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By Dennis Miller, BHC Senior Writer

Maureen Canning, MA, LMFT, noted sex addiction expert, clinician, author and public speaker, is among a full slate of intervention specialists and behavioral healthcare professionals schedule to speak at Foundations Recovery Network’s “Moment of Change” conference, September 28th to the 30th at The Breakers Hotel in Palm Beach, Florida. In keeping with the conference’s theme of intervention, her talk will be entitled "Lust, Love, Anger: Intervening on the Sexually Addicted Client."

Ms. Canning, who is also the author of the book Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy, emphasizes that interventionists and treating clinicians need to recognize and understand the key differences between a process addiction, such as sex addiction, and chemical-based addictions to drugs or alcohol. In this interview, she highlights some of the key characteristics that set process addictions apart, and why it’s so crucial for interventionists and treatment professionals to understand these differences.

We also explore the roots and development of sex addiction, which she believes can often be traced back to specific events in an individual’s psychosocial development. Often, some form of childhood abuse is at the root of a sex addiction, though Ms. Canning emphasizes that in many cases it may have been entirely unintentional. Helping guide patients toward a deeper, rational understanding of these underlying factors is critical, she says, to break down the shame barrier that too often impedes successful treatment.

To listen to this fascinating and informative interview, click on the audio icon above. The following is a written transcript of our conversation:

BHC: This is Dennis Miller of Behavioral Health Central. With me today is Maureen Canning, Clinical Consultant for The Meadows and Dakota, the extended care program for sexual addiction at The Meadows. Ms. Canning will be presenting a talk at Foundations Recovery's "Moment of Change" conference, taking place September 28th through 30th, in Palm Beach, Florida, entitled "Lust, Love, Anger: Intervening on the Sexually Addicted Client." Maureen is a past board member of the Society for the Advancement of Sexual Health and past president of the Arizona Council on Sexual Addiction. She is also the author of Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy.

Maureen, thanks for joining us today.

Maureen Canning: Thank you for having me.

BHC: Give us a quick overview of what you’re planning to cover in your presentation.

MC: Well what I plan to talk about is how sexual addiction sort of differs from other addictions. As far as, if someone is going to intervene on a particular client, what would be helpful is to sort of understand the specifics about this addiction.

Every addiction has its own characteristics. For instance, sexual addiction is what we call a process addiction and how that sets it apart from say chemical addiction is that the high or the reward system is received in the brain. Let me give you an example of what I mean by that. Is that if you think about what is your favorite food. So, what would be your favorite food, Dennis?

BHC: Well, I’m very partial to Boston baked beans.

MC: Okay, well that’s an interesting one. So what I want you to do is to think about what brand of Boston baked beans — do you make your own or do you buy it in a can? What do you do?

BHC: Typically in a can.

MC: Okay. So you get your favorite brand and I want you to think about opening that can and I want you to think about it simmering in the pot and you kind of feel the steam coming up, as you’re smelling the aroma and as you’re doing that, you’re anticipating the actual ingesting of that, which includes the activation of your taste buds and the response to that.

So how are you feeling right now when you just think of that big bowl of Boston baked beans?

BHC: Actually, I’m feeling hunger pangs.

MC: Yes! So you’re having a physiological reaction and a neurological response to just thinking about those baked beans.

So this is what happens for sex addicts. When they start to think about acting out or they start to think about actual specific acts of sex that they might have had or what we call euphoric recall, what happens is that it triggers the chemicals in the brain. And so the chemicals become released, and that release of those chemicals creates the high or the pleasure. So just like when you’re thinking about something pleasurable like your baked beans, the sex addict is thinking and creating that sense of pleasure by thinking about the sexual addiction until it becomes a process addiction. They don’t have to take anything, they don’t have to go anywhere, they don’t have to do anything to activate that chemical response.

BHC: Is this what you’ve referred to as the “cycle of sexual addiction”?

MC: Well, the cycle of sexual addiction, yes, that’s part of what the cycle is. The cycle of sexual addiction is similar to other addictions. Again, what sort of sets it apart is when we get into the actual preoccupation of the acting out. When they get into thinking of acting out with sexual addiction, they’ve already created a high or trance-like state. And then, what they do is they usually have a ritual around that acting-out behavior. A certain time of day they might act out; a certain place they might go; they might include chemicals such as getting high on cocaine or using alcohol as a way to relax themselves to be able to go and do what they’re going to do. And so that’s where you’re going to see the addiction interaction.

Oftentimes, therapists, clinicians and interventionists just stop at the chemical issue and don’t look into what else might be going along with that. And I think it’s really important that we educate people on how those two or other addictions can relate to each other. So that usually becomes a set or a specific pattern or ritual around it, often involving other addictive patterns that becomes a pattern that really needs to be explained and explored so the client understands how that is so self-destructive.

BHC: You’ve described something you refer to as the “ideology of sexual disorders.” Can you explain what you mean by that?

MC: Yes, in my book Lust, Anger, Love, the reason I wrote the book was because I really wanted people [and] the general public to understand how this addiction works. This is an addiction that at times is thought of as being perverted or deviant, which oftentimes the behaviors are. But what happens for the individuals is that no matter what behavior they have — and the ranges are really far reaching: they can go from people that act out with prostitutes, people that have affairs, people that are into bestiality, people that are into S&M, people that are into cross-dressing, there’s all kinds of behaviors.

And what’s fascinating to me is to see how these behaviors, these specific behaviors for this particular individual were developed. And what we find is that we can trace it back to specific events in the psychosocial development of the individual. So they were exposed to, they were abused by, or there were specific events, whether overt or covert (which means they were aware of them or not) that set them up to want to act out in these specific behaviors.

Does that make sense? Am I being clear?

BHC: Yes. Absolutely.

MC: I find that that’s really fascinating and when someone walks into my office, it’s sort of like, I want to work with them and say, “Okay, I know there’s a lot of shame around these issues but what I want to help you to do is reduce that shame by understanding why you do what you do.” And once we start to connect those dots, the individual starts to feel such a relief because they understand why they’re doing what they’re doing.

BHC: Well, on the issue of shame and our natural tendency in our society to avoid discussing topics of sex, how does that impede the intervention process? What are the unique characteristics of sexual addiction that make intervention tricky, if you will?

MC: What we know about sexual addiction [is that] really more than any other addiction it’s tied to what we call the “shame core.” Not only are the individuals shame-based about what they’ve done and what the consequences are of those behaviors — the demise of their relationship or their marriage, the loss of their children, the loss of their jobs, the financial consequences, etc. — but what they really believe at the core of who they are is that they don’t deserve. They don’t deserve to be loved, they don’t deserve to be respected, they don’t deserve to feel safe.

And those are unconscious messages that come from their childhood. So when you’re intervening on a client, they might look [fine], because sex addicts tend to be very intelligent and very personable. And so what you see on the outside is very different than what’s going on the inside or internally for this person. They may present very well. They might have all the right answers. You might think, “Wow, this person really has their act together” by what they say or are able to communicate, when in reality, internally they feel completely alone, isolated, and filled with shame.

So I think when someone’s intervening it’s important for them to understand that, [and to often] say things like, “I understand how lonely it must feel inside and how much you’ve isolated yourself because of your addiction, etc.” That can really be a helpful tool.

BHC: What do you feel are some of the forces driving the increase in sexual addiction in our society?

MC: I don’t know if there is an increase in sexual addiction. What I think — and I’m not talking statistically — but what I think anecdotally is that it’s been going on forever. It’s just that we as a culture are starting to accept that and look at it, and that people are willing to come forward and talk about the issues.

Again, this is a very shame-based addiction. People in the past have not really been willing to come forward because of the stigma associated with it. And now that we are sort of normalizing it — it’s sort of like alcohol 40 years ago — now that we’re normalizing it, I think that more and more people are willing to tell their stories and talk about their recovery.

BHC: Interesting. There’ve been a number of very high profile public cases in the news of late —the situation with David Duchovny and former New York Governor Elliott Spitzer. Do you think those as well have kind of shone a spotlight on the issue and gotten society talking about it a little more?

MC: Yes, I do. And I really am grateful for those folks for their courage to come forward and to acknowledge that they have this problem and to talk about it. I think that it helps to normalize this issue and reduce the shame culturally. And hopefully more and more people will be willing to seek out support and help around sexual addiction because of that.

BHC: Is that something you’ve been experiencing as a clinician specializing in this area? Are you noticing more people coming to you for help than before?

MC: I don’t know if that’s the case. I’ve always specialized in sexual addiction. What I do think is happening is more and more clinicians are wanting to get more information about it, to be trained in this field, understand the specifics of how this particular disorder manifests itself and how to support people in getting the treatment that they need.

So that to me is real exciting and I think as more and more clinicians are trained in this they’ll be able to ask the questions and explore with the clients ways that will help them open up and get the help that they need.

BHC: Are people who have other addictions, whether to substances like drugs or alcohol or other process addictions, are they more likely to become sex addicted?

MC: What I say is that I’ve never met a sex addict who is only a sex addict. In other words, everyone I’ve ever treated, men and women, gay, lesbian, all have other addictions associated or interacting with the sexual addiction. So it’s really important for people when they are working with addiction, period, is to assess what else might be going around their sexuality. It’s something they should be thinking about and looking at as a clinician.

BHC: Are the addictive processes that underlie all addictions essentially the same?

MC: As I explained earlier, not necessarily. There are the process addictions, and then there are those addictions that you actually take something that changes the chemicals in your brain and in your body. So there are process addictions and those can include money disorders or spending. Gambling is a process addiction as well because you don’t need to take anything into your body to get that high, as well as sexual addiction. So I think what’s helpful is to understand the difference between those two and the specifics around how to identify that and then leading the person to the right treatment plan.

BHC: In your book you explore some of the potential causes of sexual addiction including early childhood trauma and sexual templates developed through one’s psychosexual development. Can you give us some examples of how that can cause sexual addiction?

MC: Sure. And I do that specifically in the book, which I think is really helpful. At least the feedback I’ve been getting is that it’s very helpful for people to understand that.

An example would be that a child’s mother — this is kind of an extreme case — wanted to have a girl as opposed to a boy, and was disappointed. And in her anticipation of having a girl, she had made lots of girl clothes for them and decorated their room, because she didn’t want to know what it was before the birth, the child’s birth.

So when she has a boy, she’s disappointed and what she does is she dresses the son up in these clothes secretively while her husband is away at work. And the child starts to become confused as to who I am and what is my identity? And so the child starts to think, “Well, maybe if I’m going to get love and attention and emotional safety from my mother, what I need to do is to be a girl.”

And so all kinds of things can spring from that. From them wanting to continue with that from rewarding their mother and having a connection with their mother and cross-dressing. It could be that they think they need to act out with the same sex. So these kinds of messages can really confuse a child, because what the child really wants to do is to make the parent happy. By making the parent happy and feeling safe with the parent, they know that they will be rewarded. And that reward is by attention and a sense of well-being. So that’s an example of it.

Another example, let’s say for cross-dressing, would be that the mother is depressed and not able to really be present for the child and so the child really wants a closeness, a physical closeness, an emotional closeness. So they become angry and they become resentful and they can’t express that to the parent because they feel guilt because the mother is sick. So they go into the drawer and they start sneaking into the bedroom and taking out of the drawer her undergarments, the most intimate piece of garments that they can hold onto, that they can smell, that they can feel close to. And in doing that they feel like they have some power, they feel like they have some control. And then before you know it they’re stealing the garments and then before you know it they’re wearing the garments. So it’s sort of a progression. And all this is really based out of the feeling that they don’t really belong, that they aren’t really deserving of love and attention.

Now, the mothers didn’t really do anything consciously to hurt the kids, but in their behavior they have wounded them as far as helping them to understand their sense of worth, value and self-esteem.

BHC: So then it goes well beyond what people might typically think of as sexual abuse of a child. It goes into kind of unintentional abuse.

MC: Exactly. There are two ways of being abused. There’s overt, which is if you were raped by somebody, if you’re fondled by somebody, or if you’re verbally abused by somebody — those are overt actions. A lot of people have more of the covert sort of behaviors, where there’s energy in the house, where one of the parents, let’s say, is very sexual or has their own sexual addiction, but the child doesn’t necessarily come in contact with it. They just feel this energy in the house, and they soak that up. They get an unconscious message about what that means for them or how they’re supposed to relate to their sexuality, which is oftentimes very confusing and, again, on a very unconscious level.

So often when I have people come into my office to start to explore these issues, they’ll say to me, “I have no history of trauma. I have no history of abuse.” And when I sit down and talk to them about the subtleties of what had happened during their childhood and the events that took place, we’re able to start to flush out some of the messages that they’ve gotten that are much more subtle.

BHC: What are some of the clues that behavioral healthcare clinicians need to be on the lookout for to identify a potential sexual addiction where a patient may not be presenting in front of them with that particular complaint?

MC: What I suggest is that they simply start asking questions about their sexual history. And what you’re going to be listening for [are] messages that they got about who they are sexually, and how they are supposed to interact or connect. There’s a flip side to the acting out and that is a sexual anorexia. We haven’t really talked about that, but also a lot of people are sexually shut down or have an aversion to being sexual. Also, I discussed that in the book as well.

BHC: Is that what you’ve referred to as “acting in” as opposed to “acting out”?

MC: That’s correct. So instead of seeking out a sexual connection or a sexual energy, expression of sexual energy or the objectification of the self, what they’re doing is they’re shutting down. They have a real fear of being sexual. And both sides of the spectrum are based in the same reasoning, and that is that they want to have power and control — power and control over their original trauma.

So, if I act out in these ways, then I can undo the original trauma by having control over it. So if I go have affairs, like my father did, then I’ll get the love that I want. Or, if you’re sexually abused and you say, “I don’t ever want to be sexual again, because I can control or stop the horrible things that happened to me, then I’ll have that power and control.” So the clients can act out in either way.

So, I think really asking specific questions; and I mean really being fearless around that. “Do you masturbate? Are you able to orgasm? When did you first have your sexual experience? How did your parents relate sexually? Are you able to have an orgasm?” And all those specific questions. You don’t want to just ask them, “How do you relate sexually?” You want to get in there and ask specific questions. And when you’re listening, you’re listening for those kinds of patterns. Do you see or do you hear messages or patterns of behaviors that might indicate that there is an out-of-control component or a shutting-down component around sexuality?

BHC: How can folks kind of get in touch with you, and get more information about you and your books and so forth?

MC: I have a website and it’s maureencanning.com and they can also contact me at The Meadows. The Meadows has a website which is themeadows.org and there are links that can help them. Or they can call The Meadows at 1-800-THEMEADOWS and they can put them in touch with me.

BHC: Well, excellent, I really want to thank you for taking the time and talking with us today and good luck with your presentation.

MC: Thank you very much.

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