5.7 Contribution and Applicability
This study contributes to the field as it addresses counselling psychology’s ‘demand for rigorous empirical enquiry with a firm primacy of the counseling or psychotherapeutic relationship’ (Division of Counselling Psychology, 2005:p.1) and in doing so contributes to a ‘greater understanding of explicit and implicit communications’ between therapist and client (Kaskett, 2011). The implications of the findings for counselling psychologists lie more in the value of a trans-theoretical framework, as it transcends adherence to one modality and, by centralizing processes of the therapeutic relationship, therefore has applicability to a wider range of clinical presentations. While this argues for the therapeutic endeavour as drawing on multiple perspectives it particularly highlights the reliance on the person of the therapist of the therapeutic process and as such as drawing on their tolerance and capacity for the deep sexual, affective and relational disturbance that is communicated in the implicit dialogue with female sex addicts.
This research adds to the small number of empirical studies addressing female sex addiction. By drawing on the field of addiction, attachment, neuroscience and relational psychotherapy, this investigation contributes to the understanding of the therapeutic endeavour with female sex addicts as a two-person psychology, thus pushing the concern further into the field of relational psychology. It highlights the importance of the subjective in the work of the therapist and of the researcher and suggests that the extent to which counselling psychologists are able to use their subjective receptivity in response in the service of the client and of the work is a clinical concern worthy of consideration. This topic generates in the therapist a strong countertransference response both to the client and in the therapist’s own unformulated and unconscious relationship with their sexuality which is arousing in and of itself. There is something here, therefore, for clinicians in the field, of the subjective availability of the therapist in order that the client must not be left alone with the disturbance. I argue that what this demands of counselling psychologists is both a capacity for conceptualization as a vehicle for thinking and the emotional range and capacity required to convey to the client an experience of non-judgmental and empathic relationality. While I would argue that both approaches are imperative, perhaps the greater contribution lies in contemplating the fallacy of therapeutic objectivity and neutrality and instead asserting that the ‘emotionally responsive therapist is always irreducibly subjective’ (Renik, 1993:p.565). I would argue that we might
not reject the use of any standard technique and that, while therapists, of course, need all the theory, without the responses to it we are unable to truly contribute.
There are significant implications for the personhood of the individual psychological therapist in terms of suitability to this particular work, both before the work commences and once they have found themselves committed to the work. Therapists need to have a particular capacity for their own subjectivity and a tolerance for the deep affective, erotic and relational disturbances in these clients so that they can offer the client a quality of therapeutic connection and responsiveness. A central contribution of this study is to highlight the centrality of specific and ongoing supervision as well as the availability of professional training that supports personal development, particularly as involving and navigating the unconscious relationship and erotic intersubjectivity. I would argue that what this demands of
counselling psychologists is both a capacity for conceptualization as a vehicle for thinking,
and an emotional range and capacity; therapists’ willingness to explore and engage in depth with their own social and political constructs around gender, sexuality and addiction stands to enhance capacity to work relationally with this challenging clinical group. While this research has certainly taken me beyond my own thinking, having to think deeply and reflect on the process of immersion and emergence enabled me to reflect on the therapist’s ability to use their subjectivity in the service of the client, and to understand that inevitably we cannot go into these areas with our clients until we inevitably can go into these areas ourselves.
Sex addiction for women can perhaps be understood as an extreme version of dysregulation characterized by the outlet of deep relational and psychology disturbance created by the derailment of internal mechanisms of self and self/other regulation and, as such, as sharing features of addiction, deliberate self-harm, borderline personality disorder (BPD) and trauma. While the processes underlying these conditions may share certain features, I argue that female sex addiction reflects a severe and damaging acting out behaviour reflecting the deeper and greater level of internal disturbance. Therapists might be aware that the presence of sexually excessive and risky sexual behaviours points to an underlying borderline and/or narcissistic personality organization arising from a disorganized attachment style and that this creates ongoing difficulty with affect regulation as it organizes the self and self/other configurations. The contribution of the study to counselling psychology, lies in and beyond the understanding of the relational processes involved in the therapeutic encounter with female sex addicts and as such has value in the context of its clinical applicability to the therapeutic work in the wider field with clients suffering deep psychological disturbance.
The originality of this study is in not using questionnaires or measures of symptomology to create something objective, but is in the pursuit of a theoretical construction that requires subjective immersion and involvement. This research has gone beyond description of what therapists do, and makes an attempt to explain the processes involved in the experience of doing. This contribution required a particular pull on me as the researcher to allow conscious and unconscious processes to emerge and, with this in mind, great emphasis was placed on care in the struggle not to impose my presuppositions on the data.