Patrick B. McGinnis, PhD, LMHC

Psychotherapy, Sex Therapy, Couple's Counseling, Addictions Counseling, Psychological & Psychosexual Assessment and Polygraph Testing

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An interview with Patrick Carnes, PhD, CAS
Conducted by Patrick B. McGinnis, PhD

 

Patrick Carnes is the Clinical Director for Sexual Disorders Services at The Meadows. Dr. Carnes is a world-renowned speaker on addiction and recovery issues, mostly notable in the area of sex addiction. Much of the current work being done around sex addiction is based on the research and studies of Dr. Carnes. He is also co-editor of "Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention", the official publication of the National Council of Sexual Addiction and Compulsivity. He is the author of several best-selling books, including Out of the Shadows, A Gentle Path Through the Twelve Steps and In the Shadows of the Net.

I interviewed Dr. Carnes for Recover and asked:

Q: How many books on addiction and recovery have you written now?
 

A: Ten; we’re right on the cusp because Clinical Management is coming off the press this week.


Q: Your book, A Gentle Path Through the Twelve Steps has helped many addicts in recovery from a multitude of addictions. I noticed that it has been revised. Why and what was changed?


A: There is quite a story behind it. I knew that there needed to be a more structured way of doing the twelve steps and there is kind of a spirit of going about it. When I wrote that book I couldn’t get it published. The publisher said it would never sell; but I pressed him on it, and the only way that he agreed to sell it at all was as part of a tape set. And then about six months after the release he called me and said, “You know people are buying the book without the tapes.” And then, of course, the rest is history and it just grew. We did the revision simply because people would write or discuss it with me, and I could see where the book needed to be more. And the truth is, now in many ways, the task-centered approach to therapy and recovery which Facing the Shadow, and The Recovery Zone, and all these things I’m working on now, are the next generation Gentle Path.


Q: You use the task-centered approach for treating sexual addiction. What do you see as the most difficult and most common types?


A: In terms of types of sex addicts, 10 types were identified. (See Sidebar) We started off in 1985 researching 1000 families; we had 144 different behaviors we asked about. We did a factor analysis and they literally clustered into 10 specific types. Those types have really been helpful to many addicts in understanding that while they were doing what seemingly are different kinds of behavior that there is an underlying commonality that made those behaviors occur in the same person.


Q: When I read about the ten types being correlated with the stages of courtship (See Sidebar) in The Shadows of the Net, I immediately began incorporating that material into my treatment groups. (That was before I discovered the Facing the Shadow workbook-which I now use) I am really looking forward to The Recovery Zone being published.


A: Actually The Recovery Zone is one of the most exciting things I have done in years.


Q: What does it feel like to touch and help so many people through your books?


A: I appreciate that people are grateful, but I am also kind of awed by it. There is a part of me that responds that all of this stuff has helped me too. I don’t feel thrilled about it; I see it as a journey that we have all been on. There are times, for example, people will read something to me from Out of the Shadows and I will wonder where did that come from. Sometimes I don’t think I even wrote that book, because I just go into a state where it seems that these things come. Sometimes I don’t think it’s me.


Q: Right. That happens to me a lot in doing therapy; I say things and wonder to myself, where did that come from? And then I realize that I need to listen to what I’m saying for my own growth.


A: Great. That works for me too.


Q: Do you believe it is possible to be in a good solid recovery from sexual addiction or a constellation of addictions using just the twelve steps?


A: No. I think it works both ways, that you cannot do this without the twelve steps. The twelve steps are the basis of it all. However, the level of self-examination that is assisted through therapy is also indispensable; and it’s never been an either/or for me; they both go together. The therapist should be supporting the twelve step process and twelve step processes should be supporting the therapy.


Q: What do you see as the number one addiction-related problem that is not being addressed?


A: Multiple addictions. When the field realizes that it’s not simply that there are addictions and they coexist, but, literally, there is this interaction that occurs between them. That there are patterns in which addictions and deprivations literally reinforce each other.

I guess that the other thing would be deprivations. In the sense that a lot of people who have addictions don’t realize that they also have deprivations that literally are part of the whole pattern. It is a combination of living in the extremes, either over or under, and that the reason that we have failed, and why we have so much recidivism has a lot to do with people not seeing the pattern in addiction and deprivation and how they reinforce one another. The term we use for that is Addiction Interaction Disorder.



Q: Those multiple addictions and deprivations don’t usually get addressed in most rehab facilities.

A: I find that there are a number of key factors in relapse. The number one is that not all the addictions are treated. The second is no one has shown people how addictions relate to one another. The third is not addressing the core issues, like trauma and family-of-origin issues. All of those are critical, but also there has not been a structured way for people to go through this process; which is where The Gentle Path stuff comes in.

For instance, we found in a hospital study that only 23% of our patients where doing steps one through nine of the twelve steps in the first eighteen months after treatment. Of those who did do steps one through nine there was very little relapse. In other words recovery has a lot to do with how much you do. So what we are talking about here, is that we focus on treatment as the fix for addiction, when in fact, recovery is an ongoing process which has a series of tasks which take time to do. The Gentle Path was a book that taught me about how important it was to create a structure which people would be able to follow.


Q: What do you think about people using Rational Recovery, or other recovery programs, instead of using the twelve steps?


A: I would never presume that I knew all of the ways that people could do recovery; but I know empirically that the people who did the best appeared to be in the twelve step program. As a scientist following people for years, it appears that there has to be some spiritual transformation.


Q: Research has shown that in relationships where one partner is in recovery that it is important that both people be involved in their own recovery work, and couples recovery and/or counseling. You have recommended Recovering Couples Anonymous (RCA) and Imago Relationship Therapy. Would you comment on this issue?


A: When we followed 1000 addicts the people who did the very best were in a twelve step program for couples. The common denominator for those with the highest quality of recovery was that they were in Alanon Twofers, SAnon family group, or RCA. In part it is that research which inspired Open Hearts as a book for couples. Also it lead to the "We Came To Believe" program, which is a retreat program for recovering couples.


Q: I believe that the twelve step program is one of many spiritual paths toward recovery and ultimately self-actualization. I believe that I have been hearing you say that?


A: My belief is that we are learning that addiction, and what makes for excellence in optimum performance taps into the same physiological, emotional and intellectual processes. Too often, what people do in recovery is surviving or white-knuckling, as opposed to looking at excellence and how they can be the most they can be. When we do that we fail people by not asking more of them then survival.


Q: So this gets in the way of self-actualization occurring?

A: One of the things that Maslow said, and others have written about, is what sustains excellence is your coming from a basis of where it can matter so much. Recovery has to matter. It has got to matter enough that you’re willing to go through any lengths to make it happen.


Q: You would say that self-actualization is an attainable goal?


A: Not only obtainable, I’m saying that is what The Recovery Zone book is going to be about. It’s not just about obtainable; it’s got to be what we really strive for, otherwise, it’s just surviving.


Q: Some people seem to get stuck going to meetings almost compulsively even years into recovery almost at the same rate that they did at the beginning of their recovery. Can this be a problem?


A: I think that it’s important that people make meetings central to their recovery. But the twelve steps and the meetings are a recipe; it’s like making a cake. If you do certain things, you have a predictable result. That’s why we talk about specific tasks in Facing the Shadow and The Recovery Zone. It’s a recipe; follow the recipe and you’re going to have the result. That’s not to say you can’t tinker with the recipe. Some great recipes have evolved from moving things around  a little more sugar, a little less flour. When we make the recipe sacerdotal is when we get into trouble. By sacerdotal, I mean making it sacred and making it so that it is immutable, we can’t change it. That’s when we get into rigidity. When that rigidity comes in, then you’re losing the spirit which recovery was trying to obtain.


Q: One of the things that I have written about in previous articles in “Recover” concerned people being in too big a hurry to have their character defects removed. I believe that we need to be asking for integration of those pieces of ourselves and find the gifts those have for us and integrate that into our lives rather than just asking that something be removed. In doing that, we are losing a valuable part of ourselves when we could be gaining something greater. Can you comment on that?


A: Yes. I believe that the core of the program is not the first step. The core of the program is the sixth and seventh steps. There we are doing that work on the shadow side of ourselves; it is exactly what this is all about. We need to continue to work on this. It is the core part; it is the examined life. Which is what therapy is  stringent self-examination. In many ways we get people so focused on the first step and getting sober; yet many of us have gotten sober over and over again. It’s staying sober which is the critical part. Getting sober is, by comparison, easy. The core issue is really involved in looking at the deeper inner-issues. So the sixth and seventh steps are core requirements. They are the parts that people gloss over; they go to their fourth and fifth step to the eighth and ninth steps. They want to make amends and they want to do the confessional experience, and they are skipping over that deeper work of understanding what is it that keeps bringing them to this place of addictive behaviors. This is a long-term project.

In the book,
The Recovery Zone, it really is where we do an anatomy of all the parts of our defects ... the shame, the multiple addictions. How does all this thrive together? It is one of the ways to make that process easier.


Q: Out of that, and working the twelve steps as an ongoing process, is what self-actualization or living in excellence would come from?


A: Absolutely.

Q: What do you see as hope for the future of addiction treatment and recovery?


A: I think there are a number of things that are hopeful. I believe that the response around the country to the canceling of the addiction parity act is going to mobilize people. The average Congressional District has 644,000 people, approximately 127,000 of those people are either addicts or loved ones. So literally, a fourth of the voters are involved in this problem. If we can ever get to the point where we stop hiding and start voting. The reason we lost the addiction parity dollars is because we have not spoken up. If you looked at some agencies and groups, like the National Rifle Association, who really has, compared to their influence, a modest level of membership. And you look at the number of recovering people in the system who are affected by addictions, or people who are affected by these people, it’s tremendous. If they were to mobilize, we’d change the healthcare system. Not just a little bit, we would change the healthcare system dramatically because the number one source of medical cost is addiction. The number one source of problems in school is addiction. The number one source of abuse of children is addiction. The number one social problem; most crimes are committed under the influence. The number one problem in terms of violence comes out of addiction. Why would we not make this a priority? When we, as recovering people, start articulating, then we’ll see massive social change.

Q: What I’m hearing you say is almost like doing the twelfth step on a massive level.


A: It will change this country. It already has ... the twelve step programs have literally created a different way that people take care of their health. Self-help – we are now taking more and more responsibility for our healthcare. We know, in other illnesses (like cancer, diabetes, leukemia) that patients actually often know more than their physicians. Technically, they know more. That started when Bill W. and Dr. Bob got together; people taking responsibility for their health.

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(Sidebar)

10 Types of Sex Addicts
 

 

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Fantasy Sex – Noticing and being attracted but dissociating from reality and the real world.

 

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Voyeurism – Objectifying people sexually and avoiding a personal relationship.
 

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Exhibitionism – Capturing, forcing another’s attention on you, or breaking the rules.
 

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Seductive Role Sex – Using power and conquest to win another’s attention or love then losing interest.
 

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Trading Sex – Often a replication of childhood sexual abuse with money or power symbolizing success.
 

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Intrusive Sex – A predatory way of “stealing sex” and bypassing intimacy without another’s knowledge or risking rejection.
 

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Paying for Sex – Simulated intimacy without the work of relationship.
 

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Anonymous Sex – Sex without intimacy or attachment while secretly feeling lonely and isolated.
 

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Pain Exchange – Often a reenactment of childhood sexual abuse involving pain and/or shame.
 

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Exploitive Sex – Arousal and attraction is dependent on the vulnerability of another.


Stages of Courtship
 

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Noticing – Noticing and discriminating traits in others.
 

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Attraction – Beginning of attraction, curiosity, and passion.
 

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Flirtation – Sending signals of interest through playfulness and seductiveness.
 

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Demonstration – Seeking admiration or interest from a desired person through showing strengths.
 

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Romance – Experiencing, expressing and receiving passion through vulnerability yet using reality testing.
 

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Intimacy – Profound vulnerability and deepening of relationship through being fully known.
 

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Individuation – Maintaining oneself within the relationship.
 

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Touching – Imparting care and trust using good judgment to affirm the other.
 

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Foreplay – The expression of sexual passion without genital intercourse (often identified as the best part of sex.
 

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Intercourse – The ability to surrender oneself (giving up control) to passion and being fully trusting and vulnerable.
 

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Commitment – Bonding and attachment to a meaningful relationship.
 

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Renewal – Sustaining all of the previous dimensions in the existing relationship.

 

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Copyright © 2002 Patrick B. McGinnis, PhD. All rights reserved.
Revised: 01/09/09.

 
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