Pornography, Cultural/Religious Shaming, and Compulsivity/Addiction
As digital technologies become more ubiquitous and porn usage becomes more prevalent, clinicians, especially Certified Sex Addiction Therapists (CSATs), have seen a corresponding increase in the number (and variety) of people seeking help with porn-related problems.
Importantly, there are multiple and often very different populations seeking such assistance. For instance, some clients seek treatment because they are compulsive/addicted, while others seek treatment because they feel shame (cultural, religious, or interpersonal) about their porn use. Still others seek help for porn use that is symptomatic of underlying mental health issues like Bipolar Disorder, OCD, and Depression – an issue I have written about previously at this link.
Unfortunately, all of these populations may self-identify as compulsive/addicted, even when they’re not.
Needless to say, these differing porn abusing cohorts, while seeking help for the same basic behavior, can have very different treatment needs. This means that addiction treatment (as provided in my Seeking Integrity programs) is appropriate and effective for those who are truly compulsive/addicted, but not appropriate or effective with individuals whose primary issue is shame tied to their use of pornography.
Admittedly, individuals in each of these groups arrive in treatment unhappy about their use of pornography, often to the point where they report severe depression or debilitating anxiety. They are all displeased with their sexual fantasy lives and the way they’re living them out. They also tend to keep secrets and lie about their porn use. But this does not mean they’re all struggling with the same issue. For example, shame-based clients, rather than being compulsive/addicted, may simply be applying a self-diagnosis of compulsivity/addiction as a way of explaining and justifying sexual fantasies and behaviors about which they feel deep emotional discomfort.
Recognizing this, therapists should never automatically accept any porn using client’s self-diagnosis of compulsivity/addiction. To do so would be a disservice to both the client and the psychotherapeutic community. Proper clinical assessment is always required.
Shame-Based Porn Users vs. Addicted Porn Users
There are two primary categories of shame-based porn users. First up is the person whose social, religious, or moralistic belief system vilifies pornography (and, perhaps, sexuality in general). Research tells us that religion, especially strict/conservative/sexually repressive religions, is the primary culprit. For example, one recent, relatively large-scale study found that religious beliefs lead a meaningful percentage of people to believe they are addicted to pornography, even when a proper assessment clearly indicates they’re not.
A typical client of this type is a young man with a strict religious background who looks at porn occasionally, maybe a few times per month for no more than 30 minutes. Though porn use does not directly affect his day-to-day functioning, he feels horrible about the behavior because his church, his family, his friends, and pretty much every other important person in his life says that viewing porn is sinful. Now he believes he is addicted to porn. Otherwise, why would he use it?
The second type of shame-based porn user seeks treatment related to ego-dystonic sexual attractions. A typical client of this sort is a married, supposedly heterosexual man who feels great shame about his use of gay or trans porn, which he looks at occasionally for short periods of time with no direct effects on his day-to-day functioning. However, his self-esteem is damaged because the porn he looks at leaves him feeling like he’s “less than a man.” Now, he’s deeply depressed. In therapy, he may blame his same-sex fantasies and behaviors on porn compulsivity/addiction, likely because he sees that as the lesser of two evils. He seems to think (or wants to believe), “I only look at porn with men and trans-women because I’m an addict. If I wasn’t addicted, I wouldn’t have these desires.”
At this point you may be asking: Is it possible for a shame-based porn user to also be addicted? The answer to that question is yes, absolutely. But only if that person’s behaviors meet the criteria used by CSATs to properly assess for porn compulsivity/addiction. These benchmarks are:
- Preoccupation to the point of obsession with pornography.
- Loss of control over the use of pornography, generally evidenced by multiple failed attempts to quit or cut back.
- Real-world consequences directly related to out of control porn use, including damaged relationships, trouble at work or in school, loss of interest in previously enjoyable hobbies and activities, social isolation, lack of self-care, declining physical and emotional health, sexual dysfunction with real-world partners, financial struggles, legal issues, etc.
The Need for Proper Diagnosis
Neither of the shame-based clients described above meets the criteria for porn compulsivity/addiction, and no therapist should treat them as such. Instead, therapists should try to help these individuals normalize, accept, and integrate their sexual desires and behaviors so they don’t feel so much shame, and to then reconcile their desires and behaviors with their social, religious, and interpersonal ideals. In short, clinicians should try to help these clients find a sexual comfort zone, which might or might not include future porn use. More importantly, if/when such clients attempt to self-label as compulsive/addictive with pornography, therapists should educate them as to the nature of that disorder vs. the issue(s) they are reporting.
In truth, treating either of these non-addicted individuals for porn compulsivity/addiction, using the techniques that have proven effective in that regard, would be counterproductive, inadvertently reinforcing their mistaken belief that their attractions and behaviors are abnormal, sinful, or whatever else it is that they feel shame about. And that, in turn, would almost certainly deepen their presenting symptoms (depression, anxiety, lowered self-esteem, and the like).
At the same time, trying to treat a person who really is compulsive/addicted with porn by helping him feel better about (less shamed by) his or her porn use can be equally damaging, as this approach may be interpreted as encouraging the obsessive, out-of-control activity that’s creating problems in the client’s life. It’s a bit like telling an alcoholic, “Oh, don’t worry about it. Everybody has a cocktail once in a while.” Such an approach willfully ignores the addict’s loss of control and the resultant negative consequences. So, once again, when dealing with clients seeking treatment related to their use of pornography, proper assessment and diagnosis is a must. Without it, clinicians can do more harm than good.