Mentalization-based therapy for sexual addiction: foundations for a clinical model

Abstract

Sexual addiction is an important clinical consideration for sex therapists. Particularly in light of the wide range of theories about the etiological course, and divergent views about the clinical usefulness of formal diagnostic categories, treatment models that can be applied integratively, across settings and therapy modalities, are warranted. In this paper, mentalization-based therapy is identified as a broadly applicable, research-based psychotherapeutic model for application in the treatment of sexual addiction. In our model of mentalization-based therapy for sexual addiction (MBT-SA) we hold that out-of-control sexual behaviour may often be a maladaptive psychological strategy to defend the individual against difficult or problematic thoughts and feelings. It is assumed that the client's cognitive and affective experiences will be unique, and the client's symptomatology will be multifactorial. MBT, which can be used conjunctively alongside other therapeutic modes and techniques, provides a means for understanding and working with the client's unique and subjective experience of out-of-control sexual behaviour. Within the mentalization-based treatment model, sexual addiction seen as characterized by breakdowns in mentalizing (the client's ability to understand thoughts, feelings, and behaviours in terms of intentional mental states), and informed by a diverse array of possible contributing factors. To reduce out-of-control sexual behaviours and their negative personal and interpersonal consequences, MBT-SA provides a clinical framework for conceptualizing and treating sex addiction through the restoration of mentalizing.