hypersexuality
also had standing in the manual as a research diagnosis or component of the
catch-all diagnosis; Psychosexual Disorder Not Otherwise Specified (NOS). But AASECT is not alone in resolutely
regarding the scientific evidence for ‘sex addiction’ to be too weak and pejorative
to serve as a diagnosis. Eli Coleman has
long championed work to make some form of excessive sexual behavior a billable
diagnostic code, but his efforts had foundered in a thicket of competing
terminologies.
Back in the 1980’s, the
addictionologists and the sexology community worked together in the effort to
research, define and treat excessive sexual behavior. In their second year of joint meetings, they
even conducted mini-SAR’s to spread sophistication about sexual variability
among the two communities, but starting in the third year of regular meetings,
the addiction community decided on meeting separately and insisted on their own
terminology, much bolstered by the success of Patrick Carnes book “Out of the
Shadows”. Over time, the addiction
community became self-certifying, yet failed to incorporate sexual
science-based sexual criteria in their certification standards.
I have written extensively on
this blog about the 2014 publishing of the DSM – 5 with scant mention of
hyoersexuality and the problems this has posed for the addictions
community. For those interested, here the links follow this paragraph. But
AASECT is neither premature, nor is it taking a radical position to assert
that, even though the neuroscience is still coming in, sex addiction is not an
appropriate clinical definition of most sexual problems involving high
frequency or variant consensual sexual problems.
Finally, I chose to cooperate
with Doug Braun-Harvey and Michael Vigorito on this effort because of a crucial
concept in their writing that I believe constitutes a cornerstone of good
clinical work. Although every effort
should be made by all practitioners to ground their work in the best science,
the long history of clinical ideas illustrates that we have been providing good
quality psychotherapy with inadequate, scientifically weak, but widely
practiced treatment models. Between
Krafft-Ebing’s first modern attempt at nosology in 1886 and today, we spent the
first 66 years with no classification system at all, and almost a hundred years
without one based upon defined and observable symptoms. So modesty about our methods and care not to
abuse our clinical authority in treatment is exceeding important. Sex addiction therapy is not client-centered,
even if the client comes in with intense, ego syntonic shame and needs no urging
to adopt self-shaming labels like ‘sex addict’.
David Ley has emphasized the risk to a client’s sense of agency regarding
their sexual behavior through adoption of such labels. And overstating the power of sexual urges
feeds the shaming social discourses that underlie many clinical problems we as
sexology clinicians see presenting for treatment. Terms like out of control sexual behavior and
problem sexual behavior are appropriately atheoretical, less stigmatizing, and
appropriately modest about what science knows right now. It is an ethical cornerstone of diversity-sensitive
practice that we not employ terms that imply that we know more than we do
simply because they constitute effective marketing techniques. Such behavior is objectionable because it puts
our welfare before that of our clients.
In Summary:
This discussion of AASECT’s
Position Statement on Sex Addiction emphasizes organizational histories and
missions, changing social forces, with emphasis on the changing social
environment in which sex is practiced and discussed and in which quality
sexuality education and therapy are conducted.
This is not because gifted individuals do not deserve recognition for
their efforts to promote sexual health.
There are many heroes. But none
of these people would have been successful if their efforts were not supported
by others, and didn’t take advantage of the opportunities their times afforded
them. In the actual event, the impulse
to take a position on sex addiction came from AASECT’s program accreditation function,
their own educational programs, their commitment to supporting good educational
and clinical work for alternative sexualities, the opening of AASECT to
increasingly diverse Members and exhibitors, and AASECT’s responsibilities to
support a constructive practice environment. Ultimately, it is within AASECT's primary mission to protect the field and the public.
I participated because I believed
this is the correct step at the correct time in a long history, and I thank all
my colleagues for their support in this effort.
© Russell J Stambaugh, PhD, Ann Arbor Michigan, December 2016. All rights reserved.
Russell, this is wonderfully written. Great job. Thank you
ReplyDeleteSeveral lengthy comments regarding the IITAP response to AASECT's position statement can be found in the next post.
ReplyDelete