Aviel, M.D. Goodman
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Scholarly, comprehensive approach to sexual addiction. 5 out of 5 stars.
31 of 34 people found this review helpful.
This work proves itself to be a substantial addition to the expanding field of literature on sexual addiction theory and treatment. This is a scholarly and meticulous presentation designed for careful review by clinicians rather than by the general public. It is likely to be particularly well-received by psychiatrists and others of psychoanalytical training who may not have a full appreciation for some of the more popular authors in the field. It will admirably serve the additional purpose of introducing psychoanalytic theories of sexual deviancy to the clinician who may not be strongly grounded in this approach.The book starts with a thorough review of the issues surrounding the terminology of sexual addiction, including the clinical arguments for and against classifying such behavior as either addictive, obsessive-compulsive or impulsive. It then reviews etiological theories of sexual addiction, including biological, sociocultural, cognitive-behavioral, and psychoanalytic, the latter of which occupies almost a quarter of the book. The author notes that this emphasis is designed in part to address the fact that psychodynamic psychotherapy "is given little attention by more contemporary approaches to treating sexual addiction....."
Dr. Goodman's extensively documented and intelligently presented approach then integrates the biological and psychological understandings of addictive disorders in general and sexual addiction in particular. According to this theory, "the addictive process originates in an impairment of the self-regulation system......(which) leads individuals to depend on external actions to regulate their subjective states....." Explanation is given of the three main components of this self-regulation system: affect regulation, self-care, and self-governance functions. Behavioral implications of impairments in each of these functional areas are then explored in some detail.
Turning to issues of the diagnosis and epidemiology of sexual addiction, Goodman addresses differential diagnostic issues, prevalence rates and comorbidity issues. The rest of the book focuses on treatment modalities, including medication (both antiandrogenic and affect-regulating agents); behavior modification (including aversion conditioning, covert sensitization, imaginal desensitization); cognitive-behavioral therapies; groups; couples therapy and psychodynamic psychotherapy.
Goodman's integrated treatment involves addressing "both the addictive sexual behavior and the underlying addictive process", bringing together all of the above components of treatment into "one theoretically coherent, clinically unified approach." It is here that the book moves from the theoretical to the imminently practical, reviewing behavioral symptom management such as relapse prevention (including risk-recognition, urge-coping, and slip-handling), and psychodynamic psychotherapy (including helping clients to understand, integrate and internalize insights and self-regulatory functions that lead to adaptive rather than symptomatic behavior).
After examining the relationship between behavioral symptom management and psychotherapy, the author offers a useful approach to integrating pharmacotherapy into the overall treatment of sexually addictive behavior. Countertransference is touched upon, as are cautions about limited outcome measures which complicate prognosis. The last section of the book addresses illustrative clinical vignettes showing how an integrated treatment approach is tailored to a variety of cases.
This book earns its place among the top shelf of titles worth reading by clinicians wishing to ground themselves in theory and practice strategies for the treatment of sexually addictive behavior. With fifty pages of references, it serves admirably as a coherent, theory-driven approach which adds order and intellectual rigor to a subject that is complex and remains inadequately conceptualized. While far from being able to serve as a definitive text, this book lays out an important framework for future outcomes-oriented research
