A 32-year-old male patient at a nationally recognized inpatient addiction treatment center is observed exposing his erect penis under the lunchroom table twice in the past week. The treatment professionals describe his sex addiction as a serious safety concern for the other patients.
A 61-year-old man enters an outpatient addiction treatment program. He wants help because he was discovered watching his wife's cousin undress at a summer lake home. For the first time he is acknowledging a life long pattern of watching women undress without their knowledge or consent. Recalling these situations is his primary source of orgasm. He calls this behavior his sex addiction.
Men with patterns of non-adjudicated nonconsensual sex (They have not been arrested or convicted of a sex crime) sometimes voluntarily seek help from psychotherapists treating out of control sexual behavior, sexual addiction, hypersexual behavior and compulsive sexual behavior. The men almost universally think of this behavior as their "sex addiction". Many sexual behavioral specialty inpatient programs and outpatient groups admit men with histories of non-consensual sex. Some sexual addiction programs limit their non-consensual patients to only non-adjudicated clients. On the other hand sex offender treatment programs may exclude men who have not been arrested and accountable to the court system. Is treatment for non-consensual sex available only for men meeting assessment criteria for "sexual addiction" or convicted of a sex crime?
Twenty years ago, when I first considered treating men with out of control sexual behavior, I thought a great deal about whether to treat sex offenders. Would I have both consenters and non-consenters in the same group? Was I interested in developing the necessary range of skills to competently assess and treat this wide spectrum of sexual behavior? At the time, most research on out of control sexual behavior was sexual addiction theory. Early sex addiction theory conceptualized the range of consent to non-consent as a degeneration process of worsening sexual addiction symptoms. What might start out as high frequency masturbation with sexual images may degenerate (symptom acuity increase) to paid sex which in turn may lead to increasing levels of boundary violations of exploitation, coercion or force. It was commonly believed that sex addiction left untreated inevitably led to degenerative decline. This theory eventually expanded to distinguish between paraphillic and non-paraphillic sexual addiction. "Normative" compulsive sexual behaviors were now distinguished from the entire range of kink, unconventional sexual interests as well as violent, coercive and exploitive sexual behavior. The more complex question of non-consent within the sex addiction model remained relatively unchallenged. Sex offenders continued to be treated for their sex addiction.