New blog: 'Dilemmas of Desire: How CAT May Help Chemsex-related Distress'

CAT as a relational model of therapy can be applied to aid the understanding of human sexuality and patterns of sexual behaviour that are restricting or harmful. A client may tell you that they frequently attend group sex sessions but are distressed by it. The task then could be to explore the source of the distress for that person in their own context.

It could be that distress is related to shame.  The person may have internalised a set of beliefs and values about sex that restrict a sense of ease in following their desires.  Such beliefs might cause them to feel damned.  Uncomfortable feelings may then interfere with sexual desire and responsiveness.  For another person, distress may be related to continued disappointment about their experience not matching up to expectations.  They might hold idealised fantasies that everyone’s erection will be as hard as steel and stamina will last all night long.

John Money was a psychologist and sexologist who developed the idea of “love maps”.  These refer to a kind of mental map about the individual's unique set of sexual activities that are experienced as arousing. In my clinical work with gay men with chemsex problems, often the range of sexual activities that produce arousal become more and more restricted. For many clients, sex without condoms has become highly eroticised and sober sex is no longer desired or experienced as arousing.  CAT enables us to understand these patterns relationally.  It is as if choices become restricted as all or nothing:  either I get what I want (condomless sex) and I feel euphoric, or I don’t get what I want, and I feel desolate.   

There is much reference to trauma and the impact of homophobia as factors associated with the problematic use of sex and drugs in gay men. While in some cases, these factors are relevant, I also think it is much easier than people think for someone without a history of trauma or exposure to toxic homophobia to get lost in chemsex. In my experience it is not uncommon for the end of a relationship to push someone towards the chemsex scene. 

John Money’s ideas about the formation of love maps can explain why and is useful for accounting for this narrowing of sexual activities that produce arousal. New sexual activities can easily become associated with high levels of arousal, and if libido enhancing drugs are involved, then these increase arousal levels still further.  This at first seduces with an offer of powerful sexual and drug highs and as an effective way to escape, but then traps the individual into an increasingly time-consuming search for a repetition, that starts to encroach upon other areas of their lives.    

For these reasons, interventions designed to help clients overcome patterns of sexual behaviour that are harming or restricting, need to explore what makes them feel horny and why.  Crucially, therapeutic approaches may benefit from trying to help the person widen their repertoire of arousing sexual activities. For many clients this can be about revisiting their sexual lives prior to their entry to chemsex.  Remembering and exploring previously arousing sexual activities and situations from which they have disconnected might offer a road back to a greater sense of wellbeing.

In a practical sense this means taking a careful sexual history which includes what past sexual activities were experienced as arousing, with whom and under what circumstances.  Asking clients to recall their top three best and worst sexual experiences can help broaden out the options and dialogues around expressing sexual desire.

To learn more about using CAT's relational understanding to help support people struggling with chemsex and other sexual activities which have come to feel out of control, join Robert Watson at this ACAT workshop on Friday 8th March in Manchester.


Published by Alison Marfell on 14th Feb 2019

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