Nashville Psychotherapy - Steven Davidson

Pornography Addiction in the 21st Century

2010-08-15T17:19:00.000-07:00

(Pornography Addiction in the 21st Century) I will be presenting this subject at the 2010 Journey Together Conference for Addiction Professionals in Nashville in September. Follow this link to see the complete list of presentations and workshops and to register for the conference http://www.mtaadac.org/journey_conf.html

Sexual Disorders and the DSM V

2010-04-27T08:12:00.000-07:00

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) is expected to be released in May 2013 (www.psych.org/dsmv.aspx). A work group has been appointed by The American Psychiatric Association (APA) to address the categories of Sexual and Gender Identity Disorders and make recommendations for changes based on recent research outcomes and current cultural attitudes. Mental health professionals and special interest groups have lobbied the APA with recommendations and requests for changes to some DSM IV sexual disorder classifications. Several changes are anticipated, but cannot be confirmed until the final draft is approved. This article highlights some of the proposed changes.

The DSM V will distinguish Paraphilias from Paraphilic Disorders .The Paraphilic Disorder category will be reserved for individuals who present with distress or impairment related to a specific paraphilia. The DSM V will also make distinction of those paraphilias that involve nonconsenting individuals (voyeurism, exhibitionism, and sexual sadism). The National Coalition for Sexual Freedom (NCSF) requested that the APA remove or restructure the Paraphilias section of the new DSM. NCSF complained that the interpretations of specific sexual behaviors identified in the DSM IV are politically based and not substantiated by scientific evidence (www.ncsfreedom.org/ ). The proposed changes are intended to “depathologize” alternative sexual behaviors among consenting adults.

In that same category of sexual disorders, Pedophilia is expected to be reclassified as Pedohebophilic Disorder and make distinction between pedophilic and hebophilic type. Pedophilia refers to individuals with sexual attraction to prepubescent children (age 10 and younger). Hebophilia refers to individuals with sexual attraction to pubescent children (age 11-14). The term Pedohebophilia will be used to refer to individuals attracted to both prepubescent and pubescent children.

APA workgroups that convene to review and amend specific diagnostic categories generally include individuals who have those diagnoses. There is currently a dispute between the APA and B4U-ACT, a non-profit organization in Maryland with a mission to increase services and resources to “minor attracted people”. Supporters and representatives from B4U-ACT are requesting that the APA include on its paraphilia work group individuals who identify as “minor attracted,” but have never been convicted of a sex crime (www.b4uact.org/news.htm ). They complain that current research on pedophilia is only conducted with individuals who are convicted sex offenders and therefore does not give an accurate representation of the general population of people who meet clinical criteria for the diagnosis. They would like increased research and services to those who meet criteria for this diagnosis but who have never acted on their attraction.

A new diagnosis, Hypersexual Disorder, is expected to be added. The criteria for this disorder are congruous with those presently used to diagnose sexual addiction. Therapists currently treating sexual addiction have not had specific APA guidelines to help them arrive at a consistent diagnosis. The symptoms have been classified under Sexual Disorder NOS, Impulse Control Disorder NOS, and Obsessive Compulsive Disorder. It has sometimes been misdiagnosed as Bipolar I Disorder based solely on the individual’s risky hypersexual behavior. The new diagnosis will increase uniformity across the profession in criteria and classification for those treating these symptoms.

The work group is proposing that Sexual Aversion Disorder be removed from the new DSM and reclassified under anxiety disorders as a specific phobia. This may increase the likelihood of insurance companies paying for treatment. Most insurance companies currently do not cover treatment for Sexual Aversion Disorder.

Gender Identity Disorder will be replaced with Gender Incongruence. Transgender advocates have expressed concern over the phrasing of the disorder in the DSM IV. They believe the situation is more biological than psychological and that the term Gender Identity Disorder adds to stigmatization (www.transgender.org/gidr/ ). Currently the diagnosis is often misused by mental health professionals to diagnose individuals who may present with some characteristics traditionally associated with the opposite gender even when the client is very comfortable with their assigned gender. Gay and lesbian adolescents have been misdiagnosed with gender identity disorder simply on the basis of their sexual attraction to the same gender. Misdiagnosis tends to result from clinician bias and lack of understanding of the complexity of human sexuality. Unfortunately, the new diagnosis of Gender Incongruence will not alleviate the problem of misdiagnosis by clinicians.

The APA’s position on sexual disorders has continued to evolve since the first publication of the DSM in 1952. Sexual minority advocates have historically played an important role in the APA’s classification of these disorders. They challenge the APA to identify and define sexual disorders based on reliable scientific research instead of popular political opinion. Over time advances in research and an evolving social climate have increased our knowledge of the broad spectrum of human sexuality. Each edition of the DSM captures our profession’s perspectives at that point in time. Revisions to the category of Sexual and Gender Identity Disorders in the DSM V will document our level of knowledge and acceptance of sexuality in the early 21st century.

More information about sexual disorders and the proposed DSM V can be retrieved by visiting www.dsm5.org . The website has information about all DSM diagnoses and the revisions anticipated in 2013.

Demystifying Hypnosis

2010-04-20T15:09:00.000-07:00

There are many myths and misconceptions about hypnosis. Science fiction has done a disservice to the hypnotherapy profession by portraying hypnosis as a theatrical and magical state in which individuals lose control to vampires and sinister villains. People either believe this is an accurate representation of hypnosis or they dismiss hypnosis as fictitious. Hypnosis is real and it is not as strange as it has been depicted to be.

Everyone can be hypnotized. It “is a natural state that each of us has the ability to enter” (Stevenson, 2004). Everyone can also resist it. Hypnosis allows us to open the subconscious mind to new suggestions while the conscious mind is distracted.

During hypnosis, brain waves shift to an alpha state where creativity and relaxation are enhanced. The alpha state is most conducive to new learning. We naturally slip in and out of the alpha state between 5-30 times a minute without ever knowing it. In the alpha state we can enjoy a movie or read an interesting book. Our conscious mind takes a break while we become absorbed in the action on the screen or the words on the pages of the book. Beta waves produce a state of conscious alertness, theta waves leave us on the brink of sleep and delta waves produce a state of profound sleep (Krasner, 2002).

When the brain has shifted into alpha waves we refer to this as the “trance”. You have achieved the trance if you have ever driven from one location to another and discovered you remember little about the journey. You stopped and turned at all the right places while your mind wandered and day dreamed. The hypnotherapist helps you shift your brain waves through relaxation techniques and guided imagery. At this time, suggestions are introduced to facilitate modifications in behavior or thought in order to achieve a desired outcome. No one gets stuck in the “trance”.

Hypnosis is not mind control, magic, or casting of spells. “Hypnosis has nothing to do with will power. Will power is a function of the conscious mind” (Krasner, 2008). Hypnosis is not sleep. Some patients may fall asleep as a result of hypnosis because they become so relaxed by the process. They always wake up.

During hypnosis you will be awake and in control. You are suggestible but not commandable (Stevenson, 2004). You are in charge of how deep into the trance you are willing to go. Hypnosis is a “cooperative activity” between therapist and client. The hypnotherapist facilitates the process based on the unique needs of the client, but basically “all hypnosis is self-hypnosis”. Deeper trance states are the most beneficial.

Hypnosis has been determined to be a beneficial tool for reducing anxiety, decreasing or eliminating unwanted behaviors, facilitating positive changes in behavior and attitude, causing relaxation, and reducing or eliminating pain. It is one of several effective and legitimate interventions a therapist might choose to help a client achieve the desired outcome.

Krasner, A. M. (2002). The Wizard Within. Santa Ana: American Board of Hypnotherapy Press

Stevenson, M (2004). Learn Hypnosis Now. Laguna Hills: Liquid Mirror Enterprises

Gender Identity Disorder: A Commonly Misused Diagnosis

2010-04-12T09:45:00.000-07:00

According to the Diagnostic and Statistical Manual of Mental Disorders this diagnosis is made when an individual has a strong and persistent desire to be the opposite sex or insists that one is of the other sex. There must also be persistent discomfort about one’s assigned sex or discomfort in the role of the assigned sex. This diagnosis is most commonly used for individuals who feel as if their body and mind are of different genders.

Currently individuals who are transgender or transsexual argue that the diagnosis is illegitimate because they believe the problem is more biological than psychological. Advocates are encouraging the American Psychiatric Association to reconsider if it is really valid to classify this situation as a mental disorder. Most transgender and transsexual individuals lead very functional and productive lives and don’t perceive themselves to be mentally ill.

The diagnosis has also been used incorrectly to label individuals who identify as gay or lesbian or who have had at least one consensual homosexual experience. Though homosexuality is not a mental disorder, a therapist who is inexperienced in treating sexual minorities may wrongly conclude that a same-sex attraction is a manifestation of the client’s discomfort with his/her gender. This mistake can be prevented by simply following the diagnostic criteria.

Mental health professionals are rarely trained to effectively diagnose and treat sexual disorders. Human sexuality courses are generally not required in graduate programs that train psychotherapists and sometimes are not even offered as electives. Do your research before choosing a therapist to consult regarding a sexual problem. It is appropriate to ask about his training and expertise with specific populations or diagnoses.

Visit www.aasect.org to find certified sex therapists in your community.

Hypoactive Sexual Desire Disorder

2010-03-31T14:23:00.000-07:00

Hypoactive Sexual Desire Disorder is the diagnosis given to those individuals who experience very low or no desire for sexual activity. The disorder can be lifelong or acquired. It can be true in all situations or specific to certain sexual situations. A thorough sexual history is needed for the clinician to determine cause and course of treatment.

Initially, it should be determined if a medical condition is causing the lack of desire. Hormone imbalances, medication side effects, and pain during sexual activity are all factors to be considered. A consultation with a primary care physician can determine if a referral to an Urologist or Gynecologist is necessary.

If no medical explanation exists, the cause is likely psychological or relational. A qualified sex therapist can assess the individual and his/her partner during a clinical interview to determine what factors are contributing to the problem. Some common psychological factors include depression, anxiety, a history of sexual abuse or shame about one’s sexuality or sexual behavior.

The problem is relational if it is a symptom of unresolved conflict between the individual and his/her partner. Anger, distrust, and loss of respect for the partner can cause a loss of sexual desire. The individual may continue to have a drive to be sexual, just not with the partner. Inquiring about the frequency of masturbation can help make this determination.

In my own practice, I see this disorder more frequently in women than men. It is most difficult to treat when it has been lifelong and the individual has no history of healthy sexual desire to compare to. In these cases the motivation for change is usually low and the client may be participating in treatment only at the insistence of a partner.

For a list of certified sex therapists in your community visit www.aasect.org .

Are You a Porn Addict?

2010-03-29T10:43:00.000-07:00

Pornography addiction (one form of sex addiction) is primarily a male problem. Women view pornography too, but are less likely to become psychologically dependent on it. It has become an increasing problem in the 21st century due to the vast quantity of material available on the internet. It is often free and easily accessible anytime, anywhere.

Many men occasionally use pornography out of curiosity or for sexual entertainment. The male brain is aroused by the images which drive up dopamine and testosterone levels creating a sense of euphoria. Some men discover that once they begin looking at pornography, they want to view it with greater frequency and for longer durations of time. These men eventually feel like they have lost control over their use and it has become a compulsion/addiction. Meeting 3 or more of the following criteria suggests a problem with pornography.

1. Frequent thoughts about looking at porn.
2. Porn use has increased over time
3. Obsessive thoughts about previously viewed images even when not looking at porn
4. Using porn for longer durations of time
5. Engaging in use when expected to be fulfilling other obligations (work, friends, family)
6. Continued use despite actual or potential consequences (legal, family, financial, relational)
7. Attempts to stop or decrease use have been unsuccessful
8. Experiencing anxiety, irritability, or other emotional distress if unable to engage in use
9. Need to view more extreme images over time in order to obtain the same degree of euphoria
10. Avoiding opportunities for interaction with friends or family or other forms of recreation in order to accommodate the drive for porn

You can learn more about porn addiction and other forms of sexual addiction by accessing the website www.sexhelp.com .

You can find a support group in your area by visiting www.saa-recovery.org , (Sex Addicts Anonymous)

You can locate a certified sex therapist in your area by visiting www.aasect.org (American Association of Sexuality Educators, Counselors, and Therapists)

Men in Therapy

2010-03-26T06:33:00.000-07:00

Though many of us have a hard time admitting it, we too need a little help now and then. The average life expectancy for men in the U.S. is seven years shorter than that for women. Infant males are more likely to have complications during delivery and have a higher tendency toward birth defects than females. We have higher rates of addiction and completed suicide than women. We have fewer friendships than women and a limited social support system. We have difficulty identifying feelings, much less talking about them.
However, I have witnessed a trend over the past twenty years; more men are seeking therapy. Personally, I see more male than female clients. This was not typical for me early in my career. More men call to make their own appointments. Men today seem easier to keep engaged in therapy and less embarrassed about seeking help.
Establishing a solid action plan early in treatment can help men feel more empowered in the treatment process. We are goal oriented and want to see results. We are less likely to find benefit in simply talking about our feelings. Identifying clear goals gives us a greater sense of control in the process. It is still important to help male clients identify and understand emotions, but he is more likely to enter treatment focused on facts.