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Out of the Shadows: Understanding Sexual Addiction (3Rd Ed.)
By Patrick Carnes, Ph.D. Hazelden, 2001, 219 pages, $16.00.
Out of the Shadows is an extremely useful tool to open up a topic that carries significant misunderstanding. Originally published in 1983, Out of the Shadows was a pioneer in the very new field of sexual addiction. Now in its third edition, Patrick Carnes has updated his book to reflect the changing times and changing faces of sexual addiction. This edition remains a key component to helping the addict, their family and friends, and the psychotherapist understand the nature of the addiction and how to break free from it’s grip.
Carnes identifies sexual addiction as similar to any other addiction in that the person’s addictive behavior is maintained by the addiction cycle: Preoccupation, Ritualization, Compulsive sexual behavior, and Despair. He places significant emphasis on helping the reader also understand how this cycle is regenerated over and over again by discussing the individual’s maladaptive belief system. Fueled by beliefs such as that the person is worthless and that no one will love them as they are, he shows how the person justifies their destructive behavior. The book also describes sexual addiction as it is broken into four levels. Each level explains specific maladaptive behaviors and their impact on the individual. This is an especially important section to the book because it identifies how the addiction can start at level one as simple behaviors such as masturbation and pornography. Then, as the addiction levels intensify, the behaviors increase in severity as well, leading possibly to the ultimate violations of molestation, rape, and incest. Carnes makes a point that, like any other addiction, an individual will usually progress from one stage to another, however, someone “stuck” in a lower level may still have problems with addiction.
The book discusses another critical issue in understanding addiction, co-dependency of friends and family members. Carnes ties in how the family not only withstands the addict’s behaviors, but how they can add fuel to the cycle by denying, enabling, and covering for the addict. He gives excellent real life case examples of family members stuck in the addiction, just as the addict is. This may be a good opportunity, if used correctly, to demonstrate to a client that his or her actions are not isolated, but affect everyone around them.
A major advantage to this third edition is that it places the addiction in the context of modern times. A chapter entitled “Sex and the Internet” is based on how sexual addiction has evolved along with society into the 21st century. He details how, with the expansion of the Internet, a person can become trapped in their addictive behavior. According to Carnes, the perpetuation of addictive behavior is dependent on how well the addict can mask their addiction and lead a “double life”. The Internet provides a safer haven for those that want to indulge in sexually explicit materials and lifestyles without having to risk exposure to others. The danger is that a person can fall deeper into addictive behavior, neglecting their daily responsibilities and shutting out the outside world. This chapter is extremely important for both psychotherapists and those in therapy to understand how their “online” activities are affecting their daily lives.
The major strength of this book is that it still stands as one of the core textbooks on a subject that many of us don’t know much about. With the third edition, Carnes has made a very easy-to-read book even easier because it is applicable to 2002. The book makes use of charts and workbook exercises that can be assigned to clients to help them chronicle their thoughts and activities; something that fits in well with cognitive-behavioral treatment approaches. It also gives psychotherapists and clients options of how to treat these addictive behaviors in a resource section in the appendix that gives specific support groups, books, and national numbers for addiction services. The major limitation to the book is that the treatment focus is parallel to the 12-step process that was popularized by Alcoholics Anonymous. Although effective in treating substance addictions, this may not be effective with all types of clients. Particularly with clients that have other psychological disorders, such as schizophrenia and other thought disorders, the therapist should carefully weigh that into the treatment of the sexually addictive behaviors. But, with higher functioning clients, this type of treatment can be extremely effective. By helping the person understand what they are using the sexual behavior for and the maladaptive thoughts behind these actions, real steps to recovery can be made.
I would recommend this book to both psychotherapists to help expand their knowledge on a misunderstood topic and to their clients to use in conjunction with ongoing psychotherapy. The workbook format and exercises may be easily integrated into the psychotherapy process. This book should make a useful bibliotherapy resource for those suffering from sexual addiction.