Hello there! I’m Ash Rehn, counsellor and therapist at Forward Therapy. Please take a look around the site and discover how counselling and therapy over the Internet can be confidential, comfortable and so much more convenient.
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Help for pornography addiction is a therapy topic I am regularly consulted about. I’ve been working with ideas and strategies associated with ‘porn addiction’ for a number of years. I’ve had therapeutic consultations with many individuals, particularly men, concerned about their use of sexually explicit websites, videos and images.
Recently I completed a series of online counselling appointments with a man who had been struggling with what he described as an addiction to pornography. I am always careful to maintain the confidentiality of people who consult me but this particular man invited me to share the story of our work together. I’ve changed his name and any identifying details to protect his privacy.
When he initially contacted me over email, Frank wrote that he wanted his life back. He had been spending hours, sometimes almost all his weekends, in front of his computer, feeling compelled to look at pornographic websites. At our first appointment, he spoke about the importance of ‘getting it out in the open’ and his hope that this might help. Thinking about how things had changed or progressed since our first meeting Frank remembered the feeling of not being in control,
I was feeling very fatalistic, I was trapped in a hole. Every weekend I felt it was something that I had to do or was compelled to do and afterwards you feel so bad about yourself.
Something that comes up quite regularly in my work with people around pornography and sex ‘addiction’ is the idea of trying to ‘control’ the use of pornography. Many therapists and psychologists appear to be in favour of people trying to control themselves by putting boundaries into place around their porn use. However by all reports this just tends to flare up the ‘Addiction’. Frank and I worked together over webcam for a number of months. At our last appointment, I asked him about the benefit in us having this connection over time.
You can only tell a person things, but they have to go through it. I went over in my head what I wanted to say. And a few things you said that opened the blinds. For example, that I didn’t need boundaries when I was younger. I didn’t always have to do stuff like that.
Here Frank was referring to masturbation. During one appointment we had a conversation about the choices he made about masturbation when he was a younger man. There had been times Frank chose to masturbate and times that he decided not to. In other words, even as a teenager, Frank had been capable of making his own decisions about sexual expression. If you take a wild animal and put a cage around it, the first thing the animal will do is to try to break out of the cage. I don’t make people construct rules for their pornography use. This is something they have generally already tried before they come to see me and it has often not worked.
I often encourage people to step back and just watch the ‘Addiction’ come and go without intervening. In doing so, I am inviting the people who work with me to become co-researchers in the problems in their lives. Of course many people start off by assuming the therapist will be an expert or source of all the answers or even an authority figure. This is how therapists are popularly portrayed but it isn’t generally such a helpful idea for a couple of reasons. Firstly, while there might be similarities of experience, everyone has a different story as to how they came to be using pornography and why they want to stop. And of course, if there was a manual or technique that worked for everyone, it would be sold at the newsagent!
When Frank started making his own observations about the ‘Addiction’ he began to notice times at which it was more likely to ‘take over’ and times at which it took a back seat. He was also in a position to reflect on how he wanted his life to be. He spoke to me about ‘missing out on a real life’, how the time looking at porn was time that he could be doing his sport training and what his family meant for him. He talked about wanting to get back to having respect for his body. This was something he had valued quite early in life but seemed to have slipped in recent years. At the same time, he started to get a new perspective on masturbation.
I don’t have to be scared that it is going to kill me.
Frank started talking about having used pornography as a kind of conditioning he had done to himself. He had got into a pattern around sex and was relying on that. And this gave us the idea that if he had been conditioned to using porn, perhaps it was just a case of re-conditioning himself, like a motor can be re-conditioned, or an athlete can condition himself. These were metaphors that came from the realms of mechanics and sport, both of which were interests for Frank.
As our webcam counselling appointments continued, Frank shared with me some of the discoveries he had made during his re-conditioning…
I’ve started talking to more people. The interaction with people, having a laugh and joking, it’s so much more…
I don’t see it as a major part of my life, or casting a shadow.
The Australian narrative psychotherapist and author Michael White writes about taking up a position outside the language of psychiatry and working with people to identify ways in which their own lives are knowledged. For me this means creating opportunities for people to talk about their lives in ways that reflect they are able to do something themselves.
For most adults, the experiences of life goes back a long way. But without assistance we don’t always easily recall those times in our lives where we had a sense of ourselves as capable or skilled or in control. Narrative Therapy conversations about pornography use or ‘sex addiction’ can help people recover the sense that they have some authority over their own lives again.
Frank talks about how the work we did together was a journey for him.
You get too frustrated with yourself. You get frustrated that you are not chatting up these women, you are not working out. But you have to realise if you just be patient with it, it will change. It takes time. For me that was an important part. A step by step approach. Take it step by step and more and more you will feel less frustrated with yourself.
If you are concerned about the amount of time you spend using pornography or looking at erotic or adult-oriented websites and would like to make some changes, contact me through my email form to arrange a private online consultation.
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by Niclas Ericsson.
Have you ever wondered if you are addicted to sex? Or have you had anxiety because you could not seem to stop surfing porn despite trying? In this case you are not alone. It is not uncommon for gay men to seek help for what they perceive as sex or porn addiction.
Maybe it was the Hollywood actor Michael Douglas who first gave sex addiction a face. When his marriage to Catherine Zeta-Jones came under strain and she accused him openly of being sex addicted, Douglas enrolled in a clinic for treatment and the tabloid press revelled in the details.
Since then, numerous celebrities, mainly in the United States, have identified themselves as sex addicts. Best known is perhaps the golfer Tiger Woods, whose recent affairs caused his Swedish wife Elin to seek divorce – despite the fact that Woods also enrolled in a rehabilitation centre to treat his “sex addiction”.
In the wake of celebrity scandals and media interest in the phenomenon, sex addiction appears to have become almost popular. Tabloids offer checklists to “test if you are a sex addict” featuring questions such as “Have you had sex with someone even though you did not want it?” and “How many partners have you had?”
If you Google sex addiction and treatment you will find a few million hits. CBT – cognitive behavioural therapy – and medication are standard treatments in conventional care. Others choose to go through a twelve-step program for addiction, like the model Alcoholics Anonymous uses.
There are also therapists who specialize in issues concerning sex and sex addiction. One of them is Ash Rehn, who has 20 years experience working with counselling and therapy with gay men. He practices online through webcam and instant message and has clients across the world.
“I estimate that 30 per cent of my clients, straight and gay, turn to me to talk about sex addiction or porn addiction. But that is to do with the fact I specialize in it,” says Rehn.
The term sex addiction is quite problematic, he says – not least for gay men.
“Gay men often have a lot of negative feelings to overcome in order to feel comfortable with their sexuality. Most have been exposed to many years of implicit messages telling them they are not as good as heterosexual men. Or they have been told that the sex they like is ‘wrong’ or ‘unnatural’ in some way.”
Rehn says that when he grew up in Brisbane Australia, homosexual acts were still prohibited by law and could lead to 14 years in prison. And although there is now legislation to protect gay rights in many countries, he believes that young people growing up today are still influenced by the idea that homosexuality is lower status than heterosexuality.
“There is a strong tendency to condemn gay men, and this can become like a judgmental voice they hear in their head if they compare themselves with norms or have more sexual partners than the average heterosexual person.”
“Sex is not a problem in itself. But if something we are doing is getting in the way of our intentions and hopes for our life, then it may be a problem for us.”
According to Rehn, there are many gay men who reject the concept of sex addiction or laugh at it. And what we mean by addicted in this context is actually unclear. In strict medical sense, people cannot become addicted to sex in the same way as, for example, heroin.
“Is it about biochemical reactions in the brain? Or is it about behavioural patterns? Or is it just something that is difficult to stop? Even the idea of sex addiction is very confusing,” explains Rehn. “Sex addiction or porn addiction can easily become labels we paste on people, but they do not really say much about the nature of the problem.”
“The differences from person to person are much greater than the similarities. The shared experience might be that it is hard to stop watching porn. But the unique experience might be a man who is trying to finish his masters’ degree and not getting the work done because he keeps looking at porn. Or it could be a man whose boyfriend refuses to let him look at porn, so he does it in secret and then feels guilty about having lied to his partner. Someone else might feel that looking at porn is taking away from making a connection with other ‘real’ men. And this man might want that connection more than anything else in life. Yet another man might see nothing wrong with porn but live in a country where he could face the death penalty if he is caught watching it. So there are many completely different stories.”
Rehn is interested in the way people transform their life stories and make meaning of the events in their lives.
“We make sense of our lives through the stories we tell ourselves and others. Say you meet someone you’re interested in. You might tell yourself a story like I’m not good enough for him, but I’ll still try to get him to like me. Or you might say to yourself This is the man I’ve been waiting for my whole lifetime.”
“Sometimes we construct meanings of failure or shortcomings, sometimes meanings of courage, or success. But they are always stories we construct so we can also deconstruct them and rebuild different stories.”
One of the significant aspects of Rehn’s approach is to avoid seeing a problem as located within a person.
“If we see the problem as part of the person, that often leads to very negative feelings when that person blames himself. In addition, a man might feel that he really is stuck with this problem, because it’s part of him. So how can he change the situation?”
Rehn’s way to work is to externalize the problem, so that a person can have a relationship with it.
“In my experience, therapeutic conversations take a different turn when we start talking about what these men really want in life instead of what they don’t want. Often I ask them after a few sessions ‘by the way, how’s the porn addiction?’ and then they can say ‘it’s weird, because I have not even watched any porn recently’.”
Are there some criteria for when a person’s sexual behaviour really becomes a problem?
“Good question. For me as a therapist something is a problem when the person who contacts me sees it as a problem. I do not make diagnoses or tell people that they have – or don’t have – a problem. Instead I ask them why this is a problem for them. The way I see it those who turn to me are the experts in their own lives. My role is to help them investigate the problem, rather than just pasting a label onto them that says ‘addict’. That doesn’t actually say very much. Another problem with the label ‘addiction’ is that it can lead to feelings of shame that paralyses a person or has them denying responsibility with reasoning such as ‘I can’t help it, I am addicted’.”
So what about someone who wonders whether his Internet habits and sexual behaviour are a problem or not? How should someone proceed if they are not sure?
“I might say this: ‘Do you think this is becoming a problem for you? Can you tell me more about why this is a problem?’ Or I might ask: ‘Has something happened recently that made you think that this is a problem?’ I let people call things what they want. So if someone contacts me and wants to talk about his ‘sex addiction’ we use those words.”
Rehn does not think problems related to sex or pornography are a new thing. What is new is the idea of a ‘sex addiction’. It has become increasingly prevalent in the media especially the last five years.
Why is it that that we are so happy to accept such concepts if they are not really telling us so much?
“I think partly it is about media and that we have a tendency to want to put labels on things. We live in an age where ‘normal’ has become the new god. We monitor ourselves all the time so that we do not move too far away from the ‘normal’.”
“There is also always an alternative story,” says Rehn. “Those who have problems with sex or porn have always tried to do something about it. They have really tried to quit. Often it has been a very difficult time and they have felt really bad. So putting a label on the problem can be a relief. Having a label may be an explanation for them. It’s just that the label cannot provide the solution to the problem.”
The question whether sex addiction exists or not is perhaps not so important after all. It is up to each individual to define what he thinks is a problem in his own life. And there seem to be many forms of assistance and therapy for those who feel that sexual behaviour or surfing porn has begun to take over too much of life.
(This article originally appeared in Swedish on the website www.sentry.nu in September 2010)
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Have you ever found yourself thinking about a particular person who lives across the hall, across the street or on the other side of the world and who has it better than you?
They have more money, a better job, or a love-life you yearn for. You envy their talent or looks. You watch them and wish. You work hard. Maybe you find yourself struggling. Or failing.
The criteria for success – success in work, in relationships, with our bodies – seems to be well documented in newspapers, magazines, on television and websites. We are surrounded by the promise of more and are constantly told how to make goals, enhance our performance and get the most out of life. Meeting these expectations isn’t easy and can be stressful. And even if we do achieve what we set out to achieve, how often is it that we forget to acknowledge that because we are too busy striving for the next goal?
Is the grass greener on the other side? There is a difference between being inspired by the possibilities of life and being trapped by our own or others expectations. When we are constantly measuring ourselves against standards of success, we become our own harshest critics. Not measuring up to perceived expectations can have us in the lows of despair or the throes of anxiety.
Comparing ourselves to others is something that is generally encouraged in modern life as a way of ensuring we are ‘normal’. Being ‘normal’ is considered to be a way of achieving social acceptance and self esteem.
But comparing ourselves to others also can leave us feeling as though we simply can’t measure up to what is regarded as normal. We can end up feeling deficient or disturbed in some way. Similarly, we might even want to prove we are better than average and can achieve beyond the norm. This dissatisfaction, and the search for relief from it, supports a huge industry of self-help publishing and seminars, psychoanalysis and cognitive behaviour therapy.
If we are lucky, while we are desperately trying to measure up, we start to question whether there is a point to it all. This questioning is the beginning of awareness and may even lead us to step back and start to look at what is really important to us. We can start to realise that desire for more leads to a kind of blindness that has us only noticing certain things about certain people. We might start to see that we can easily lose ourselves or get stuck in normality.
Stepping back provides a way of appreciating what we already have. Practically, there are different ways to do this. Meditation is one technique as are Mindfulness practices, which are akin to meditation ‘on the go’.
Another technique is to open our eyes and really draw in the world around us. For example, we can take a walk down a busy street and just look at people. We can look at everyone, not just the ‘attractive’ people. And rather than looking at people with a critical eye, we can try to approach the act of observing others with appreciation. All around us are ordinary people living extraordinary lives. How often do we notice them? And how often do we acknowledge the extraordinariness of our own lives?
There is a skill to the art of contentment. It takes practice and appreciation. Therapeutic conversations can help too. When we verbalise our thoughts, we give life to ideas. When, through a dialogue with someone else, we hear our ideas resonate with another’s experience, it affirms that we are onto something.
Contentment is a conscious choice. It is about seeing what is present rather than what is not, appreciating what we already have and who we already are and celebrating that uniqueness. Contentment is looking at the detail and finding the extraordinary within the everyday. Acknowledging the miracle of each moment.
Please make a link to Forward Therapy from your website if you are inspired by these ideas.
More more information or to make an appointment, Contact me.
Despite the best attempts to try to regulate counselling practice and therapy, paying for any service will always be, to some extent, a matter of ‘let the buyer beware’. A professional online counsellor or therapist will only work within his or her competencies. If you are considering online counselling, you can make some enquiries of the practitioner that may reduce the risks involved.
Choose a counsellor or therapist who is a member of a reputable professional association and has insurance to practice. Membership of a professional body means the practitioner has some degree of accountability for their work. You can also check with the association to ensure they are who they say they are.
If you have any particular concerns, write them down and send them to the therapist or ask for a preliminary conversation to discuss these issues. These may include matters like qualifications, privacy and confidentiality, technical problems and payment. I encourage people to shop around for a counsellor or therapist they feel comfortable with, just as you would do if you needed to choose a new doctor, mechanic, decorator or architect.
In terms of who an online counsellor should and should not see, there are no hard and fast rules for this. In my own practice, I do not make myself available to people who are at any significant risk of personal danger or if there is extreme urgency to the situation. I work with individuals and couples from all around the world so I am not in a position to easily engage local emergency services. If the situation is one of domestic violence or recent sexual assault for example, I direct people to contact a GP or their nearest public hospital. Medical professionals and institutions are usually much better resourced to find the most appropriate help for anyone in such a situation.
You don’t need to be isolated or disabled or even short of time to choose an online therapist. Meeting with a therapist or counsellor over the Internet can be just as effective as consulting a practitioner who is in the same room. Online counselling is suitable for those who want to discuss anxiety or depression, relationship issues, sexuality concerns, confidence, shyness, addiction, career problems, burnout or difficulties with life direction and purpose. In fact almost anything you might talk about with a therapist in person can be explored with a competent and professional online therapist.
Thinking about going ahead with online counselling? You can send me an email. I welcome your comments.
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Some people are highly critical of long-term therapy. To others, ongoing conversations with their psychotherapist might be as frequent and regular a visit as to their motor mechanic, hairdresser or fitness centre. How effective is long term therapy and how is it different to seeing a counsellor for a limited amount of time?
Long term therapy often is equated with psychotherapy and even a belief that the therapist will be analysing the person to reveal deep seated ‘issues’ that may take years to uncover let alone resolve. People speak of being ‘in therapy’ or even ‘in analysis’.
In the short term, therapeutic relationships are often referred to as counselling. Some people assume counselling is about the counsellor just listening, and indeed some practitioners might do only this. More recently, the elevation of CBT as a preferred approach by health authorities has established the idea of counsellor or therapist as a kind of teacher of skills or techniques.
But is there really such a difference between what happens during long-term and short-term therapy? The idiom ‘how long is a piece of string?’ comes to mind. When exactly does short-term counselling become long term psychotherapy?
In thinking about the difference between long term and short term therapy, we can start by asking what ideas are influencing us when we ask this question.
In both the examples above, the practitioner is the expert and the person attending therapy is very much a subject of treatment. Most therapists have been through training courses aligned with this model. They have learned certain strategies to approaching problems, even formulas for addressing particular ‘issues’ or diagnoses. Some of these are traditionally associated with psychotherapy, some with counselling. Many practitioners are very clear about what constitutes long-term therapy and what is the realm of short-term counselling.
But could these definitions get in the way of the effectiveness of the work?
For me, the role of both therapist and counsellor is about opening up a space where people can make meaning of their lives. There isn’t a formula to this or a set time-frame required. Similarly, the therapeutic relationship is a collaboration where the therapist can also have permission to ‘not know’. This is the creativity of the therapy space.
I recently heard a story of someone who met with a psychologist for an initial appointment and was told that ‘the treatment’ would take 2 years. Now I wonder, how did the psychologist know this?
Because they have experience in working with people, psychologists, counsellors and other talk therapists can have a sense that some conversations might take longer than others. But they never really know when the work will be ‘finished’ for the person who meets with them. As I mentioned previously, I don’t believe there is a ‘formula’ that can be applied with any guarantee. As much as we hear and would like to believe promises such as “proven to increase self esteem” or “guaranteed to build confidence”, these promises locate therapists back in the expert position which, in terms of effectiveness of the therapy as a creative space to explore and construct meaning, might not be a particularly useful place for the therapist to be!
Even this concept of ‘effectiveness’ can be questioned. What are the expectations of the therapy space? What invisible promises does it suggest? These are subjects that can be explored in initial appointments. Making hopes and expectations visible can help to give us an idea about the length of time we want to continue meeting and what might be possible in the time available.
No doubt building a relationship of trust can take time. Someone who has previously met with a counsellor or psychotherapist, and felt this to have been a positive experience, often finds it easier to talk than someone who has reservations about what might be ahead or bad memories of unpleasant experiences of therapy. These are also helpful things to discuss early in a therapeutic relationship.
I liken narrative practices to rebuilding or renovating aspects of our lives. Sometimes it is necessary to start with a bit of de-construction: what does ‘getting closure’ look like if you are doing it? If we took apart ‘self-esteem’, what might we see it to be comprised of?
There might also be some redesign required. Before we start to reconstruct, it can be worth exploring some alternatives or the expectations behind the plans we have for our aspects of our lives.
Often our ideas, particularly psychological ideas, are so familiar that we do not stop to notice them. What evolves from these conversations, and how effective we judge them to be, depends on the relationship we develop with the therapist and, of course, the approach we take in the therapeutic space.
Want more information about long term therapy? Send me an email and we can talk options.
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