Dan: Hey, what’s going on my name is Dan Sevigny and you are watching Recovery X, where experts thought leaders and people in recovery meet to exchange information, educate the public and help solve the problem of addiction. Today I’ll be speaking with Dr. Kate Balestrieri, who’s a clinical psychologist certified sex addiction therapist and the Executive Director/Co-founder of Triune Therapy Group in Los Angeles. Dr. Kate how you doing? Thank you so much for joining me.
Kate: Hi Dan, thanks so much for having me. Great job on my name, by the way.
Dan: Thank you, it’s a minefield but we got through it. So tell me about your practice and about Triune Therapy and some of the things that you do over there.
Kate: Oh great thanks. Yeah, so at Triune Therapy Group, my business partner Lauren Dummit and I work primarily on treating trauma and all different kinds of addiction issues related to traumas, as we know oftentimes trauma underlies addictive processes. We also treat a lot of different kinds of sexual and relationship issues so we approach sexuality from a very broad spectrum of perspective and our goal is to help people achieve their most healthy sexual potential and oftentimes that looks like correcting addictive problems and helping them redirect their sexual energies into something that actually is intimate and generative in their lives.
Dan: Interesting. Could you talk to me more about how you know sex plays a role in addiction recovery and how they’re sort of correlated?
Kate: Sure, are you speaking specifically about sex addiction or other kinds of addictions?
Dan: Yeah, you mentioned that healthy sexuality can play a role in recovery from addictions so how does that exactly manifest itself in the patients that you see?
Kate: Sure. So often what we see is when people are coming into treatment for any kind of addiction, whether it’s a chemical addiction or a process of addiction – which is a more behavioral addiction like gambling, eating disorder or sex addiction, they’re there because that was their primary coping strategy for all of the emotional upset. And the addictive behavior served a really important function for them at one time and then they kind of got out of control, not kind of they usually get pretty out of control. At that time people are coming into treatment and at that point they recognize how isolated they are, how lonely they are, and how deficient their other coping strategies are. So what we do is help people reconnect with themselves, first and foremost, and reconnect with a community that can start to address some of those underlying intimacy needs. Because under all that addiction is really an intimacy disorder and when we think about it in that way, it makes a lot of sense. Because when we’re struggling in our addictions, we’re usually really alone in that and we don’t know how to connect with other people. We don’t know how to ask for what we need and get our needs met in other ways so our addiction becomes our best friend. It becomes our partner in crime, it becomes our primary relationship.
And so when someone gets into recovery, they’re learning how to have relationships all over again and oftentimes that’s clunky. And so when they’re just starting out oftentimes people will get compulsive in other areas of their lives until they learn new coping skills. So I’m sure many people who are listening to this show right now or watching it, would understand that when they got sober or when they’ve tried to get sober in the past usually that addictive tendency pops up somewhere else. We call it ‘whack them all’. So we see that show up on relational behavior. If someone gets sober from alcohol, suddenly their sex life goes off the charts and they start acting out or they get really love addicted. And so we’re looking at how to help people best utilize those intimate relationships in a way that is Pro recovery and really strengthens their ability to get through life and not only get through it but thrive in it.
Dan: Nice, that sounds great. I just heard from our Channel Manager that we sent you the link. If you want share this to your page so we can get some of your people in here. And while you’re doing that, I just want to say to anyone watching this live or later on if you have any questions about sex addiction or addiction recovery that you want to make sure that we get answers on this episode, definitely drop us a line in the comments and let us know. We’ll get them answered right away. A lot a lot of interesting stuff coming up here. Because I know that a lot of people deal with what you’re talking about, sort of this whack-a-mole situation. Where you address one addiction and then ten more behavioral addictions can jump up in their place. So I think that’s a very important issue to a lot of people.
Kate: Yeah. That kind of addiction interaction happens a lot and oftentimes there can be a fusion between people’s addictions. So for example, some people might act out sexually only when they’re intoxicated with alcohol and when they get sober with their alcohol, they might see their sexual patterns change. And so we look at what is the role of the different kinds of addictions and how are they connected? How do we need to address them simultaneously or separately?
Dan: Yeah. How do you find typically with patients that you see, that those are addicted- you find more people come in for drug addiction but find out that they also have a co-occurring sex addiction? Or do you kind of see it all as one big thing? How do you classify it?
Kate: That’s a really good question. I think a lot of that depends on what kind of treatment setting you’re in because if you’re in a place that treats chemical addiction that’s what primarily people are going to get treatment for. But when you are specializing in treating sex addiction, people understand that’s what they’re coming in for and then they might recognize they have a substance abuse disorder that is piggybacking on that sexual compulsive issue.
Dan: Yeah, that makes sense. So how do you treat sex addiction? I mean it’s not like drugs and alcohol, where abstinence is always the best answer. How do you actually go about treating it given that a certain amount of sex or sexuality is healthy but where’s that line?
Kate: It’s a great question and I think it’s one of the biggest fears that people have when they’re getting into treatment for sex addiction or compulsively sexual behavior, they think: ‘oh my gosh, I’m never going to be able to be sexual again and this means I’m going to have to be a monk the rest of my life’, and that’s not at all what we are advocating. Because people are naturally sexual beings and our sexuality is a key component of who we are as a human and to our experience in our most vital selves. So what we do is help people understand what for them, is the line that feels that they can’t cross anymore. So how does their sexual behavior stop being pleasurable, stop being intimate and where does it cross over into being compulsive and something that is driving them? And each person’s recovery plan looks different and it’s really important because there’s a lot of fear about what sex addiction therapists are going to say is a recommendation. We at Triune Therapy Group and many sex addiction therapists are very specific in being sex-positive and encouraging people to develop a new sexual plan. A healthy sex plan that really does encompass what is arousing to them. But sometimes that means taking a break from sexuality for a little while so that the neural pathways and their brains can reset and we certainly don’t advocate for that for a long period of time. But when it’s necessary, then we might make that recommendation and then we really help people develop healthy scripts and move forward and practicing that and it often feels really clunky to people because they’re not used to having sex or having relationships in a certain way. So a lot of the recovery work is around how to do that in a way that feels healthy and aligned with their value system.
Dan: Yeah that makes sense. What’s an example of a script that you might use in that situation?
Kate: I don’t necessarily mean a literal script. It’s more developing a new approach to sexuality and intimacy that feels rejuvenating to them and does feel compulsive. So helping someone get on board with for example, if part of their sex addiction was to have sex outside their marriage- for example -or outside their primary relationship how do we redirect that energy back into the relationship that they have identified they want to stay in? And so we help them, recondition sounds very scientific and like we’re maniacal doctors and so map coding that’s not it at all, how do we help them kind of recondition themselves to direct their arousal and their intimacy needs toward their partner? Because people often act out because they are trying to get some of their intimacy needs met indirectly.
Dan: Yeah that makes sense. It is interesting that you say recondition because there is sort of a chemical like physical component to sex addiction, isn’t that right?
Dan: Can you talk more about that? What’s that?
Kate: Sure, it’s just like with any addiction. The different parts of the brain that are impacted by a chemical addiction are also impacted by the behavioral addictions. So the mesolimbic pathway is in the brain get activated our brain releases dopamine, it feels good and our brain says; ‘yes more please thank you’ and then it goes from there and snowballs.
Dan: Yeah. So do you guys recommend a period of abstinence for most people just to reset those chemical pathways? How do you go about that typically?
Kate: It really varies from person to person. So if someone is in a primary relationship whether married or not we might say that sex within that relationship is going to be promoting their recovery. For some people, we might recommend that they take a 30, 60 or 90-day break from all sexual activity. It depends on what they’ve identified to be the behaviors that are addictive and how acute their addiction really is.
Dan: Yeah. So do you see just clients by themselves, do you do couples counseling? How does the therapy process usually work? What does it look like with you guys?
Kate: Great. I usually start with an assessment and that assessment can consist of some kind of psychological or psychosexual questionnaires. And then we sit down together sometimes it is with a couple sometimes it is with an individual. And we develop a course of treatment that feels like it will fit with their resources, with their time and you know their goals primarily. But I work with couples we also treat individuals in intensives we can see people on a weekly basis. And the goal really is to figure out what is important to them because no one can say: ‘oh you’re a sex addict’, only you can identify that way. And so it’s not my position to be forceful with treatment. Somebody has to want to change and if they want to change we are there to help them make that happen.
Dan: Nice. And what are some of the methodologies that you use just beyond setting. It sounds like you set goals for the treatment depending on the person and presenting problems. How do you go about actually treating the underlying issues?
Kate: Great question. It’s intense, it’s involved. So first what we do is, identify a plan for containment for the behaviors and we use a program that was developed by Patrick Karnes called the Task Model. And the Task Model is designed to help people walk through every step of this recovery gradually and in a really safe contained way. Because when we think about addiction as a process of coping that has gone awry, what we’re really saying is: ‘since I have all of your coping skills, just go into the world raw’ and that doesn’t really work and people get overwhelmed and they get flooded and then they relapse. So we look at how do we increase people’s resources and their coping strategies at the same time that we’re asking them to set aside what has been working up until this point. So it’s a two-fold process. And in that process, we’re identifying why do people get triggered? How can we slowdown that process and make them more aware so that they can intervene more quickly on their own behalf? So we’re identifying where they need to establish containment and then how to help them cope in different ways and once those strategies are in place then we really get into: ‘alright what are the underlying traumas,’ if any that exist and how can we address those problems so that your addiction doesn’t play whack-a-mole.
Dan: Yeah. You mentioned trauma, does that mean that -do you think most people have some kind of underlying trauma? And in cases where there isn’t trauma, what are the core issues typically?
Kate: It’s a good question. I do think that the majority of people that I work with do you have some underlying traumas and I think most of us in the world have had a traumatic experience here or there. But often times when somebody has a very acute case of addiction there are some underlying traumas. Now they might not be big T traumas or very easily recognizable things. But we often see people come in with a litany of what we call, little T traumas or kind of death by a thousand pokes. Lots of little things happened over time and accumulated and have left a bit of a traumatic residue, if you will, on our psyche. So we look at dismantling all of those things and helping people heal any wounds that do exist. And so for some people where they don’t have an identifiable little T or big T trauma, what we’re seeing is that they tend to be more addicted to pornography. And they started watching them when they were younger, we’re seeing that in younger generations now. With the prevalence of pornography online, teens don’t necessarily have any kind of trauma but they’re seeing so much and their brains are developing with technology in a way that wasn’t the case for previous generations.
Dan: Yeah, that’s a really interesting point. I mean as long as the internet has existed more or less the porn industry has existed. In a lot of ways, the porn industry drove innovation on the internet so there’s a whole generation like you mentioned, that have only been exposed to that from their entire lives. That has to be affecting their brains in some kind of way. Can you elaborate on that? How do you see that actually playing out with people of a certain generation?
Kate: Sure. So what we’re seeing is the younger the brain the more amenable it is to an earlier porn addiction or any kind of Internet addiction, gaming addiction included. Because what’s happening is the technology makes the visual stimuli occur so quickly and our brain metabolizes that information so fast and then it needs more and more and more in order to stay sufficiently stimulated, satisfied, excited, whether we’re talking about pornography or other internet addictions. And so people’s brains are changing and developing in ways that we haven’t seen because technology didn’t exist to this degree in earlier generations. So it’s still a bit of a study in process and more will be revealed as the younger generations mature.
Dan: Yeah along those lines you know with the technology in mind, do you recommend for either patients or parents of patients to set limits on, I mean obviously parents are going to set limits on pornography, but are there any sort of apps or ways that people can limit those things using technology?
Kate: Yes there are lots of different apps that people can download to limit their use of technology. And one of the apps that we use pretty regularly is called Covenant Eyes and they do a really nice job of helping people block the websites or the apps that are problematic for them. but there are myriad other apps that can be used to help people reduce their time and put time limits on their internet use and really just be more accountable to what kind of interface they’re having with technology.
Dan: Nice, yeah. I mean that’s got to be huge too. I think right now we’re as a society really experiencing the negative effects of the way technology has been designed with the way that you know apps are designed to be addictive, the way that Facebook even is designed to be addictive and yeah it’s really starting to come to the forefront because we just can’t ignore it anymore. So that sounds like a great tool. And we’ll make sure for anyone watching, we’ll make sure to link to that app in the show notes so you can download it. I assume sex addiction sort of progresses the same way as any other drug or alcohol addiction. It might start out as a solution even and slowly over time become more of a problem. Can you describe sort of the arc of that and the behaviors associated with it? How it would maybe start and then where it might end up before somebody seeks treatment?
Kate: That’s a really great question and there is no cookie cutter answer. Because again each person has to define their own addictive process for themselves. But what I will say is that what ends up happening more often than not, is that people recognize that they’ve started with some sort of sexual ritual or behavior that was arousing to them and over time it ceases to be arousing and it ceases to deliver the same kind of pleasure and they need more and more and more or something more intense to achieve this same kind of orgasmic release. And over time even that orgasmic release doesn’t in and of itself contribute to the same kind of pleasure that they once had. So we might get to people who use a substance for the first time and feel that incredible rush and then are constantly chasing the same high over and over again. And so our bodies develop a tolerance just like with drugs to sexual behavior when we have an addiction and people will seek out things that they never in a million years would imagine would have been arousing to them. So here’s an example a more concrete example, we work with many men who identify as cisgender and heterosexual men and they are only attracted to women. they want to be in relationships with women but their sexual addiction has taken them down a path of acting out with men. And this is very confusing to them because they don’t identify as someone who is gay and they’re not attracted to men and they don’t understand what’s happening. But their sex addiction has gotten to the point where they need something that is a bigger risk or carries with it a more opportunistic ritual. And so their sexual behavior gets out from under them and they don’t understand and they don’t like it. And so that distress is something that is really important to pay attention to. I’ve also worked with lots of people who find themselves getting into serious trouble because of their sexual behavior. So that can look like people acting out with pornography for example, four six seven eight hours at a time and masturbating to the point of injury. And that’s a problem, that’s a physical consequence. And some people have to have some pretty serious medical repair to counteract the injuries that they instill on themselves. Some people’s behavior catches a lot of other kinds of consequences financial and relationally. So it’s usually when people see the wreckage of their behavior that they start to think okay this is not helping me anymore this has become a disservice.
Dan: yeah and I imagine even – I know you’ve worked with the court systems and even in prisons I’m sure there’s an element along those lines where at a certain point people might start committing illegal acts or being interested in more taboo things that are either on the border of illegal early illegal.
Kate: Absolutely. A lot of people with a porn addiction find themselves infiltrated with child pornography and it’s not something they sought out but in downloading, these images that they’re downloading something pops up into their computer and is stored there and they find themselves in really hot water
Dan: I mean it sounds a lot. I’m seeing parallels between, like you mentioned, just like regular drug addiction or anything else like that where the same drug that got you high before isn’t working anymore and so people graduate to a more a heavier drug. So what is it about the like changing into more taboo things into more, you said riskier things, why does that stimulate the brain in a way that the same way a harder drug might stimulate the brain?
Kate: It’s a great question. So anytime we introduce fear or anger into our brain it’s an exciting – so it pumps up the brain it’s sympathetically arousing. Which means it is upregulated in our nervous system and so when we connect that with any kind of sexual arousal it’s like throwing gasoline on flame because we’re already wrapped and then we add something that is an accelerator to it and boom off to the races. So it becomes something that for some people can become really fused in their sexual ritual and they end up needing fear or they need the taboo or they need the risk in order to achieve the same kind of arousal. It would be very similar to somebody who is abusing alcohol and then introduces cocaine into the mix and now suddenly their brains like whoop, I need both.
Dan: Yeah and then every time -I know for from personal experience back in the day every time that you drink you’ve now linked that mentally with a different drug. So it’s a very slippery slope and once you go past there’s a lot of you know it’s the point of no return in a sense, well not no return. Obviously they can come get treatment but yeah that’s interesting. So what are some of the signs and symptoms of sex addiction how would you well first how would you know for yourself? And then we’ll know I’ll ask you how would you know for like a loved one?
Kate: Yeah good question. so we look at sex addiction like any other addiction and use the same criteria to define whether or not an addiction might be present, so the things that I would look for; if I thought I was- if I was questioning do I have a sex addiction or not, would be things like do I need more and more sexual behavior in order to achieve the same kind of high? Or am I looking for more intense sexual behavior to achieve the same kind of high? In other words am I developing a tolerance? (That’s important) are there significant consequences in my life because of my behavior? So is it costing me more money than I can afford? Are there any physical or medical side effects that have come as a consequence to my behavior? Is it costing me problems in my relationships? Is my partner hurt? Does my family know what’s going on? Am I hiding from everybody? Am I leading a double life to avoid those kinds of consequences what’s the wreckage relationally? And have I tried to stop and can’t despite all these other problems that have shown up in my life? And if those three things exist then I would ask myself the last question, am I experiencing any kind of withdrawals? When do I try to stop the behavior? So for sex addiction you know a lot of people think: ‘well it’s not a chemical so I can’t really get addicted to that’, or ‘I won’t have withdrawals’ but people do have withdrawals because their brain chemistry has become dependent on the ritual of the behavior. So they can experience what looks like post-acute withdrawal symptoms usually emotionally and psychologic. They can experience anxiety, irritability, depression, dysphoria a lot of shame despair. And all of those emotions become triggers for another cycle of addictive behavior because those are the same kinds of feelings that usually people are trying to avoid with the addictive behavior in the first place. So it does get the pretty vicious cycle. so I would say if you recognize yourself in any of that you might want to call a professional and have a conversation about whether or not you might have a sex addiction and for people who are concerned about someone that they care about whether they’re in a relationship with that person or it’s a family or a friend or co-worker you could ask all of the same questions but then also look for you know people who seem to be living very compartmentalized lives. Because when we’re in any kind of addiction you know what happens over here happens here what happens over here happens here and we keep our life very separate, very church and state. And so when we’re in recovery our goal is to be in more integration. I can show up, who I am, how I am, in every context and that’s okay. When someone’s in the throes of an addiction they’re very fragmented
Dan: Yeah that makes sense. and I know that that shame especially in drugs and alcohol addiction and I’m sure it’s true with this as well the shame that’s caused by the action like you said is a vicious cycle, so that can be really hard. How do you stop that? How do you intervene on that process? Because they’re going to feel the anxiety. They might feel the shame so at a certain point you just have to break it and they have to deal with that discomfort. How do you walk them through that?
Kate: It’s a great question. I mean recovery is about learning how to feel your feelings in moderation right and learning how to live life in reality and so that can be really uncomfortable for people who are recovering from any kind of addiction. So what we do again is to try to help people contain the behavior that’s become problematic and develop other coping skills so that they learn how to tolerate those feelings in a way that allows them to get through it without relapsing.
Dan: Yeah that makes sense. And you guys do some you use like cognitive behavioral therapy or DBT?
Kate: Yeah we use a lot of different modalities and one of the things that I’m most proud of in our practice is that we use both top-down and bottom-up approaches. What that means is that we address people where they are. So some people need to really kind of get in and noodle things cognitively and so CBT is a more appropriate place to start for them. Some people experience things more somatically they don’t necessarily have a vocabulary for what they’re experiencing or they might not have a memory for it per se so we try to help them kind of get to what they need to get to through somatic means so what that looks like is using neuro feedback or using EMDR or using somatic experiencing work to help people really get through somatically to regulate their emotions more effectively that way. So we use a combination of a lot of different modalities depending on what someone is most responsive to
Dan: Oh nice yeah that sounds great. So basically depending on their personality type or their learning style there’s a modality that’s best suited for them.
Kate: Yeah we’re not rigid in that way we want to make sure that people are walking away with something that works for them.
Dan: Yeah that’s great. So I know like support and community is such a big part of recovery, how do you recommend your clients and how you help your clients find that community?
Kate: Well usually one of the things that we recommend right off the bat is that they find a 12-step or another kind of recovery group that speaks to them that they can connect to. Because community is such a huge part of recovery and as I said earlier any kind of addiction but specifically sex and love addiction are really diseases and disorders of intimacy deficits. And so community is the antithesis to that. So community is usually the thing that most people are resistant to because it’s scary and they feel a lot of shame and so it’s really important to try and get in and you know we say feel the shame and feel it faster just get it over with and get in the room and try to let other people hear your story and listen to other people’s stories and it’s really key. Because what most people find when they find a community is that they’re not alone and other people have lived in the same pain that they’re living and are on the other side of it or in the throes of it but there’s a lot of strength when you’re with other people who are going through similar experiences.
Dan: yeah that makes a lot of sense you mentioned 12-step groups are there other groups that or can you list some groups and we can make sure to link to them in case anyone is interested in learning more about them.
Kate: Absolutely. So there are a couple of groups, 12-step groups that we would recommend if somebody has a sex or love addiction. There are groups called Sexaholics Anonymous (SA) and that group focuses primarily on maintaining a relationship that’s between a husband and a wife so it’s usually good fit for people who are married or more religiously organized and want to make sure that that is aligned with their value system. There’s also Sex Addicts Anonymous or (SAA) and that group has a more liberal definition of sobriety that aligns with what I described earlier, each person identifying their bottom lines and identifying their healthy sexuality plan. And so it’s different for everyone. A lot of people find solace in that group and then there’s also Sex And Love Addicts Anonymous or SLAA for shorthand and that’s a great group for people who have concurrent sex or love addiction issues and often times we see those things go hand in hand
Dan: Nice what is the difference between a sex and a love addiction? And how do they sometimes, I imagine they probably co-occur and may exist separately, what’s the main difference?
Kate: Great question. So the way that I think about love addiction is that, it’s really more fantasy based and all addiction is fantasy based to some degree. But with a love addiction somebody becomes really preoccupied with the object of their affection and they tend to attach to that person a lot of unconscious hopes and needs about who they are as a person or who they are in relation to this relationship. And it becomes something that fulfills them and so they become addicted to the euphoria of falling in love and having that connection be something that feels so strong it gives them a boost, fills a avoid for them. With sex addiction it’s a little bit more transactional usually, it’s more about the ritual of the behavior that a person becomes addicted to. So again they can co-occur and they can be separate.
Dan: Nice, thank you. That’s a great differentiator and we’ll make sure for everyone watching, we’ll make sure to include links to those groups in the show notes so if you’re interested in learning more about them you can find them there. Yeah that’s awesome. We’re coming up on the end of the time here but I want to make sure we talk about everything that you want to talk about I know you also have a radio show and a podcast called Behind Closed Doors and I want to make sure to give that a quick plug. Can you tell us about sort of what you guys talk about on there and what that’s all about?
Kate: Yeah absolutely thank you. So Behind Closed Doors with Dr. Kate and Lauren airs every Saturday at 6 p.m. Pacific Time on talk radio 790 KABC, which is a local talk radio station in Los Angeles. But if you’re interested in hearing the show and you’re not local to Los Angeles you can stream it live at 6 p.m. Pacific time at KABC.com. You can also jump on our website where we have all of the podcasts there available and you can subscribe on iTunes, Apple podcasts, Spotify a couple of other places too. But our show is really designed to talk about all things related to sex, relationships, addiction, mental health, staying healthy, being fit and really thriving. So we talked about myriad of issues related to all of those things and anything going on in the news media that might be related as well, so it’s a fun show.
Dan: Awesome that sounds really cool. Definitely going to tune in one of these days and for anyone that’s interested in learning more about that will include some links in the show notes. Is there anything else? Where else can people find you if they wanted to if they’re in the Los Angeles area and want to contact you about services or social media? Where can people find you online?
Kate: Yes so people can check out our website at www.triunetherapy.com. We also have a YouTube channel with a growing library of videos that people can check out all of our podcasts are there too with really fantastic pictures and videos of our radio show actually;
Dan: pg-13-rated pictures and videos.
Kate: PG rated and then on social media they can follow us on Instagram and Facebook at Triune Therapy Group you can follow me @dr. Kate Balestrieri and my business partner Lauren @Lauren Dummitlmftcsat and all of that’s on our website.
Dan: Excellent. Again more links in the show notes check them out for anyone watching thank you so much really information-packed interview. I have actually so many more questions but we’re at the end of the time so we’ll have to have you on again to talk about the rest of them.
Kate: That sounds great Dan thanks so much for having me on the show.
Dan: Thank you really appreciate your time. For everyone watching, thank you so much for watching. If you or someone that you love is suffering from addiction to drugs and alcohol or to sex and behaviors, please reach out to us either myself or the team here at Recovery X and we’ll get you hooked up with someone who can help you in your area right away and we’ll get your questions answered. So if you have any questions please drop them in the comments and yeah, we’re always here as a resource. All right thank you so much again. I’m Dan Sevigny, this is Recovery X that was Dr. Kate Balestrieri, from how do you say it again, sorry?
Kate: Triune Therapy.
Dan: Triune therapy group in Los Angeles. Alright guys, thanks so much. Dr. Kate thanks again.