The purpose of this study was to examine the clinical approaches therapists adopt in working with couples in which the husbands' pornography use is an aspect of the presenting problem; and to determine variables that may be associated with clinical approaches. Ninety-nine clinical members of the AAMFT described the therapeutic approach they would adopt in response to a clinical vignette. Results show that clients are regularly disclosing pornography use in therapy, and AAMFT clinicians have received little to no training to prepare them to assist clients in dealing with problems related to pornography use. Findings also indicate that therapists' personal attitudes about pornography influence their treatment approach. Given the likelihood that AAMFT clinicians will see clients experiencing problems associated with habitual on-line pornography use, it is important that continuing education opportunities related to this topic are available and utilized.

This article examines the effect father closeness has on adult married men's non-marital sexual behaviors (e.g., sexual fantasy, masturbation, viewing pornography), marital satisfaction and family satisfaction. Participants include 993 predominantly Protestant Christian men who voluntarily completed the National Survey of Men. Using five father closeness levels ranging from very low closeness to very high closeness, a series of one-way analyses of variance were conducted using the dependent variables: Sexual Behaviors and Fantasies, Marital Satisfaction, and Family Satisfaction. Results indicate that men reporting higher levels of father closeness engage in significantly fewer non-marital sexual behaviors and have significantly higher levels of marital and family satisfaction than men reporting lower levels of father closeness. Discussion considers the role of father closeness in child and adult outcomes.

Countertransference and intersubjectivity are concepts emerging from contemporary psychoanalytic practice and transtheoretical psychotherapy that represent golden opportunities for strengthening clinical supervision. Examination of countertransference within the intersubjective matrix of client, therapist, and supervisor promises to improve clinical supervision and professional practice. Case studies addressing unresolved shame and addictive family dynamics demonstrate the clinical benefits of careful examination of parallel processes in the client-therapist and therapist-supervisor dyads. Historical antecedents and recent literature indicate directions for research and training.

Mental health professionals may erroneously assume that clients seeking help for hypersexual behavior are ready to begin working on their issues at the outset of treatment. Prochaska and DiClemente (e.g., 1983, 1984) proposed the transtheoretical model (TTM) stages of change to advance their belief that clients move through several stages when attempting to alter specific target behaviors. If a clinician gets ahead of a client by administering interventions that are improperly matched with the client's readiness to change, treatment may be prematurely terminated or high levels of resistance may be encountered during therapy. In this study, clients (N = 67) who were referred for treatment in a specialty outpatient clinic for hypersexual behavior completed the Sexual Compulsivity Scale (Kalichman et al., 1994; Kalichman & Rompa, 1995, 2001) and the Stages of Change Scale (McConnaughy, DiClemente, Prochaska, & Velicer, 1989; McConnaughy, Prochaska, & Velicer, 1983). The data collected from these measures revealed that 70% (n = 47) of clients who expressed an interest in receiving help with issues related to hypersexuality also had high levels of ambivalence about the changes they desired to make and that individuals with ADHD were significantly (chi-square, p ≤ .001) more likely to be in the contemplation stage than subjects presenting with alternative diagnoses. Implications for these finding are discussed and suggestions for future research are offered.

Controversies exist about the diagnostic concept of “sexual addiction.” The aim of this study was to investigate if German specialized sex therapists are confronted with patients who possess sexual addiction symptoms and to obtain information about diagnoses, comorbidity and treatment. A 12-item questionnaire was sent to all members of the German Society of Sex Research asking them about diagnoses, comorbidity and treatment of patients who experienced sexual addiction problems. Forty-three out of 149 members (28.9%) responded to the survey and reported about 97 patients with sexual addiction symptoms. Most common were pornography dependence, compulsive masturbation, and protracted promiscuity. Using ICD-10 definition “excessive sexual drive” was diagnosed more often in women while “disorder of sexual preference” was mainly diagnosed in men. In women neurotic (e.g., anxiety disorders) and eating disorders were most commonly diagnosed as comorbid disorders, while in men substance disorders were most commonly diagnosed. Most patients were treated by individual psychotherapy. We discuss the difficulties of the “sexual addiction” concept critically and propose an algorithm to facilitate the diagnostic process. This algorithm differentiates between the paraphilic and non-paraphilic (we use the term paraphilia-related disorder) types of excessive sexual behavior first. As a second step it includes a dynamic perspective differentiating between a progressive and a non-progressive course.

The prevalence and features of sexual addiction in sexual offenders incarcerated in a Canadian Federal prison were examined. Eighty male respondents (40 sexual offenders, 40 community subjects) completed questionnaires on sexual addiction and drug and alcohol problems. Sexual offenders were significantly more likely than the comparison group to be classified as sexual addicts. Fourteen of 40 sexual offenders (35%), and 5 of 40 community subjects (12.5%) were classified as sexual addicts. Sexual offender sexual addicts were more likely than non-addicts to report a preoccupation with sex and having been a victim of childhood or adolescent sexual abuse. However, sexual offender sex addicts were no more likely than sexual offender non-addicts to report co-morbid addiction problems with drugs or alcohol. Results are discussed in terms of their implication for the notion of sexual addiction and its relationship to sexual offending.

Wives of sexual addicts experience distressing symptoms in response to the disclosure of their husbands' compulsive sexual behaviors and often describe the disclosure event as traumatic. The results of this study suggest that a majority of wives of sexual addicts respond to disclosure with significant trauma-related distress. The data also reveal that years married at the time of disclosure and number of previous traumatic event exposures best predicted total trauma symptom severity scores. The study concluded with a discussion of the benefits of using a trauma model to understand and treat wives of sexual addicts following disclosure.

Little is known regarding how what normally might be considered positive leisure and recreation activities, may actually contribute to criminal behavior, and specifically to repeated sexual offending. Leisure and recreation are often thought to bring various physical, psychosocial, and cultural benefits to those who participate. Nevertheless, leisure as it relates to crime, in general, is often conceptualized as deviant leisure, and tends to emphasize sensation-seeking aspects of criminal behavior. However, in this article it is demonstrated via an instrumental case study that normal leisure experiences in the form of recreation potentially may, in some instances, serve to reinforce sexual assault, due to its various potential functions within a criminal behavior process. This realization is important to both practitioners and researchers who deal with treating sexual addiction and assault, and a careful consideration of leisure in specific cases warrants further attention.

A segment of the population of adolescents who sexually abuse can be classified with a pattern that may be called compulsive or “addictive.” This article will first explore the use of an “addictions view” in conceptualizing sexually offending behavior in certain adolescents, and will help to demonstrate that such a view is not at odds with current practices in treatment of sexually abusive youth. Focus is then shifted to examining how modifications of approaches typically used with chemically addicted populations may be integrated into existing sex offense specific treatment regimes. Finally, sixteen treatment strategies will be explored that may be used with the target population, and which may also have value with other categories of sexual offenders as well.

Gay male teenagers are at high risk for the development of sexual addiction. There exists a regular assault on the sexuality of gay males. This covert cultural sexual abuse suffered by these gay adolescents predisposes them to reenact this trauma through sexual acting out. The trauma model is useful in conceptualizing how to treat this population and address the post traumatic stress disorder suffered from the cultural victimization of homophobia and heterosexism.