208: Sex and Porn Addiction - Myths and Reality - with Paula Hall

How do you know if you, or someone you love, is addicted to sex, or porn? What can you do about it? And along with healing patterns of addiction, what is most helpful for the partners of people with addiction? Our guest today is Paula Hall, one of the world’s leading experts on treating sex and porn addiction, and the author of “"Understanding and Treating Sex and Pornography Addiction” - along with many other books on the topic for addicts, partners, and the therapists who are helping them. Although the idea that people can be addicted to sex or porn is still controversial - we’re going to tackle this topic head-on, so you can identify ways that you might be impacted. And, as always, you’ll learn powerful strategies for how to overcome addiction and get back on track to a healthy sex life.

As always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you. Please join us in the Relationship Alive Community on Facebook to chat about it!

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Resources:

Visit Paula Hall’s website for more information about her work, her books, and her public speaking.

Check out the Laurel Centre’s offerings for help with Sex and Porn addiction.

Read the Paula Hall books that are right for you.

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Visit www.neilsattin.com/addiction to download the transcript, or text “PASSION” to 33444 and follow the instructions to download the transcript to this episode with Paula Hall.

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Transcript:

Neil Sattin: Hello and welcome to another episode of Relationship Alive. This is your host Neil Sattin. 

Neil Sattin: We're going to revisit a topic today that we've talked about before on the show and we're going to take an even deeper dive into the question of addiction. Especially as it pertains to sex addiction, porn addiction, love addiction. How do I identify if that's something that's impacting you or someone that you love? And if the answer is yes, what can you do about it? Is there hope? How do you facilitate change in a way that actually leads you to someplace that's healthier, and not being impacted by addiction? To talk about the topic today, we have with us Paula Hall, who is a licensed psychotherapist from the U.K. and whose book, "Understanding and Treating Sex and Pornography Addiction," is a masterful work on understanding exactly where sex addiction comes from and what you can do to treat it. And her words are based on years of practice with clients and seeing what works and what doesn't. Paula is the founder of the Laurel Center which offers treatment programs in the UK for people and they also offer sessions in the UK and over Skype and Zoom for people everywhere in the world. So it's powerful work that they're doing. She's written a couple of other books. Well actually many other books, but a couple others that are notable in terms of sex addiction recovery one for the partners and one for the couple as a whole, and we'll probably get a chance to talk about that as we go. In the meantime, there will be a detailed transcript of today's episode, if you are interested in downloading that just visit Neil-Sattin-dot-com-slash-addiction. And as always you can text the word "Passion," to the number 3-3-4-4-4, and follow the instructions which will also get you the transcript to today's episode. I think that's it for now. Paula Hall thank you so much for joining us today on relationship alive. 

Paula Hall: Hi! Thanks for inviting me. 

Neil Sattin: It's really great to have you here. I'm curious to know maybe for starters, what just led you to focusing your work on sex addiction and and porn addiction? How did how did you end up there?

Paula Hall: Oh gosh I thought you might start with an easy question, Neil. I guess so I've been a therapist for gosh nearly 30 years, now initially I started in drug addiction, did that about three years and then I trained as a couples' psychotherapist and sex therapist. And it was probably about 15 years ago now I was working in private practice and I had seen a couple of clients, a couple of male clients, coming on their own. Both of them very happily married, young families, devoted fathers but they had these habits. One of them, it was visiting massage parlors. The other one was picking up women in bars basically. And what I noticed was that, being a psychotherapist for some years, I was able to kind of work with these guys to understand why they were doing what they were doing, and in a typical psychotherapy style: How was your relationship with your mother? And you know all of that kind of stuff exploring that. And we were able to kind of find those answers but unfortunately both of those guys, towards the end of the case. they understood why they did it and carried on doing it. I didn't seem to have any tools to help them stop. And then basically what happened was I went to a conference and one of the speakers that a guy called Thaddeus Birchard, also someone in the UK, did a talk on sex addiction. He is one of the very much one of the pioneers out here in the UK. And he talked about a cycle of addiction and having come from drug addiction, all the pennies just dropped into place. I just started seeing how what I had been sitting with those two guys was just like the work that I was doing with drug addiction. But this was around sexual behaviors, and for some reason that penny hadn't dropped before. So yeah, that I guess, failing my clients is what drove me to be so passionate about understanding this problem more, learning more and really developing tools and models and services that could help. 

Neil Sattin: And can you talk a little bit about your perspective? Cuz I know you also do couples work and you've done sex therapy with clients. I think in the UK, they call it psychosexual therapy.

Paula Hall: Yeah yeah. 

Neil Sattin: So I'm curious where does sex positivity intersect with this question about whether or not we can be addicted to sex?

Paula Hall: I think it's a completely different thing. In terms of being a therapist and being sex positive, I think it's a bit like you know being food negative if you work with people who chronically overeat. Of course, I think sex is brilliant. It's great. The problem is addiction robs people of their sexuality. I've never met a happy sex addict. Now you could argue that perhaps they're out there but they're not seeking help. So perhaps I'm the wrong person to know that. But my experience has been that addiction and compulsion robs people of their positive sexuality. It takes away their ability to choose the lifestyle they want to lead. It becomes a place where they feel shame, where they feel dissatisfied, where they feel insatiable or where it feels seedy, it feels stolen. It's no longer a pleasure. And I think treating sex addiction is about helping people get their sex lives back. When I run the group so we do a lot of group work over here with guys, and the guys often think I'm kind of joking when I quite often start off by saying, "I'm going to make sure that your sex lives are better than they have ever been, ever." And they kind of look at me curiously and think that's an odd thing to say, but actually I think that is one of the goals of treating sex and porn addiction is helping people have brilliant sex lives and really enjoying sex again, in whatever shape or form that makes. Whether that's within a monogamous relationship, a heterosexual relationship, whether in kink or whatever your taste is, I think that's irrelevant. 

Neil Sattin: Yeah. Great. And that seems to touch in to the question about how someone would know whether what they're experiencing is addiction or not. So can we can we steer a little bit towards assessment, and how that how that works. 

Paula Hall: Yeah, I think it does lead to that very much so. I think a really critical question is do you enjoy what you're doing? Are you still enjoying it or is it never enough? You always gotta go for the next hit? Are you noticing that your behavior is escalating, that you're preoccupied by it? I think a good sexual experience should leave you with a smile on your face, a sense of wholeness and fullness, and you feel satiated, a bit like a good meal. You're not worried about where the next one's coming from, you're not anxious about it. You're not worried that someone's going to find out. So, if it's a positive experience that you've really enjoyed and then you're probably not acting out compulsively. But if you're preoccupied with it. If it's never enough it is nowhere near as much fun as you thought it was going to be. Then perhaps this has become a compulsive. I think ultimately escalation is the, is the real critical sign of compulsivity, it's when it's escalating. 

Neil Sattin: And so just to really be specific about escalation, what are some different forms that that could take?

Paula Hall: So, that might be spending more and more time on the activity or planning for the activity or recovering from the activity or needing higher and higher stimulus. So, that might be more hard core porn or taking more risks with sort of cruising or whatever, in order to get the same kind of impact.  I think most of us understand escalation if we think about it around alcohol, escalation might be the wrath of the one glass of wine and it's become a bottle. So it's more and more of it or rather than the glass of wine, it's now become a glass of whiskey, you need something that's stronger and harder to get the same impact. 

Neil Sattin: Got it and then there's also, right, the potential for certain kinds of activity to lead to other kinds of activity. So you might start out in an online realm and end up chatting with people, end up on dating sites or visiting escorts, and like there's that kind of escalation as well. 

Paula Hall: Absolutely escalation into... Yeah, I mean there's other forms of kind of higher stimulation but they may be ones that are you know going to cause you more and more harmful consequences. If you're beginning to cross your own boundaries. Things that you always said you wouldn't do. Promised you wouldn't do. Never thought you'd even want to do, perhaps. Then again, that's showing that that escalation is is really pushing into your own value system. 

Neil Sattin: Yeah. And, is there a point in making a distinction between like, it's an addiction that's pushing your past your values or it's an inability to live according to your values, that's keeping you from sticking with your values? Do you know what I mean? 

Paula Hall: Yeah, yeah, yeah. No. Good point. Yeah. Okay, so I think this is where shame comes in. And shame unfortunately comes up a heck of a lot in this work. If you keep crossing your moral values and actually, Hey you aren't really that bothered about it, you probably won't feel any shame. Also, the experience of shame demonstrates that you actually have strong values. If he didn't have strong values you wouldn't experience it, you just wouldn't care. So, if you know your going against your value system and you feel really bad about it but nonetheless you are unable to stop, then it's likely to be addiction. If you're crashing your value system but you don't really care, you may still be an addict, but you've also got a problem with your moral compass. So you know, classically you have kind of sometimes I have a first session with a guy and he'll go," You know, I just, am I an addict? I dunno if I'm an addict, or whether I'm just a bit of a womanizer and I just want my cake and eat it. Maybe that's what it is." And I often say, "Well you know what. You can be an addict AND a womanizer, who wants a cake and eat it. They're not mutually exclusive. You can be both or one or the other." But escalation is the side where it really is addiction, I would say. 

Neil Sattin: Yeah so just a quick point of clarification. You've mentioned working with guys a lot. How gendered is this problem?

Paula Hall: So, most of the research seems to say, in the research certainly I did for my first book as well on this, suggested that about 30 percent of the people with sex and porn addiction were women. And certainly, if you sort of look at some of the forums, some of the kind of free spaces if you like, you'll see more and more women's voices coming up talking about their problem. But they don't seem to come forward for help and this seems to be something that's international, I've got colleagues delivering programs in other parts of the world as well and obviously there's there's a lot of therapists working in the States. And though, women don't seem to come forward for help as often. And you know, I'm quite curious about that some of that to do with economics, is that to do with different different types of shame that are around for female sex and love addicts? Is it because there aren't enough services offered on a few occasions. We have tried to offer very, very specific female services but still had very little take up. So I think... 

Neil Sattin: Yeah, that is interesting because there are so many other realms where I think the women lead in terms of you know, couples therapy or even like personal growth work. There seem to be a lot more women on average in terms of like the demographics of people who are writing me and listening to my show just as one sample group, predominantly women. So it's interesting that that that that would be the case that they'd be less inclined to seek help for sex and porn addiction. 

Paula Hall: Yeah, and my hypothesis would be, well, two. One, is I suspect an awful lot of those women who are addicted or using sex compulsively may actually be working within the sex trade. So for them finding help is also going to get in the way of their income stream. But, I think we do still live in a society where the message is about how, dare I use the old fashioned word "promiscuity." Male promiscuity still viewed quite differently to female promiscuity. So you know a man that is sleeping around, has multiple partners, is a bit of a lad, is a bit of a cad, is you know a bit of a womanizer, a bit of a player. The words we use for women are still tend to be "slut," or so much more derogatory. So I do think it's harder for women to come forward. I think there's, I don't know if it's more shame, but a different kind of shame for women coming forward for help. And as I said, I think it's a Catch-22, because in the media, in situations such as this, I find myself talking predominantly about men because that's who we generally work with. Most of my services are targeted at men because they're the people that come. I think that means a lot of women begin to feel increasingly invisible. So I really hope it will change. And yeah, we are going to launch an online group for women because then at least we don't have to worry so much about the geography. So is anybody listening out there who would define themselves as a female sex addict do get in touch because you could join one of our online support groups. And I hope that might begin to get something going and then as we're talking about it, more and more women come forward, and it will make it easier for more women to come forward and get into that positive spiral. 

Neil Sattin: Yeah yeah. Great. One thing that I'm curious about is, so we've talked about some of the kinds of behaviors that might fall into this category and in researching for our conversation and also resulting from my conversation with Alex Katehakis before, I've talked to a lot of people about masturbation. More than I've ever talked to people about masturbation before which is in itself been interesting because I think there's so much shame that we hold around self pleasuring. And there's this question about how masturbation can potentially be addictive or can be used as a coping strategy for dealing with emotionally challenging situations or emotionally challenging places in one's life. And so I'm curious about like if someone first, is using masturbation as a way to kind of cope with stress and hardship. I've talked to some people who've said, "Well isn't that normal like, like, that's a mechanism that we have in our bodies to do that." But then if you suggest to someone, "Well how about not doing that?" They would say, "Well why would I not," or, "I could never stop doing that." And then it starts to bridge that question until like, "Well is it an addiction for you to be to be masturbating as a way to cope or is it not?" So there's this gray area here that I'd love to have your insight on because I think a lot of people when I talk to them about it they're like well, "Wow if like that means I'm an addict then I got to think like you know 90 percent of guys out there are sex addicts using masturbation as a way of dealing with their lives and fantasizing and things like that." And overall, I want just people to be pulled toward feeling like whatever they're doing is healthy for them and positive. Can you shine some light on that?

Paula Hall: Yeah. So first and foremost I absolutely do not think there is anything wrong with using sex, whether it's partnered sex or masturbation for comfort. I think couples have kissed and made up as we euphemistically call it, for years, centuries people have masturbated to help them get to sleep at nights, masturbating to help them get out to work in the morning, masturbating because they're bored, masturbating because they're sad. That in itself I don't think is a problem at all. It's when he becomes a primary coping mechanism. It's when, if for some reason you couldn't then actually you start feeling worse and worse and worse. And again is when it's escalating. So I think if somebody uses masturbation as a way to get to sleep every night. And if it takes 10 minutes whatever is never escalated it's never got worse than that, it's not getting in the way of their relationship. So let's assume they're single or whatever. It's a habit. There's no harmful consequences, I think the problem is you say, we're trying stop. Well why? Why do that? I you know I watch television quite often to switch off. "Dunno. Well maybe you're addicted, maybe you should stop." Or maybe I just don't have the motivation to try and stop because I don't see why it's a problem? 

Neil Sattin: Right. 

Paula Hall: I think that's where we start getting into the realms of pathologizing sexuality. For me you know masturbation, it's a physical comfort. Why is that any worse than having a soak in the bath or putting your feet in a foot spa? 

Neil Sattin: Yeah. Great. So I think that maybe the question is where it bumps up against your values. And that question of escalation. 

Paula Hall: I think in terms of addiction it's about escalation. If there's been no escalation then... I realize I'm being quite categoric and there's bound to be some exceptions. But, on the whole if there's been no escalation I'd say there was no addiction in just because it bumps up against your values. That doesn't make it an addiction. I've had a number of clients come and want to work with me. They've been a people of faith where masturbation for them is a sin, it's something they're not comfortable with but they keep doing it. And they will use the language of addiction. And if there's no escalation and the only problem is that it's against their values, then it's not addiction. Now that doesn't mean that you might not work with that person, you might not help them to find other things to do. So let's say my feet somehow became allergic to my foot spa, so I couldn't use it anymore. Let's find some other ways of getting some physical comfort that aren't going to cause a problem in other areas of my life. But let's not call it an addiction because it's just not accurate. 

Neil Sattin: Great. That's a helpful distinction to have. 

Paula Hall: And I think it's also important to recognize that as I'm sure you know CSBD, Compulsive Sexual Behavior Disorder has been accepted by the World Health Organization to go into ICD-11. So it will be, we're not calling it addiction yet, it's going to be called compulsive sexual behavior disorder, which will include pornography. This will be an official diagnosis that can be used but that's coming online quite soon. But very, very clearly in the diagnostic criteria is that it can not be purely a problem caused by morality. It has to be causing problems outside of that. I mean another sort of way I often describe this is if alcohol was against your moral values. So for some people of faith of course drinking alcohol is not OK just because you have a small glass of wine every single evening to get to sleep would not make you an alcoholic, if it's never ever escalated. That would not make you an alcoholic. Even though it's against your values. And you need to stop drinking if it's against your values, and something else. So I'm not saying you shouldn't change but you wouldn't call that person an alcoholic. 

Neil Sattin: Really helpful distinctions. And where this I think also gets interesting is because it plays into the partner dynamic. And that question of like well of course I don't have a problem with you masturbating but what are you thinking about and or you're looking at porn like that doesn't seem like it is you know aligns with my values or that sort of thing. So how does that when you look at addiction and that sense of like is what you're doing is causing a problem for you in your life. How do you how do you separate that from those other kinds of conversations that people need to be having with their partners anyway about what's appropriate what is and how to handle it when they actually have differences. 

Paula Hall: Yeah absolutely. And of course for up for some couples pornography is just not okay, it's not okay for a partner. And if your partner is looking at pornography something that you are morally opposed to then that is going to create an issue within your relationship. And I would say that's an issue for couples' counseling. So assuming it's not escalating there's nothing to define it as an addiction. This is a couple counseling issue to decide what to do about this. And I think if you're somebody who is just can't stop looking at pornography in spite of how your partner feels about it, then maybe you either need to look at your feelings towards your partner and how much you respect them and their views or you need to look at whether or not this is a compulsion. I think in terms of fantasy, I mean that again is a really interesting one it is perfectly possible to masturbate and not to use fantasy. And of course some partners don't have an issue with fantasy, some partners will thoroughly enjoy sharing their fantasies with each others. Some people use fantasy but it's always a fantasy of their partner so their partner doesn't object. Again and as a sex therapist and I have been a sex therapist for what 18 years now. Talking about fantasies is something that commonly comes up when you're working with couples with sexual difficulties and want to enhance their sex life and every couple is different. 

Neil Sattin: Yeah. Yeah. You said something... 

Paula Hall: Did I answer your question? 

Neil Sattin: Yeah you did. And they're like so many things flying around in so many different directions we could go. I think to ground us, I'm curious like as a partner what are some ways that you might sense that there's something going on that would need to be addressed as an addiction. 

Paula Hall: Yeah that that is a tricky one isn't it? I think it's uh... changes in behavior. So someone who might be becoming more and more withdrawn from the relationship. Someone who's becoming more and more secretive. Somebody who's finding more and more excuses or reasons to not engage in activities that they previously would have seen as important. So if they've never wanted to go to the parents evening and are making excuses now then it's probably not relevant. But if they you know, if this is a new thing, if they seem to be finding excuses to get out of responsibilities that they would have enjoyed otherwise, then I think you might question that. Struggling with stress more. I think if you've... It's tricky partners often when they reflect back recognize that there have been changes. It's only in hindsight that they realized why. But there are of course 101 other explanations for why somebody might be withdrawing behaving secretively,  maybe there are issues within the relationship that need addressing that've got nothing to do with sex or porn addiction. Or it may be something else altogether. But yeah I think withdrawing from the relationship, becoming more secretive and changes in character. Behavior. That's really vague, isn't it? It's tough, it's really tough for partners. 

Neil Sattin: It's a little vague. And I mean what comes up for me is the sense that if you are sensing something is going on then you want to do your best I think to lean in and to have vulnerable conversations. 

Paula Hall: Absolutely yeah. 

Neil Sattin: And so that brings up this question of like how can people in partnership particularly, how can they create a context that allows them to talk about this safely? Especially because in partnership so many of the things that happen are are a violation of the integrity of the relationship. So as a partner, I think you ideally you want to, if something's going on with your spouse or your partner, you want to know what's going on. But then once you find out what's going on, and that of course I think is what often keeps these things in the shadows right. Is that someone might be willing to talk about their struggle except knowing the impact that that could have on their on their partner and on their relationship. 

Paula Hall: Yeah it is. It is very difficult. I think sometimes as a partner, if you do have a sense that there may be something around this that they don't want to talk to you about, can they talk to somebody else? And that might be the bridge to them talking to you. So, I wouldn't say that that is a lot of alternative of course but that might be the bridge to them being able to talk to you. But it is really difficult and you know I've worked with partners who have you know, tried to say and did that with all integrity and commitment, "I will support you. If this is about this and let me know. Tell me. There's nothing we can't work through." And then they find out something and they are absolutely devastated and the guy feels cheated because he trusted that she wasn't going to react like that, she had no idea what he was going to say when she said that. It's really difficult. It really is. It really is difficult of course that's what couple counseling often comes in,  so it may be that you are noticing there are issues within your relationship, there's issues within your sexual relationship. Also your emotional intimacy and you agree to some couple counseling for that and maybe within that environment it comes out. I mean certainly one of the things we're a training organization as well, and one of the things I say whenever I'm speaking to or training couple counselors, is always ask about poor news, always do individual history sessions and always ask about porn use and compulsive behaviors. Because so often what increasingly, that is at play if not the cause of, that is at least a contributing factor to so many issues for so many couples. 

Neil Sattin: What advice do you have for a partner who's in that quandary of feeling, on the one hand the impact of the betrayal, so that betrayal trauma, and somewhere in there saying, "Well I love this person and I do want to help them but I'm I'm really angry or feeling devastated," or all of those things. 

Paula Hall: I think firstly be gentle with yourself and give yourself time. It is perfectly okay to be angry. It is understandable to be angry. It is okay to have those feelings, find somebody that you can share those feelings with. Ultimately, if you want your relationship to survive then you need to be at both of you need to get to the place where you're blaming the addiction rather than your partner and you're able to rebuild your relationship from what the addiction has done to you, rather than what your partner has done to you. But that takes time. And initially when there is so much pain around it, and fear, and of course you can't break through that fear unless your partner really is getting into recovery and able to support you in your recovery. But yeah it takes time so often it is just be just be gentle with yourself. 

Neil Sattin: I know in your in your book you advocate not making any drastic decisions for a period of time so that you have time to kind of think it all through and regain your footing. 

Paula Hall: Yeah, especially if you've got children. I mean there's you know, there's some decisions that are very hard to take back. I think if you've got children then wait... What I often say to partners is: "Don't let what he has done, his complete and total screw up, force you to make decisions that you're not ready to make, or force you to make decisions that you and your children potentially will have to live with forever." His crisis does not have to create urgency for you. It doesn't have to and that's tough to hold on to that. It's true.

Neil Sattin: Yeah. And do you have thoughts for someone who's now listening to this and thinking well maybe I do struggle with that or maybe that is an issue for me. How can they come forward in a way that has the best chance of panning out well for them. 

Paula Hall:  I think for partners, I believe in connecting with others in all kinds of work. I think recovering on your own is incredibly difficult. Whether you'll be on the addicted partner or the partner. So certainly for partners I'd encourage them to find other partners but do find other partners who, trying think how to say this respectfully, who want to move on from this. Occasionally, I have stumbled across some partner forums or partners who've been on certain partner forums where everything's about staying in the same places, it's a year on, two years on, three years on, five years on, and they still feel completely trapped and burdened by this situation. And I think that is so disheartening and discouraging for other partners. You're not trapped. There may be some very very difficult decisions to make and they're decisions that have been forced on you. But you're not trapped, you do have choices about where you move forward so find support from other people who are trying to find ways of moving forward. Whether, that's together or apart. 

Neil Sattin: Great, great. And I think where I was heading was also, you know, we've been talking a little bit about if you suspect something's going on for your partner what can you do and how do you handle the betrayal and all that. If you are potentially the addicted partner, what are some ways to step forward that help you handle the betrayal trauma that your partner is experiencing, or own what's happening for you? That sort of thing. 

Paula Hall: Well, you hit the nail on the head there, Neil. Own what's happening. Own the fact that you did cause this and I think that's really, really difficult. I think we've just run one of a couple of weeks ago, a couples' intensive, as the first time we've run the couples program since the book came out for couples and it was so powerful, it was incredibly powerful. And I think the absolute number one tool for helping couples move forward is for the addicted partner to express empathy. As soon as the addicted partner gets into defensiveness, gets into: "Yeah but... " It just all falls apart. Relentless empathy.  I think for the partner, if you try and think about it like this, if your partner doesn't believe that you know how it feels and what you've done. How on earth can they trust you won't do it again? And you have got whether it's something was an accident, whether it's deliberate, whatever it was you have got to demonstrate relentless empathy and drop the defensiveness, of course you can't live in a place of constant accusations, two years, three years, five years on. But if you're in the first 12 months post full disclosure and this is assuming that has been the disclosure that's required, and you are fully in recovery. You have got to just keep taking it on the chin and relentless empathy. 

Neil Sattin: Yeah, yeah. And I like how we're bridging and it's starting to get towards recovery and repair. When you talk about the disclosure just so that everyone understands what you're talking about, what are you talking about?

Paula Hall: So, we talk about therapeutic disclosure. We recommend therapeutic disclosure. Unfortunately, there are few partners who know absolutely everything. That's not necessarily because they haven't been told, it may be that actually much of what was told was late at night. It was in the height of emotion, a lot of it may have been forgotten. What I've experienced so often as a couple counselor is that if you don't do a therapeutic disclosure then some additional bit of information that either gets discovered, disclosed or remembered, sabotages the healing process. So a therapeutic disclosure is about getting the facts out on the table. And it's important to distinguish between a therapeutic disclosure and a forensic disclosure. This is not every single nitty gritty of sexual position and cup size and place and whatever, that's forensic and completely unhelpful. But a broad brush understanding of the chronology, the dates, the times, the where's, the when's, the what kind of things, the behaviors, are really important.  And really, and in that's between the therapist and the partner to kind of negotiate what's going to be genuinely helpful. Then when you have got that information when you both know what it is you're dealing with, in the couples book I use the metaphor of more of a tidal wave crashing over your relationship. And it's kind of really understanding what that tidal wave is saying, so you know what the damage is so you know what you're repairing from. And I think until that happens you keep getting the aftershocks. So a therapeutic disclosure is a way of putting the past in the past. Assuming of course, no relapses but putting the past in the past so you really can move on from it. 

Neil Sattin: Right, and I like the support that you suggest for having that kind of disclosure where you know they're supported by a couples' therapist, and also each by their own therapists, so that there are a lot of people holding the container around the information coming out. 

Paula Hall: Absolutely. Absolutely. And you know for some people that there are extra bits of information or things that are remembered or I mean an example it was... In some respects, looking back on it it's almost quite comical. But my goodness it wasn't at the time. I had a couple where the partner knew the addicted partner often acted out. And he said he often acted out, and I just happened to ask the question, "How often is often?" And her interpretation of "often" was... Let's see I can't remember exactly now, but say once a month. Whereas his definition of "often" was twice a week. They both thought the other one knew what "often" meant, this what really was a genuine miscommunication but it caused such devastation and going almost back to square one for that poor partner, again. So again, this is how a therapeutic disclosure really helps people be sure that they have got the story as it were, the narrative, and doing it in a safe way or safe a way as possible. Unfortunately we can't guarantee it's pain free. But having some way to move forward from that as well, a process of moving forward. 

Neil Sattin: Yeah and let's let's veer our conversation towards recovery. And what you see as required. I know that you came up with your choices... Is it choice, or choices? 

Paula Hall: Choice. 

Neil Sattin: Choice model. And that was a little bit of a departure from there's a model created by Patrick Carnes here in the States, and you did some training with him and then decided there was something more that needed to be there. So how is your model different? And then let's let's dive in, because I want to make sure that everyone listening to this conversation feels like there actually is a pathway forward. 

Paula Hall: Absolutely. Absolutely there is. And I think that the whole the whole field of sex and politician recovery has grown so much and indeed chemical addiction recovery and the training initially I was doing with Patrick Carnes was oh gosh I think the first course was over 10 years ago that I did and some of his early writings of course a pre internet. Some of those stats still get quoted from a book that was written before the Internet and then clearly the profile of sex and politics has changed considerably. So yeah, I know their training is evolved and their models would have evolved, as well since I did the training. But I think what really changed for me, is understanding how getting into recovery from addiction is about so much more than stopping. There's one of the kinds of sayings of recovery is that recovery is about what you take up not about what you give up. And I think the initial models that I were trained in were all about focusing on stopping your behaviors. And if you stop your behaviors you'll get better, your depression will lift, your anxiety will lift, your relationship...you will live happily ever after. And actually I think it's a lot more complicated than that. I think life is a lot more complicated than that. So for me most addictive behaviors or a lot of them are symptoms of other issues that are going on in life. So you absolutely need to be sure you've identified those, recognize those, and are dealing with those. But even from a simply, from a biological perspective, if you just try and stop your porn use, and you don't replace it with healthy alternative activities that give your life a sense of meaning and purpose, then you just end up with a void. You end up with an emptiness and nothingness. And I work with so many young guys now where the huge chunks of their time is spent on porn, they've never had a partnered relationship and they really need to find a new way of living their life, living unaddicted love. So the "choice model" really is the C, the first is an acrostic, the first C, is all about challenging any unhelpful beliefs, so those beliefs: "I can't change. It's just who I am. I've just got a high sex drive. I'm just a weirdo." The H is about having a vision. And again I think this is something that has really changed for me, understanding how much easier it is to drive people towards something than away from something. Let's focus on what you will gain not what you will lose. The "have a vision." The O is about overcoming the behaviors, now I used to think that was the whole treatment program and now I recognize that's just one part of it. The I is about identifying positive sexuality, as I was saying, right at the beginning of this podcast for me, it really is about reclaiming sexuality from the addiction. The second C is about connecting with other people. And one of the real joys of group work and whether that's within a therapeutic group, a peer support group, a 12 step group, whatever it is, I think is building those relationships with other people breaking through the shame and secrecy and I think you as humans we were created to connect. I think that's so important. And the final E is about establishing confident recovery, that really is building your life well with meaningful other relationships and hobbies and pastimes and career and personal growth and all that other stuff. So I think in my kind of recovery model has become increasingly integrative and has been about changing your life, rather than just changing your addiction. 

Neil Sattin: Great. Yeah. 

Paula Hall: That was a lecture wasn't it? 

Neil Sattin: No. It was perfect. You went right through the entire choice model and of course each of those, you know, we could talk for you know five or ten minutes on and we don't have time to do that. Sadly. I will say that each of your books, they're fairly concise and direct and that's really helpful I think you can dive into understanding and treating sex and pornography addiction and come away with some very practical strategies as well as a comprehensive understanding of what you're dealing with. 

Paula Hall: Yeah, very much written as a self-help book as well as a research book. So yeah. 

Neil Sattin: Great. Could we talk for a moment about the cycle of addiction that you've identified and particularly, how that can be a way for people to kind of understand themselves and where they are in that cycle and end and how to make different choices depending on where they are in the cycle? 

Paula Hall: Yeah, so. Six stages on the cycle of addiction. So dormant phase is where you're not acting out. And some people will might go weeks, months, without acting out. Critically dormant is not the same as recovered. Yeah. A period of abstinence is not the same as recovery. And often what's hiding in that dormant phase are all sorts of unresolved issues that you've not dealt with. You're still lonely you're still isolated you still hate your job you still feel you're trapped in the wrong marriage or feel bad about your sexuality whatever it is. Then, there are triggers whatever those triggers might be, that kind of push you out of that dormant phase and often they're either environmental, and I think we often underestimate just the impact of having the opportunity to act out when it's on the plate and we now really understand some of the neuroscience about why that is so hard to resist, it's not purely psychological. But of course there might be emotional triggers as well so you having  an argument, feeling particularly isolated, rejected, whatever it might be. Then there's often a period of a series of triggers and you thinking should I shouldn't I and all those cognitive distortions. "Yes. But, everybody looks at porn. But does it really matter? It'll only be for five minutes." All the lies we tell ourselves for why it will be okay for us to do it, and we all do this. I have fun when I'm doing public speaking, I'll often ask for a show of hands of anybody who's never broken the speed limit in their car. And of course there's always one person and I say do you drive a car and they all say no, and put their hand. I've never yet met anybody who drives the car who's not broken the speed limit and we all believe that speed limits are right and good. But we make excuses for why on some occasions it's okay. I was late. The driving conditions were perfect. I wasn't going fast as that person. I'm a very good driver. We all have our reasons why we break our own rules, so it's no different for addicts. Then of course there's the actual acting out behavior whatever that might be. Really it doesn't matter whether your thing is a porn or cam sex or sex workers or cruising or whatever it is. It's the way that behavior makes you feel that you are addicted to, not actually what it is.  Period of regret. I think the sort of big difference between my cycle of addiction and Patrick Carnes' cycle that he refers to, is he talks about despair and for an awful lot of people I've worked with, there isn't despair and shame. If you're single and you've been looking at porn yet again, for another night for five hours, and you're not going to get to sleep 'til 1:00 in the morning, you regret it because you're going to be tired and you feel a bit of an idiot. But despair? No. Often despair isn't experienced until much, much later in the evolution of the addiction. But then often there's a period of time in the reconstitution phase of trying to put everything back together again: "Right. That's it. I'm gonna put those blockers back on. I'm going to make more of an effort. You know, I'm going to do this, I'm going to do that, I'm going make sure I don't do that." But, what you're doing then is just going back into dormant because you still haven't managed and dealt with those issues that get triggered and set you off going around again. 

Neil Sattin: Yeah. One thing that I thought was really interesting you talk about that the preparation phase, like getting ready, that that often is actually what is bringing relief to people. 

Paula Hall: Yeah. It's not a perfect model, no models are. It's it's really tricky to identify when something is acting out, because I think often in the seeking and searching phase particularly for example people who visit sex workers, they may spend days and days and days looking at the website, reading the reviews, chatting for a few different people. Really, that is all the acting out. I'm not sure that is the preparation phase that I think the preparation phase and the acting out phase kind of blur. Because often by the time they get to acting out, that's just trying to get the damn thing I've done. It's the window shopping as it were, that really has been the addiction, rather than buying, the being at the till and paying for the item. 

Neil Sattin: That's so interesting right because the dopamine is fueled by the seeking, right?

Paula Hall: Exactly. Exactly. 

Neil Sattin:  Yeah. That's where that addictive biologic cycle happens. 

Paula Hall: Yeah. I think that's where people sometimes, and I think that with assessment, that's why the questions are so important. If you just say to somebody how often do you act out? They might say, "Oh I visit a sex work once a month." And it's never escalated it seems, it's been once a month for the last two years. If you ask how much time do you spend online seeking sex workers, looking at sex worker reviews, sending text to sex workers, exchanging messages and pictures with sex workers. You might get quite a different answer and that might be the piece that is escalating significantly. 

Neil Sattin: Right. Right. I just want to highlight that you mentioned that along with obviously treating people who have or are struggling with sex addiction and also treating couples and working with partners, that you also train therapists to work with people who are struggling with sex addiction and are impacted by it. So how does that work. Do people come to the UK to train with you or is it online?

Paula Hall: Yeah. No. We haven't done anything online yet. Yet. Everything's evolving isn't it. So, we do obviously just kind of you know single day training events and I've done quite a lot in house stuff, as well. So I've been to a few rehabs and done kind of dedicated four-day training programs to really upskill addiction stuff, particularly in sex and sexuality, and working with sex addiction. So I've done that in quite a few places. And we can kind of tailor make those programs, but we also have an accredited diploma. So it's an independently accredited diploma, so one of the professional awarding bodies in the UK has apprenticeships accredited it. And that's a level five diploma and that's three modules of four days. And really what we're teaching therapists is an integrative model. So this is what's also very different from Patrick Carnes model, if you do the Patrick Carnes model, then you're being trained to deliver the 30 task approach. Whereas what we're doing is training you in sex and porn addiction and some of the models we use, but how you then interpret that, there's no set program it's not a manualized system that you're being taught, it's much more about people. For people who kind of work more relationally with clients whether that's in developing programs or one to one to kind of tailor it to the places where they work and their own personal modalities as well. 

Neil Sattin: Got it. Well, we only have about a minute left and so if you are interested in Paula Hall and her work I encourage you to visit the Laurel Center website, Paula's website to get one of her many great books on the topic. So whether you're a therapist or someone who's impacted, I heartily recommend her work. We will have those links in the show notes for today's episode which you can pick up if you go to Neil-sattin-dot-com slash addiction or text the word "Passion," to the number 3-3-4-4-4 and follow the instructions. Paula, I'm wondering if you have a minute for one last question. 

Paula Hall: OK. 

Neil Sattin: And that is, we've talked a little bit about not just stopping things and putting new healthy behaviors in. And there are some great suggestions around that in your book I'm wondering if you can just talk for a minute. Obviously, this is way too short but about the healing aspect of how someone goes about healing the underlying issues that lead to being an addict and acting out?

Paula Hall: Yeah. So I think that the model that I used, and I talk about in the book, is now often referred to as "OAT model" there has to be opportunity. And of course this has been the big game change over the years, isn't it, is the fact that we can now access pornography and sex through our mobile phone. Absolute anonymity. It's been the absolute game changer. So there has to be the opportunity for some people there's greater opportunity because of their work because of whatever their personal and private situation is, their financial means whatever they have more opportunity than others. And that in itself of course is a temptation because we all are drawn to sex and sexual novelties, it's part of how we've been wired up. But for some people they're more susceptible to that opportunity, those opportunities, than others are and some are more susceptible because they've experienced issues in their childhood and those issues may be around kind of neglectful or absent parenting. So, they may have been brought up with a sense that nobody will really care for their needs. They can't really trust other people. And what tends to happen in those situations is that you turn to, for comfort, you tend to turn to things rather than people. So, if you've got a history where people have let you down, you may decide to look after yourself in terms of things rather than others. And of course porn and sex are effective comforters but then there's trauma as well. So for some people it's the attachment wounds in childhood, for some people it's trauma. So if you've experienced a significant trauma and that might be in childhood it might be as an adult -- we work with a number of people from the armed forces, emergency services, who had significant traumas kind of later in life and we know that trauma actually impacts the brain directly. So this isn't just a psychological issues then, it's become a biological issue. So we know that the way that trauma impacts the brain makes it harder. You need more comfort because you end up hypersensitive to a lot of cues and triggers. But also it's harder to actually access the self soothing chemicals within the brain because of the trauma, so you're more likely to look to external things to soothe that. But I think there's one other thing I would say Neil, that's why I'm so grateful to people like me for doing these kind of podcasts. And one of the great causes for sex and porn addiction, is naivete, is ignorance, is knowing, is the lack of education. And unfortunately so often we get caught up in the moral debates about pornography and sexuality, and of course those debates exist and I'm not trying to say they're not important ones. But I think often we lose the health issues. And I believe very passionately that we need to start educating people particularly our young people about the potential risks of sex addiction and pornography addiction so they could recognize it in themselves. So many people develop these addictions simply because they didn't know they could become addicted. 

Neil Sattin: Well we are undoing the naivete right here. And I so appreciate your time and wisdom today and hopefully we can have you back on it. I know we could easily talk for another hour. And I just want to point out to our listeners that we have had Peter Levine on the show to talk about healing from trauma. We've had David Burns on the show to talk about cognitive distortions. We've had Diana Fosha to talk about AEDP, which is an attachment centered therapy so healing early attachment wounds. So all of this is meant to offer you a big integrated package of healing and hope for you. And Paula thank you so much for being part of that picture with us today. 

Paula Hall: You're very welcome.