Embracing darkness: clinical work with adolescents and young adults addicted to sexual enactments

This paper described common themes and transitions in the treatment of adolescents and young adults presenting as addicted to sexual enactments. Central to their experience is a highly addictive reliance on a bad object, which both enables and relies upon sexually perverse enactments. The paper follows the therapeutic process with patients seen in either group or individual long-term psychotherapy. Their experience is understood in the context of theories central to the work at the Portman Clinic relating to perversion and addiction, combined with some ideas from the field of criminology. Patients usually start by noticing their relationship with their compulsive behaviour, moving from a passive stance to a perception of themselves as active agents. They discover moments that are described as ‘pressing a button’, at which they move from passivity to taking perverse action. Those insights lead to a slowing down of the addictive cycle and emergence of phantasies, core complex anxieties and even hopes, all desperately avoided by taking sexualised action. The paper follows a pathway of change and transformation, which when successful enables patients to reduce or cease addictive behaviours by coming in contact with a good object, enabling both emotional pain and the experience of potency and hope.