Sex Addiction
In my practice, I have found that sex addiction oftentimes has very little to do with sex. Rather, I believe sex addiction has much more to do with fears of intimacy, difficult feelings, shame, self-esteem, and identity. Many people who treat sex addiction take a symptom-focused approach, which means they view sexual behavior as a problem that needs to be reduced. I believe this causes all kinds of problems because sexual activity and sexual fantasy are so closely woven into a person's identity. In my work with patients who struggle with sex addiction, the goal is not to reduce sexual behavior, although this often happens as a secondary effect over time. Instead, we try to understand the underlining roots of sex addiction and how sex addiction is used to cope with more internal issues. My patients who struggle with sex addiction work towards achieving greater intimacy with others. They develop more awareness and understanding of their difficult thoughts and painful feelings, which may or may not be connected to their sexuality. Ultimately, they learn to develop a greater capacity to tolerate these painful thoughts and feelings, which allows them to spend less of their time and energy on sex and more on nourishing other parts of their life.
Alcoholism and Chemical Dependency
Alcoholism and chemical dependency are highly debated topics in the mental health field. There are many different approaches to treating alcoholism and chemical dependency. The two most familiar models that are used to treat alcoholism and chemical dependency are the abstinence model (model used by Alcoholics Anonymous) and the harm reduction model. In short, the abstinence model takes an all or nothing approach and the harm reduction model attempts to reduce the addictive behavior gradually. I believe when subscribing solely to one of these models you come up against the following risks. The abstinence model can be overly pejorative and punishing while the harm reduction model can be overly permissive and enabling. I have found in my work with people who struggle with alcoholism and chemical dependency, I tend to use both of these models and my approach differs with each patient. I believe that some patients absolutely must take the abstinence route, while for other patients it is essential to take a more gradual approach. Regardless of how I am working with a patient who struggles with alcoholism or chemical dependency, I have found that these patients need a lot more support than can be offered by once-a-week psychotherapy. The temptation to use and the emotional distress that comes during the withdrawal phase is too difficult to tolerate on one's own. This support can come in a variety of different ways, through friends and family, AA, other group treatments, or more regular meetings with me. If you are seeking treatment for alcoholism or chemical dependency and are still confused about whether I would be an appropriate therapist for you, please contact me to set up an assessment consultation.
Jonathan Lichtenstein, Psy.D.
1774 Union Street
San Francisco, CA 94123
415-267-6199
