Sex & Love Addiction Video Interview - Expert Series

Interview with Tanya Fruehauf, MA. Canadian Certified Counsellor and Certifed Sex Addictions Therapist.

A full written transcript of this interview can be found below

00:02 Constance: All right. So, hi everyone. My name is Constance Lynn Hummel, and welcome to Westland Academy's guest expert interview series. And today we are so lucky to be speaking to Tanya Fruehauf, and she is a clinical counsellor in private practice at Catalysts Counselling in Vancouver, BC, where she specializes in relationships, trauma, and addictions, and that includes love and sex addiction. So welcome, Tanya.

00:28 Tanya: Thank you, Constance.

00:29 Constance: Thanks for being with us.

00:30 Tanya: It’s good to be here. Thanks.

00:33 Constance: So before we dive into the real specifics of the work that you do, we would just love for you to maybe share with the community a little bit about your background and what really drew you to this area of relationships and codependency and addictions.

00:48 Tanya: Okay. So it's pretty multifaceted. I have a very varied background, so to speak. So, I think what I can first say is that I was always interested in relationships. I found myself over the years watching movies that could be sort of an adventure movie, and I was always really caught up with the relationship plot line. So I was always like, ‘Well, the world is ending, but oh my god! What about the relationship, and what are they going to do?’ I was always really preoccupied with that part of movies, and I would just sort of be like, ‘Well, that's kind of curious. I think that’s an interesting thing. So, there was always that kind of natural inclination towards wanting to understand what makes relationships work, just the ins and outs of relationships. I was always very kind of fascinated, very drawn to that.

01:36 Tanya: I originally did my BA back in 1997, in Toronto, and I was interested in psychology back then. So I did a psych and English major, and then I left the world of education. I completed my degree, but I was really drawn to the world of acting and I, again, more relationship dynamics stuff. So I thought that I wanted to be an actor for quite many years. I got stuck in kind of jobs that didn't really meet my potential, just so that I could fund myself auditioning and pursue acting. And what ended up happening is that I found myself, you know, many, many years later kind of underachieving, very frustrated and realizing that I needed to do something different.

02:23 Tanya: So I went back to school and I got my master's in counselling psychology. At that time I needed to find a practic and every practicum that I thought that I wanted they wouldn't hire me on, and the doors were shutting all around me. And the only door that opened for me was in addiction. So, I found myself at Pacifica Treatment Center, and I was told, before I even started, someone in the industry had said to me, “Well, that's just never gonna work for you because the addicts are gonna eat you alive. You're way too nice for addiction.” And I was like, “Okay, great. I've got eight months ahead of me on this practicum.”

03:01 Tanya: I was dreading it and wondering, “What's going to happen?” And what ended up happening is that I walked into the room— and it was the first day that I was there—there was a graduation ceremony for the people that had completed a 28-day program. And in that room, there was more emotion and more genuine connection than I had ever seen in any of the sets where I had been on in any of the actual losses I was trying to do. It was real. And there wasn't, you know, “I'm playing addict or I’m playing a counsellor.” It was raw, and it was really powerful. And I thought, “I love this, and this is pretty incredible.”

03:37 Tanya: So, that was kind of a professional route to doing this work. Then when I sort of found my way personally, I was involved with someone years ago, who was in his own substance addiction. So, I had personal experience of being affected by someone with addiction. And then, after did my work on myself, I realized that, for many, many years, I was actually codependent. And it sort of masked as me thinking I was being very independent, but I was in a very codependent relationship. And I did a lot of work on myself to start working through that. And they kind of have the same—if you scratch an addict, you find a codependent. So everything was kind of — I think working its way through and resolved even though I didn’t know it. I didn't realize it. So it was amazing. Yeah

04:31 Constance: No, I love that. I mean, I think that's so many people's story in our industry. It's kind of that idea of “make your mess, your magic.”

04:40 Tanya: Absolutely. Absolutely.

04:41 Constance: You know, sometimes there’s obviously, we need to do the actual clinical training side of things, and yet also some of those personal experiences can really put us in a position to just really understand where our clients are coming from, from a real felt sense, as opposed to just, you know, I read about it in a book or took a class in this.

05:00 Tanya: Absolutely. Absolutely. Because you had those experiences, it's so different than, as you're saying, like, “Oh yeah, I read it in a book,” or “It seems like that would be hard,” you know? I mean, it gives you a whole other idea or connection to what you're working with.

05:15 Constance: Absolutely. So then, can you tell us a little bit more about your background with the sex and love addiction piece in particular and how you feel like that actually compares to the substance addictions?

05:28 Tanya: Sure. So when I was working, I ended up working in Edgewood in Nanaimo, which is a treatment center—residential treatment center. Again, similar to what I was saying before, about how I was always sort of more interested in the relationship dynamics of things in my life pre- doing this work. When I was working at Edgewood, we would have people obviously coming in for substance addictions, and some of the women that I got to work with had a problematic issues really, and that was kind of tied to their addiction, so they call that addiction interaction. And when I was at Edgewood, we got to do some very specific targeted work on things like relationship history and understanding how that acting out related to past into addiction. And again, I found myself in the treatment center kind of, again, leaning more towards this relationship track of what was going on for people.

06:31 Tanya: So, that sort of developed for me while I was at Edgewood and, when I was there, they kind of put a word out, or a suggestion of like, “Hey, maybe you should do sex addiction training.” And it kind of piqued my curiosity. And a few years later it took me to actually do this training. But again, it was my interest in just seeing how sexuality is impacted by addiction, addiction impacted by sexuality, how people use their sexuality in maladaptive ways, and helping people find some more healthy sexuality in their life. So that sort of how all of that came to pass.

07:13 Tanya: With addiction, you know, substances versus sex addiction, there definitely are similarities, but there's also quite a lot of differences that I've seen. So in terms of the similaritiese, we sort of see, or the sex addiction community will see addiction pretty much as a failure of boundaries. So, it's like, “I have a boundary that I do this, but I actually pushed that boundary while I'm doing that.” And then, “Oh, you know, we won't go any further to this, but maybe I'll just push the boundary a little bit more,” and you find yourself pushing boundaries to the point where you realize that you've just totally lost the plot in your life.

07:50 Tanya: And that idea, I think really translates. That comes more from the sex addiction model, but I really see that as applicable to the substance abuse, addictions. Fundamentally, I think that they're very similar because of the diagnostic criteria. So with substance addiction and sex addiction, we find similar things of, you know, unsuccessful efforts to stop. You're preoccupied. There's a lot of mental obsession, a lot of mental rumination. You're engaging in this in spite of negative consequences time and time again. You are not attending to things that you need to in life, such as work, such as family commitment, you're neglecting those things. There's tolerance that will occur with both sets of addictions. Loss of control. It looks the same, but we're dealing with sex versus substances.

08:50 Tanya: So, I would say that there's a lot of similarities, but I think that, for me, the sex addiction actually really resembles more— it’s a process addiction, right? So it's more a behavioural thing. But actually for me, it has more connections with disordered eating. So, we're kind of saying, “Okay, this is something that's natural to us. Sex is natural to us. Eating natural to us. But somewhere along the way, things have gotten out of control, and it's a behavioural thing. And we can't live our lives without sex. We can't live our lives without food. So how — what is sobriety here? How do we, you know, understand “What is sex? What is sexual health in this way?”

09:33 Tanya: And there's also cycles, you know, with like a binge purge, sort of with disordered eating. We actually will see that sometimes in sex addiction where some people go and have like, you know, binge acting out, but then they'll swing into a deprivation cycle, and it's actually very similar to— so it's kind of more of a process addiction and that’s where it is different, very different than the substance.

10:00 Constance: Absolutely. So, I guess I wonder what then is your opinion because, you know, we know that AASECT has gone on record saying that they don't believe that sex addiction actually exists. So, in your opinion, how, how do you feel about that given the work that you do?

10:21 Tanya: Yeah, so I think, you know, I'm not here to criticize the critics. I think that we all can kind of get into our little corners and say, “No, this is the one.” From what I understand from AASECT people that are critiquing sex addiction, you know, they're saying “We don't want to put a label on sexuality. We don't want to say that it's something that's a natural thing is bad, and we don't want to pathologize it.” I understand where they're coming from, because they're kind of saying, “Hey, this is a natural urge. Why are you saying that? Why are you recreating that into a pathology?” Where I want to kind of push back on that though, we're challenging the diagnostic criteria that is in addiction of what I just mentioned before. So, if it's not addiction, then what is that? We're dealing with behaviours that are escalating. We're dealing with behaviours that are putting people at serious risk. They’re going to keep on continuing to do it. We're seeing brain changes that are very similar to— in a sex addict as in a substance addict. There's brain changes that happen with dopamine, with reward. It's very, very similar. So if it's not addiction, then I would, you know, just want to know, in their opinion, then what is it?

11:41 Tanya: I think that there's also the issue with tolerance. With sex addiction and with substances, we get tolerant to the things that we think are giving us pleasure, so we need more, and it changes, and we're seeking out more novelty all the time. There's too many similarities in the way that I see it, in terms of addiction, to say the problem is not the addiction.

12:07 Constance: Yeah. And it's definitely something that— we're wanting to keep the conversation open because, like you said, if it's not that, then what is it? And at the end of the day, just how can we help people?

12:19 Tanya: Exactly.

12:20 Constance: Because often a piece is that there's some level of distress that is happening.

12:27 Tanya: Absolutely. And when people are continuing this behaviour in spite of the distress that it's causing, that's a problematic thing. That's very different than saying, “Hey, I've got, you know, a high sex drive, and I just want to have a lot of sex.” That's not the issue, the issue isn't how much sex that you want or how much you think about sex, it's how is the quality of the sex in your life, and how was that impacting your life? And, again, the diagnostic criteria for me, it lines up. And there's brain changes, and there's tolerance, and there's these negative consequences. And, and that to me is pretty much a carbon copy of, you know, the other side of substance addiction. So, I think that it's hard to refute it, and perhaps we need to maybe find another label for it, but for me, addiction is the best label that we can find right now for this behaviour.

13:33 Constance: Perfect.

13:34 Tanya: And I'm not really into pathologizing. I just think that it meets the criterion.

13:41 Constance: Yeah, thank you for sharing that.

13:43 Tanya: Yeah

13:45 Constance: So, what would you say is the most rewarding aspect of the work that you're doing, but also maybe the most challenging of this work. You obviously have a real passion for it.

13:55 Tanya: Thank you. Yeah. I love what I do. I think that with anybody in a helping sort of industry, you know, we're here to help. We're here to help people make changes in their life and challenge their ways of thinking and their ways of behaving. And so seeing changes that happen in clients, seeing, on a more global level in terms of, you know, “I've made these changes, and I'm living healthier and feeling better about myself.” Or, you know, “I'm challenging the limitations that I've had in my life up until now.” That's very, very rewarding.

14:32 Tanya: But even in session, I find that just the relationship between clients and myself, to see those changes even happen in that moment, you know, where something will just come across, kind of like an aha moment, and that person is just like, “Oh my gosh, I get it.” It's not that it happens all the time. We sort of, you know, dig in and kind of put a lot of things out there and rummage around and put a flashlight or put a light onto different aspects of people's lives, but when people can actually come to moments of truth that they wouldn't be able to perhaps on their own is a really, really satisfying part of the work for me.

15:12 Contance: Perfect.

15:14 Tanya: I find that the challenges— there are a lot of challenges. Addiction is way bigger than I am. Addiction is way bigger than sometimes even the treatment centers that are treating it. So, you know, you’ll see people that have done great work in like any program, you know, however long they stay in treatment. And then a person will leave and they’ll relapse, and, you know, I’ve had probably the most challenging experience for me was having a client OD and die, after treatment. And you realize that there's some instances where it's just, you're kind of slaying a huge, trying to slay a huge dragon. And that's really hard that the outcomes are not all about me.

15:58 Constance: Mhmm.

16:01 Tanya: And I have to know my limits in terms of boundaries, in terms of, you know, what's going to change and what's the client's responsibility to change. And sometimes you have a tendency to get caught up in that too, right? So, we’re always doing our work as therapists, and especially, I think many of us have had some codependency at some point. My codependency can definitely get in the way, and it can cloud how much I can detach.

16:27 Constance: Yeah. Yeah. I think no matter what field that someone is working in this industry, it’s always that point of realizing, you know, here's the limit to what I can do and how I can help, and just being able to let go of the fact that sometimes the outcome isn't going to be what you want it to be.

16:46 Tanya: It’s true. And even then the client will say to you, “Well, so what are you gonna do? How are you gonna change me?” you know? “What are you going to do for me?” And those are difficult conversations because it's like, “Well, this is what I can do, but this is not all about what I can do. This is about what you're willing to do and how to come together to help you achieve the changes that you want to make.”

17:08 Constance: Yeah, absolutely. Well, and you brought it up a couple of times, so I guess for those people who aren't really aware, can you actually talk about the definition, I guess, that you use as far as codependency is, and how you see that manifesting sexually for clients?

17:26 Tanya: Yes. Okay. That's a great question. So, codependency, I think has become a bit of an overused buzzword in our society now. So kind of like everyone—and I do think, you know, maybe on some level, we all have some degree of codependency, but when I speak of codependency, I see it really as blurred boundaries. Again, we're getting back to the boundary piece I was talking about at the beginning. But it’s kind of blurred bounderies where I'm kind of losing sight of where I end and where you begin, and we kind of become one and the same. So, I'm kind of surviving to meet your needs. I'm preoccupied with what's going on in your life and I'm going to sacrifice what I need to do in my life because I'm going to focused so much on you. The other person's needs will become more important than your own.

18:14 Contance: Yeah.

18:15 Tanya: And it’s sort of what I see as like an unhealthy dependence and relationships. So, if you're kind of leaning on each other like this and that, or the addict kind of falls, then the co-dependent will fall as well, right? Instead of saying like, “I have my life, and you have your life, and we're kind of mutually coexisting,” it's unhealthy attachment onto the other person.

18:40 Tanya: In terms of how I think that plays out into sexual behaviours and that sort of thing, in my experience, codependency really is seen mostly in the love addicts. You know, Pia Mellody has a really great quote and she'll say, “Not all codependents are love addicts, but every love addict that you see is a codependent.” So, the codependents are sort of, in terms of the unhealthy and the compulsive sexual relationships, they're typically more of like the love addicts, where they're kind of just chronically seeking out attention, chronically seeking out the love that, “this relationship is going to be the best thing, the ultimate thing,” and it's a very kind of intense, unhealthy, whirlwind of emotions. That person is trying to develop their sense of self through another person, without having any sense of who they are, and that tendency, that sort of compulsive pattern of like, “Maybe this one's going to be the one, and the next thing is going to be the one.” That's the same thing as an addiction where it's like, “The next hit is it or the next pornography clip that I get to is going to be the ultimate.” Like there's a desire to use the behaviour. And so that’s what I see typically in how the codependency part of addiction.

19:57 Tanya: I think I also want to say, and I probably should have said this before, is that when I worked with them in the field of addiction, I'm not just working with the addicts, but I'm also working with loved ones that are affected by addiction, and the loved ones, typically with substance addiction, we see a little bit more codependency there. And it's not ever that we're blaming, we're not here to blame and say, “Okay, this is what you're doing, and this is why the person is an addict,” but a lot of times there is that enabling, you know, where the mother is driving her child to pick up because she just needs to, “I just need to see where he or she is going. I just want to know that I'm going to be there in case anything happens” or the typical, like, you're giving money to the addict. There’s a lot of codependency on that side of the coin in addiction.

20:45 Constance: Mhmm.

20:47 Tanya: Interesting enough, in the partners of sex addicts, we see more of trauma in the loved ones of sex addicts. So the way that the addiction affects the loved ones is a little bit different in terms of the focus of our therapies. So, if I'm working with codependency and a loved one of an addict, I'm going to really be focused on the enabling behaviours, and “How do you detach from this addiction?”

21:12 Constance: Mhmm.

21:13 Tanya: For the partners of a sex addict or the loved ones of the sex addict, it's going to be, you know, they've been betrayed, and there's a lot of PTSD symptoms that can come about because of that. So we're not using the same kind of codependency focus because there really has been a true betrayaland, that partner really hasn’t often been enabling or doing anything; they're just kind of doing their thing, and the partner is unfortunately acting out in sexual compulsive behaviours. So, the codependency sort of rears its head in different areas of the addictive process and the addiction.

21:49 Constance: Perfect. Yeah. Thanks for explaining that. And so, I guess, in your practice, do you mind if there's any common experiences or maybe belief systems that you feel maybe contribute to individuals using love, you know, and or sex in maladaptive ways?

22:09 Tanya: Yes, absolutely.

22:11 Constance: It’s a firm yes.

22:12 Tanya: Absolutely. Yeah. For sure. So, in general, I—and I think this extends to not just addictions, but in general, we tend to, in my experience, behave based on our beliefs and what we believe in. So, core beliefs, in my experience, in addiction kind of drive a lot of those initial behaviours for people. So, what I mean by core beliefs is that they're going to be beliefs that are kind of traditionally based on distrust, based on fear, and based on lack. So, the coret beliefs for an example might be typical for addicts, believing, you know, “Hey, my needs are not going to be met by other people, so it's going to be safer for me to use a substance or another behaviour to meet my needs. Or for sex addicts, the idea that intimacy is dangerous; people are dangerous, or that shame core of like, “No one will love me as I am.”

23:12 Constance: Yeah.

23:13 Tanya: These are all kind of beliefs that are part and parcel of a distrustful stance, a stance of disconnection. And those are the beliefs that I find kind of lead them to that impaired thinking of like, “Hey, maybe then I need to do this to get my needs met.” And then that thing being leading you into the addictive cycle. So, in terms of people who are more love addicts, they would have sort of an opposite idea of like their core belief might be, you know, “My needs are only going to be met by some other person.” So, they're very kind of rigid all-or-nothing belief systems that kind of perpetuate a very rigid and unhealthy behaviour.

23:57 Tanya: So, these beliefs are really, really kind of part and parcel of the whole addiction. And they're, in my experience, really, really important because if you don't believe that you're worth it, or you don't believe that people are safe in life, and some people's experiences are very much—I mean, that is true for a lot of people, right. And there's some people that have never really had a safe, emotional experience with a caregiver or with anyone in their life. So, if that belief is that entrenched? A lot of that work is sort of challenging those beliefs and the value of the root of the therapeutic relationship is that this might be the first time that that person gets unconditional love, unconditional acceptance, sort of thing.

24:42 Tanya: Modelling a healthy, safe behaviour where they can do what they— they might distance. They might push back. They might do whatever they do in the session, but that you as the therapist are there, and you're not leaving them. You're not abandoning, you're not judging them. So, the beliefs are, I think, very essential to addictive behaviour and any behaviour.

25:05 Constance: Mhmm, perfect. So do you have any tools or exercises that you use to help people uncover some of these patterns that are happening over and over again in their lives?

25:16 Tanya: Yeah. So I think in terms of the types of things that we're talking about, I’m trained in EMDR, eye motion reprocessing desensitization. Basically it's a trauma modality that helps to deal with trauma, and that's a really powerful modality because it really is helping a person uncover beliefs that they might not even know they had. So, if someone has, let's say a memory or something that was really distressing for them in the past, you know, “My mom never picked me up at school. She was always late. My mom never gave me hugs.” We kind of take those three tenets discussing memories, and we will usually ask them a question of like, “Well, if that happened—obviously that happened. What does that say about you?” Often times that question will help them uncover a lot of those—maybe the core beliefs— that are driving the whole addictive cycle.

26:18 Tanya: So, that for me is a helpful thing when it comes to like a tool to address core beliefs. Obviously in cognitive behavioural therapy, we'll do things to obviously try and challenge those thoughts. And often times that'll be a more logical intervention, but sometimes interventions and tools will be inner child work. Sometimes it will be dialoguing between the core belief and the person. We're trying to uncover that relationship between you and that belief that you have, and so, EMDR techniques are going to be helpful to uncover the core belief. Actual EMDR is helpful in processing through memories that are connected to those core beliefs, but there's a lot of things, whether, again, you're using CBT, or I find journaling interventions or techniques like more gestalt techniques can be helpful. Anything to sort of change the relationship between you and that core belief that you've been hearing.

27:25 Constance: Perfect. So, do you find that those, you know, the beliefs or the behaviours or these types of concerns, do you find that they show up differently based on a client's gender?

27:36 Tanya: Yes and no. I think that there is quite a lot of consistency across the board in genders with problematic sexuality and sexual addiction. The one thing I do see in gender is that men traditionally will be coming in with more pornography issues. I don't really see any women identifying and saying, “Hey, I'm a porn addict.” But it's traditionally the men that are identifying more as the pornography consumers and problematic issues with pornography. The love addicts tend to be a bit more of the women. So that would be the only kind of very general thing that I can see, but really, I find that there's sort of equal opportunity issues with addiction and sex addiction as well.

28:29 Constance: Mhmm.

28:30 Tanya: Also, I know for me, up until this point, I haven't noticed a ton of major gender differences.

28:37 Constance: Yeah. And thanks for sharing that piece because I find that a lot of times people have certain ideas around, you know, “Women can't be sex addicts,” or you know, “Men will always be this way,” or kind of, again, you're thinking along that gender binary of this is how it's going to show up, and as you said, these types of behaviours and patterns and addiction in general is pretty equal opportunity.

29:06 Tanya: It pretty much is. It pretty much is. I think that there is, in my experience, there is less women that do identify with problematic sexuality. They just don't appear as often in the office. Those are actually the people I want to work with. So if anyone one is a woman who acting out in her sexual behaviour, then I would love to come see you. I’d love for you to see me. But they don’t—I think there’s a bit around what they're doing, to just say, “Hey, maybe you need help with this.” So they for whatever reasons, they're not identifying themselves as much in rooms, not even in my practice, but even in treatment centers in Canada. The United States has quite—obviously the population is a lot bigger, so there's a lot more of programs in the United States that are really focused on women’s intimacy issues and sexuality issues. So I think in terms of numbers, more men will identify with problematic sexuality than women, but I think that they're just different nuances there sometimes as well.

30:16 Constance: Yeah. Great. And you’ve made reference to attachment style previously, and so I guess, how do you see a client's attachment style actually playing into some of these compulsive sexual behaviours?

30:31 Tanya: Yeah. I think that attachment is huge. I think that it's huge in terms of sexual behaviour, but also with substance abuse or any addiction. So, I think a few things that I want to say first of all, is that we are all wired for attachment. As human beings, we are wired for attachment. So, if we come from a secure attachment base, where we have a parent, who’s—they call it the “good enough parent” or the parent that at least the child knows that, “Hey, my needs are going to be attuned to, and I’m you know, I'm going to get comforted. I'm not going to be abandoned by my mom, or the caregiver’s there for me.” Ideally that’s where we're developing a secure attachment style.

31:15 Tanya: But, for addicts, I find that because they're wired for attachment, they're going to attach to something. So, if the parent or the caregiver is not someone who is safe or someone who has been—they've been neglected as a child and that sort of thing, that desire for attachment doesn't go anywhere, but it's going to go into another direction. So often times with addiction, I see addicts that are attaching to the substances or attaching to sexual behaviour or attaching to whatever it is because they need to attach to something. The same with food and sex and drugs and alcohol is that they're pretty predictable in the beginning to the person. So that person also knows, “I'll get this and I'm going to be feeling this way.” You know, the problem is that the pleasure, the initial pleasure and that memory of like, “Oh, this was really great for me,” you know, that's where tolerance happens, right? And the dopamine gets affected in the brain, so you're going to need more and more over time to create that feeling of getting those needs met. But you always are hoping that the next, as I said, piece of porn, or the next sexual partner, or the next hit of whatever you're taking, the next drink is going to be the thing. So that desire really drives the bus for people.

32:37 Tanya: So, I think that attachment is an important thing just in terms of, “Hey, you're going to be bonding to something.” If it's not a person, it could be problematic attachment with inanimate objects or behaviours. In terms of attachment style, attachment style is going to be looking at the amount of avoidance and the amount of anxiety that a person has in relationships. And so we talk about attachment style, we see different sexual issues, sometimes accompanying different styles of attachment, such as like a preoccupied attachment. That person is going to be really preoccupied with relationships, and you're not going to have a lot of anger— they're going to have a lot of anxiety about the relationship, but they still pursue the relationship. So not like they're backing away from a relationship, they're actually going towards the relationship. They have huge amounts of anxiety about it. They often feel unworthy deep down inside, so that in my experience, is going to be sort of more of the classic codependent, the classic sex and love addict. So they're sort of pursuing the relationship, but they're feeling very unstable within the relationship. On the other side of the spectrum, someone who has more of an avoidant or dismissive attachment style, the most likely we see are gonna be more going in the direction of something that's more autoerotic, something that's less involving people, so perhaps more of the porn. They're really avoiding the experience of people. They still want to attach to something, but they're going to avoid the actual person, so they don't want to be vulnerable. So something like porn, something that's a bit more once removed from the person.

34:24 Constance: That idea of a person

34:25 Tanya: Exactly. That’s exactly right. So that will sort of come with more of an avoidant style of attachment. So, I think with the attachment idea is that we were going to attach to something depending on your attachment style. Then we kind of see, this is what you're going to be more inclined to attach to.

34:44 Constance: Okay. Great. So in your work, how would you typically either assess for or explore these more compulsive sexual behaviours that clients may present with?

35:03 Tanya: So in terms of assessing, we do— so there's a few different things. If someone is concerned about sexually compulsive behaviour, there's a paper and pen test that you can get online. It's called the SAST-R, so it's a sexual addiction screening test, and that's a 52-question test. Again, this is not— I want to really be clear, like it’s not that you should take this test and then decide that you are a sex addict after you take this test, but it's basically more of a screening tool to say, “Hey, there might be something that's happening here. That's an issue.” And if you do score higher on that test, then that would be something where I would encourage someone to talk to a therapist and seek out a CSAT, a Certified Sex Addiction Therapist and say, “Hey, like I’ve taken this test, and I scored pretty high on it.”

35:56 Tanya: So those are kind of ‘yes’ and ‘no’ answers. You know, “Are you in crisis? What's the riskiness of your behaviour? Have there been negative consequences and the whole thing?” I do a— a CSAT will administer what's called an SDI, a Sexual Dependence Inventory, and that's a huge test. It's a battery of tests that includes the SAST, but it also includes specific behavioural scales and preoccupation scales, so it will give you a sense of what's the exact problematic behaviour this person has. So, how much are you preoccupied by this? And also what, what is the behaviour, so the looking at behaviour and the preoccupation levels. That also includes an attachment scale. It includes a readiness to change scale. It includes consequences of addiction. So it's about a 600-question test. It's submitted through a secure portal, so you only the person who's taking it only has access to it along with me as a therapist. So, it's a very powerful tool, and that tool is, again, you only want to do that with a CSAT. You can probably only get that through a CSAT, and it will be a great assessment tool then to indicate, you know, where we need to go in treatment and creating a treatment plan for the person. So, those would be the two kind of big assessments or main assessments you would use.

37:32 Tanya: I don't want to get too off track. We have what’s called a PTSI, it's a trauma assessment as well. And often times, we see trauma, obviously it accompanies addictive behaviour, so that it is a scale assessment that gives us an idea of what the trauma behaviours are and how the trauma is impacting the addiction. And we usually— I really would give that SDI test and the PTSI together so that we can see the correlation, the interaction, between trauma and the addictive behaviour because obviously trauma is right up there with addiction.

38:08 Constance: Yeah. They tend to play together.

38:13 Tanya: They do.

38:14 Constance: Yeah. So, once you, you know, with the client have agreed, “Okay, I think this is an area that we need to focus on,” do you have any kind of tools or approaches or techniques? And I know you've talked about EMDR, whether it's even psychoeducational information for the clients, books, things like that.

38:37 Tanya: Absolutely. Yeah. The great thing about the sex addiction world is that they do give a ton of tools and a ton of exercises and a ton of help. So first of all, absolutely psychoeducation I would have clients often times read about addiction because it's something that often times people will feel like they are the only ones that are experiencing this, and there’s so much that’s involved with it. So, Patrick Carnes wrote a really great book called Out of The Shadows. That was sort of the big— it's a small book, but it was a big book in terms of unpacking what sex addiction is.

39:17 Tanya: I use tools that are given to us by the CSAT community. And so I will use them. There's a workbook that's called Facing The Shadow, and that is a great resource in terms of breaking denial and delusion because that's really what we're here to do in the very beginning parts of the addiction because no one is really— no one really wants to admit that they have a problem and that it is out of control. You know, most people they're trying to find a loophole to see, “Okay, well, how can I still do this without getting into negative consequences?” So what we're really trying to do in the beginning is to break denial and delusion. EMDR techniques would come more down the road, and they were addressing the negative core beliefs that are driving the addictive cycle. But the workbooks that we use that are basically like, “What are the excuses that you make? What are the ways that you justify this?” The three circles technique is an amazing technique to very clearly have the person identify, what are the behaviours that you really are saying I need to abstain from? What are the middle, kind of— there's three circles, and so the middle circle is abstinence. Then the other circle is a boundary behaviour. So what are the slippery slope behaviours that you do that might get you back into the abstinent behaviours that you're trying to stop. And then what are the healthy things that you need to do? So again, we're trying to create boundaries with the person.

40:40 Constance: Yeah

40:41 Tanya: And that to me is a very clear, concise tool to help the person understand, “Okay, this is what I can do. This is what I won't do, and this is what I need to do more of.” So, that tool is really helpful, but there's so many— there’s core dialogue questions that are kind of dialoguing with that part of you that is your addiction, because I don't think that people are their addiction. I think that, you know, the person that part of them that has the addiction is addiction. So, those core dialogue questions let you really dialogue with that part of you that is addicted, and it sort of helps you, again, change the relationship between you and the addictive part of you so that you're understanding more about your process. And they're very powerful questions that you do daily.

41:33 Tanya:And one other thing, I don't know if we have time, but one other thing that I quite love is basically like a personal chaos index. And so you’ll say to a person, “How does unmanageability show up in different areas of your life?” Often times, before the relapse happens, because relapse is a process. It’s not a one-time event. The relapse will kind of be preceded by all these other little things that a person might not even realize that they're doing. So, they might stop taking phone calls when a phone call comes in because they're isolating, or they might find themselves pushing snooze, and they're always late to get the bus because they're just not on top of their sleep hygiene, or they're not eating properly or, you know, the place is a mess and we haven't, you know, we haven't been keeping, you know, the apartment or the house in good shape. And all these little things show that, “Hey, these are signs of unmanageaility kind of slowly that add up.” And for someone, too, we can help them look at these signs of unmanageability so that they can really have that awareness because the more awareness that you have, is the more ability you're going to have to be able to make a different choice.

42:48 Constance: Yeah. It sounds like in this case, really the knowledge in general, it's really great tool.

42:52 Tanya: The knowledge is huge. The knowledge is huge. And it’s a really, really great tool. So what I like about the tools that we have is that they're psychoeducational. They’re cognitive behavioural. They are— they're there to break denial and delusion, and some of them then obviously go a bit deeper into understanding your neural pathways and the arousal templates of the person because those change often times when someone progresses in their addiction.

43:19 Constance: Mhmm.

43:20 Tanya: So, they might start off with just watching homemade porn with, you know, a man and wife, or boyfriend and girlfriend, and slowly, you know, they need more. Or we talk about the tolerance, you know, they need more to kind of satisfy that urge that they have. And so they kind of find themselves like, “Well, what's this kind of pornography and that kind of pornography?” and their arousal template ends up changing. So it’s kinda like, “Well, I would never watch that stuff that I used to watch in the beginning. It was just a man and a woman.” It's going to be a lot more, it's going to change for people, and we can help them understand that arousal template for themselves as well. So there's a ton.

43:59 Constance: Okay.

44:00 Tanya: And we didn’t even have enough time to go through all the interventions that we have.

44:04 Constance: No, yeah. This has been amazing. Yeah. These are some great ideas for people. And it gives people a bit of a sense of what, you know, if this is an area that they would like to continue to work in, kind of what they might be getting if they went and did the CSAT training themselves because it sounds like there's a lot of tools that are available to you from that training that would really help you in this area.

44:24 Tanya: Totally. There is a lot. There is a lot, a lot. And I do— will take with substance abuse because I think that, again, some have similarities and a lot of differences, but there's some things I think that can help. So talking about behaviours of unmanageability and early signs of it with someone who's dealing with alcoholism or a drug addiction is just as helpful for me as talking about it with someone who's in a sex addiction or even a food.

44:54 Constance: Yeah. Great.

44:55 Tanya: Disordered eating. Yeah.

44:56 Constance: So then as far as— for other practitioners who maybe don't necessarily have as much training or don't work in this area as much, what do you wish they knew about the field of working with sex and love addiction?

45:13 Tanya: Really simply. I just wish that people would— I just hope that they know that it is real and that it does exist. I think that, again, that would be debatable by certain people, but I think that having a bit more of an open mind with what people are dealing with, it is a very helpful thing. I think that knowing the boundaries of what you can practice in and can't practice in. So, you know, there was a lot to this, so I wouldn't recommend that someone just kind of goes, “Oh yeah, well I know about sex, and I know about addiction, so I'm sure I can, you know, treat that person in the same way.” There are some really specific things that we we've learned within the field of sex addiction through IITAP and through the training that I did being a Certified Sex Addiction Therapist. So I think that, you know, if it's interesting to you, then definitely get yourself trained.

46:10 Tanya: Edgewood in Nanaimo has been hosting trainings for the CSAT designation. So I think they just finished their module one. They're hosting module two in the next few months. So this is starting to become more of a recognized thing, I think even in Canada. And I think we're going to start seeing a lot more of this in the future in terms of people that are CSATs right now. There's not a whole lot of people doing this work in Vancouver, so it's still quite small of a bunch of us that I would just really want other therapists to know that you know, that this does exist. And either get yourself educated, or refer that person to someone who can help them, you know, for sexual addiction.

46:50 Tanya: There is a really great website www.sexhelp.com, which is a great website through IITAP on just going on kind of understanding about sex addiction. There is an online assessment. So I do think you can get SAST through that website. There's a therapist finder. So helping you find a therapist in your area kind of thing, and it does give you a lot of information because I think, again, as you’ve said, the more information that you have, the more knowledge you have, the more power you have, and the more ability that you have to make choices and informed choices. So, I would really encourage people to just have an openness to this. This is a thing, and maybe we haven't found the right word for it. And maybe we're overusing the word addiction, but you know, it looks like addiction, it smells like addiction, and walks like addiction. It’s addiction in my opinion.

47:47 Constance: Yeah. Okay. Amazing. And so if somebody did want to actually do the CSAT training, it sounds like Edgewood in Nanaimo is offering some of that. Is there somewhere someone— is there a website that people could go to just to find out more about where some of these trainings are held?

48:02 Tanya: For sure. So, the, iitap.com website. It’s the International Institute of Trauma Professionals. “I”, “I”, “T”, “A” “P”.com, or if you just Google CSAT trainings, they will come up. They're typically offered all over the United States. They're happening all the time. They're actually starting to happen in Australia and internationally. So there is, like, this community is becoming very international across the board. But, yeah, you basically would have to— there are four modules that you are training in, so you would obviously have to start with module one and go sequentially because they go in sequence. As I said, Nanaimo has already started their first modules, so I'm not sure when they're going to start it again or if they’re going to start it again.

48:50 Tanya: But, I went down to Bellevue, so in Washington, so it was a nice, you know, ride down there, gave me a different location, you know, which was nice, and a lot of information. But they happen all around the States, so you can kind of pick and choose. And I think it happened in Calgary for a period of time, so they change their locations constantly.

49:11 Constance: Perfect.

49:11 Tanya: And the facilitators are amazing. And the supervision, you need quite a lot of supervision hours to get this training. You need about 30 supervision hours to be a certified therapist. And those are, you know, the people that I've had access to and working with them all, and those are some of the best people in the field, so it's been a real honor to gain some of their insight and that kind of thing.

49:39 Constance: Incredible. Well, we'll make sure to put all the links down below so people can check that out.

49:43 Tanya: Yes, yes.

49:44: Wonderful. Well, just thank you so much for everything that you've shared. This has just been a wealth of information, and I'm sure it's really opened some people's minds to maybe looking at this in a slightly different way then maybe they would have been approaching this in the past. So thank you for sharing that.

49:49 Tanya: Yeah. I hope so. Thank you. And thank you for having me. Thank you for the work that you guys are doing. I think it's great that you're getting information in a place and disseminating it and really just— you guys are doing great work.

50:14 Constance: Thank you. Thank you. Well, we'll make sure to have a link to your website as well. So if anybody has clients or even has questions, we really recommend reaching out to Tanya, just because, you know, this is the area that she knows in our industry and made a really big piece with all of this is just practicing within your competencies, and if you're feeling like you're outside of it, either referring or getting supervision and connecting to people who could support you. So, we're really glad to have you as a resource and just thank you so much for sharing everything that you know. All right. Thanks.

50:42: Absolutely. Absolutely. Okay. Thanks for having me.