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Mar. 25 2010 - 1:45 pm | 1,100 views | 0 recommendations | 15 comments

A clinical portrait of excessive online porn use (Part 1)

From the recently delayed sex.com domain auction all the way back to early alt.sex newsgroups—even perhaps to dirty teletype messages lost to history—sex and (on?) the Internet have been intimately bound together. Many have tried to understand these online sexual experiences using the tools of behavioral and social science, including the kind of in-depth individual understanding that takes place behind white noise machines in psychotherapy offices.

But psychotherapists are constrained, we can’t just say what we’ve learned because clinical confidentiality is inviolate; no one should ever be concerned that their therapist would write about or otherwise inappropriately divulge any (ANY) private, confidential information. Privacy and trust are necessary blocks in psychotherapy’s foundation.

The need to balance learning with clinical confidentiality has led to a genre of disguised clinical case histories. Such “clinical portraits” are common both in the professional literature and in popular books like Irving Yalom’s Love’s Executioner. Patients (past, current, and future), families, and friends are protected by thoroughly disguising all identifying information and sometimes, as is the case in “Paul and His Girls,” the tale told will cross several individuals. While any creative non-fiction is all too easy to ridicule or exploit (see James Frey), the genre can also illuminate when both reader and writer are faithful to their roles. I hope we will keep the faith in the “Paul and His Girls” series in which I present a narratively true “clinical portrait” of a young man struggling with excessive use of online pornography.

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Part 1 of “Paul and His Girls”

Getting started: Anything too good to be true, is

As therapeutic relationships go, we ended up having a rough start; it would be almost two years before Paul and I even started talking about his relationship to online porn.

It started with an initial voice-mail requesting an appointment. Busy schedules meant several rounds of phone tag. He was friendly and precise; we quickly worked through several rounds of telephone tag to set-up a first meeting. He told me he got my name from a former teacher I happen to hold in very high regard; I found myself really looking forward to our first meeting.

But as nice an impression as Paul made on the phone, it was nothing compared to meeting him in person. “Dr. Essig?” he asked with an expectant grin that first Monday morning while he took my hand in a brief, warm handshake, “thanks for seeing me.” Although Paul was taller and possibly even more handsome, I noticed a striking resemblance to Tom Cruise.

“Please, come in, have a seat,” I said gesturing to one of my office chairs.

He moved with the grace of a star athlete. While I got my papers organized, he looked around the office and made a point of catching my eye with a cool, approving smile.

I was surprised to find myself pleased he liked my office. I had only just met Paul, he hadn’t even started to tell me his story, and I already found him quite compelling. Like the movie star he resembled, Paul had me from “hello.”

“So what brings you here?” I asked to get started.

“Well,” he said, “I never thought I’d be here, in therapy.” Paul then began describing, step-by-step, his accelerating success: good family—with some problems, but nothing atypical, he said—fine university, several jobs with major companies, each leading to better positions culminating in a recent promotion to a fast-track, early-career managerial role with a multinational pharmaceutical company. Paul was coming to therapy, he then said, because “the issue I’m facing is that I need to become more pro-active about building a family. What’s going on now in my life is not exactly what I want. I have high expectations for myself and I’m under-performing.”

“What a resume!” I thought. Yet as I listened to Paul I also heard something missing, a gap in his story that made his obvious talents and charms stand out in even sharper relief: Paul did not seem terribly pleased or impressed with himself. I certainly was impressed with him, and the fact that he wasn’t created a contrast that only made me like him even more than I already did. And his was neither a false humility nor an entitled arrogance. He simply recounted all his impressive accomplishments with unadorned matter-of-fact clarity, as though the successes of his life were like train stations from a familiar schedule: valedictorian and tennis-team captain, Ivy League student, management trainee, and then stellar evaluations, promotions, and large bonuses.

But this was therapy, not a job interview. I needed to quiet the “wows” and “cools” going off inside my head and see whether he would let me on the train with him, let me become part of his story. Before I could make any decisions about whether and how I could help him I needed to learn how he responded when I moved the conversation away from a schedule of his accomplishments towards that which was missing, his here-and-now experiences and feelings about the autobiography he was sharing.

An opportunity came in our first meeting. When he once again summed up his accomplishments and reason for seeking treatment—”I’m getting all the pieces in place … except for family”—I was struck again by how he neglects any mention of feelings he might have about all those pieces he was getting in place. The absence gave me the space I needed to make a small attempt at joining rather than just listening to his story. I said to Paul, “I hear your self-criticism about not yet having gotten your family life together, but at the same time I also notice you don’t sound like you are terribly pleased with all you have accomplished. You seem to almost take it all for granted.”

And I waited: Would he just toss it back at me? Ignore it altogether? Feel criticized, like he was again “under-performing”? Or would he use this opening to discuss how he actually felt about what he had been doing with his young life? Regardless, it would say something about how this treatment might, or might not, progress.

He nodded, appeared thoughtful and said “I’m making good money, that’s for sure. Last year I paid for the condo on a trip out West with my college buddies. They paid their own airfare and lift tickets, but I picked up the tab for the digs. Plus I get to go out whenever I want. Dating is never a problem.” He told me about several of his adventures, including nights on the town with some of the many women he has dated. But he still did not mention any feelings or emotions about all the adventures he was having. While he had used my joining his story to change the content into a schedule of his social rather than business life, it did not change the relative absence of how he felt about it all.

So I pushed a bit harder. “You talk about living through what will someday be your ‘good old days’,” I said. “It sounds like you’re both working hard and playing hard. It sure sounds like you should be having the time of your life” underlining the irony of my “should” with a sing-song intonation and raised eyebrows; he got the point

He dropped my gaze and sighed. “You know, not really, truth be told, it all feels sort of artificial, sort of empty, maybe because I’m doing it all without the right girl. It’s hard to talk about, no one wants to hear the “golden boy” complain. But the job, the stuff, it all feels the same, kinda empty.”

I looked him in the eye and repeated, “Artificial? Empty?” He sighed and held my gaze; his chiseled face seemed to sag. We sat quietly for several moments with the sun streaming through the slats in my blinds, long enough for me to know I really wanted to hear more about how he felt and for him to realize he had had enough.  He smiled, shaking -off our brief moment of emotional contact; he would not now talk more about his artificial, empty feelings.

But I was pleased that we had at least put a marker down for the kind of talk that makes therapy work. And while I still did not have anywhere near enough information to determine whether or not I could specifically help him develop the enduringly intimate relationship he had identified as the missing piece in his life, I knew that I really wanted to help this guy.

All that therapeutic zeal should have been a warning sign. Instead, I took my enthusiasm as simple fact; I would help him get the intimacy and family life he said he wanted. I even closed the initial interview by uncharacteristically offering a prediction, “I’m sure we’re going to make real progress.”

I ended up being very, very wrong, but in fascinating ways.

[End of Part 1 ... go to Part 2]


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  1. collapse expand

    Hi Todd – I’d like to interview you for an article I’m writing on the merging of our online and offline lives. Could you please email me? jvchamary@bbcmagazines.com

  2. collapse expand

    I am unbelievably excited to read all 10 parts of this. I am just about to graduate with my BA in Psych and I plan on moving on to get my MSW so I can practice ASAP. This is deeply fascinating, thank you for sharing.

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    I'm a psychologist and psychoanalyst with a full-time therapy practice. Over the last 20 years I've noticed how the NEXT BIG THING, or the one after that, sometimes leaves people feeling more miserable than before; life in the "future" doesn't always feel very good by the time it gets here. But sometimes it does. We just don't know how the future will feel.

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