Counseling in Vienna by Richard L. Fellner

Contents: IntroductionDetection and Diagnosis of 'Sexual Problems'Most Common IssuesCauses for Sexual IssuesStructure of Sex TherapyFeesEpilogue

"I just can't get enough." - The Sex Drug.

Interview about "Sex Addiction" / Hypersexuality

Does the "sex addiction" really exist as a dysfunction, is it scientifically approved?
Where's the difference to "Hypersexuality"?

In colloquial speech, the term "sex addiction"* is often already applied if someone just enjoys sexuality freely and intensively. Often this can be explained with one's rigid system of norms and values, which is strongly influenced by Christian moral concepts, especially in western culture. As someone who deals with people who suffer from partially tense psychological strain and their quality of life reduced, I don't just consider this term as unexact, but considering its regular use, also as inappropriate and deprecative.

From a scientific-psychological view, under the more adequate term "hypersexuality", we understand a dysfunction requiring appropriate treatment, which can impose considerable psychological strain. Like the so-called "Computer/Internet Addiction", which I started dealing with more than 10 years ago on a professional basis, it belongs to the group of non-substance based addictions.
Sexuality occupies a great deal of thoughts and behavior during everyday life, caused by an excessively increased sexual drive. Affected people are constantly looking for sexual satisfaction, can rarely build personal bounds relations to their respective partner, can rarely experience a sexual climax or a long-lasting sexual satisfaction (sometimes no satisfaction at all). The unsatisfactory feeling right after their sexual experiences virtually forces them to continuously desire for new sexual experiences - even if just on a virtual basis.

Typical symptoms which are associated with dependency occur:

Unfortunately, there are no reliable numbers about the prevalence of hypersexuality. Based on my own professional experience in Europe, I'd estimate for about 1-3% of men and 0.5-2% of women suffering from hypersexuality at least once in their lives."

*) other often used (and partially outdated) terms are "Satyriasis" or "Donjuanism" of the man, "Nymphomania" of the woman or "sexual mania" (for both genders)

Do we have similar clinics like in the USA* here, where people can be treated?

David Duchovny

"No, I didn't hear of any. Actually, I guess that the existence of such facilities can rather be explained with the business sense of clever clinic managers than on factual requirements for successful therapy. In difference to substance-based addictions, there is no need to protect hypersexuals from their social environment, and there are no 'capabilities' that would have to be trained or teached.
According to my experiences with all patients so far, an ambulant therapy is very sufficient in order to achieve good and longterm success with regard to lasting exemption of compulsive induced sexuality."

* (allusion to a similar therapy Hollywood actor David Duchovny was undergoing in 2008 in a rehab clinic in Arizona; this treatment was mentioned in another part of the magazine supplement)

What happens during such a therapy?

"The goal -like in any other addiction treatment- is the reacquisition of the ability to say 'no' - to self-harming behavior patterns. But in order to achieve that, it is crucial to understand the interdependencies of one's own addiction: what 'makes me' dependent, what 'presses' me to go 'hunting' over and over again? That's an essential question especially with non-substance-based addictions, since there's no organic dependency. The sufferers first have to gain control over their lives again.

The basis and an essential part of the therapy is the therapeutically guided dialogue, which will focus on the jointly search on interrelations and the development of strategies for solutions. Occationally - if my clients want to make use of it - I offer hypnotherapy sessions as a supplementary 'tool' and ask to do certain 'homework' like observations or experiments which might help to make new experiences and get new ideas.

Often, quite a good stabilization can be achieved within a few months of regular psychotherapy / counseling sessions (in ambulant context, no clinic stay is required). Sometimes, even a total relieve of burden is possible. To reach permanent relieve of the psychological pressure, as with any form of addiction it's crucial to consequently push through these counseling sessions on a regular basis."

What happens psychologically during a 'sex flush'? Do sex addicts permanently think of sex?

"There's a wide range of hypersexuality: some people are even reacting strongly on physical key amenities (like tantalizingly dressed women or the atmosphere of redlight districts) and create an almost unsatiable desire for sexual activity, others are living a very normal life, but their thoughts are occupied by their next holiday or sex trip on which they will act very much driven to catch up for everything they feel they missed during their 'regular' life.
The common ground within this broad range is the strong orientation on sexual activity, which sex 'addicts' invest a considerable amount of their viability, their mental-, time- and financial resources. Some hypersexual clients are living a very modest and even frugal life, but invest enourmous amounts of money in the context of real or hoped for sexual encounters. Outsiders or friends often ask themselves whether their lives are ruled by anything else than basically just sex."

What's the definition for 'sex addiction' - i.o.w., where is the borderline between strong virility and addiction?

"This borderline is in fact hard to define, since sexuality is strongly co-determined by hormonal factors different between people. Some men are not just mentally but also physically feeling very uncomfortable if they can't sexually 'relieve' themselves at least twice a week, while for others it's no problem at all even to go without any sexual activity for several weeks or months. For women, drawing the borderline to purely physiologically caused desires is even more difficult.
According to the diagnostic specification schemes like the ICD-10, hypersexuality is defined as 'excessive sexual drive' by diagnostic key F52.7, just like 'habit and impulse disorders' (F63.8). Quite often, other disorders, particularly so-called 'sexual dysfunctions' are diagnosed as well.
Pornografie-Konsum These symptoms occur in the behavior patterns described before, especially the extraordinarily intensive occupation with 'all things sex', addictive sexual behavior while neglecting other areas of life and social relationships (like family, friends and job). If sex is out of reach for any reason, affected people often uncontrollably try to compensate for it by surrogates like pornography, telephone sex or excessive masturbation. Orgasms often just provide momentary relief or no satisfaction at all.

In the diagnostic scheme DSM IV (used in the USA), hypersexuality is classified in the group of impulsive sexual disorders. However, it's not explicitely defined and thus not diagnosable as a standalone disorder. Since it's not diagnosable, health insurances typically don't pay for it in the USA."

What are catalysts for hypersexuality - is it heritable?

"Hypsersexuality or sex addiction is most often a purely mentally caused problem and not heritable.

As a systemic brief therapist, the term 'heritable' has a double meaning though: behavior patterns can absolutely be passed down through generations, which we also see in the affinity to paraphilias (sexual deviant behavior). Indeed, there's often a deviant relationship towards sex in the personal history of affected people - often, there was strong tabooing of sexuality by parents or formative incidences in their lives (not necessarily related to sexuality, it could as well have been traumatizing experiences or continuously straining living circumstances indirectly activating this behavior). There are also potential organic causes for hypersexual behavior, like dysfunctions of the adrenal cortex or the pancreas, a damage on the temporal lobes, certain pharmaceuticals or drugs, but stages of hypersexuality may also occur during puberty and as a side symptom of bipolar disorders."

What do you suggest to hypersexuals?

"Moral concern, as often expressed directly or subtly by the environment, is out of place and doesn't help the affected at all.
Self-assessment can be done by asking themselves whether they harm others by their behavior (by playing around) and by estimating the emotional or financial cost their behavior is involving (like by frequent visits of prostitutes or neglecting other spheres of life). Like with other forms of addiction, self-disclosure is often distorted, while own behavior will be idealized, rationalized or simply blanked out.

Hypersexuals often practice their behavior in quite obsessive ways for many years, and in most of the cases only seek support when "sich der Karren bereits viel zu tief in den Dreck gegraben hat", as a client recently said about himself. Only at the point where serious health problems occur, the marriage is threatened, financial problems are causing nightmares or sexual dysfunctions have turned into a regular nuisance, affected persons would look for therapeutic support. I'd wish that these men or women don't just restrict their wide range of possible experiences just to the ones related to sex, but to open their views for the 'life outside there' as well, to get rid of and emancipate from their addictions and regain complete control over their own actions again. Simple steps can support to achieve this goal, carefully aimed and funded therapeutic support by a sex therapist or a psychotherapist can do so as well. Every step that helps to reachieve true inner freedom and satisfaction with life is a step one will be able to look back on with positive feelings."

(Interview 09/2008)

 

DSP Richard L. Fellner is psychotherapist, sex therapist and counselor in Vienna.
Reproduction permitted, but only correctly quoted.
For fullquotes / complete reproductions, please ask the author for permission.

1 "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (official definition of 'health' as in the Constitution of the World Health Organization (WHO) signed on 22 July 1946 by the representatives of 61 States; this definition has not been amended since 1948.)
2 Austria: § 212 Abs. 2 StGB, Switzerland: Art. 193 Abs. 1 StGB, Germany: § 174 c StGB

Related keywords and terms: Hypersexuality, sex addiction, Sex Therapy, Sexual dysfunctions, sexual problems, low sexual drive, appetence disorder, Orgasmusprobleme, Orgasmusstörungen, vorzeitige Ejakulation, Ejaculatio praecox, Vaginismus, Beratung, Supervision, Therapie

 

DSP Richard L. Fellner is a psychotherapist, sex therapist and counselor in Vienna (Austria) and Thailand.
Reprints welcome , but only if correctly quoted.
Full reprints or quotations require a formal permit of the author.

1 "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (official definition of 'health' as in the Constitution of the World Health Organization (WHO) signed on 22 July 1946 by the representatives of 61 States; this definition has not been amended since 1948.)
2 Austria: § 212 Abs. 2 StGB, Switzerland: Art. 193 Abs. 1 StGB, Germany: § 174 c StGB

Appendix: literature about this topic, with reader comments: