We Ask The Expert: Does Sex Rehab Work?

Alman, who writes the nationally syndicated advice column 'Ask Isadora,' adds: "The whole setup for addiction-ology is that the person is not responsible, that their disease is responsible. I am very much in a 'here and now' perspective, saying, 'You may have a bad habit, you may have a compulsion, you may have an escape mechanism, you can call it all sorts of things that is not a choice-ful, thoughtful behavior, but it is not an addiction, it's a behavior problem.' While they may get the help that they need in whatever expensive rehab facility they go to, I think essentially what it does is just get them off the hook."
The Girls on Pop discuss the merits of sex rehab:

Read the rest of the interview with Alman below:

Do you think day-to-day life in a rehab facility, with the benefit of group therapy, is in any way worthwhile? Does that counteract the negative aspect of disease blaming?
"It's really hard to say. I do see great value in group therapy. People get called on their bulls**t. It's not only their outraged partner or their publicity agent, it is other people on the same social strata. If Tiger Woods and Jesse James were confronting each other, that would be a lot more meaningful than if Joe Schmoe did it to either one of these big stars. But I don't know what goes on in the day-to-day facility. I've never been in one, and most of the clients I see don't take that escape route, because they wouldn't be my clients if they did. They come to see me because they know I'm going to say, 'Let's take responsibility for your behavior and look at why you are doing this and what you can do to not do it.' Not say, 'Oh, you're helpless.'"

Therapy for an addiction like substance abuse seems black and white -- the goal is to stop the behavior completely and permanently. How do you treat something like this? Certainly you can't tell just tell a sex addict to just stop having sex.
"If I get a call from a prospective client and they say to me, 'I am a sex addict, I am a porn addict, I am a compulsive user of prostitutes,' I tell them quite clearly I don't work in a 12-step model. I really work from a perspective of your being able to change your behavior by choice. If that's not the perspective that you want to take, if you believe in addictions to behaviors, rather than compulsive behaviors, or if you really like the 12-step model, I'm not the therapist for you. I self-select my clients. They're not going to define as a sex addict. They're going to define as somebody whose behavior is out of control, which is different. It may look like the same thing, but how you phrase it to yourself is going to make a huge difference in what you feel you can do about it."

If sex becomes 'bad,' how can a patient continue living a normal life after treatment?
"That's how I feel about a lot of these 12-step programs, like Sexaholic Anonymous. They're so sex-negative. I think it's really important for people who ... have really done something dreadful -- betrayed their wife, been caught in an act like the famous Hugh Grant with a street prostitute -- if they somehow or other have screwed up royally and the public has gotten a hold of it, whether they beat their breast and say, 'Why, why, why?' my approach is, 'Okay, now what are you going to do? What are you going to do when you're feeling lonely, feeling angry? How do you handle those feelings in a constructive way rather than a deconstructive way?'"

It's fairly constructive to be crack-negative, but it's very difficult, in the context of real life, to be sex-negative.
"You're absolutely right. Nor is it healthy to be sex-negative."

Do you believe these celebrities, aside from the suggestions of their agents and PR people... do you actually think somebody like Jesse James trusts sex rehab, or is this a gesture to the world and to Sandra Bullock?
"I have no idea, because I only get what view media, like PopEater, presents to me. And I'm not terribly interested in this guy; he doesn't impinge on my life at all. He looks to me like someone who has not lead a very introspective life -- he acts out, he loses his temper, he's a publicity figure, he looks like he's kind of out of his league. All the things I see are just what's being presented to me. He may genuinely love his wife, feel he screwed up and genuinely want to change his ways. I have no idea. I just always am very suspect when the people disappear from the public eye -- we don't see Tiger for two months and now he comes back and he's doing what he does, which is what he's supposed to do. And when someone like the governor is caught with his hand in the cookie jar, I'm always rooting for them to say to anybody who asks, 'It's none of your business. I am a golfer, I am a governor, I am a publicity hound, whatever it is, and what I do with my private life is private.' So if they're going to play it out in public, I don't believe any of it."

Kudos to you -- I've been reading a lot of very specific observations by medical professionals and celebrity therapists, and it's killing me -- you can't genuinely call Sandra Bullock a "love addict," having never met her.
"I have a lot of feelings about a lot of media docs and advice columnists. It's what I call the Don Rickles school of advice -- 'You got a problem? Well screw you, buddy.' [Laughs] That's not how I've ever presented myself to my clients, or to the public when I write."

You've written this before: "Know your partner and know the character of your partner." In a case like this, you have to assume Bullock didn't know what she was getting into. A lot of people say "the woman always knows," but...
"I don't believe that. And when you fall in love, you're not making the best choices. Your pheromones are working, you're thinking with your gonads. Jesse James, on the surface, does not seem like a great marriage bet. It doesn't look like a fabulous match made in heaven, but these things work out or they don't. Look at Susan Sarandon and her sweetheart of 23 years -- that didn't look like a match made in heaven, either, and it worked really well for as long as it did. Sandra may have known he was a scuzzball or seen him as a poor, sweet boy who was acting out -- we don't know how she saw him. But if you see your partner has a history or gambling, of screwing around, you worry a little bit, and you don't put all your emotional eggs in one basket."

When do you know your partner well enough -- should we be looking for a history of behavior?
"History of behavior, yes, but we all take a risk when we join up with another person and put our heart in their hands. We hope that they will treat it with respect and kindness and not stomp on it with a high-heeled boot. But we can't know. If, however, they've been married seven times, they've been involved in public fights with their previous partners, you get a pretty good, large, red flapping flag saying, 'Proceed with caution.' But it doesn't mean don't proceed -- people can change."

Can these two reconcile? Could a marriage like this get back together after being in this media circus?
"Absolutely. And what they need to do is go someplace, close the door, pull down the blinds and deal with each other face to face. After -- and here's a big point -- after having dealt with themselves. Whether he has to do it in a rehab situation and she has to do it crying in her best friend's arms, they have to look at how they were complicit in this huge blow-up that's all over every piece of media they see. How did they contribute to it? How can they prevent such misery in the future? And if they try to reconcile, they have to do it as much as possible out of the public eye and ask for privacy, demand privacy, or just clam up. They can't play out their lives in public and expect them to do any important work."

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Isadora Alman, a Board certified sex therapist, writes the syndicated 'Ask Isadora' advice column. You can visit her on Red Room. Her books include Doing It: Real People Having Really Good Sex and the recent novel Bluebirds of Impossible Paradises: A Sexual Odyssey of the Seventies.

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