Sex Addiction

In Sex Addiction, Dr. Goodman works with a woman suffering from an addiction to pornography. He starts by making an empathetic connection and establishing a therapeutic alliance with the client and uses mentalizing interventions to set the foundation for identifying the client’s relationship with her partner. He then identifies interpersonal dynamics by uncovering moment-to-moment emotional states that occur before, during, and after she fuels her addiction to pornography. Finally, he helps explore her family of origin relationships and how they influence her relationship with her partner. Dr. Goodman helps the client increase her awareness of her emotional states and the ways in which these emotional states influence her solitary sexual behavior watching porn, thus giving her more freedom to choose a different path. He makes sure to emphasize to her that psychotherapy is not enough to treat a sex addiction and that to stop this behavior, the patient must also join a support group such as a sex addiction 12-step fellowship program to take advantage of the peer support and accountability that such programs offer. This demonstration is framed by a discussion with host Dr. Katherine Helm.

Goodman helps his patients to use healthy relationships with others to meet their emotional needs and the emotional needs of others rather than sex addiction. To establish and maintain healthy relationships, he works with the client on understanding their own and others’ mental states (wishes, feelings, intentions) and how these are connected to how they behave toward themselves and others.

Geoff Goodman is professor of psychiatry and behavioral sciences in the Emory School of Medicine and associate professor of psychology and spiritual care in the Candler School of Theology, Atlanta, GA. He is also director of new psychodynamic programs and research and director of the psychodynamic research lab in the Emory University Psychoanalytic Institute (EUPI) and coordinator of the society and personality concentration in the Candler School of Theology.

APA videos

Cognitive–Behavioral Relapse Prevention for Addictions
G. Alan Marlatt, PhD

Relapse Prevention Over Time
G. Alan Marlatt, PhD

Working With Emotion in Psychodynamic Therapy
Norka T. Malberg, PsyD, Leslie S. Greenberg, PhD, and Michael A. Tompkins, PhD

Psychodynamic Therapy Skills
Hanna Levenson, PhD

Attachment-Based Psychotherapy in Practice
Peter C. Costello, PhD

Working With Issues in Divorce
Jay Lebow, PhD

The Core Conflictual Relationship Theme Method
Hadas Wiseman, PhD, and Orya Tishby, PsyD

APA books

The Dynamics of Infidelity: Applying Relationship Science to Psychotherapy Practice
Lawrence Josephs, PhD

Attachment-Based Psychotherapy: Helping Patients Develop Adaptive Capacities
Peter C. Costello, PhD

The Neuroscience of Risky Decision Making
Valerie F. Reyna, PhD, and Vivian Zayas, PhD

Working With Emotion in Psychodynamic, Cognitive Behavior, and Emotion-Focused Psychotherapy
Leslie S. Greenberg, PhD, Norka Malberg, PhD, and Michael A. Tompkins, PhD

Deliberate Practice in Psychodynamic Psychotherapy
Hanna Levenson, PhD, Volney Gay, PhD, and Jeffrey L. Binder, PhD

Sex and Love in Intimate Relationships
Robert W. Firestone, PhD, Lisa A. Firestone, PhD, and Joyce Catlett, MA

Other suggested resources 

Carnes, P. (2001). Out of the shadows: Understanding sexual addiction (3rd ed.). Hazelden.

Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. Other Press.

Goodman, G. (2010). Therapeutic attachment relationships: Interaction structures and the processes of therapeutic change. Jason Aronson.

Katehakis, A. (2016). Sex addiction as affect regulation: A neurobiologically informed holistic treatment. Norton.

Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry, 21, 189-213.

Sharp, C., & Bevington, D. (2022). Mentalizing in psychotherapy: A guide for practitioners. Guilford Press.