Bringing together in consciousness the various disintegrated aspects of a person's psychic processes gradually heals the personality and enables it increasingly to function as an integrated whole. The result is more conscious choice, more flexibility and more freedom.
Internalization is the process through which the self-regulation system-the built-in system that regulates our affects and sense of self-develops in early life. Through interactions between the maturing child and his or her responsive caregivers, regulatory functions that had been provided for the child by the caregivers gradually become integrated into the child's autonomous functional system. The capacity for such developmental internalization is greatest during early childhood, but it continues throughout life.
The function of internalization in psychotherapy derives from its role in the development of self-regulation. A primary means by which psychotherapy promotes the healing of impaired self-regulation is by providing new opportunities for patients to internalize self-regulatory functions that were not adequately internalized during childhood.
Therapeutic groups, including 12-step groups, can facilitate the development of abilities to make meaningful connections with others and to turn to people in times of need instead of turning to addictive behavior. Some therapeutic processes may be more likely to occur in groups than in individual psychotherapy.
Psychiatric pharmacotherapy is direct intervention to enhance affect regulation, to stabilize psychobiological functioning or to modulate psychotic symptoms, and to treat other symptoms of comorbid psychiatric disorders.
A number of studies have indicated that antidepressant medications, particularly the serotonin reuptake inhibitors, can reduce the frequency of addictive sexual behavior and the intensity of urges to engage in addictive sexual behavior, even when the patient is not suffering from major depression (Kafka, 1991; Kafka and Prentky, 1992; Kruesi et al., 1992; Stein et al., 1992).
Additionally, numerous case reports have described the effectiveness of antidepressants for symptoms of sexual addiction, and a few have reported successful treatment with lithium. In my experience, divalproex (Depakote) also can be helpful for sexual addiction symptoms that arise in the context of atypical manic-depressive conditions or "emotionally unstable character disorders."
Such findings make sense when the biopsychological process that underlies addictive disorders is understood to originate in impaired affect regulation, impaired behavioral inhibition and aberrant motivational-reward function. Addictive craving and addictive urges are then recognized to be both expressions of dysregulated affect, and conditioned stimuli for coping responses (responses to cope with dysregulated affect) that have been learned in the context of impaired behavioral inhibition and aberrant motivational-reward function.